Encyclopedia of Health and Medicine

Lifestyle Variables: Smoking and Obesity 283
2004—40 years after the first surgeon general’s
report on smoking and health—48 million American
adults remained smokers, fewer than a quarter
of the US adult population, and the number of
new smokers reached an all-time low. Nonetheless,
cigarette smoking remains the leading cause
of CVD, cancer, chronic lung disease, and premature
death in the United States.
Lifestyle and Obesity
Cultural and social perceptions strongly influence
the extent to which people understand the health
risks and consequences of obesity, representing a
complex intertwining of personal accountability
and societal pressures. Until the 20th century
being overweight was a sign of personal prosperity
and even a hallmark of health. The corpulent individual
was one who could afford unlimited access
to food and indulged in its luxury. No correlation
as yet existed to link obesity with common and
debilitating ailments such as “dropsy” (the generalized
edema of congestive HEART FAILURE) and
“quinsy” (ANGINA PECTORIS, a symptom of CORONARY
ARTERY DISEASE [CAD]). As doctors began to recognize
the health implications of obesity a key challenge
that emerged was that of convincing people
of the connections between health, longevity, and
body weight.
Despite what now amounts to decades of scientific
evidence, misperceptions persist about the
roles of EATING HABITS, food choices, and daily
physical activity in WEIGHT LOSS AND WEIGHT MAN-
AGEMENT efforts. Furthermore, food is essential for
life—unlike cigarettes and ALCOHOL, which also
influence health. One cannot simply stop eating as
one can stop smoking or drinking alcohol (which
are not easy accomplishments themselves). As is
the case with cigarette smoking, the health consequences
of obesity accumulate slowly over
decades, lulling a person into believing that nothing
adverse is happening in his or her body. The
first recognition that obesity is a health problem
often comes when the doctor diagnoses a health
condition such as OBSTRUCTIVE SLEEP APNEA or HYPER-
TENSION and prescribes weight loss among the
treatment recommendations.
For many people with class 2 or 3 obesity, the
prospect of losing enough weight to have an effect
on health is daunting if not overwhelming and
often requires medical assistance. Yet even the loss
of 10 or 20 pounds over six months, a goal most
people can reach simply by adding 30 minutes of
walking to every day’s activities, makes a measurable
difference in health. Health improvements
are apparent almost immediately and extend as
weight loss continues. Some people are able to
stop taking medications to treat conditions such as
hypertension and type 2 DIABETES when their
weight reaches healthier levels.
Between 1990 and 1999 the percentage of
American adults who have obesity doubled. In
2001 the US Office of the Surgeon General issued
The Surgeon General’s Call to Action to Prevent and
Decrease Overweight and Obesity, another landmark
report identifying obesity as a significant as well as
preventable cause of hypertension, type 2 diabetes,
ATHEROSCLEROSIS, OSTEOARTHRITIS, and numerous
types of cancer. Weight loss became an explicit
health objective in HEALTHY PEOPLE 2010, the US
national agenda for public health improvement.
Many health experts believe obesity, which affects
more than 55 million American adults, now rivals
cigarette smoking for its deleterious effects on
health.