2004—40 years after the first surgeon general’s
report on smoking and health—48 million Ameri-
can adults remained smokers, fewer than a quar-
ter of the US adult population, and the number of
new smokers reached an all-time low. Nonethe-
less, cigarette smoking remains the leading cause
of CVD, cancer, chronic lung disease, and prema-
ture death in the United States.
Lifestyle and ObesityCultural and social perceptions strongly influence
the extent to which people understand the health
risks and consequences of obesity, representing a
complex intertwining of personal accountability
and societal pressures. Until the 20th century
being overweight was a sign of personal prosperity
and even a hallmark of health. The corpulent indi-
vidual was one who could afford unlimited access
to food and indulged in its luxury. No correlation
as yet existed to link obesity with common and
debilitating ailments such as “dropsy” (the gener-
alized edema of congestive HEART FAILURE) and
“quinsy” (ANGINA PECTORIS, a symptom of CORONARY
ARTERY DISEASE[CAD]). As doctors began to recog-
nize the health implications of obesity a key chal-
lenge that emerged was that of convincing people
of the connections between health, longevity, and
body weight.
Despite what now amounts to decades of scien-
tific evidence, misperceptions persist about the
roles of EATING HABITS, food choices, and daily
physical activity in WEIGHT LOSS AND WEIGHT MAN-
AGEMENTefforts. Furthermore, food is essential for
life—unlike cigarettes and ALCOHOL, which also
influence health. One cannot simply stop eating as
one can stop smoking or drinking alcohol (which
are not easy accomplishments themselves). As is
the case with cigarette smoking, the health conse-
quences of obesity accumulate slowly over
decades, lulling a person into believing that noth-
ing adverse is happening in his or her body. The
first recognition that obesity is a health problem
often comes when the doctor diagnoses a health
condition such as OBSTRUCTIVE SLEEP APNEAor HYPER-
TENSION and prescribes weight loss among the
treatment recommendations.
For many people with class 2 or 3 obesity, the
prospect of losing enough weight to have an effect
on health is daunting if not overwhelming and
often requires medical assistance. Yet even the loss
of 10 or 20 pounds over six months, a goal most
people can reach simply by adding 30 minutes of
walking to every day’s activities, makes a measur-
able difference in health. Health improvements
are apparent almost immediately and extend as
weight loss continues. Some people are able to
stop taking medications to treat conditions such as
hypertension and type 2 DIABETES when their
weight reaches healthier levels.
Between 1990 and 1999 the percentage of
American adults who have obesity doubled. In
2001 the US Office of the Surgeon General issued
The Surgeon General’s Call to Action to Prevent and
Decrease Overweight and Obesity, another landmark
report identifying obesity as a significant as well as
preventable cause of hypertension, type 2 dia-
betes, ATHEROSCLEROSIS, OSTEOARTHRITIS, and numer-
ous types of cancer. Weight loss became an explicit
health objective in HEALTHYPEOPLE 2010 , the US
national agenda for public health improvement.
Many health experts believe obesity, which affects
more than 55 million American adults, now rivals
cigarette smoking for its deleterious effects on
health.Lifestyle Variables: Smoking and Obesity 283