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Obesity looms as the single largest threat to world health in the next few decades. In countries such as the United States, its consequences pose the very real likelihood that the next generation may not live longer or be more healthier than the previous one.1 This would reverse a trend that has been present for centuries. The rate of obesity is rising worldwide, not just in countries that enjoy privileged economic status. The rise in obesity over the past 25 years in the United States has been dramatic. Currently nearly one-third of adults in the United States are obese, defined as having a body mass index (BMI, calculated as being weight in kg divided by height in meters squared) of 30 kg/m2 or greater.2 More concerning yet, the rate of obesity in young adolescents and teenagers is approaching or exceeding the adult rate in many geographic areas. Because obese adolescents have a very high likelihood of being obese adults, this predicts that the problem will continue to grow in terms of its consequences on the health of the population.
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Obesity was not a major health problem in many areas of the world, such as Asia and Africa, until the past decade. Now even those countries, where the problem was previously rare, are experiencing a significant increase in its prevalence. It is likely that wider access to high-calorie fast-food meals and other higher-calorie foods from Western countries, combined with the decreased need for physical labor and activity with increasing mechanization present in these countries, are significant contributing factors. The flattening of the world has also led to its fattening.
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Obesity also remains the only major characteristic or attribute for which discrimination is not illegal. Laws exist to prevent discrimination on the basis of gender, sexual preference, race, religion, or handicapped status. However, there are no laws to prevent the current and prevalent discrimination against obesity in the workplace, in travel, in accommodations, and in other areas of life that are often overlooked by nonobese individuals. Most damaging, however, is the persistent belief by the majority of the public that obesity stems from laziness and gluttony, rather than being a disease. Even more sadly, there are still medical care providers who hold such opinions. The Centers for Medicare and Medicaid Services (CMS) has officially recognized obesity as a disease and sanctioned its treatment as appropriate for recipients of federal insurance.3 Unfortunately, the insurance industry overall, including those companies assigned to administer services to federally insured patients and the federal administrators as well in certain situations, has consistently raised barriers and made it difficult for patients with obesity, and particularly those with severe obesity, to obtain optimal treatment for their disease.4 While such short-sighted behavior may save money for their balance sheets in the short term, it will not make the problem go away. The next generation worldwide will be required to pay the price of addressing the needs ...