Etiology and epidemiology

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Obesity is a multifactorial, complex disease that occurs following an interaction between genotype and the environment. While the etiology is not known completely, it involves overlapping silos of social, behavioral, and cultural influence; patho-

physiology; metabolism; and genetic composition. The majority of overweight or obese individuals are adults, but these diseases are also prevalent in children between 2 and 19 years of age. Thirty-two percent of adults 20 years of age and older are considered obese. Almost 5% meet the criteria for extreme obesity. The prevalence of obesity in men and women of various racial or ethnic origins differ. Thirty percent of non-Hispanic white adults are considered obese where approximately 37% of Mexican Americans and 45% of non-Hispanic black Americans are obese.

Among children and adolescents, 17% are considered overweight. Overweight children typically mature to overweight adults, but most obese adults were not overweight as children.9 Overweight and obesity, when present in young adults, may be a better predictor of prevalence.9 Additionally, adulthood overweight and obesity contribute to an increased risk of death in the presence of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease (CAD), stroke, sleep apnea, gallbladder disease, osteoarthritis, and certain cancers. Psychosocial functioning also may be hindered because obese patients may be at risk for discrimination if negatively stereotyped.6 Pediatric obesity is also associated with significant health-related problems and thus is a risk factor for much of the adult morbidity and mortality discussed previously.10,11 Cardiovascular (e.g., dyslipidemia and hypertension), endocrine (e.g., hyperinsulinemia, impaired glucose tolerance, type 2 diabetes mellitus, and menstrual irregularities), and mental (e.g., low self-esteem and depression) health problems ex-

ist for obese children and adolescents. pathophysiology

While a correlation between body weight in parents and children exists, the specific gene or genes contributing to obesity are unknown.13 Syndromes where obesity is a major component collectively contribute very little to the incidence of obesity.14 The key factor in the development of overweight and obesity is the imbalance that occurs between energy intake and energy expenditure. The extent of obesity is determined by the length of time this imbalance has been present. Energy intake is affected by environmental influences, including social, behavioral, and cultural factors, whereas genetic composition and metabolism affect energy expenditure.15

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