The prevalence of overweight and obesity in the United States makes obesity a leading public health problem. The United States has the highest rates of obesity in the developed world. From 1980 to 2002, obesity has doubled in adults and overweight prevalence has tripled in children and adolescents. From 2003-2004, “children and adolescents aged 2 to 19 years, 17.1% were overweight and 32.2% of adults aged 20 years or older were obese. The prevalence in the United States continues to rise.
The prevalence of obesity has been continually rising for two decades. This sudden rise in obesity prevalence is attributed to environmental and population factors rather than individual behavior and biology because of the rapid and continual rise in the number of overweight and obese individuals. The current environment produces risk factors for decreased physical activity and for increased calorie consumption. These environmental factors operate on the population to decrease physical activity and increase calorie consumption. Environment strongly influences obesity. Consider that most people in the United States alive today were also alive in 1980, when obesity rates were lower. Since this time, our genetic make-up has not changed, but our environment has.
Environment includes lifestyle behaviors such as what a person eats and his or her level of physical activity. Too often Americans eat out, consume large meals and high-fat foods, and put taste and convenience ahead of nutrition. Also, most people in the United States do not get enough physical activity.
Environment also includes the world around us—our access to places to walk and healthy foods, for example. Today, more people drive long distances to work instead of walking, live in neighborhoods without sidewalks, tend to eat out or get “take out” instead of cooking, or have vending machines with high-calorie, high-fat snacks at their workplace. Our environment often does not support healthy habits.
In addition, social factors including poverty and a lower level of education have been linked to obesity. One reason for this may be that high-calorie processed foods cost less and are easier to find and prepare than healthier foods, such as fresh vegetables and fruits. Other reasons may include inadequate access to safe recreation places or the cost of gym memberships, limiting opportunities for physical activity. However, the link between low socio-economic status and obesity has not been conclusively established, and recent research shows that obesity is also increasing among high-income groups.
Scientists have made tremendous strides in understanding obesity and in improving the medication treatment of this important disease. In 2006 a first obesity treatment drug has been approved in the world. On 21 June 2006, the European Commission approved the sale of Rimonabant in the then 25-member European Union.
Rimonabant is a CB1 endocannabinoid receptor antagonist. CB1 blockers act on the endocannabinoid system, a system controlling energy and nicotine dependence, reducing the overstimulation thought to lead to obesity and nicotine addiction. In a recent study, 1,036 overweight or obese patients with blood lipid disorders were randomly placed in one of three groups (placebo vs. 5 mg or 20 mg per day of Rimonabant). After one year of treatment, patients receiving 20 mg per day of Rimonabant lost an average of 20 pounds.
Medications should be considered helpful adjuncts to diet and exercise for patients whose health risk from obesity clearly outweigh the potential side effects of the medications. Medications should be prescribed by doctors familiar with the patients’ conditions and with the use of the medications. Medication(s) and other “herbal” preparations with unproven effectiveness and safety should be avoided.