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The Origin of Obesity

Since the 1980s, scientists have begun tracking an alarming and unusual increase in the prevalence of obesity in the human population around the world. It is not yet understood how and why genetic variants with a detrimental impact on human health continue to persist through our evolution. Several theories and hypotheses have been proposed in an attempt to explain this ongoing phenomenon, however, none have been proven to accurately explain what is causing obesity to not only remain in the human population, but continue to increase in frequency. Many of them look back to our ancestors and their lifestyles to try to explain the shape we are taking today. There are many factors that need to be considered, both genetic and environmental, to help uncover the reason behind the perplexing rise in human obesity.

Waist circumference of average, overweight, and obese person

Obesity

Obesity is a medical condition where excess body fat accumulates to the point that it may have a negative effect on health. Body mass index is measured through dividing a person's weight by the square of the person's height. People are generally considered to have this medical condition when their body mass index (BMI) is over 30kg/m2, ranging from 25-30kg/m2. Obesity is considered to increase the likelihood of certain diseases and conditions, especially cardiovascular diseases, type 2 diabetes, sleep apnea, cancer, and depression.

Obesity is most commonly caused as a result of a combination of excessive food intake, lack of physical activity, and genetic susceptibility. In some cases, obesity is primarily by genetics, disorders, and medications. On average, obese people have greater energy expenditure than their non-obese counterparts due to the amount of energy required to maintain an increased body mass.

Obesity can be preventable through a combination of social changes and personal changes. Changes to diet and exercise are the main treatments to obesity, however, there are now new attempts such as liposuction and surgeries that remove excess fat. Diets attempting to reduce obesity reduce the consumption of energy-dense foods, such as those high in fat or sugars. It also encourages the intake of dietary fiber. Medications, along with a suitable diet, can be used to reduce appetite or decrease fat absorption. If all else fails, surgery may be performed to reduce stomach volume or the length of the intestines, therefore, leading to feeling full earlier or a reduced ability to absorb nutrients from food.

Obesity is one of the leading, preventable causes of death worldwide, with increasing rates in both children and adults. Obesity is more common in women than men. It has been stigmatized in much of the westernized world, although it is also seen as a symbol of wealth and fertility in other parts of the world.

Population history

For centuries, the human species has struggled to overcome food scarcity, disease, and their constantly changing environment. The industrial revolution led to the idea that increasing the average body size of the population was an important social and political factor. The military and economy of countries were critically dependent on the body size and strength of their younger generations, from which soldiers and workers were produced. Altering the body mass index (BMI) distribution of the population from underweight toward normal standards had an important impact on survival and productivity. This dramatic change in the population’s physicality played a central role in the economic development of industrialized societies.

Overtime, height and weight have progressively increased, particularly during the 19th century. During the 20th century, populations began to gain proportionally more weight than height, resulting in an increase in average BMI. By 2000, for the first time in evolution, the number of adults with excess weight surpassed the number of those who were underweight. This trend has continued to present day and continues to be recognized as one of today's leading health threats in most countries around the world and as a major risk factor for type 2 diabetes, cardiovascular disease, and hypertension.

Causes

A combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity. Other cases are due to genetics, medications, or psychiatric illness. Increasing rates at a societal level are due to an easily accessible and palatable diet, especially through the fast food industry, increased reliance on transportation, as well as mechanized manufacturing.

Diet

Many researchers have found that excess food is the primary factor contributing to obesity. The United States has the highest availability and has continued to grow rapidly. Total food energy consumption has been found to be related to obesity. The widespread availability of nutritional guides has barely succeeded in addressing the problem of overeating and poor consumer dietary choice. Obesity rates have rapidly increased and during the same period, there has been an increase in the average amount of food energy consumed. The primary sources of these extra calories are through sweetened beverages and potato chips, which account for approximately 25 percent of daily food energy in American youth. Consumption of sweetened drinks, such as soft drink, fruit drinks, iced tea, and energy and vitamin water drinks are believed to be main contributors to the rising rates of obesity and to the increased risk of metabolic syndrome and type 2 diabetes.

As societies become more accustomed and increasingly reliant on energy-dense, large portions, and fast food meals, the correlation between this diet and obesity becomes more concerning. In the United States alone, the consumption of fast food meals has tripled and food energy intake from these meals has quadrupled over 20 years. Due to agricultural policies and techniques, costs of food in the United States and Europe has dropped. This has led to an increase in food-energy consumption, which ultimately leads to obesity.

Sedentary lifestyle

A sedentary lifestyle plays a significant role in obesity. Globally, there has been a large shift towards less physically demanding work due to the increase in technology. Currently, at least 33% of the world's population does not get sufficient exercise. This is due to the rapidly increasing demand and use of mechanized transportation and the greater prevalence of labor-saving technology in the home. In youth, there appears to be declines in levels of physical activity due to a decrease in walking and physical education. People worldwide are taking up less active recreational pursuits.

In both children and adults, there is an association between television viewing time and the risk of obesity. 86% of studies showed that an increased rate of childhood obesity is associated with increased media exposure, with rates increasing proportionally to time spent watching television.

Genetics and environmental factors

Obesity is the result of an extreme energy imbalance in a person that regularly consumes more calories from food and drink than they need to in order to power their body's metabolic and physical functions.The increasing obese population in the recent decades has been attributed to an "obesogenic" environment - one which offers easily accessible high calorie foods and limits opportunity for physical activity. As a result, many people have become obese in response to this environment. Despite the environment, not everyone can become obese. Due to research studies, it has been found that a sizable portion of variation in weight among populations is due to genetic factors.

The most commonly implicated gene is MC4R, which encodes the melanocortin 4 receptor. Changes in this gene that diminish its function are found in a small fraction (<5%) of obese people in various ethnic groups. Children that are affected usually feel extremely hungry and as a result, become obese because of consistent overeating known as hyperphagia.

In most obese people, no single genetic cause can be identified. Studies have found more than 50 genes associated with obesity, most with very small effects. Most obesity seems to be a result of complex interactions among many different genes and environmental factors.

Polymorphism in various genes that control appetite and metabolism predispose to obesity when there is sufficient food energy present. People with two copies of the fat mass and obesity associated gene (FTO gene) have been found to weigh on average three to four kg more and have a greater risk of obesity when compared to those without the risk allele. Obesity is also a major characteristic in several syndromes, such as Prader–Willi syndrome, Bardet–Biedl syndrome, Cohen syndrome, and MOMO syndrome. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.)

Obesity risk is two to eight times higher for a person with a family history as opposed to a person with no family history of obesity, and there is an even higher risk in cases of severe obesity. Heritability of obesity can vary depending on the phenotype studied, however, it tends to be higher for phenotypes linked to adipose tissue distribution (40-55%) and for weight or body fat excess (5-40%). Weight gain and adiposity increase with age. It has been found that when both parents are overweight, 80% of the offspring of two obese parents would also be obese, in contrast to less than 10% of the offspring of two parents who are of normal weight. This indicates an intergenerational transmission of obesity.

Different people exposed to the same environment have different risks of obesity due to their underlying genetics. Humans are prone to obesity due to dietary scarcity during human evolution. They take advantage of period of food abundance by storing energy as fat. This is because it would advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive famine. However, this tendency to store fat would be maladaptive in societies with stable food supplies. Additionally body fat tends to be greater in populations inhabiting colder environments. Increased energy stores in cold environments can ensure a supply of energy for thermogenesis, while also combating negative energy balance that is more harmful in colder environments. Many stresses vary with climate, including dietary ecology, food insecurity, and disease.

Table: Selected genes with variants that have been associated with obesity

Gene symbol	Gene name	Gene product’s role in energy balance
ADIPOQ	Adipocyte-, C1q-, and collagen domain-containing	Produced by fat cells, adiponectin promotes energy expenditure
FTO	Fat mass- and obesity-associated gene	Promotes food intake
LEP	Leptin	Produced by fat cells
LEPR	Leptin receptor	When bound by leptin, inhibits appetite
INSIG2	Insulin-induced gene 2	Regulation of cholesterol and fatty acid synthesis
MC4R	Melanocortin 4 receptor	When bound by alpha-melanocyte stimulating hormone, stimulates appetite
PCSK1	Proprotein convertase subtilisin/kexin type 1	Regulates insulin biosynthesis
PPARG	Peroxisome proliferator-activated receptor gamma	Stimulates lipid uptake and development of fat tissue

Negative effects on health

Mortality

Obesity is one of the leading causes of death worldwide that can be preventable. Morality risk is lowest at a body mass index of 20-25kg/m2 in non-smokers and 24-27kg/m2 in smokers. The risk increases along with changes either by increasing or decreasing and applies in at least four continents. In Asians, the risk of negative health effects increase when BMI is between 22-25kg/m2. A BMI of 32kg/m2 and above has also been associated with a double mortality rate among women over a 16 year period. In the United States, obesity is estimated to cause between 111,909 to 365,000 death per year. Similarly, 1 million (7.7%) of deaths in Europe are attributed to excess weight as well. On average, obesity is known to reduce life expectancy by approximately six to seven years, where a BMI of 30-35 kg/m2 reduces life expectancy by two to four years and severe obesity (a BMI greater than 40 kg/m2) reduces life expectancy by ten years.

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Morbidity

Obesity increases the risk of many physical and mental conditions. These conditions are commonly shown through metabolic syndrome, which is a combination of medical disorders that include: diabetes mellitus type 2, high blood cholesterol, high blood pressure, and high triglyceride levels.

Complications are either caused directly by excess weight or indirectly through mechanisms that share a common cause, such as poor diet or lack of exercise. The strength of the link between obesity and specific conditions vary. For example, with type 2 diabetes, excess body fat is attributed to 64% of cases of diabetes in men and 77% of cases in women.

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass and those due to the increased number of fat cells. Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance.

Adaptive benefits of fat

Despite seemingly compelling evidence that obesity is harmful for human health, both public health efforts to reduce its prevalence as well as clinical efforts to treat it have had only some success. This can be attributed in part to the general poor understanding of what obesity really is. Obesity confounds the standard medical model of disease, which developed historically to address biological pathogens and can be more difficult to apply to other forms of ill health. Many associate high levels of adiposity with poor health, ultimately leading to the belief that adipose tissue is a “toxic” tissue. This perspective is supported by growing evidence of obesity as a chronic inflammatory state. According to this view, adipose tissue is the main contributor to the issue of obesity and that the less body fat someone has, the better health they will have as well. However, most research on adiposity is conducted with overweight subjects, therefore only highlighting the effects of this physiological tissue in a certain state. As a result, researchers have failed to direct attention to understanding the contributions of adipose tissue to health and function. In order to do so, an evolutionary approach is required.

Adipose tissue and metabolism are fundamental to primary life-history functions. Adipose tissue can work against starvation through storing sufficient energy to meet daily requirements for several weeks. Fat is one of a wider range of energy stores. In addition to providing fuel for metabolism, a key function of adipose tissue is to maintain a viable immune system and protect vital bodily functions. Energy stores are also important for short and long term fluctuations in energy balance caused by ranging energy supply or stresses. Energy stores are also responsible for stable body growth. Maternal nutritional status is representative of their ability to conceive, while baseline adiposity and pregnancy weight gain contribute to growth of the developing fetus. Additionally, in the early postnatal life, storing energy contributes to body mass.

Cultural practices and mating systems

Body Image

Throughout history it is evident that there are cross-cultural differences in attitudes toward body fat, obesity, and thinness. In westernized and modernized societies, cultural changes are widely prevalent that promote a thin ideal body type. This has lead to many issues regarding body image, especially associated with women. This has led to many eating disorders as well as depression.

Cultural Practices

A rikishi taking part in Sumo wrestling (a competitive full-contact wrestling sport originating from Japan).

However, in many traditional cultures, excess fat, or plumpness, is linked with heightened perceptions of self-worth, sexuality, femininity, and fertility. Furthermore, in some societies, where women attained their status through motherhood, having greater body fat is also perceived as a symbol of maternity and nurturance.Traditionally, fatness among South Pacific Islanders, for example, is associated with high status, authority, and wealth. The contemporary idealization of extreme thinness in Western Europe and the United States demonstrates the vast difference to the aforementioned idealization of plumpness in other societies.

For example, Sumo wrestlers are not normally allowed to eat breakfast and are expected to have a form of siesta after a large lunch. The most common type of lunch served is the traditional meal that is usually eaten with rice and washed down with beer. This regimen of no breakfast and a large lunch followed by a sleep is intended to help wrestlers put on a lot of weight so as to compete more effectively.

Mating

Assortative mating occurs when men and women do not mate at random with respect to phenotype and cultural traits. Assortative mating can also occur according to body weight or body fat, where obesity would aggregate within families and increase its prevalence. As mentioned previously, the likelihood of two obese parents producing an obese child is much higher than that of two non-obese partners.

Economic Impact

In addition to its health impacts, obesity leads to many problems including disadvantages in employment and increased business costs. These effects are felt by all levels of society from individuals, to corporations, to governments.

The estimate range for annual expenditures on diet products is $40 billion to $100 billion in the US alone. Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, with greater life expectancy rates, the more medical costs will incur. Reducing obesity may improve the public's health, however, it is unlikely to reduce overall health spending. Services must accommodate obese people with specialist equipment such as much wider chairs. Obesity can lead to social stigmatization and disadvantages in employment. When compared to their normal weight counterparts, obese workers on average tend to have higher rates of absenteeism from work and take more disability leave, therefore increasing the costs and risks for employers and decreasing productivity. Obese people are less likely to be hired for a job and are less likely to be promoted. Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.

Specific industries, such as the airline, healthcare and food industries, also have reservations. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width and space. In 2000, the extra weight of obese passengers cost airlines US$275 million. The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and bariatric ambulances.

Epigenetic mechanisms

The epigenome is the collective epigenetic information that an individual carries. It represents heritable and transient changes brought about by environmental factors. Chemical markers added to DNA, known as epigenetic modifiers, contribute to the regulation of gene expression. One of the many epigenetic modifications, DNA methylation, consists of the addition of methyl groups to cytosine residues along the DNA. Methylation usually results in the silencing of a gene and are specific to certain tissues. Obesity has found to be associated with the expression of different genes in blood and adipose tissue. Methylation in adipose depots have been observed to change before and after bariatric surgery and dramatic weight loss, which proves the correlation between altered methylation and obesity. There are two different ways by which epigenetic modifiers can be inherited. The germline of an individual may be affected by environmental factors that cause epigenetic alterations. On the other hand, genetic variants, such as obesity risk alleles, are able to modify their own patterns of methylation in addition to those present in other genes. It is estimated that approximately 34% of the variability observed in methylome is attributed to these genetic variants.

Hypotheses and Theories

Due to the unusual nature of the continuous rise in human obesity, many scientists have attempted to formulate theories and hypotheses in an attempt to explain the observed human propensity to obesity.

One of the most well-known hypothesis is known as Neel’s Thrifty Genotype Hypothesis, or the Thrifty Gene Hypothesis. This hypothesis is based on the idea that extra adipose tissue enabled our ancestors to survive feast-famine cycles. The problem with this hypothesis is that if obesity variants truly increased survival, then obesity would be fixed in humans and be a norm in the modern human population, which is not the case. While human obesity is more prevalent today than we’ve ever seen before, it is not observed in every human, which means that the “thrifty gene” that helps store fat is not present in all genomes. It also argues that the prevalence of the thrifty genes is not a result of positive selection for energy-storage genes, but rather due to genetic drift resulting from the removal of predative selection pressures.

Another popular hypothesis attempting to explain modern rises in obesity is called the Thrifty Phenotype Hypothesis. This hypothesis advances the notion that inadequate nutrition in early life alters the structure and function of organs and tissues. This implies that energy abundance experience later in life leads to an increased risk of cardiovascular disease and hyperglycemia which often comes hand in hand with obesity.

Some other lesser known hypotheses include the Thrifty Epigenotype Hypothesis and the Predation Release Hypothesis. The Thrifty Epigenotype Hypothesis proposes that all humans possess a thrifty genotype, as mentioned in the Thrifty Genotype Hypothesis, but environmental cues lead to phenotypic variability within a range of acceptable phenotypes through epigenetic modifications. The Predation Release Hypothesis proposes that relaxation of predation pressures and random genetic drift both contributed to the variability in genetic predisposition to obesity.

Pleiotropic effects

As mentioned in the Thrifty Genotype Hypothesis, genes linked to obesity are thought to be involved in appetite regulation, metabolic efficiency, and food seeking behaviors. In addition, these genes have other pleiotropic effects that may be driving the evolution through natural selection. These complex selection patterns may help explain the diversity of obesity risk allele frequencies in humans. When looking at this case through Darwinian selection, which is based on fitness, the body fat trait may have been directly selected for due to the role it plays in defining reproductive capacity. It has been found that a minimum amount of fat is necessary for the regulation of menarche, menstruation, and ovulation. In addition, cases of delayed puberty have been associated with abnormally low body weight. This shows that a minimum amount of fat is essential for reproductive success. There have also been reports of higher miscarriage and caesarean section rates among anorexic women. However, the effects of obesity on male fertility have not been concluded. Although common sperm parameters (ex. concentration, morphology, and volume) are not significantly different between obese and average weight males, there have been differences observed in the sperm’s motility and percentage of damaged DNA, which is measured by %DFI (DNA fragmentation index). Additionally, high BMI has not been observed to compromise DNA integrity, instead, being overweight has been associated with a reduction in DNA fragmentation. This characteristic shows an advantage of adiposity. For both sexes, epidemiological data has shown that a certain minimum of "fatness" is essential for reproductive success. Studies also suggest that variants with a predisposition to obesity are also pleiotropically associated with earlier pubertal development.