The pandemic of obesity is a well-known phenomenon affecting the world population, but more so the Western Hemisphere, with Americans being among the heaviest people in the world.

This pandemic has occurred since the 1980s with increasing frequency, despite attempts and recommendations by health organisations to mitigate the prevalence of obesity and its many collateral morbidities.

After three decades of research, scientists believe genetics play a role but structural environmental changes have a greater impact.

These changes are characterised by an abundance of low-quality food, economical variants, underactivity and psychological factors.

• Abundance of low-quality food

Unregulated marketing and advertising strategies allowed the food industry to mass-manufacture, mass-promote and make readily available “food-like” foods defined by their low cost, large portion, high-calorie, high-fat and high-sugar content.

They include artificial and highly orexigenic (or appetite stimulating) components, and multi-step processing that contradicts the concept of natural and simple nutrients.

Suffice to note that over the past 40 years, the US Federal Drug Administration has approved more than 70,000 food additives.

• Economical variants

Economical policies implemented over the past three decades have produced a relative stagnation of income for the preponderance of the population. For people with limited income, consistently buying healthy food became financially difficult and cheap, junk foods came to replace that.

In addition, long working hours and other changes and challenges in family and social structures made the option of fast foods quite attractive.

As an example, eating a ready-made shelf meal, alone, and in front of a TV or computer screen, replaced family gatherings around the dinner table to eat nutritious meals that might take time to prepare.

Another example is the misinformation and advertising — commonly done on purpose and targeting young people — that portray the joy of consuming a burger, fried sandwich or soda. In parallel with that, there is little education offered at schools, in work spaces and on media outlets about the value of healthy choices in food and lifestyle in general, since these positive campaigns would require funding resources and strategies that are very limited compared with the food industry’s capabilities.

• Under-activity

This stems from a total metamorphosis in Western lifestyle over the past four or five decades, including ubiquitous prevalence of passive transportation (cars, trains, elevator, etc) along with a change in living conditions where massive migrations had taken place to big, congested cities with fewer outdoor opportunities and more eating-centred activities. For example, going to a party instead of going for a run or a swim. There has also been a lack of emphasis on the need to integrate regular, low-level exercise into people’s lifestyles.

Paradoxically, there’s been a media idolisation of professional athleticism that has made sports part of the entertainment world, only worthy of a very narrow elite of highly trained individuals. The large majority of the people are there to sit and watch these athletes perform, while they themselves are eating.

• Psychological “risk factors” for obesity

Individuals who suffer from depression, anxiety and eating disorders may have more difficulty controlling their consumption of food, exercising an adequate amount, and maintaining a healthy weight. These psychological conditions may not need to be severe enough to require professional attention, but they would still profoundly impact people’s choices.

With the increase in the scale of depression, stress, and anxiety in modern societies, inflation in the obesity rate has been witnessed. In many obese individuals, there appears to be a perpetual cycle of mood disturbance, overeating and weight gain, as follows:

• When they feel distressed, they turn to food to help cope. Though such “comfort eating” may result in temporary attenuation of their distressed mood, the weight gain that results may cause a worsening of their mood disorder and self-esteem.

The resulting guilt may reactivate the cycle, leading to a continuous pattern of using food to cope with emotions.

• In addition to depression and anxiety, other obesity risk factors include problematic eating behaviours such as “mindless eating”, frequent snacking on high-calorie foods and night eating syndrome, which can lead to significant weight gain.

Night-eating syndrome is characterised by excessive night-time consumption of more than 35 per cent of daily calories after the evening meal, morning anorexia, and psychological distress. This occurs in more than 20 per cent of morbidly obese patients.

Unless there is a serious attempt at radically evaluating and correcting the above “roots” or causes of obesity, this devastating epidemic will continue to be rampant.

• Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.