Understanding and Addressing the Epidemic of Obesity: An Energy Balance Perspective
James O. Hill
Center for Human Nutrition, University of Colorado School of Medicine, Denver, Colorado 80262
Correspondence: Address all correspondence and requests for reprints to: James O. Hill, Ph.D., Center for Human Nutrition, Box C263, University of Colorado at Denver and Health Sciences Center, 4200 East Ninth Avenue, Denver, Colorado 80262. E-mail: James.hill{at}uchsc.edu
The intent of this paper is to address the obesity epidemic,which is a term used to describe the sudden and rapid increasein obesity rates that began in the 1980s and continues unabatedtoday. Since 1980, the entire population, regardless of startingweight, is gradually gaining weight. This has led to escalatingobesity rates and to obesity being considered one of the mostserious public health challenges facing the world. At one level,the obesity epidemic is a classic gene-environment interactionwhere the human genotype is susceptible to environmental influencesthat affect energy intake and energy expenditure. It is alsoa problem of energy balance. Understanding the etiology of obesityrequires the study of how behavioral and environmental factorshave interacted to produce positive energy balance and weightgain. Reversing the epidemic of obesity will require modifyingsome combination of these factors to help the population achieveenergy balance at a healthy body weight. While body weight isstrongly influenced by biological and behavioral factors, changesin the environment promoting positive energy balance have beenmost responsible for the obesity epidemic. Our best strategyfor reversing the obesity epidemic is to focus on preventingpositive energy balance in the population through small changesin diet and physical activity that take advantage of our biologicalsystems for regulating energy balance. Simultaneously, we mustaddress the environment to make it easier to make better foodand physical activity choices. This is a very long-term strategyfor first stopping and then reversing the escalating obesityrates, but one that can, over time, return obesity rates topre-1980s levels.
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