The word obesity (from the Latin ob-esum, meaning on account of having been eaten) is a lay term which means the same as fatness but with moderately abusive overtones. Obesity is a disease with International Classification of Disease code E66 (World Health Organization, 1997). In adults ‘obesity’ is now defined by international convention to indicate the state of having a BMI of < 30 kg/m2 (or ‘grade 2 obesity’), while a BMI of > 25 kg/m2 is designated ‘overweight’ (or ‘grade obesity’) and a BMI of 18•5–25 kg/m2 is ‘normal’, so by definition a BMI of > 25 kg/m2 is abnormal. The disease itself is the process of excess fat accumulation, and obesity is a progressive systemic disease process, with multiple organ-specific manifestations. Obesity brings a host of debilitating symptoms plus secondary metabolic effects, many of which conspire to cause IHD. Obesity now presents one of the biggest health problems of our times. Diet and exercise are best for both prevention and treatment; unfortunately, both require much discipline and are difficult to maintain. Medications offer a possible adjunct, but their effect is modest, they are limited by side effects, and the weight loss lasts only as long as the drug is being taken, since as soon as treatment is stopped, the weight is regained. Sibutramine, a sympathomimetic medication which was available for long-term treatment is the most recent of the drugs to be withdrawn from the market due to side effects; in this case it was an increased risk of cardiovascular events. A number of other drugs remain available, but learning more about the combination of existing medications and new drug development will hopefully provide better treatment for this very difficult.
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