The process of developing strategies to accelerate obesity prevention begins with a situation assessment. This chapter provides such an assessment by presenting data on the consequences the nation faces if the epidemic persists; the starting point for acceleration of preventive efforts with respect to obesity prevalence in the general population and in populations at particularly high risk; contributory trends related to physical activity, food intake, and media use and other factors relevant to sedentary behavior; and positive steps that have already been taken and have momentum, along with the roadblocks that could limit further advances. The nature of change trajectories needed to track progress toward the goal of seeing obesity levels decline is also discussed.


The consequences of today’s high rates of obesity have two broad dimensions. The first is the direct and sometimes devastating health and social consequences to individuals—the potential for illness or disability, social ostracism, discrimination, depression, and poor quality of life. The second dimension encompasses the indirect effects of obesity on society, reflected in population fitness, health care costs, and other aspects of the economy.

Human Costs

As shown in Table 2-1, obesity is associated with major causes of death and disability, as well as with psychosocial consequences that impair functioning and quality of life. The effect of obesity in predisposing to the development of type 2 diabetes is particularly strong, so much so that the onset of this disease—formerly observed only in adults—also now occurs during childhood (CDC, 2011). Adverse effects are observed throughout the life course and may be transmitted from mother to child through the characteristics of the gestational environment (IOM, 2009). According to current estimates, one-third of all children born today (and one-half of Latino and black children) will develop type 2 diabetes in their lifetime (Narayan et al., 2003). One dire projection is that obesity may lead to a generation with a shorter life span than that of their parents (American Heart Association, 2010; Olshansky et al., 2005).

The highest prevalence of obesity-related conditions occurs in middle-aged and older adults, with direct effects on quality of life and on rates of disease, disability, and death at an early age. High blood pressure is the most prevalent of these con-

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