Professional Documents
Culture Documents
Obesity in Biocultural
Perspective
Stanley J. Ulijaszek and Hayley Lonk
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
337
ANRV287-AN35-18 ARI 9 September 2006 8:39
Human genetics likely have undergone se- scale, as colonial models of economic man-
lection for traits that promote energy intake agement fell from favor. In tandem, changes
and storage and minimize energy expendi- in diet and activity patterns have been cen-
ture. Thus it is no surprise that there are a tral to the emergence of obesity among many
great many obesity-related genotypes. Mod- of the worlds populations, including poorer
els linking genetic susceptibilities with physi- ones (Popkin & Doak 1998). In the vast ma-
ology and feeding behavior are emerging, and jority of nations for which comparative data
although they only explain a small propor- are available, rates of obesity are increasing
tion of global obesity rates, might underlie (de Onis 2005, Nishida & Mucavele 2005). It
the more-common and genetically complex is estimated that over 300 million adults are
forms of human obesity. Human physiology currently obese, as dened by having a body
can only exert weak control on the reduction mass index (BMI) above 30 kg/m2 . A further
of food intake and the increase of energy ex- 700 million people are considered overweight,
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
penditure when energy stores are replete and with BMIs between 25 kg/m2 and 30 kg/m2 .
food security is high, and obesity is almost an The prevalence of obesity among children is
by Appalachian State University on 08/13/08. For personal use only.
for signicant sectors of society and for (Shetty & James 1994, Cole et al. 2000), al-
some nations as a whole, while denying though this measure is not independent of
food security for many others (Dyson 1996). stature, lean body mass, or body proportion
Underpinning such global phenomena are in- (Norgan 1994a,b). This index is widely used
terrelated physiological, genetic, and behav- largely because of the need for a simple com-
ioral factors (Shuldiner & Munir 2003, Clegg parative measure of obesity in the worlds
& Woods 2004, Flier 2004), as well as cul- populations.
tural norms that make humans susceptible to
obesity (Brown 1991, de Garine & Pollock
1995). How food use is structured socially and MEASUREMENT OF OBESITY
culturally has been slow to adjust to chang- AND FATNESS
ing patterns of food security, as have percep- Measures used to assess body fatness and
tions of appropriate body size for health and obesity include (a) visual appearance; (b) an-
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
beauty, which has contributed to the emer- thropometry; (c) body density by underwater
gence of obesity in various societies (de Garine weighing, isotopic dilution, dual X-ray ab-
by Appalachian State University on 08/13/08. For personal use only.
BMI range of 18.525 kg/m2 is likely to be 33 nations had obesity rates exceeding 10%
maintained in many populations by way of of their adult populations (Figure 1) (Nishida
balancing selection. The BMI cut-offs are & Mucavele 2005). Currently, obesity is most
used to dene overweight and obesity in prevalent in some Pacic Island nations; the
adults are 25 kg/m2 and 30 kg/m2 , respec- United States; most European, many Mid-
tively (Shetty & James 1994). However, the dle Eastern, and some Latin American na-
relationship between BMI and fatness varies tions; and South Africa. Four Pacic Island
across populations, as do relationships be- nations (Nauru, Tonga, the Cook Islands, and
tween morbidity and BMI. In some Chinese French Polynesia) have the highest rates of
(Li et al. 2002) and South Asian popula- obesity in the world, in all cases exceeding
tions (Gill 2001, Sullivan 2001, Wahlqvist 40% of their adult populations. Obesity rates
2001), increased chronic disease risk occurs for Bahrain and Kuwait lie close to that of
at lower BMIs than among European popu- the United States, at a little below 30% of
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
lations (Li et al. 2002). The BMI does not the adult population. The rate for Canada is
give a measure of intra-abdominal (visceral) approximately half that of the United States.
by Appalachian State University on 08/13/08. For personal use only.
or lower-body fatness, however. High levels For the adult South African population, the
of intra-abdominal fatness are independently rate is 22%, similar to Egypt, Turkey, Hun-
associated with risk markers of cardiovascular gary, and Germany, the latter two having the
disease, NIDDM, and various cancers (World highest rates in Europe. The lowest rate in
Health Organization 2000). High lower-body Europe, 5%, is among adults in Norway and
fatness relative to waist size is associated with Switzerland. Of Latin American populations,
lower risk of the same disorders, and among Mexico, Uruguay, and Peru have rates that ex-
females it is important for buffering the en- ceed 15%. Rates among wealthier Asian na-
ergetic stresses of pregnancy and lactation tions vary from 6% in Singapore to 3% of
(Garaulet et al. 2000). adult populations in Japan and South Ko-
Classication of childhood obesity using rea. In the vast majority of nations, obesity
BMI is more problematic than for adults be- rates among females are higher than for males
cause of the variability in the growth rates by an average of 5%. Obesity rates of fe-
of children both within and between popu- males exceed those of males by more than
lations. The BMI changes with age, and Cole 2% in 32 of the 66 nations for which data
et al. (2000) have proposed for international exist for both sexes, whereas obesity rates
use age-specic cut-offs for childhood over- of males exceed those of females in only
weight and obesity that pass through BMIs 4 nations.
of 25 kg/m2 and 30 kg/m2 , respectively, at Rising obesity rates have varied in different
the age of 18, using a normative distribu- nations. In Pacic Island nations, rates of obe-
tion that varies by age and sex. However, un- sity were already high by the 1960s and con-
like in adults where it is possible to establish tinued to increase dramatically into the 1990s
increased health risks associated with an in- (Ulijaszek 2005). The United States and
creased BMI, most health effects of childhood Canada had similar rates of obesity 40 years
obesity are manifested in adult life and not ago, at approximately 10% of the adult pop-
childhood, with the possible exception of risk ulation; subsequently, rates became higher in
markers for NIDDM. the United States than in Canada (Nishida &
Mucavele 2005). In the past 20 years, obesity
rates have risen in the majority of nations with
POPULATION TRENDS IN available data. Of 28 nations for which data
OBESITY are available, increased obesity rates have been
Obesity at the population level was largely un- observed for adult males in 20 and for adult fe-
known in the 1950s. However, by the 1990s, males in 19 (Nishida & Mucavele 2005). The
males. This has importance in reproductive good food security and sedentary lifestyle,
function: Lower-body fat is less-readily avail- given that the almost-worldwide increases
able for everyday energetic needs than upper- in survivorship and longevity have taken
body or abdominal fat, but lower-body fat place often in tandem with the emergence of
is mobilized during pregnancy and lactation obesity (Eaton et al. 1998).
(Garaulet et al. 2000). Reproductive ef- Because energy stores are vital to survivor-
fort during pregnancy and lactation is thus ship and reproduction, the ability to con-
buffered from environmental energetic con- serve energy as adipose tissue would have con-
straints (Ellison 2003). ferred selective advantage to Homo sapiens.
Human genetics are likely to have under- Neel (1962) suggested the existence of thrifty
gone selection for traits that promote energy genotypes that code for efcient and poten-
intake and storage and minimize energy ex- tially excessive energy accumulation. This for-
penditure (Rosenbaum & Leibel 1998). There mulation has undergone modication, with
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
jority of obesity is related to more than one lo- and hypertension considered to have been
cus, each accounting for only part of the phe- adaptive in the remote past but now com-
notypic variance (Comuzzie 2002). Because promised by changed environments. These
all aspects of metabolism are under genetic terms include syndromes of impaired genetic
control, and the expression of obesity phe- homeostasis, civilization syndromes, and al-
notypes is much more limited than the ex- tered lifestyle syndromes (Neel et al. 1998).
pression of peptides that regulate metabolism, Genes corresponding to such syndromes may
natural selection for the capacity to save and be called stockpiling (Garrow 1993), greedy,
store energy is likely to have taken place for or acquisitive instead because little obesity is
different genes with the same phenotypic re- caused by thrifty metabolism (Lev-Ran 2001).
sult (Lev-Ran 2001), perhaps ultimately to de- The biological drives of feeding, hunger,
fend the energy needs of large brain size. Neel and the dietary regulation of macronutrient
et al. (1998) argued that many different genes intake may have shared physiological and be-
underwent such selection in different popula- havioral bases with other animals (Ulijaszek
tions and geographic areas and under different 2002b, Berthoud 2004). Various mammals are
kinds of environmental pressure. Against this susceptible to overeating and increased body-
microevolutionary scenario, that most mam- fat deposition when presented with diets that
mals are able to overeat to high levels of body are plentiful, palatable, and/or high in fat, in-
fatness suggests the genetic basis for the ma- dicating that the tendency to overeat in re-
jority of human obesity lies in deeper evolu- sponse to food-portion size, palatability, en-
tionary time, although the greater normative ergy density and to overeat fat passively are
level of body fatness of humans relative to general mammalian evolutionary traits. Fur-
other primates and most mammals is likely thermore, social aspects of feeding are far
to have evolved with the encephalization that from unique to humans; the social facilita-
took place with H. erectus. tion of food intake (in which social interac-
Seasonality of food availability likely was tion during eating increases food intake) has
a major environmental pressure, given that long been known to take place among animals
it occurred during hominid evolution (Foley from chickens to primates.
1993) and is common in primate (Hladik Body size in the genus Homo was greater
1988) and human subsistence ecologies of than that of most australopithecines, and al-
all kinds (de Garine & Harrison 1988). Hu- though meat and nutritionally dense plant
man genotypes for obesity, however, are not foods were the major dietary components
incompatible with present environments of most likely to have fueled body-size increase
and encephalization in Homo (Plummer take is lower, generally varying between 0.11
2004), decreased taste sensitivities associated to 0.65 (Keller et al. 2003). With respect to
with greater body size would have also favored eating behaviors and styles, heritabilities of
increased diet breadth. Low sweetness and 0.44 and 0.65 have been reported for meal
bitterness sensitivities allow larger primate frequency and size, respectively (de Castro
species to nd food sources of lower-energy 1999), 0.40 and 0.45 for disinhibition (Neale
density palatable and to eat them more fre- et al. 2003, de Castro & Lilenfeld 2005), 0.44
quently than among primate species of small for cognitive restraint, and 0.24 for perceived
body size (Simmen & Hladik 1998). Fur- hunger (de Castro & Lilenfeld 2005).
thermore, basal metabolic rate per unit of Over 600 genes, markers, and chromoso-
body mass scales negatively with body weight mal regions have been associated with human
among primates (Martin 1993), making the obesity phenotypes (Perusse et al. 2005), and
energy requirement per unit of body size the numbers continue to grow. By October
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
lower in large primates than in small ones. 2004, 173 human obesity cases owing to
Human eating behavior differs from other single-gene mutations in 10 different genes
by Appalachian State University on 08/13/08. For personal use only.
mammalian species in the extent to which had been reported, whereas 49 loci related
(a) food availability is controlled, (b) social to Mendelian syndromes relevant to human
and cultural norms of diet and eating exist, obesity had been mapped to a genomic re-
and (c) personal feeding constraints operate gion, with causal genes or strong candidate
(Ulijaszek 2002b). Social and cultural norms genes identied for most of them. Further-
of diet and eating are likely to have increased more, 204 quantitative trait loci (single genes
in complexity only with the emergence of with large effects on a given quantitative trait)
complex symbolic behavior among H. sapiens for obesity-related phenotypes had been iden-
by 75,000 years ago (Henshilwood et al. 2004). tied from 50 genome-wide scans (Perusse
With cooking, the emergence of cuisine, and et al. 2005). Several single-point mutations
increased complexity of food use, great di- have also been associated with various obesity
versity in the social patterning of feeding has phenotypes (Bouatia-Naji et al. 2006, Wilson
taken place. Social feeding may have been a et al. 2006). At the population level, obesity
behavioral adaptation of early Homo that has is mainly polygenic, with genetic variations
continued to have implications for the energy inuencing metabolism. There are interac-
balance of contemporary human populations. tions of different obesity genes, and gene-
dosage effects in heterozygotes of obesity
genotypes, such that intermediate phenotypes
GENETICS OF OBESITY are less extreme than homozygotes (Chung &
Various types of evidence have been used to Leibel 2005). Success in the identication of
identify genetic contributions to human obe- polygenic determinants of obesity across hu-
sity. These include (a) familial clustering of man populations has been limited (Comuzzie
body fatness (Allison et al. 1996), (b) esti- 2002), although genome-wide scans in differ-
mates of heritability for obesity and fatness ent populations have localized major obesity
phenotypes in twin studies (Stunkard et al. loci on chromosomes 2, 5, 10, 11, and 20
1986, Keller et al. 2003), (c) identication of (Clement et al. 2002). The study of polygenic
monogenic severe early-onset obesity (Flier obesity requires the analysis of genotype-
2004), and (d) genotyping of polygenic obe- phenotype associations while taking into ac-
sity (Clement et al. 2002). count the inuence of environmental factors
The heritability of human adiposity (es- such as diet and sedentary lifestyle (Clement
timated in most studies from BMI, but also 2005). However, such an integrated approach
from skinfolds) varies from 0.49 to 0.93 requires large samples and the expansion
(Keller et al. 2003). Heritability of food in- of biocomputing tools for the analysis of
Figure 2 Brain
Genetic regulation
of energy balance
Adipose
by way of leptin tissue
signaling and
agouti related POMC PC1
protein (AGRP).
Leptin neuron - MSH
Modied from Leptin
Mizuno et al. 2003 receptor
and Flier 2004. Neurons
-MSH,
NPY expressing
-melanocyte
stimulating NPY/AGRP MC4R
hormone; MC4R, neuron
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
melanocortin 4 AGRP
receptor; NPY,
neuropeptide Y; Energy
PC1, prohormone expenditure
by Appalachian State University on 08/13/08. For personal use only.
convertase 1; Reproduction
POMC, pro- Appetite &
opiomelanocortin. energy intake
multiple interactions with no a priori hy- pathway identied more recently include de-
potheses (Clement 2005). ciency syndromes of leptin, leptin recep-
For over 50 years, monogenic rodent mod- tor, pro-opiomelanocortin (POMC), MC4-
els of obesity have been used widely in at- R, and prohormone convertase 1 (Farooqi &
tempts to understand body-weight regulation ORahilly 2005). These peptides function in
in humans. Linkages between the genetic and a central nervous system pathway for energy-
physiological study of obesity became possi- balance regulation (Figure 2) (Mizuno et al.
ble with the identication of (a) the ob gene 2003, Flier 2004). Although the mechanism
product leptin (Zhang et al. 1994) and the lep- whereby MC4R inuences food intake is rea-
tin receptor (Tartaglia et al. 1995), and (b) the sonably elaborated, its inuence on energy
agouti gene and agouti related protein (AGRP) expenditure is not. However, in the Quebec
(Zemel et al. 1995, Mizuno et al. 2003). Lep- Family Study, Loos et al. (2005) have identi-
tin is a cytokine secreted from adipose tissue ed a DNA-sequence variation at the MC4R
at a rate proportional to the size of body-fat gene locus that may contribute to physical in-
stores and is the principal physiological indi- activity. Although the major leptin-regulatory
cator of nutritional state and fatness. AGRP, arm of this model accounts for less than 4%
along with neuropeptide Y (NPY) and - of severe early-onset obesity, quantitative dif-
melanocyte stimulating hormone (-MSH), ferences in the expression or function of these
is a central mediator of leptin action. The same genes, either alone or in combination
melanocortin 4 receptor (MC4-R) plays a cen- with one another, may underlie the more-
tral regulatory role in the action of leptin common and genetically complex forms of
and is inuenced by levels of -MSH, NPY, human obesity (Flier 2004).
and AGRP. The signaling pathways involv-
ing leptin and MC4-R inuence the regula-
tion of all aspects of energy balance (Barsh PHYSIOLOGY AND BEHAVIOR
& Schwartz 2002, Fan et al. 2005). Several Physiologically, obesity can only develop if
types of monogenic human obesity owing food consumption is high and/or energy ex-
to genetic disruption of the leptin-signaling penditure is low, resulting in positive energy
balance across months or years. A positive en- lamus (often thought of as the satiety center
ergy balance of 10% can lead to approximately of the brain), stimulating appetite. Stimula-
a 13.5-kg increase in body weight within a year tion of NPY/AGRP neurons also causes cellu-
(Bray 1987). The increasing rates of obesity lar and tissue growth and appetite-stimulating
among adults in many industrialized popula- effects in the lateral hypothalamus, which in
tions across the second half of the twentieth turn upregulate energy intake and downreg-
century are a result of a disregulation of en- ulate energy expenditure. Decreasing leptin
ergy balance of less than 1% per year. The and insulin concentrations also lead to re-
physiology of energy accumulation is that of duced stimulation of POMC neurons, re-
neuroendocrine, gut- and adipose-tissue reg- sulting in lowered secretion of -MSH in
ulation of energy balance, the maintenance the pituitary. -MSH is a secondary peptide
of which involves coordinated and physi- product of the POMC gene, one of eight
ologically linked changes in energy intake yielded by differential processing of the pri-
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
and expenditure (Moore 2000). Both leptin- mary peptide product of this gene. This in
and melanocortin-signaling pathways are up- turn lowers its stimulation of the downstream
by Appalachian State University on 08/13/08. For personal use only.
a. Starvation
Adipose
tissue Brain
Leptin
Catabolism
Leptin
receptor POMC -MSH
neuron
Pancreas
NPY Neurons
Insulin
receptor NPY/AGRP expressing
Insulin MC4R
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
neuron
AGRP
by Appalachian State University on 08/13/08. For personal use only.
Energy
Grhelin
expenditure
GLP1 PYY3-36 Reproduction
Gut Appetite &
energy intake
b. Overfeeding
Figure 3 Adipose
Neuroendocrine tissue Brain
regulation of Leptin
energy balance. Catabolism
Modied from Leptin
Schwartz & receptor POMC -MSH
Morton 2002, neuron
Tschop et al. 2000,
and Flier 2004. Pancreas
AGRP, agouti
NPY Neurons
related protein; Insulin
-MSH, receptor NPY/AGRP expressing
Insulin MC4R
-melanocyte neuron
stimulating AGRP
hormone; GLP1,
glucagon-like
peptide 1; MC4-R, Energy
Grhelin
melanocortin 4 expenditure
receptor; NPY, GLP1 PYY3-36 Reproduction
neuropeptide Y;
POMC, pro- Gut Appetite &
opiomelanocortin. energy intake
of reproduction by way of the hypothalamo- reserves are depleted and fuel security is low.
pituitary-gonadal axis (Schioth et al. 2003). However, it can only exert weak control on
The neurophysiological system described reducing food intake and increasing energy
in Figure 3 strongly controls feeding and expenditure when energy stores are replete
reduced energy expenditure when energy and food security is high (Ahima et al. 1996).
Environmental factors associated with mod- haviorally. At any given time they are highly
ern life and good food security create constant stable but are heavily determined by social
pressures on food intake that are not compen- contexts of eating, in addition to expectations
sated by equivalent increases in energy expen- from foods prior to eating (Mela 1999). In
diture, with surplus energy stored overwhelm- the absence of food limitation in either vol-
ingly in adipose tissue (Berthoud 2004). This ume, weight, or energy, the most-powerful
model is a partial one, however, because food behavioral inuences on the amounts of food
intake is driven by additional cognitive and en- eaten by humans include (a) other individu-
vironmental factors (Berthoud 2004). At the als at a meal (de Castro 1999, Bell & Pliner
low end of the BMI distribution, consider- 2003, Wansink 2004), (b) television viewing
able research has been conducted on low food (Stroebele & de Castro 2004), (c) the size of
intake and adaptation to low energy intakes food packages and portion sizes (Rolls et al.
(Waterlow 1990, Shetty 1993), showing en- 2004, Wansink 2004), (d ) palatability (Spitzer
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
ergy balance at low intakes to be strongly & Rodin 1981), (e) the energy density of food
defended. The major components are feed- (Stubbs 1998), and ( f ) the consumption of
by Appalachian State University on 08/13/08. For personal use only.
forward mechanisms between the brain and caloric beverages with a meal (Della Valle et al.
gut that anticipate the nutritional needs of the 2005). In all cases, the greater the size or dose
body (Myers & Sclafani 2003) by respond- of the inuence, the more is eaten. Inuences
ing to the abundance of food cues in food- on the energy intake and density of food eaten
secure and socially enhanced environments in societies where there is food insecurity in-
(de Castro & Stroebele 2002, Ulijaszek 2002b, clude (a) economic constraints (Darmon et al.
Rolls 2003). Such cues include perceived qual- 2002, 2003; Drewnowski & Darmon 2005),
ities of potential foods, including (a) smell; (b) consumption of energy-containing bever-
(b) associations with pleasure, displeasure, ages (Bray et al. 2004), (c) passive overcon-
or disgust; (c) expectations from foods; and sumption of fat in high-fat diets (Blundell &
(d ) sensory properties while eating. Thus the Stubbs 1997), and (d) social and cultural mores
neuroendocrine pathways regulating energy (de Garine & Pollock 1995). There remains,
balance must intersect with systems regulat- however, great within-population variation in
ing pleasure and reward (Saper et al. 2002). food-consumption behavior not explained by
Leptin is known to inhibit sweet-sensitive these factors. Both food novelty and palatabil-
taste cells in the tongue (Kawai et al. 2000). ity play to powerful behavioral inuences on
Thus, when leptin levels increase (as in over- the size of food intake. Many industrial food
feeding), perception of the sweetness of food products appeal to the palate as well as being
declines and with it the range of food intake energy dense, whereas the range of novel food
because of the reduced palatability of foods items marketed in the industrialized world has
with sweetness as a component of their avor. increased dramatically in the past 20 years.
Furthermore, the gut peptide CCK is a phys- Furthermore, technology in such societies has
iological satiety factor in humans. However, now divorced the sensory and nutritional at-
little else is known of the links between the tributes of foods in a way that prevents learn-
pathways for pleasure and reward and those ing by associative conditioning of palatabil-
regulating hunger and satiety (Flier 2004). ity, appetite, and satiety (Stubbs & Whybrow
Food cues involve learning because there 2004). The extent to which this uncoupling
are few unlearned sensory preferences for between sensory and nutritional properties of
foods and taste among humans (Mela & Catt food is responsible for overconsumption is not
1996). Although infants have innate prefer- known, however (Stubbs & Whybrow 2004).
ences for sweetness in food and aversions to Two theories have been proposed to ex-
sour and bitter tastes, food preferences are plain between-individual differences in food
molded from birth, both culturally and be- consumption behaviors and the tendency to
overeat. The rst, that of externality, postu- United States and Mexico that show humans
lates that obese people are more reactive to are largely blind to portion size (Rolls et al.
external cues (such as the time of day, presence 2004, Mrdjenovic & Levitsky 2005, Levitsky
of food, and situational effects) and less sensi- et al. 2005, Wansink & Cheney 2005), with in-
tive to internal physiological hunger and sati- creased portion size predicting increased en-
ety signals than are lean subjects (Schachter & ergy consumption (Fisher et al. 2003, Dilberti
Rodin 1974). According to this view, high re- et al. 2004, Levitsky & Youn 2004, McConahy
activity to external cues encourages overeat- et al. 2004, Rolls et al. 2004, Wansink &
ing and the development of obesity in envi- Cheney 2005). In the United States, portion
ronments in which highly palatable food is sizes of prepackaged and restaurant-prepared
readily available. However, evidence conrm- foods have increased greatly across the past
ing such an eating style among obese subjects two decades (Harnack et al. 2000, McConahy
is not conclusive (Brownell & Wadden 1991). et al. 2002, Young & Nestle 2002, Smiciklas-
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
If it exists, externality may be an antecedent Wright et al. 2003, Kral & Rolls 2004). In-
of obesity and not a consequence or corre- creased snacking and decreased structure of
by Appalachian State University on 08/13/08. For personal use only.
late of overeating (Mela 1996). The second meals have also taken place in many industri-
theory, that of psychosomatic feeding, focuses alized (Decarli et al. 2000, Samuelson 2000,
on emotional eating (Allison & Heshka 1993). Jahns et al. 2001, Zizza et al. 2001, Crooks
The usual response to arousal (such as fear, 2003, St-Onge et al. 2003) and industrializ-
anxiety, or anger) is loss of appetite. How- ing nations. Children in the United States
ever, some individuals respond by overeating. eat more food away from home, drink more
This may be a result of an inability to differ- soft drinks, and snack more frequently than
entiate between the need for food and other 20 years ago (Jahns et al. 2001, Nielsen et al.
uncomfortable sensations and feelings, prob- 2002, St-Onge et al. 2003). Snack foods are of-
ably as a result of early learning experiences. ten densely caloric, prepared, processed, and
The balance of conicting evidence suggests packaged foods (Nielsen et al. 2002). Both
relative overeating in obese individuals during adults (Tucker & Friedman 1989, Tucker &
negative emotional states (Geliebter & Aversa Bagwell 1991, Jeffrey & French 1998) and
2003). However, people can counteract their children (Dietz & Gortmaker 1985, Del Toro
externally or emotionally induced tendency to & Greenberg 1989, Renders et al. 2004,
overeat by cognitive restraint of their food in- van den Bulck & van Mierlo 2004,) often
take. Obese people are less likely to practice snack without feeling physically hungry, espe-
restraint in eating, however (Herman & Mack cially when distracted by an external stimulus,
1975), regardless of any psychological reason such as watching television (Stroebele & de
as to why they might overeat. Castro 2004). It is more difcult for humans
to accurately monitor how much they have
eaten when distracted (Wansink 2004). Tele-
CULTURAL, BEHAVIORAL, AND vision also increases exposure to the commer-
ECONOMIC PERSPECTIVES cial marketing of energy-dense foods. In the
Although good food security and sedentiza- 1990s, children in the United States watched
tion of life are central to the generation of obe- on average approximately 10,000 television
sogenic environments, various other factors advertisements for food each year, 95% of
also contribute to them. The maintenance which were for foods in one of four categories:
of parsimonious food behaviors, involving sugared cereals, sweets/chocolate, fast food,
avoidance of waste or getting the best value and soft drinks (Brownell 2002). However, al-
for money, becomes maladaptive in the con- though both time spent watching television
text of good food security. Indirect evidence and rates of obesity increased concurrently in
for waste avoidance comes from studies in the the United States since the 1960s, a causal link
between the two has yet to be demonstrated more likely to diet to control weight (Jeffrey
(Gorely et al. 2004). et al. 1991, Molarius 2003, Bielicki et al. 2005,
Fast food has characteristics that favor Stamatakis et al. 2005). It has also been linked
the development of obesity, including its to dietary energy density and energy cost
high-energy density, fat, and fructose content (Darmon et al. 2002, French 2003). In the
(Isganaitis & Lustig 2005), and Jebb (2003) United States, the price of fresh fruit and veg-
has proposed a possible mechanistic link be- etables has increased as a proportion of dispos-
tween fast foods, energy density, and obe- able income across time, whereas the price of
sity. However, Bandini et al. (1999) found rened grains, sugars, and fats has declined
that obese adolescents in the United States (Sturm 2005). Diets that are more energy-
eat no more fast food than nonobese adoles- dense are associated with lower daily food
cents, emphasizing that excess energy intake consumption costs (Drewnowski & Darmon
may come from a variety of food sources and 2005). However, they also have lower effects
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
not solely from energy-dense snack foods. Al- on satiety and can result in passive overeating
though the globalization of fast food is be- and weight gain (Prentice & Poppitt 1996).
by Appalachian State University on 08/13/08. For personal use only.
ginning to affect childrens eating patterns in Obesity may thus be linked with disparities
many countries undergoing nutrition transi- in food choice because affordability and ac-
tion, the contribution of fast food and soft cessibility to foods recommended or seen as
drinks to childrens diet remains relatively healthy may be limited by nancial constraints
small compared with the United States (Adair in low-income groups. In an ecological study
& Popkin 2005). of obesity in 21 developed nations, Pickett
Increasing time constraints on home cook- et al. (2005) found income inequality to be
ing in food-secure nations also likely con- positively associated with energy intake and
tribute to obesity rates because of high female obesity.
engagement in the workforce (St-Onge et al. Low levels of physical activity are as-
2003). A consequence of this has been the sociated with an increased risk of obesity
emergence and rise in demand for prepack- (Erlichman et al. 2002), and obesogenic
aged convenience foods with short prepa- environments not only discourage physical
ration times (Schluter & Lee 1999) and of activity but also encourage inactivity both oc-
food consumption away from the home (Lin cupationally and during leisure time (Hill &
et al. 1996, McCrory et al. 1999, French Peters 1998, Brownell 2002, Hill & Wyatt
et al. 2001, Nielsen et al. 2002, Critser 2003, 2005). There has been a great decline in oc-
St-Onge et al. 2003). Both phenomena have cupationally related activity since the turn of
increased dependence on industrialized food the twentieth century (Popkin et al. 2005). In
in many countries. Other time-saving devices industrialized nations and urban areas of de-
(including drive-through, 24-hour, take-away, veloping countries, jobs requiring heavy man-
and home-delivery food services) have helped ual labor have been largely replaced by jobs
make food ubiquitous in everyday life in the in service and high-technology sectors, which
United States (Brownell 2002) and increas- require minimal physical exertion (French
ingly elsewhere. et al. 2001). The increased use of automo-
In the United States, Sweden, United biles and public-transportation systems en-
Kingdom, Poland, and other industrialized courages inactivity, whereas increased time
nations, the inverse relationship between so- spent watching television, playing electronic
cioeconomic status and obesity has been ex- games, and/or using computers has increased
plained by class differences in obesity-relevant sedentary behavior of both adults and children
health behaviors that have persisted, with peo- (Hill & Peters 1998, Jeffrey & French 1998,
ple of higher social class eating diets with Brownell 2002). Obesity is uncommon among
lower fat content, exercising more, and being occupational groups that undertake high
levels of physical activity during working ence dissatisfaction with their own body size
hours. In one population with high levels at lower BMIs than either Hispanic Americans
of obesity, Keighley et al. (2006) found that or African Americans (Fitzgibbon et al. 2000).
adults in American Samoa engaged in farm Studies showing an increased value of thin-
work had lower BMIs than those not en- ness and increased awareness of the risk fac-
gaged in such work. In the United States and tors associated with overweight and obesity
elsewhere, children participate less in phys- suggest that sociocultural factors, such as par-
ical activity at school (Hill & Peters 1998), ticipation in the global economy and expo-
whereas unsafe neighborhoods and limited ac- sure to western ideas, may inuence body-
cess to recreation areas in some urban en- image perceptions worldwide. A number of
vironments discourage leisure-time physical communities and societies in which obesity
activity (Pucher & Dijkstra 2003). has risen in recent decades and that previ-
Cultural variations of appropriate and ously were shown to desire and/or accept
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
preferable body image (de Garine & Pollock larger bodies and obesity now prefer thinner
1995) also may have contributed to obesity bodies (Madrigal et al. 2000, Anderson et al.
by Appalachian State University on 08/13/08. For personal use only.
rates. In some societies, larger body size has 2002, Tur et al. 2005). This has been observed
traditionally been seen as attractive and in- among African American girls (Katz et al.
dicative of attributes such as health, fertility, 2004) and women with diabetes (Anderson
beauty, wealth, and power. In a cross-cultural et al. 1997, Lieberman et al. 2003), British
comparison of appropriate body size in differ- Bangladeshis with diabetes (Greenhalgh et al.
ent traditional societies, Brown (1991) found 2005), Turkish adolescents (Canpolat et al.
that the vast majority favored plumpness as 2005), Pacic Islanders (Wilkinson et al.
being attractive. Such societies include ones 1994, Craig et al. 1996, Brewis et al. 1998,
in Nauru, Samoa, and Malaysia (de Garine Becker et al. 2005), the Ojibway-Cree in
& Pollock 1995). Various societies across the Canada (Gittelsohn et al. 1996), urban Native
world practice or have practiced ritual fat- American youth (Rinderknecht & Smith
tening to promote fertility, marriageability, 2002), and Korean children (Lee et al. 2004).
and embodied social status. These include Among Europeans, the desire for thinner
groups in Africa, Central and North America body size is increasingly observed in children
(Mexican Americans and African Americans in and adolescents and is not conned to fe-
particular), Japan, and the Pacic (de Garine males of upper-socioeconomic status (Story
& Pollock 1995). Among these, only popula- et al. 1995, Katz et al. 2004, Lee et al. 2004,
tions in the Pacic now experience widespread Canpolat et al. 2005). Although high cultural
obesity. valuation of body fatness may contribute to
Relationships between obesity and per- the emergence of obesity, it may possibly cease
ceived attractiveness vary among communi- to be an important contributor in subsequent
ties and societies. African American women generations.
prefer body size that is larger, on average, than
similar groups of European American women
(Stevens et al. 1994, Flynn & Fitzgibbon CONCLUSIONS
1998, Becker et al. 1999, Fitzgibbon et al. Increasing rates of obesity across the world
2000). Furthermore, overweight and obese are broadly attributed to environments that
African American women perceive themselves are obesogenic, against an evolutionary her-
as healthier, more attractive, and more attrac- itage that is maladaptive in these new contexts.
tive to the opposite sex than white women The extensive emergence and rise of obesity
of similar weight and age (Stevens et al. among most of the worlds populations indi-
1994, Flynn & Fitzgibbon 1998, Becker et al. cate that the ability to become obese is uni-
1999), whereas European Americans experi- versal, whereas great variation in obesity rates
across geographical regions indicates possi- tively few serious setbacks; (b) an increased
ble population differences in genetic suscep- food security for much of the worlds popula-
tibility to obesity. Human genetics are likely tions, yet unchanged or signicantly declined
to have undergone selection for traits that food security for the rest; (c) the penetration of
promote energy intake and storage and that the world food system into the remotest parts
minimize energy expenditure, and there are of the world; (d ) declining prices for energy-
a great many obesity-related genotypes. Cur- dense foods; (e) the progressive mechaniza-
rent models linking genotypes with physiol- tion of the vast majority of labor-intensive
ogy and feeding behavior are only able to ex- tasks; ( f ) the urbanization and sedentization
plain a small proportion of all obesity, but they of work in the form of service-oriented jobs
may underlie the more-common and geneti- as replacements for labor-intensive produc-
cally complex forms of human obesity. Stud- tion jobs; (g) the mechanization of transport;
ies of the regulation of energy balance show and (h) the sedentization of leisure time. That
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
that human physiology exerts strong control humans have biological tendencies to maxi-
of feeding under conditions of fasting or food mize food intake and use it efciently is clear
by Appalachian State University on 08/13/08. For personal use only.
shortage, but only weak control on reducing and increasingly elaborated by physiologists,
food intake and increasing energy expenditure but the picture is still far from complete. The
under conditions of replete energy stores and human tendency to minimize energy expen-
good food security. Thus it is almost inevitable diture where possible is well-known but even
that obesity should have emerged as a major less well understood biologically than food in-
human biological phenomenon in the envi- take. However, many of the economic trajec-
ronments that have been constructed in in- tories of the second half of the twentieth cen-
dustrialized nations over the past 60 years and tury may be environmentally unsustainable
that have been transferred across the world (Parker 1993, Kasun 1999, von Geibler et al.
with modernization since. 2004) because they rely on ever-increasing
Because of the diverse contexts in which consumption of global resources. Economic
obesity has emerged and the complex envi- systems create and respond to markets, and
ronments in which it persists, a ubiquitous re- these will change as sustainability issues be-
versal in the prevalence of obesity at any stage come more important and new technologies
is unlikely in the near future. Any ceiling on emerge. These undoubtedly will be reected
the potential for obesity in the majority of the in changes in human body size and nutritional
worlds populations is clearly far from being status into the future. If food security con-
reached. However, we should avoid the dan- tinues to improve across the twenty-rst cen-
ger of extrapolating from the recent past into tury, obesity rates possibly may at least sta-
the future because present obesity patterns are bilize in the richer nations, while emerging
outcomes of conjoining forces: (a) a contin- and increasing at greater rates in nations that
uing economic development with compara- emerge economically.
LITERATURE CITED
Adair LS, Popkin BM. 2005. Are child eating patterns being transformed globally? Obes. Res.
13:128199
Ahima RS, Prabakaran D, Mantzoros C, Qu D, Lowell B, et al. 1996. Role of leptin in the
neuroendocrine response to fasting. Nature 382:25052
Aiello LC, Wells JCK. 2002. Energetics and the evolution of the genus Homo. Annu. Rev.
Anthropol. 31:32338
Allison DB, Faith MS, Nathan JS. 1996. Rischs lambda values for human obesity. Int. J. Obes.
Relat. Metab. Disord. 20:99099
Allison DB, Heshka S. 1993. Emotion and eating in obesity? A critical analysis. Int. J. Eat.
Disord. 13:28995
Anderson LA, Eyler AA, Galuska DA, Brown DR, Brownson RC. 2002. Relationship of sat-
isfaction with body size and trying to lose weight in a national survey of overweight and
obese women aged 40 and older, United States. Prev. Med. 35:39096
Anderson LA, Janes GR, Ziemer DC, Phillips LS. 1997. Diabetes in urban African Americans.
Body image, satisfaction with size, and weight change attempts. Diabetes Educ. 23:3018
Bandini LG, Vu D, Must A, Cyr H, Goldberg A, Dietz WH. 1999. Comparison of high-calorie,
low-nutrient-dense food consumption among obese and nonobese adolescents. Obes. Res.
7:43843
Barsh GS, Schwartz MW. 2002. Genetic approaches to studying energy balance: perception
and integration. Nat. Rev. Genet. 3:58990
Becker AE, Gilman SE, Burwell RA. 2005. Changes in prevalence of overweight and in body
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
image among Fijian women between 1989 and 1998. Obes. Res. 13:11017
Becker DM, Yanek LR, Koffman DM, Bronner YC. 1999. Body image preferences among
by Appalachian State University on 08/13/08. For personal use only.
urban African Americans and whites from low income communities. Ethn. Dis. 9:37786
Bell R, Pliner PL. 2003. Time to eat: the relationship between the number of people eating
and meal duration in three lunch settings. Appetite 41:21518
Berthoud HR. 2004. Mind versus metabolism in the control of food intake and energy balance.
Physiol. Behav. 81:78193
Bevegni C, Adami GF. 2003. Obesity and obesity surgery in ancient Greece. Obes. Surg. 13:808
9
Bianchini F, Kraaks R, Vainio H. 2002. Overweight, obesity and cancer risk. Lancet Oncol.
3:56574
Bielicki T, Szklarska A, Koziel S, Ulijaszek SJ. 2005. Changing patterns of social variation
in stature in Poland: effects of transition from a command economy to the free-market
system? J. Biosoc. Sci. 37:42734
Blundell JE, Stubbs J. 1997. Diet composition and the control of food intake in humans. In
Handbook of Obesity, ed. GA Bray, C Bouchard, WPT James, pp. 24372 New York: Marcel
Dekker
Bray G. 1987. Obesitya disease of nutrient or energy balance? Nutr. Rev. 45:3343
Bray GA, Nielsen SJ, Popkin BM. 2004. Consumption of high-fructose corn syrup in beverages
may play a role in the epidemic of obesity. Am. J. Clin. Nutr. 79:53743
Brewis AA, McGarvey ST, Jones J, Swinburn BA. 1998. Perceptions of body size in Pacic
Islanders. Int. J. Obes. Relat. Metab. Disord. 22:18589
Brown PJ. 1991. Culture and the evolution of obesity. Hum. Nat. 2:3157
Brown PJ, Konner M. 1987. An anthropological perspective of obesity. Ann. N. Y. Acad. Sci.
499:2946
Brown PJ, Krick SV. 2001. Culture and ethnicity in the etiology of obesity: diet, television
and the illusion of personal choice. In Obesity, Physical Growth and Development, ed. FE
Johnston, G Foster, pp. 11157. London: Smith-Gordon
Brownell KD. 2002. The environment and obesity. In Eating Disorders and Obesity: A Compre-
hensive Handbook, ed. CG Fairburn, KD Brownell, pp. 43338. New York: Guilford Press.
2nd ed.
Brownell KD, Wadden TA. 1991. The heterogeneity of obesity: tting treatments to individ-
uals. Behav. Ther. 22:15377
Bouatia-Naji N, Meyre D, Lobbens S, Seron K, Fumeron F, et al. 2006. ACDC/adiponectin
polymorphisms are associated with severe childhood and adult obesity. Diabetes 55:54550
Campbell P, Ulijaszek SJ. 1994. Relationships between anthropometry and retrospective mor-
bidity in poor men in Calcutta, India. Eur. J. Clin. Nutr. 48:50712
Canpolat BI, Orsel S, Akdemir A, Ozbay MH. 2005. The relationship between dieting and
body image, body ideal, self-perception, and body mass index in Turkish adolescents. Int.
J. Eat. Disord. 37:15055
Chung WK, Leibel RL. 2005. Molecular physiology of syndromic obesities in humans. Trends
Endocrinol. Metab. 16:26772
Clegg DJ, Woods SC. 2004. The physiology of obesity. Clin. Obs. Gynecol. 47:96779
Clement K. 2005. Genetics of human obesity. Proc. Nutr. Soc. 64:13342
Clement K, Boutin P, Froguel P. 2002. Genetics of obesity. Am. J. Pharmacogenomics 2:17787
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. 2000. Establishing a standard denition for
child overweight and obesity world wide: international survey. Br. Med. J. 320:124043
Comuzzie AG. 2002. The emerging pattern of the genetic contribution to human obesity. Best
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Beyond the interaction of genetic and environmental factors. Clin. Nutr. 23:28991
Craig P, Swinburn B, Matenga-Smith T, Matangi H, Vaughan F. 1996. Do Polynesians still
believe that big is beautiful? Comparison of body size perceptions and preferences of Cook
Islands, Maori and Australians. N. Z. Med. J. 14:2003
Critser G. 2003. Fat Land. New York: Houghton Mifin
Crooks DL. 2003. Trading nutrition for education: nutritional status and the sale of snack
foods in an eastern Kentucky school. Med. Anthropol. Q. 17:18299
Cunnane SC, Crawford MA. 2003. Survival of the fattest: fat babies were the key to evolution
of the large human brain. Comp. Biochem. Physiol. A Physiol. 136:1726
Darmon N, Ferguson EL, Briend A. 2002. A cost constraint alone has adverse effects on food
selection and nutrient density: an analysis of human diets by linear programming. J. Nutr.
132:376471
Darmon N, Ferguson EL, Briend A. 2003. Do economic constraints encourage the selection
of energy dense diets? Appetite 41:31522
Decarli B, Cavadini C, Grin J, Blondel-Lubrano A, Narring F, Michaud PA. 2000. Food and
nutrient intakes in a group of 11 to 16-year-old Swiss teenagers. Int. J. Vitam. Nutr. Res.
70:13947
de Castro JM. 1999. Measuring real world eating behavior. Prog. Obes. Res. 8:21521
de Castro JM. 2006. Heredity inuences the dietary energy density of free-living humans.
Physiol. Behav. 87:19298
de Castro JM, Lilenfeld LR. 2005. Inuence of heredity on dietary restraint, disinhibition, and
perceived hunger in humans. Nutrition 21:44655
de Castro JM, Stroebele N. 2002. Food intake in the real world: implications for nutrition and
aging. Clin. Geriatr. Med. 18:68597
de Garine I, Harrison GA, eds. 1988. Coping with Uncertainty in Food Supply. Oxford, UK:
Oxford Univ. Press
de Garine I, Pollock NJ. 1995. Social Aspects of Obesity. Amsterdam: Gordon & Breach
Della Valle DM, Roe LS, Rolls BJ. 2005. Does the consumption of caloric and noncaloric
beverages with a meal affect energy intake? Appetite 44:18793
Del Toro W, Greenberg BS. 1989. Television commercials and food orientations among
teenagers in Puerto Rico. Hisp. J. Behav. Sci. 11:16877
Denney JT, Krueger PM, Rogers RG, Boardman JD. 2004. Race/ethnic and sex differentials
in body mass among US adults. Ethn. Dis. 14:38998
de Onis M. 2005. The use of anthropometry in the prevention of childhood overweight and
obesity. United Nations Syst. Standing Comm. Nutr. 29:512
Dietz WH, Gortmaker SL. 1985. Do we fatten our children at the television set? Obesity and
television viewing in children and adolescents. Pediatrics 75:80712
Dilberti N, Bordi PL, Concklin MT, Roe LS, Rolls BJ. 2004. Increased portion size leads to
increased consumption in a restaurant meal. Obes. Res. 12:56268
Drewnowski A, Darmon N. 2005. The economics of obesity: dietary energy density and energy
cost. Am. J. Clin. Nutr. 82:S26573
Drewnowski A, Popkin BM. 1997. The nutrition transition: new trends in the global diet. Nutr.
Rev. 55:3143
Dyson T. 1996. Population and Food. London: Routledge
Eaton SB, Konner M, Shostak M. 1998. Stone agers in the fast lane: chronic degenerative
diseases in evolutionary perspective. Am. J. Med. 84:73949
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Ellison PT. 2003. Energetics and reproductive effort. Am. J. Hum. Biol. 15:34251
Erlichman J, Kerbey AL, James WPT. 2002. Physical activity and its impact on health out-
by Appalachian State University on 08/13/08. For personal use only.
comes. Paper 2: Prevention of unhealthy weight gain and obesity by physical activity: an
analysis of the evidence. Obes. Rev. 3:27387
Fan W, Voss A, Cao WH, Morrison SF. 2005. Regulation of thermogenesis by the central
melanocortin system. Peptides 26:180013
Farooqi IS, ORahilly S. 2005. Monogenic obesity in humans. Annu. Rev. Med. 56:44358
Fisher JO, Rolls BJ, Birch LL. 2003. Childrens bite size and intake of an entree are greater
with large portions than with age-appropriate or self-selected portions. Am. J. Clin. Nutr.
77:116470
Fitzgibbon ML, Blackman LR, Avellone ME. 2000. The relationship between body image
discrepancy and body mass index across ethnic groups. Obes. Res. 8:58289
Flegal KM, Carroll MD, Ogden CL, Johnson CL. 2002. Prevalence and trends in obesity
among US adults, 19992000. J. Am. Med. Assoc. 288:172327
Flier JS. 2004. Obesity wars: molecular progress confronts an expanding epidemic. Cell
116:33750
Flynn KJ, Fitzgibbon M. 1998. Body images and obesity risk among black females: a review of
the literature. Annu. Behav. Med. 20:1324
Foley RA. 1993. The inuence of seasonality on hominid evolution. In Seasonality and Human
Ecology, ed. SJ Ulijaszek, SS Strickland, pp. 1737. Cambridge, UK: Cambridge Univ.
Press
French SA. 2003. Pricing effects on food choice. J. Nutr. 133:S84143
French SA, Story M, Jeffrey RW. 2001. Environmental inuences on eating and physical
activity. Annu. Rev. Public Health 22:30935
Garaulet MP, Perez-Llamas F, Fuente T, Zamora S, Tebar FJ. 2000. Anthropometric, com-
puter tomography and fat cell data in an obese population: relationship with insulin,
lepton, tumor necrosis factor-, sex hormone-binding globulin and sex hormones. Eur. J.
Endocrinol. 143:65766
Garcia M, Kennedy E. 1994. Assessing the linkages between low body mass index and morbidity
in adults: evidence from four developing countries. Eur. J. Clin. Nutr. 48(Suppl.): S9097
Garrow JS. 1978. Energy Balance and Obesity in Man. Amsterdam: Elsevier. 2nd ed.
Garrow JS. 1993. The thrifty genotype and noninsulin dependent diabetes. Br. Med. J. 306:933
34
Geliebter A, Aversa A. 2003. Emotional eating in overweight, normal weight, and underweight
individuals. Eat. Disord. Resour. 3:34147
Gill TP. 2001. Cardiovascular risk in the Asia-Pacic region from a nutrition and metabolic
point of view: abdominal obesity. Asia Pac. J. Clin. Nutr. 10:8589
Gittelsohn J, Harris SB, Thorne-Lyman AL, Hanley AJ, Barnie A, Zinman B. 1996. Body
image concepts differ by age and sex in an Ojibway-Cree community in Canada. J. Nutr.
126:29903000
Gorely T, Marshall SJ, Biddle SJ. 2004. Couch kids: correlates of television viewing among
youth. Int. J. Behav. Med. 11:15263
Greenhalgh T, Chowdhury M, Wood G. 2005. Big is beautiful? A survey of body image
perception and its relation to health in British Bangladeshis with diabetes. Psychol. Health
Med. 10:12638
Grifths PL, Bentley ME. 2001. The nutrition transition is underway in India. J. Nutr.
131:2692700
Harnack LJ, Jeffery RW, Boutelle KN. 2000. Temporal trends in energy intake in the United
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Herman CP, Mack D. 1975. Restrained and unrestrained eating. J. Personality 43:64760
Hill JO, Peters JC. 1998. Environmental contributions to the obesity epidemic. Science
280:137174
Hill JO, Wyatt HR. 2005. Role of physical activity in preventing and treating obesity. J. Appl.
Physiol. 99:76570
Hill JO, Wyatt HR, Reed GW, Peters JC. 2003. Obesity and the environment: Where do we
go from here? Science 299:85355
Hladik CM. 1988. Seasonal variations in food supply for wild primates. In Coping with Uncer-
tainty in Food Supply, ed. I de Garine, GA Harrison, pp. 125. Oxford, UK: Oxford Univ.
Press
Horrobin DF. 1999. Lipid metabolism, human evolution and schizophrenia. Prostaglandins
Leukot. Essent. Fatty Acids 60:43137
Isganaitis E, Lustig RH. 2005. Fast food, central nervous system insulin resistance, and obesity.
Arterioscler. Thromb. Vasc. Biol. 25:245162
Jahns L, Siega-Riz AM, Popkin BM. 2001. The increasing prevalence of snacking among US
children from 1977 to 1996. J. Pediatr. 138:49398
Jebb SA. 2003. Fast foods, energy density and obesity: a possible mechanistic link. Obes. Rev.
4:18794
Jeffrey RE, French SA. 1998. Epidemic obesity in the United States: Are fast foods and television
viewing contributing? Am. J. Public Health 88:27780
Jeffrey RW, French SA, Firster JL, Spry VM. 1991. Socioeconomic status differences in health
behaviors related to obesitythe healthy worker project. Int. J. Obes. 15:68996
Kahn HS, Williamson DF. 1994. Abdominal obesity and mortality risk among men in nine-
teenth century North America. Int. J. Obes. 18:68691
Kasun JR. 1999. Doomsday every day: sustainable economics, sustainable tyranny. Independent
Rev. 4:91106
Katz ML, Gorden-Larsen P, Bentley ME, Kelsey K, Shields K, Ammerman A. 2004. Does
skinny mean healthy? Perceived ideal, current, and healthy body sizes among African-
American girls and their female caregiver. Ethn. Dis. 14:53341
Kawai K, Sugimoto K, Nakashima K, Miura H, Ninomiya Y. 2000. Leptin as a modulator of
sweet taste sensitivities in mice. Proc. Natl. Acad. Sci. USA 97:1104449
Keighley ED, McGarvey ST, Turituri P, Vial S. 2006. Farming and adiposity in Samoan adults.
Am. J. Hum. Biol. 18:11222
Keller KI, Pietrobelli, Faith MS. 2003. Genetics of food intake and body composition: lessons
from twin studies. Acta Diabetol. 40:S95100
Kirchengast S, Schober E, Waldhor T, Sefranek R. 2004. Regional and social differences in
body mass index, and the prevalence of overweight and obesity among 18-year-old men
in Austria between the years 1985 and 2000. Coll. Antropol. 28:54152
Kral TV, Rolls BJ. 2004. Energy density and portion size: their independent and combined
effects on energy intake. Physiol. Behav. 82:13138
Kuzawa CW. 1998. Adipose tissue in human infancy and childhood: an evolutionary perspec-
tive. Am. J. Phys. Anthropol. 27(Suppl.):177209
Lee K, Sohn H, Lee S, Lee J. 2004. Weight and BMI over 6 years in Korean children: rela-
tionships to body image and weight loss efforts. Obes. Res. 13:195966
Leonard WR, Robertson ML, Snodgrass JJ, Kuzawa CW. 2003. Metabolic correlates of ho-
minid brain evolution. Comp. Biochem. Physiol. A Physiol. 136:515
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Levitsky DA, Obarzanek E, Mrdjenovic G, Strupp BJ. 2005. Imprecise control of energy intake:
absence of a reduction in food intake following overfeeding in young adults. Physiol. Behav.
by Appalachian State University on 08/13/08. For personal use only.
84:66975
Levitsky DA, Youn T. 2004. The more young adults are served, the more they overeat. J. Nutr.
134:254649
Lev-Ran A. 2001. Human obesity: an evolutionary approach to understanding our bulging
waistline. Diabetes Metab. Res. Rev. 17:34762
Li G, Chen X, Jang Y, Wang J, Xing X, et al. 2002. Obesity, coronary heart disease risk factors
and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population.
Obes. Rev. 3:16772
Lieberman LS, Probart CK, Schoenberg NE. 2003. Body image among older, rural, African-
American women with type 2 diabetes. Coll. Antropol. 27:7986
Lin B, Guthrie J, Blaylock JR. 1996. The diets of Americas children: inuences on dining out,
household characteristics, and nutritional knowledge. Agric. Econ. Rep. 746:137
Loos RJF, Rankinen T, Tremblay A, Perusse L, Chagnon Y, Bouchard C. 2005. Melanocortin-4
receptor gene and physical activity in the Quebec Family Study. Int. J. Obes. 29:42028
Madrigal H, Sanchez-Villegas A, Martinez-Gonzalez MA, Kearney J, Gibney MJ, Irala J. 2000.
Underestimation of body mass index through perceived body image as compared to self-
reported body mass index in the European Union. Public Health 114:46873
Martin RD. 1993. Scaling. In The Cambridge Encyclopedia of Human Evolution, ed. S Jones, R
Martin, D Pilbeam, p. 42. Cambridge, UK: Cambridge Univ. Press
McConahy KL, Smiciklas-Wright H, Birch LL, Mitchell DC, Picciano MF. 2002. Food por-
tions are positively related to energy intake and body weight in early childhood. J. Pediatr.
140:34047
McConahy KL, Smiciklas-Wright H, Mitchell DC, Picciano MF. 2004. Portion size of com-
mon foods predicts energy intake among preschool-aged children. J. Am. Diet. Assoc.
104:97579
McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. 1999. Overeating
in America. Association between restaurant food consumption and body fatness in healthy
adult men and women ages 19 to 80. Obes. Res. 7:56471
Mela DJ. 1996. Eating behavior, food preferences and dietary intake in relation to obesity and
body-weight status. Proc. Nutr. Soc. 55:80316
Mela DJ. 1999. Food choice and intake: the human factor. Proc. Nutr. Soc. 58:51321
Mela DJ, Catt S. 1996. Ontogeny of human taste and smell preferences and their im-
plications for food selection. In Long-Term Consequences of Early Environment: Growth,
Development and the Lifespan Developmental Perspective, ed. CJK Henry, SJ Ulijaszek,
pp. 13954. Cambridge, UK: Cambridge Univ. Press
Mizuno TM, Makimura H, Mobbs CV. 2003. The physiological function of the agouti-related
peptide gene: the control of weight and metabolic rate. Ann. Med. 35:42533
Molarius A. 2003. The contribution of lifestyle factors to socioeconomic differences in obesity
in men and women: a population-based study in Sweden. Eur. J. Epidemiol. 18:22734
Monteiro CA, DA-Benicio MH, Conde WL, Popkin BM. 2000. Shifting obesity trends in
Brazil. Eur. J. Clin. Nutr. 54:34246
Moore MS. 2000. Interactions between physical activity and diet in the regulation of body
weight. Proc. Nutr. Soc. 59:19398
Moran TH. 2000. Cholecystokinin and satiety: current perspectives. Nutrition 16:85865
Mrdjenovic G, Levitsky DA. 2005. Children eat what they are served: the imprecise regulation
of energy intake. Appetite 44:27382
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Myers KP, Sclafani A. 2003. Conditioned acceptance and preference but not altered taste
reactivity responses to bitter and sour avors paired with intragastric glucose infusion.
Physiol. Behav. 78:17383
by Appalachian State University on 08/13/08. For personal use only.
Neale BM, Mazzeo SE, Bulik CM. 2003. A twin study of dietary restraint, disinhibition and
hunger: an examination of the eating inventory (three factor eating questionnaire). Twin
Res. 6:47178
Neel J. 1962. Diabetes mellitus: a thrifty genotype rendered detrimental by progress? Am.
J. Hum. Genet. 14:35362
Neel JV, Weder AB, Julius S. 1998. Type II diabetes, essential hypertension, and obesity as
syndromes of impaired genetic homeostasis: The thrifty genotype hypothesis enters
the 21st century. Perspect. Biol. Med. 42:4474
Nielsen SJ, Siega-riz AM, Popkin BM. 2002. Trends in energy intake in U.S. between 1977
and 1996: Similar shifts seen across age groups. Obes. Res. 10:37078
Nishida C, Mucavele P. 2005. Monitoring the rapidly emerging public health problem of
overweight and obesity: the WHO global database on body mass index. United Nations
Syst. Standing Comm. Nutr. 29:512
Norgan NG. 1994a. Population differences in body composition in relation to the BMI. Eur.
J. Clin. Nutr. 48(Suppl.):S1027
Norgan NG. 1994b. Relative sitting height and the interpretation of the body mass index. Ann.
Hum. Biol. 21:7982
Norgan NG. 1997. The benecial effects of body fat and adipose tissue in humans. Int. J. Obes.
Relat. Metab. Disord. 21:73846
Parker K. 1993. Economics, sustainable growth, and community. Environ. Values 2:23345
Pena M, Bacallao J. 2002. Malnutrition and poverty. Annu. Rev. Nutr. 22:24153
Perusse L, Rankinen T, Zuberi A, Chagnon YC, Weisnagel SJ, et al. 2005. Human obesity
gene map: the 2004 update. Obes. Res. 13:381490
Pickett KE, Kelly S, Brunner E, Lobstein T, Wilkinson RG. 2005. Wider income gaps, wider
waistbands? An ecological study of obesity and income inequality. J. Epidemiol. Comm.
Health 59:67074
Plummer T. 2004. Flaked stones and old bones: biological and cultural evolution at the dawn
of technology. Am. J. Phys. Anthropol. 125(Suppl.):11864
Popkin BM. 2004. The nutrition transition: an overview of world patterns of change. Nutr.
Rev. 62:S14043
Popkin BM, Doak CM. 1998. Obesity is a worldwide phenomenon. Nutr. Rev. 56:10614
Popkin BM, Duffey K, Gorden-Larsen P. 2005. Environmental inuences on food choice,
physical activity and energy balance. Physiol. Behav. 86:60313
Poskitt EME. 1995. Assessment of body composition in the obese. In Body Composition Techniques
in Health and Disease, ed. PSW Davies, TJ Cole, pp. 14655. Cambridge, UK: Cambridge
Univ. Press
Prentice AM, Poppitt SD. 1996. Importance of ED and macronutrients in the regulation of
energy intake. Int. J. Obes. Metab. Disord. 20:S1823
Pucher J, Dijkstra L. 2003. Promoting safe walking and cycling improve public health: lessons
from The Netherlands and Germany. Am. J. Public Health 93:150916
Renders CM, Henneman L, Timmermans DR, Hirasing RA. 2004. Television watching and
some eating habits of 614 year-old children in Amsterdam, the Netherlands; a cross
sectional study. Ned. Tijdschr. Geneeskd. 148:207276
Rennie KL, Jebb SA. 2005. Prevalence of obesity in Great Britain. Obes. Rev. 6:1112
Rinderknecht K, Smith C. 2002. Body image perceptions among urban Native American youth.
Obes. Res. 10:31527
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Rolls BJ. 2003. The supersizing of America: portion size and the obesity epidemic. Nutr. Today
38:4253
by Appalachian State University on 08/13/08. For personal use only.
Rolls BJ, Roe LS, Kral TV, Meengs JS, Wall DE. 2004. Increasing the portion size of a packaged
snack increases energy intake in men and women. Appetite 42:6369
Rosenbaum M, Leibel RL. 1998. The physiology of body weight regulation: relevance to the
etiology of obesity in children. Pediatrics 101:52539
Samuelson G. 2000. Dietary habits and nutritional status in adolescents over Europe. An
overview of current studies in the Nordic countries. Eur. J. Clin. Nutr. 54(Suppl. 1):S21
28
Saper CB, Chou TC, Elmquist JK. 2002. The need to feed: homeostatic and hedonic control
of eating. Neuron 36:199211
Schachter S, Rodin J. 1974. Obese Humans and Rats. Washington, DC: Erlbaum/Halsted
Schioth HB, Lagerstrom MC, Watanobe H, Jonsson L, Vergoni AV, et al. 2003. Functional
role, structure, and evolution of the melanocortin-4 receptor. Ann. N.Y. Acad. Sci. 994:74
83
Schluter G, Lee C. 1999. Changing good consumption patterns: their effects of the US food
system, 197292. Food Rev. 22:3537
Schwartz MW, Morton GJ. 2002. Obesity: keeping hunger at bay. Nature 418:59597
Shetty PS. 1993. Chronic undernutrition and metabolic adaptation. Proc. Nutr. Soc. 52:26784
Shetty PS, James WPT. 1994. Body Mass Index: A Measure of Chronic Energy Deciency in Adults.
Rome: Food Agric. Org.
Shuldiner AR, Munir KM. 2003. Genetics of obesity: more complicated than initially thought.
Lipids 38:97101
Simmen B, Hladik CM. 1998. Sweet and bitter taste discrimination in primates: scaling effects
across species. Folia Primatol. 69:12938
Smiciklas-Wright H, Mitchell DC, Mickle SJ, Goldman JD, Cook A. 2003. Foods commonly
eaten in the United States, 19891991 and 19941996: Are portion sizes changing? J. Am.
Diet. Assoc. 103:4147
Sobal J, Stunkard AJ. 1989. Socioeconomic status and obesity: a review of the literature. Psychol.
Bull. 105:26075
Spitzer L, Rodin J. 1981. Human eating behavior: a critical review of studies in normal weight
and overweight individuals. Appetite 2:293329
Stamatakis E, Primatesta P, Chinn S, Rona R, Falascheti E. 2005. Overweight and obesity
trends from 1974 to 2003 in English children: What is the role of socioeconomic factors?
Arch. Dis. Child. 90:9991004
Stevens J, Kumanyika SK, Keil JE. 1994. Attitudes toward body size and dieting: differences
between elderly black and white women. Am. J. Public Health. 84(8):132225
St-Onge M, Keller KL, Heymseld SB. 2003. Changes in childhood food consumption pat-
terns: a cause for concern in light of increasing body weights. Am. J. Clin. Nutr. 78:106873
Story M, French SA, Resnick MD, Blum RW. 1995. Ethnic/racial and socioeconomic differ-
ences in dieting behaviors and body image perceptions in adolescents. Int. J. Eat. Disord.
18:17379
Stroebele N, de Castro JM. 2004. Television viewing is associated with an increase in meal
frequency in humans. Appetite 42:11113
Stubbs RJ. 1998. Appetite feeding behavior and energy balance in human subjects. Nutr. Rev.
57:116
Stubbs RJ, Whybrow S. 2004. Energy density, diet composition and palatability: inuences on
overall food energy intake in humans. Physiol. Behav. 81:75564
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Stunkard AJ, Fock TT, Hrubec Z. 1986. A twin study of human obesity. J. Am. Med. Assoc.
256:5154
Sturm R. 2005. Childhood obesitywhat we can learn from existing data on societal trends,
by Appalachian State University on 08/13/08. For personal use only.
Wansink B. 2004. Environmental factors that increase the food intake and consumption volume
of unknowing consumers. Annu. Rev. Nutr. 24:45579
Wansink B, Cheney MM. 2005. Super bowls: serving bowl size and food consumption. Obes.
Res. 293:172728
Waterlow JC. 1990. Mechanisms of adaptation to low energy intakes. In Diet and Disease, ed.
GA Harrison, JC Waterlow, pp. 523. Cambridge, UK: Cambridge Univ. Press
Wilkinson J, Ben-Tovim D, Walker M. 1994. An insight into the personal signicance of weight
and shape in large Samoan women. Int. J. Obes. Relat. Metab. Disord. 18:6026
Wilson SG, Adam G, Langdown M, Reneland R, Braun A, et al. 2006. Linkage and potential
association of obesity-related phenotypes with two genes on chromosome 12q24 in a
female dizygous twin cohort. Eur. J. Hum. Genet. 14:34043
World Health Organization. 2000. Obesity: preventing and managing the global epidemic.
WHO Tech. Rep. Ser., No. 894. Geneva
Annu. Rev. Anthropol. 2006.35:337-360. Downloaded from arjournals.annualreviews.org
Yamamoto H, Lee CE, Marcus JN, Williams TD, Overton JM, et al. 2002. Glucagon-like
peptide-1 receptor stimulation increases blood pressure and heart rate and activates auto-
by Appalachian State University on 08/13/08. For personal use only.
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Figure 1
Nauru Nauru
Cook Is Tong a
Obese (%)
Obese (%)
Fr. Polynesia Cook Is
Croatia Fr. Polynesia
Kuwait Bahrain
USA Kuwait
Bahrain USA
Hungary Egypt
Ireland Tu rkey
Saudi Arabia
Turke y Ireland
Egypt Serbia
New Saudi Arabia
Spain Tun isia
Vanuat u Peru
Belgium Vanuat u
Peru Lithuania
09:22 AM
Lithuania Belgium
Russia Canada
Estonia Czech Rep
Finland New Zealand
Latvia Mauritius
South Africa Fiji
Seychelles Latvia
UK
Page C-1
Spain
Austria
Denmark Iran
Mauritius Morocco
www.annualreviews.org
Fiji Finland
Sweden UK
Italy Kyrgyzstan
Netherlands Brazil
France Denmark
Tunisi a Estonia
Switzerland Sweden
Singapore France
Norway Italy
Iran Singapore
Brazil Malaysia
Kyrgyzstan Switzerland
Obesity rates by nation (body mass index greater than 30 kg/m2). Figure created using data from
Morocco Norway
Malaysia Pakistan
Japan
Philippines
Philippines
Ghana
C-1
Lao
b. Males only
Ghana
India India
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Nauru
C-2
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Obese (%)
Fr Polynesia
Bahrain
Egypt
HI-RES-AN35-18-Ulijaszek.qxd
USA
South Africa
Ulijaszek
Turke y
Figure 1
Kuwait
(Continued)
Seychelles
Russia
9/9/06
Mexico
Lofink
Lesotho
Tunisi a
Germany
Hungary
Fiji
Saudi Arabia
Mauritius
09:22 AM
Peru
Vanuat u
Uruguay
Cyprus
Australia
Belgium
Lithuania
Page C-2
Latvia
New Zealand
Czech Rep
Morocco
Ireland
Croatia
Iran
Canada
Spain
Kyrgyzstan
UK
Brazil
Finland
Netherlands
Austria
France
Malaysia
Sweden
Denmark
Singapore
Italy
Ghana
Estonia
Norway
Pakistan
Philippines
Switzerland
China
Japan
South Korea
c. Females only
Lao
India
Contents ARI 13 August 2006 13:30
Annual Review of
Anthropology
Contents
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Prefatory Chapter
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Archaeology
Biological Anthropology
ix
Contents ARI 13 August 2006 13:30
Sociocultural Anthropology
x Contents
Contents ARI 13 August 2006 13:30
Theme 2: Food
Contents xi
Contents ARI 13 August 2006 13:30
Indexes
Errata
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the present) may be found at http://anthro.annualreviews.org/errata.shtml
xii Contents