Created page with "いくつかの低カロリー食は効果的である。短期的には、低炭水化物食の方が低脂肪食よりも体重減少に良いと思われる。しかし、長期的には、すべてのタイプの低炭水化物食と低脂肪食が等しく有益であるように見える。さまざまな食事に関連する心臓病と糖尿病のリスクは同程度のようである。肥満者における地中..."
While a majority of obese individuals at any given time attempt to lose weight and are often successful, maintaining weight loss long-term is rare. There is no effective, well-defined, evidence-based intervention for preventing obesity. Obesity prevention requires a complex approach, including interventions at societal, community, family, and individual levels. Changes to [[diet (nutrition)|diet]] as well as [[physical exercise|exercising]] are the main treatments recommended by health professionals. Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of [[dietary fiber]], if these dietary choices are available, affordable, and accessible. [[Anti-obesity medication|Medications]] can be used, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective, a [[gastric balloon]] or [[bariatric surgery|surgery]] may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier, or a reduced ability to absorb nutrients from food.
Obesity is a leading [[preventable causes of death|preventable cause of death]] worldwide, with increasing rates in adults and [[childhood obesity|children]]. In 2022, over 1 billion people were obese worldwide (879 million adults and 159 million children), representing more than a double of adult cases (and four times higher than cases among children) registered in 1990. Obesity is more common in women than in men. Today, obesity is [[Social stigma of obesity|stigmatized]] in most of the world. Conversely, some cultures, past and present, have a favorable view of obesity, seeing it as a symbol of wealth and fertility. The [[World Health Organization]], the US, Canada, Japan, Portugal, Germany, the [[European Parliament]] and medical societies, e.g. the [[American Medical Association]], classify obesity as a disease. Others, such as the UK, do not.
肥満は世界的に[[preventable causes of death/ja|予防可能な死因]]のトップであり、成人および[[childhood obesity/ja|小児]]の割合が増加している。2022年には、世界で10億人以上が肥満であり（成人8億7900万人、小児1億5900万人）、1990年に登録された成人の症例の2倍以上（小児の症例の4倍）であった。肥満は男性よりも女性に多い。今日、肥満は世界のほとんどの地域で[[Social stigma of obesity/ja|スティグマ]]である。逆に、過去も現在も、肥満を富と豊穣の象徴とみなして好意的にとらえている文化もある。[[World Health Organization/ja|世界保健機関]]、アメリカ、カナダ、日本、ポルトガル、ドイツ、[[:en:European Parliament|欧州議会]]、医学会、例えば[[:en:American Medical Association|アメリカ医師会]]は肥満を病気として分類している。英国のように、そうでない国もある。
[[File:Obesity6.JPG|thumb|upright=1.2|alt=A front and side view of a "super obese" male torso. Stretch marks of the skin are visible along with gynecomastia.|A "super obese" male with a BMI of 53 kg/m<sup>2</sup>: weight {{cvt|182|kg}}, height {{cvt|185|cm|ftin}}. He presents with [[stretch marks]] and [[Adipomastia|enlarged breasts]].]]
Obesity is typically defined as a substantial accumulation of [[body fat]] that could impact health. Medical organizations tend to classify people as obese based on [[body mass index]] (BMI) – a ratio of a person's weight in [[kilogram]]s to the [[Square (algebra)|square]] of their height in [[meter]]s. For adults, the [[World Health Organization]] (WHO) defines "[[overweight]]" as a BMI 25 or higher, and "obese" as a BMI 30 or higher. The U.S. [[Centers for Disease Control and Prevention]] (CDC) further subdivides obesity based on BMI, with a BMI 30 to 35 called class 1 obesity; 35 to 40, class 2 obesity; and 40+, class 3 obesity.
肥満とは一般的に、健康に影響を及ぼす可能性のある[[body fat/ja|体脂肪]]の実質的な蓄積として定義される。医療機関では、[[body mass index/ja|体格指数]]（BMI）、つまり[[:en:kilogram|キログラム]]単位の体重と[[:en:meter|メートル]]単位の身長の[[:en:Square (algebra)|2乗]]の比率に基づいて、人々を肥満として分類する傾向がある。成人の場合、[[World Health Organization/ja|世界保健機関]]（WHO）はBMI 25以上を「[[overweight/ja|過体重]]」、BMI 30以上を「肥満」と定義している。米国[[:en:Centers for Disease Control and Prevention|疾病管理予防センター]]（CDC）では、BMIをもとに肥満をさらに細分化しており、BMI30～35をクラス1肥満、35～40をクラス2肥満、40以上をクラス3肥満と呼んでいる。
For children, obesity measures take age into consideration along with height and weight. For children aged 5–19, the WHO defines obesity as a BMI two [[standard deviation]]s above the [[median]] for their age (a BMI around 18 for a five-year old; around 30 for a 19-year old). For children under five, the WHO defines obesity as a weight three standard deviations above the median for their height.
Some modifications to the WHO definitions have been made by particular organizations. The surgical literature breaks down class II and III or only class III obesity into further categories whose exact values are still disputed.
* BMIが35以上または40以上の場合は、''高度肥満''である。
* Any BMI ≥ 35 or 40 kg/m<sup>2</sup> is ''severe obesity''.
As Asian populations develop negative health consequences at a lower BMI than [[White people|Caucasians]], some nations have redefined obesity; Japan has defined obesity as any BMI greater than 25 kg/m<sup>2</sup> while China uses a BMI of greater than 28 kg/m<sup>2</sup>.
The preferred obesity metric in scholarly circles is the [[body fat percentage]] (BF%) – the ratio of the total weight of person's fat to his or her body weight, and BMI is viewed merely as a way to approximate BF%. Levels in excess of 32% for women and 25% for men are generally considered to indicate obesity.
BMI ignores variations between individuals in amounts of lean body mass, particularly [[muscle]] mass. Individuals involved in heavy physical labor or sports may have high BMI values despite having little fat. For example, more than half of all [[NFL]] players are classified as "obese" (BMI ≥ 30), and 1 in 4 are classified as "extremely obese" (BMI ≥ 35), according to the BMI metric. However, their mean [[body fat percentage]], 14%, is well within what is considered a healthy range. Similarly, [[Sumo]] wrestlers may be categorized by BMI as "severely obese" or "very severely obese" but many Sumo wrestlers are not categorized as obese when body fat percentage is used instead (having <25% body fat). Some Sumo wrestlers were found to have no more body fat than a non-Sumo comparison group, with high BMI values resulting from their high amounts of lean body mass.
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==健康への影響==
==Effects on health==
{{Anchor|Effects on health}}
Obesity increases a person's risk of developing various metabolic diseases, [[cardiovascular disease]], [[osteoarthritis]], [[Alzheimer disease]], [[Depression (mood)|depression]], and certain types of cancer. Depending on the degree of obesity and the presence of comorbid disorders, obesity is associated with an estimated 2–20 year shorter life expectancy. High BMI is a marker of risk for, but not a direct cause of, diseases caused by diet and physical activity.
肥満は世界的に主要な[[preventable causes of death/ja|予防可能な死因]]の一つである。死亡リスクは、非喫煙者ではBMI20～25kg/m<sup>2</sup>で最も低く、現在喫煙者ではBMI24～27kg/m<sup>2</sup>で最も低く、どちらかに変化するとリスクは増加する。これは少なくとも4大陸で当てはまるようである。他の研究によると、BMIおよびウエスト周囲径と死亡率との関連はU字型またはJ字型であるが、[[waist-to-hip ratio/ja|ウエスト-ヒップ比]]および[[waist-to-height ratio/ja|ウエスト-身長比]]と死亡率との関連はよりポジティブである。アジア人では、健康への悪影響のリスクは22～25kg/m<sup>2</sup>の間で増加し始める。2021年、[[World Health Organization/ja|世界保健機関（WHO）]]は、肥満が毎年少なくとも280万人の死亡を引き起こすと推定した。平均して、肥満は平均余命を6～7年縮め、BMIが30～35 kg/m<sup>2</sup>では平均余命を2～4年縮め、重度の肥満（BMI ≥ 40 kg/m<sup>2</sup>）では平均余命を10年縮める。
Obesity is one of the leading [[preventable causes of death]] worldwide. The mortality risk is lowest at a BMI of 20–25 kg/m<sup>2</sup> in non-smokers and at 24–27 kg/m<sup>2</sup> in current smokers, with risk increasing along with changes in either direction. This appears to apply in at least four continents. Other research suggests that the association of BMI and waist circumference with mortality is U- or J-shaped, while the association between [[waist-to-hip ratio]] and [[waist-to-height ratio]] with mortality is more positive. In Asians the risk of negative health effects begins to increase between 22 and 25 kg/m<sup>2</sup>. In 2021, the [[World Health Organization]] estimated that obesity caused at least 2.8 million deaths annually. On average, obesity reduces life expectancy by six to seven years, a BMI of 30–35 kg/m<sup>2</sup> reduces life expectancy by two to four years, while severe obesity (BMI ≥ 40 kg/m<sup>2</sup>) reduces life expectancy by ten years.
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===罹患率===
===Morbidity===
{{Main/ja|Obesity-associated morbidity/ja}}
{{Main|Obesity-associated morbidity}}
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肥満は多くの身体的・精神的疾患のリスクを高める。このような併存疾患は、[[metabolic syndrome/ja|メタボリックシンドローム]]に最もよく見られる： [[diabetes mellitus type 2/ja|2型糖尿病]]、[[hypertension/ja|高血圧]]、[[hypercholesterolemia/ja|高コレステロール血症]]、[[hypertriglyceridemia/ja|高トリグリセリド血症]]が含まれる。[[:en:RAK Hospital|RAK病院]]の研究によれば、肥満の人は[[long COVID/ja|長いCOVID]]を発症するリスクが高い。CDCは、肥満がCOVID-19の重症化に対する唯一最強の危険因子であることを明らかにした。
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in [[metabolic syndrome]], a combination of medical disorders which includes: [[diabetes mellitus type 2]], [[hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]], and [[hypertriglyceridemia|high triglyceride levels]]. A study from the [[RAK Hospital]] found that obese people are at a greater risk of developing [[long COVID]]. The CDC has found that obesity is the single strongest risk factor for severe COVID-19 illness.
Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a [[sedentary lifestyle]]. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with [[type 2 diabetes]]. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.
Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as [[osteoarthritis]], [[obstructive sleep apnea]], social stigmatization) and those due to the increased number of [[fat cells]] ([[diabetes mellitus|diabetes]], [[cancer]], [[cardiovascular disease]], [[non-alcoholic fatty liver disease]]). Increases in body fat alter the body's response to insulin, potentially leading to [[insulin resistance]]. Increased fat also creates a [[inflammation|proinflammatory state]], and a [[thrombosis|prothrombotic]] state.
{| class="wikitable"
{| class="wikitable"
|-
|-
! Medical field
! 医療分野
! Condition
! 状態
! Medical field
! 医療分野
! Condition
! 状態
|-
|-
| width="10%" | [[Cardiology]]
| width="10%" | [[Cardiology/ja]]
|
|
* [[Coronary heart disease]]: [[angina pectoris|angina]] and [[myocardial infarction]]
* [[Major depressive disorder|Depression]] in women
* 女性における[[Major depressive disorder/ja|うつ病]]
* Social [[Social stigma|stigmatization]]
* 社会的[[Social stigma/ja|スティグマティゼーション]]
| [[Respirology]]
| [[Respirology/ja]]
|
|
* [[Sleep apnea|Obstructive sleep apnea]]
* [[Sleep apnea/ja|閉塞性睡眠時無呼吸症候群]]
* [[Obesity hypoventilation syndrome]]
* [[Obesity hypoventilation syndrome/ja]]
* [[Asthma]]
* [[Asthma/ja]]
* Increased complications during [[general anaesthesia]]
* [[general anaesthesia/ja|全身麻酔]]中の合併症の増加
* increased risk of severe COVID-19
* 重症COVID-19のリスクが高まる
|-
|-
| [[Rheumatology]] and [[orthopedics]]
| [[Rheumatology/ja]]と[[orthopedics/ja]]
|
|
* [[Gout]]
* [[Gout/ja]]
* Poor mobility
* 運動能力が低い
* [[Osteoarthritis]]
* [[Osteoarthritis/ja]]
* [[Low back pain]]
* [[Low back pain/ja]]
| [[Urology]] and [[Nephrology]]
| [[Urology/ja]]と[[Nephrology/ja]]
|
|
* [[Erectile dysfunction]]
* [[Erectile dysfunction/ja]]
* [[Urinary incontinence]]
* [[Urinary incontinence/ja]]
* [[Chronic renal failure]]
* [[Chronic renal failure/ja]]
* [[Hypogonadism]]
* [[Hypogonadism/ja]]
* [[Buried penis]]
* [[Buried penis/ja]]
|}
|}
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==== 健康の指標 ====
==== Metrics of health ====
{{Main/ja|Metabolically healthy obesity/ja}}
{{Main|Metabolically healthy obesity}}
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新しい研究では、臨床医がより健康的な肥満者を特定する方法と、肥満者を一枚岩として扱わない方法に焦点が当てられている。肥満による医学的合併症を経験しない肥満者を''[[metabolically healthy obese/ja|（代謝的に）健康な肥満]]''と呼ぶことがあるが、このグループが（特に高齢者において）どの程度存在するかについては論争がある。''メタボ健常者''とみなされる人の数は、使用される定義によって異なり、普遍的に受け入れられる定義はない。代謝異常が比較的少ない肥満者も多数存在し、医学的合併症のない肥満者も少数派である。[[:en:American Association of Clinical Endocrinologists|米国臨床内分泌学会]]のガイドラインでは、2型糖尿病発症リスクの評価方法を検討する際に、肥満患者に対して[[risk stratification/ja|リスク層別化]]を行うよう医師に呼びかけている。
Newer research has focused on methods of identifying healthier obese people by clinicians, and not treating obese people as a monolithic group. Obese people who do not experience medical complications from their obesity are sometimes called ''[[metabolically healthy obese|(metabolically) healthy obese]]'', but the extent to which this group exists (especially among older people) is in dispute. The number of people considered ''metabolically healthy'' depends on the definition used, and there is no universally accepted definition. There are numerous obese people who have relatively few metabolic abnormalities, and a minority of obese people have no medical complications. The guidelines of the [[American Association of Clinical Endocrinologists]] call for physicians to use [[risk stratification]] with obese patients when considering how to assess their risk of developing type 2 diabetes.
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2014年、BioSHaRE-[[:en:European Union|EU]]（[[:en:Research Institute of the McGill University Health Centre|マギル大学保健センター研究所]]傘下のチームであるMaelstrom Researchがスポンサー）は、''健康的肥満''の定義を2つに分けた：
In 2014, the BioSHaRE–[[European Union|EU]] Healthy Obese Project (sponsored by Maelstrom Research, a team under the [[Research Institute of the McGill University Health Centre]]) came up with two definitions for ''healthy obesity'', one more strict and one less so:
To come up with these criteria, BioSHaRE controlled for age and tobacco use, researching how both may effect the metabolic syndrome associated with obesity, but not found to exist in the metabolically healthy obese. Other definitions of metabolically healthy obesity exist, including ones based on waist circumference rather than BMI, which is unreliable in certain individuals.
Another identification metric for health in obese people is [[Triceps surae muscle|calf]] [[Muscle strength|strength]], which is positively correlated with [[physical fitness]] in obese people. [[Body composition]] in general is hypothesized to help explain the existence of metabolically healthy obesity—the metabolically healthy obese are often found to have low amounts of [[Ectopia (medicine)|ectopic]] fat (fat stored in tissues other than adipose tissue) despite having overall fat mass equivalent in weight to obese people with [[metabolic syndrome]].
Although the negative health consequences of obesity in the general population are well supported by the available research evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox. The paradox was first described in 1999 in overweight and obese people undergoing [[hemodialysis]] and has subsequently been found in those with [[heart failure]] and [[Peripheral vascular disease|peripheral artery disease]] (PAD).
In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill. Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased. Even after [[Coronary artery bypass surgery|cardiac bypass surgery]], no increase in mortality is seen in the overweight and obese. One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event. Another study found that if one takes into account [[chronic obstructive pulmonary disease]] (COPD) in those with PAD, the benefit of obesity no longer exists.
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==原因==
==Causes==
{{Anchor|Causes}}
The "[[a calorie is a calorie]]" model of obesity posits a combination of excessive [[food energy]] intake and a lack of [[physical activity]] as the cause of most cases of obesity. A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness. In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet, increased [[Effects of the car on societies|reliance on cars]], and mechanized manufacturing.
肥満の「[[a calorie is a calorie/ja|a calorie is a calorie]]」モデルは、ほとんどの肥満の原因として、過剰な[[food energy/ja|食物エネルギー]]摂取と[[physical activity/ja|身体活動]]不足の組み合わせを仮定している。遺伝、医学的理由、精神疾患によるものは限られている。対照的に、社会レベルでの肥満率の増加は、簡単に手に入り、口にしやすい食事、増加した[[:en:Effects of the car on societies|自動車への依存]]、機械化された製造業によるものと考えられている。
Some other factors have been proposed as causes towards rising rates of obesity worldwide, including [[sleep debt|insufficient sleep]], [[endocrine disruptor]]s, increased usage of certain medications (such as [[atypical antipsychotics]]), increases in ambient temperature, decreased rates of [[tobacco smoking|smoking]], demographic changes, increasing maternal age of first-time mothers, changes to [[epigenetic]] dysregulation from the environment, increased phenotypic variance via [[assortative mating]], social pressure to [[dieting|diet]], among others. According to one study, factors like these may play as big of a role as excessive food energy intake and a lack of physical activity; however, the relative magnitudes of the effects of any proposed cause of obesity is varied and uncertain, as there is a general need for randomized controlled trials on humans before definitive statement can be made.
According to the [[Endocrine Society]], there is "growing evidence suggesting that obesity is a disorder of the [[energy homeostasis]] system, rather than simply arising from the passive accumulation of excess weight".
<div class="thumbimage">[[File:World map of calory consumption 1961 (v2).svg|200px|alt=(Left) A world map with countries colored to reflect the food energy consumption of their people in 1961. North America, Europe, and Australia have relatively high intake, while Africa and Asia consume much less.]]
<div class="thumbimage">[[File:World map of calory consumption 1961 (v2).svg|200px|alt=（左）1961年における国民の食料エネルギー消費量を反映するように、各国を色分けした世界地図。北米、ヨーロッパ、オーストラリアは比較的摂取量が多いが、アフリカとアジアはかなり少ない。]]
<div class="thumbimage">[[File:World map of Energy consumption 2001-2003.svg|200px|alt=(Right) A world map with countries colored to reflect the food energy consumption of their people in 2001–2003. Consumption in North America, Europe, and Australia has increased with respect to previous levels in 1971. Food consumption has also increased substantially in many parts of Asia. However, food consumption in Africa remains low.]]
<div class="thumbimage">[[File:World map of Energy consumption 2001-2003.svg|200px|alt=（右）2001年から2003年の食料エネルギー消費量を反映するように、各国を色分けした世界地図。北米、ヨーロッパ、オーストラリアの消費量は、1971年の以前の水準に比べて増加している。アジアの多くの地域でも食料消費は大幅に増加している。しかし、アフリカの食糧消費量は依然として低い。]]
</div><div class="thumbcaption" style="clear: left; text-align: left; background: transparent">Map of dietary energy availability per person per day in 1961 (left) and 2001–2003 (right) Calories per person per day (kilojoules per person per day)
[[File:World Per Person Energy Consumption.png|thumb|upright=1.6|alt=A graph showing a gradual increase in global food energy consumption per person per day between 1961 and 2002.|Average per capita energy consumption of the world from 1961 to 2002]]
[[File:World Per Person Energy Consumption.png|thumb|upright=1.6|alt=1961年から2002年にかけての、世界の1人1日当たりの食料エネルギー消費量の漸増を示すグラフ。|1961年から2002年までの世界の一人当たり平均エネルギー消費量]]
[[File:Prevalence Of Obesity In The Adult Population By Region.svg|thumb|地域別成人人口における肥満の有病率（2000年～2016年）|330x330px]]
[[:en:Dietary Guidelines for Americans|食事ガイドライン]]が普及しても、過食や食生活の選択ミスの問題に対処することはほとんどできなかった。1971年から2000年にかけて、米国の肥満率は14.5％から30.9％に増加した。同じ期間に、食品の平均消費エネルギー量も増加している。女性の平均増加量は1日あたり{{convert|335|Cal}}（1971年では{{convert|1542|Cal}}、2004年では{{convert|1877|Cal}}）であり、男性の平均増加量は1日あたり{{convert|168|Cal}}（1971年では{{convert|2450|Cal}}、2004年では{{convert|2618|Cal}}）であった。この余分な食物エネルギーのほとんどは、脂肪消費よりもむしろ炭水化物消費の増加によるものである。これらの余分な炭水化物の主な供給源は、アメリカの若年成人の1日の食物エネルギーのほぼ25％を占めるようになった甘味飲料と、ポテトチップスである。清涼飲料水、果実飲料、アイスティーなどの[[sweetened beverages/ja|甘味飲料]]の消費は、肥満率の上昇、メタボリックシンドロームや2型糖尿病のリスクの上昇に寄与していると考えられている。[[Vitamin D deficiency/ja|ビタミンD欠乏症]]は肥満に関連する疾患と関連している。
Excess appetite for palatable, high-calorie food (especially fat, sugar, and certain animal proteins) is seen as the primary factor driving obesity worldwide, likely because of imbalances in neurotransmitters affecting the drive to eat. [[Dietary energy supply]] per capita varies markedly between different regions and countries. It has also changed significantly over time. From the early 1970s to the late 1990s the average [[food energy]] available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with {{convert|3654|Cal}} per person in 1996. This increased further in 2003 to {{convert|3754|Cal}}. During the late 1990s, Europeans had {{convert|3394|Cal}} per person, in the developing areas of Asia there were {{convert|2648|Cal}} per person, and in sub-Saharan Africa people had {{convert|2176|Cal}} per person. Total food energy consumption has been found to be related to obesity.
[[File:Prevalence Of Obesity In The Adult Population By Region.svg|thumb|Prevalence of obesity in the adult population by region (2000 - 2016)|330x330px]]
The widespread availability of [[Dietary Guidelines for Americans|dietary guidelines]] has done little to address the problems of overeating and poor dietary choice. From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%. During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was {{convert|335|Cal}} per day ({{convert|1542|Cal}} in 1971 and {{convert|1877|Cal}} in 2004), while for men the average increase was {{convert|168|Cal}} per day ({{convert|2450|Cal}} in 1971 and {{convert|2618|Cal}} in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption. The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America, and potato chips. Consumption of [[sweetened beverages]] such as soft drinks, fruit drinks, and iced tea is believed to be contributing to the rising rates of obesity and to an increased risk of metabolic syndrome and type 2 diabetes. [[Vitamin D deficiency]] is related to diseases associated with obesity.
As societies become increasingly reliant on [[food energy|energy-dense]], big-portions, and [[Fast food|fast-food]] meals, the association between fast-food consumption and obesity becomes more concerning. In the United States, consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.
[[Agricultural policy]] and [[Green Revolution (agriculture)|techniques]] in the United States and Europe have led to lower [[food prices]]. In the United States, subsidization of corn, soy, wheat, and rice through the [[U.S. farm bill]] has made the main sources of processed food cheap compared to fruits and vegetables. [[Calorie count laws]] and [[nutrition facts label]]s attempt to steer people toward making healthier food choices, including awareness of how much food energy is being consumed.
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===座りっぱなしのライフスタイル===
Obese people consistently under-report their food consumption as compared to people of normal weight. This is supported both by tests of people carried out in a [[calorimeter]] room and by direct observation.
A sedentary lifestyle may play a significant role in obesity. Worldwide there has been a large shift towards less physically demanding work, and currently at least 30% of the world's population gets insufficient exercise. This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home. In children, there appear to be declines in levels of physical activity (with particularly strong declines in the amount of walking and physical education), likely due to safety concerns, changes in social interaction (such as fewer relationships with neighborhood children), and inadequate urban design (such as too few public spaces for safe physical activity). World trends in active leisure time [[physical activity]] are less clear. The World Health Organization indicates people worldwide are taking up less active recreational pursuits, while research from Finland found an increase and research from the United States found leisure-time physical activity has not changed significantly. Physical activity in children may not be a significant contributor.
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===遺伝学===
In both children and adults, there is an association between television viewing time and the risk of obesity. Increased media exposure increases the rate of childhood obesity, with rates increasing proportionally to time spent watching television.
{{Main/ja|Genetics of obesity/ja}}
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[[File:La monstrua desnuda (1680), de Juan Carreño de Miranda..jpg|thumb|upright=1.3|alt=黒髪のピンク色の頬の肥満した若い女性のヌードがテーブルにもたれている絵。彼女は左手に葡萄と葡萄の葉を持ち、性器を覆っている。|1680年に[[:en:Juan Carreno de Miranda|フアン・カレーニョ・デ・ミランダ]]によって描かれた、[[Prader–Willi syndrome/ja|プラダー・ウィリー症候群]]と推定される少女の絵「La Monstrua Desnuda（裸の怪物）」である。]]
[[File:La monstrua desnuda (1680), de Juan Carreño de Miranda..jpg|thumb|upright=1.3|alt=A painting of a dark haired pink cheeked obese nude young female leaning against a table. She is holding grapes and grape leaves in her left hand which cover her genitalia.|"La Monstrua Desnuda" (The Nude Monster), an 1680 painting by [[Juan Carreno de Miranda]] of a girl presumed to have [[Prader–Willi syndrome]]]]
Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors. [[Polymorphism (biology)|Polymorphisms]] in various [[gene]]s controlling [[appetite]] and [[metabolism]] predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present. People with two copies of the [[FTO gene]] (fat mass and obesity associated gene) have been found on average to weigh 3–4 kg more and have a 1.67-fold greater risk of obesity compared with those without the risk [[allele]]. The differences in BMI between people that are [[heritability|due to genetics]] varies depending on the population examined from 6% to 85%.
Obesity is a major feature in several syndromes, such as [[Prader–Willi syndrome]], [[Bardet–Biedl syndrome]], [[Cohen syndrome]], and [[MOMO syndrome]]. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.) In people with early-onset severe obesity (defined by an onset before 10 years of age and body mass index over three [[standard deviation]]s above normal), 7% harbor a single point DNA mutation.
Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two [[parental obesity|obese parents]] were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight. Different people exposed to the same environment have different risks of obesity due to their underlying genetics.
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===その他の病気===
The [[thrifty gene hypothesis]] postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive [[famine]]. This tendency to store fat, however, would be maladaptive in societies with stable food supplies. This theory has received various criticisms, and other evolutionarily-based theories such as the [[drifty gene hypothesis]] and the [[thrifty phenotype|thrifty phenotype hypothesis]] have also been proposed.
Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions: [[hypothyroidism]], [[Cushing's syndrome]], [[growth hormone deficiency]], and some [[eating disorder]]s such as [[binge eating disorder]] and [[night eating syndrome]]. However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IVR]] as a psychiatric illness. The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders. Obesity and [[Depression (mood)|depression]] influence each other mutually, with obesity increasing the risk of clinical depression, and also depression leading to a higher chance of developing obesity.
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===社会的決定要因===
=== Drug-induced obesity ===
{{Main/ja|Social determinants of obesity/ja}}
Certain medications may cause weight gain or changes in [[body composition]]; these include [[insulin]], [[sulfonylurea]]s, [[thiazolidinedione]]s, [[atypical antipsychotic]]s, [[antidepressant]]s, [[glucocorticoids|steroids]], certain [[anticonvulsant]]s ([[phenytoin]] and [[valproate]]), [[pizotifen]], and some forms of [[hormonal contraception]].
[[File:Yamai no Soshi - Obesity.JPG|thumb|upright=1.3|病気絵巻（「山井の草紙」、12世紀後半）には、金持ちの病気とされる肥満症の金貸しの女性が描かれている。]]
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[[File:More adults are obese in more unequal rich countries (cropped).jpg|thumb|upright=1.3|先進国における肥満は、[[:en:economic inequality|経済格差]]と相関関係がある。]]
[[File:Yamai no Soshi - Obesity.JPG|thumb|upright=1.3|The disease scroll (''Yamai no soshi'', late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.]]
[[File:More adults are obese in more unequal rich countries (cropped).jpg|thumb|upright=1.3|Obesity in developed countries is correlated with [[economic inequality]].]]
While genetic influences are important to understanding obesity, they cannot completely explain the dramatic increase seen within specific countries or globally. Though it is accepted that energy consumption in excess of energy expenditure leads to increases in body weight on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.
The correlation between [[social class]] and BMI varies globally. Research in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity. In 2007 repeating the same research found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of [[globalization]]. Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with [[economic inequality|income inequality]]. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.
Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for [[physical fitness]]. In [[undeveloped countries]] the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns. Attitudes toward body weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses. Stress and perceived low social status appear to increase risk of obesity.
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years. However, changing rates of smoking have had little effect on the overall rates of obesity.
In the United States, the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child. This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.
In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%. In part, this may be because of urban design issues (such as inadequate public spaces for physical activity). Time spent in motor vehicles, as opposed to [[active transportation]] options such as cycling or walking, is correlated with increased risk of obesity.
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===腸内細菌===
[[Malnutrition]] in early life is believed to play a role in the rising rates of obesity in the [[developing world]]. Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.
The study of the effect of infectious agents on metabolism is still in its early stages. [[Gut flora]] has been shown to differ between lean and obese people. There is an indication that gut flora can affect the metabolic potential. This apparent alteration is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally. The use of [[antibiotics]] among children has also been associated with obesity later in life.
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=== その他の要因 ===
An association between [[viruses]] and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to the rising rate of obesity is yet to be determined.
睡眠不足は[[sleep and weight/ja|肥満と関連している]]。一方が他方を引き起こすかどうかは不明である。短時間睡眠が体重増加を増加させるとしても、それが意味のある程度なのか、睡眠時間を増やすことが有益なのかは不明である。
Not getting enough sleep [[sleep and weight|is also associated with obesity]]. Whether one causes the other is unclear. Even if short sleep does increase weight gain, it is unclear if this is to a meaningful degree or if increasing sleep would be of benefit.
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[[:en:personality|性格]]のある側面は肥満であることと関連している。[[:en:Loneliness|孤独感]]、[[neuroticism/ja|神経症]]、[[:en:impulsivity|衝動性]]、報酬に対する感受性は肥満の人に多く、[[:en:conscientiousness|良心性]]と[[:en:self-control|自制心]]は肥満の人に少ない。このテーマに関する研究のほとんどは質問紙ベースであるため、これらの結果が性格と肥満の関係を過大評価している可能性がある：肥満の人は[[:en:social stigma of obesity|肥満の社会的スティグマ]]を意識している可能性があり、それに応じて質問紙回答が偏っている可能性がある。同様に、子供の頃に肥満であった人の性格は、肥満の危険因子として働くというよりも、むしろ肥満のスティグマに影響されているかもしれない。
Some have proposed that chemical compounds called "[[obesogens]]" may play a role in obesity.
Certain aspects of [[personality]] are associated with being obese. [[Loneliness]], [[neuroticism]], [[impulsivity]], and sensitivity to reward are more common in people who are obese while [[conscientiousness]] and [[self-control]] are less common in people who are obese. Because most of the studies on this topic are questionnaire-based, it is possible that these findings overestimate the relationships between personality and obesity: people who are obese might be aware of the [[social stigma of obesity]] and their questionnaire responses might be biased accordingly. Similarly, the personalities of people who are obese as children might be influenced by obesity stigma, rather than these personality factors acting as risk factors for obesity.
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==病態生理学==
In relation to globalization, it is known that trade liberalization is linked to obesity; research, based on data from 175 countries during 1975-2016, showed that obesity prevalence was positively correlated with trade openness, and the correlation was stronger in developing countries.
[[File:Fatmouse.jpg|thumb|upright=1.3|alt=Two white mice both with similar sized ears, black eyes, and pink noses. The body of the mouse on the left, however, is about three times the width of the normal sized mouse on the right.|A comparison of a mouse unable to produce [[leptin]] thus resulting in obesity (left) and a normal mouse (right)]]
Two distinct but related processes are considered to be involved in the development of obesity: sustained positive energy balance (energy intake exceeding energy expenditure) and the resetting of the body weight "set point" at an increased value. The second process explains why finding effective obesity treatments has been difficult. While the underlying biology of this process still remains uncertain, research is beginning to clarify the mechanisms.
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弧状核には2つの異なる[[neuron/ja|ニューロン]]群が存在する。第一のグループは[[neuropeptide Y/ja|神経ペプチドY]]（NPY）と[[agouti-related peptide/ja|アグーチ関連ペプチド]]（AgRP）を共発現し、LHへの刺激性入力とVMHへの抑制性入力を持つ。第二のグループは[[pro-opiomelanocortin/ja|プロオピオメラノコルチン]]（POMC）と[[cocaine- and amphetamine-regulated transcript/ja|コカイン・アンフェタミン制御転写物]]（CART）を共発現し、VMHへの刺激入力とLHへの抑制入力を持つ。その結果、NPY/AgRPニューロンは摂食を刺激し満腹感を抑制し、POMC/CARTニューロンは満腹感を刺激し摂食を抑制する。弧状核ニューロンの両グループは、レプチンによって部分的に制御されている。レプチンはNPY/AgRP群を抑制する一方、POMC/CART群を刺激する。したがって、レプチン欠乏症またはレプチン抵抗性のいずれかを介したレプチンシグナル伝達の欠乏は、摂食過多を引き起こし、遺伝性肥満や後天性肥満の一部を説明する可能性がある。
At a biological level, there are many possible [[pathophysiology|pathophysiological]] mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until the [[leptin]] gene was discovered in 1994 by J. M. Friedman's laboratory. While leptin and [[ghrelin]] are produced peripherally, they control appetite through their actions on the [[central nervous system]]. In particular, they and other appetite-related hormones act on the [[hypothalamus]], a region of the brain central to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the [[melanocortin]] pathway being the most well understood. The circuit begins with an area of the hypothalamus, the [[arcuate nucleus]], that has outputs to the [[lateral hypothalamus]] (LH) and [[ventromedial hypothalamus]] (VMH), the brain's feeding and satiety centers, respectively.
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==管理==
The arcuate nucleus contains two distinct groups of [[neuron]]s. The first group coexpresses [[neuropeptide Y]] (NPY) and [[agouti-related peptide]] (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses [[pro-opiomelanocortin]] (POMC) and [[cocaine- and amphetamine-regulated transcript]] (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.
{{Anchor|Management}}
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{{Main/ja|Management of obesity/ja}}
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肥満の主な治療は、処方された[[Diet (nutrition)/ja|食事]]や[[physical exercise/ja|身体運動]]などの生活習慣への介入による[[weight loss/ja|減量]]である。どのような食事が長期的な体重減少をサポートするのかは不明であり、[[Calorie restriction/ja|低カロリー食]]の有効性については議論があるが、長期的にカロリー消費を減らしたり、身体運動を増やしたりするライフスタイルの変化も、時間の経過とともに体重の戻りは緩やかであるものの、ある程度の持続的な体重減少をもたらす傾向がある。[[:en:National Weight Control Registry|全米体重コントロール登録]]の参加者の87％が10年間10％の体重減少を維持することができたが、長期的な体重減少維持のための最も適切な食事療法はまだわかっていない。米国では、食事の変更と運動の両方を組み合わせた集中的な行動介入が推奨されている。[[Intermittent fasting/ja|間欠的絶食]]は、継続的なエネルギー制限と比較して、体重減少の追加的利益はない。減量を成功させるには、どのような食事療法を行うかよりも、アドヒアランスの方が重要である。
The main treatment for obesity consists of [[weight loss]] via lifestyle interventions, including prescribed [[Diet (nutrition)|diets]] and [[physical exercise]]. Although it is unclear what diets might support long-term weight loss, and although the effectiveness of [[Calorie restriction|low-calorie diets]] is debated, lifestyle changes that reduce calorie consumption or increase physical exercise over the long term also tend to produce some sustained weight loss, despite slow weight regain over time. Although 87% of participants in the [[National Weight Control Registry]] were able to maintain 10% body weight loss for 10 years, the most appropriate dietary approach for long term weight loss maintenance is still unknown. In the US, intensive behavioral interventions combining both dietary changes and exercise are recommended. [[Intermittent fasting]] has no additional benefit of weight loss compared to continuous energy restriction. Adherence is a more important factor in weight loss success than whatever kind of diet an individual undertakes.
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=== 健康政策 ===
Several hypo-caloric diets are effective. In the short-term [[Low-carbohydrate diet|low carbohydrate diets]] appear better than [[Low-fat diet|low fat diets]] for weight loss. In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial. Heart disease and diabetes risks associated with different diets appear to be similar. Promotion of the Mediterranean diets among the obese may lower the risk of heart disease. Decreased intake of [[sweet drink]]s is also related to weight-loss. Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%. Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child. Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.
[[File:Prevalence Of Obesity In The Adult Population, Top Countries (2016).svg|thumb|330x330px|成人人口における肥満の有病率、上位国（2016年）]]
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[[File:Prevalence Of Obesity In The Adult Population (2016).svg|thumb|330x330px|2016年の成人人口における肥満の有病率]]
肥満は、その有病率、コスト、健康への影響から、複雑な公衆衛生・政策問題である。そのため、肥満の管理には、より広い社会的背景の変化と、地域社会、地方自治体、政府による取り組みが必要である。公衆衛生の努力は、人口における肥満の有病率増加の原因となっている[[Obesity and the environment/ja|環境要因]]を理解し、是正しようとするものである。解決策は、過剰な食物エネルギー消費を引き起こし、身体活動を阻害する要因を変えることにある。取り組みとしては、連邦政府から払い戻しのある学校での給食プログラム、子どもたちへの直接的な[[junk food/ja|ジャンク]][[food marketing/ja|食品販売]]の制限、学校での砂糖入り飲料へのアクセスの減少などがある。世界保健機関（WHO）は、砂糖入り飲料への課税を推奨している。都市環境を構築する際には、公園へのアクセスを増やし、歩行者ルートを整備する努力がなされてきた。
[[File:Prevalence Of Obesity In The Adult Population, Top Countries (2016).svg|thumb|330x330px|Prevalence of obesity in the adult population, top countries (2016)]]
[[File:Prevalence Of Obesity In The Adult Population (2016).svg|thumb|330x330px|Prevalence of obesity in the adult population in 2016]]
Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects. As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments. Public health efforts seek to understand and correct the [[Obesity and the environment|environmental factors]] responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct [[junk food|junk]] [[food marketing]] to children, and decreasing access to sugar-sweetened beverages in schools. The World Health Organization recommends the taxing of sugary drinks. When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.
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==医療介入==
[[Mass media]] campaigns seem to have limited effectiveness in changing behaviors that influence obesity, but may increase knowledge and awareness regarding physical activity and diet, which might lead to changes in the long term. Campaigns might also be able to reduce the amount of time spent [[Sedentary lifestyle|sitting or lying down]] and positively affect the intention to be active physically. [[Nutrition facts label|Nutritional labelling]] with energy information on menus might be able to help reducing energy intake while dining in restaurants. Some call for policy against [[ultra-processed foods]].
Since the introduction of medicines for the management of obesity in the 1930s, many compounds have been tried. Most of them reduce body weight by small amounts, and several of them are no longer marketed for obesity because of their side effects. Out of 25 anti-obesity medications withdrawn from the market between 1964 and 2009, 23 acted by altering the functions of chemical [[neurotransmitters]] in the brain. The most common side effects of these drugs that led to withdrawals were mental disturbances, cardiac side effects, and [[Substance abuse|drug abuse]] or [[drug dependence]]. Deaths were reportedly associated with seven products.
Five medications beneficial for long-term use are: [[orlistat]], [[lorcaserin]], [[liraglutide]], [[Phentermine/topiramate|phentermine–topiramate]], and [[naltrexone/bupropion|naltrexone–bupropion]]. They result in weight loss after one year ranged from 3.0 to 6.7 kg (6.6-14.8 lbs) over placebo. Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, phentermine–topiramate is available only in the United States. European regulatory authorities rejected lorcaserin and phentermine-topiramate, in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate. Lorcaserin was available in the United States and then removed from the market in 2020 due to its association with cancer. Orlistat use is associated with high rates of gastrointestinal side effects and concerns have been raised about negative effects on the kidneys. There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death; however, liraglutide, when used for type 2 diabetes, does reduce cardiovascular events.
In 2019 a [[systematic review]] compared the effects on weight of various doses of [[fluoxetine]] (60 mg/d, 40 mg/d, 20 mg/d, 10 mg/d) in obese adults. When compared to placebo, all dosages of fluoxetine appeared to contribute to weight loss but lead to increased risk of experiencing side effects such as dizziness, drowsiness, fatigue, insomnia and nausea during period of treatment. However, these conclusions were from low certainty evidence. When comparing, in the same review, the effects of fluoxetine on weight of obese adults, to other [[Anorectic|anti-obesity agents]], [[Omega-3 fatty acid|omega-3]] gel and not receiving a treatment, the authors could not reach conclusive results due to poor quality of evidence.
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=== 手術===
Among antipsychotic drugs for treating schizophrenia [[clozapine]] is the most effective, but it also has the highest risk of causing the [[metabolic syndrome]], of which obesity is the main feature. For people who gain weight because of clozapine, taking [[metformin]] may reportedly improve three of the five components of the metabolic syndrome: waist circumference, fasting glucose, and fasting triglycerides.
The most effective treatment for obesity is [[bariatric surgery]]. The types of procedures include [[laparoscopic adjustable gastric banding]], [[Roux-en-Y gastric bypass]], [[vertical-sleeve gastrectomy]], and [[biliopancreatic diversion]]. Surgery for severe obesity is associated with long-term weight loss, improvement in obesity-related conditions, and decreased overall mortality; however, improved metabolic health results from the weight loss, not the surgery. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures. Complications occur in about 17% of cases and reoperation is needed in 7% of cases.
それ以前の歴史的な時代には、肥満は健康上の問題としてすでに認識されていたものの、ごく一部のエリートによってのみ達成されるまれなものであった。しかし、[[:en:Early Modern period|近世]]に繁栄が進むにつれて、肥満はますます多くの人々に影響を及ぼすようになった。1970年代以前は、肥満は最も裕福な国でも比較的まれな状態であり、肥満が存在するとしても裕福な人々の間で起こる傾向があった。その後、さまざまな出来事が重なり、人間の状態が変わり始めた。第一世界の人々の平均BMIが上昇し始め、その結果、過体重や肥満の人の割合が急増したのである。
==Epidemiology==
{{Main|Epidemiology of obesity}}
[[File:Obesity rate.png|thumb|Share of adults with BMIs > 30 (2016)]]
{{Global Heat Maps by Year| title=| table=Obesity Males.tab| column=percent_overweight| columnName=Rate of BMI>25| year=2014}}
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1997年、WHOは肥満を世界的な疫病として正式に認定した。2008年現在、WHOは少なくとも5億人（10％以上）の成人が肥満であり、男性よりも女性の方が肥満率が高いと推定している。1980年から2014年の間に、肥満の世界的有病率は2倍以上に増加した。2014年には、6億人以上の成人が肥満であり、これは世界の成人人口の約13％に相当する。2015-2016年現在のアメリカにおける成人の割合は、全体で約39.6％（男性37.9％、女性41.1％）である。2000年、[[World Health Organization/ja|世界保健機関]]（WHO）は、[[overweight/ja|過体重]]と肥満が、[[undernutrition/ja|栄養不足]]や[[infectious diseases/ja|感染症]]といった、より伝統的な[[public health/ja|公衆衛生]]の懸念に取って代わり、健康不良の最も重大な原因のひとつになっていると述べた。
In earlier historical periods obesity was rare and achievable only by a small elite, although already recognised as a problem for health. But as prosperity increased in the [[Early Modern period]], it affected increasingly larger groups of the population. Prior to the 1970s, obesity was a relatively rare condition even in the wealthiest of nations, and when it did exist it tended to occur among the wealthy. Then, a confluence of events started to change the human condition. The average BMI of populations in first-world countries started to increase, and consequently there was a rapid increase in the proportion of people overweight and obese.
In 1997, the WHO formally recognized obesity as a global epidemic. As of 2008, the WHO estimates that at least 500 million adults (greater than 10%) are obese, with higher rates among women than men. The global prevalence of obesity more than doubled between 1980 and 2014. In 2014, more than 600 million adults were obese, equal to about 13 percent of the world's adult population. The percentage of adults affected in the United States as of 2015–2016 is about 39.6% overall (37.9% of males and 41.1% of females). In 2000, the [[World Health Organization]] (WHO) stated that [[overweight]] and obesity were replacing more traditional [[public health]] concerns such as [[undernutrition]] and [[infectious diseases]] as one of the most significant cause of poor health.
The rate of obesity also increases with age at least up to 50 or 60 years old and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity. The [[OECD]] has projected an increase in obesity rates until at least 2030, especially in the United States, Mexico and England with rates reaching 47%, 39% and 35%, respectively.
Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world. These increases have been felt most dramatically in urban settings.
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==歴史==
Sex- and gender-based differences also influence the prevalence of obesity. Globally there are more obese women than men, but the numbers differ depending on how obesity is measured.
{{Anchor|History}}
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===語源===
==History==
''Obesity''は[[:ja:ラテン語|ラテン語]]の''obesitas''に由来し、「がっしりした、太った、ふくよかな」を意味する。''Ēsus''は''edere''（食べる）の過去分詞で、それに''ob''（超える）が加わったものである。''[[:en:The Oxford English Dictionary|オックスフォード英語辞典]]'には1611年に[[:en:Randle Cotgrave|Randle Cotgrave]]によって初めて使われたと記録されている。
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===歴史的姿勢===
===Etymology===
[[File:Charles Mellin (attributed) - Portrait of a Gentleman - Google Art Project.jpg|thumb|upright=1.0|alt=二重あごと口ひげが目立つ、非常に肥満した紳士で、左脇に剣を持った黒い服を着ている。|[[:en:Middle Ages|中世]]から[[:en:Renaissance|ルネサンス]]期にかけて、''トスカーナの将軍[[:en:Alessandro del Borro|アレッサンドロ・デル・ボッロ]]''（シャルル・メリン作とされる、1645年]]
''Obesity'' is from the [[Latin]] ''obesitas'', which means "stout, fat, or plump". ''Ēsus'' is the past participle of ''edere'' (to eat), with ''ob'' (over) added to it. ''[[The Oxford English Dictionary]]'' documents its first usage in 1611 by [[Randle Cotgrave]].
[[File:Venus von Willendorf 01.jpg|thumb|upright=1.0|alt=石に彫られたミニチュアの置物には、肥満した女性が描かれていた。|''[[:en:Venus of Willendorf|ヴィレンドルフのヴィーナス]]''は紀元前24,000年～22,000年に作られた。]]
[[File:Charles Mellin (attributed) - Portrait of a Gentleman - Google Art Project.jpg|thumb|upright=1.0|alt=A very obese gentleman with a prominent double chin and mustache dressed in black with a sword at his left side.|During the [[Middle Ages]] and the [[Renaissance]] ''The Tuscan General [[Alessandro del Borro]]'', attributed to Charles Mellin, 1645]]
[[File:Venus von Willendorf 01.jpg|thumb|upright=1.0|alt=A carved stone miniature figurine depicted an obese female.|''[[Venus of Willendorf]]'' created 24,000–22,000 BC]]
[[Ancient Greek medicine]] recognizes obesity as a medical disorder and records that the Ancient Egyptians saw it in the same way. [[Hippocrates]] wrote that "Corpulence is not only a disease itself, but the harbinger of others". The Indian surgeon [[Sushruta]] (6th century BCE) related obesity to diabetes and heart disorders. He recommended physical work to help cure it and its side effects. For most of human history, mankind struggled with food scarcity. Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Ancient East Asian civilizations. In the 17th century, English medical author [[Tobias Venner]] is credited with being one of the first to refer to the term as a societal disease in a published English language book.
With the onset of the [[Industrial Revolution]], it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers. Increasing the average body mass index from what is now considered underweight to what is now the normal range played a significant role in the development of industrialized societies. Height and weight thus both increased through the 19th century in the developed world. During the 20th century, as populations reached their genetic potential for height, weight began increasing much more than height, resulting in obesity. In the 1950s, increasing wealth in the developed world decreased child mortality, but as body weight increased, heart and kidney disease became more common.
この時期、保険会社は体重と寿命の関係に気づき、肥満者に対する保険料を値上げした。
During this time period, insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.
Many cultures throughout history have viewed obesity as the result of a character flaw. The ''obesus'' or fat character in [[Ancient Greek comedy]] was a glutton and figure of mockery. During Christian times, food was viewed as a gateway to the sins of [[Sloth (deadly sin)|sloth]] and [[lust]]. In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes. People of all ages can face social stigmatization and may be targeted by bullies or shunned by their peers.
Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%. On the other hand, people's views concerning healthy weight have changed in the opposite direction. In Britain, the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999. These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.
Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This has become particularly common since the [[HIV]] epidemic began.
The first sculptural representations of the human body 20,000–35,000 years ago depict obese females. Some attribute the [[Venus figurines]] to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time. Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.
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[[:en:Renaissance|ルネサンス]]期には、[[:en:Henry VIII of England|イギリスのヘンリー8世]]や[[:en:Alessandro dal Borro|アレッサンドロ・ダル・ボッロ]]の肖像画に見られるように、上流階級の一部が大柄であることを誇示し始めた。[[:en:Peter Paul Rubens|ルーベンス]]（1577年-1640年）は定期的に大柄な女性を描いており、そこから[[:en:Peter Paul Rubens#Work|ルーベネスク]]という言葉が生まれた。しかし、これらの女性たちは、豊穣と関係のある「砂時計」の形を維持していた。19世紀、西洋世界では肥満に対する見方が変わった。何世紀にもわたって肥満が富と社会的地位の代名詞とされてきた後、スリムであることが望ましい標準とみなされるようになった。1819年の版画「The Belle Alliance, or the Female Reformers of Blackburn!!!」で、画家[[:en:George Cruikshank|George Cruikshank]]は[[:en:Blackburn|Blackburn]]の女性改革者たちの活動を批判し、彼女たちを女性らしくないと描く手段として太り方を用いた。
During the [[Renaissance]] some of the upper class began flaunting their large size, as can be seen in portraits of [[Henry VIII of England]] and [[Alessandro dal Borro]]. [[Peter Paul Rubens|Rubens]] (1577–1640) regularly depicted heavyset women in his pictures, from which derives the term [[Peter Paul Rubens#Work|Rubenesque]]. These women, however, still maintained the "hourglass" shape with its relationship to fertility. During the 19th century, views on obesity changed in the Western world. After centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard. In his 1819 print, ''The Belle Alliance, or the Female Reformers of Blackburn!!!,'' artist [[George Cruikshank]] criticised the work of female reformers in [[Blackburn]] and used fatness as a means to portray them as unfeminine.
In addition to its health impacts, obesity leads to many problems, including disadvantages in employment and increased business costs. These effects are felt by all levels of society, from individuals, to corporations, to governments.
In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical expenditures, while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs). The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies. The estimated range for annual expenditures on diet products is $40 billion to $100 billion in the US alone.
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[[:en:The Lancet|ランセット誌]] 2019年の肥満に関する委員会は、[[:en:WHO Framework Convention on Tobacco Control|WHOたばこ規制枠組条約]]をモデルとして、肥満と栄養不足に対処することを各国に約束し、政策立案から食品業界を明確に除外した世界的な条約を求めた。彼らは、肥満の世界的なコストは年間2兆ドル、世界GDPの約2.8％と見積もっている。
[[The Lancet]] Commission on Obesity in 2019 called for a global treaty—modelled on the [[WHO Framework Convention on Tobacco Control]]—committing countries to address obesity and undernutrition, explicitly excluding the food industry from policy development. They estimate the global cost of obesity $2 trillion a year, about or 2.8% of world GDP.
Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers, therefore, conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending. Sin taxes such as a [[sugary drink tax]] have been implemented in certain countries globally to curb dietary and consumer habits, and as an effort to offset the economic tolls.
[[File:Wide Chair.jpg|thumb|left|upright=1.3|alt=An extra wide chair beside a number of normal sized chairs.|Services accommodate obese people with specialized equipment such as much wider chairs.]]
Obesity can lead to social stigmatization and disadvantages in employment. When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity. A study examining Duke University employees found that people with a BMI over 40 kg/m<sup>2</sup> filed twice as many [[workers' compensation]] claims as those whose BMI was 18.5–24.9 kg/m<sup>2</sup>. They also had more than 12 times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs. The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35 kg/m<sup>2</sup> and who fail to make improvements in their health after one year.
Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted. Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.
Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width. In 2000, the extra weight of obese passengers cost airlines US$275 million. The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and [[bariatric ambulance]]s. Costs for restaurants are increased by litigation accusing them of causing obesity. In 2005, the US Congress discussed legislation to prevent civil lawsuits against the food industry in relation to obesity; however, it did not become law.
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2013年に[[:en:American Medical Association|アメリカ医師会]]が肥満を慢性疾患に分類したことで、健康保険会社が肥満の治療やカウンセリング、手術の費用を負担する可能性が高まり、脂肪治療薬や遺伝子治療法の研究開発費も、保険会社がその費用を補助することでより手頃な価格になると考えられている。ただし、AMAの分類には法的拘束力はないため、医療保険会社には治療や処置の保険適用を拒否する権利が残っている。
With the [[American Medical Association]]'s 2013 classification of obesity as a chronic disease, it is thought that health insurance companies will more likely pay for obesity treatment, counseling and surgery, and the cost of research and development of fat treatment pills or gene therapy treatments should be more affordable if insurers help to subsidize their cost. The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.
In 2014, The European Court of Justice ruled that morbid obesity is a disability. The Court said that if an employee's obesity prevents them from "full and effective participation of that person in professional life on an equal basis with other workers", then it shall be considered a disability and that firing someone on such grounds is discriminatory.
In low-income countries, obesity can be a signal of wealth. A 2023 experimental study found that obese individuals in Uganda were more likely to access credit.
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===サイズの受容===
===Size acceptance===
{{See also/ja|Fat acceptance movement/ja|Social stigma of obesity/ja|Health at Every Size/ja|Fat fetishism/ja}}
{{See also|Fat acceptance movement|Social stigma of obesity|Health at Every Size|Fat fetishism}}
[[File:PresidentTaftTelephoneCrop.jpg|thumb|upright=1|[[:en:United States President|アメリカ大統領]]の[[:en:William Howard Taft|ウィリアム・ハワード・タフト]]は、太っているとよく揶揄された。]]
[[File:PresidentTaftTelephoneCrop.jpg|thumb|upright=1|[[United States President]] [[William Howard Taft]] was often ridiculed for being overweight.]]
[[File:Wahlkampf_Landtagswahl_NRW_2022_-_Bündnis_90-Die_Grünen_-_Heumarkt_Köln_2022-05-13-4484.jpg|thumb|upright=1|German politician [[Ricarda Lang]] is a victim of fat shaming on the internet.]]
The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese. However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.
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肥満の容認を推進する団体は数多く存在する。それらは20世紀後半にその存在感を増してきた。米国を拠点とする[[:en:National Association to Advance Fat Acceptance|全米ファット・アクセプタンス推進協会]] (NAAFA)は1969年に結成され、サイズ差別をなくすことを目的とした公民権団体であると自称している。
A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th century. The US-based [[National Association to Advance Fat Acceptance]] (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination.
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[[:en:International Size Acceptance Association|国際サイズ受容協会]]（ISAA）は1997年に設立された[[:en:non-governmental organization|非政府組織]]（NGO）である。よりグローバルな方向性を持ち、サイズ受容を促進し、体重による差別をなくすことを使命としている。これらの団体はしばしば、アメリカの[[:en:Americans With Disabilities Act|障害者自立支援法（ADA）]]の下で肥満を障害として認めるよう主張している。しかし、アメリカの法制度は、この差別禁止法を肥満にまで拡大するメリットを、潜在的な公衆衛生上のコストが上回ると判断している。
The [[International Size Acceptance Association]] (ISAA) is a [[non-governmental organization]] (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination. These groups often argue for the recognition of obesity as a disability under the US [[Americans With Disabilities Act]] (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.
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===業界による研究への影響===
===Industry influence on research===
2015年、''ニューヨーク・タイムズ''紙は、2014年に設立された非営利団体[[:en:Global Energy Balance Network|グローバル・エネルギー・バランス・ネットワーク]]に関する記事を掲載した。この団体は、肥満を回避し、健康であるためには、摂取カロリーを減らすことよりも、運動を増やすことに重点を置くべきだと提唱している。この団体は[[Coca-Cola Company|コカ・コーラ社]]から少なくとも150万ドルの資金提供を受けて設立され、同社は2008年以来、設立者の2人の科学者グレゴリー・A・ハンドと[[:en:Steven Blair|スティーブン・ブレア]]に400万ドルの研究資金を提供している。
In 2015, the ''New York Times'' published an article on the [[Global Energy Balance Network]], a nonprofit founded in 2014 that advocated for people to focus on increasing exercise rather than reducing calorie intake to avoid obesity and to be healthy. The organization was founded with at least $1.5M in funding from the [[Coca-Cola Company]], and the company has provided $4M in research funding to the two founding scientists Gregory A. Hand and [[Steven Blair|Steven N. Blair]] since 2008.
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===報告書===
===Reports===
多くの団体が肥満に関する報告書を発表している。1998年、「成人の過体重および肥満の同定、評価、治療に関する臨床ガイドライン」と題する米国初の連邦ガイドラインが発表された： "The Evidence Report"と題された。2006年、[[:en:Canadian Obesity Network|カナダ肥満ネットワーク]]（現在は[[Obesity Canada/ja|肥満カナダ]]として知られる）は、"成人および小児の肥満の管理と予防に関するカナダの臨床実践ガイドライン（CPG）"を発表した。これは、成人および小児の過体重と肥満の管理と予防に対処するための包括的なエビデンスに基づくガイドラインである。
Many organizations have published reports pertaining to obesity. In 1998, the first US Federal guidelines were published, titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report". In 2006, the [[Canadian Obesity Network]], now known as [[Obesity Canada]] published the "Canadian Clinical Practice Guidelines (CPG) on the Management and Prevention of Obesity in Adults and Children". This is a comprehensive evidence-based guideline to address the management and prevention of overweight and obesity in adults and children.
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2004年、イギリスの[[:en:Royal College of Physicians|王立医師会]]、[[:en:Faculty of Public Health|公衆衛生学部]]、[[:en:Royal College of Paediatrics and Child Health|王立小児科・小児保健大学]]は、報告書「Storing up Problems」を発表し、イギリスにおける肥満問題の深刻化を強調した。同年、[[:en:British House of Commons|英国下院]][[:en:Health Select Committee|健康特別委員会]]は、肥満が英国の健康と社会に与える影響と、この問題に対する可能なアプローチについて、「これまでで最も包括的な調査[...]」を発表した。2006年、[[:en:|National Institute for Health and Clinical Excellence|NICE]]は、肥満の診断と管理に関するガイドラインを発表し、地方議会のような非医療機関への政策的影響についても言及した。2007年に[[:en:Derek Wanless|デレク・ワンレス]]が[[:en:King's Fund|キングス・ファンド]]のために作成した報告書は、さらなる対策を講じない限り、肥満は[[:en:National Health Service|国民保健サービス]]を財政的に衰弱させる可能性があると警告した。2022年、[[:en:National Institute for Health and Care Research|国立医療介護研究機構]]（NIHR）は、肥満を減らすために[[:en:Local government in England|地方自治体]]ができることに関する研究の包括的なレビューを発表した。
In 2004, the United Kingdom [[Royal College of Physicians]], the [[Faculty of Public Health]] and the [[Royal College of Paediatrics and Child Health]] released the report "Storing up Problems", which highlighted the growing problem of obesity in the UK. The same year, the [[British House of Commons|House of Commons]] [[Health Select Committee]] published its "most comprehensive inquiry [...] ever undertaken" into the impact of obesity on health and society in the UK and possible approaches to the problem. In 2006, the [[National Institute for Health and Clinical Excellence]] (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils. A 2007 report produced by [[Derek Wanless]] for the [[King's Fund]] warned that unless further action was taken, obesity had the capacity to debilitate the [[National Health Service]] financially. In 2022 the [[National Institute for Health and Care Research]] (NIHR) published a comprehensive review of research on what [[Local government in England|local authorities]] can do to reduce obesity.
The Obesity Policy Action (OPA) framework divides measure into ''upstream'' policies, ''midstream'' policies, and ''downstream'' policies. Upstream policies have to do with changing society, while midstream policies try to alter behaviors believed to contribute to obesity at the individual level, while downstream policies treat currently obese people.
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==小児肥満==
==Childhood obesity==
{{Anchor|Childhood obesity}}
{{Main|Childhood obesity}}
{{Main/ja|Childhood obesity/ja}}
The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th [[percentile]]. The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity. Childhood obesity has reached epidemic proportions in the 21st century, with rising rates in both the developed and the developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over 30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children. In the UK, there were 60% more obese children in 2005 compared to 1989. In the US, the percentage of overweight and obese children increased to 16% in 2008, a 300% increase over the prior 30 years.
As with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important causes for the recent increase in the incidence of child obesity. [[Food marketing toward children|Advertising of unhealthy foods to children]] also contributes, as it increases their consumption of the product. Antibiotics in the first 6 months of life have been associated with excess weight at age seven to twelve years of age. Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for [[hypertension]], [[diabetes]], [[hyperlipidemia]], and [[fatty liver disease]].
Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success. In the United States, medications are not FDA approved for use in this age group. Brief weight management interventions in [[primary care]] (e.g. delivered by a physician or nurse practitioner) have only a marginal positive effect in reducing childhood overweight or obesity. Multi-component behaviour change interventions that include changes to dietary and physical activity may reduce BMI in the short term in children aged 6 to 11 years, although the benefits are small and quality of evidence is low.
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==その他の動物==
==Other animals==
{{Anchor|Other animals}}
{{Main|Obesity in pets}}
{{Main/ja|Obesity in pets/ja}}
Obesity in pets is common in many countries. In the United States, 23–41% of dogs are overweight, and about 5.1% are obese. The rate of obesity in cats was slightly higher at 6.4%. In Australia, the rate of obesity among dogs in a veterinary setting has been found to be 7.6%. The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.
肥満の「a calorie is a calorie」モデルは、ほとんどの肥満の原因として、過剰な食物エネルギー摂取と身体活動不足の組み合わせを仮定している。遺伝、医学的理由、精神疾患によるものは限られている。対照的に、社会レベルでの肥満率の増加は、簡単に手に入り、口にしやすい食事、増加した自動車への依存、機械化された製造業によるものと考えられている。
ルネサンス期には、イギリスのヘンリー8世やアレッサンドロ・ダル・ボッロの肖像画に見られるように、上流階級の一部が大柄であることを誇示し始めた。ルーベンス（1577年-1640年）は定期的に大柄な女性を描いており、そこからルーベネスクという言葉が生まれた。しかし、これらの女性たちは、豊穣と関係のある「砂時計」の形を維持していた。19世紀、西洋世界では肥満に対する見方が変わった。何世紀にもわたって肥満が富と社会的地位の代名詞とされてきた後、スリムであることが望ましい標準とみなされるようになった。1819年の版画「The Belle Alliance, or the Female Reformers of Blackburn!!!」で、画家George CruikshankはBlackburnの女性改革者たちの活動を批判し、彼女たちを女性らしくないと描く手段として太り方を用いた。
多くの団体が肥満に関する報告書を発表している。1998年、「成人の過体重および肥満の同定、評価、治療に関する臨床ガイドライン」と題する米国初の連邦ガイドラインが発表された： "The Evidence Report"と題された。2006年、カナダ肥満ネットワーク（現在は肥満カナダとして知られる）は、"成人および小児の肥満の管理と予防に関するカナダの臨床実践ガイドライン（CPG）"を発表した。これは、成人および小児の過体重と肥満の管理と予防に対処するための包括的なエビデンスに基づくガイドラインである。
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Quotations related to Obesity at Wikiquote