noteworthy that among adults, leisure-time activity
has remained stable or increased since the mid-1980s,
the time period during which the prevalence of
obesity increased. Given this paradoxical finding, it
is likely that increases in sedentary activities such as
television watching and computer use and decreases
in lifestyle, household, and occupational activity that
have been less carefully measured have contributed to
reductions in overall energy expenditure at the popu-
lation level. Data from the Americans’ Use of Time
study show that the amount of free time spent watch-
ing television increased from about 4 h per week in
1965 to about 15 h in 1985. Documenting the preva-
lence of sedentary behavior among children and
adults and targeting the reduction of sedentary activ-
ity as a health-behavior goal have received consider-
able attention in recent years.
Future Directions
0024 Understanding and addressing the epidemic of
obesity has become a global public-health priority.
A recent 1997 WHO report on obesity, entitled
‘Obesity: Preventing and Managing the global Epi-
demic,’ noted that overweight and obesity represent a
rapidly growing threat to the health of populations
world-wide. Both children and adults in developing
and developed countries are affected. The report con-
cluded that the spectrum of problems seen across the
world is of such magnitude that obesity should be
regarded as the principally neglected public-health
problem.
0025 The recently released goals of Healthy People 2010
are to reduce the prevalence of obesity among adults
from 23 to 15% and to reduce the prevalence of
obesity among children and adolescents from 11 to
5%. The etiology of obesity is complex and encom-
passes a wide variety of social, behavioral, cultural,
environmental, physiological, and genetic factors. To
achieve these ambitious goals, considerable effort
must be focused on helping individuals at the popula-
tion level modify their diets and increase their
physical activity levels, key behaviors involved in
the regulation of body weight. A challenge to
public-health professionals is to develop educational
and environmental interventions that support diet
and exercise patterns associated with a healthy body
weight. Prevention of obesity should begin early in
life and involve the development and maintenance of
healthy eating and physical activity patterns. These
patterns need to be reinforced at home, in schools,
and throughout the community. Communities,
government, health organizations, the media, and
the food and health industry must form alliances if
we are to combat obesity.
0026A coherent and standard international system for
classifying overweight and obesity in children and
adults is also needed. The WHO and US agencies
recommend using BMI for adults, with BMI 25
denoting ‘overweight’ and BMI > 30 denoting
‘obesity.’ Criteria and methods for assessing and
documenting obesity in children and adolescents
need to be similarly developed. A common inter-
national standard would allow meaningful compari-
sons of obesity within and across populations and
document obesity trends over time.
See also: Adolescents; Children: Nutritional Problems;
Nutritional Assessment: Anthropometry and Clinical
Examination; Obesity: Etiology and Diagnosis
Further Reading
Allison DB, Fontaine KR, Manson JE, Stevens J and Van-
Itallie TB (1999) Annual deaths attributable to obesity
in the United States. Journal of the American Medical
Association 282(16): 1530–1538.
Clinical Guideline on the Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults. The
Evidence Report (1999) National Institutes of Health.
National Heart, Lung, and Blood Institute.
Flegal KM, Carroll MD, Kuczmarski RJ and Johnson CL
(1998) Overweight and obesity in the United States:
prevalence and trends, 1960–1994. International Jour-
nal of Obesity 22: 39–47.
Harnack L, Jeffery R and Boutelle K (in press) Temporal
trends in energy intake in the U.S.: an ecological perspec-
tive. American Journal of Clinical Nutrition.
Kuczmarski RJ, Flegal KM, Campbell SM and Johnson CL
(1994) Increasing prevalence of overweight among US
adults. Journal of the American Medical Association
272(3): 205–211.
Mokdad AH, Serdula MK, Dietz et al. (1999) The spread of
the obesity epidemic in the United States, 1991–1998.
Journal of the American Medical Association 282(16):
1519–1522.
Must A, Spadano J, Coakley EH, Field AE, Colditz G and
Foryx WD (1999) The disease burden associated with
overweight and obesity. Journal of the American Med-
ical Association 282(16): 1523–1529.
Obesity: Preventing and Managing the Global Epidemic.
Report of a WHO Consultation on Obesity.3–5 June
1997. Division of noncommunicable diseases. Geneva:
WHO.
Strauss R (1999) Childhood obesity. Current Problems in
Pediatrics 29: 5–29.
Troiano RP and Flegal KM (1998) Overweight children and
adolescents: description, epidemiology, and demograph-
ics. Pediatrics 101(supplement 3): 497–504.
US Department of Health and Human Services (1996)
Physical Activity and Health: A Report of the Surgeon
General. Atlanta, GA: US Department of Health and
Human Services, Centers for Disease Control and
OBESITY/Epidemiology 4245