The Epidemic of Overweight and Obesity: A Challenge to Medicine, Public Health and Public Policy

Abstract

Heart Lung and Blood Institute (NHLBI) define adult overweight as a body mass index (BMI) between 25 and 29.9, and adult obesity as a BMI greater than 30. By those definitions, the United States is in the midst of a dramatic obesity/overweight epidemic with data being quoted from a variety of perspectives and timeframes. North Carolina is representative of national trends, with the Behavioral Risk Factor Surveillance System (BRFSS) reporting 52.3% of adults as overweight or obese in 1995 and 62.6% in 2005. The prevalence of overweight amongst children (6-11 years) and adolescents (12-19 years) rose from 11% to 19% and 11% to 17%, respectively, between the 1988-1994 and 2003-2004 National Health and Nutrition Examination Surveys (NHANES). In this issue of the North Carolina Medical Journal, staff of the NC State Center for Health Statistics have provided recent data on the extent of the overweight and obesity epidemic in our population, along with data on trends in the behaviors of youth putting them at risk of these conditions. Some critics argue that not everyone who has a BMI >25 is overweight, that the health and economic impacts of overweight/obesity are greatly exaggerated, and/or that all the hype about the obesity epidemic is a ploy by the weight-loss industry, pharmaceutical companies and some researchers to create business. Actually, their arguments have some validity, which suggests several caveats as the reader “digests” the following diverse compendium of well-reasoned articles by a distinguished set of authors. First, the critical issue is control of obesity’s comorbid conditions, not weight per se. A singular focus on weight or BMI misdirects both clinician and patient regarding the importance of lean versus fat body composition or distribution of fat. BMI is a correlate, though not a direct measure of body fat and fat distribution. Rather, weight/BMI should be considered a vital sign, giving the practitioner an objective, but non-specific metric that relates to potential underlying conditions. Two commentaries in this special issue of the North Carolina Medical Journal offer specific advice to clinicians regarding how discussion of overweight and obesity can be handled in the context of conventional clinical encounters with patients with or at-risk for these conditions. The first of these by Dr. Donald Hensrud of the Mayo Clinic in Minnesota outlines a broad, but specific, approach to how these issues may be addressed as part of clinical practice routine. The second, a sidebar commentary by Dr. Suzanne Lazorick of the NC Division of Public Health, gives further illustrations of how BMI and other related measures can be integrated with normal practice procedures.