Obesity is defined as condition characterized by excess body fat.

It usually occur when calories consumed exceeds those expended through exercise and activity. (Port, 2007) The terms overweight and obesity are used interchangeably. However, according to Beers (2003), a distinction is made between being overweight and being obese. Overweight is defined as a BMI of 25 to 29.9,while obesity is defined as a BMI of 30 or more (p.831). Presently, obesity is a serious nutritional disorder that encompasses cosmetic considerations. Attempts to combat this health crisis have placed a burden both on health resources as well as governmental finances. Nevertheless, the fight against obesity should not be neglected. It is a growing epidemic that must be remedied. This paper is written for the purpose of educating people on obesity. It will: examine the prevalence of obesity locally, regionally and internationally, the causes of obesity and discuss how it contributes to the development of common diseases. In addition, aspects of obesity prevent strategies will be outlined and, two approaches used to treat obesity will be analysed. Local, regional as well as global facts on obesity are quite similar and tend the share the following characteristics. They reflect a tremendous increase in the prevalence of obesity. It is prevalent both in adults and children and the rate of incidence is higher in women than in men. During the late nineties, obesity emerged as a health problem in Trinidad and Tobago. Unpublished data from 1999 considered obesity to be a serious problem only among adults during that time. While 4.6% adolescents,13-19 years were overweight 16.8% of adults(20 years and older) were obese. Additionally, the rate of incidence among women was almost twice as high as in men. (Nutrition Country Profile [NCP]). Over the last ten year the incidence of obesity has tripled in Trinidad and Tobago. Bishops, (2011). Also it is prevalent more than ever among children and adolescents. As a matter of fact, twenty-three percent of pupils from primary schools and twenty- five percent of

secondary school pupils in Trinidad and Tobago were recorded as being overweight by the Caribbean Food and Nutrition Institute for the period 2009-2011 (King, 2011). The Bahamas, Barbados, Guyana and St. Lucia are among the Caribbean countries which show a substantial level of obesity (Ford & Mokdad, 2008, vol.93, p.51). Over the years, the prevalence of obesity in the Caribbean has increased at freighting rates. In two decades obesity has grown by almost 400% ... (Henry, 2004, vol.37, p. 1) Twenty- five percent of adult Caribbean women are seriously... obese, and this is almost twice as many as their male counterparts (CFNI, 2001) (Henry, 2004, vol.37, p. 1). In addition to these startling statistics, the Caribbean Food and Nutrition Institute reported that 15 % of the populations of various Caribbean countries are made up by obese children (Wilkinson, 2007). Because obesity has been increasing at shocking rates, the World Health Organization nicknamed the term obesity as globesity Worldwide obesity has more than doubled since 1980. In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. Nearly 43 million children under the age of five were overweight in 2010. (World health organization, 2011). Indefinitely! Obesity is a serious cause for concern. But what should we blame for the cause of this epidemic crisis? Although factors that lead to the development obesity are not understood, evidence reflects a complex interaction between genetics and a variety of non genetic factors such as: unhealthy lifestyle, socioeconomic factors, physiologic changes, and psychological factors. Genetic factors may influence the development of obesity in a number of ways. According to Shepherd (2009), There is a growing body of evidence that describes obesity as a polygenic disorder, with many genes being linked to, or associated with, a predisposition to adiposity (Batch and Baur 2005 ). Ones genotype also determines one fat stores and distribution of body fat.

(National Heart Blood and Lung Institute [NHBLI], 2010). Obesity also tends to run in families (Beers 2003,p.831). The risk of becoming obese is three times greater for a person with an obese parent that someone with parents with a healthy weight (WebMD, 2011). Additionally, families do not only share genes. They influence a persons patterns of living and values about health and illness as well (Taylor, Lillis, LeMone& Lynn, 2011). Individuals belonging to families where it is customary to consume large amount of high fat foods and snacks, eat at irregularly times skip meal, and partake in little physical activity are at an increased risk of becoming obese. (Obesity-Cause, 2011) Unhealthy lifestyle habits of little physical activity coupled with poor eating habits are too often the culprits for the development of obesity. According to Myers (2004) much of the increase in obesity in the last 25 years has resulted from the decreased level of physical activity in everyday life. This partly due to technological changes. Actually, technology has made the environment more sedentary. Take a look around! Today, elevators and escalators are often chosen over walking up the stairs, emailing and text messaging are sent rather than walking over to co-workers desks and a taxi is taken for travel to short distance rather than walking. Additionally, the popularity of television, computers, and video games translates into an increasingly sedentary lifestyle for many children (Ferry) as this influences physical activity levels. As for diet, studies confirms that there is an increased risk of being obese because of poor eating habits such as skipping meals, eating away from home consuming large amounts of fast and processed foods, and eating little fruit and vegetables ("Hefty impact of," 2011).Poor eating habit is often the underlying cause for obesity among working people and college students. With erratic working hours many find it difficult to follow a diet (Mallela, 2009) and running from class to class barely leaves

enough time for sufficient and healthy meals(Brady,2008). Consequently, meals are frequently shipped, and fast foods and energy drinks high in calories become a major part of their diet for. Too often I have witnessed many of my colleagues COSTAATT, Tobago consume lunches from popular fast food outlets: KFC and Royal Castle, bags of high calorie snacks and fried pies and high calorie energy drinks. Un fortunately I have sadly watched my colleagues and I got fatter over the years as a result of our poor eating habits. Additionally, socioeconomic factors which includes: income, level of education as well as their culture can have a profound effect on ones health and can also contribute to the development of obesity. Beers (2003) stated that socioeconomic factors are the leading cause of obesity especially among women. In the United States and other developed counties, obesity is more than twice as common among women of lower socioeconomic class as it is among women of higher ones(Beers, 2003, p.832). Generally, lower-income populations are more exposed to fast foods and lower quality dietary choices than are the higher-income subgroups, leading to increased incidence of obesity (Kenney, 2010). Additionally, poverty is often associated with poor education. This also affects ones ability to make healthy decisions and also lead to poor lifestyle habits and inevitably, obesity. As for cultural influences, several societies have related obesity to attractiveness, strength and good health. The acceptance of this notion is quite evident in Trinidad and Tobago, and by extension, the Caribbean. Actually in the Caribbean, thick is in!( Hope, 2010) .Obesity is a socially acceptable form of prejudice, where being solid or having size is preferred over slimness or thin bodies (Henry, 2004, vol.37, p. 18), This cultural norm has influenced our dietary choices and consequently has resulted in such a high prevalence of obesity in the Caribbean.

Certain physiological changes can also account for the prevalence of obesity. Two common examples are pregnancy and aging. Gaining weight during pregnancy is normal and necessary(Beers, 2003) and it usually occur as a result of hormonal changes. However, the widely accepted view of "eating for two" during pregnancy often result in excessive weight gain. (Heerden,2009). In most cases weight problems established during pregnancy are unresolved thereafter and obesity occurs as a result. The issue of being obese is further exacerbated in women with a high childbearing rate and little spacing between children (Beers , 2003, p.832). One of the hallmarks of aging is decreased muscle mass due to reduced activity. Consequently, muscle loss gives rise to a slower metabolic rate. If calorie intake is not reduced with age, the risk of obesity in the elderly increases. (National Heart Blood and Lung Institute [NHBLI] 2010). Lastly, psychological factors such a emotional disturbances ( Beers, 2003,p.832) of anxiety, stress, or illnesses such as depression can lead to overeating. (WebMD, 2011). Food is sometimes used as a reward, comfort or as a means of getting attention(Port,2007, p.172) Some people eat to calm themselves, to avoid dealing with unpleasant tasks or situations, or to dampen negative emotions Such poor coping strategies practiced overtime, often leads to obesity. (Obesity-Cause, 2011) Serious consideration must be given to obesity because it is extremely detrimental to ones health As a matter of fact, is closely associated with the development of serious health conditions. Let take for example coronary heart disease (CHD). A study highlighted in Harms (n.d) article stated that obesity increases an individual's risk of heart failure from coronary heart disease by 104

percent. Excessive calorie intake associated with obesity, produces high BMI, raises blood cholesterol and triglyceride levels leads to the accumulation of plaque in the arteries and eventually causes coronary heart disease. Although most of the comorbidities relating obesity to coronary artery disease increase as BMI increases, they also relate to body fat distribution (Eckel,1997). Eckel (1997) mentioned that: Long-term longitudinal studies indicate that obesity as such not only relates to but independently predicts coronary atherosclerosis. In a 14-year prospective study, middleaged women with a BMI >23 but <25 had a 50% increase in risk of nonfatal or fatal coronary heart disease, and men aged 40 to 65 years with a BMI >25 but <29 had a 72% increased risk. There is also a correlation between obesity and Diabetes Mellitus. People with type 2 Diabetes mellitus tend to overwhelmingly have one thing in common; that is: being obese or overweight. As a matter of fact, approximately, 80-90% of Americans diagnosed with Type 2 diabetes are obese ("A codependent relationship:," .Moreover, In Trinidad and Tobago, where more than half its population is overweight records the highest rate of Diabetes cases in the Caribbean ("T&T leads Caribbean," 2011). The pathophysiology behind the interrelationship between obesity and diabetes identifies weight gain with impaired glucose metabolism. In actuality, excessive weight gain act as an inhibitor to insulin production as well as insulin action. (Huntley, 2011) With the inability to properly maintain blood sugar level, diabetes develops. Similarly to diabetes Mellitus, obesity and Hypertension /toxaemia as well as gallbladder disease intimately connect to each other. Like Diabetes Mellitus, the risks for hypertension increases with obesity. Generally, risk estimates

suggest that approximately 75 and 65 percent of the cases of hypertension in men and women, respectively, are directly attributable to an overweight condition and obesity (Bethesda, 2004). The risk for Toxaemia or pregnancy induced hypertension also increases as a result of excess body fat resulting from obesity. As stated by Myers (2004): The reasons that obesity causes hypertension are multiple, but it appears that the excess adipose (fat) tissue secretes substances that are acted on by the kidneys, resulting in hypertension. Additionally, with obesity there are generally higher amounts of insulin are produced and this excess insulin also elevates blood pressure. Concerning gallbladder disease, in comparison with people of normal weight, the bile of obese people is supersaturated with cholesterol (Hoffman,n.d.). In a super-saturated state, solid particles form and block the bile duct. This results in a chronic inflammation of the gallbladder and subsequent scarring of the bile duct( Medical consequences of obesity,2004).

Inevitably, obesity significantly impairs ones health. Because of it is close association with so many health problems, obesity as itself, can be regarded as a disease . The more severe obesity is, the higher the health risk associated with it. In severe cases, obesity can result in early death As a matter of fact, obesity double or triples the risk of premature deaths.(Beers, 2003) At least 2.8 million adults die each year as a result of being overweight or obese (WHO). In the United States alone, 300,000 deaths per year are related to obesity (Beer, 2003p.834). During the late nineties, obesity and its associated health problems accounted for more than half the death in the Caribbean

region ("Caribbean unity to," 2007). Additionally, sixty-three per cent of the deaths are obesityrelated in Trinidad and Tobago (Homer,2011).

Due to the high incidence of obesity and the disease risk associated with it, a proactive approach must be taken to reduce its occurrence by all means necessary. Most health related issues can be prevented and there is no exception to obesity. The main aspect obesity prevention is to maintain body weight within normal range in relation to age and gender and other health-related considerations. A more active lifestyle together with a low-fat diet(<30% 0f calories is seen as the strategy for prevention( Port,2007, p.172) Young Children, adolescents and young adults should be targeted. Exercising has many benefits. It helps to reduce body fat by building or preserving muscle mass and improving the body's ability to use calories, maintain a normal weight and prevents related health problems caused by being overweight. Exercise is for everyone! Simple activities such as walking to short distances rather than taking a taxi, walking up the stairs rather than taking the elevators and reducing time spent in sedentary activities can contribute to active lifestyle. Aerobic exercises such as: jogging, biking and walking briskly (Beers, 2003) can maintain a healthy body weight. One commonly suggested goal for exercise is 30minutes or more 5 to seven days a week(Beers,2003)Exercise cannot substitute for intake, therefore, great attention must also be placed on dieting in prevent obesity. There are many approaches to dieting. This includes avoiding foods that are low in overall nutrients (such as candy and soda pop) and limiting intake of trans and saturated fats, cholesterol ,sodium , and foods with a high glycemic index ("Obesity / overweight,"2009).Adding healthier food (fruits vegetables, grains) to ones diet,

practicing healthier eating habits an also eating moderation can contribute a great deal in preventing obesity The major focus of obesity treatment is weight loss. As said by Port (2007), the goals for weight loss areprevention of further weight gain, reduction of current weight and maintenance of a lowered body weight..(p.172). Although there are many ways of treating obesity, the method of treatment depends on ones: level of obesity, overall health condition, and motivation to lose weight. Dietary therapy and surgery can both treat obesity. While dietary therapy is a recommended, first- step, obesity treatment that focuses of lifestyle changes, surgery is available as an adjunct to lifestyle changes. Both treatments are based on the evaluation individuals status. Dietary therapy is individually prescribed based on the persons overweight status and risk factor profile and surgery is recommended for individuals who meet specific requirement. Weight loss surgery is limited to person with a BMI greater 40; those with a BMI greater than 35 who have comorbid conditions and those with complications of extreme obesity. On the other hand, Dietary therapy is almost, usually modified to meet the patients needs (Port, 2007,p.172) In summary, obesity is defined as excess body fat resulting from the consumption of calories in excess of those expended for exercise and activities. There is evidence that obesity is increasing at alarming rates, locally regionally and globally. Genetics and non-genetic factors: unhealthy lifestyle, socioeconomic factors, physiologic changes, and psychological factors are implicated as causative factors in the development of obesity. The health risks related to obesity include: coronary heart disease, diabetes, hypertension, toxaemia, gallbladder disease an early death.

Through exercise and diet, obesity is preventable. Although treatment such as dietary therapy and surgery differ from each other, the focus of obesity treatment is weight loss.