Obesity Epidemic, Medical and Quality of Life Consequences: A Review
Obesity is excessive body weight that leads to bad health. The scourge of obesity is a serious public health problem that has reached epidemic proportions in both developed and developing countries. The epidemic has to be addressed and given serious attention because of its medical, health, economic and quality of life consequences at local, national and global levels. Besides the high cost of treating obesity or associated diseases, there is loss of work productivity and loss of earning power as well as loss of quality of life in people living with excessive weight gain and obesity. This paper will address the growing obesity epidemic and its various consequences. It will review several published studies as well as some unpublished anecdotal reports on the consequences of obesity in different populations. It is hoped that this review may contribute in raising awareness on the burden of obesity; it may also stimulate interest in weight management and inspire some individuals to take action to control their excessive body weight. In addition, discussion of the consequences may act as a deterrent or wakeup call in those individuals who are complacent and unrestrained in their dietary consumption, or those who feel unconcerned by their excessive body weight. Highlighting the serious consequences of obesity may also ignite the public to take action to curb the epidemic and improve the lives of people living with this chronic disease. The collaborative efforts of government, industry, health professionals, nutritionists as well as affected individuals will help to reduce the obesity epidemic, minimize its consequences and ensure good health and wellness in many populations.
Obesity, Epidemic, Consequences, Costs, Medical, Quality of Life, Weight Management, Wellness
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, et al. The 2013 AHA/ACC/TOS guidelines for the management of overweight and obesity in adults: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines & the Obesity Society. J Am Coll Cardiol 2014; 63(25 Pt B): 2985-3023.
Uzogara SG. Assessment of Obesity, Presumed and Proven Causes and Prevention Strategies: A Review. Adv Obes Weight Manag Control 2016; 5(1): 00121.
Uzogara SG. Underweight, the Less Discussed Type of Unhealthy Weight and Its Implications: A Review. American Journal of Food Science and Nutrition Research 2016; 3(5): 126-142.
Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for Type 2 Diabetes Screening. Diabetes Care 2015; 38(1): 150-158.
Joslin Diabetes Center. What is BMI: BMI for Asian and Asian American Adults? Asian American Diabetes Initiative, 2016.
Flegal KM, Carroll MD, Kit BK & Ogden CL. Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010. JAMA. 2012 Feb 1; 307(5): 491-497.
Health USA: Health United States, 2014. Obesity & Overweight Prevalence. Table 59. CDC Fast Stats; Center for Disease Control and Prevention. Atlanta GA; www.cdc.gov/nchs/faststats/obesity-overweight.htm.
OECD, Organization for Economic Cooperation and Development. Obesity Update 2014. Report of the Organization for Economic Co operation and Development. Website: www.oecd.org/Accessed 22 Jan 2016.
Caballero B. "The global epidemic of obesity: An overview". Epidémiol Rev 2007; 29: 1–5.
Rennie KL, Jebb SA. Prevalence of obesity in Great Britain. Obes Rev. 2005 Feb; 6(1):11–2.
Chan RSM, Woo J. Prevention of Overweight and Obesity: How Effective is the Current Public Health Approach? Int. J. Environ. Res. Public Health 2010; 7: 765-783.
Kumanyika SK, Obarzanek E, Stettler N, Bell R, Field AE, Fortmann SP, Franklin BA, Gillman MW, Lewis CE, Poston WC, Stevens J, Hong Y, AHA Council on Epidemiology & Prevention, Interdisciplinary Committee for Prevention. Population-Based Prevention of Obesity. The Need for Comprehensive Promotion of Healthful Eating, Physical Activity and Energy Balance. Circulation. 2008;118:428-464.
Flynn MA, McNeil DA, Mutasingwa D, Wu M, Ford C, Tough SC. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes Rev 2006 Feb; 7 (Supp # 1):7-66.
Kemper HC, Stasse-Wolthuis M, Bosman W. The prevention and treatment of overweight and obesity. Summary of the Advisory Report by the Health Council of The Netherlands. Neth J Med. 2004 Jan; 62(1):10-7.
Johnsson T, Olsson S, Ahren B, Bog-Hansen TC, Dole A, Lindeberg S. Agrarian diet and diseases of affluence: Do evolutionary novel dietary lectins cause leptin resistance? BMC Endocr Disord 2005; 5:10.
Caballero B. “A Nutrition Paradox: Underweight and Obesity in Developing Countries”. New England Journal of Medicine 2005; 352(#15): 1514-1516.
WHO: World Health Organization, Controlling the Global Obesity Epidemic. The Challenge. WHO Expert Consultation on Waist Circumference and Waist-to-Hip Ratio; 8-11 December 2008, Geneva, Switzerland.
Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood Obesity: Causes and Consequences. J Family Med Prim Care. 2015 Apr-Jun; 4(2): 187–192.
Ferns SJ, Wehrmacher WH, Serratto M. Effects of obesity and gender on exercise capacity in urban children. Gend Med. 2011 Aug; 8(4):224-30.
Anderson PM, Butcher KE. Childhood obesity: Trends and potential causes. Future Child 2006 Spring; 16(1):19-45.
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of High Body Mass Index in U.S. Children and Adolescents, 2007- 2008. J American Medical Association 2010; 303(3): 242-249.
Ogden CL, Carroll MD, Fryar CD and Flegal KM. Prevalence of Obesity among Adults and Youth: United States, 2011- 2014; CDC NCHS Data Brief No. 219, November 2015; http://www.cdc.gov/nchs/data/databriefs/db219.htm; Assessed 28th Jan 2016.
Raj M & Kumar RK. Obesity in children & adolescents. Indian J Med Res 2010 Nov; 132(5): 598-607.
Rillamas-Sun E, LaCroix AZ, Waring ME, Kroenke CH, LaMonte MJ, Mara Z. Vitolins MZ, Seguin R, Bell CL, Gass M, Manini TM, Masaki KH, Wallace RB. Obesity and Late-Age Survival without Major Disease or Disability in Older Women. JAMA Intern Med. 2014; 174(1):98-106.
Vincent HK, Vincent KR, Lamb KM. Obesity and mobility disability in the older adult. Obes Rev. 2010 Aug; 11(8): 568-579.
Barnes AS & Coulter SA. Obesity and Sedentary Lifestyles: Risk for Cardiovascular Disease in Women. Tex Heart Inst J 2012; 39(2): 224–227.
Frilander H, Solovieva S, Mutanen P, Pihlajamaki H, Heliovaara M,Viikari-Juntura E. Role of overweight and obesity in low back disorders among men: a longitudinal study with a life course approach. BMJ Open 2015; 5:e007805.
Gunderson EP. Childbearing and Obesity in Women: Weight Before, During, and After Pregnancy. Obstet Gynecol Clin North Am. 2009 Jun; 36(2): 317–332.
Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal Obesity and Occurrence of Fetal Macrosomia: A Systematic Review and Meta-Analysis. Biomed Res Int. 2014; 2014: 640291.
Tian C, Hu C, He X, Zhu M, Qin F, Liu Y, Hu C. Excessive weight gain during pregnancy and the risk of macrosomia: a meta analysis. Arch Gynecol Obstet. 2016 Jan; 293 (1): 29-35.
Endres LK, Straub H, McKinney C, Plunkett B, Minkovitz CS, Schetter CD, Ramey S, Wang C, Hobel C, Raju T & Shalowitz MU, for the Community Child Health Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Postpartum Weight Retention Risk Factors and Relationship to Obesity at One Year. Obstet Gynecol 2015, Jan; 125(1): 144-152.
Taylor VH1, Forhan M, Vigod SN, McIntyre RS, Morrison KM. The impact of obesity on quality of life. Best Pract Res Clin Endocrinol Metab. 2013 Apr; 27(2):139-146.
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt, WL, Griffin JM and van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr; 16(4): 319–326.
Grundy SM. Obesity, metabolic syndrome and cardiovascular disease. J Clin Endocrinol Metab 2004 Jun; 89(#6): 2595-2600.
Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, Marceau P, Franklin BA. Cardiovascular evaluation and management of severely obese patients undergoing surgery: A science advisory from American Heart Association. Circulation 2009; 120 (1):86-95.
Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH. Obesity and Cardiovascular Disease.: Pathophysiology, Evaluation and Effect of Weight Loss. Arteriosclerosis, Thrombosis, and Vascular Biology.2006; 26: 968-976.
Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, Hu FB. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr, 2001, Jan; 73(1):61-67.
Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, Smith RJ & Smith SR. Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized? Diabetes Care June 2011; 34 (# 6): 1424-1430.
Bray GA and Popkin BM. Dietary sugar and body weight: Have we reached a crisis in the epidemic of obesity and diabetes? Health be damned. Pour on the sugar. Diabetes Care, April 2014; 37(4): 950-956.
Guilherme A, Virbasius JV, Puri V, Czech MP. Adipocyte dysfunctions linking obesity to insulin resistance and Type 2 Diabetes. Nat Rev. Mol Cell Biol. 2008 May; 9(5):367-377.
Singh AK, Singh SK, Singh N, Agrawal N & Gopal K. Obesity and dyslipidemia. Int J Biol Med Res. 2011; 2(3): 824-828.
Després J-P, Lemieux I. Abdominal obesity and metabolic syndrome: A Review. Nature 2006 December 14; 444: 881-887.
Varbo A, Benn M, Tybjaerg-Hansen A, Jorgensen AB, Frikke-Schmidt R, Nordestgaard BG. Remnant cholesterol as a causal risk factor for ischemic heart disease. J Am Coll Cardiol. 2013 Jan 29; 61(4): 427-436.
Varbo A, Benn M, Nordestgaard BG. Remnant cholesterol as a cause of ischemic heart disease: evidence, definition, measurement, atherogenicity, high risk patients and present and future treatment. Pharmacol Ther. 2014 Mar; 141(3):358-367.
Varbo A, Benn M, Tybjærg-Hansen A, Nordestgaard BG. Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. Circulation. 2013 Sep 17; 128(12):1298-309.
Pasquali R, Patton L & Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes 2007 Dec; 14(6):482-487.
Leddy MA, Power ML, Schulkin J. The Impact of Maternal Obesity on Maternal and Fetal Health. Rev Obstet Gynecol. 2008 Fall; 1(4): 170–178.
Leslie WS, Gibson A and Hankey CR. Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women. BMC Pregnancy and Childbirth 2013 Jan 16; 13:10.
Institute of Medicine (US),National Research Council (US) of the National Academy of Sciences, NAS, Committee to Re-examine IOM Pregnancy Weight Guidelines, Food and Nutrition Board, & Board on Children, Youth and Families; Rasmussen KM, Yaktine AL, editors. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US); 2009. May; Consequences of Gestational Weight Gain for the Mother. Available from: https://www.ncbi.nlm.nih.gov/books/NBK32818/.
Jevitt C, Hernandez I & Groer M. Lactation complicated by overweight and obesity: Supporting the mother and newborn. J Midwifery Women's Health. 2007 Nov-Dec; 52(6):606-613.
Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010 May; 33(5):386-93.
Mobley D & Baum N. The Obesity Epidemic and Its Impact on Urologic Care. Rev Urol. 2015; 17(3):165-70.
Semins MJ, Shore AD, Makary MA, Weiner J & Matlaga BR. The impact of obesity on urinary tract infection risk. Urology 2012 Feb; 79(2):266-9.
Hryhorczuk C, Sharma S, Fulton SE. Metabolic disturbances connecting obesity and depression. Front Neurosci. 2013 October; 7: 177.
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx B. Overweight, Obesity and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies. Arch Gen Psychiatry 2010 Mar; 67(3): 220-229.
Simon G, Von Korff M, Saunders K, Miglioretti D, Crane P, Van Belle G, Kessler R. Association Between Obesity and Psychiatric Disorders in the U.S Adult Population. Archives of General Psychiatry 2006; 63(7):824–830.
Taura P, Rivas E, Martinez-Palli G, Blasi A, Holguera JC, Balust J, Delgado S, Lacy AM. Clinical markers of the hypercoagulable state by rotational thrombelastometry in obese patients submitted to bariatric surgery. Surg Endosc 2014 Feb; 28(2):543-551.
Juhan-Vague I & Alessi MC. Abdominal obesity, insulin resistance and alterations in hemostasis. CMR eJournal 2008 May; 1 (# 2): 11-16.
Halvorson EE, Ervin SE, Russell TB, Skelton JA, Davis S, Spangler J. Association of Obesity and Pediatric Venous Thrombo-embolism. Hospital Pediatrics, 2015; 6 (1): 22.
Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and Type 2 Diabetes. Diabetes Res Clin Pract. 2014 Aug; 105(2):141-150.
Gregor MF & Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011; 29: 415-445.
Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 2013 Aug 13; 62(7):569-576.
Gibson PG. Obesity and asthma. Annals Amer. Thoracic Soc 2013; 10(Supplement): S138-S142.
Zammit C, Liddicoat H, Moonsie I, Makker H. Obesity and respiratory diseases. Int J Gen Med. 2010; 3: 335–343.
Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. Journal of Applied Physiology 2010 Jan; 108(1): 206-211.
Licht L, Murray M, Vassaur J. Jupiter DC, Regner JL, Chaput CD. The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma. The Journal of Bone & Joint Surgery, 2015; 97 (22): e73.
Chan G, Chen CT. Musculoskeletal effects of obesity. Curr Opin Pediatrics. 2009 Feb; 21(1):65-70.
Wearing SC, Hennig EM, Byrne NM, Steele JR & Hills AP. Musculoskeletal disorders associated with obesity: A biomechanical perspective. Obesity Rev. 2006 Aug; 7(3):239-250.
Lu B, Hiraki LT, Sparks JA, Malspeis S, Chen CY, Awosogba JA, Arkema EV, Costenbader KH, Karlson EW. Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study. Ann Rheum Dis, 2014 Nov; 73(11):1914-1922.
Magliano M. Obesity and arthritis. Post Reprod Health 2008 Dec; 14 (4): 149-154.
Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: Pathophysiology and clinical implications. Gastroenterology. 2012 Apr; 142(4):711-725.e6.
De Ridder RJ, Schoon EJ, Smulders JF, van Hout GC, Stockbrügger RW, Koek GH, Review article: Non-alcoholic fatty liver disease in morbidly obese patients and the effect of bariatric surgery. Aliment Pharmacol Ther 2007 Dec; 26 (Suppl 2):195-201.
Anderson AD, Solórzano CM, McCartney CR. Childhood obesity and its impact on the development of adolescent PCOS. Semin Reprod Med. 2014 May; 32(3): 202–213.
Motta AB. The role of obesity in the development of polycystic ovary syndrome. Curr Pharm Des. 2012; 18(17):2482-2491.
Sam S. Obesity and Polycystic Ovary Syndrome. Obes Manag. 2007 Apr; 3(2): 69–73.
De Pergola G & Silvestris F. Obesity as a Major Risk Factor for Cancer. J. Obes. 2013; 2013: 291546.
Roberts DL, Dive C, Renehan AG. Biological mechanisms linking obesity and cancer risk: New perspectives. Annual Review of Medicine 2010; 61:301–316.
Fleming JB, Gonzalez RJ, Petxzel MQB, Lin E, Morris JS, Gomez H, Lee JE, Gan CH, Pisters PWT, Evans DB. Influence of obesity on cancer related outcomes after pancreatectomy to treat pancreatic adeno-carcinoma. Arch Gen Surg.2009; 144(3):216-221.
Brewer CJ & Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010 Sep; 140(3):347-364.
Palmer NO, Bakos HW, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis 2012 Oct 1; 2(4): 253-263.
Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, Saade G, Eddelman K, Carter SM, Craigo SD, Carr SR, Dalton ME. Obesity, obstetric complications and Cesarian delivery rate: a population based screening study. Amer J. Gynecol 2004 April; 190(4): 1091-1097.
Chu SY, Kim SY, Schmidt CH, Dietz PM, Callaghan WM, Lau J, Curtis KM. Maternal obesity and risk of Cesarean delivery: a meta-analysis. Obes Rev. 2007 Sep; 8(5):385-94.
Declerc E, MacDorman M, Cabral H, Stotland N. Prepregnancy Body Mass Index and Infant Mortality in 38 U.S. States, 2012–2013. Obstetrics & Gynecol Feb 2016; 127(#2):279-287.
Rauh K, Gunther J, and Kunath J Stecher L, Hauner H. Lifestyle intervention to prevent excessive maternal weight gain: Mother and infant follow up at 12 months postpartum. BMC Pregnancy Childbirth 2015 Oct; 15:265.
Puhl, RM, Heuer, CA. The stigma of obesity: A review and update. Obesity, 2009; 17: 941-964.
Puhl RM, Heuer CA. Obesity stigma: Important considerations for public health. Am J Pubic Health, 2010 June; 100(6): 1019--1028.
Sikorski C, Luppa M, Kaiser M, Glaesmer H, Schomerus G, Konig HH, Riedel-Heller SG. The stigma of obesity in the general public and its implications for public health: A systematic review. BMC Public Health. 2011 Aug 23; 11:661.
Puhl R, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep. 2015 Jun; 4(2):182-90.
Martin A, Saunders DH, Shenkin SD, Sproule J. Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev. 2014 Mar 14; 3:CD009728.
Washington RL. Childhood Obesity: Issues of Weight Bias. Prev Chronic Dis. 2011 Sep; 8(5): A94.
Puhl RM, Andreyeva T, Brownell, KD. Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity, 2008; 32: 992-1001.
Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming Weight Bias in the Management of Patients with Diabetes and Obesity. Clinical Diabetes 2016 Jan; 34(1): 44-50.
Jackson SE, Steptoe A, Beeken RJ, Croker H, & Wardle J. Perceived weight discrimination in England: A population-based study of adults aged 50 years. Int J Obes (Lond). 2015 May; 39(5): 858–864.
Sutin AR, Terracciano A, Newton RL. Perceived weight discrimination and obesity. PLoS One 2013 July; 8(7): e70048.
Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl RM. Impact of perceived weight stigma among underserved women on doctor-patient relationships. Obes Sci Pract. 2016 Jun; 2(2): 128–135.
Sutin AR, Stephan Y, Luchetti M, Terracciano A. Perceived weight discrimination and C-reactive protein. Obesity (Silver Spring) 2014 Sep; 22(9):1959-1961.
Geiger TM & Muldon R. Complications following colon rectal surgery in the obese patient. R. Clin Colon Rectal Surg. 2011 Dec; 24(4):274-82.
Markary M, John R, Clark JM, Manahan M. Surgical complications twelve times more likely in obese patients; Hopkins News Releases: 2011 (June 29); website: http://www.hopkinsmedicine.org/news/media/releases/surgical_complications_twelve_times_more_likely_in_obese_patients; Accessed 22 Jan 2016.
DeMaria EJ, Potenier D, Wolfe L. Obesity surgery mortality risk score: Proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surgery for Obesity and Related Diseases 2007(March-April); 3(2):134-140.
Gunderson CC, Java J, Moore KN & Walker JL. The impact of obesity on surgical staging, complications, and survival with uterine cancer: A Gynecologic Oncology Group LAP2 ancillary data study. Gynecol Oncol. 2014 Apr; 133(1):23-27.
Downey L. How to Eliminate Body Odor in Overweight People. Livestrong Inc. Last Updated: Jun 23, 2015; Website: http://www.livestrong.com/article/160837-home-remedies-for-rashes-under-the-rolls-of-belly-fat/.
Zizza C, Herring AH, Stevens J, and Popkin BM. Length of Hospital Stays Among Obese Individuals. Am J Public Health. 2004 September; 94(9): 1587–1591.
Peitz GW, Troyer J, Jones AE, Shapiro NI, Nelson RD, Hernandez J, Kline JA. Association of body mass index with increased cost of care and length of stay for emergency department patients with chest pain and dyspnea. Circ Cardiovasc Qual Outcomes 2014; 7(2): 292-298.
Dee A, Kearns K, O'Neill C, Sharp L, Staines A, O'Dwyer V, Fitzgerald S, Perry IJ. The direct and indirect cost of overweight and obesity: A systematic review. BMC Res Notes 2014 Apr 16; 7:242.
Teuner CM, Menn P, Heier M, Holle R, John J, Wolfenstetter SB. Impact of BMI and BMI change on future drug expenditures in adults: Results from the MON-ICA/KORA cohort study. BMC Health Services Research 2013; 13(424): 2013.
Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet 2011; 378(9793):815–825.
Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. The Lancet, 2010 Nov; 376. (Issue 9754): 1775-1784.
Tsai AG, Williamson DF, & Glick HA. Direct medical cost of overweight and obesity in the United States: A quantitative systematic review. Obes Rev 2011 Jan; 12(1):50-61.
Li Q, Blume SW, Huang JC, Hammer M, Graf TR. The economic burden of obesity by glycemic stage in the United States. Pharmacoeconomics 2015 Jan; 33(7): 735-748.
Finkelstein EA, DiBonaventura MD, Burgess SM, Hale BC. The costs of obesity in the workplace. J Occupn Environ Med 2010, Oct; 52(10): 971-976.
Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes, 2010; 3:285-295.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, and Viikari-Juntura E. The Association between Obesity and Low Back Pain: A Meta-Analysis. Am. J. Epidemiol. 2010; 171 (2):135-154.
Groen VA, van de Graaf VA, Scholtes VA, Sprague S, van Wagensveld BA, Poolman RW. Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: A systematic review. Obes Rev. 2015 Feb; 16(2):161-170.
Krakauer NY, Krakauer JC. Dynamic association of mortality hazard with body shape. PLoS One 2014; 9: e88793.
Alley DE, Chang VW. The changing relationship of obesity and disability, 1988-2004. JAMA 2007; 298(17):2020-2027.
Snih SA, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach, K, Goodwin JS. The Effect of Obesity on Disability vs. Mortality in Older Americans. Arch Intern Med. 2007; 167(8):774-780.
Sturm R, Ringel JS, Andreyeva T. Increasing obesity rates and disability trends. Health Affairs, March 2004; 23(2):199-205.
Bacchini D, Licenziati MR, Garrasi A, Corciulo N, Driul D, Tanas R, Fiumani PM, Di Pietro E, Pesce S, Crino A, Maltoni G, Iughetti L, Sartorio A, Deiana M, Lombardi F, and Valerio G. Bullying and Victimization in Overweight and Obese Outpatient Children and Adolescents: An Italian Multicentric Study. PLoS One. 2015; 10(11): e0142715.
Wang J, Iannotti RJ, Luk JW. Bullying victimization among underweight and overweight US youth: Differential associations for boys and girls. J Adolesc Health 2010; 47: 99–101.
Baldwin JR, Arseneault L, Odgers C, Belsky DW, Matthews T, Ambler A, Caspi A, Moffitt TE, Danese A. Childhood Bullying Victimization and Overweight in Young Adulthood. Psychosomatic Medicine, 2016; 78 (9): 1094.
King's College London. "Victims of childhood bullying more likely to be overweight as young adults." ScienceDaily, 11 November 2016. www.sciencedaily.com/releases/2016/11/161111132249.htm.
Uzogara SG. Obvious and hidden calories in food and their impact on weight, obesity and wellness: A review. Adv Obes Weight Manag Control 2016 May; 4(5): 1-11.
James WPT. The epidemiology of obesity: The size of the problem. J. Int Medicine 2008 April; 263(4):336-352.