Obesity and its related sequelae represent a growing epidemic in the United States. Overweight is defined by the World Health Organization as a body mass index (BMI) of 25.0­29.9 kg/m², and obesity as BMI ≥ 30 kg/m². Recent data estimate that more than 50% of U.S. adults are overweight, with 31% of men and 35% of women considered obese, or at least 20% above their ideal body weight (Yanovski and Yanovski 1999).

Results of the 1999 National Health and Nutrition Examination Survey (NHANES), released in December 2000 by the National Center for Health Statistics, noted that the proportion of obese individuals in the United States in 1999 was 80% greater than the proportion measured by NHANES II in 1976­1980, and 17% greater than that measured by NHANES III in 1997 (Flegal and Troiano 2000). Similarly, the Centers for Disease Control (CDC) performed a telephone survey in 1991 that found that only 4 of the 47 states surveyed had obesity rates of 15% or greater, whereas the 2000 survey, which was repeated in all 50 states, found that every state except Colorado had an obesity rate ≥ 15% (Mokdad et al. 2000a, 2000b).

The economic burden of health care costs related to obesity has also grown dramatically in the past decade. Direct health costs of obesity in the United States were over $50 billion in 1995, or 7% of the total U.S. health care budget (Wolf and Colditz 1998), whereas both direct and indirect costs of obesity were estimated to be $98 billion in 1997 and $241 billion in 2001 (Schlosser 2001). This compares with an estimated $17.3 billion for direct health care costs of schizophrenia in the United States in 1995, with indirect costs of close to $50 billion (Knapp 2000).

A major source of the health care costs for obesity relates to the development of comorbid medical disorders, particularly diabetes mellitus, which itself accounts for approximately 60% of the health care costs attributed to obesity (Colditz 1999). Other conditions such as hypertension, coronary heart disease, cholelithiasis, arthritis, and certain cancers (e.g., breast) become increasingly prevalent as BMI increases into the overweight and obese range (Must et al. 1999).

In addition to the health care costs of obesity, social stigma, discrimination, and low self-esteem are common problems among patients with obesity (Myers and Rosen 1999). This stigmatization can lead to psychological distress and could exacerbate illness in the vulnerable, psychotic individual.

The stigma of mental illness combined with that of being overweight or obese is a significant burden for patients suffering from both conditions.

Donna A. Wirshing, M.D.
Jonathan M. Meyer, M.D.

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