Obesity is caused by many interrelated factors including flaws in nutritional education and healthcare, genetics, socioeconomic status, unhealthy habits developed in childhood, lack of access to healthy foods, large portion sizes, and sedentary lifestyles. Key stakeholders in obesity include food producers, marketers, consumers, and healthcare providers. Preventing and reducing obesity will require addressing all of these causes on individual, community and policy levels.

1. What is the cause of obesity
in the United States?
Jennifer Holder
Kate Herman
Christina Janushevich
Lindy Paul

2. Approach
To complete this project our group used a
Google Document to gather our
information into one place. We used
resources from online and Anne Belk
Library. To coordinate meetings we sent
texts and emails to each other.

3. What is Obesity?
Definitions:
Obesity refers to an increase in body fat; “overweight” is an increase in body weight
relative to some standard and has become a surrogate for “obesity” both clinically
and epidemiologically (Ripper).
Obesity is an “abnormal or excessive fat accumulation that presents a risk to health”
but this is not very specific (WHO, Obesity and Overweight).
BMI is the most common way to measure overweight and obesity but it does not take
into account body composition (Rossen) (Stern) (Cawley).
“„Overweight‟ is defined as having body weight than is considered normal or healthy
for one‟s age or build. The term „obese‟ is used for very overweight people who have
a high percentage of body fat.” (Stern)
“Overweight and obesity are defined as abnormal or excessive fat accumulation that
presents a risk to health. Population measure of obesity is the body mass index
(BMI), a person‟s weight (in kilograms) divided by the square of his or her height (in
meters). A person with a BMI of 30 or more is generally considered obese. A person
with a BMI equal to or more than 25 is considered overweight.” (WHO, Obesity)

4. Background
Causes
Effects
Facts

5. Causes
Flaws in nutritional education, resources, and healthcare:
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Doctors are not educated enough in nutrition (Chen, 2010)
Asking for a doctor‟s advice isn‟t always the best idea; consulting a dietician or
nutritionist would be more beneficial (Chen, 2010)
American healthcare is based off of treatment and not prevention (Fromke, 2012)
Doctors paid based on number of patients seen, operations, surgeries not on success
of treatment or prevention; quantity over quality (Fromke, 2012)
Food Pyramid has major flaws and isn‟t based in research (Willett, 2001)
"The thing to keep in mind about the USDA Pyramid is that it comes from the [U.S.]
Department of Agriculture, the agency responsible for promoting American
agriculture, not from agencies established to monitor and protect our health, like the
Department of Health and Human Services, or the National Institutes of Health, or the
Institute of Medicine.” (Willett, 2001)
Food labels based on faulty Food Pyramid system

6. Causes (con’t)
Genes
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“Obesity usually results from interaction of certain gene polymorphisms with
environment. Moreover, only a small number of cases of obesity (5%) result from
mutations in specific genes (monogenic obesity), causing in some cases Mendelian
syndromes with a very low incidence in the population. One hundred and thirty genes
related to obesity have been reported, some of which are involved in coding of
peptide transmitting hunger and satiety signals, while others are involved in adipocyte
growth and differentiation processes, and still others are involved in regulation of
energy expenditure. In addition, obesity is a chronic inflammatory state. In this
regard, altered expression of genes related to insulin metabolism and adipose tissue
inflammation is a basic process which may explain the etiology of obesity” (González
Jiménez, 2011)
Socioeconomic rank
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“Many studies have shown an overall socio-economic gradient in obesity in modern
industrialized societies. Rates tend to decrease progressively with increasing socioeconomic status.” (Perez, 2013)

7. Causes (con’t)
Bad habits in childhood
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Feeding Infants and Toddlers Study (FITS) in North America: “higher than generally
recommended energy, protein, and saturated fat intakes. The majority of infants are
bottle fed at some point in their first year of life, and their weaning diet often includes
low intakes of fruits and vegetables, with high starchy, rather than green or yellow,
vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and
high juice intake in the first 2 years - all less desirable diet practices - are improving,
but are still prevalent. More preschoolers are likely to get sweets or sweetened
beverages than a serving of fruit or a vegetable on a given day” (Savedra, 2013)
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“These food intake patterns mimic the adult American diet and are associated with an
increased risk of obesity in childhood and later life.” (Savedra, 2013)
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“Obesity prevention needs to include specific targets in terms of breastfeeding and
adequate formula feeding, as well as appropriate introduction of weaning foods with
goals of changing the inadequate patterns documented in the FITS. These
interventions will also require addressing parent and caregiver behaviors, including
attending to hunger satiety cues (responsive feeding), and shaping early food
preferences. This needs to be done starting at birth, in the first months of life. Early
intervention offers a unique and potentially efficacious opportunity to shape the future
dietary patterns of the next generation.” (Savedra, 2013)

8. Causes (con’t)
Food deserts
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“A “food desert” is defined as a populated area with deficient access to the most wellstocked outlets, the large stores or supermarkets that usually provide abundant, good
quality, low-priced food choices” (Hubley,2011)
“food deserts—low-income communities without ready access to healthy and
affordable food—by developing and equipping grocery stores, small retailers, corner
stores, and farmers markets with fresh and healthy food” ("USDA defines food,"
2010)
“Low access to supermarkets in the United States has been linked with poor quality
diets” (Hubley, 2011)
“predominately lower income neighborhoods and communities” (Hubley, 2011)
Cheapest food lacks quality and nutrition
Sedentary lifestyles
Emotional issues, binge eating, food addiction
Portion sizes
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“Portion distortion”: “Food portions in America's restaurants have doubled or tripled over
the last 20 years, a key factor that is contributing to a potentially devastating increase in
obesity among children and adults.” ("Portion distortion" 2013)
American portion size can feed 2 or 3 people
Huge in comparison to most other countries

9. Effects
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diabetes
cancer
respiratory functions: alters the relationship between the lungs,
chest wall, and diaphragm (Ray).
cardiovascular diseases
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coronary heart diseases: a condition in which plaque builds up inside the
arteries that supply oxygen-rich blood to the heart which narrow or block the
coronary arteries and reduce blood flow to the heart muscle which leads to
chest pain and heart attack (NHI).
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heart failure: a serious condition where the heart can't pump enough blood to
meet the body's needs (NHI).

10. Facts
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When did obesity emerge in the US?
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What cause obesity to emerge in the US?
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1980s-2000s
Doubled in children
Tripled in adolescence
60 million adults were considered obese, which is about 30% of the population
(CDC)
25% of Americans eat the recommended 5 servings of fruit and vegetables per
day
More than 50% of Americans do not get the recommended amount of physical
activity (CDC)
Obesity is dramatically on the rise in low- and middle-income
countries, particularly in urban settings.
In 2008, 35% of adults were overweight, 11% were obese.
More people are killed from being over weight than underweight.
Obesity is preventable. (WHO, http://www.who.int/topics/obesity/en/)

11. Factors
Key Issues
Key Stakeholders

12. Key Issues
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Health (see Effects)
Food (cheapest)
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Seasonality
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Transportation
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Subsidies
Processed foods contain many low quality ingredients
Food marking
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Grocery store setup
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Focus on children: TV, internet and movie adverts, collectibles (toys in cereal
boxes, fast food meals)
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Identifying key buying
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Loyalty programs

13. Key Stakeholders
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Primary:
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Marketers
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Endorsers
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Sellers
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Producers/ restaurants
Consumers
Secondary
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Doctors/ plastic surgeons
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Medicare
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Health insurance companies
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Weight loss companies, gyms, trainers

14. Conclusion
Obesity is caused by a number of things that
vary from eating large proportions to the way
food is marketed. Our group concluded that
sources of obesity are preventable and the
cost of stopping them outweighs the cost of
letting obesity to continue to harm
individuals.

15. References
Cawley, J. (2011). The Oxford Handbook of the Social Science of Obesity. Oxford University Press, Inc.: New York, NY.
CDC. (2010). Facts About Obesity in the United States. Retrieved from:
http://www.cdc.gov/pdf/facts_about_obesity_in_the_united_states.pdf
Chen, P. (2010, September 16). Teaching doctors about nutrition and diet. The New York Times. Retrieved from
http://www.nytimes.com/2010/09/16/health/16chen.html?_r=0
Fromke, S. (Director) (2012). Escape fire: The fight to rescue american healthcare [Web]. Retrieved from http://www.escapefiremovie.com
González Jiménez, E. (2011). Genes and obesity: A cause and effect relationship. Endocrinología y Nutrición, 58(9), 492–496. Retrieved from
http://dx.doi.org/10.1016/j.endoen.2011.06.005
Hubley, T. (2011). Assessing the proximity of healthy food options and food deserts in a rural area in maine. Applied Geography , 31(4), 1224–
1231. Retrieved from http://dx.doi.org/10.1016/j.apgeog.2010.09.00
NHI. (2012, July 13). What Are the Health Risks of Overweight and Obesity? Retrieved From:
http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks.html
Pérez Rodrigo, C. (2013). Current mapping of obesity. Nutricion Hospitalaria, 2821-31. doi:10.3305/nh.2013.28.sup5.6869
Portion distortion and serving size. (2013, February 13). Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eatright/distortion.htm
Ray C. S., Sue D. Y., Bray G., Hansen J. E., Wasserman K. (1983). The American Review of Respiratory Disease.
Rippe, J. M. Angelopoulos, T. J. (2012, May). Obesity : Prevention and Treatment. Retrieved from:
http://appencore.wncln.org/iii/encore/record/C__Rb4659894__SObesity%20%3A%20Prevention%20and%20Treatment.__O
rightresult__X4?lang=eng&suite=ncapp
Rossen, L. M., Rossen, E. A. (2012). Obesity 101. Springer Publishing Company, LLC: New York, NY.
Saavedra, J. M., Deming, D., Dattilo, A., & Reidy, K. (2013). Lessons from the Feeding Infants and Toddlers Study in North America: What
Children Eat, and Implications for Obesity Prevention. Annals Of Nutrition & Metabolism, 6227-36. doi:10.1159/000351538
Stern, J. S., Kazaks, A. (2009). Obesity. ABC-CLIO, LLC: Santa Barbara, CA.
USDA defines food deserts. (2010). Retrieved from http://americannutritionassociation.org/newsletter/usda-defines-food-deserts WHO.
(2013). Obesity. Retrieved from: http://www.who.int/topics/obesity/en/
WHO. (2013). Obesity and overweight. Retrieved from: http://www.who.int/mediacentre/factsheets/fs311/en/
Willett, W. (2001). Eat, drink, and be healthy: The harvard medical school guide to healthy eating. New York, NY: Simon & Schuster, Inc.
Retrieved from http://www.health.harvard.edu/newsweek/Eat_Drink_and_Be_Healthy.htm