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CONTEMPORARY WORLD ISSUES

Obesity

A REFERENCE HANDBOOK

SECOND EDITION

Judith S. Stern and Alexandra Kazaks

Copyright © 2015 by ABC-CLIO, LLC
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by
any means, electronic, mechanical, photocopying, recording, or
otherwise, except for the inclusion of brief quotations in a review,
without prior permission in writing from the publisher.
Library of Congress Cataloging-in-Publication Data
Stern, Judith S., 1943– , author.
Obesity : a reference handbook / Judith S. Stern and Alexandra
Kazaks. — Second edition.
p. ; cm. — (Contemporary world issues)
  
Includes bibliographical references and index.
ISBN 978-1-4408-3804-0 (alk. paper) —
ISBN 978-1-4408-3805-7 (ebook)
I. Kazaks, Alexandra, author. II. Title. III. Series:
Contemporary world issues.
[DNLM: 1. Obesity—United States—Handbooks. WD 101]
RA645.O23 2015
616.3'98—dc23 2015024913
   
ISBN: 978-1-4408-3804-0
EISBN: 978-1-4408-3805-7
19 18 17 16 15 1 2 3 4 5
  
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ABC-CLIO, LLC
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This book is printed on acid-free paper
Manufactured in the United States of America
Contents
SCIENCE, TECHNOLOGY, AND MEDICINE

Preface, xv

1 BACKGROUND AND HISTORY, 3

Introduction, 3
Defining and Measuring Overweight and Obesity, 7
Indirect Measuring Methods, 7
Obesity Trends in the United States, 19
Obesity as a National Health Problem, 21
Why Are We Overweight?, 22
Factors That Contribute to Obesity, 25
Can We Blame Obesity on Our Genes?, 35
Consequences of Overweight and Obesity, 36
Discrimination, 38
Economic Consequences, 40
We Live in an Obesogenic Environment, 41
References, 42

2 PROBLEMS, CONTROVERSIES, AND SOLUTIONS, 55

Introduction, 55
Is Obesity a Disease?, 55

vii
viii Contents

Is Obesity an Epidemic?, 60
Treatment of Obesity, 64
Diet Foods, 72
Adequate Nutrition Labeling, 74
Physical Activity, 76
Behavioral Strategies for Responding to an
Obesogenic Environment, 77
Long-Term Success, 79
Medications: Nonprescription, 80
Prescription Medications: History and Current
Weight Loss Options, 87
Obesity (Bariatric) Surgery, 92
Other Invasive Treatments for Obesity, 96
How Does the Health Care System Deal
with Obesity?, 97
Why Can’t We Just Prevent Obesity?, 99
Obesity as a Public Health Issue, 100
Affordable Care Act and Labeling, 103
Industry, 104
Strategic Plan for NIH Obesity Research, 106
Summary, 106
References, 108

3 PERSPECTIVES, 121
Obesities: Nikhil V. Dhurandhar, 121
References, 125
No More Obesity: Rajiv Narayan, 127
References, 131
 Contents ix

Obesity Prevention: The Bathroom Scale Model—A

Perspective on Weight Reduction, Weight Regain
Prevention, and Obesity Prevention:
Barbara Hansen, 132
References, 136
Pros and Cons of Dietary Supplements for Weight
Management: Kelly Morrow, 137
Dietary Supplement Labeling, 138
What Are the Risks of Taking Supplements for
Weight Management?, 138
How to Choose a Quality Supplement, 140
Where to Learn More about Supplements, 141
References, 141
Low-Calorie Sweeteners and Weight Management:
Lyn O’Brien Nabors, 142
References, 145
Shape Up America! Vision for the Future:
Focus on Childhood Obesity and Parenting: Barbara
J. Moore, 147

4 PROFILES, 153
Activists, Thinkers, and Researchers, 153
S. Daniel Abraham (b. 1924), 153
David Allison (b. 1963), 154
Elizabeth Applegate (b. 1956), 155
Arne Astrup (b. 1955), 155
Robert C. Atkins (1930–2003), 156
Richard L. Atkinson (b. 1942), 156
George Blackburn (b. 1936), 157
x Contents

Steven N. Blair (b. 1939), 158

Claude Bouchard (b. 1939), 159
George A. Bray (b. 1931), 160
Kelly Brownell (b. 1951), 161
Henry Buckwald (b. 1932), 162
Jenny Craig (b. 1932), 163
Nikhil Dhurandhar (b. 1960), 163
William H. Dietz, 164
Adam Drewnowski (b. 1948), 165
Johanna Dwyer (b. 1938), 165
Katherine M. Flegal (b. 1944), 166
Jared Fogle (b. 1977), 167
Jeffrey M. Friedman (b. 1954), 168
M. R. C. Greenwood (b. 1943), 168
Barbara Hansen (b. 1941), 169
Marion M. Hetherington (b. 1961), 170
James O. Hill (b. 1951), 171
Hippocrates (460 BC–370 BC), 172
Jules Hirsch (b. 1927–2015), 172
W. P. T. James (b. 1938), 173
Patricia R. Johnson (b. 1931), 173
Robin B. Kanarek (b. 1946), 174
Janet King (b. 1941), 175
Ahmed Kissebah (1937–2013), 175
C. Everett Koop (1916–2013), 176
John Kral (b. 1939), 177
Shiriki Kumanyika (b. 1945), 178
Jack LaLanne (1914–2011), 178
 Contents xi

Antoine Lavoisier (1743–1794), 179

Rudolph Leibel (b. 1942), 180
Maimonides (1135–1204), 180
Jean Mayer (1920–1993), 181
Barbara J. Moore (b. 1947), 181
Jean Neiditch (1923–2015), 182
Michelle Obama (b. 1964), 182
Xavier Pi-Sunyer (b. 1933), 182
Nathan Pritikin (1915–1985), 183
Barbara J. Rolls (b. 1945), 184
Wim H. M. Saris (b. 1949), 185
Ethan Allen Sims (1916–2010), 185
Sachiko St. Jeor (b. 1941), 186
Albert J. Stunkard (1922–2014), 187
Oprah Winfrey (b. 1954), 187
Rena Wing (b. 1945), 188
David A. York (b. 1945), 189
Agencies, Programs, and Organizations, 190
Government Agencies and National Programs and
Initiatives, 191
International Agencies and Organizations, 196
Nonprofit, Professional, and Trade
Organizations, 198

5 DATA AND DOCUMENTS, 215

Data, 215
Figure 5.1 Trends in adult overweight, obesity, and
extreme obesity, 220
xii Contents

Figure 5.2 Food away-from-home expenditures

divided by total food expenditures, 220
Figure 5.3 Algorithm for the assessment and
treatment of overweight and obesity, 221
Table 5.1 1943 Metropolitan Life Height and
Weight Table for Women, 222
Table 5.2 1942 Metropolitan Life Height and
Weight Table for Men, 223
Table 5.3 Body Mass Index (BMI) Chart, 224
Table 5.4 Determining Percentage Body Fat Using
Skinfold Calipers, 226
How to Measure Body Area Skinfolds, 226
Estimation of Percent Fat with Siri Equation, 226
Table 5.5 USDA Estimated Calorie Needs per Day
by Age, Gender, and Physical Activity Level, 227
Table 5.6 USDA Pyramid Food Intake Patterns,
Daily Amount of Food from Each Group, 230
Table 5.7 Daily Food Record Form, 231
Table 5.8 Types of Diet Plans with Claims and
Advantages, 232
Documents, 233
Government Reports, 233
Legislation, 265

6 RESOURCES FOR FURTHER RESEARCH, 275

Books, 275
Reference Books, 275
Popular Books, 276
Reports, 282
 Contents xiii

Guidelines, 287
Journals and Magazines, 290
Web Sites, 294
General Population Information and
Interactive Sites, 294
Children and Adolescents Information and
Interactive Sites, 301
Databases, 304
Calculators and Counters, 308

7 CHRONOLOGY, 313
Glossary, 331
Index, 339
About the Authors, 361
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Preface
SCIENCE, TECHNOLOGY, AND MEDICINE

Obesity impacts the lives of pregnant women, the unborn,

newborn, children, adults, the elderly, and even our pets.
But the problem of obesity is not confined to the United
States. It is worldwide. In the year 2000, the estimated num-
ber of overweight people worldwide exceeded the number of
people suffering from malnutrition. And this is not a recent
phenomenon—it goes back more than 10,000 years.
Today, in the United States, obesity is not a disease of the
rich. People with low incomes tend to be more obese than peo-
ple with high incomes. This is confounded by the observation
that if you are obese, you are more likely to be socially down
mobile.
And, obese people are discriminated against and made fun
of. Even the medical community discriminates against obese
patients. For example, very obese people need bigger beds. The
causes of obesity are also simplified—if you didn’t eat so much
you wouldn’t be fat. The cure for obesity is also simplified—just
eat less and exercise more. But, in truth, research has shown
that food restriction is more important for weight loss and
exercise is more important to maintain the weight loss. If you
suddenly stop exercising, you will start to regain the weight.
How much exercise is recommended for you to lose more than
5 percent body weight and to keep it off? According to the Na-
tional Heart, Lung, and Blood Institute of the National Insti-
tutes of Health (NIH), one may need to be moderately active
(like walking briskly) for more than 300 minutes per week.

xv
xvi Preface

Could some of this be due to genetics? For example, we study

certain rats and mice whose obesity is clearly due to genetics. In
people, this is best seen in identical twins whose body weights
are more similar in comparison to fraternal twins.
Clearly, the amount that we eat influences weight gain,
weight loss, weight maintenance, and weight regain. In this
area, time has not been kind. In the United States, over the
last 20 years, portion size has increased. There has been “por-
tion distortion.” For example, according to NIH, 20 years ago
a bagel was 3 inches in diameter and 140 calories. Today, it is
6 inches in diameter and 350 calories. There is portion distor-
tion in other categories: sodas (6.5 ounces or 82 calories to 20
ounces or 250 calories). To be accurate, the number of portions
listed on a 20 ounce bottle of soda is 2.5. But, have you ever
seen someone share it with 1.5 other people? Even the size of a
blueberry muffin has increased from 1.5 ounces (210 calories)
to 5 ounces (500 calories). That’s easier to share. But, if you
have a bigger portion of food, you eat more even if you do not
eat it all.
Obesity: A Reference Handbook will open your eyes to the
complex causes of obesity, the use of imprecise definitions, the
variety of measures of obesity, and the variety of treatments
from diet to behavior to drugs to surgery. For example, obesity
can be categorized using a measure called Body Mass Index
which is weight (kg)/height2 (meters). Using BMI, under-
weight is less than 18.5, normal weight is 18.50–24.99, over-
weight is 25.0–29.9, and obesity is a BMI > 30. Obesity is then
classified into three categories: Obesity 1 (BMI 30–34.9), Obe-
sity 2 (BMI > 35.0–39.9), and Obesity 3 (BMI > 40). Body fat
distribution (upper body obesity) also can increase your risk for
certain chronic diseases (cancer, coronary vascular disease, and
hypertension). Risk is increased in men with a waist circumfer-
ence of more than 40 inches and in women with a waist cir-
cumferences of more than35 inches. When you visualize upper
body obesity, think of a “pot belly.” If a person has lower body
obesity, think about “fat” buttocks and thighs.
 Preface xvii

If we are not very successful in curing obesity, one solution

could be to prevent obesity. Simple, straightforward solutions
have been proposed. We could label all manufactured food.
But labels are complicated. It’s hard to find the information for
calories and portion size without a magnifying glass. Another
proposal is to change government-funded programs like the
school lunch program to provide healthier food.
Our bottom line is that we do not know how to prevent
obesity. We need more long-term research. And, we need a lot
more funding for obesity research. This will take many years.
But this should not be used as an excuse to do nothing until we
have the research data. To paraphrase our colleague Dr. David
Kritchevsky, “We are making progress with obesity research
and the scientific findings are changing over time. But we can’t
wait to treat the obese because by the time all the evidence is in
our patients will be dead.”
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