by an individual for its management and the extent of discrimination its victims suffer.

While people often wish to lose weight for the sake of their appearance, public health concerns about obesity relate to this disease's link to numerous chronic diseases that can lead to premature illness and death. The scientific evidence summarized in Chapter 2 suggests strongly that obese individuals who lose even relatively small amounts of weight are likely to decrease their blood pressure (and thereby the risk of hypertension), reduce abnormally high levels of blood glucose (associated with diabetes), bring blood concentrations of cholesterol and triglycerides (associated with cardiovascular disease) down to more desirable levels, reduce sleep apnea, decrease their risk of osteoarthritis of the weight-bearing joints and depression, and increase self-esteem. In many cases, the obese person who loses weight finds that an accompanying comorbidity is improved, its progression is slowed, or the symptoms disappear.

Healthy weights are generally associated with a body mass index (BMI; a measure of whether weight is appropriate for height, measured in kg/m2) of 19–25 in those 19–34 years of age and 21–27 in those 35 years of age and older. Beyond these ranges, health risks increase as BMI increases. Health risks also increase with excess abdominal/visceral fat (as estimated by a waist-hip ratio [WHR] >1.0 for males and >0.8 for females), high blood pressure (>140/90), dyslipidemias (total cholesterol and triglyceride concentrations of >200 and >225 mg/dl, respectively), non-insulin-dependent diabetes mellitus, and a family history of premature death due to cardiovascular disease (e.g., parent, grandparent, sibling, uncle, or aunt dying before age 50). Weight loss usually improves the management of obesity-related comorbidities or decreases the risks of their development.

The high prevalence of obesity in the United States together with its link to numerous chronic diseases leads to the conclusion that this disease is responsible for a substantial proportion of total health-care costs. We estimate that today's health-care costs of obesity exceed $70 billion per year. To this figure can be added the more than $33 billion spent yearly on weight-reduction products (including diet foods and drinks) and services, for an estimated total of more than $100 billion per year as the economic costs of obesity. Such an estimate cannot include the psychosocial costs of obesity, which range from lowered self-esteem to the more serious binge-eating disorders and clinical depression.

Given the huge economic and personal costs of obesity, research must continue to identify the fundamental biological defects that underlie obesity and discover how to manage and ultimately treat them. At the same time, however, it is important to improve the success of obesity treatments available now. This report is directed to the latter purpose. Treatment



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