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January 10, 2005

Sleepless in America: A Pathway to Obesity and the Metabolic Syndrome?

Arch Intern Med. 2005;165(1):15-16. doi:10.1001/archinte.165.1.15

Whether one is reading recent reports from the Centers for Disease Control and Prevention, articles in the scientific literature or popular press, or just glancing around and looking at people in the subway or the shopping mall, it is apparent that there is a major epidemic in America: obesity! Obesity is a disease that, in just the past few decades, has been rising dramatically in developed countries and reached epidemic levels in the United States. Data from the Behavioral Risk Factor Surveillance Program (available at: www.cdc.gov/brfss) have revealed a striking increase, over the past 15 years and across the United States, in the prevalence of overweight (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters], 25-30) and obesity (BMI >30), and there is recent evidence of an alarming rise in the proportion of children affected with the disorder. Besides the social stigma attached to obesity, these trends are cause for concern because of the risks of secondary complications, including insulin resistance and type 2 diabetes mellitus, hyperlipidemia, cardiovascular disease, hypertension, stroke, cancer, and arthritis. The increase in levels of proinflammatory cytokines and prothrombotic factors associated with obesity is now recognized as an independent cause of morbidity and has been targeted by the National Cholesterol Education Program Adult Treatment Panel as an important independent contributor to cardiovascular risk.1 Many fingers are being pointed at many causes: not enough exercise, high-fat foods, poor eating habits, watching too much television, genetics, family history, fast-food hysteria, or exposure to advertising luring us to eat unhealthy foods. Even our early prenatal and postnatal environments may be putting us on a trajectory for an unhealthy metabolic state later in life.2 A common denominator may be the excessive intake of carbohydrates encouraged by the wave of “low fat” dieting that began in the 1970s. We can even blame our genes, which evolved in humans engaged in high physical activity (much of it chasing and looking for food) with eating habits requiring one to eat as much as possible (and as much meat and fat as possible) when a meal became available, ie, rarely, as opposed to having the food lying around us all of the time.