Uncoiling the Tightening Obesity Spiral


While an underweight prevalence was once more than double that of obesity, now more people are obese than underweight.  Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030.  Escalating obesity-related disease costs threaten to bankrupt the world’s healthcare systems.

The author reviews some of the causes for the increasing prevalence of this disease, identifies opportunities to intervene to prevent its progression, and discusses possible methods that may avert further increase in the overall prevalence of obesity in the general population.


2,100,000,000 people or nearly 30% of all people about the globe are obese with the U.S. population being the most obese.  Not one country has achieved success in reducing obesity rates.1 Although some models suggest leveling off may limit the prevalence to a more modest 42%, linear trends forecast 51% of the world’s population is forecast to be obese by 20302. Obesity related diseases include gastric reflux, sleep apnea, hypertension, hyperlipidemia, autoimmune diseases and cancer, heart disease, strokes, and most significantly type 2 diabetes mellitus.  In a report published November 20, 2014, McKinsey Global Institute estimated worldwide annual Obesity related disease costs reached $2,000,000,000 and are forecast to grow by 9.6% annually to $17,000,000,000 in 2030, threatening to bankrupt national healthcare systems. 

In the vast majority of circumstances, diet and counseling are less successful than weight loss surgery as long-term solutions3,4 and successful treatment requires a multidisciplinary approach.5 However, in spite of the increasing obesity problem, the number of bariatric surgeries performed annually remains limited to a very small portion of the afflicted population.

Established surgical options are either restrictive or bypass in nature.  These surgeries involve cutting into the bowel, rearranging the body’s alimentary plumbing or leaving behind a foreign body to force the patient to eat less or make food wind up in the toilet incompletely digested, with potential of creating nutritional cripples.  The number of bariatric surgeries has plateaued with annual costs exceeding $1,500,000,0006 and was estimated at approximately 196,000 by the American Society for Metabolic and Bariatric Surgery for 2015 with Roux-en-Y and gastric banding losing popularity in favor of gastric sleeves.  They reported revisions have more than doubled between 2011 and 2015 and comprise almost 14% of all such surgeries.  The low plateau evidences patient and physician dissatisfaction with the costs, risks and long-term sequelae of current surgical options. Read more