The Problem

Obesity is steadily and inexorably becoming the greatest health problem in the developed world. It has recently been estimated that 1.1 billion people are overfed and overweight, a number that rivals the number who are underfed and underweight. Overweight becomes the disease of obesity when excess fat has accumulated to the extent that it may adversely affect health. This point is most commonly defined by the body mass index (BMI). Although a BMI of ³ 25 kg/m2 can be seen to be associated with a reduced life expectancy and a risk of exacerbating many diseases, it is now usual to consider BMI of 30 as the cutoff—the point at which the accumulation of fat is a major health hazard [2].

The majority of adults in Australia , the United States , and most of Western and Eastern Europe are overweight (BMI >25) and more than 20% are obese [3]. The most recent National Health and Nutrition Examination Survey (NHANES) from the US Centers for Disease Control and Prevention [4] indicated that 61% of adults in the United States in 1999 were overweight and that 27% were obese. Fig. 1 shows the rise in obesity through 3 survey periods. In less than 20 years, the number of obese has nearly doubled.

Figure. 1. The increasing prevalence of overweight and obesity in the United States, based on National Health and Nutrition Examination Surveys in 1976-80 (1), 1988-94 (2), and 1999 (3)[4]).

Throughout the world, in both developed and developing nations, a similar pattern is occurring [3]. In Russia , 54% of adults are overweight, in Brazil , 36%, and in Malaysia , 27% [3]. Even China has a developing problem. A recent survey of adults in urban Shanghai reported that 29.5% were overweight and 4.3% were obese [5].

After millions of years evolving a genetic structure to survive the life of the hunter/ gatherer, our health and our lives are now threatened by a lifestyle characterized by ready access to copious amounts of attractive food and very little need for physical activity. Foods high in fat, carbohydrates, and, in particular, simple sugars are booming. The US Department of Agriculture reports that the US per capita intake of sugar was 152.4 lbs in 2000, an increase of more than 20% in the last 14 years. And we don’t even need to get out of the chair to order the food delivered or even to change the channels on the television.