Who says obesity is an epidemic? How excess weight became an American health crisis

Purpose – To understand why obesity came to be considered an American epidemic, or even a global pandemic, in the mid-to-late 1990s. Why not decades earlier, given that by 1960 over 40% of Americans had body mass indexes (BMIs) above 25? Alternately, why at all, given the myriad ways in which obesity challenges standard definitions of an epidemic? Methodology/approach – Four decades of American medical journal articles and best-selling diet books are reviewed for definitions, measures, prevalence estimates, and presumed causes of excess weight. Findings – Developments paving the way for the “epidemicization” of American obesity include: (1) diffusion of the BMI as a standard measure of weight-for-height, and acceptance of increasingly low BMI cutoffs to define excess weight; (2) use of nationally representative surveys to estimate obesity prevalence; and, (3) the decline of psychoanalysis-driven prejudices predicating a wide gulf between a deviant obese minority and a nonobese majority. Contribution to the field – By showing how the obesity epidemic was able to transcend metaphor and become fact within the American medical community, this study demonstrates that health issues can come to the fore of public consciousness for a complex host of reasons. Better understanding of such reasons could help in evaluating, prioritizing, and ameliorating those health problems.