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Abstract
Excess bodyweight is the sixth most important risk factor contributing to the overall
burden of disease worldwide. 1.1 billion adults and 10% of children are now classified
as overweight or obese. Average life expectancy is already diminished; the main adverse
consequences are cardiovascular disease, type 2 diabetes, and several cancers. The
complex pathological processes reflect environmental and genetic interactions, and
individuals from disadvantaged communities seem to have greater risks than more affluent
individuals partly because of fetal and postnatal imprinting. Obesity, with its array
of comorbidities, necessitates careful clinical assessment to identify underlying
factors and to allow coherent management. The epidemic reflects progressive secular
and age-related decreases in physical activity, together with substantial dietary
changes with passive over-consumption of energy despite the neurobiological processes
controlling food intake. Effective long-term weight loss depends on permanent changes
in dietary quality, energy intake, and activity. Neither the medical management nor
the societal preventive challenges are currently being met.