Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Obesity in adults: Etiology and natural history

George A Bray, MD
Section Editor
F Xavier Pi-Sunyer, MD, MPH
Deputy Editor
Kathryn A Martin, MD


Obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children, and is now considered to be a global epidemic. Obesity is associated with a significant increase in mortality and with risk of many disorders, including diabetes mellitus, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, cancer, and others. This topic will review the natural history of obesity and the etiologic factors associated with being overweight and obese (table 1). The etiology of obesity in children and adolescents is reviewed separately. The genetic causes of obesity as well as the evaluation, prevalence, and treatment of obesity in adults are also discussed separately.

(See "Definition; epidemiology; and etiology of obesity in children and adolescents".)

(See "Pathogenesis of obesity".)

(See "Obesity in adults: Health hazards".)

(See "Obesity in adults: Prevalence, screening, and evaluation".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Mar 9, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. National Institutes of Health. National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obes Res 1998; 6 Suppl 2:515.
  2. WHO Consultation on Obesity. Obesity: Preventing and managing the global epidemic. Geneva, 3-5 June 1997. World Health Organization, Geneva, 1998.
  3. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129:S102.
  4. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363:157.
  5. Ozanne SE. Epigenetic signatures of obesity. N Engl J Med 2015; 372:973.
  6. Oken E, Taveras EM, Kleinman KP, et al. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol 2007; 196:322.e1.
  7. Baptiste-Roberts K, Nicholson WK, Wang NY, Brancati FL. Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project. Matern Child Health J 2012; 16:125.
  8. Bray GA. A Guide to Obesity and the Metabolic Syndrome, CRC Press, Boca Raton, FL 2011.
  9. Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. Int J Obes (Lond) 2008; 32:201.
  10. Loos RJ. Genetic determinants of common obesity and their value in prediction. Best Pract Res Clin Endocrinol Metab 2012; 26:211.
  11. The NS, Suchindran C, North KE, et al. Association of adolescent obesity with risk of severe obesity in adulthood. JAMA 2010; 304:2042.
  12. Must A, Phillips SM, Naumova EN. Occurrence and timing of childhood overweight and mortality: findings from the Third Harvard Growth Study. J Pediatr 2012; 160:743.
  13. Deshmukh-Taskar P, Nicklas TA, Morales M, et al. Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study. Eur J Clin Nutr 2006; 60:48.
  14. Mannan M, Doi SA, Mamun AA. Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis. Nutr Rev 2013; 71:343.
  15. Smith DE, Lewis CE, Caveny JL, et al. Longitudinal changes in adiposity associated with pregnancy. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study. JAMA 1994; 271:1747.
  16. Gunderson EP, Sternfeld B, Wellons MF, et al. Childbearing may increase visceral adipose tissue independent of overall increase in body fat. Obesity (Silver Spring) 2008; 16:1078.
  17. Robinson WR, Cheng MM, Hoggatt KJ, et al. Childbearing is not associated with young women's long-term obesity risk. Obesity (Silver Spring) 2014; 22:1126.
  18. Lovejoy JC. The menopause and obesity. Prim Care 2003; 30:317.
  19. Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab 2007; 92:895.
  20. Chen Z, Bassford T, Green SB, et al. Postmenopausal hormone therapy and body composition--a substudy of the estrogen plus progestin trial of the Women's Health Initiative. Am J Clin Nutr 2005; 82:651.
  21. Vasan RS, Pencina MJ, Cobain M, et al. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med 2005; 143:473.
  22. Church TS, Thomas DM, Tudor-Locke C, et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One 2011; 6:e19657.
  23. Maher CA, Mire E, Harrington DM, et al. The independent and combined associations of physical activity and sedentary behavior with obesity in adults: NHANES 2003-06. Obesity (Silver Spring) 2013; 21:E730.
  24. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA 1996.
  25. Hu FB, Li TY, Colditz GA, et al. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003; 289:1785.
  26. Borghese MM, Tremblay MS, Leduc G, et al. Independent and combined associations of total sedentary time and television viewing time with food intake patterns of 9- to 11-year-old Canadian children. Appl Physiol Nutr Metab 2014; 39:937.
  27. Bellisle F. Meals and snacking, diet quality and energy balance. Physiol Behav 2014; 134:38.
  28. Weil E, Wachterman M, McCarthy EP, et al. Obesity among adults with disabling conditions. JAMA 2002; 288:1265.
  29. National Sleep Foundation. Sleep in America Poll, National Sleep Foundation, Washington, DC 2002.
  30. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846.
  31. Greer SM, Goldstein AN, Walker MP. The impact of sleep deprivation on food desire in the human brain. Nat Commun 2013; 4:2259.
  32. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 2008; 16:643.
  33. Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008; 31:619.
  34. Nedeltcheva AV, Kilkus JM, Imperial J, et al. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med 2010; 153:435.
  35. Filozof C, Fernández Pinilla MC, Fernández-Cruz A. Smoking cessation and weight gain. Obes Rev 2004; 5:95.
  36. Leslie WS, Koshy PR, Mackenzie M, et al. Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial. BMC Public Health 2012; 12:389.
  37. Parsons AC, Shraim M, Inglis J, et al. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev 2009; :CD006219.
  38. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 378:804.
  39. Mozaffarian D, Hao T, Rimm EB, et al. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364:2392.
  40. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 2013; 98:1084.
  41. Qi Q, Chu AY, Kang JH, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012; 367:1387.
  42. McCaffery JM, Papandonatos GD, Peter I, et al. Obesity susceptibility loci and dietary intake in the Look AHEAD Trial. Am J Clin Nutr 2012; 95:1477.
  43. Phillips CM, Kesse-Guyot E, McManus R, et al. High dietary saturated fat intake accentuates obesity risk associated with the fat mass and obesity-associated gene in adults. J Nutr 2012; 142:824.
  44. Konttinen H, Haukkala A, Sarlio-Lähteenkorva S, et al. Eating styles, self-control and obesity indicators. The moderating role of obesity status and dieting history on restrained eating. Appetite 2009; 53:131.
  45. Bouchard C, Tremblay A, Després JP, et al. The response to long-term overfeeding in identical twins. N Engl J Med 1990; 322:1477.
  46. Jääskeläinen A, Schwab U, Kolehmainen M, et al. Associations of meal frequency and breakfast with obesity and metabolic syndrome traits in adolescents of Northern Finland Birth Cohort 1986. Nutr Metab Cardiovasc Dis 2013; 23:1002.
  47. Toschke AM, Thorsteinsdottir KH, von Kries R, GME Study Group. Meal frequency, breakfast consumption and childhood obesity. Int J Pediatr Obes 2009; 4:242.
  48. Rampersaud GC, Pereira MA, Girard BL, et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005; 105:743.
  49. Odegaard AO, Jacobs DR Jr, Steffen LM, et al. Breakfast frequency and development of metabolic risk. Diabetes Care 2013; 36:3100.
  50. Bhutani S, Varady KA. Nibbling versus feasting: which meal pattern is better for heart disease prevention? Nutr Rev 2009; 67:591.
  51. Allison KC, Grilo CM, Masheb RM, Stunkard AJ. Binge eating disorder and night eating syndrome: a comparative study of disordered eating. J Consult Clin Psychol 2005; 73:1107.
  52. Mostad IL, Langaas M, Grill V. Central obesity is associated with lower intake of whole-grain bread and less frequent breakfast and lunch: results from the HUNT study, an adult all-population survey. Appl Physiol Nutr Metab 2014; 39:819.
  53. Leslie WS, Hankey CR, Lean ME. Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review. QJM 2007; 100:395.
  54. Fava M, Judge R, Hoog SL, et al. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry 2000; 61:863.
  55. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393.
  56. Weight gain associated with intensive therapy in the diabetes control and complications trial. The DCCT Research Group. Diabetes Care 1988; 11:567.
  57. Larger E. Weight gain and insulin treatment. Diabetes Metab 2005; 31:4S51.
  58. Hochberg I, Hochberg Z. Expanding the definition of hypothalamic obesity. Obes Rev 2010; 11:709.
  59. Daousi C, Dunn AJ, Foy PM, et al. Endocrine and neuroanatomic features associated with weight gain and obesity in adult patients with hypothalamic damage. Am J Med 2005; 118:45.
  60. Morton NM, Seckl JR. 11beta-hydroxysteroid dehydrogenase type 1 and obesity. Front Horm Res 2008; 36:146.
  61. Knudsen N, Laurberg P, Rasmussen LB, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005; 90:4019.
  62. Fox CS, Pencina MJ, D'Agostino RB, et al. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med 2008; 168:587.
  63. Drewnowski A, Rehm CD, Solet D. Disparities in obesity rates: analysis by ZIP code area. Soc Sci Med 2007; 65:2458.
  64. Drewnowski A. The economics of food choice behavior: why poverty and obesity are linked. Nestle Nutr Inst Workshop Ser 2012; 73:95.
  65. Dubowitz T, Ghosh-Dastidar MB, Steiner E, et al. Are our actions aligned with our evidence? The skinny on changing the landscape of obesity. Obesity (Silver Spring) 2013; 21:419.
  66. McTigue KM, Garrett JM, Popkin BM. The natural history of the development of obesity in a cohort of young U.S. adults between 1981 and 1998. Ann Intern Med 2002; 136:857.
  67. Dhurandhar NV. Contribution of pathogens in human obesity. Drug News Perspect 2004; 17:307.
  68. So PW, Herlihy AH, Bell JD. Adiposity induced by adenovirus 5 inoculation. Int J Obes (Lond) 2005; 29:603.
  69. Whigham LD, Israel BA, Atkinson RL. Adipogenic potential of multiple human adenoviruses in vivo and in vitro in animals. Am J Physiol Regul Integr Comp Physiol 2006; 290:R190.
  70. Atkinson RL, Dhurandhar NV, Allison DB, et al. Human adenovirus-36 is associated with increased body weight and paradoxical reduction of serum lipids. Int J Obes (Lond) 2005; 29:281.
  71. Zhang H, DiBaise JK, Zuccolo A, et al. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci U S A 2009; 106:2365.
  72. Tremaroli V, Bäckhed F. Functional interactions between the gut microbiota and host metabolism. Nature 2012; 489:242.
  73. Murphy EF, Clarke SF, Marques TM, et al. Antimicrobials: Strategies for targeting obesity and metabolic health? Gut Microbes 2013; 4:48.