Body fat distribution has been widely overlooked, although
excess abdominal visceral fat predisposes to coronary disease,
hyperinsulinemia, and hyperlipidemia.

Molecular biology will ultimately provide the "cure" for obesity. In the
mean time, says Weigle, managing obesity involves recognizing that the
health hazards of moderate obesity may have been somewhat overstated and
probably do not justify calorie-restricted diets that are ineffective,
counter-productive, and associated with adverse effects. Proper food choices
and regular aerobic exercise are preferable to calorie restriction. When
body weight drops below the set point by exercise, energy expenditure
appears to adapt to the new weight, unlike weight loss by calorie
restriction, which elicits strong counterregulatory mechanisms. Exercise
also has other important benefits. Since upper body obesity carries higher
risks, patients with central obesity, particularly younger patients, should
be targeted (waist-to-hip ratio greater than 0.95 in men and greater than
0.85 in women). Weight reduction won't change the waist-to-hip ratio, but
absolute weight loss does help. Health professionals should stress exercise
and correct food choices, keep dietary weight loss goals moderate, and treat
obesity-related disorders such as hypertension, hyperglycemia, and
hyperlipidemia rather than waiting for the pounds to "melt away." (Weigle
DS. West J Med. 1990; 153: 421-428. Leibel RL. West J Med. 1990; 153:
429-431. NIH Panel. Ann Intern Med. 1993; 119: 764-770.)

The Public Nature of Obesity
Obesity is a physical disability that is intensely stigmatized in our
society. Studies have shown a striking inverse relationship between obesity
and socioeconomic status in the developed world, especially among women. Gortmaker et al. found that being overweight during adolescence has a
particularly deleterious effect on subsequent socioeconomic attainment. They
studied the relationship between overweight (body-mass index above the 95th
percentile for age and sex -- which in many cases is not even obese) and
educational attainment, marital status, household income, and self-esteem in
10,039 randomly selected individuals aged 16 to 24 years in 1981. To assess
the social consequences of obesity, the investigators compared disability
from obesity with that associated with other forms of chronic illness.
The prevalence of overweight was 3.4% in males and 3.0% in females (5.8% in
black females versus 2.5% in non-Hispanic whites).