what is a good research question for obesity

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http://orcid.org/0000-0002-8577-6574 Ailsa R Butler 1 ,
http://orcid.org/0000-0001-9301-7458 Nerys M Astbury 1 ,
Lucy Goddard 1 ,
Anisa Hajizadeh 1 ,
Philippa Seeber 2 ,
Bruce Crawley 2 ,
http://orcid.org/0000-0002-1802-4217 Paul Aveyard 1 ,
Susan A Jebb 1
1 Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
2 Patient and Public contributor , N/A , UK
Correspondence to Nerys M Astbury; nerys.astbury{at}phc.ox.ac.uk

Objectives To identify and prioritise the most impactful, unanswered questions for obesity and weight-related research.

Design Prioritisation exercise of research questions using online surveys and an independently facilitated workshop.

Setting Online/virtual.

Participants We involved members of the public including people living with obesity, researchers, healthcare professionals and policy-makers in all stages of this study.

Primary outcome measures Top 10 research questions to be prioritised in future obesity and weight-related research.

Results Survey 1 produced 941 questions, from 278 respondents. Of these, 49 questions held satisfactory evidence in the scientific literature and 149 were out of scope. The remaining 743 questions were, where necessary, amalgamated and rephrased, into a list of 149 unique and unanswered questions. In the second survey, 405 respondents ranked the questions in order of importance. During the workshop, a subset of 38 survey respondents and stakeholders, agreed a final list of 10 priority research questions through small and large group consultation and consensus. The top 10 priority research questions covered: the role of the obesogenic environment; effective weight loss and maintenance strategies; prevention in children; effective prevention and treatment policies; the role of the food industry; access to and affordability of a healthy diet; sociocultural factors associated with weight; the biology of appetite and food intake; and long-term health modelling for obesity.

Conclusions This systematic and transparent process identified 149 unique and unanswered questions in the field of obesity and weight-related research culminating in a consensus among relevant stakeholders on 10 research priorities. Targeted research funding in these areas of top priority would lead to needed and impactful knowledge generation for the field of obesity and weight regulation and thereby improve population health.

GENERAL MEDICINE (see Internal Medicine)
NUTRITION & DIETETICS
PREVENTIVE MEDICINE
PUBLIC HEALTH

Data availability statement

Data are available on reasonable request. Requests can be made for the deidentified participant level data collected during this study from the Nuffield Department of Primary Care hosted Datasets Independent Scientific Committee (PrimDISC): [email protected] on approval of a protocol, statistical analysis plan and the signing of a suitable data sharing agreement.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjopen-2021-058177

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Strengths and limitations of this study

This is the first research priority setting specific to the field of obesity and weight-related research.

This exercise involved input from a large number of participants from a broad range of relevant stakeholder groups including patients, members of the pubic, researchers, policy-makers and charities.

The final list of priorities was reached through consultation and consensus in a workshop guided by independent facilitators to minimise bias towards certain questions or areas.

Obesity is a major preventable cause of ill health and is affecting an increasing number of children and adults globally. 1 2 Obesity is defined as a body mass index (BMI) of ≥27.5 kg/m 2 (or ≥30 kg/m 2 if of white ethnic groups). No country has managed to achieve a sustained decrease in the prevalence of obesity, despite evidence-based clinical and public health guidelines and polices aimed at tackling obesity. 3 4 Obesity increases the risk of developing several conditions including type 2 diabetes, cardiovascular disease, osteoarthritis and some cancers. 4 The cost attributable to overweight and obesity are substantial. For example, in the UK’s National Health Service the cost is projected to reach £9.7 billion per annum, with wider costs to society projected to reach £49.9 billion by 2050 per year. 5 6 The detrimental effects of excess weight are not restricted to those who meet the BMI threshold of obesity as the increased morbidity is seen in people with any degree of excess adiposity. 7 Accordingly, strategies to prevent obesity or excess weight or adiposity are needed, defined here as obesity and weight-related research.

Presently, the research agenda is mainly driven by the interests and concerns of researchers, or research commissioners. A more transparent, systematic and collaborative approach involving multiple stakeholders to identify research priorities could accelerate progress. The James Lind Alliance (JLA) priority setting process brings patients, carers and clinicians together on an equal basis to define uncertainties, consider their importance and thereby set research priorities. 7 8 The output should, and typically has, informed researchers and research funders about the key questions to address in research because it is based on what matters most to people with lived experience of having a condition and those treating it. 9 Policies to prevent obesity typically affect the whole of society, for example fiscal policies or policies restricting the promotion or selling of some goods. Likewise, providing treatment for obesity as part of publicly funded healthcare is contested, and thus questions about research in this area seem to call for a much wider group of stakeholders than patients, carers, and clinicians. As in a previous tobacco control priority setting partnership (PSP), 10 we adapted the JLA approach to incorporate the perspectives of this wider range of stakeholders including people without experience of obesity, policy-makers, charities and, as for JLA, patients and members of the public with a lived experience of obesity (or related disease) and clinicians. 10 The objective of this work, as the first prioritisation project in obesity and weight-related research, was to identify unanswered questions across the whole of the field, from basic science through to health policy.

Patient and public involvement

We involved two members of the public (BC and PS) with lived experience of overweight in all stages of the project, from conception and design of the study, to its conduct, data collection and analysis. Our wider public involvement (surveys and workshop) incorporated members of the public with and without lived experience of being overweight and patients, defined as people with lived experience of being overweight and experience of receiving clinical treatment for overweight, obesity or an associated condition. Members of the public were involved in all stages of the work alongside and as equal partners with other stakeholders.

Subjects and methods

The priorities for obesity and weight-related research (POWeR) project took place between December 2019 and December 2020. The process was guided by Viergever et al, 11 which outlines principles of priority setting in health research and by the priority setting process carried out by Lindson et al. 11 We were guided by the general principles of the JLA PSP, however, we involved a wider range of stakeholders. We engaged a diverse and representative group of stakeholders comprising members of the public, people with lived experience of overweight and/or obesity, and people who work for organisations and charities, funders, policy-makers, clinicians and academic researchers all involved in the field of overweight and obesity. The prioritisation process had three stages: first an online survey to collect research questions stakeholders deemed to be priorities; a second online survey to rank the priority questions amalgamated from survey 1; and finally, an online workshop to reduce the ranked questions from survey 2 to produce a final list of top 10 priorities. The scope was limited to research questions on the aetiology, consequences, prevention or treatment of overweight and obesity in both adults and children, and did not include questions about whether currently evidenced interventions or polices should be implemented. For example, research questions relating to the prevention or treatment of eating disorders were not within the scope of this prioritisation project, however, eating disorders and related psychological adverse events related to weight management programmes were within scope. There was a study management group of investigators and patient and public involvement representatives that met regularly. Survey respondents provided consent to survey 1 and survey 2. Participants in the online workshop gave explicit consent prior to participation.

Survey 1: gathering questions and identifying those unanswered

Gathering questions:

The first survey in the process asked respondents to submit up to four questions that they felt should be prioritised in the field of obesity and weight-related research. The survey was administered online using JISC Online Survey and was piloted with our public coauthors and colleagues in the research team, prior to being launched. The survey asked respondents to identify research questions that they felt were the most important unanswered questions on the topic and to say why they felt each question was important. The latter information was used by the team to interpret, contextualise, group and sort questions.

We publicised the survey passively via a web link on our POWeR project website ( https://www.phc.ox.ac.uk/research/participate/power ), and actively via email to relevant stakeholders and Facebook adverts targeted to men. We invited our stakeholders to circulate the link, resulting in the distribution of the survey by more than 40 organisations to their members, visitors to their webpages and readers of their newsletters ( online supplemental table S1 ). We targeted organisations relevant to the field which included but was not limited to, obesity charities, community groups, funding bodies, hospital trusts, general practices and city councils. Participation in survey 1 was incentivised through a prize draw. We made physical copies of the survey, and versions with a large font size readily available on request. The survey was only available in English, and open for responses for 37 days between 15 January 2020 and 21 February 2020.

Supplemental material

Identifying unanswered questions:

Survey 1 questions were grouped by topic area and rephrased to form answerable research questions ( online supplemental tables S2 and S3 ). We used a multilevel coding system to categorise questions into overarching categories that were iteratively deduced throughout the grouping. For example, the submitted question ‘which diets work’ fell into a macro category, ‘treatment’ and was then further filtered into the sub-category ‘behavioural’ over ‘pharmaceutical’. Questions organised into groups were then rephrased as research questions in collaboration with our public coauthors who ensured that the groupings and rephrasing retained the intent of the original questions, and that they were understandable to a lay audience while making them tractable to empirical research. For example, a question such as ‘Are there medications to treat obesity?’ would have been combined with others to become a tractable research question such as ‘What is the effectiveness, safety, tolerability and cost-effectiveness of medications to treat obesity?’

We then searched the literature using keywords and MeSH terms informed by the questions, to determine if these were areas that were already adequately addressed in the scientific literature. Questions were deemed ‘answered’ if there was satisfactory evidence. We accepted satisfactory evidence primarily in the form of preprocessed literature in: (1) systematic reviews published within the last 10 years, with little to no uncertainty; (2) proof of evidence in national clinical guidelines (eg, National Institute for Health and Care Excellence, and Scottish Intercollegiate Guidelines Network). We also accepted primary literature by way of high certainty if there was evidence in randomised controlled trials (RCTs). Such an approach would indicate that the question on currently available pharmacotherapy for obesity, for example, was at least partially answered by current reviews and trials.

We noted how many questions fed into each research question.

Survey 2: prioritising unanswered research questions

The second online survey was piloted with members of the public and colleagues in the research team. The survey was administered via REDCap, and sent to the 256 survey 1 respondents who had provided us with their email addresses, as well as to the organisations approached to share survey 1 (see online supplemental table S1 ).

The second survey remained open for 30 days between 6 August 2020 and 14 September 2020. Survey 2 asked respondents to prioritise the unanswered questions gleaned from survey 1, which were sent in batches of about 50 questions to lower the response burden. The questions in each batch covered the whole range of submitted research questions. Respondents were asked to rate each question on a scale of 1–10 with 10 representing ‘very important’ and 1 representing ‘not important’. The mean priority score was calculated for the resulting rated questions and ranked ( online supplemental table S3 ) to create a list of the top 30 priority research questions.

Workshop: determining the top 10 research priorities

We invited a subset of survey respondents and other stakeholders including NGO representatives, healthcare professionals, public members including people with lived experience of overweight to take part in a 3-hour online workshop in the winter of 2020 to determine the top 10 questions. This was a real-time, facilitator-led consultation, replacing a full-day in person event that was not possible due to local COVID-19 restrictions. The group was representative of the multidisciplinary stakeholders involved in the project; patients and members of the public, researchers, policy-makers, clinicians and relevant research funders. The workshop was held via a videoconferencing platform (Zoom), and led by external facilitators from Hopkins van Mil, a service that specialises in guiding impartial discussions to elucidate views and opinions of a diverse group of people in a safe, productive space. 12 Prior to the workshop, participants were given the resulting top 30 questions from survey 2, in addition to a list of 10 other questions from survey 1 that had been asked by more than 10 people ( online supplemental table S4 ). The difference between the mean ranked scores in survey 2 was subtle. Workshop participants were offered the opportunity to advocate to include any of these extra 10 that they felt should be considered in the workshop to be as inclusive as possible. The workshop was divided into small groups of 4–6 people representing the range of stakeholders involved, to balance expertise and experience. Each small group was guided by a Hopkins van Mil facilitator.

The 3-hour workshop was divided into three parts with a final plenary session. Throughout the workshop participants were asked to justify their choices, and reveal the values and reasoning behind their prioritisation. Important questions were defined as those that would have the most impact if answered by research. In the first session, each group was asked to debate what they considered to be the four most and least important research questions from the 30 questions. In session 1, the highest and lowest questions were determined.

In session 2, facilitators shared a list of questions that were of medium importance, that is, not the highest or lowest priority questions determined in session 1. Facilitators asked participants to categorise these as either: (1) a priority, (2) low priority, (3) not a priority. This was determined by debate, discussion and justification of the participants’ reasoning. The facilitator moved the questions around on the shared slide. The highest ranking questions from session 1 and session 2 were brought together. By the end of the second session each group had a list of top 14 questions ranked in order of importance.

The facilitators then met to combine the top 14 questions from all the small groups, this led to one list of 16 questions. In the third session of the workshop, this combined list of 16 questions was shared with the individual groups for debate. Here the groups were asked to determine and rank their final list of 10 research questions. Facilitators guided this final prioritisation stage by asking groups to focus on questions that would have the highest impact if taken forward as a research question. The groups then came together in a final plenary session and the top two questions from each group were shared with the larger group. After an amalgamation of the top two questions from each group and invariable overlap, the third and fourth questions from each group were added to produce a final list of the top 10 questions.

This three-stage prioritisation project involved a diverse group of stakeholders in prioritising a list of top 10 unanswered research questions for obesity and weight-related research, which are presented here and at: https://www.phc.ox.ac.uk/research/participate/power

Demographics of respondents and questions gathered:

Survey 1 received 278 responses ( table 1 ), yielding 941 original questions ( figure 1 online supplemental table S2 ). Demographic information collected during the survey indicated a diverse range of ages, ethnicities and stakeholder groups among survey respondents. Thirty-seven per cent of respondents had lived experience of obesity, and 80% were educated to degree level or above ( table 1 ).

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Demographic characteristics for respondents to survey 1 and survey 2

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Flow diagram for the priority research questions. RQ, Research questions.

Final top 10 priority research questions*

What are the most effective methods for weight maintenance following weight loss? What are the effective components of treatments/programmes incorporating a behavioural element? How many and in what combination are most effective? What is the optimal duration of these programmes?

What are the most effective methods for weight loss? What are the effective components of treatments/programmes incorporating a behavioural element? How many and in what combination are most effective? What is the optimal duration of these programmes?

What is the most effective and cost-effective mix of population/public health and individual interventions to tackle obesity?

Do interventions that target the ‘obesogenic environment’, such as community interventions, urban planning, placement of fast-food outlets or workplace polices, affect population mean weight and do these effects differ by baseline weight status (underweight, healthy weight, overweight, obesity)? Which interventions are most effective at reaching low socioeconomic groups?

Do interventions (eg, nutrition education and physical activity) in preschool, primary school and secondary school reduce children’s risk of unhealthy weight gain and, if so, how do they act? Does the effect of such interventions differ by social and cultural groups?

What changes in supermarkets or the wider food industry are effective in promoting healthier diets? Does changing labelling and/or packaging on foods affect purchasing, consumption and body weight?

What is the cost and affordability of a healthy balanced diet? How can we make healthier foods more affordable? How can we improve access to healthy diets for social and cultural groups, such as people in poverty, people in inner cities, or young and older people?

How do demographic, social and cultural factors (eg, age, socioeconomic status, lifestyle, environment, psychosocial functioning) affect weight status, weight gain and regional fat distribution? What are the mechanisms involved? Does the effectiveness of weight loss methods depend on social and cultural background and, if so, can the effects be made more equitable? Are weight loss methods tailored to people’s background more effective for weight loss and weight maintenance than general methods?

How accurate are existing models of health consequences of excess weight and the impact of weight loss? Which assumptions are critical in determining the long-term effectiveness and cost effectiveness of weight loss interventions? What do these models predict is the impact of weight loss interventions on health and disease incidence and the cost-effectiveness of such interventions? What is the impact of weight regain on the incidence of disease and cost-effectiveness of weight loss interventions?

What are the drivers of food choice, appetite and intake and do variations in these drives explain who develops obesity and who does not? How does the brain control food intake and can we use these mechanism to aid weight loss? What are the brain responses (neural correlates) in response to food during weight loss and following weight regain?

The 941 questions were grouped by topic. We excluded 49 (5.2%) questions as already answered, and 149, (15.8%) as out of scope ( figure 1 , online supplemental table S2 ). The remaining 743 questions were rephrased following the process above to yield 149 individual research questions ( online supplemental table S3 ). These questions covered a range of topics ( figure 2 ). Of the 941 submitted questions most questions concerned: prevention and intervention; mental health; illness, disease and health; and food industry, policy and environment ( figure 2A ). Of the 149 grouped research questions taken forward ‘illness, disease and health’ and ‘metabolism, physiology and appetite’, were the most popular categories and fewer questions concerned age of onset and duration of obesity ( figure 2B ).

(A) 941 submitted questions by topic; (B) 149 research questions grouped by topic. BMI, body mass index; NHS, National Health Service.

Survey 2 received 405 responses; 61% of respondents reported lived experience with obesity and 74% held an education to degree level or above ( table 1 ). A total of 149 questions to be taken forward from survey 1 were divided into three batches of up to 50 questions, and randomly assigned to respondent’s survey 2. Each question was rated in order of importance, by a mean of 115 people (SD 9.7) ( online supplemental table S3 ).

We invited 64 stakeholders, 39 people confirmed their acceptance and one person dropped out on the day. Thirty-eight attendees (20 female, 18 male) were made up of 4 public members, 8 participants from related organisations, 13 researchers, 7 policy makers and 6 healthcare professionals. One person asked for the question on the role of the gut microbiome to be included from the list of 10 extra questions. At the workshop 31 questions were debated in small groups. In the first session the groups sorted questions into highest and lowest priority. In the second session, the top 14 questions were determined by all groups except one that determined their top 10 and another that grouped questions as high medium and low priority. The facilitators combined the lists from all the groups into a list of 16 as many of the top 14 from each group overlapped. In the third session participants ranked the 16 questions into a top 10 list. The top two from all these lists was shared at a final plenary session. Consolidation of the top two questions and the questions ranked third and fourth resulted in 11 unique research questions by the end of the workshop. On analysis of recordings of each group’s discussion, multiple participants noted that two questions in the 11 that were similar in meaning. We, therefore, combined these two questions (concerning food choice, appetite and the brain’s control of food intake) post hoc to produce a final list of the top 10 research questions ( box 1 ). There was consistency between the top questions in this final list produced from the workshop, and popular questions submitted in the surveys as indicated by number of people asking each question ( online supplemental table S3 ). Five of the final top 10 questions were among the 10 most frequently submitted questions in survey 1. Seven of the final questions were in the top 10 from survey 2, ranked by mean score. The final list of the top 10 priorities are not listed in order of priority ( box 1 ).

Summary of findings

Our priority setting exercise identified the top 10 research questions that stakeholders in the field, and those with an interest overweight and obesity, believe to be the key priorities to advance obesity and weight-related research. In two online surveys and a workshop, we collated nearly 1000 questions, and guided participants in a structured and systematic prioritisation process to reach the final list of 10 ( box 1 ). These questions cover a wide spectrum of areas, and if answered by research, would generate knowledge applicable for individuals, healthcare, public health and policy.

Strengths and limitations

The main strength of this project was the successful collaboration between a diverse range of stakeholder groups, though it was not without its challenges. Our stakeholders included patients, members of the public, clinicians, charities, researchers and policy-makers connected to the field. Identifying the most appropriate group for a condition where a third of the adult population are clinically obese and more than 60% are overweight, while at the same time, considering how to prevent the condition developing which is relevant to the whole population, resulted in the inclusion of both patients and members of the public. Members of the public naturally included some people without lived experience of overweight or obesity, though it seems unlikely that they would not be aware of family members, and friends who are affected, and they may become affected themselves, justifying their inclusion in this prioritisation process. To have found consistency in the questions being posed throughout the entire process by a variety of individuals bringing different experience and expertise to a common area of focus, supports the validity of the resulting top 10 questions. The majority of survey respondents and workshop participants appear to be highly educated. Nonetheless there was evidence of an awareness of the need for interventions to help reduce inequalities and the top 10 priorities include questions on social determinants of health like low-socioeconomic status and cultural factors. We commissioned third-party, impartial facilitators to guide the workshop without input from the research team, so as to not inadvertently sway the prioritisation of questions being considered in each session. Additionally, the number of questions submitted and finally categorised is in line with similar priority setting exercises in health research, using an analogous process set out by the JLA, with a comparable number of stakeholders involved. 13 14

There are limitations that we identified and strived to address throughout the stages of the process. To begin with survey 1, we deemed that 5.2% of all questions submitted were already answered by empirical evidence. We assessed this through a thorough search of the literature to identify systematic reviews, clinical and public health guidelines and high-quality primary studies in the form of RCTs. Although this necessitated some subjective judgement, we ensured that all decisions were made in duplicate, and discrepancies were resolved by a third researcher. Our confidence in the categorisation of answered versus unanswered questions is strengthened by consensus among stakeholders involved, some of whom were researchers with expertise in the question areas being considered. That 5.2% of the submitted questions were considered answered indicates that research may not being adequately communicated in these areas. This could be addressed by improved or targeted communication.

In survey 2, we asked participants to rate questions on a scale of 1–10, but found that participants were disinclined to use the full range. Many questions had means between 6 and 8 meaning that differences in the scoring were subtle. Future work could consider using a condensed scale to perhaps mirror ratings that people are more familiar with (eg, 5-point ratings seen in 5-star reviews or 4-point grading of evidence 15 however unless people used the top and the bottom of the scale a condensed scale could lead to questions being rated as even more similar. In regards to the workshop, while facilitators had standardised methods for the structure of the small group discussion, one group did not rank their questions during the workshop, and instead batched them as high, medium and low priority. This made no difference to the outcome, as the group’s top three high-priority questions were included in the final priority list across all groups.

An additional limitation of the workshop was the shift to a virtual vs in-person meeting due to local COVID-19 restrictions, which limited the length of the discussions. On analysis of the recordings from each group’s consultations, it was clear that the virtual setting maintained a clean discussion where moderators were clearly able to garner input from each participant without anyone talking over-another, as may have been the case in an in-person discussion. It was possible to rank the top 10 in the small groups in the workshop, however, it was harder to achieve this with 38 participants in the plenary sessions so we did not seek to order the final 10 priorities. Lastly, obesity is a worldwide problem calling for a global research response, but we only involved UK-based stakeholders. It is likely that the process identified questions that are generalisable outside of the UK, but it is unlikely that this process fully captured priorities that may be relevant to low-income countries or countries with a low prevalence of overweight and obesity.

Implications for research and policy

The main implication of this work is for the top 10 POWeR to be considered by funding bodies concerned with advancing the field. Similar priority setting work in other areas of health research have resulted in research calls that reflect priorities identified by stakeholders. 16 Along with the top 10 questions, this project identified a further 139 unanswered questions that may also serve as a resource for researchers trying to match gaps in the evidence with perceived needs.

We make two recommendations for future priority setting exercises in this area based on what we learnt from the process. The first would be to limit the focus to a prespecified area in the field. The breadth of topic areas produced by the large number of stakeholders engaged was onerous to process, and resulted in high level areas for research. Future exercises may wish to restrict their scope to a certain area of research, such as treatment for people living with obesity, or population-wide prevention strategies to allow more granular questions to emerge. The second would be to incorporate work to boost awareness of the existing research evidence for common questions that were submitted, but deemed to be answered. Questions that were commonly submitted, but already answered and therefore excluded from progressing through the prioritisation process are telling of a discrepancy between published research and knowledge dissemination.

We have identified 10 priorities that cover: the role of the obesogenic environment; effective weight loss and maintenance; prevention in children; effective prevention and treatment policies; the role of the food industry; access to and affordability of healthy diets; the sociocultural factors associated with weight; the biology of appetite and food intake and long-term health modelling. Research funders may want to prioritise these questions when considering research proposals, or commissioning programmes of research to answer these key questions.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

The study was approved by the University of Oxford Medical Sciences Inter Divisional Research Ethics Committee (Ref: R6721/RE003). Participants gave informed consent to participate in the study before taking part.

Acknowledgments

We would like to thank Nicola Lindson and Jamie Hartmann Boyce for help and guidance and David Dyson, Gavin Hubbard, Alice Crouch and Dan Richard-Doran for support with the surveys and webpages, Michaela Noriek for help with public engagement, Goher Ayman for helpful advice We also want to thank everyone who worked on the POWER project including all the members of the health behaviours team who helped us with questions from survey 1. Elizabeth Morris, Carmen Piernas-Sanchez, Dimitrios Koutoukidis, Tanisha Spratt, Anne Ferrey, and Jenny Brooks. We would like to thank all the people who took the surveys and provided us with their original questions, everyone who ranked the questions and to all the workshop participants and the many organisations that distributed the surveys on our behalf. We are grateful to the workshop participants for giving us their time. We would like to thank Hopkins Van Mil for conducting the workshop.

NHS DIgital
World Health Organization
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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Data supplement 1

Contributors NMA, PA and SAJ conceived the concept. ARB, LG and NMA were responsible for collecting and collating data with guidance from PS and BC. ARB, LG, AH and NMA produced an initial draft of the manuscript, PA, SAJ, PS and BC provided comments and edited the original draft. All authors reviewed and approved the final submitted version of the manuscript. NMA is responsible for the overall content as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

Funding The study was funded by the National Institute for Health Research (NIHR) Oxford and Thames Valley Applied Research Collaboration. NMA, PA and SAJ are supported by the NIHR Oxford Biomedical Research Centre. PA and SAJ are NIHR senior investigators.

Disclaimer The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views are those expressed by the authors and not necessarily those of the NHS, NIHR, or Department of Health.

Competing interests NA, PA, and SAJ led an investigator-initiated study funded by Cambridge Weight Plan. PA has spoken at two symposia organised by the Royal College of General Practitioners that were funded by Novo Nordisk. None of these activities led to personal payment. ARB, LG, AH, PS and BC have no interests to declare.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Obesity Research

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Over the years, NHLBI-supported research on overweight and obesity has led to the development of evidence-based prevention and treatment guidelines for healthcare providers. NHLBI research has also led to guidance on how to choose a behavioral weight loss program.

Studies show that the skills learned and support offered by these programs can help most people make the necessary lifestyle changes for weight loss and reduce their risk of serious health conditions such as heart disease and diabetes.

Our research has also evaluated new community-based programs for various demographics, addressing the health disparities in overweight and obesity.

NHLBI research that really made a difference

In 1991, the NHLBI developed an Obesity Education Initiative to educate the public and health professionals about obesity as an independent risk factor for cardiovascular disease and its relationship to other risk factors, such as high blood pressure and high blood cholesterol. The initiative led to the development of clinical guidelines for treating overweight and obesity.
The NHLBI and other NIH Institutes funded the Obesity-Related Behavioral Intervention Trials (ORBIT) projects , which led to the ORBIT model for developing behavioral treatments to prevent or manage chronic diseases. These studies included families and a variety of demographic groups. A key finding from one study focuses on the importance of targeting psychological factors in obesity treatment.

Current research funded by the NHLBI

The Division of Cardiovascular Sciences , which includes the Clinical Applications and Prevention Branch, funds research to understand how obesity relates to heart disease. The Center for Translation Research and Implementation Science supports the translation and implementation of research, including obesity research, into clinical practice. The Division of Lung Diseases and its National Center on Sleep Disorders Research fund research on the impact of obesity on sleep-disordered breathing.

Find funding opportunities and program contacts for research related to obesity and its complications.

Current research on obesity and health disparities

Health disparities happen when members of a group experience negative impacts on their health because of where they live, their racial or ethnic background, how much money they make, or how much education they received. NHLBI-supported research aims to discover the factors that contribute to health disparities and test ways to eliminate them.

NHLBI-funded researchers behind the RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study want to discover why people in poor rural communities in the South have shorter, unhealthier lives on average. The study includes 4,000 diverse participants (ages 35–64 years, 50% women, 44% whites, 45% Blacks, 10% Hispanic) from 10 of the poorest rural counties in Kentucky, Alabama, Mississippi, and Louisiana. Their results will support future interventions and disease prevention efforts.
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is looking at what factors contribute to the higher-than-expected numbers of Hispanics/Latinos who suffer from metabolic diseases such as obesity and diabetes. The study includes more than 16,000 Hispanic/Latino adults across the nation.

Find more NHLBI-funded studies on obesity and health disparities at NIH RePORTER.

Closeup view of a healthy plate of vegan soul food prepared for the NEW Soul program.

Read how African Americans are learning to transform soul food into healthy, delicious meals to prevent cardiovascular disease: Vegan soul food: Will it help fight heart disease, obesity?

Current research on obesity in pregnancy and childhood

The NHLBI-supported Fragile Families Cardiovascular Health Follow-Up Study continues a study that began in 2000 with 5,000 American children born in large cities. The cohort was racially and ethnically diverse, with approximately 40% of the children living in poverty. Researchers collected socioeconomic, demographic, neighborhood, genetic, and developmental data from the participants. In this next phase, researchers will continue to collect similar data from the participants, who are now young adults.
The NHLBI is supporting national adoption of the Bright Bodies program through Dissemination and Implementation of the Bright Bodies Intervention for Childhood Obesity . Bright Bodies is a high-intensity, family-based intervention for childhood obesity. In 2017, a U.S. Preventive Services Task Force found that Bright Bodies lowered children’s body mass index (BMI) more than other interventions did.
The NHLBI supports the continuation of the nuMoM2b Heart Health Study , which has followed a diverse cohort of 4,475 women during their first pregnancy. The women provided data and specimens for up to 7 years after the birth of their children. Researchers are now conducting a follow-up study on the relationship between problems during pregnancy and future cardiovascular disease. Women who are pregnant and have obesity are at greater risk than other pregnant women for health problems that can affect mother and baby during pregnancy, at birth, and later in life.

Find more NHLBI-funded studies on obesity in pregnancy and childhood at NIH RePORTER.

Learn about the largest public health nonprofit for Black and African American women and girls in the United States: Empowering Women to Get Healthy, One Step at a Time .

Current research on obesity and sleep

An NHLBI-funded study is looking at whether energy balance and obesity affect sleep in the same way that a lack of good-quality sleep affects obesity. The researchers are recruiting equal numbers of men and women to include sex differences in their study of how obesity affects sleep quality and circadian rhythms.
NHLBI-funded researchers are studying metabolism and obstructive sleep apnea . Many people with obesity have sleep apnea. The researchers will look at the measurable metabolic changes in participants from a previous study. These participants were randomized to one of three treatments for sleep apnea: weight loss alone, positive airway pressure (PAP) alone, or combined weight loss and PAP. Researchers hope that the results of the study will allow a more personalized approach to diagnosing and treating sleep apnea.
The NHLBI-funded Lipidomics Biomarkers Link Sleep Restriction to Adiposity Phenotype, Diabetes, and Cardiovascular Risk study explores the relationship between disrupted sleep patterns and diabetes. It uses data from the long-running Multiethnic Cohort Study, which has recruited more than 210,000 participants from five ethnic groups. Researchers are searching for a cellular-level change that can be measured and can predict the onset of diabetes in people who are chronically sleep deprived. Obesity is a common symptom that people with sleep issues have during the onset of diabetes.

Find more NHLBI-funded studies on obesity and sleep at NIH RePORTER.

Learn about a recent study that supports the need for healthy sleep habits from birth: Study finds link between sleep habits and weight gain in newborns .

Obesity research labs at the NHLBI

The Cardiovascular Branch and its Laboratory of Inflammation and Cardiometabolic Diseases conducts studies to understand the links between inflammation, atherosclerosis, and metabolic diseases.

NHLBI’s Division of Intramural Research , including its Laboratory of Obesity and Aging Research , seeks to understand how obesity induces metabolic disorders. The lab studies the “obesity-aging” paradox: how the average American gains more weight as they get older, even when food intake decreases.

Related obesity programs and guidelines

Aim for a Healthy Weight is a self-guided weight-loss program led by the NHLBI that is based on the psychology of change. It includes tested strategies for eating right and moving more.
The NHLBI developed the We Can! ® (Ways to Enhance Children’s Activity & Nutrition) program to help support parents in developing healthy habits for their children.
The Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project standardizes data collected from the various studies of obesity treatments so the data can be analyzed together. The bigger the dataset, the more confidence can be placed in the conclusions. The main goal of this project is to understand the individual differences between people who experience the same treatment.
The NHLBI Director co-chairs the NIH Nutrition Research Task Force, which guided the development of the first NIH-wide strategic plan for nutrition research being conducted over the next 10 years. See the 2020–2030 Strategic Plan for NIH Nutrition Research .
The NHLBI is an active member of the National Collaborative on Childhood Obesity (NCCOR) , which is a public–private partnership to accelerate progress in reducing childhood obesity.
The NHLBI has been providing guidance to physicians on the diagnosis, prevention, and treatment of obesity since 1977. In 2017, the NHLBI convened a panel of experts to take on some of the pressing questions facing the obesity research community. See their responses: Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (PDF, 3.69 MB).
In 2021, the NHLBI held a Long Non-coding (lnc) RNAs Symposium to discuss research opportunities on lnc RNAs, which appear to play a role in the development of metabolic diseases such as obesity.
The Muscatine Heart Study began enrolling children in 1970. By 1981, more than 11,000 students from Muscatine, Iowa, had taken surveys twice a year. The study is the longest-running study of cardiovascular risk factors in children in the United States. Today, many of the earliest participants and their children are still involved in the study, which has already shown that early habits affect cardiovascular health later in life.
The Jackson Heart Study is a unique partnership of the NHLBI, three colleges and universities, and the Jackson, Miss., community. Its mission is to discover what factors contribute to the high prevalence of cardiovascular disease among African Americans. Researchers aim to test new approaches for reducing this health disparity. The study incudes more than 5,000 individuals. Among the study’s findings to date is a gene variant in African Americans that doubles the risk of heart disease.

Explore more NHLBI research on overweight and obesity

The sections above provide you with the highlights of NHLBI-supported research on overweight and obesity . You can explore the full list of NHLBI-funded studies on the NIH RePORTER .

To find more studies:

Type your search words into the Quick Search box and press enter.
Check Active Projects if you want current research.
Select the Agencies arrow, then the NIH arrow, then check NHLBI .

If you want to sort the projects by budget size — from the biggest to the smallest — click on the FY Total Cost by IC column heading.

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Obesity in america: research obesity, start learning about your topic.

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Obesity is a complex issue with many causes and consequences. You could concentrate on one set of issues and do in-depth research on that or use several of the questions below to focus on the topic of obesity more generally.

Is obesity a serious problem?
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Overweight and Obesity From the Centers for Disease Control and Prevention, this site provides data and statistics on obesity.
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Strategic Plan

Strategic Plan for NIH Obesity Research

The Purpose of the Strategic Plan

The Strategic Plan for NIH Obesity Research serves as a guide to accelerate a broad spectrum of research toward developing new and more effective approaches to address the tremendous burden of obesity, so that people can look forward to healthier lives.

The Plan was originally published in 2011. In 2018-2019, the Obesity Research Task Force confirmed that the challenges and opportunities identified in the Plan reflect the current research landscape and should continue to guide obesity research.

Full Report for the scientific community (PDF, 716.76 KB)
Summary Report non-technical (PDF, 627.47 KB)
View a video of former NIH Director Dr. Francis Collins discussing the Strategic Plan

Development of the Strategic Plan

The Strategic Plan was developed by the NIH Obesity Research Task Force with crucial input from researchers external to the NIH, professional and other health-focused organizations, and others through a public comment period. Research challenges and opportunities identified at meetings and workshops also helped shape the Strategic Plan, and will continue to inform NIH research planning.

Major Themes for Research Highlighted in the Strategic Plan

Research Opportunities:

Discover fundamental biological processes that regulate body weight and influence behavior
Understand the factors that contribute to obesity and its consequences
Design and test new interventions for achieving and maintaining a healthy weight
Evaluate promising strategies for obesity prevention and treatment in real-world settings and diverse populations
Harness technology and tools to advance obesity research and improve healthcare delivery

Application of Research Findings:

Facilitate integration of research results into community programs and medical practice

Questions and Answers

What are the goals of the plan.

The efforts of many individuals and institutions are essential to reducing the prevalence of obesity – including government, businesses, community organizations, healthcare professionals, schools, and families. Research can provide the foundation for these efforts. As the country's medical research agency, the NIH funds a spectrum of research to reduce the prevalence and burden of obesity. Research can lead to a better understanding of the causes and consequences of obesity and will give us the evidence for what works to prevent and treat obesity. In addition, research will help us reduce health disparities and inform policies.

Researchers seek to answer many questions, for example:

How can we increase and use our knowledge of human biology and behavior to develop new and more effective prevention and treatment approaches?
What aspects of our community environments and daily lives contribute to unhealthy eating and insufficient physical activity–and what can we change to make it easier for people to achieve a healthy weight?
How can we rigorously evaluate interventions–whether based on individual lifestyle changes, pharmacological or surgical approaches, community-based programs, policy changes, or other environmental changes–to determine which really work?
How do we scale up the approaches that show promise and expand those proven effective, in order to reach more people?
Given that no single intervention will solve this complex problem, how can we continue to develop new and innovative approaches?

We hope that the plan will serve as a guide to accelerate progress in obesity research, and that this research will ultimately help extend healthy life and reduce the burdens of illness and disability.

Why create a strategic plan for obesity research?

Obesity is highly prevalent in the United States. Obesity increases a person’s chance of developing many health problems, including type 2 diabetes, heart disease, high blood pressure, fatty liver disease, respiratory problems (e.g., asthma and sleep apnea), and some cancers. Obesity adversely affects people's quality of life and exacts a substantial economic toll on the nation.

Obesity arises from a complex interplay of forces and affects some populations disproportionately. We need to take a multifaceted approach to combat it. Simply telling people to "eat less and exercise more" is not enough.

Research is the foundation for finding viable solutions. Research allows us to explore the roles that genetics and biology, our environment, and our lifestyles play in obesity – and to transform that knowledge into better prevention and treatment strategies. Through research, we rigorously evaluate interventions to see which ones really work and who can benefit most.

How can scientists apply to the NIH for funding for obesity-related research?

Information on funding opportunities , including lists of NIH obesity-related research solicitations, is available.

The strategic plan identifies and encourages a broad range of research opportunities and priorities to accelerate obesity research.

Researchers can obtain information about applying for NIH funding, and about the peer review system through which applications are evaluated, on the NIH Grants and Funding website . NIH publishes Notices of Funding Opportunities to solicit research on topics specific to many diseases and conditions, including obesity. Additionally, researchers are invited to submit applications independent of these topic-specific solicitations. View complete listings of all NIH research solicitations .

Grant applications that fall within the areas covered in the strategic plan are considered under the same review processes as other NIH research applications.

Who can be involved in implementing the strategic plan?

Advancing the progress of obesity research requires a strong pool of researchers with diverse areas of expertise who are dedicated to understanding and ameliorating obesity and its many adverse outcomes.

But researchers alone can't solve the obesity problem. We need the commitment of policymakers, healthcare practitioners, businesses, communities, families, and individuals to partner in research and implement what we learn. The NIH works with groups across the country and around the world—including universities, medical centers, businesses, schools, and communities—to study obesity, develop and evaluate strategies for prevention and treatment, train researchers, and teach people about science-based interventions to improve their health.

How can people act on the plan?

Everyone can play a role in enhancing obesity research and moving research results to longer and healthier lives. For example:

Researchers can submit obesity-related grant applications that align with the areas of opportunity highlighted in the plan.
When taking actions to reduce obesity—such as adding sidewalks or playgrounds to increase opportunities for physical activity or improving access to fresh, healthy foods—policymakers, community organizations, and others can participate in research to evaluate these efforts, to determine what is working, and how successful approaches could be expanded.
The public can participate in clinical research studies to help inform the science of obesity – helping scientists to identify contributing factors and evaluate new prevention and treatment strategies.

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Obesity and Nutrition

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More than one-third of U.S. adults — and about 17 percent of U.S. children — are obese. Obesity puts people at risk for many health issues including heart disease, stroke, type 2 diabetes, arthritis, and certain types of cancer. Because these conditions are some of the top preventable causes of chronic illness and death, NIH has a considerable interest in addressing obesity.

The problem of obesity seems straightforward: When we eat more calories than we burn, our bodies store this extra energy as fat. Yet, we all know how hard it can be just to lose a few pounds. And solving this problem on a population-sized scale has proven to be tremendously difficult. That is because so many factors play a role: where we live and work, how much time we spend sitting – and the availability of safe spaces for exercise – and the fact that many people cannot choose alternatives. Access to nutritious food can be a major barrier for many with low incomes or mobility limitations.

Heredity also has an impact. For example, NIH research shows that certain gene variations that occur in one of six people of European descent translate into an extra 7 pounds, on average. Those discoveries are pointing to pathways involved in obesity that suggest potential ways to prevent undesirable weight gain. Research on the social factors contributing to obesity also offers ideas for intervention. When people are provided funds to buy food once a week, instead of monthly, they are more likely to buy fresh fruits and vegetables instead of pre-packaged (and often less-nutritious) goods. We also know that affordable housing programs lead to better nutrition, because people no longer must compromise on food in order to pay rent.

Did you know?

NIH research funding across the nation generated $65 billion in new economic activity in 2016.

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This page last reviewed on November 16, 2023

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Six Hard Questions to Ask About Obesity Cause and Effect

Yesterday, Kevin Fontaine and David Allison opened their third conference on causality in obesity research at the UAB Nutrition and Obesity Research Center. They explained the growing urgency to ask hard questions about cause and effect in obesity.

Targeting Elusive Causes for Obesity

For three decades, obesity prevalence has been growing relentlessly. And yet, we do not know exactly why. Plenty of ideas come forward to explain it. And some become articles of faith. Through the 1980s and 1990s, high-fat foods were prime suspects. And yet policies to promote lower-fat diets appeared to make the problem worse.

As a result, attention has shifted to sugar. Policymakers now regard added sugars in processed foods as especially bad actors. So consumers are growing wary of them and nutrition facts labels will soon call them out. Soda taxes are gaining traction in many places to target added sugar.

Many other causes – e.g. food deserts, restaurant food, built environments – receive attention for contributing to obesity. But efforts to reduce their presumed impact have yielded little success.

Allison and Fontaine acknowledge progress in understanding obesity – its physiology, genetics, neuroscience, measurement, stigma, and more. But progress on interventions has been more modest. Despite advances on behavioral, drug, and surgical therapies, the current options leave much to be desired.

Population-health strategies have not yet been adequate to reverse the continuing rise in obesity’s impact on health.

Asking Hard Questions

Considering all this, we need to ask hard questions about what we think we know about obesity.

1. How can we know that? For instance, how can we be more confident of dietary factors that contribute to obesity. Presumptions and logic are not good enough.

2. What else could explain this? Reverse causality is just one explanation frequently overlooked.

3. Does the study test it? Without an adequate design, we cannot know if a cause and effect relationship truly exists. Associations are mere starting points.

4. What’s the mechanism? If we cannot explain how a presumed effect might result from an action or an exposure, causality remains a assumption. Not a fact.

5. Can we measure it? Without robust methods, we cannot provide reliable results. Measuring dietary intake in the real world is one such challenge.

6. Did we measure the real outcome? Surrogate measures are convenient, but useless if not validated. Many of the outcomes for soda taxes are tied only to soda consumption. Overall dietary patterns are tougher to measure. But the real outcome to watch is the impact on obesity prevalence. We have nothing on that yet, except for high hopes.

Children have great skills for asking hard, but simple questions. Perhaps we can remember to do the same.

For more information on this year’s conference, along with the full video proceedings of the first two, click here .

Any Questions? Photograph © Matthias Ripp / flickr

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July 25, 2017

One Response to “Six Hard Questions to Ask About Obesity Cause and Effect”

July 29, 2017 at 12:04 pm, Allen Browne said:

I wish I could have been there.

Data and reason can overcome dogma and bias.

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Research Priorities

The NIH supports obesity research across the lifespan, examining the causes and consequences of obesity, developing and evaluating new prevention and treatment strategies, and determining how to implement and expand promising approaches to reach those who could most benefit.

Resources for Researchers

Explore databases and tools for obesity research.

Cancer Trends Progress Report: Weight

National data trends that examine obesity prevention and reducing the risk of certain types of cancer, and improving cancer outcomes.

Catalogue of Surveillance Systems

Access to over 100 publicly available datasets relevant to childhood obesity research, including obesity-related health behaviors, outcomes, and determinants; and policies and environmental factors.

Measures Registry

User guides to help researchers select measures for studies in obesity among youth, including an overview of measurement, principles of measurement selection, case studies, and resources.

Registry of Studies

A searchable database of community-based studies assessing known factors impacting rates of childhood obesity, providing information on the study design, measures, content areas, and populations examined.

Interested in funding opportunities or planning to submit an application in obesity research? Use these tools to find what you need:

NIH-Funded Projects

ClinicalTrials.gov

NIH Institutes/Centers and Federal Partner Activities

Many NIH Institutes and Centers (ICs) actively engage in and support obesity research and may be helpful starting points as you plan your research or if you’re exploring the latest work in a specific area. Because ICs and other federal agencies may have several ongoing obesity programs and projects, we encourage you to use the links provided to find the most up-to-date information, including how to contact program officials who may be able to address your specific questions.

U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP)

Healthy People 2030 – Overweight and Obesity

Centers for Disease Control and Prevention (CDC)

Division of Nutrition, Physical Activity, and Obesity

National Cancer Institute (NCI)

Health Behaviors Research Branch (HBRB)
Risk Factor Assessment Branch (RFAB)

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Section on Overweight and Obesity
Pediatric Growth and Nutrition Branch (PGNB)
Pregnancy and Perinatology Branch (PPB)
Fertility and Infertility (FI) Branch
Intellectual and Developmental Disabilities Branch (IDDB)
Child Development and Behavior Branch (CDBB)
Division of Intramural Population Health (DIPHR)

National Heart, Lung, and Blood Institute (NHLBI)

National institute of diabetes and digestive and kidney diseases (niddk).

Office of Obesity Research (OOR)
NIH Obesity Research Task Force

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Adult Obesity Prevalence Remains High; Support for Prevention and Treatment Needed

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Table of Contents

what is a good research question for obesity

Obesity is such a disease when the percent of body fat has negative effects on a person’s health. The topic is very serious as obesity poisons the lives of many teens, adults and even children around the whole world.

Can you imagine that according to WHO (World Health Organization) there were 650 million obese adults and 13% of all 18-year-olds were also obese in 2016? And scientists claim that the number of them is continually growing.

There are many reasons behind the problem, but no matter what they are, lots of people suffer from the wide spectrum of consequences of obesity.

Basic guidelines on obesity research paper

Writing any research paper requires sticking to an open-and-shut structure. It has three basic parts: Introduction, Main Body, and Conclusion.

According to the general rules, you start with the introduction where you provide your reader with some background information and give brief definitions of terms used in the text. Next goes the thesis of your paper.

The thesis is the main idea of all the research you’ve done written in a precise and simple manner, usually in one sentence.

The main body is where you present the statements and ideas which disclose the topic of your research.

In conclusion, you sum up all the text and make a derivation.

How to write an obesity thesis statement?

As I’ve already noted, the thesis is the main idea of your work. What is your position? What do you think about the issue? What is that you want to prove in your essay?

Answer one of those questions briefly and precisely.

Here are some examples of how to write a thesis statement for an obesity research paper:

The main cause of obesity is determined to be surfeit and unhealthy diet.
Obesity can be prevented no matter what genetic penchants are.
Except for being a problem itself, obesity may result in diabetes, cancers, cardiovascular diseases, and many others.
Obesity is a result of fast-growing civilization development.
Not only do obese people have health issues but also they have troubles when it comes to socialization.

20 top-notch obesity research paper topics

Since the problem of obesity is very multifaceted and has a lot of aspects to discover, you have to define a topic you want to cover in your essay.

How about writing a fast food and obesity research paper or composing a topic in a sphere of fast food? Those issues gain more and more popularity nowadays.

A couple of other decent ideas at your service.

The consequences of obesity.
Obesity as a mental problem.
Obesity and social standards: the problem of proper self-fulfilment.
Overweight vs obesity: the use of BMI (Body Mass Index).
The problem of obesity in your country.
Methods of prevention the obesity.
Is lack of self-control a principal factor of becoming obese?
The least obvious reasons for obesity.
Obesity: the history of the disease.
The effect of mass media in augmentation of the obesity level.
The connection between depression and obesity.
The societal stigma of obese people.
The role of legislation in reducing the level of obesity.
Obesity and cultural aspect.
Who has the biggest part of the responsibility for obesity: persons themselves, local authorities, government, mass media or somebody else?
Why are obesity rates constantly growing?
Who is more prone to obesity, men or women? Why?
Correlation between obesity and life expectancy.
The problem of discrimination of the obese people at the workplace.
Could it be claimed that such movements as body-positive and feminism encourage obesity to a certain extent?

Best sample of obesity research paper outline

An outline is a table of contents which is made at the very beginning of your writing. It helps structurize your thoughts and create a plan for the whole piece in advance.

…Need a sample?

Here is one! It fits the paper on obesity in the U.S.

Introduction

Hook sentence.
Thesis statement.
Transition to Main Body.
America’s modern plague: obesity.
Statistics and obesity rates in America.
Main reasons of obesity in America.
Social, cultural and other aspects involved in the problem of obesity.
Methods of preventing and treating obesity in America.
Transition to Conclusion.
Unexpected twist or a final argument.
Food for thought.

Specifics of childhood obesity research paper

A separate question in the problem of obesity is overweight children.

It is singled out since there are quite a lot of differences in clinical pictures, reasons and ways of treatment of an obese adult and an obese child.

Writing a child obesity research paper requires a more attentive approach to the analysis of its causes and examination of family issues. There’s a need to consider issues like eating habits, daily routine, predispositions and other.

Childhood obesity outline example

As the question of childhood obesity is a specific one, it would differ from the outline on obesity we presented previously.

Here is a sample you might need. The topic covers general research on child obesity.

The problem of childhood obesity.
World’s childhood obesity rates.
How to diagnose the disease.
Predisposition and other causes of child obesity.
Methods of treatment for obese children.
Preventive measures to avoid a child’s obesity.

On balance…

The topic of obesity is a long-standing one. It has numerous aspects to discuss, sides to examine, and data to analyze.

Any topic you choose might result in brilliant work.

How can you achieve that?

Follow the basic requirements, plan the content beforehand, and be genuinely interested in the topic.

Option 2. Choose free time over struggle on the paper. We’ve got dozens of professional writers ready to help you out. Order your best paper within several seconds and enjoy your free time. We’ll cover you up!

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399 Obesity Essay Topics & Research Questions + Examples

Are you looking for the best obesity essay topics? You are at the right place! We’ve compiled a list of obesity research questions and catchy titles about various aspects of this problem. Read on to discover the most controversial topics about obesity for your research paper, project, argumentative essay, persuasive speech, and other assignments.

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The Causes and Effects of Obesity
Unhealthy Food Culture and Obesity
Childhood Obesity: The Parents’ Responsibility
Causes and Consequences of Childhood Obesity
Parents Are Not to Blame for Obesity in Children
Childhood Obesity: Causes and Solutions
Link Between Watching Television and Obesity
Obesity Issue: Application of Nursing Theory This analysis will show that well-established theories are valuable to nursing problem-solving as frameworks for analyzing issues and planning solutions.
Junk Food and Children’s Obesity Eating junk foods on a regular basis causes weight gain and for one in five Americans, obesity, is a major health concern though no one seems to be sounding the alarm.
Health Promotion Proposal Obesity Prevention The purpose of this proposal is to inform and educate parents, children and adolescents of the importance of having a well balance diet and exercise in their daily lives to avoid obesity.
Obesity as a Disease: Arguments For and Against Although some people consider that obesity is a disease caused by biological and psychological factors, others are confident that it should not be perceived as a disease.
Children Obesity Prevention Proposals The purpose of this paper is to propose the study of motivational interviewing benefits in preventing childhood obesity in the context of the literature review method.
Obesity Prevention and Weight Management Theory The issue of obesity prevention will be guided by a nursing theory. One of the theories applicable in the case of childhood overweight is a theory of weight management.
Obesity: A Personal Problem and a Social Issue Obesity is a problem affecting many persons and society as a whole. According to World Health Organization, over 40% of the US population is either overweight or outright obese.
Obesity in Children and Adolescents: Quantitative Methods Obesity in children and adolescents has increasingly become prevalent in the recent past and is now a major problem in most developed countries.
Health Promotion for Obesity in Adults This is a health promotion proposal for preventing obesity among adults in the US. People get obesity when they acquire a given body mass index.
Childhood Obesity and Nutrition The prevalence of childhood obesity in schools can be compared to an epidemic of a virulent disease on a global scale.
Obesity Prevention: Social Media Campaign A variety of programs aimed at reducing the risk of obesity has been suggested by healthcare practitioners and scholars. Among them, diet interventions are highly popular.
Obesity: Background and Preventative Measures Obesity is an epidemic. It tends to have more negative than positive effects on the economy and can greatly reduce one’s life expectancy.
Physical Exercises as Obesity Treatment Exercise cannot be considered an effective tool for weight loss, but it does help individuals to maintain their normal and healthy weight.
Betty Neuman’s System Model for Adult Obesity Betty Neuman’s system model can beneficially influence a physical and emotional state of the person who is experiencing difficulties with being overweight.
Obesity in the World: the Prevalence, Its Effects to Human Health, and Causes There are various causes of obesity ranging from the quantity of food ingested to the last of physical exercises that utilize the accumulated energy.
Prevention of Obesity in Teenagers This paper aims to create an education plan for teenage patients and their parents to effectively inform them and help them avoid obesity.
Childhood Obesity Prevention: The Role of Nursing Education Nurse practitioners have to deal with childhood obesity challenges and identity healthy physical and environmental factors to help pediatric patients and their parents.
Childhood Obesity: Methods and Data Collection The first instrument that will be used in data collection is body mass index (BMI). The BMI is measured by dividing a patient’s weight in kilograms by height in meters squared.
Childhood Obesity Study and Health Belief Model A field experiment will be used in the research to identify the impact of a healthy lifestyle intervention on children diagnosed with obesity.
Childhood Obesity: Causes and Effects Childhood obesity has many causes and effects, which denotes that parents and teachers should make children with obesity engage in regular physical exercise in school and at home.
The Consequences of Obesity: An Annotated Bibliography To review the literature data, the authors searched for corresponding articles on the PubMed database using specific keywords.
Obesity, Diabetes and Self-Care The paper discusses being overweight or obese is a high-risk factor for diabetes mellitus and self-care among middle-aged diabetics is a function of education and income.
Depression as It Relates to Obesity This paper will argue that there is a positive correlation between depression and obesity. The paper will make use of authoritative sources to reinforce this assertion.
Nursing Diabetes and Obesity Patients Nursing diabetes and obese patients are regarded as one of the most serious problems of contemporary nursing practices.
Childhood Obesity: Research Methodology Based on their body mass index measurement or diagnosis by a qualified physician, all children in the sample should be qualified as having obesity.
Pediatric Obesity and Self-Care Nursing Theory The presence of excess body fat in children has to be given special consideration since healthy childhood is a prerequisite to normal physical and psychological maturation.
Childhood Obesity Interventions: Data Analysis The described analysis of research variables will make it possible to test the research and null hypotheses and contribute to the treatment of obesity in children.
Obesity Counteractions in Clark County, Washington The prevalence of obesity has been increasing sharply among children and adults in the Clark County because of the failure to observe healthy eating habits.
Nutrition and Obesity: Management and Prevention Obesity is currently one of the leading health problems in the United States. Three quarters of all Americans will be either overweight or obese if the current trend continues.
Obesity Interventions and Nursing Contributions Detecting health problems that may affect children later in their adulthood is worthwhile. This paper reviews roles of nurses’ actions in replacing obesity with wellness.
Parents’ Education in Childhood Obesity Prevention It can be extremely important to compare and contrast the role of parent education and common methods of treatment in childhood obesity prevention.
Link Between Obesity and Genetics Obesity affects the lives through limitations implemented on the physical activity, associated disorders, and even emotional pressure.
Obesity in Miami-Dade Children and Adults The problem of childhood obesity is rather dangerous and may produce a short-term and long-term effect on young patients’ social, emotional, and physical health.
Obesity as a Global Health Issue The purpose of this research is to identify obesity as a global health issue, evaluate the methods and findings conducted on obesity, and find solutions to reduce obesity globally.
Addressing Teenage Obesity in America The paper states that adolescence is one of the most crucial developmental phases of human life during which the issue of obesity must be solved.
Oral Health and Obesity Among Adolescents This research paper developed the idea of using dental offices as the primary gateway to detect potential obesity among Texas adolescents.
The Science Behind Obesity and Its Impact on Cancer The paper addresses the connection between cancer and physical activity, diet, and obesity in Latin America and the USA. The transitions in dietary practices may be observed.
Obesity From Sociological Perspectives The social problem under focus is obesity originating from Latino food norms. The problem of obesity is the direct result of adherence to social norms.
Obesity: Causes, Consequences, and Care Nowadays, an increasing number of people suffer from having excess weight. This paper analyzes the relationship between obesity and other diseases.
Obesity Prevention Policy Making in Texas Obesity is a national health problem, especially in Texas; therefore, the state immediately needed to launch a policy to combat and prevent obesity in the population.
Childhood Obesity: Quantitative Annotated Bibliography Childhood obesity is a problem that stands especially acute today, in the era of consumerism. Children now have immense access to the Internet.
Behavioral Modifications for Patients With Obesity This paper aims to find out in obese patients, do lifestyle and behavioral changes, compared to weight loss surgery, improve patients’ health and reduce complications.
Sleep Deprivation Effects on Adolescents Who Suffer From Obesity The academic literature on sleep deprivation argues that it has a number of adverse health effects on children and adolescents, with obesity being one of them.
Eating Fast Food and Obesity Correlation Analysis The proposed study will attempt to answer the question of what is the relationship between eating fast food and obesity, using correlation analysis.
Adult Obesity: Treatment Program An effective treatment program for obese patients ought to have a significant impact on the utilization of medical resources and the costs of health care.
A Dissemination Plan on Adolescent Obesity and Falls in Elderly Population Research on clinical diagnoses and conditions is essential for obtaining practical information and adjusting current intervention strategies.
How to Reduce Obesity and Maintain Health? Health is becoming a matter of grave concern, especially the health of teenagers and adolescents, who are becoming increasingly overweight and obese.
Childhood Obesity: Medical Complications and Social Problems The children have also suffered from the adverse effects that have been instilled into our society. Obesity has become a common problem in children of American and European countries.
Depression and Other Antecedents of Obesity Defeating the inertia about taking up a regular programme of sports and exercise can be a challenging goal. Hence, more advocacy campaigns focus on doing something about obesity with a more prudent diet.
Obesity Management: Hypothesis Test Study This paper will show how a hypothesis test study can help inform evidence-based practice regarding obesity management.
The Epidemiology of Obesity Nowadays, the weight loss strategies are promoted in modern media as the quickest and easiest ways to become slim.
Community Health: Obesity Prevention The community is located in the state of Florida’s most southeastern part. The data obtained from the 2017 census indicates that the county is the most populous one in the state.
Obesity Treatment in Primary Care: Evidence-Based Guide This paper gives a detailed discussion and critical analysis of the article, “An Evidence-Based Guide for Obesity Treatment in Primary Care” by Fitzpatrick et al.
Obesity in School-Aged Children as a Social Burden In addition to personal concerns, overweight and obese children are at risk for long-term health consequences, including cardiovascular problems and additional comorbidities.
Childhood Obesity Prevention: Physical Education and Nutrition The paper examines how physical education in schools can prevent child obesity and how to educate parents about the importance of proper nutrition.
Childhood Obesity and Self-Care Deficit Theory To help the target audience develop an understanding of the effects that their eating behavior has on their health, Dorothea Orem’s Theory of Self-Care Deficit can be utilized.
Childhood Obesity Causes: Junk Food and Video Games The problem of “competitive foods and beverages” that are sold in schools outside the existing breakfast and lunch programs has been discussed for a while now.
Childhood Obesity Risks, Reasons, Prevention In the modern world, obesity is the most widely spread health problem among children. That is why it should be the primary concern of the public.
Fast Food as a Cause of Obesity in the US and World In the contemporary rapidly developing world people are always on the move. They want to save time whenever it is possible.
Child Obesity as London’s Urban Health Issue According to the World Health Organisation, child obesity is regarded as one of the crucial public health problems of the 21st century for the citizens of the United Kingdom.
Obesity as American Social Health Issue In the public health sector, obesity is defined as a social problem because it is associated with the eating habits and bodily lifestyles of every community.
Childhood Obesity and Public Policies in England The study identifies the preventive measures of the English government to deal with childhood obesity and compares the trends in England with the rest of the UK.
Childhood Obesity: Prevention and Mitigation Over the past three decades, childhood obesity has developed into an epidemic and is considered as one of the major health issues in the world.
Children Obesity Research Method and Sampling This paper presents a research method and sampling on the investigation of the issue of childhood obesity and the impact parents` education might have on reducing excess weight.
Food Ads Ban for Childhood Obesity Prevention In order to prevent childhood obesity, it is necessary to ban food ads because they have adverse effects on children’s food preferences, consumption, and purchasing behaviors.
Childhood Obesity and Parent Education Work studies the relations between overweight and parental education, child overweight and physical activity, and the domestic co-occurrence of overweight on a country-wide scale.
Childhood Obesity and Socio-Ecological Model Childhood obesity can be significantly reduced through a public health intervention grounded in the socio-ecological model.
Childhood Obesity, Social Actions and Intervention This literature review presents the major social actions and family-based interventions that have been in use to address the problem of obesity in children.
Humanistic Theory in Childhood Obesity Research The humanistic theory will assist in research investigating how the use of dieting and parental supervision can help to resolve the issue of obesity.
Technological Progress as the Cause of Obesity Obesity is the increase of the body’s weight over the natural limit because of accumulated fats. Technology is a cost to the lost creativity and control over the required healthy lifestyle.
Health Promotion Strategies for Obesity The paper outlines and critically analyses the population based strategy as a method of managing and preventing obesity used in United Kingdom.
Best Interventions for Obesity The best plan for preventing obesity involves the combination of healthy eating habits and regular physical exercises.
The Childhood Obesity Problem Significance Childhood obesity is one of the most severe issues that affects children and teenagers. It involves various risks to their health.
Parental Education to Overcome Childhood Obesity Parental education plays a crucial role in addressing childhood obesity by influencing children’s behaviors and habits. Encouraging healthy eating, and promoting physical activity.
Obesity Management: Educational Behavioral Interventions The current project is devoted to the use of educational behavioral interventions in the management of obesity.
Reducing Obesity Among Children Aged 5-19 From Low-Income Families According to Jebeile et al., since 1975, the number of obese children has increased by 4.9% among girls and 6.9% among boys.
Obesity and Lack of Its Treatment Project The paper aims to treat obesity in a primary care setting, thus reducing the individual and social health burden that obesity poses.
“Overweight and Obesity Statistics” by the USDHHS In the article “Overweight and Obesity Statistics” by the USDHHS, the dire situation concerning excessive weight in adults and children is discussed.
Obesity: High Accumulation of Adipose Tissue It is important to point out that obesity is a complex and intricate disease that is associated with a host of different metabolic illnesses.
Obesity and Iron Deficiency Among College Students The study seeks to establish the relationship between obesity and iron deficiency by analyzing the serum hepcidin concentration among individuals aged between 19 to 29 years.
Should fast-food restaurants be liable for increasing obesity rates?
Does public education on healthy eating reduce obesity prevalence?
Is obesity a result of personal choices or socioeconomic circumstances?
Should the government impose taxes on soda and junk food?
Weight loss surgery for obesity: pros and cons.
Should restaurants be required to display the caloric content of every menu item?
Genetics and the environment: which is a more significant contributor to obesity?
Should parents be held accountable for their children’s obesity?
Does weight stigmatization affect obesity treatment outcomes?
Does the fashion industry contribute to obesity among women?
Childhood Obesity During the COVID-19 Pandemic While the COVID-19 pandemic elicited one of the worst prevalences of childhood obesity, determining its extent was a problem due to the lockdown.
Overweight and Obesity Prevalence in the US Obesity is a significant public health problem recognized as one of the leading causes of mortality in the United States. Obesity and overweight are two common disorders.
Obesity Screening Training Using the 5AS Framework The paper aims to decrease obesity levels at the community level. It provides the PCPs with the tools that would allow them to identify patients.
Prevalence and Control of Obesity in Texas Obesity has been a severe health issue in the United States and globally. A person is obese if their size is more significant than the average weight.
Nutrition: Obesity Pandemic and Genetic Code The environment in which we access the food we consume has changed. Unhealthy foods are cheaper, and there is no motivation to eat healthily.
Preventing Obesity Health Issues From Childhood The selected problem is childhood obesity, the rates of which increase nationwide yearly and require the attention of the government, society, and parents.
Describing the Problem of Childhood Obesity Childhood obesity is a problem that affects many children. If individuals experience a health issue in their childhood, it is going to lead to negative consequences.
Researching of Obesity in Florida It is important to note that Florida does not elicit the only state with an obesity problem, as the nation’s obesity prevalence stood at 42.4% in 2018.
Preventing Obesity Health Issues From the Childhood The paper is valuable for parents of children who are subject to gaining excess weight because the report offers how to solve the issue.
The Role of Social Workers in Addressing Teenage Obesity The social worker should be the bridge uniting obese individuals and society advertising social changes, and ending injustice and discrimination.
Obesity and Health Outcomes in COVID-19 Patients The COVID-19 pandemic has posed many challenges over the last three years, and significant research has been done regarding its health effects and factors.
Childhood Obesity in the US from Economic Perspective The economic explanation for the problem of childhood obesity refers to the inability of a part of the population to provide themselves and their children with healthy food.
Obesity in the United States of America The article discusses the causes of the obesity pandemic in the United States of America, which has been recognized as a pandemic due to its scope, and high prevalence.
The Problem of Childhood Obesity Obesity in childhood is a great concern of current medicine as the habits of healthy eating and lifestyle are taught by parents at an early age.
Obesity, Weight Loss Programs and Nutrition The article addresses issues that can help increase access to information related to the provision of weight loss programs and nutrition.
Childhood Obesity in the US From an Economic Perspective Looking at the problem of childhood obesity from an economic point of view offers an understanding of a wider range of causes and the definition of government intervention.
Obesity From Sociological Imagination Viewpoint Most obese individuals understand that the modern market is not ready to accept them due to negative sociological imagination.
The Current Problem of Obesity in the United States The paper raises the current problem of obesity in the United States and informs people about the issue, as well as what effect obesity can have on health.
Childhood and Adolescent Obesity and Its Reasons Various socio-economic, health-related, biological, and behavioral factors may cause childhood obesity. They include an unhealthy diet and insufficient physical activity and sleep.
Pediatric Obesity and Its Treatment Pediatric obesity is often the result of unhealthy nutrition and the lack of control from parents but not of health issues or hormonal imbalance.
Impact of Obesity on Healthcare System Patients suffering from obesity suffer immensely from stigma during the process of care due to avoidance which ultimately affects the quality of care.
Trending Diets to Curb Obesity There are many trending diets that have significant effects on shedding pounds; however, the discourse will focus on the Mediterranean diet.
Issues of Obesity and Food Addiction Obesity and food addiction have become widespread and significant problems in modern society, both health-related and social.
Diet, Physical Activity, Obesity, and Related Cancer Risk One’s health is affected by their lifestyle, which should be well managed since childhood to set a basis for a healthier adulthood.
Articles About Childhood Obesity The most straightforward technique to diagnose childhood obesity is to measure the child’s weight and height and compare them to conventional height and weight charts.
Childhood Obesity and Overweight Issues The paper discusses childhood obesity. It has been shown to have a negative influence on both physical health and mental well-being.
Discussion of Freedman’s Article “How Junk Food Can End Obesity” David Freedman, in article “How Junk Food Can End Obesity”, talks about various misconceptions regarding healthy food that are common in society.
Obesity and How It Can Cause Chronic Diseases Obesity is associated with increased cardiovascular diseases, and cancer risks. The modifications in nutrition patterns and physical activity are effective methods to manage them.
Physical Wellness to Prevent Obesity Heart Diseases Heart disease remains to be one of the most severe health concerns around the world. One of the leading causes of the condition is obesity.
Obesity and General State of Public Health Obesity is a condition caused by an abnormal or excessive buildup of fat that poses a health concern. It raises the risk of developing various diseases and health issues.
Ways of Obesity Interventions The paper discusses ways of obesity interventions. It includes diet and exercise, patient education, adherence to medication, and social justice.
Obesity, Cardiovascular and Inflammatory Condition Under Hormones The essay discusses heart-related diseases and obesity conditions in the human body. The essay also explains the ghrelin hormone and how it affects the cardiovascular system.
Aspects of Obesity Risk Factors Obesity is one of the most pressing concerns in recent years. Most studies attribute the rising cases of obesity to economic development.
Obesity in Adolescence in the Hispanic Community The health risks linked to Hispanic community adolescent obesity range from diabetes, heart problems, sleep disorders, asthma, and joint pain.
Obesity as a Wellness Concern in the Nursing Field A critical analysis of wellness can provide an understanding of why people make specific health-related choices.
Physio- and Psychological Causes of Obesity The paper states that obesity is a complex problem in the formation of which many physiological and psychological factors are involved.
How Junk Diets Can Reduce Obesity To control obesity there is a need to ensure that the junk foods produced are safe for consumption before being released into the foods market.
The Problem of Obesity: Weight Management Obesity is now a significant public health issue around the world. The type 2 diabetes, cardiac conditions, stroke, and metabolism are the main risk factors.
Hypertensive Patients Will Maintain Healthy Blood Pressure and Prevent Obesity Despite hypertension and obesity are being major life threats, there are safer lifeways that one can use to combat the problem.
Evolving Societal Norms of Obesity The primary individual factors that lead to overeating include limited self-control, peer pressure, and automatic functioning.
The link between excess weight and chronic diseases.
The role of genetics in obesity.
The impact on income and education on obesity risks.
The influence of food advertising on consumer choices.
Debunking the myths related to weight loss.
Obesity during pregnancy: risks and complications.
Cultural influences on eating patterns and obesity prevalence.
Community initiatives for obesity prevention.
The healthcare and societal costs of obesity.
The bidirectional relationship between sleep disorders and obesity.
Obesity: Racial and Ethnicity Disparities in West Virginia Numerous social, economic, and environmental factors contribute to racial disparities in obesity. The rates of obesity vary depending on race and ethnicity in West Virginia.
The Worldwide Health Problem: Obesity in Children The paper touch upon the main causes of obesity, its spread throughout the world, the major effects of the condition and ways of prevention.
Mental Stability and Obesity Interrelation The study aims to conduct an integrative review synthesizing and interpreting existing research results on the interrelation between mental stability and obesity.
Crutcho Public School: Obesity in School Children Numerous school children at Crutcho Public elementary school, Oklahoma City, are obese revealing how obesity is a threat to that community.
Obesity in Low-Income Community: Diet and Physical Activity The research evaluates the relationship between family earnings and physical activity and overweight rates of children in 8 different communities divided by race or ethnicity.
Dealing with Obesity as a Societal Concern This essay shall discuss the health issue of obesity, a social health problem that is, unfortunately, growing at a rapid rate.
Adolescent Obesity in the United States The article reflects the problem of overweight in the use, a consideration which the authors blame on influential factors such as age and body mass index.
Obesity Problem Solved by Proper Nutrition and Exercise Most people who suffer from obesity are often discouraged to pursue nutrition and exercise because their bodies cannot achieve a particular look.
Hispanic Obesity in the Context of Cultural Empowerment This paper identifies negative factors directly causing obesity within the Hispanic people while distinguishing positive effects upon which potential interventions should be based.
Health Psychology and Activists’ Views on Obesity This paper examines obesity from the psychological and activists’ perspectives while highlighting some of the steps to be taken in the prevention and curbing of the disease.
Childhood Obesity Teaching Experience and Observations The proposed teaching plan aimed at introducing the importance of healthy eating habits to children between the ages of 6 and 11.
Nature vs. Nurture: Child Obesity On the basis of the given assessment, it is evident that a child’s environment is a stronger influencer than his or her genetic makeup
Care Plan: Quincy Town, Massachusetts With Childhood Obesity This study will develop a community assessment program based on the city with the aim of creating a care plan for tackling the issue of child obesity in the town.
Exercise for Obesity Description There are numerous methods by which obesity can be controlled and one of the most effective ways is through exercising.
Obesity and Disparity in African American Women Several studies indicate that the rate of developing obesity is the highest in African American populations in the US.
Factors Increasing the Risk of Obesity The consumption of fast food or processed products is one of the major factors increasing the risk of obesity and associated health outcomes.
Childhood Obesity in Modern Schools Most schools have poor canteens with untrained staff and poor equipment for workers. That’s why they can’t cook quality food and offer better services to students.
Obesity in Hispanic American Citizens The issue of obesity anong Hispanic Americans occurs as a result of poor dieting choices caused by misinformed perceptions of proper eating.
Effectiveness of a Diet and Physical Activity on the Prevention of Obesity Research indicates that obesity is the global epidemic of the 21st century, especially due to its prevalent growth and health implications.
Community Obesity and Diabetes: Mississippi Focus Study The paper provides a detailed discussion of the correct method to be used in the state of Mississippi to control and avoid obesity and diabetes issues.
Multicausality: Reserpine, Breast Cancer, and Obesity All the factors are not significant in the context of the liability to breast cancer development, though their minor influence is undeniable.
The Home Food Environment and Obesity-Promoting Eating Behaviours Campbell, Crawford, Salmon, Carver, Garnett, and Baur conducted a study to determine the associations between the home food environment and obesity.
The Problem of Childhood Obesity in the United States Childhood obesity is one of the reasons for the development of chronic diseases. In the US the problem is quite burning as the percentage of obese children increased significantly.
Obesity Management and Intervention Many patients within the age brackets of 5-9 admitted in hospital with obesity cases have a secondary diagnosis of cardiovascular disease exceptionally high blood pressure.
Children Obesity in the United States Together with other problems and illnesses, obesity stands as one of the main difficulties in modern societies.
The Situation of Obesity in Children in the U.S. The paper will discuss the situation of obesity in Children in the U.S. while giving the associated outcomes and consequences.
Childhood Obesity and Healthy Lifestyles The purpose of this paper is to discuss childhood obesity and the various ways of fostering good eating habits and healthy lifestyles.
Screen Time and Pediatric Obesity Among School-Aged Children Increased screen time raises the likelihood of children becoming overweight/obese because of the deficiency of physical exercise and the consumption of high-calorie foods.
Policymaker Visit About the Childhood Obesity Problem The policy issue of childhood obesity continues to be burning in American society. It causes a variety of concurrent problems including mental disorders.
Public Health Interventions and Economics: Obesity The purpose of this article is to consider the economic feasibility of public health interventions to prevent the emergence of the problem of obesity.
Obesity Overview and Ways to Improve Health The main focus of this paper is to analyze the problems of vice marketing and some unhealthy products to teens and children.
Nursing: Issue of Obesity, Impact of Food Obesity is a pandemic problem in America. The fast food industry is under pressure from critics about the Americans weight gain problem.
Childhood Overweight and Obesity Childhood overweight and obesity have increased in the US. Effective transportation systems and planning decisions could eliminate such overweight-related challenges.
Childhood Obesity as an International Problem This paper explores the significance of using the web-based technological approach in combating obesity among Jewish children.
Obesity Negative Influence on Public Health In recent years the increased attention has been paid to the growing obesity trends in connection to a possible negative influence on public health.
The Effects of Gender on Child Obesity The high percentage of women’s obesity prevalence is a result of poor nutrition in childhood and access to greater resources in adulthood.
Problematic of Obesity in Mexican Americans With this strategy, patients and guardians will embrace the best habits and eventually address the problem of obesity among Mexican Americans.
Child Obesity Problem in the United States Obesity is a disease commonly associated with children in most countries in the world. Obesity means weighing much more than is healthy for someone.
Obesity Rates and Global Economy The process of obesity in modern society is undoubtedly a severe obstacle to the development of the global economy, as well as to the achievement of its sustainability.
Screen Time and Pediatric Obesity in School-Aged Children Obesity in school-aged children negatively influences their health, educational accomplishment, and quality of life.
Obesity: Cause and Treatment
Obesity Treatment – More Than Food
Effects of Exercise on Obesity Reduction in Adults
The Problem of Obesity in the Latin Community
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StudyCorgi . "399 Obesity Essay Topics & Research Questions + Examples." September 9, 2021. https://studycorgi.com/ideas/obesity-essay-topics/.

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Setting the top 10 priorities for obesity and weight-related research (POWeR): a stakeholder priority setting process

Affiliations.

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK [email protected].
3 Patient and Public contributor, N/A, UK.
PMID: 35858732
PMCID: PMC9305808
DOI: 10.1136/bmjopen-2021-058177

Objectives: To identify and prioritise the most impactful, unanswered questions for obesity and weight-related research.

Design: Prioritisation exercise of research questions using online surveys and an independently facilitated workshop.

Setting: Online/virtual.

Participants: We involved members of the public including people living with obesity, researchers, healthcare professionals and policy-makers in all stages of this study.

Primary outcome measures: Top 10 research questions to be prioritised in future obesity and weight-related research.

Results: Survey 1 produced 941 questions, from 278 respondents. Of these, 49 questions held satisfactory evidence in the scientific literature and 149 were out of scope. The remaining 743 questions were, where necessary, amalgamated and rephrased, into a list of 149 unique and unanswered questions. In the second survey, 405 respondents ranked the questions in order of importance. During the workshop, a subset of 38 survey respondents and stakeholders, agreed a final list of 10 priority research questions through small and large group consultation and consensus. The top 10 priority research questions covered: the role of the obesogenic environment; effective weight loss and maintenance strategies; prevention in children; effective prevention and treatment policies; the role of the food industry; access to and affordability of a healthy diet; sociocultural factors associated with weight; the biology of appetite and food intake; and long-term health modelling for obesity.

Conclusions: This systematic and transparent process identified 149 unique and unanswered questions in the field of obesity and weight-related research culminating in a consensus among relevant stakeholders on 10 research priorities. Targeted research funding in these areas of top priority would lead to needed and impactful knowledge generation for the field of obesity and weight regulation and thereby improve population health.

Keywords: GENERAL MEDICINE (see Internal Medicine); NUTRITION & DIETETICS; PREVENTIVE MEDICINE; PUBLIC HEALTH.

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Conflict of interest statement

Competing interests: NA, PA, and SAJ led an investigator-initiated study funded by Cambridge Weight Plan. PA has spoken at two symposia organised by the Royal College of General Practitioners that were funded by Novo Nordisk. None of these activities led to personal payment. ARB, LG, AH, PS and BC have no interests to declare.

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Flow diagram for the priority research questions. RQ, Research questions.

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Obesity: Symptoms, Causes, Treatment

What Is Obesity?

Doctors define obesity as a chronic (long-lasting) disease that results when have you have excess body fat that puts your health at risk.

It's a complicated condition, and it's about much more than the number on the scale. Carrying extra weight affects the way your body works. These changes influence almost every system in your body. They contribute to diseases like heart disease, diabetes, and cancer.

Obesity is a growing problem in many areas of the world. According to the World Health Organization, more than 4 million people die every year due to obesity or overweight.

Obesity Symptoms

Doctors have traditionally used body mass index (BMI) as a tool to determine whether someone is overweight or obese. BMI is a calculation that compares your weight to your height. A BMI of 30 or more is in the obese category. If your BMI is 25 to 29.9, your weight is classified as overweight but not obese.

Measuring your waist is another way to check your risk for weight-related conditions. A waist size over 40 inches (102 centimeters) for men or 35 inches (88 centimeters) for women is considered high.

Some day-to-day symptoms you might have with obesity include:

Getting out of breath easily
A hard time doing physical activities

Types of Obesity

Doctors divide obesity into three classes:

Class I: You're in this category if your BMI is between 30 and 35.

Class II: People in this category have a BMI between 35 and 40.

Class III: In this category, your BMI is 40 or above.

Morbid obesity

You might have heard the term " morbid obesity " to refer to obesity that's likely to pose serious threats to your health. Doctors formerly used to use this phrase to describe what they now call class III obesity.

Causes of Obesity

Many things contribute to obesity, including your genes, your eating patterns, and how much activity you get. Hormones and your emotions play a role, too. Some illnesses and some medications can also lead to weight gain.

Other things that may be involved include:

Living in areas where healthy food and safe places to exercise aren't easily available
Jobs that require you to sit for long periods of time
Cultural and family preferences for certain foods
Advertising and marketing that make high-calorie food seem more appealing

Obesity Risk Factors

You're more likely to have obesity if others in your family do. Experts think genes affect your metabolism, your appetite, and how much body fat you tend to store. Also, people around you influence your diet and exercise patterns.

Other risk factors for obesity include:

Age. Your metabolism (the rate at which your body burns calories) often slows down as you get older. You may become less physically active as well. Menopause can also make you more prone to weight gain.
Sleep loss. Regularly sleeping less than 7 hours a night causes hormone changes that can boost your appetite and lead you to overeat.
Pregnancy. It's easy to gain extra weight during pregnancy, and it can be hard to lose it after you give birth.
Stress. People tend to crave high-calorie foods when they're under stress.
Certain illnesses and medications. Conditions that can cause weight gain include Cushing, Prader-Willi, and polycystic ovary syndromes . Disabilities and illnesses that make it harder to move around, like arthritis, can contribute, too. Among medications linked to weight gain are some antidepressants, antipsychotics, anti-seizure drugs, beta-blockers, and steroids.

Obesity epidemiology

Obesity is very common. More than 40% of adults in the U.S. are considered obese, as are nearly 20% of children.

Among adults in the U.S., rates of obesity by race/ethnicity are:

American Indian/Alaska Native 48%
Hispanic 46%

The rates among children are:

Hispanic 26%

(National obesity rates for American Indian/Alaska Native children were not available.)

Obesity is more common in people at middle age and older. By age, obesity rates are:

44% for adults ages 40-59
42% for people 60 and up
40% of those ages 20-39

Although researchers say that overall rates of obesity are similar for men and women, women are more likely to have severe, or class 3, obesity.

Obesity Diagnosis

To screen you for obesity, your doctor might talk to you about your health history to learn about your eating and activity patterns, history of weight gain and loss, and more.

They may also do a:

Physical exam. They'll check vital signs like your blood pressure and heart rate as well as measure your height and weight.
BMI calculation . Your doctor can use your height and weight to determine your BMI. But because it's based on averages, BMI isn't always an accurate measure of obesity. For example, athletes may have high BMIs although their body-fat levels are low. BMI also doesn't recognize differences in age, gender, or race. Your doctor should take these limitations into account.
Waist measurement . Your doctor may also measure around your waist to see if you carry extra abdominal fat. This type of fat boosts your risk for health issues like diabetes and heart disease.
Tests for other conditions. Your doctor may want to check you for weight-related conditions like diabetes and high cholesterol. They may also look for illnesses that could cause weight gain, such as thyroid problems .

Obesity Treatment

There are many treatments for weight loss that can make a big difference to your health and how you feel. Even a small reduction in weight benefits your health.

No matter what type of treatment or program you use, overcoming obesity will require you to change your eating and exercise habits. Your doctor can help you determine what method might be best for you.

You might start with a supervised weight loss and exercise program. Ask your doctor to help you set personal goals and refer you to other professionals who can help. For example, a dietitian can work with you to develop a plan for healthy nutrition, and a physical therapist or trainer can help you move more. A bariatric medicine or weight loss specialist can also be a part of your health care team.

You’ll want to go for steady progress over time and to make lifestyle changes that work for you in the long run. That way you can start losing weight, feel better, and keep the weight off.

Medications for obesity

Along with lifestyle changes, your doctor may recommend prescription medications that decrease your appetite, help you feel full with less food, or help you lose weight in other ways. Keep in mind that these drugs may not work for everyone, and you might regain weight when you stop taking them.

Some drugs the FDA has approved to treat obesity are:

Benzphetamine ( Didrex, Regimex)
Buproprion-naltrexone (Contrave)
Cellulose and citric acid (Plenity)
Diethylpropion (Depletite, Radtue, Tenuate)
Liraglutide (Saxenda)
Lisdexamfetamine dimesylate (Vyvanse)
Orlistat (Alli, Xenical)
Phendimetrazine (Bontril, Melfiat)
Phentermine (Adipex, Lomaira, Suprenza)
Phentermine-topiramate (Qsymia)
Semaglutide (Wegovy)
SGLT2 inhibitors with glucagon-like-1 receptor agonists

Doctors may also prescribe certain diabetes drugs, such as tirzepatide (Mounjaro), "off-label" for weight loss even though they're not FDA-approved for that purpose.

Find out about the latest drug treatments for obesity.

Procedures and surgeries for obesity

These procedures change your digestive system to limit how much food you're able to eat or how many calories your body can absorb. Some also affect hormones that play a role in hunger and metabolism.

These procedures may not only help with weight loss but also improve weight-related conditions like type 2 diabetes and heart disease. If you get one of them, you'll still need to adopt healthy lifestyle changes.

Nonsurgical procedures include:

Endoscopic sleeve gastroplasty , in which a doctor puts stitches in your stomach to reduce how much it can hold.
Intragastric balloon , in which a balloon is placed into your stomach, then filled with water, to help you feel full sooner.

If you have class 3 obesity, you might be able to get weight loss (bariatric) surgery. These surgeries include:

Gastric band , in which a band separates your stomach into two smaller compartments
Gastric bypass , in which the doctor creates a smaller compartment within your stomach and connects it right to your small intestine.
Gastric sleeve, where the surgeon removes part of your stomach.
Duodenal switch, which combines gastric sleeve surgery with a procedure that bypasses much of the small intestine.

Therapy for obesity

Cognitive behavioral therapy teaches you behavior changes that can lead to weight loss, such as finding non-food ways to reward yourself or deal with negative emotions. It can also help you learn techniques to reduce stress, which often contributes to overeating.

Alternative treatments for obesity

You can buy many types of herbs and supplements that claim to help with weight loss. But there's little scientific evidence that any of them are effective.

Some research has found that acupuncture or acupressure could have a small effect on weight. These techniques stimulate certain spots on your body to try to boost levels of serotonin, a chemical involved in moods, emotions, and appetite.

There's some evidence that hypnosis might help with weight loss, especially when used together with therapy, diet, and exercise. But not all research into this technique showed the same results.

Learn more about the treatment options for obesity .

Obesity Health Disparities

Anyone can have obesity, but it's more common in minority populations. Scientists don't know all of the reasons why. They include genetics as well as family and cultural eating habits. They may also include social aspects like:

Lack of regular access to good-quality food (food insecurity)
Unemployment rates
Easy access to unhealthy foods
Lack of access to suitable places to exercise
Lack of access to health care
Stress and trauma levels

Men have similar rates of obesity no matter what their income level. High-income women are less likely to have it than those with lower incomes. But most women with obesity aren't considered low-income. In the U.S., people living in the Southeast and in rural areas are at higher risk.

Black people are often less likely than others to be diagnosed with obesity, although they have the condition at higher rates.

Some research has found obesity treatments aren't as widely used or as effective for minorities. One study found that after 6 months of behavior therapy for weight loss, Black participants lost less weight than White ones. Certain weight loss drugs, such as orlistat, may be less effective for Black people. Others, like metformin, might not work as well for Hispanic people.

Members of racial and ethnic minority groups tend to lose less weight after weight loss surgery . Men and African-American people are less likely to consider the surgery in the first place.

Obesity Stigma

One of the hardest parts of living with obesity is the stigma that surrounds it. Some people stereotype those with obesity as undisciplined or lazy. You may face discrimination in the workplace and from health care providers. Research suggests that people who have obesity deal with stigma almost every day.

But there are signs of progress. In 2013, the American Medication Association recognized obesity as a chronic disease. And advocacy organizations like the World Obesity Federation and Obesity Action Coalition are bringing attention to the need for change.

Stigma can take a toll on your mental health. There's not a lot of research on obesity stigma. But one study found that people who dealt with it by reframing their bad experiences in a more positive way had less depression and better self-esteem. For example, they focused on good things that have happened to them and reminded themselves that many people like them just as they are.

Complications of Obesity

Extra weight means extra stress on your bones and muscles and less space for your lungs and other organs. It makes your heart and circulation system work harder and increases inflammation in your body. Obesity raises your risk of several other chronic conditions, including:

Type 2 Diabetes

When you have obesity, you're seven times more likely to get type 2 if you're male (or were assigned male gender at birth). You're 12 times more likely to get it if you're female or were assigned female at birth.

Cardiovascular d isease

Obesity boosts your risk for high cholesterol, blood pressure, and blood sugar as well as inflammation. All these things are risk factors for cardiovascular (heart and blood vessel) conditions like heart attack, stroke, and coronary artery disease.

People with obesity are at higher risk for several types of cancer, including:

Digestive Conditions

With obesity, you're more prone to heartburn and gallbladder disease as well as liver problems like fatty liver disease. Fatty liver disease happens when too much fat builds up in your liver and leads to damage.

Obesity also puts you at higher risk for:

Osteoarthritis
Sleep apnea
Infertility
Pregnancy complications
Alzheimer's disease

Living With Obesity

While not everyone with obesity has other serious health problems, research shows that it's rare to be both obese and healthy for the long term.

But you don't need to lose a lot of weight to improve your health. You could lower your risk for complications like diabetes and heart failure by 10%-25% by losing just 15-20 pounds.

Obesity diet

No single diet is best for weight loss. What works for one person may not work for another. Your doctor or a dietitian can help you find an eating plan that suits your needs and lifestyle. In general, a healthy plan will include:

Tracking your food intake
Controlling portions
Making healthier choices, such as eating more fruits and veggies and less saturated fat and cholesterol

Be wary of fad diets that promise fast weight loss. While you might lose some weight quickly, you're likely to gain it back once you go off the diet. It's better to adopt changes you can live with long-term.

Along with diet, exercise should be part of your weight loss plan. Ask your doctor about what kind of exercise, and how much, is best for you.

Obesity costs

Obesity and the medical conditions that can come with it bring extra expenses for treatments, doctor visits, hospitalizations, and more. A 2021 study found that, on average, adults in the U.S. with obesity spent $1,800 more on health care than others.

That doesn't include indirect costs like:

Missed time and reduced productivity at work
Disability and insurance expenses
The costs of weight loss programs

Managing obesity

These steps can boost your chances for successfully managing obesity:

Get support. Tell your family members and friends you need their help making lifestyle changes. Support groups, whether they're nonprofit groups or part of a paid program, can be invaluable. Sharing your experiences with others can help you learn ways to succeed and keep you from getting discouraged. People who join these groups tend to lose more weight than those who do it on their own.
Write things down. This can help in a few ways. Tracking your food intake and exercise, on paper or in an app, helps you identify and correct unhealthy habits. Journaling about your emotions helps you sort them out and learn what triggers you to eat more. Keeping records of these things makes it easy to share your learnings with doctor or mental health professional.
Set goals . Make them small and realistic. Instead of vowing to lose 10 pounds in a month, for example, substitute fresh fruit for dessert every night this week. Or take a 10-minute walk after dinner. Once you've conquered one goal, set another.
Find supportive health care providers who understand obesity is a disease and don't make you feel stigmatized. Ask your doctors to discuss all your options for treating obesity.
Ease stress. Relaxation techniques like meditation, deep breathing , and stepping away from social media can help you manage stress. That can help you avoid emotional eating and deal with the challenges of obesity.

Obesity and mental health

People with obesity are at higher risk for mood and anxiety disorders. One study found that those with obesity were 55% more likely than others to develop depression during their lifetimes. At the same time, people with depression had a 58% higher chance of obesity.

Some of the reasons for this link include:

Obesity bias . Discrimination is stressful. It can harm your self-esteem and cause you to take others' negative opinions about your weight to heart (internalize them).
Negative body image . You may be unhappy with your appearance because it doesn't fit society's norms. You may fear being judged or be embarrassed about your weight.
Reduced quality of life . Obesity can keep you from doing things you enjoy and cause you to become isolated. Pain and discomfort caused by obesity or related health conditions also contribute to depression.
Physical changes . Excess fat boosts inflammation in your body. Inflammation helps raise your risk for depression.
Emotional eating . Many people use food to help them deal with feelings of sadness, stress, or anxiety .
Depression saps your energy . When you're depressed, you may not feel up to exercise or take part in other healthy lifestyle habits.

Losing weight can help ease depression. But you're not likely to succeed at weight loss when you're feeling sad or stressed. Think about getting treatment for any emotional health issues before you try to overhaul your eating and exercise habits.

Obesity Prognosis

Can obesity be cured?

Some obesity experts believe diet and exercise just aren't enough to address obesity. They say our bodies evolved to help us survive periods when food was scarce. So whenever we cut back on calories, our bodies drive us to eat high-calorie foods and gain weight. That's why most weight loss efforts don't succeed in the end.

These experts believe that people with obesity who do manage to lose weight are biologically different from people who've never had obesity. They consider obese people who've lost weight to be in remission rather than cured.

What to expect with obesity

Even moderate obesity (defined as having a BMI of 30-35) can shorten your lifespan by 3 years. Severe obesity (a BMI of 40-50), could take 10 years off your life. That's about the same as a lifetime of smoking.

Weight loss can prevent and sometimes reverse most of the health problems linked to obesity. But losing weight and keeping it off takes commitment and time. While many people can lose some weight with diet and exercise alone, only 10% to 20% are able to maintain the loss for a long time.

Research shows that treatment programs in which you and your doctor work closely together are most effective for long-term weight loss. Weight loss surgery has a high success rate: Some 90% of people who have it are able to lose at least 50% of their extra weight and maintain the loss. And some newer obesity medications are so promising that many doctors consider them game-changers.

Obesity Prevention

It's easier to prevent obesity than to treat it. If obesity runs in your family or you notice you've picked up a few pounds, start taking simple steps to improve your health habits. You might:

Give up soda in favor of unsweetened soda water.
Add a 30-minute walk or other workout 5 days a week.
Stop keeping fatty, sugary foods in the house.
Limit screen time to an hour a day on most days of the week.

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v.6(11); 2016

‘Now I care’: a qualitative study of how overweight adolescents managed their weight in the transition to adulthood

Helen sweeting.

1 MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow,, Glasgow, UK

Emily Smith

2 University Hospital Southampton NHS Foundation Trust, Southampton, UK

Joanne Neary

3 Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK

Charlotte Wright

4 School of Medicine, University of Glasgow,, Glasgow, UK

Associated Data

bmjopen-2015-010774supp1.pdf

bmjopen-2015-010774supp2.pdf

bmjopen-2015-010774supp_tables.pdf

A qualitative study of recalled experiences of early adolescent overweight/obesity revealed low levels of weight-related concern. This further analysis aimed to explore weight-related concern and weight-loss efforts as participants transitioned into adulthood.

Design, participants and methods

Participants were 35 young adults from a population-based cohort study who had body mass index (BMI) >95th centile between ages 11 and 15 and participated in semistructured interviews aged 24. At age 24, they were categorised as: ‘ slimmers ’ (N=13) who had lower BMI Z-scores at 24 than their adolescent peak and were not obese (BMI<30 kg/m 2 ); ‘ relapsers ’ (N=8, of whom 2 were morbidly obese (BMI>35 kg/m 2 ) at age 24); ‘ stable ’ (N=3, of whom 1 morbidly obese); and ‘ gainers ’ (N=11, of whom 5 morbidly obese). Themes were identified and coded using NVivo qualitative data analysis software, blind to participants’ current weight status.

Contrasting with the lack of concern recalled in respect of earlier adolescence, weight-related concerns and/or desire to lose weight generally increased around the time of school leaving and almost all participants described some form of exercise (formal/informal) and dietary weight-control strategies. Among ‘slimmers’, there was some (subtle) evidence of more consistent use of exercise, self-monitoring of diet and exercise and of lifestyle changes becoming habitual and/or part of identity. Few participants had accessed professional support. Diet clubs seemed to have been used most by ‘gainers’, some only recently. Labour-market and housing transitions were strong influences, described as facilitating weight losses by some, but increases by others. For some participants, it appeared that weight loss was simply a by-product of these transitions.

Conclusions

In contrast to earlier adolescence, even the heaviest participants tended to show actual weight loss action or preparation for action. The transition to adulthood could thus be a key life stage for interventions.

Strengths and limitations of this study

This is one of very few qualitative studies, and the first in the UK, to explore reasons why overweight community-based adolescents do or do not lose weight, in the transition to adulthood.
It subsampled from a longitudinal study with measured body mass index (BMI) at several points in adolescence, enabling objective categorisation of BMI changes over time.
Our findings resulted from secondary analysis of qualitative data from a study which did not specifically set out to identify some of the highlighted themes.
Not all adolescent weight changes described by participants were detected by our measurement schedule (eg, some described losing then regaining weight in the years between) and some categorised as ‘slimmers’ had experienced BMI increases since their very lowest point.

Introduction

Adolescent overweight is associated with greatly increased likelihood of adult obesity, 1 but up to a third of obese adolescents do not go on to be obese adults. 2 What is not clear is why and how some overweight/obese adolescents (defined broadly, by the WHO, as those aged 10–19 3 ) lose weight and others do not, 4 and why some adolescents maintain weight loss while others regain weight. The few population-based studies that have examined this question have generally found very limited or inconsistent behavioural differences between adolescent weight losers, gainers and/or maintainers. A national US survey of adolescents found differences in physical activity, but none in reported diet. 5 Two smaller US and New Zealand studies found ‘healthful’ dietary and PA behaviours, and self-monitoring were associated with loss, but specific dietary plans were not 6 7 and a study of female Swedish adolescents found no clear behavioural differences. 8 Analysis of the Scottish cohort from which participants in the present study were drawn found no differences in reported dieting at either 11 or 15 between the continually obese and those who had slimmed. 9

Active initiation of weight loss behaviours requires that overweight/obesity is recognised and perceived as a problem. 10–13 Community-based quantitative studies have shown obese children and adolescents tend to have more negative body image than non-obese peers. 14 15 However, a qualitative UK study found high acceptance of body size among disadvantaged overweight/obese Scottish 13–14 years, 16 while qualitative US and Australian studies have found that adolescents recognise obesity as a societal issue, but not in themselves, and thus have low motivation to implement behavioural changes. 17–19

One reason why so little is known about how young adults view overweight/obesity or approach weight loss is that while it is relatively easy to study adolescents ‘captive’ in school or treatment programmes, they become largely invisible to researchers once they leave school. We have previously reported findings from a qualitative study of young adults nested within a large Scottish cohort study, where participants were well documented as having been overweight/obese in adolescence. This revealed widespread recalled recognition of, but lack of major recalled concern about their overweight/obesity during adolescence, 20 consistent with other studies. 16–19 This data set also included reflections by participants on their lives since adolescence which have not so far been reported. Thus, this new qualitative analysis aimed to explore their transition to adulthood, by examining postschool weight-related concerns, behaviours and experiences related to young adult transitions among 24 year-olds categorised in terms of measured adolescent body mass index (BMI) trajectories and current BMI. Specifically, we considered whether they described more concern about their overweight/obesity in the postschool transition to adulthood and how other aspects of their late adolescent/young adult lives impacted on their weight-related behaviours.

Participants and recruitment

In 2008, 35 young adults (age 24; 17 males; 33 White Scottish and 2 mixed/Asian ethnicity) participated in a study of recalled adolescent experiences of obesity conducted by ES. 21 They were purposively subsampled from the longitudinal West of Scotland 11–16/16+ Study, which obtained data from school pupils at age 11 (N=2586; 93% of issued sample), 13, 15 9 and 19 (N=1256). Height and weight measurements were taken at each stage, allowing calculation of BMI and BMI z-scores 22 and identification of participants with BMI z-scores >95th centile compared with British 1990 growth references 22 between ages 11 and 15, as described previously. 20 21

University of Glasgow ethical approval was obtained for the qualitative substudy and participants completed consent forms, including permission to publish anonymised extracts from their interviews.

Semistructured interviews were conducted by ES and audio-recorded with consent. They began with a picture task designed for this study (paired images of young people with a range of BMIs and diet/exercise behaviours) to stimulate discussion around perceptions of bodies and health. Next, participants were asked to describe themselves and their lives as a teenager and changes as they became young adults. These generally prompted discussion of postschool labour market transitions, health, concerns (including in relation to health/weight), interests and activities, eating patterns and relationships/support (see online supplementary file 1 —interview topic guide and example picture task items).

supplementary file

The interviews were transcribed verbatim and pseudonyms applied. For this paper, a secondary analysis approach was taken. Previous analyses 20 21 meant ES, HS and CW were already familiar with the data set. A researcher with no prior knowledge of the study (JN) familiarised herself with the transcripts, then, with HS and CW, identified themes relating to postschool late adolescent/young adult experiences. Themes, identified deductively (based on previous literature) and inductively (from the data), were coded by JN using NVivo qualitative data analysis software, blind to participant BMI. These were then reviewed with HS and CW and checked against transcripts by HS during write-up of the paper. Separately, CW converted all adolescent BMIs into age-specific and gender-specific Z-scores compared with the UK 1990 reference. 23 24 Age 24 BMIs were converted to Z-scores for age 19.99, the highest age of the reference. She then categorised participants into one of four relatively homogenous BMI trajectory groups on the basis of adolescent (age 11–15) and young adult BMI: ‘ slimmers ’ had lower BMI Z-scores at age 24 than their adolescent peak and were not obese (BMI<30 kg/m 2 ); ‘ relapsers ’ had shown a decrease from their peak adolescent BMI Z-score, followed by regain and were currently obese; the BMI Z-scores of ‘ stable ’ participants had remained largely unchanged throughout; finally, the BMI Z-scores of ‘ gainers ’ had steadily increased since adolescence.

This paper describes the most common themes raised by participants in relation to late adolescence/young adulthood (weight-related concerns; exercise; diet; professional support; young adult transitions) and relates these to their adolescent/young adult BMI categories.

Table 1 shows 13 participants were ‘slimmers’, of whom 3 were of normal weight (BMI<25 kg/m 2 ) and 10 were overweight at age 24. Eight were ‘relapsers’ (6 obese, 2 morbidly obese—BMI>35 kg/m 2 ), 3 were ‘stable’ (1 overweight, 1 obese, 1 morbidly obese) and 11 were ‘gainers’ (6 obese, 5 morbidly obese). Individual graphs show considerable variations in BMI trajectory (see online supplementary file 2 —individual BMI Z-score trajectories). Some participants also described weight changes not apparent in these study measurements and discussed the circumstances in which they had occurred.

Table 1

Participants categorised according to current body mass index (BMI), change since highest BMI in adolescence and whether had slimmed and relapsed previously

	As adolescent (ages 11–15)		As young adult (age 24)
Pseudonym	Peak adolescent BMI Z-score	Age of max adolescent BMI	BMI	BMI Z-score	BMI category
‘ 6 7
Lower BMI than in adolescence and not obese as young adult
Catherine	2.37	15	24.0	0.55	Normal
Nina	1.82	13	23.8	0.49	Normal
Noel*	2.46	15	20.7	−1.04	Normal
Alan	2.06	13	27.4	1.33	Overweight
Charlie	2.90	15	28.7	1.64	Overweight
Clare	1.94	11	27.1	1.39	Overweight
Eilidh	3.08	13	29.3	1.88	Overweight
Emma	2.37	11	28.4	1.68	Overweight
Janine	2.37	15	25.4	0.95	Overweight
Mark	2.18	15	29.5	1.83	Overweight
Pete	2.17	15	28.0	1.47	Overweight
Rachel	1.71	15	26.1	1.14	Overweight
Scott	2.38	11	26.5	1.07	Overweight
5 3
Obese, slimmed previously
Colin	2.68	15	30.2	1.98	Obese
Laura	1.66	15	30.2	2.06	Obese
Malcolm	2.02	15	30.8	2.09	Obese
Patricia	2.82	13	33.1	2.55	Obese
Patrick	1.66	15	30.5	2.04	Obese
Philip	1.88	11	30.4	2.01	Obese
Donna	3.24	15	37.8	3.20	Morbidly obese
Geoff	3.14	13	44.3	3.87	Morbidly obese
‘ 1 2
No change since adolescence
Chris	1.90	13	29.6	1.84	Overweight
Christina	2.55	15	32.4	2.44	Obese
Jenny	3.24	15	38.3	3.25	Morbidly obese
5 6
Increased obesity since adolescence
Jamie	2.37	15	†	2.57†	Obese
Matthew	1.91	15	32.9	2.49	Obese
Michael	1.88	13	31.9	2.31	Obese
Natasha	2.03	15	32.0	2.37	Obese
Neil	2.06	13	34.9	2.75	Obese
Sarah	2.28	15	32.7	2.49	Obese
Anne	3.64	15	43.1	3.74	Morbidly obese
Elizabeth	3.21	15	41.2	3.56	Morbidly obese
Kirsty	2.65	15	43.5	3.78	Morbidly obese
Lisa	3.19	15	‡	3.79‡	Morbidly obese
Richard	2.84	15	42.7	3.71	Morbidly obese

*Weight loss attributed by participant to severe postviral illness at age 17.

†Did not consent to be weighed at age 24 but observed to be obese; age 19 BMI Z-score provided.

‡Did not consent to be weighed at age 24 but observed to be extremely obese; age 19 BMI Z-score provided.

Weight-related concerns

Most participants, regardless of BMI trajectory group, described increasing weight-related concerns and/or desire to lose weight as they progressed into later adolescence ( table 2 ; see online supplementary table S1 for extensive illustrative quotes). Several related their increasing concerns to a wish for a new identity as part of the postschool transition; Eilidh ‘ realised that I was going to uni, I didn't want to be big, it was like a new kinda fresh start ’. However, most described their attitudinal change in terms of more general maturity and acknowledgement of weight as personal responsibility. Examples among ‘slimmers’ included Janine, who became ‘ conscious ’ of her weight around age 15–16 and Mark who noted ‘ it was only in my late teens that I started to be aware of this concept of healthy living, yeah, it wasn't something that ever kinda touched me as a, as a fifteen year-old boy ’. Malcolm (‘relapser’) ‘ left school thinking “nah, I don't care about dieting” … and then that kinda stopped and I was like that, “oh wait a minute, need to try and do something ”’. Such accounts were also evident among ‘gainers’: Anne said that ‘ as I got older I realised that I had to do something ’, Elizabeth had ‘ changed since I've been a teenager, because I watch what I'm eating ’ and Sarah, who was ‘ finally on a diet for the first time properly in my life ’ described herself as ‘ far more mature than I used to be ’. There was no evidence that increasing concern was limited to those who had at some stage lost weight, apart from hints that perhaps non-‘slimmers’ expressed concerns in slightly vaguer terms and, for a small number, they appeared to have occurred more recently.

Table 2

Illustrative quotes according to participant ‘slimmer’, ‘relapser’, ‘stable’ and ‘gainer’ categorisation—weight-related concerns

Slimmer
Eilidh	Yeah I don't know I think when I started coming to the end of high school and realised that I was going to Uni, I didn't want to be big, it was like a new kinda fresh start Once I got to a size 16 I just got kinda lazy and went ‘well, I'm fine now’, do you know. I'd, I would like to lose a wee bit more but I'm quite content the way I am do you know
Relapser
Malcolm	I still left school thinking, ‘nah I don't care about dieting’, again ‘if I eat I'm just gonna burn it off, quicker than anyone else’ and then that kinda stopped and I was like that ‘oh wait a minute, need to try and do something’
Stable
Christina	But I'm quite vain, even though I'm big, I think I'm shit hot, do you know what I mean? … I am quite vain, even though there's things that I would like tae change, but I'm no gonna bust a gut tae change them, do you know what I mean?
Gainer
Sarah	I am now finally on a diet for the first time properly in my life, so I've joined Weight Watchers a couple of months ago so I've now lost just over a stone … so I'm finally trying to do something about it cos it bothers me

supplementary tables

However, some participants expressed current acceptance of their size. For example, Geoff (‘relapser’) was not ‘ overly concerned ’, having decided ‘ this is what I'm are ’ [sic], Christina (‘stable’) described herself as ‘ quite vain, even though I'm big, I think I'm shit hot’ and Jenny (‘stable’) did not want to ‘ go to all these classes to get healthy. As long as I don't feel like crap I'm not too bothered like ’. Two ‘slimmers’ expressed acceptance only once they felt more comfortable with their clothes size. Eilidh described herself as becoming ‘ lazy’ and ‘ content ’ on reaching size 16, and Rachel ‘ realised as I got older that I was never supposed to be a size six or a size eight, that's just not the way I'm built ’.

In response to these concerns, almost all participants described behavioural changes, including diet (next section) and exercise, particularly in gyms, but also team sports, swimming, use of home exercise DVDs/gym equipment, running and walking ( table 3 ; see online supplementary table S2).

Table 3

Illustrative quotes according to participant ‘slimmer’, ‘relapser’, ‘stable’ and ‘gainer’ categorisation—exercise and diet

Slimmers
Mark	I don't remember the moment of making the decision, but I do remember coming home from school and getting changed and going to the gym and that was, that was very… it was a bit of a departure from the way life was for me before then … it became part of my life and it has remained so to this day
Catherine	So aye, it was losing the weight, it was, it was hard at the start, but see once you get into a routine of knowing what you do, what you can eat, what you can't eat, what you need to keep yourself away fae, it is quite easy
Relapsers
Geoff	When I left school I went to I done, I done boxing, fitba, I went to the gym. … I wis I say I wis playing aw the sports. So if I could eat that but I, I wisny putting on any weight cos I wis going to the gym, playing fitba and that. I don't play a lot o’ fitba noo right enough. I'd like tae but it's getting the time and the people tae play it
Laura	Maybe in the last couple of years or so, in the sense that, yeah, you go out and do lunches with your friends and this and that, and you think that I could really do with cutting some of that out. You know, weekend fry-ups and stuff like that. Trying to be healthier and, you know, the healthy option …
Stable
Chris	I never did anything particularly excessive. I never did anything too… you know, tried… sort of stuck to anything very long I don't think when I was, when I was younger, so I guess that's probably why nothing ever worked
Jenny	I can just eat really good foods and be really good but it never makes that much of a difference
Gainers
Anne	I used to go to the gym on a Monday but it's shut now, the gym that I go to, it's not opened anymore. Em, for refurbishment. But like, I've got like exercise DVDs now that I'll do in the house
Jamie	Just cut out junk, I cut out a lot of carbs I remember… Yeah it was that what I did I remember doing, I remember saying ‘no junk’… You really do need a disciplined and healthy eating plan. You know says the man who had a bag of crisps and a Mars Bar last night …

Most ‘slimmers’ mentioned the gym. Pete and Mark started attending while still at school, which for Mark was ‘ a bit of a departure from the way life was for me before ’. Scott's, Charlie's, Claire's and Rachel's gym attendance began at university. Charlie found it ‘ wasn't even difficult ’ and this ‘ total change in lifestyle ’ resulted in weight loss. Claire used the gym ‘ throughout my uni life ’, and Rachel managed gym attendance, university classes and bar work. Exercise had been sustained by all this group. For Mark, the gym environment ‘ became part of my life and has remained so to this day ’, Scott continued to ‘ train hard ’ and Charlie described how ‘ now I jist sorta sustain ’ exercise. Claire's exercise had become ‘ kind of habit … I don't think I have to go to the gym or do this, to exercise I would just do, walking, jogging, whatever ’ and Rachel went ‘ to the gym a lot ’. Among the other ‘slimmers’, Emma's police training involved time at the gym, circuits and swimming and was ‘ the most active I think I have ever been in my life ’; she also continued to attend. Eilidh and Catherine had tried a gym, but preferred other activities; Eilidh ‘ loved’ cycling and Catherine walked with her baby buggy. While acknowledging impact on weight, Nina and Noel were vaguer about their exercise.

Some ‘relapsers’ linked weight loss to exercise. At around 17–18, Patricia ‘ lost a drastic amount of weight … and I was exercising an awful lot ’, Colin had a ‘ fitness freak stage ’ and Geoff found he could maintain his weight by balancing eating with exercise. However, only Patricia's gym attendance continued. Exercise featured less in the accounts of other ‘relapsers’, including Malcolm, for whom ‘ there's not been any exercise really, not much ’, Laura, who occasionally used a home trampoline, although ‘ there's just those weeks when you can't be bothered ’, and Donna who had recently tried to increase her exercise via walking. Similarly, Chris (‘stable’) thought not sticking with anything was ‘ probably why nothing ever worked ’ while Christina who regularly walked her dog ‘ wouldnae go tae a gym ’.

In exactly the same way, several male ‘gainers’ described earlier periods of significant exercise which had ceased for reasons, including the need to focus on academic work, injuries, lack of time or motivation. Some female ‘gainers’ described exercising: Anne had attended a gym which was now closed, but used home exercise DVDs, Elizabeth had discovered aqua-aerobics and Kirsty had recently joined a gym.

Participants tended to discuss diet in two ways. First, the importance of having a balanced diet that used home cooking rather than relying on frozen/take-away meals, with healthy choices such as less cheese or cream-based sauces and more fruit. Second, they described their experiences of participating in calorie-controlled diets, either as promoted by commercial slimming clubs or unsustainable ‘fad’ diets (eg, liquid diets, drinking vinegar, avoiding dairy/gluten/carbohydrates or foods of a particular colour) ( table 3 ; see online supplementary table S3 ).

Several female ‘slimmers’ related their weight loss to reduced food intake and meal-skipping: Rachel ‘ just changed the way I ate ’. Many ‘slimmers’ described the need to be constantly mindful of food choices: Mark had not bought certain foods in order to control his intake; Scott self-monitored, ‘ there's times whereby I'll pick up a biscuit and I'll go “no, I don't want it”’ ; Nina noted ‘ the [weight-related] worrying's definitely stayed there ’; and Eilidh described herself as ‘ very, very always watching about not getting bigger ’. However, some appeared slightly more relaxed, including Catherine who described ‘ a routine of knowing what you do, what you can eat, what you can't eat, what you need to keep yourself away fae. It is quite easy ’.

A similar range of strategies was described by participants in the other groups, but with perhaps less emphasis on real and sustainable reductions in intake or continued vigilance. Among the ‘relapsers’, Patricia had lost weight by meal skipping, Donna had achieved weight loss via severe dieting but now ate ‘healthy’ food, while one of Colin's adolescent weight-loss strategies had been to make himself sick; this had stopped and he was trying to ‘ eat something a bit more healthier ’. Malcolm believed controlling food intake was more important than exercise for weight loss, but did so by skipping breakfast. He and Philip talked about home-cooked meals while Laura mentioned ‘ you know, the healthy option ’. Christina (‘stable’) noted that ‘ I dae eat quite healthily but it's my amounts ’; she had unsuccessfully tried a range of ‘fad’ diets. However, Jenny (stable) believed ‘ I can just eat really good foods and be really good but it never makes that much of a difference ’.

Two ‘gainers’, Sarah and Kirsty, had recently started seriously dieting, using commercial slimming club regimes. Elizabeth reported losing weight when on a commercial club diet, and was currently focusing on ‘ watch[ing] what I'm eating ’, but Anne believed dieting had caused stomach problems so ‘ I'd had to eat things to suit my stomach, rather than suit my diet ’. Lisa also reported losing weight via a commercial club, but it increased once she ‘ stopped recording things and checkin g’. Although more often described by females, a small number of male ‘gainers’ also described dieting: Michael had reduced his calorie intake on the advice of his GP, and Richard ‘ didn't have a takeaway for six mon ths’, but then, to use Jamie's description, his diet went ‘ a bit awry again ’.

Professional support

Contrasting with self-initiated and/or unsupported behavioural changes, professional support (eg, slimming clubs, fitness classes, GP advice) was mentioned by very few participants ( table 4 ; see online supplementary table S4 ). Only one ‘slimmer’, Pete, mentioned that at around age 19–20, he had asked his GP and been helped by simple advice on portion control, exercise and social support. Patricia (‘relapser’) reported her GP had told her ‘ och it's OK you don't need to lose weight ’. She had also attended a council-run weight-management service, Weight-Watchers and used a personal trainer.

Table 4

Illustrative quotes according to participant ‘slimmer’, ‘relapser’, ‘stable’ and ‘gainer’ categorisation—professional support

Slimmer
Pete	I went to you know like my GP a couple of times to try and get advice on how to, you know what I should do. … [was advised] just to try and control portions and try to, to count, you know not count calories but be mindful of what the intake was and perhaps to, to exercise regularly you know with, either with friends or you know try and get support you know. So that did help a lot. That did help
Relapser
Patricia	I was referred to the Council's weight-management service by my doctor, and I went and never lost any weight there, and because I never lost any weight, they just never got back in contact. And my doctor I feel because she's so big, when I go and I say ‘I would really, really like to lose weight and I'll, I can show you a food diary of what I've been eating, I can show you my exercise, I can show you how much water I've been drinking’, my doctor will go, ‘och it's ok you don't need to lose weight’
Gainers
Lisa	I went to Weight Watchers classes and lost a good bit of weight … the reason I left was a lot of it was getting me down because, em, there was too much emphasis on figures, like you've lost or you've gained or you're this or you're that
Richard	My cousin dragged me tae Weight Watchers. … It's actually alright. I liked it. I went for aboot four months … I've got a family doctor … She's always geeing me an earful to get oan at me, and every time I go up that's the first thing she does. If I go up for a sore throat she weighs me, so she's always on my back to get me to lose weight. … So I've no been up for aboot eight month noo, coz I'm terrified of going up again in case she shouts at me again

Similar, if not more, professional input was mentioned by ‘gainers’, some describing this as helpful. Anne spoke vaguely about ‘slimming clubs’, but Lisa lost ‘ a good bit of weight ’ via 2 years' Weight-Watchers attendance. Richard reported losing around 15 kg, having been ‘ dragged ’ to Weight-Watchers. However, he subsequently regained the weight and stopped attending his GP because ‘ She's always geeing me an earful to get oan at me, and every time I go up that's the first thing she does. If I go up for a sore throat she weighs me, so she's always on my back to get me to lose weight ’. Similarly, Michael reported his GP said ‘ if I keep cerry on the way I was, I was gonna have a heart attack by the time I was thirty-five, and that put the shitters right up me ’. However, he found her simple dietary and exercise advice useful. Two ‘gainers’ had started attending slimming clubs only very recently, with Kirsty reporting that ‘ I'm ready to take that step to lose weight ’.

Young adult transitions

Participants had experienced a range of young adult transitions: 23 had attended tertiary education in the past (university and college, including college-based apprenticeships) and 4 were doing so at the time of the interview; 29 were working and 5 had performed so in the past; 19 were living in their own homes and 3 had left the parental home in the past but were living back there at the time of the interview; 1 was a parent. These young adult transitions (which were broadly similar across BMI trajectory groups) appeared key to weight changes for many participants, regardless of BMI trajectory group ( table 5 ; see online supplementary table S5 ). Thus, across the groups, some described college/university as a fresh start and/or facilitator to exercise which then meant they met active peers. A few learnt about nutrition or PA, enabling reflection on personal choices. However, others felt college/university was connected with weight-gain, mainly via poor diet and alcohol. Employment was also described as both facilitating and impeding weight loss. Several described loss resulting from active jobs and a few used their earnings to join a gym. However, others worked in sedentary jobs, felt too exhausted by work to bother with home cooking or exercise, or spent their earnings on ‘junk’ food and alcohol. Leaving home was also linked to increased dietary control and so healthier options for some but less balanced meals for others; the small number living with a partner described this as increasing the likelihood of home-cooking.

Table 5

Illustrative quotes according to participant ‘slimmer’, ‘relapser’, ‘stable’ and ‘gainer’ categorisation—young adult transitions

Slimmers
Catherine	WORK: I changed my jobs in August last year, and since then, the amount of weight I have lost is unbelievable. I think I've lost about a stone and a half since August … it's just through daen more, being more active, than compared to what I was doing
Scott	EDUCATION: The lifestyle wasn't so much a big thing about until I turned maybe eighteen, nineteen and started doing my degree then I started learning how to use a gym properly and what sort of exercise that I can do and just I'm now very aware of cos I'm working in nutrition what it is I actually take in and what it is I actually expend
Relapsers
Donna	EDUCATION/LEAVING HOME: That wasn't actually so much of a help because I was living on my own. At student houses and everything else and takeaways was a much more tempting option than cooking for yourself more often than not. Again throughout my Uni career, first to fourth year, I gradually, I definitely improved. I got a grip of that and decided that eating healthy was, was the best option so I started cooking for myself
Stable
Chris	EDUCATION/LEAVING HOME: When I was at uni and I joined the gym and pretty much spent all the money I had on cigarettes and alcohol and didn't eat as much as probably I should have, but not in a you, know, not in a deliberate way, just like I used to never have any money for food and so I lost quite a lot of weight then
Gainers
Jamie	EDUCATION: There was first, first and second year at Uni when I just, you know I discovered you know booze. And then that really was us off to the races in terms of overweight
Neil	WORK: I was labouring for a wee while. I must have laboured for about six months. … I didn't try to lose weight, when I started the job, I didn't try to lose weight, initially, at all—it didn't enter my mind. … then it became, for me, at my work, at my workplace, where I could be getting paid for losing weight, basically

Among the ‘slimmers’, Charlie, Clare, Mark and Scott all described weight loss associated with attending university. Charlie's close friends also went to the gym, while Mark was encouraged by a coach; for him ‘ coming to uni was the sort of the biggest change ever ’. When Eilidh started university, she ‘ just started really healthy eating ’ and took up swimming. Catherine and Scott's courses involved nutrition, with Catherine noting ‘ it kinda opens your eyes to things that you're eating and what it is doing to you ’. Weight loss was a requirement for Alan's admission to the RAF and Emma's police job, and their subsequent training involved PA. Both had maintained weights well below the adult obesity level, but Emma described consciously relaxing her regime since achieving her goal of becoming a police officer. Janine had worked as a show dancer, which required physical fitness, but also encouraged high levels of social drinking, ‘ so it was a bit of both—bad and good ’. Catherine had recently left a job at a fast food counter and ‘ the amount of weight I have lost is unbelievable ’.

‘Relapsers’ and those for whom our measurements showed ‘stable’ BMIs provided largely similar accounts. Patricia and Chris described losing weight at university, Patricia by meal-skipping attributed to a busy routine and Chris because he ‘ pretty much spent all the money I had on cigarettes and alcohol and didn't eat as much as probably I should have ’. Donna dealt with university workload stress by eating, and in student accommodation ‘ takeaways was a much more tempting option than cooking for yourself ’. Although several ‘relapsers’ mentioned gym attendance, Chris was the only one who linked this with university. Philip lost weight after leaving school without conscious effort because ‘ I was working full-time. … I wasn't able to go to like Gregg's [bakers] twice a day and stuff like that ’. Christina thought she had lost weight ‘ by accident ’ due to stress and other changes involved in moving into her own home, while living with a friend/partner had forced Malcolm and Philip to begin home cooking.

Weight loss facilitated by young adult transitions was also mentioned by some ‘gainers’: Jamie attended the gym and dieted during his third university year and that was ‘ probably the best shape I was in ’ and Richard attributed weight loss at college to football and gym attendance. Neil found he ‘ could be getting paid for losing weight ’ while working as a building labourer for 6 months. He also ascribed weight fluctuations to his relationship status: ‘ whenever I meet a lassie I'll be in tip top condition and then, within a year I've put on like a stone and a half’. Sarah thought her current nursing job meant ‘ I can't really preach healthy living to people if I'm not actually doing it myself ’. However, accounts in this group also tended to describe transition-related barriers to weight loss. Jamie ‘ discovered booze ’ at university ‘ and then that really was us off to the races in terms of overweight ’. Other ‘gainers’ described the impact of shift-work, on diet (‘ no eating breakfast again, and grabbing a bar of chocolate ’—Kirsty) and motivation to exercise (‘ after a day's work I'm absolutely knackered and I don't want to go out for a run ’—Matthew).

Studies that track from adolescence into adulthood are relatively rare. In our sample of previously overweight or obese adolescents, over a third had not gone on to become obese adults, but almost a quarter were already morbidly obese. The interviews revealed clearly that, contrasting with the recalled lack of concern in mid-adolescence, 20 weight-related concerns and/or desire to lose weight generally increased around the time of school-leaving and most participants described some form of both exercise (formal/informal) and dietary weight-control strategies. These changes may have partly resulted from increasing autonomy (independent/voluntary functioning), 25 self-determination 26 or self-esteem 27 with age: many participants described perceiving postschool transitions as a fresh start and acknowledgement of weight as personal responsibility; most had left the parental home and controlled their own diet and leisure activities.

Differences between ‘slimmers’ and those who had become or remained obese were subtle and hard to detect, even using qualitative methods. A qualitative study of 22 US overweight adolescents, identified via health centre records, found those whose BMI decreased over a 2-year period were more likely to describe ‘transformative experiences’ and family support as well as intense daily exercise. 4 Other qualitative studies have identified successful weight loss maintenance strategies including dietary change, ‘overwhelmingly increased’ exercise and rigorous self-correction after going ‘off course’ among US 14–20 years with sustained weight loss, 28 and a ‘healthy obsession’ with monitoring food, activity and weight among eight formerly obese US adolescents who had attended an immersion treatment. 29 A qualitative study of 20 overweight Taiwanese nursing students highlighted ‘the struggle’, of continuing to practise a new lifestyle and so reducing/maintaining bodyweight. 30 These findings are consistent with suggestions in our data of lifestyle changes becoming habitual and/or part of identity among ‘slimmers’, and of their appearing more likely to self-monitor diet and PA.

Few participants described receiving professional support and, although numbers are small, diet clubs seemed to have been used most by ‘gainers’. In contrast, ‘slimmers’ had achieved weight loss, without support, sometimes fairly easily. A previous qualitative study of obese Australian adults similarly found that few received long-term professional guidance or support as adolescents. 31 Although important for adolescent weight loss, 4 28 it has been suggested that exercise is less acceptable as a weight-loss solution because it is perceived as harder, 31 yet in this study, slimmers commonly used and sustained exercise as a method of weight-control and did not generally describe it as hard.

Our analysis highlights complex relationships between postschool transitions and weight-control behaviours. University/college, work and independent living were each described as facilitating weight losses by some and increases by others. Analysis of US longitudinal youth survey data has identified subgroups with distinctive patterns of weight-gain risk at different periods from middle-school to work/family formation. 32 Other studies have found evidence of declines in PA, increases in alcohol consumption and poor nutrition at University 33–35 36 and in young adulthood, 37 38 but these life-stages have not previously been described before as promoting weight loss. Relationships have also been found between obesity and work conditions including long hours, but again not weight loss. 39

The main strength of this paper is its objective categorisation of participants as ‘slimmer’, ‘gainer’, etc, based on (measured) BMI at several points throughout adolescence. The threshold used in childhood (95th centile) is not a stringent definition of childhood obesity, though widely used for public health analyses. 40 When compared with the more stringent clinical definition of obesity, 40 the 98th centile (Z score 2, equivalent to BMI of about 30 at age 20), nine of the participants were only overweight as adolescents, but it is of note that five of these went on to be obese as adults. Several not categorised as ‘slimmers’ or ‘relapsers’ also mentioned weight loss, not detected by our measurement schedule. Gaps and possible weight changes between measurements, and the sometimes vague nature of participants' recollections mean that precise chronological mapping of these against weight changes is impossible. As the original study did not set out to specifically identify some of the themes highlighted here, particularly professional support, identity and vigilance, we cannot know if other participants might have discussed these issues had the interview included them. The fact they emerged spontaneously is a strength, but because they were not a consistent focus of the study, conclusions on differences between the BMI trajectory groups must remain tentative. However, future research on late adolescent/young adult weight-related concerns, behaviours and experiences could explore these issues more explicitly. Another limitation of all interview data is that participants might have been providing acceptable ‘public’ accounts to a public health researcher 41 about a stigmatised issue. 42 43

In conclusion, this exploratory paper adds insights on experiences of obesity and weight loss during a rarely studied life-stage when research participants are hard to access. In contrast to their recollections of adolescence, as young adults even the heaviest participants tended to show contemplation or preparation for weight-loss action. 12 13 Although there were few really distinctive differences between those who successfully lost weight and those who became ever more obese, their accounts suggest the importance of social context and highlight potential health-change opportunities during the transition to adulthood. This could be a key life-stage for interventions, which should include workplace and educational 44 settings.

Acknowledgments

The authors would like to thank the young people, nurse interviewers, schools and all those involved in the West of Scotland 11-16/16+Study.

Contributors: HS and CW conceived the research questions and analysis, ES gathered the data as part of a wider study. JN identified relevant themes, CW categorised participants on the basis of their adolescent and age 24 BMIs, HS identified relevant literature and first-drafted the paper. All authors contributed to subsequent redrafts.

Funding: HS is funded by the MRC at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (MC_UU_12017/12 and SPHSU12). These data were gathered by ES while funded by a UK Medical Research Council (MRC) PhD studentship. JN was funded by a small grant from a Feeding Research Fund held by CW. CW is funded by Glasgow University and NHS Greater Glasgow and Clyde.

Competing interests: None declared.

Ethics approval: Approval to conduct each stage of the 11-16/16+ Study was given by the University of Glasgow Ethics Committee for Non-Clinical Research Involving Human Subjects; approval for the qualitative substudy was obtained from the University of Glasgow Law, Business, and Social Science Faculty Ethics Committee.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data sharing statement: The current MRC/CSO Social and Public Health Sciences Unit Data Sharing Policy does not cover data collected by research students. Anyone with a particular interest in this qualitative data set should contact HS.

Which artificial sweetener is the safest choice?

Collage of FDA legal documents, a person drinking coffee and a pile of sugar.

There’s mounting evidence that artificial sweeteners may be linked to heart disease and other possible health risks. Scientists say the findings are far from definitive, however, with some leading researchers calling for better-designed clinical trials investigating the long-term health effects of sugar substitutes.

That’s why, in separate trials, researchers are actively working to get a clearer understanding of how artificial sweeteners affect blood glucose levels, gut microbiome health and the cardiovascular system. Some studies are beginning to compare the alternatives against each other, while others hope to learn how they affect the body compared to sugar.

As it is, it’s difficult for consumers to determine which sugar alternative carries the fewest health risks. Most of the research is observational , meaning it doesn’t prove cause and effect. In some cases, researchers looked at people who ate nonsugar sweeteners, analyzed their incidence of certain health risks like heart attacks or diabetes, then noted associations between the two.

All the widely consumed alternatives such as saccharin, aspartame, sucralose, stevia, xylitol and erythritol are approved by the Food and Drug Administration. They’re found in countless products including sports drinks, energy bars, yogurts, cereals, beverages, candies, baked goods and syrups.

Even with FDA approval, Dr. Dariush Mozaffarian, a cardiologist and professor of nutrition science and policy at Tufts University, said “they’re all potentially worrisome and all understudied.”

In recent research, cardiologist Dr. Stanley Hazen at the Cleveland Clinic found that the high concentrations of the sugar alcohol sweeteners xylitol and erythritol may cause the platelets in the blood to become more sticky and prone to clotting, in turn raising the risk of heart attack and stroke. The phenomenon is similar to what happens with high cholesterol, Hazen said. If they get big enough, the clots can block blood flow through crucial veins and arteries.

Some experts say that instead of trying to pinpoint the safest nonsugar sweetener, better studies need to determine whether there’s a benefit to swapping out sugar in the first place.

After publishing research finding a connection between erythritol and increased risk of heart attack and stroke , Hazen and his colleagues conducted the first head-to-head human trial comparing the effects of consuming erythritol versus sugar on the blood platelets that control clotting. The results of that study are pending publication.

Vasanti Malik, an assistant professor of nutritional sciences at the University of Toronto, meanwhile, is conducting a study of more than 500 people directly comparing the health effects of drinking sugar-sweetened beverages, noncaloric sweeteners or water. Malik and her colleagues plan to measure obesity and heart health over time.

At Virginia Tech, registered dietitian Valisa Hedrick is working with the National Institutes of Health on another study comparing the effects of four different artificial sweeteners versus sugar on blood glucose levels and gut microbiome health. The study, which focuses on people with prediabetes, is a controlled feeding trial, meaning participants only eat the meals that NIH provides them, and nothing more.

This is important, Hedrick said, because one of the growing concerns with nonsugar sweeteners is that the products trick the brain in such a way that they increase sugar cravings. People may then end up eating more sugar throughout the day, spiking their blood glucose.

With a controlled study, the researchers can answer whether the sweeteners themselves raise blood glucose directly — not the sugar people could otherwise eat later.

The limits of sweetener studies

A research bias called reverse causation can make it difficult to draw decisive conclusions from prior studies, Malik said.

People often change their diets after they start developing diabetes or putting on weight, Malik said. These people, generally, are most likely to switch from sugar to nonsugar sweeteners. This is where the reverse causation comes into play.

“You get a spurious association between the intake of nonsugar sweeteners and the risk for diabetes,” she said. That is, the data ends up suggesting that these sweeteners are causing health problems that already existed.

Many studies also rely on people to report whether they’ve consumed nonsugar substitutes, which can be unreliable. Names like xylitol can be buried in a long list of ingredients.

Other studies, meanwhile — like Hazen’s erythritol and xylitol studies — may focus directly on what happens in the body after someone consumes one of these sweeteners, but they tend to enroll small numbers of people and track them only for a short time.

“A lot of these studies are really hard to interpret,” said Dr. Michelle Pearlman, a gastroenterologist and the CEO and co-founder of the Prime Institute in Miami. “And the problem is that there’s no head-to-head trials of people eating candy bars versus xylitol, so I can’t make any blanket statements recommending one or the other.”

Both Hedrick and Malik hope to share results from their respective studies in the next several years.

“We need experimental science alongside more rigorous observational research,” Malik said. “There are trials underway, and I think in the next five years we’ll have more clarity on the topic. We’re just not quite there.”

In a statement, the Calorie Control Council, an industry trade group representing more than two dozen sweetener manufacturers, said studies linking alternative sweeteners to health risks are based on flawed research and that the products are safe.

“It is irresponsible to amplify faulty research to those who look to alternative sweeteners to reduce overall sugar intake as well as the millions who use it as a tool to manage their health conditions, including obesity and diabetes,” Carla Saunders, the trade group’s president, said in the statement.

Why it’s important to know

Most low-calorie and sugar-free foods contain at least one sugar substitute, and many contain several. These products are growing more popular, especially in the U.S. By 2033, market research suggests sugar substitutes could be worth more than $28.57 billion.

“They’re ubiquitous,” Mozafarrian said. “And they’re proliferating because people have become so obsessed with avoiding sugar.”

Mozaffarian said these sweeteners soared in popularity following changes to U.S. nutrition labeling requirements in 2016 .

The change required manufacturers to list added sugars on a separate line beneath total sugars. The idea was to help consumers differentiate between foods with naturally occurring sugars, like fruit and plain Greek yogurt, and foods that had sugars mixed in.

“Now, the food industry has a big incentive to make that ‘added sugars’ number as small as possible,” he said. “So you’re seeing these compounds in everything, and we still don’t have enough information on them.”

Some products are labeled as “artificial sweeteners” or “natural sweeteners” based on whether they’re derived from natural sources or chemically engineered.

Even natural sweeteners go through heavy chemical processing, said Dr. Maria Carolina Delgado-Lelievre, a cardiologist at the University of Miami.

For example, stevia comes from processed stevia plant extract, monk fruit sweetener comes from processing a chemical in a gourdlike fruit grown in China, and sucralose is a chemically altered version of sugar about 600 times sweeter, according to the FDA .

Aspartame and saccharin are from human-made fusions of amino acids and chemicals.

Many of these sweeteners are so potent in tiny quantities that they’re mixed with xylitol or erythritol to bulk them up and fill a packet, said the Cleveland Clinic’s Hazen.

Given this label confusion, Hedrick said researchers are increasingly using the term “nonsugar sweeteners.”

Health risks of added sugars

Sugar, of course, is one of the country’s most pressing public health problems. Especially in soda and juice, excess sugar fuels the ongoing obesity epidemic , contributing to heart disease, liver disease, cancer and diabetes .

However, there’s a big difference between processed, concentrated sugars like high-fructose corn syrup and the natural sugars found in fruits, Pearlman, the Miami gastroenterologist, said. Processed sugars are highly addictive.

“Anything with high-fructose corn syrup stimulates the same reward centers in our brain as cocaine and heroin,” she said. “Natural sugars from fruit act differently in the body.”

Sugar’s bad rap has much more to do with the quantity people consume than any intrinsically bad property, experts agree.

“Added sugar is nuanced,” Mozaffarian said. “When you try to take that very real nuance and turn it into a simple message, you get the industry misleading consumers that foods are ‘not good.’”

A little bit of added sugar in otherwise healthy foods, he said — such as lightly sweetened whole-grain cereals — is usually OK.

“The harms of these different nonsugar sweeteners have been greatly underemphasized and the harms of small amounts of added sugar have been overemphasized,” he argued.

Sugar substitutes for children?

The U.S. government’s Dietary Guidelines for Americans recommend that anyone over the age of 2 consume less than 10% of their daily calories from added sugar, or the equivalent of roughly 12 teaspoons of added sugar. In reality, as of 2018, people in the U.S., including children, were consuming about 17 teaspoons of added sugar per day, on average.

Recently, the U.S. Department of Agriculture implemented a new rule limiting added sugars in public school lunches . Michael Goran, a professor of pediatrics at the University of Southern California’s Keck School of Medicine, said he worries that schools will replace sugary foods with artificially sweetened foods to comply with the new rules.

“There’s this general perception that these sweeteners are safe alternatives, but if they’re broadly applied to children, I unfortunately think that’s very risky,” he said.

Mozaffarian said that at their current levels of added sugar, most yogurts would no longer be allowed in school lunches once the new rule goes into effect.

“They’re just above the new limit, so it’s likely these yogurts are now going to be made with a series of sweeteners with uncertain health effects,” Mozaffarian said.

In the meantime, Pearlman said, it’s easy to see they haven’t helped the population become healthier on the whole.

“We have more chronic disease, more diabetes today than we’ve ever had before,” she said. “That shows that despite the diet industry being worth billions of dollars, we’re clearly missing the ball.”

A confusing body of limited research, coupled with the lack of clarity on food labels, puts consumers in a tough position when it comes to selecting the healthiest choices, the experts concluded.

All agreed on the best solution:

Eat as many whole, unprocessed foods as you can.
The less processed a food, the less likely it is to be loaded with added sugars or nonsugar sweeteners.

“If I had the choice of eating a store-bought cookie with a lot of sweeteners in it, a store-bought cookie with monk fruit, or a homemade cookie with sugar, I would choose the homemade cookie,” Goran said. “You can still enjoy the cookie, but maybe put a little less sugar in there.”

NBC News contributor Caroline Hopkins is a health and science journalist who covers cancer treatment for Precision Oncology News. She is a graduate of the Columbia University Graduate School of Journalism.

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Asking Hard Questions. Considering all this, we need to ask hard questions about what we think we know about obesity. 1. How can we know that? For instance, how can we be more confident of dietary factors that contribute to obesity. Presumptions and logic are not good enough. 2.
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Obesity. The NIH supports obesity research across the lifespan, examining the causes and consequences of obesity, developing and evaluating new prevention and treatment strategies, and determining how to implement and expand promising approaches to reach those who could most benefit.
How To Write A Strong Obesity Research Paper?
Childhood obesity outline example. As the question of childhood obesity is a specific one, it would differ from the outline on obesity we presented previously. Here is a sample you might need. The topic covers general research on child obesity. Introduction. Hook sentence. Thesis statement. Transition to Main Body. Main Body. The problem of ...
399 Obesity Essay Topics & Research Questions + Examples
This essay shall discuss the health issue of obesity, a social health problem that is, unfortunately, growing at a rapid rate. Obesity in Hispanic American Citizens. The issue of obesity anong Hispanic Americans occurs as a result of poor dieting choices caused by misinformed perceptions of proper eating.
The Benefits of Physical Activity for People with Obesity, Independent
1. Introduction. Purposeful weight loss continues to be the primary focus for treating obesity. Behavioral recommendations for weight loss include lifestyle modifications that reduce caloric intake from diet and increase caloric output with increased physical activity [1,2].However, this strategy appears to be inadequate as obesity rates continue to rise and the myriad of benefits of physical ...
Challenges in obesity research
Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors-- …
Frequent Asked Questions about Obesity
Obesity is a chronic, progressive pathology that has no cure and requires specific treatment to lose weight and continuous follow-up to avoid weight regain. There are several treatments for obesity but none of them cures it definitively. Unfortunately, physiological adaptations to weight loss favor weight regain.
Setting the top 10 priorities for obesity and weight-related research
Objectives: To identify and prioritise the most impactful, unanswered questions for obesity and weight-related research. Design: Prioritisation exercise of research questions using online surveys and an independently facilitated workshop. Setting: Online/virtual. Participants: We involved members of the public including people living with obesity, researchers, healthcare professionals and ...
Obesity (Excessively Overweight): Health Effects and Next Steps
Obesity and mental health. People with obesity are at higher risk for mood and anxiety disorders. One study found that those with obesity were 55% more likely than others to develop depression ...
BMI Frequently Asked Questions
Frequently asked questions about BMI, including how it is used and how it should be interpreted. ... For most people, BMI is a good indicator of whether they have too much or too little body fat. However, BMI is not a direct measure of body fat. ... Obesity during childhood or teenage years is associated with various physical and mental health ...
Asking a Good Questions and Preparing to Search
Constructing and parsing a research question Boolean logic Proximity operators Field searching Controlled vocabularies and database structure ... Home → Services → Library Training & Events → Instruction Menu → Asking a Good Questions and Preparing to Search. Asking a Good Questions and Preparing to Search Constructing and parsing a ...
'Now I care': a qualitative study of how overweight adolescents managed
Introduction. Adolescent overweight is associated with greatly increased likelihood of adult obesity, 1 but up to a third of obese adolescents do not go on to be obese adults. 2 What is not clear is why and how some overweight/obese adolescents (defined broadly, by the WHO, as those aged 10-19 3) lose weight and others do not, 4 and why some adolescents maintain weight loss while others ...
Which artificial sweetener is the safest choice?
A research bias called reverse causation can make it difficult to draw decisive conclusions from prior studies, Malik said. People often change their diets after they start developing diabetes or ...
Dual exposure-by-polygenic score interactions highlight disparities
The transferability of polygenic scores across population groups is a major concern with respect to the equitable clinical implementation of genomic medicine. Since genetic associations are identified relative to the population mean, inevitably differences in disease or trait prevalence among social strata influence the relationship between PGS and risk.

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Strengths and limitations of this study

Patient and public involvement

Subjects and methods

Survey 1: gathering questions and identifying those unanswered

Supplemental material

Survey 2: prioritising unanswered research questions

Workshop: determining the top 10 research priorities

Final top 10 priority research questions*

Summary of findings

Strengths and limitations

Implications for research and policy

Ethics statements

Ethics approval

Acknowledgments

Supplementary materials

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