Obesity
Obesity has a long history. In many ancient cultures, Obesity was idolized and even worshiped. There are many paleolithic artifacts found around Europe from the Southwest of France to Russia North of the Black Sea. One such example is the Venus of Laussel, aka La Femme à la Corne found in 1911 in France by the physician Jean-Gaston Lalanne dated to at least 23000 BCE. Another example is the Venus of Willendorf, found in Austria in 1908 and dated 30,000 BCE. These figurines could suggest that the obese phenotype was prevalent in that era just as it is now. It is likely also that these stone goddesses symbolized fertility both personal (offspring) and agricultural (abundance of food). ¹
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| Venus of Laussel |
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| Venus of Willendorf |
For many years obesity was seen as a sign of wealth. However, now we are in the opposite. Now being wealthy has a connotation with affording a personal trainer and the more "healthy" foods while being more poor tends to mean you are fatter because most of your meals come from fast-food restaurants serving foods high in saturated fats (see figure 2.1 below).
Figure 2.1
Obesity prevalence increases every year. It is less with higher income, yet the rate remains constant across income levels.
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| Fig. 2.2 Obesity rates increased over time in all ethnicity-gender groups.² |
Here are some perspectives of obesity from Greco-Roman Prescientific Medicine (Recorded History to 1500 AD).
- Hippocrates -- ”Sudden death is more common in those naturally fat than in the lean.”
- Galen -- Moderate vs. immoderate obesity
- Moderate -- Dionysius (360 B.C.) -A very large man that frequently fell asleep (apnea)
- Immoderate -- Magas, King of Cyrene (died in 258 B.C.) -He was “weighted down with monstrous masses of flesh in his last days; in fact he choked himself to death.” Kryger MH. 1986.
Obesity is defined as having a BMI of 30 or higher. BMI is calculated by dividing one's height in meters by their weight in kg squared (wt/ht^2). BMI is not a telltale sign of health risk for every individual, but it is a good indicator per capita. Waist circumference and body composition are important factors as well. More visceral fat tissue (fat surrounding the visceral organs like the heart) indicates a health risk. On the other hand, subcutaneous fat (fat beneath the skin) has actually shown to be health-protective. (.......)
TABLE 2.1
Above is shown a BMI chart transcribed in standard and metric (with cm) measuring systems. To find out your BMI, calculate your BMI as explained above, or find the cross between your weight (horizontal/x-axis) and your height (vertical/y-axis).
TABLE 2.2
Categories of BMI and disease risk* relative to normal weight and waist circumference.
| BMI kg/m2 | Obesity Class | Men ≤ 102cm (≤40 in) Women ≤ 88 cm (≤35 in) | >102 cm (>40 in) >88 cm (>35 in) | |
|---|---|---|---|---|
| Underweight | <18.5 | - | - | |
| Normal+ | 18.5–24.9 | - | - | |
| Overweight | 25.0–29.9 | Increased | High | |
| Obesity | 30.0–34.9 | I | High | Very High |
| 35.0–39.9 | II | Very High | Very High | |
| Extreme Obesity | ≥40 | III | Extremely High | Extremely High |
*Disease risk for type 2 diabetes, hypertension, and CVD
+Increased waist circumference can also be a marker for increased risk even in persons of normal weight.
The table is reprinted from reference 5.
Data from Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 1998;68:899–917.
Anomalies
There is something known as healthy obesity. Healthy obese are individuals who have a BMI of 30+ and do not have metabolic syndrome. Metabolic syndrome is any combination of two or more of the following: high blood pressure, cardiovascular disease, type 2 diabetes and high cholesterol. Yet still, some scientists speculate that this could be a sort of "honeymoon phase" of recently becoming obese and that health problems will set in after several years or so.
Waist circumference: Tebow vs. Trump
It is also important, however, to find out if you fall into the category of false positive. Waist circumference is an important indicator of that. For example, I did a Google search on May 30th, 2020, and found out that Tim Tebow (6'3", 255 lbs) and Donald Trump (6'3, 243 lbs) have roughly the same BMI of 32 and 30 respectively, both of which are in the obese category. However, we can probably be sure that even with a higher BMI, star quarterback turned baseball player, Tebow is probably in better physical condition than businessman turned U.S. president Trump. Tebow may weigh a lot for his height, but his waist circumference keeps him considered a false positive. Ultimately waist circumference indicates whether or not someone is at risk for health problems.
A modern look at Obesity
The following website provides a detailed world map view of the prevalence of obesity.
Treatment
To determine where you fall, you should talk to a doctor. The process will involve a body composition scan such as DEXA, MRI, Bodpod, and an assessment of your metabolism.
Weight loss medications: only allowed for those in the extremely obese category and must be accompanied by lifestyle changes. Orlistat is the most common, is not considered addictive, but is known for causing a very oily fecal discharge.
References
1. Bray and Bouchard. Handbook of Obesity. Etiology and Pathophysiology, 2nd ed. 2004.
2. Mitchell, N. S., Catenacci, V. A., Wyatt, H. R., & Hill, J. O. (2011). Obesity: overview of an epidemic. The Psychiatric clinics of North America, 34(4), 717–732. https://doi.org/10.1016/j.psc.2011.08.005
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