Weight and Physical Health - Is Obesity A Disease?

Researchers now recognize that obesity does not simply result from willful overeating and laziness, but from a complex combination of genetic, metabolic, behavioral, and environmental factors. Rather than viewing it TABLE 2.1 Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002 [CONTINUED] Adapted from "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, According to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)as a lifestyle choice or personal failing, many groups favor declaring obesity a disease. Proponents assert that many public health benefits would result from designating obesity as a disease including:

• Reducing the social stigma and prejudice associated with obesity, and promoting attitudinal changes to reduce weight-based discrimination.
• Enabling more people to seek treatment for obesity by providing health insurance coverage for treatment.
• Increasing public awareness of the severity of obesity as a threat to health and longevity.
• Stimulating scientific and medical research about prevention and treatment of the condition and speeding approval of new antiobesity drugs.

TABLE 2.1
Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002 [CONTINUED]
[Data are based on linked birth and death certificates for infants]
Race and Hispanic origin of mother	1983a	1985a	1990a	1995b	1998b	1999	2000b	2001b	2002b
*Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 deaths in the numerator. Rates not shown are based on fewer than 20 deaths in the numerator.
aRates based on unweighted birth cohort data.
bRates based on a period file using weighted data.
cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days-11 months).
dPersons of Hispanic origin may be of any race.
ePrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. National linked files do not exist for 1992–94.
SOURCE: Adapted from "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, According to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)
Hispanic or Latinod,e	3.3	3.2	2.7	2.1	1.9	1.8	1.8	1.8	1.8
Mexican	3.2	3.2	2.7	2.1	1.9	1.8	1.8	1.7	1.8
Puerto Rican	4.2	3.5	3.0	2.8	2.6	2.4	2.4	2.5	2.4
Cuban	2.5*	2.3*	1.9*	1.7*	*	*	*	1.7*	*
Central and South American	2.6	2.4	2.4	1.9	1.7	1.4	1.4	1.6	1.6
Other and unknown Hispanic or Latino	4.2	3.9	3.0	2.6	2.0	2.5	2.3	2.1	2.0
Not Hispanic or Latino
Whitee	3.2	3.0	2.7	2.2	2.0	1.9	1.9	1.9	1.9
Black or African Americane	7.0	6.4	5.9	5.0	4.5	4.6	4.4	4.5	4.6

Advocates of classifying obesity as a disease, including the World Health Organization, National Institutes of Health, National Academy of Sciences' Institute of Medicine, Federal Trade Commission, Maternal and Child Health Bureau, American Heart Association, American Academy of Family Physicians, American Society for Bariatric Surgery, American Society of Bariatric Physicians, and the American Obesity Association (AOA), observe that not long ago in American history alcoholism was viewed as a personal choice or moral weakness, whereas today it is considered a disease. They also observe that such eating disorders as anorexia and bulimia are termed diseases. In view of the size and scope of the obesity epidemic, proponents argue that the social and financial costs of allowing it to go unchecked will far exceed the costs associated with extending health-care coverage for weight-reduction programs.

The AOA argues that obesity meets the criteria for disease because according to Stedman's Medical Dictionary a disease should have at least two of the following three features:

1. Recognized etiologic (causes) agents
2. Identifiable signs and symptoms
3. Consistent anatomical alterations

The AOA describes causative agents for obesity as social, behavioral, cultural, physiological, metabolic, and genetic factors. The identifiable signs and symptoms of obesity include an excess accumulation of adipose tissue (fat), an increase in the size or number of fat cells, insulin resistance, decreased levels of high-density lipoprotein (HDL) and norepinephrine, and alterations in the activity of the sympathetic and parasympathetic nervous system as well as elevated blood pressure and blood glucose, cholesterol and triglyceride levels. The consistent anatomic alteration of obesity is the increase in body mass.

Opponents contend that while obesity increases the risk of developing many diseases, it is not an ailment in itself but an unhealthy consequence of poor lifestyle choices. They liken it to cigarette smoking, a risk factor that predisposes people to disease, and they dispute the notion that labeling obesity as a disease will have a beneficial effect on the ability of public health organizations to alter the course of the obesity epidemic. They maintain that the public tends to view diseases as conditions that are contracted or contagious, and that with disease comes a victim mentality, rather than assumption of personal responsibility. Since many health professionals consider assumption of personal responsibility as

TABLE 2.2 Life expectancy at birth, at 65 years of age, and at 75 years of age, according to race and sex, selected years 1900–2002 "Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, According to Race and Sex: United States, Selected Years 1900–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)

TABLE 2.2
Life expectancy at birth, at 65 years of age, and at 75 years of age, according to race and sex, selected years 1900–2002
[Data are based on death certificates]
Specified age and year	All races			White			Black or African Americana
	Both sexes	Male	Female	Both sexes	Male	Female	Both sexes	Male	Female
Note: — = Data not available.
aData shown for 1900–60 are for the nonwhite population.
bDeath registration area only. The death registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in 1933.
cIncludes deaths of persons who were not residents of the 50 states and the District of Columbia.
dLife expectancies (LEs) for 2000 were revised and may differ from those shown previously. LEs for 2000 were computed using population counts from census 2000 and replace LEs for 2000 using 1990-based postcensal estimates.
SOURCE: "Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, According to Race and Sex: United States, Selected Years 1900–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)
At birth	Remalining life expectancy in years
1900b,c	47.3	46.3	48.3	47.6	46.6	48.7	33.0	32.5	33.5
1950c	68.2	65.6	71.1	69.1	66.5	72.2	60.8	59.1	62.9
1960c	69.7	66.6	73.1	70.6	67.4	74.1	63.6	61.1	66.3
1970	70.8	67.1	74.7	71.7	68.0	75.6	64.1	60.0	68.3
1980	73.7	70.0	77.4	74.4	70.7	78.1	68.1	63.8	72.5
1985	74.7	71.1	78.2	75.3	71.8	78.7	69.3	65.0	73.4
1990	75.4	71.8	78.8	76.1	72.7	79.4	69.1	64.5	73.6
1991	75.5	72.0	78.9	76.3	72.9	79.6	69.3	64.6	73.8
1992	75.8	72.3	79.1	76.5	73.2	79.8	69.6	65.0	73.9
1993	75.5	72.2	78.8	76.3	73.1	79.5	69.2	64.6	73.7
1994	75.7	72.4	79.0	76.5	73.3	79.6	69.5	64.9	73.9
1995	75.8	72.5	78.9	76.5	73.4	79.6	69.6	65.2	73.9
1996	76.1	73.1	79.1	76.8	73.9	79.7	70.2	66.1	74.2
1997	76.5	73.6	79.4	77.1	74.3	79.9	71.1	67.2	74.7
1998	76.7	73.8	79.5	77.3	74.5	80.0	71.3	67.6	74.8
1999	76.7	73.9	79.4	77.3	74.6	79.9	71.4	67.8	74.7
2000d	77.0	74.3	79.7	77.6	74.9	80.1	71.9	68.3	75.2
2001	77.2	74.4	79.8	77.7	75.0	80.2	72.2	68.6	75.5
2002	77.3	74.5	79.9	77.7	75.1	80.3	72.3	68.8	75.6
At 65 years
1950c	13.9	12.8	15.0	—	12.8	15.1	13.9	12.9	14.9
1960c	14.3	12.8	15.8	14.4	12.9	15.9	13.9	12.7	15.1
1970	15.2	13.1	17.0	15.2	13.1	17.1	14.2	12.5	15.7
1980	16.4	14.1	18.3	16.5	14.2	18.4	15.1	13.0	16.8
1985	16.7	14.5	18.5	16.8	14.5	18.7	15.2	13.0	16.9
1990	17.2	15.1	18.9	17.3	15.2	19.1	15.4	13.2	17.2
1991	17.4	15.3	19.1	17.5	15.4	19.2	15.5	13.4	17.2
1992	17.5	15.4	19.2	17.6	15.5	19.3	15.7	13.5	17.4
1993	17.3	15.3	18.9	17.4	15.4	19.0	15.5	13.4	17.1
1994	17.4	15.5	19.0	17.5	15.6	19.1	15.7	13.6	17.2
1995	17.4	15.6	18.9	17.6	15.7	19.1	15.6	13.6	17.1
1996	17.5	15.7	19.0	17.6	15.8	19.1	15.8	13.9	17.2
1997	17.7	15.9	19.2	17.8	16.0	19.3	16.1	14.2	17.6
1998	17.8	16.0	19.2	17.8	16.1	19.3	16.1	14.3	17.4
1999	17.7	16.1	19.1	17.8	16.1	19.2	16.0	14.3	17.3
2000d	18.0	16.2	19.3	18.0	16.3	19.4	16.2	14.2	17.7
2001	18.1	16.4	19.4	18.2	16.5	19.5	16.4	14.4	17.9
2002	18.2	16.6	19.5	18.2	16.6	19.5	16.6	14.6	18.0
At 75 years
1980	10.4	8.8	11.5	10.4	8.8	11.5	9.7	8.3	10.7
1985	10.6	9.0	11.7	10.6	9.0	11.7	10.1	8.7	11.1
1990	10.9	9.4	12.0	11.0	9.4	12.0	10.2	8.6	11.2
1991	11.1	9.5	12.1	11.1	9.5	12.1	10.2	8.7	11.2
1992	11.2	9.6	12.2	11.2	9.6	12.2	10.4	8.9	11.4
1993	10.9	9.5	11.9	11.0	9.5	12.0	10.2	8.7	11.1
1994	11.0	9.6	12.0	11.1	9.6	12.0	10.3	8.9	11.2
1995	11.0	9.7	11.9	11.1	9.7	12.0	10.2	8.8	11.1
1996	11.1	9.8	12.0	11.1	9.8	12.0	10.3	9.0	11.2
1997	11.2	9.9	12.1	11.2	9.9	12.1	10.7	9.3	11.5
1998	11.3	10.0	12.2	11.3	10.0	12.2	10.5	9.2	11.3
1999	11.2	10.0	12.1	11.2	10.0	12.1	10.4	9.2	11.1
2000d	11.4	10.1	12.3	11.4	10.1	12.3	10.7	9.2	11.6
2001	11.5	10.2	12.4	11.5	10.2	12.3	10.8	9.3	11.7
2002	11.5	10.3	12.4	11.5	10.3	12.3	10.9	9.5	11.7

TABLE 2.3 Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002

TABLE 2.3
Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002
[Data are based on death certificates]
Sex, race, Hispanic origin, and rank order	1980		2002
	Cause of death	Deaths	Cause of death	Deaths
All persons
…	All causes	1,989,841	All causes	2,443,387
1	Diseases of heart	761,085	Diseases of heart	696,947
2	Malignant neoplasms	416,509	Malignant neoplasms	557,271
3	Cerebrovascular diseases	170,225	Cerebrovascular diseases	162,672
4	Unintentional injuries	105,718	Chronic lower respiratory diseases	124,816
5	Chronic obstructive pulmonary diseases	56,050	Unintentional injuries	106,742
6	Pneumonia and influenza	54,619	Diabetes mellitus	73,249
7	Diabetes mellitus	34,851	Influenza and pneumonia	65,681
8	Chronic liver disease and cirrhosis	30,583	Alzheimer's disease	58,866
9	Atherosclerosis	29,449	Nephritis, nephrotic syndrome and nephrosis	40,974
10	Suicide	26,869	Septicemia	33,865
Male
…	All causes	1,075,078	All causes	1,199,264
1	Diseases of heart	405,661	Diseases of heart	340,933
2	Malignant neoplasms	225,948	Malignant neoplasms	288,768
3	Unintentional injuries	74,180	Unintentional injuries	69,257
4	Cerebrovascular diseases	69,973	Cerebrovascular diseases	62,622
5	Chronic obstructive pulmonary diseases	38,625	Chronic lower respiratory diseases	60,713
6	Pneumonia and influenza	27,574	Diabetes mellitus	34,301
7	Suicide	20,505	Influenza and pneumonia	28,918
8	Chronic liver disease and cirrhosis	19,768	Suicide	25,409
9	Homicide	18,779	Nephritis, nephrotic syndrome and nephrosis	19,695
10	Diabetes mellitus	14,325	Chronic liver disease and cirrhosis	17,401
Female
…	All causes	914,763	All causes	1,244,123
1	Diseases of heart	355,424	Diseases of heart	356,014
2	Malignant neoplasms	190,561	Malignant neoplasms	268,503
3	Cerebrovascular diseases	100,252	Cerebrovascular diseases	100,050
4	Unintentional injuries	31,538	Chronic lower respiratory diseases	64,103
5	Pneumonia and influenza	27,045	Alzheimer's disease	41,877
6	Diabetes mellitus	20,526	Diabetes mellitus	38,948
7	Atherosclerosis	17,848	Unintentional injuries	37,485
8	Chronic obstructive pulmonary diseases	17,425	Influenza and pneumonia	36,763
9	Chronic liver disease and cirrhosis	10,815	Nephritis, nephrotic syndrome and nephrosis	21,279
10	Certain conditions originating in the perinatal period	9,815	Septicemia	18,918
White
…	All causes	1,738,607	All causes	2,102,589
1	Diseases of heart	683,347	Diseases of heart	606,876
2	Malignant neoplasms	368,162	Malignant neoplasms	482,481
3	Cerebrovascular diseases	148,734	Cerebrovascular diseases	139,719
4	Unintentional injuries	90,122	Chronic lower respiratory diseases	115,395
5	Chronic obstructive pulmonary diseases	52,375	Unintentional injuries	90,866
6	Pneumonia and influenza	48,369	Diabetes mellitus	58,459
7	Diabetes mellitus	28,868	Influenza and pneumonia	58,346
8	Atherosclerosis	27,069	Alzheimer's disease	55,058
9	Chronic liver disease and cirrhosis	25,240	Nephritis, nephrotic syndrome and nephrosis	32,615
10	Suicide	24,829	Suicide	28,731
Black or African American
…	All causes	233,135	All causes	290,051
1	Diseases of heart	72,956	Diseases of heart	77,621
2	Malignant neoplasms	45,037	Malignant neoplasms	62,617
3	Cerebrovascular diseases	20,135	Cerebrovascular diseases	18,856
4	Unintentional injuries	13,480	Diabetes mellitus	12,687
5	Homicide	10,172	Unintentional injuries	12,513
6	Certain conditions originating in the perinatal period	6,961	Homicide	8,287
7	Pneumonia and influenza	5,648	Human immunodeficiency virus (HIV) disease	7,835
8	Diabetes mellitus	5,544	Chronic lower respiratory diseases	7,831
9	Chronic liver disease and cirrhosis	4,790	Nephritis, nephrotic syndrome and nephrosis	7,488
10	Nephritis, nephrotic syndrome, and nephrosis	3,416	Septicemia	6,137

TABLE 2.3 Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED]

TABLE 2.3
Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED]
[Data are based on death certificates]
Sex, race, Hispanic origin, and rank order		1980		2002
	Cause of death	Deaths	Cause of death	Deaths
American Indian or Alaska Native
…		All causes	6,923	All causes	12,415
1		Diseases of heart	1,494	Diseases of heart	2,467
2		Unintentional injuries	1,290	Malignant neoplasms	2,175
3		Malignant neoplasms	770	Unintentional injuries	1,488
4		Chronic liver disease and cirrhosis	410	Diabetes mellitus	744
5		Cerebrovascular diseases	322	Cerebrovascular diseases	567
6		Pneumonia and influenza	257	Chronic liver disease and cirrhosis	547
7		Homicide	217	Chronic lower respiratory diseases	452
8		Diabetes mellitus	210	Suicide	324
9		Certain conditions originating in the perinatal period	199	Influenza and pneumonia	293
10		Suicide	181	Homicide	267
Asian or Pacific Islander male
…		All causes	11,071	All causes	38,332
1		Diseases of heart	3,265	Malignant neoplasms	9,998
2		Malignant neoplasms	2,522	Diseases of heart	9,983
3		Cerebrovascular diseases	1,028	Cerebrovascular diseases	3,530
4		Unintentional injuries	810	Unintentional injuries	1,875
5		Pneumonia and influenza	342	Diabetes mellitus	1,359
6		Suicide	249	Influenza and pneumonia	1,171
7		Certain conditions originating in the perinatal period	246	Chronic lower respiratory diseases	1,138
8		Diabetes mellitus	227	Suicide	661
9		Homicide	211	Nephritis, nephrotic syndrome and nephrosis	649
10		Chronic obstructive pulmonary diseases	207	Septicemia	423
Hispanic or Latino male			—
…		—                       —		All causes	117,135
1	—		—	Diseases of heart	27,887
2	—		—	Malignant neoplasms	23,141
3	—		—	Unintentional injuries	10,106
4	—		—	Cerebrovascular diseases	6,451
5	—		—	Diabetes mellitus	5,912
6	—		—	Chronic liver disease and cirrhosis	3,409
7	—		—	Homicide	3,129
8	—		—	Chronic lower respiratory diseases	3,058
9	—		—	Influenza and pneumonia	2,824
10		—                       —		Certain conditions originating in the perinatal period	2,402
White male
…		All causes	933,878	All causes	1,025,196
1		Diseases of heart	364,679	Diseases of heart	296,904
2		Malignant neoplasms	198,188	Malignant neoplasms	249,867
3		Unintentional injuries	62,963	Unintentional injuries	58,467
4		Cerebrovascular diseases	60,095	Chronic lower respiratory diseases	55,409
5		Chronic obstructive pulmonary diseases	35,977	Cerebrovascular diseases	52,959
6		Pneumonia and influenza	23,810	Diabetes mellitus	28,110
7		Suicide	18,901	Infl uenza and pneumonia	25,381
8		Chronic liver disease and cirrhosis	16,407	Suicide	23,049
9		Diabetes mellitus	12,125	Alzheimer's disease	15,874
10		Atherosclerosis	10,543	Nephritis, nephrotic syndrome and nephrosis	15,850
Black or African American male
…		All causes	130,138	All causes	146,835
1		Diseases of heart	37,877	Diseases of heart	37,094
2		Malignant neoplasms	25,861	Malignant neoplasms	32,627
3		Unintentional injuries	9,701	Unintentional injuries	8,612
4		Cerebrovascular diseases	9,194	Cerebrovascular diseases	7,828
5		Homicide	8,274	Homicide	6,896
6		Certain conditions originating in the perinatal period	3,869	Human immunodeficiency virus (HIV) disease	5,301
7		Pneumonia and influenza	3,386	Diabetes mellitus	5,207
8		Chronic liver disease and cirrhosis	3,020	Chronic lower respiratory diseases	4,341
9		Chronic obstructive pulmonary diseases	2,429	Nephritis, nephrotic syndrome and nephrosis	3,427
10		Diabetes mellitus	2,010	Influenza and pneumonia	2,768

TABLE 2.3 Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED]

TABLE 2.3
Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED]
[Data are based on death certificates]
Sex, race, Hispanic origin, and rank order		1980		2002
	Cause of death	Deaths	Cause of death	Deaths
American Indian or Alaska Native male
…		All causes	4,193	All causes	6,750
1		Unintentional injuries	946	Diseases of heart	1,412
2		Diseases of heart	917	Malignant neoplasms	1,081
3		Malignant neoplasms	408	Unintentional injuries	1,003
4		Chronic liver disease and cirrhosis	239	Diabetes mellitus	336
5		Cerebrovascular diseases	163	Chronic liver disease and cirrhosis	319
6		Homicide	162	Suicide	258
7		Pneumonia and influenza	148	Cerebrovascular diseases	236
8		Suicide	147	Chronic lower respiratory diseases	220
9		Certain conditions originating in the perinatal period	107	Homicide	185
10		Diabetes mellitus	86	Influenza and pneumonia	133
Asian or Pacific Islander male
…		All causes	6,809	All causes	20,483
1		Diseases of heart	2,174	Diseases of heart	5,523
2		Malignant neoplasms	1,485	Malignant neoplasms	5,193
3		Unintenti onal injuries	556	Cerebrovascular diseases	1,599
4		Cerebrovascular diseases	521	Unintentional injuries	1,175
5		Pneumonia and influenza	227	Chronic lower respiratory diseases	743
6		Suicide	159	Diabetes mellitus	648
7		Chronic obstructive pulmonary diseases	158	Influenza and pneumonia	636
8		Homicide	151	Suicide	469
9		Certain conditions originating in the perinatal period	128	Nephritis, nephrotic syndrome and nephrosis	320
10		Diabetes mellitus	103	Homicide	277
Hispanic or Latino male
…		—                       —		All causes	65,703
1	—		—	Diseases of heart	14,798
2	—		—	Malignant neoplasms	12,235
3	—		—	Unintentional injuries	7,698
4	—		—	Cerebrovascular diseases	3,003
5	—		—	Diabetes mellitus	2,779
6	—		—	Homicide	2,635
7	—		—	Chronic liver disease and cirrhosis	2,437
8	—		—	Suicide	1,651
9	—		—	Chronic lower respiratory diseases	1,625
10		—                       —		Human immunodeficiency virus (HIV) disease	1,440
White female
…		All causes	804,729	All causes	1,077,393
1		Diseases of heart	318,668	Diseases of heart	309,972
2		Malignant neoplasms	169,974	Malignant neoplasms	232,614
3		Cerebrovascular diseases	88,639	Cerebrovascular diseases	86,760
4		Unintentional injuries	27,159	Chronic lower respiratory diseases	59,986
5		Pneumonia and influenza	24,559	Alzheimer's disease	39,184
6		Diabetes mellitus	16,743	Influenza and pneumonia	32,965
7		Atherosclerosis	16,526	Unintentional injuries	32,399
8		Chronic obstructive pulmonary diseases	16,398	Diabetes mellitus	30,349
9		Chronic liver disease and cirrhosis	8,833	Nephritis, nephrotic syndrome and nephrosis	16,765
10		Certain conditions originating in the perinatal period	6,512	Septicemia	15,191
Black or African American female
…		All causes	102,997	All causes	143,216
1		Diseases of heart	35,079	Diseases of heart	40,527
2		Malignant neoplasms	19,176	Malignant neoplasms	29,990
3		Cerebrovascular diseases	10,941	Cerebrovascular diseases	11,028
4		Unintentional injuries	3,779	Diabetes mellitus	7,480
5		Diabetes mellitus	3,534	Nephritis, nephrotic syndrome and nephrosis	4,061
6		Certain conditions originating in the perinatal period	3,092	Unintentional injuries	3,901
7		Pneumonia and influenza	2,262	Chronic lower respiratory diseases	3,490
8		Homicide	1,898	Septicemia	3,434
9		Chronic liver disease and cirrhosis	1,770	Influenza and pneumonia	3,103
10		Nephritis, nephrotic syndrome, and nephrosis	1,722	Human immunodeficiency virus (HIV) disease	2,534

TABLE 2.3 Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED] "Table 31. Leading Causes of Death and Numbers of Deaths, According to Sex, Race, and Hispanic Origin: United States, 1980 and 2002, in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)

TABLE 2.3
Leading causes of death and numbers of deaths, according to sex, race, and Hispanic origin, 1980 and 2002 [CONTINUED]
[Data are based on death certificates]
Sex, race, Hispanic origin, and rank order	1980		2002
	Cause of death	Deaths	Cause of death	Deaths
Notes: … = Category not applicable. — = Data not available.
SOURCE: "Table 31. Leading Causes of Death and Numbers of Deaths, According to Sex, Race, and Hispanic Origin: United States, 1980 and 2002, in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)
American Indian or Alaska Native female
…	All causes	2,730	All causes	5,665
1	Diseases of heart	577	Malignant neoplasms	1,094
2	Malignant neoplasms	362	Diseases of heart	1,055
3	Unintentional injuries	344	Unintentional injuries	485
4	Chronic liver disease and cirrhosis	171	Diabetes mellitus	408
5	Cerebrovascular diseases	159	Cerebrovascular diseases	331
6	Diabetes mellitus	124	Chronic lower respiratory diseases	232
7	Pneumonia and influenza	109	Chronic liver disease and cirrhosis	228
8	Certain conditions originating in the perinatal period	92	Influenza and pneumonia	160
9	Nephritis, nephrotic syndrome, and nephrosis	56	Nephritis, nephrotic syndrome and nephrosis	124
10	Homicide	55	Septicemia	100
Asian or Pacific Islander female
…	All causes	4,262	All causes	17,849
1	Diseases of heart	1,091	Malignant neoplasms	4,805
2	Malignant neoplasms	1,037	Diseases of heart	4,460
3	Cerebrovascular diseases	507	Cerebrovascular diseases	1,931
4	Unintentional injuries	254	Diabetes mellitus	711
5	Diabetes mellitus	124	Unintentional injuries	700
6	Certain conditions originating in the perinatal period	118	Influenza and pneumonia	535
7	Pneumonia and influenza	115	Chronic lower respiratory diseases	395
8	Congenital anomalies	104	Nephritis, nephrotic syndrome and nephrosis	329
9	Suicide	90	Alzheimer's disease	231
10	Homicide	60	Essential (primary) hypertension and hypertensive renal disease	221
Hispanic or Latino female
…	—	—	All causes	51,432
1	—	—	Diseases of heart	13,089
2	—	—	Malignant neoplasms	10,906
3	—	—	Cerebrovascular diseases	3,448
4	—	—	Diabetes mellitus	3,133
5	—	—	Unintentional injuries	2,408
6	—	—	Chronic lower respiratory diseases	1,433
7	—	—	Influenza and pneumonia	1,426
8	—	—	Certain conditions originating in the perinatal period	1,050
9	—	—	Alzheimer's disease	1,010
10	—	—	Chronic liver disease and cirrhosis	972

crucial for the long-term success of obesity treatment, any action that releases people from assuming personal responsibility is counterproductive.

In July 2004 Rick Berman, executive director of the Center for Consumer Freedom, a food-industry-funded advocacy group, decried the move to designate obesity as a disease. "This is truly a dumbing-down of the term 'disease.' This is the only disease that I'm familiar with that you can solve by regularly taking long walks and keeping your mouth shut. It's terrible to start using taxpayer money like this when there are other legitimate diseases that need to be addressed" (Rob Stein and Ceci Connolly, "Medicare Changes Policy on Obesity: Some Treatments May Be Covered," Washington Post, July 16, 2004).

In addition to Berman's concern that dollars spent to pay for weight-loss therapies would be diverted from other serious ailments, some observers fear that the nation's health-care system could collapse under the weight of a far-reaching official policy that declares obesity a disease. Opponents to granting disease status to obesity predict that the financial ramifications would be devastating for taxpayers and the health insurance industry. Health-care costs, already escalating every year, would skyrocket. Antiobesity programs would drive insurance premiums even higher and place unreasonable FIGURE 2.1 Overweight and obesity by age, selected years 1960–2002 "Figure 15. Overweight and Obesity by Age: United States, 1960–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 8, 2006)burdens on the already overburdened Medicare and Medicaid programs. Employers, especially small businesses, might be forced by high health-care costs to drop employee coverage altogether.

A related concern is the lack of universally accepted, effective treatment for obesity. If obesity is classified as a disease, which treatment or therapies should be covered? For example, if exercise is deemed beneficial, then health insurers might be required to pay for gym memberships. Further, some opponents believe that it is not necessary to designate obesity as a disease in order to encourage Americans to seek treatment. They cite the more than $50 billion spent annually on weight-loss programs and services as evidence that Americans are not reluctant to seek treatment.

FIGURE 2.2 Obesity among adults 20-74 years of age, by sex, race, and Hispanic origin, 1999–2002 "Figure 17. Obesity among Adults 20-74 Years of Age by Sex, Race, and Hispanic Origin: United States, 1999–2002," in Health, United States, 2004, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004, http://www.cdc.gov/nchs/data/hus/hus04.pdf (accessed January 8, 2006)

Although the debate has not been fully resolved, obesity is rapidly acquiring recognition as a disease. In 2002 the Internal Revenue Service ruled that for tax purposes, obesity is a disease, allowing Americans for the first time to claim a deduction for some health-care expenses related to obesity, just as they can for expenditures related to heart disease, cancer, diabetes, and other illnesses.

In July 2004 the federal Medicare program discarded its long-standing position that obesity is not a disease, which effectively removed a major roadblock for people seeking coverage for treatment of obesity. After years of review, the Centers for Medicare & Medicaid Services, which administers the health program for older adults and people who are disabled, announced that it had eliminated language—that "obesity itself cannot be considered an illness"—from its policy that had been used to deny coverage for weight-loss treatment. Although the decision stopped short of declaring obesity a disease and does not automatically imply coverage for any specific treatment, it enables individuals, physicians, and companies to apply to Medicare for reimbursement for a variety of weight-loss therapies. Since private insurance companies often use Medicare as a model for their coverage and benefits, the Medicare decision has pressured them to expand coverage for weight-loss treatments. Ironically, the Medicare decision was announced at the same time many private insurers intended to eliminate or sharply curtail coverage of weight-loss surgery.

TABLE 2.4

Health consequences of overweight and obesity

Premature death

• An estimated 300,000 deaths per year may be attributable to obesity.
• The risk of death rises with increasing weight.
• Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years.
• Individuals who are obese (body mass index (BMI) > 30) have a 50 to 100% increased risk of premature death from all causes, compared to individuals with a healthy weight.

Heart disease

• The incidence of heart disease (heart attack, congestive heart failure, sudden cardiac death, angina or chest pain, and abnormal heart rhythm) is increased in persons who are overweight or obese (BMI >25).
• High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight.
• Obesity is associated with elevated triglycerides (blood fat) and decreased high density lipoprotein (HDL) cholesterol ("good cholesterol").

Diabetes

• A weight gain of 11 to 18 pounds increases a person's risk of developing type 2 diabetes to twice that of individuals who have not gained weight.
• Over 80% of people with diabetes are overweight or obese.

Cancer

• Overweight and obesity are associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and postmenopausal breast cancer.
• Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausal breast cancer, compared to women whose weight remains stable.

Breathing problems

• Sleep apnea (interrupted breathing while sleeping) is more common in obese persons.
• Obesity is associated with a higher prevalence of asthma.

Arthritis

• For every 2-pound increase in weight, the risk of developing arthritis is increased by 9 to 13%.
• Symptoms of arthritis can improve with weight loss.

Reproductive complications

Complications of pregnancy

• Obesity during pregnancy is associated with increased risk of death in both the baby and the mother and increases the risk of maternal high blood pressure by 10 times.
• In addition to many other complications, women who are obese during pregnancy are more likely to have gestational diabetes and problems with labor and delivery.
• Infants born to women who are obese during pregnancy are more likely to be high birthweight and, therefore, may face a higher rate of Cesarean section delivery and low blood sugar (which can be associated with brain damage and seizures).
• Obesity during pregnancy is associated with an increased risk of birth defects, particularly neural tube defects, such as spina bifida.
• Obesity in premenopausal women is associated with irregular menstrual cycles and infertility.

Additional health consequences

• Overweight and obesity are associated with increased risks of gall bladder disease, incontinence, increased surgical risk, and depression.
• Obesity can affect the quality of life through limited mobility and decreased physical endurance as well as through social, academic, and job discrimination.

Children and adolescents

• Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to those with a healthy weight.
• Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.
• Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese.
• The most immediate consequence of overweight, as perceived by children themselves, is social discrimination.

SOURCE: "Overweight and Obesity: Health Consequences," in The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, U.S. Department of Health & Human Services, Office of the U.S. Surgeon General, 2001, http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm (accessed January 9, 2006)

Inspired by the change in Medicare policy, Blue Cross and Blue Shield of North Carolina, the state's largest health insurance company announced in October 2004 that it would offer more than one million of its members comprehensive coverage and benefits to prevent and treat overweight and obesity. The insurance company began paying for four visits to a physician per year specifically to evaluate body weight and provide a range of treatment options including nutritional counseling, prescription diet drugs, and weight-loss surgery.

In 2005 the American Medical Association (AMA) adopted directives that suggest that this powerful professional organization will soon enter into this debate. Specifically, the AMA "Will work with the Centers for Disease Control and Prevention to convene relevant stakeholders to evaluate the issue of obesity as a disease, using a systematic, evidence-based approach." The AMA also resolved to continue to "actively pursue measures to treat obesity as an urgent chronic condition, raise the public's awareness of the significance of obesity and its related disorders, and encourage health industries to make appropriate care available for the prevention and treatment of obese patients."

TABLE 2.5 Obesity and genetics "Obesity and Genetics: What We Know, What We Don't Know and What It Means," Public Health Perspectives, Centers for Disease Control and Prevention, Office of Genomics and Disease Prevention, 2005, http://www.cdc.gov/genomics/info/perspectives/files/obesknow.htm (accessed January 9, 2006)

TABLE 2.5
Obesity and genetics
What we know	What we don't know
SOURCE: "Obesity and Genetics: What We Know, What We Don't Know and What It Means," Public Health Perspectives, Centers for Disease Control and Prevention, Office of Genomics and Disease Prevention, 2005, http://www.cdc.gov/genomics/info/perspectives/files/obesknow.htm (accessed January 9, 2006)
Biological relatives tend to resemble each other in many ways, including body weight. Individuals with a family history of obesity may be predisposed to gain weight and interventions that prevent obesity are especially important.	Why are biological relatives more similar in body weight? What genes are associated with this observation? Are the same genetic associations seen in every family? How do these genes affect energy metabolism and regulation?
In an environment made constant for food intake and physical activity, individuals respond differently. Some people store more energy as fat in an environment of excess; others lose less fat in an environment of scarcity. The different responses are largely due to genetic variation between individuals.	Why are interventions based on diet and exercise more effective for some people than others? What are the biological differences between these high and low responders? How do we use these insights to tailor interventions to specific needs?
Fat stores are regulated over long periods of time by complex systems that involve input and feedback from fatty tissues, the brain and endocrine glands like the pancreas and the thyroid. Overweight and obesity can result from only a very small positive energy input imbalance over a long period of time.	What elements of energy regulation feedback systems are different in individuals? How do these differences affect energy metabolism and regulation?
Rarely, people have mutations in single genes that result in severe obesity that starts in infancy. Studying these individuals is providing insight into the complex biological pathways that regulate the balance between energy input and energy expenditure.	Do additional obesity syndromes exist that are caused by mutations in single genes? If so, what are they? What are the natural history, management strategy and outcome for affected individuals?
Obese individuals have genetic similarities that may shed light on the biological differences that predispose to gain weight. This knowledge may be useful in preventing or treating obesity in predisposed people.	How do genetic variations that are shared by obese people affect gene expression and function? How do genetic variation and environmental factors interact to produce obesity? What are the biological features associated with the tendency to gain weight? What environmental factors are helpful in countering these tendencies?
Pharmaceutical companies are using genetic approaches (pharmacogenomics) to develop new drug strategies to treat obesity.	Will pharmacologic approaches benefit most people affected with obesity? Will these drugs be accessible to most people?
What it means
For people who are genetically predisposed to gain weight, preventing obesity is the best course. Predisposed persons may require individualized interventions and greater support to be successful in maintaining a healthy weight. Obesity is a chronic lifelong condition that is the result of an environment of caloric abundance and relative physical inactivity modulated by a susceptible genotype. For those who are predisposed, preventing weight gain is the best course of action. Genes are not destiny. Obesity can be prevented or can be managed in many cases with a combination of diet, physical activity, and medication. Drugs that will aid in losing weight or maintaining a healthy weight are being developed and are expected to be available in the next few years. People who are affected with overweight and obesity are often victims of stigmatization and discrimination. It is time to stop blaming the victim. Many obesity researchers believe that people who struggle with their weight are pushing against thousands of years of evolution that has selected for storing energy as fat in times of plenty for use in times of scarcity. It is time to recognize their struggle, understand their challenges and support their need for lifelong efforts to achieve better health.