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INTRODUCTION

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Despite the widely described negative consequences of obesity on health, the obesity epidemic continues to challenge clinicians, researchers, public health policy makers, and the healthcare system, while placing large segments of our population at risk for a multitude of serious maladies and premature death. The problem is not solely limited to the developed world, as obesity has become a World Health Organization (WHO) focus as it relates to global health initiatives. Cancer, orthopedic complications, diabetes, hypertension, stroke, heart disease, premature death and other serious complications (Table 6-1) have been well described, and yet the public health goal of the populace achieving a normal body mass index (BMI) has been elusive. Sadly, obesity is a well-recognized “common denominator” to preventable mortality, and obese (as well as overweight) adults have been shown to be at significantly higher risks for any-cause mortality, than their leaner counterparts. The unfortunate trend toward a sedentary lifestyle and unhealthy eating habits has likely contributed to this unfortunate and costly situation, although unquestionably, myriad psychosocial, economic, and environmental factors are likely contributory. Ironically, despite the decades-long and wide availability of dietetic, fat-free, low-fat, sugar-free, and low-calorie foods and beverages, not to mention the ubiquitous presence of health clubs in our communities, there are more obese Americans today than at any previous time in our history. More than 78 million American adults are obese, which is more than one-third of the adult population, and account for nearly $150 billion of annual obesity-related healthcare expenditures. While obesity is now recognized in 12.5 million American children and adolescents (17% of this population), sadly, nearly one-third of all children ages 2 to 19 years are now either overweight or obese. The prevalence of obesity for adult men and women is now equivalent (35.7% vs 35.8%, respectively), with prevalence increases in recent decades noted primarily in men. Despite some differences in obesity prevalence based on levels of education, income, and ethnicity or race, it is clear that over the past decades, obesity rates have increased for both men and women of all socioeconomic strata. While the number of obese Americans stood at just 13% in 1962, presently, approximately 2 in 3 US women are either overweight or obese, with the highest prevalence noted in the non-Hispanic Black population. Colorado is the “leanest" state, with just over 20% of its population obese, while the “heaviest” state is Mississippi, with nearly 35% of its adult population obese. Clearly, the Healthy People 2010 goals for 15% obesity among adults and 5% in children were not met. In fact, the average BMI of adult women in the United States is 28.7. This unfortunate “state of the weight” in the United States may ultimately undo the steady gains in overall health we have enjoyed as Americans since the dawn of the 20th century, and now contributes to the deaths of 300,000 Americans annually. The remarkably high prevalence of this condition and its significant negative impact on overall health ...

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