9 Obesity
Madison Cook and Tyler Steven Thompson
“Obese” has become a word-wrapped in negative connotations due to societal pressures, changing diet culture, and the fast-food industry continuously promoting economic growth at the expense of people’s health. Between the discrepancies in energy intake and expenditure, plus food lacking proper nutrition, our community is growing their waistbands and damaging their mental health.
Our body thrives off of six essential nutrients: vitamins, minerals, proteins, fats, water, and carbohydrates. Combining these helps our bodies run smoothly; however, too much or too little of these can cause more harm than good. An excess in fat can cause one to become obese, ultimately leading to many other issues such as cardiovascular disease, diabetes, and many others.
BIOLOGY BEHIND OBESITY
The biology behind obesity lies in the digestive process. Our digestion is an essential body system allowing our bodies to absorb the necessary nutrients it needs to thrive. The food we eat starts its digestion process in the mouth with chemical digestion through salivary amylase and lingual lipase plus mechanical digestion through the teeth to take you on a brief tour. The bolus (a ball of chewed food) travels through the esophagus to the stomach, further chemically digesting it. The food then travels through the small intestines, where most of the nutrient absorption occurs. Most processed fast foods are high in sugar, salt, and fat and low in fiber. The sugar and fat content promote weight gain, and the low fiber doesn’t allow for the food to take its time during digestion, allowing for appropriate nutrient uptake. Once passed through the small intestines, the food makes its way to the large intestines, where water reabsorption occurs. The food is then sent to the rectum to be expelled. A process essential to overall health.
Fat is a crucial part of our diet. Fat not needed for immediate energy sources are bundled up into triglycerides and stored in fat cells. Because fat cells have unlimited capacity, we retain it. So, the fat consumed through a McDonalds’ lunch will most likely be stored rather than used right away due to its excess and its pairing with too much sugar and salts. “According to the Centers for Disease Control and Prevention (CDC), Americans are eating more calories on average than they did in the 1970s.” And by 2006, Americans were spending 46% on away-from-home food. (Harvard Health. “Why People Become Overweight.” Harvard Health, 2009, www.health.harvard.edu/staying-healthy/why-people-become-overweight.) The sedentary lifestyle of today’s society has also greatly contributed to the rise in obesity. The lack of energy expenditure coupled with the excess calorie intake promotes the ballooning of waistbands.
WHAT COULD HAPPEN
The rising numbers on the scale don’t come without health risks. Obesity increases the risk of: “mortality, high blood pressure, high LDL cholesterol, low HDL cholesterol, or high triglycerides, type II diabetes, coronary heart diseases, stroke, gallbladder disease, osteoarthritis, sleep apnea, many types of cancer, low quality of life, mental illness and body pain with the difficulty of physical functions” states the Centers for Disease Control. [1] These health conditions are also commonly seen together in obese patients. For example, the high LDL cholesterol within one’s body can lead to diabetes or heart attack due to the arterial plaque buildup.
Refer to the graph below for distinctions between health conditions in those with normal weight compared to those obese. [2]
Joint pain and diminishing mental health are two widespread side effects of obesity. Even though muscle weighs more than fat, obesity greatly affects our muscular and skeletal systems. The adipose tissue, commonly known as fat, accumulates all around our bodies when there is a lack of proper nutrition and exercise. Common places of buildup are the stomach, legs, butt, arms, etc. The extra weight can put a lot of pressure on the joints, leading to chronic pain and a further sedentary lifestyle. This chronic pain and societal pressures and stigmas around the obese community can lead to declining mental health.
Common Diseases at Risk
Throughout history, there had been many epidemics. From the Black Plague to the most recent Covid-19, epidemics have been spreading for centuries. However, the real epidemic that has been spreading over the last five decades, not contagiously but individually, is obesity. In the last fifty years, I say this because society (especially in America) has increased from an overall 15% in 1970 to 40.3% for men and 39.7% for women between the ages of 20-39. This isn’t contagious, though, as I said before; every individual has eaten their way into obesity by themselves. Although each person has the ability to reverse obesity, the diseases that follow obesity can be challenging to address. According to the Centers for Disease Control and Prevention (CDC), the leading causes of death in the US are heart disease (655,381), cancer (599,274), accidents (unintentional injuries, 167,127), chronic lower respiratory diseases (159,486), stroke (147,810), Alzheimer’s disease (122,019), diabetes (84,946), influenza and pneumonia (59,120), Nephritis, nephrotic syndrome and nephrosis (51,386), and suicide (48,344). Three out of ten of these leading causes correlate with obesity and are heart disease (number 1), stroke (number 5), and diabetes (number 7). Although obesity can cause three often causes of death, other diseases can result from obesity that can make living more challenging than it can be. As we read throughout this section, we will learn together the common diseases linked to obesity.
Type 2 Diabetes
Although there are two types of diabetes, a person can develop type 2 diabetes over time due to a poor diet. Type 1 diabetes is more genetic and often develops in children between the ages of 10 and 14. Type 2 diabetes often occurs in overweight and obese (80% – 90%) caused by insulin insensitivity. Insulin insensitivity, or insulin resistance, is when a condition in which the body becomes less sensitive to a given amount of insulin, resulting in insulin having a biological effect that is less than expected. Another cause would be that the pancreas secretes the sufficient amount of insulin the body needs, or the pancreas stops insulin secretion altogether.
A common misconception is that you can develop type 2 diabetes by consuming an overabundance of sugars. Consuming a surplus amount of carbohydrates and sugars causes the blood sugar to rise, which causes the pancreas to react by releasing an abundance of insulin; however, excessive production becomes insufficient over time. Once the pancreas stops secreting insulin, there’s no going back.
On a positive note, there are ways to prevent type 2 diabetes. Type 2 diabetes is incurable; however, prediabetes can be turned around. Prediabetes is when a person most likely has a condition called impaired fasting glucose. The fasting blood glucose levels are higher than normal but not high enough to lead to type 2 diabetes diagnosis. When diagnosed with prediabetes, it is obviously strongly encouraged to change the diet they’re consuming or continue into type 2 diabetes. When diagnosed with prediabetes, preventing type 2 diabetes diagnosis includes reducing the bad carbohydrates, sugars, and increasing physical activity.
Cardiovascular Disease (CVD)
Cardiovascular disease is something that you would not want to have. CVD usually starts with an underlying condition called atherosclerosis, a disease in which arterial walls accumulate deposits of lipids and scar tissue, which build up to a point at which they impair blood flow. CVD is a term used to pertain to the abnormal condition that involves dysfunction of the heart and blood vessels. What happens first is the cells that line the insides of all the arteries become damaged; this process is usually caused by smoking nicotine or excessive blood glucose in people with badly controlled diabetes. What happens next is the cells’ injury attracts immune cells and triggers vessel [i]inflammation. Inflamed vessels become weak and allow lipids, mainly cholesterol, to seep through the layers of vessel walls and become oxidized. Once the immune cells absorb the oxidized lipids, they also accumulate as foam cells, joined by calcium, protein fibers, and other debris to become trapped in thick deposits referred to as plaque. The examples below show the plaque builds up. Although there are many CVD forms, the three most common forms include coronary heart disease, hypertension, and stroke.
Hypertension
Hypertension, also known as high blood pressure, is when the force of your blood pushing against the walls of your blood vessels (blood pressure) is consistently too high. When your heart pumps blood into the arteries, it’s performing the first force called systolic pressure and should be 120mm Hg or less. The second force will be diastolic pressure and is created as the heart rests between beats; diastolic pressure should be 80mm Hg or less. Once plaque starts building up in your arteries, your blood pressure begins to increase, and eventually, you’ll be facing Hypertension Stage 1 (130-139mm Hg systolic and 80-89mm Hg diastolic). When an individual is obese, especially morbidly obese, they have a high risk of having either stage 1, 2, or 3 hypertension; considering what they eat, when they eat, and how much they eat, especially with a severe lack of physical activity. When you have stage 1 hypertension, you still have a good chance to bring your blood pressure down only if you take proper precautions like committing to a diet plan and becoming more active. Once a person hits stage 3 hypertension, it becomes more severe by having a great risk of having a stroke or heart attack and leading to death.
Stroke
A stroke is at greater risk once your blood pressure reaches more than 180mm Hg systolic and 120 Hg diastolic. This is when you’re in a hypertension crisis and need medical attention right away. There are signs of having a stroke, such as blurred vision, sudden numbness, and trouble speaking, so you have a chance to save yourself from death. However, the consequences of having a stroke can be troubling as you can paralysis on the left side of the body, vision problems, and memory loss.
Coronary Heart Disease or Coronary Artery Disease
Like hypertension, coronary heart disease is caused by plaque build-up in the arteries, the coronary arteries to be exact, which are the arteries that lead to the heart. When the coronary arteries are built up with plaque, as we learned earlier, it’ll restrict the blood flow, although this time it restricts the blood flow to the heart. When this happens, it can result in a heart attack and death. Like a stroke, though, if you get medical attention in time, you can survive a heart attack. Just like a stroke, surviving a heart attack has its consequences as well; you’ll have to change your diet immediately to lower your blood pressure, keep a constant eye on your blood pressure and heart rate, and stay away from anything exciting that might trigger another attack because once you have a heart attack, you’re prone to have another one or two. Coronary heart disease can also lead to something more tragic than a heart attack, and it can also lead to heart failure.
Developed countries and third world countries have something in common that leads to this obesity epidemic: their diet. Although very different, the diets between these two worlds promote extreme weight gain. There are fast-food restaurants on every other corner enticing each passerby to devour far beyond what is healthy. In countries such as Nauru and Palau, the average income is much lower than in a more developed country. Economics plays a role in diet and food consumption in these areas where fresh fruit and vegetables are too expensive than meat, fish, rice, and potatoes.
Your Turn; A Healthy Diet and Lifestyle for Obesity
Obesity is tough to battle; once you become obese, I understand it can be hard to turn it around for the better. Someone who becomes obese may lose hope to become healthy and fit or just doesn’t try because it can become too difficult. The bad news is if one doesn’t do anything to change, they’re at risk for plenty of problems in the future (see section four); however, the good news is that the body is always willing to adapt for the better. Even if someone who is obese is diagnosed with any diseases such as CVD, type 2 diabetes, heart disease, hypothyroidism, etc., they can still rehabilitate their body and mind for a better and healthier future. The only issue with this is that it will take some discipline and will power to do so, along with quite a bit of time, but it can definitely be done. Having contracted a disease because of obesity will be a challenge for it as well, but with a proper diet and a strategic exercise plan, even with a disease, it can also be done. I will go over a diet plan, what to eat, what not to eat, and some exercise plans to help recover from obesity and get on the right track.
The Diet
Obesity usually comes from eating an abundance of unhealthy foods with improper nutrients, causing the arteries to clog and adipose cells to continuously form throughout the body, making it hard to move around as much. When eating fast food and junk food consistently, you are most likely putting saturated fats, trans fats, low-density lipoproteins (LDL, bad cholesterol), refined sugars, and high fructose corn syrup into your digestive tract, which then gets absorbed into the body. The only thing is, by consuming these improper nutrients, there isn’t anything the body can really do with them but to store them into fatty tissue. The body constantly needs proper nutrients to function properly for life. Of course, telling someone about it is easy, but the hard part is actually doing it. The body tends to become addicted to sugars and carbohydrates; the brain releases dopamine when sugar is consumed and causes addiction. Dopamine is when neurons in the brain signal when something positive is happening and can get quite addicting. I believe that someone who has obesity can’t just cut his or her calorie count dramatically. Once the body is used to consuming 3,000 to 6,000 calories a day, it’ll have sudden drawbacks when cut down to 1,800 to 2,200 calories a day, but the idea is to lower it slowly but surely. Also, tricking the mind into what you eat is a great way to consume food when hungry or when the appetite is triggered. How can we trick the mind into doing so? Substitutions are always a great way to break unhealthy eating habits; however, we will get to that shortly; for now, let’s venture to see what not to eat.
The Diet: What Not to Eat
As we learned before, consuming saturated fats, trans fats, LDLs, refined sugars, and high fructose corn syrup can further damage the body. When you get hungry and go out for lunch, let’s say a burger joint, you’re most likely will get a huge meal. When your hungry, just the smell of food will trigger hunger causing your eyes to be bigger than your stomach. With that being said, you’re most likely going to get a double cheeseburger with French fries and a large soda. Sometimes the burger restaurant will have specialty burgers on the menu as well.
Let’s say, for example, I am obese, and I get hungry; I go to a burger restaurant and see they have a double bacon cheeseburger with Portobello mushrooms. The advertisement that they have makes it look so delicious, and the more I look at it inline, the more I want it. So once it’s my turn in line and I do decide to order such burger, then I order large French fries because you can’t have a burger without fries; plus I was going to get a medium fries, but getting the large fries is only a dollar more, so it’s a better value. I will need something to wash it down with, so I order a large drink, and I get myself a Lemon-lime soda. That right there is most likely a 2,000-calorie meal or more that I hypothetically just consumed, which is the daily-recommended amount. Not to mention that there are no proper nutrients in that meal as well. The sodium content in the burger and the fries are sky-high, which is not good for blood pressure, and the lemon-lime soda I consumed probably has at least 32 grams of sugar alone, which is not good for my insulin levels. The French fries and burgers also have an abundance of saturated fats and trans fats from the meat and the grease the fries were fried in, not to mention the fats from the burger’s sauce.
Fast food isn’t always the enemy either; junk food does as much damage. You can get numerous grocery store items that can damage your body, from frozen foods, potato chips to desserts. Let’s use another example: again, I am obese; I go to the grocery store to do some shopping. I get some protein, and I pick out some ground beef with 75% fat; I then go to the bread aisle and pick up some white bread. After that, I go down to the canned section to pick up some canned vegetables. I also pick up some canned tomato sauce and spaghetti pasta. After that, I go down the chip aisle and pick up a couple of bags of chips, original and hot. I then grab some American cheese and some processed lunchmeat along with some shredded cheddar cheese and bacon. From there, I go down the soda aisle and pick up a couple of 12 packs, cola, and lemon-lime soda. After that, I go down the snack aisle and pick up a few boxes of snack cakes, which reminds me I need cereal. So I go to the cereal aisle and pick up a couple of boxes of cereal. There I see some pop tarts and sandwich cookies, so I think to myself, “Eh, what the heck?” Lastly, I’ll need some milk with the cereal and cookies, so I grab a gallon of whole white milk.
That grocery list to me is a bit scary. The amount of sugar in that list from the snack cakes, cookies, cereal, white bread, pasta, and soda is a weight gain ticket. Not to mention the fat from the ground beef, potato chips, lunchmeat, milk, and cheeses are very high. The sodium levels from the canned vegetables, lunch meats, potato chips, and cheeses are extreme; the sodium levels and the fats combined are also a one-way ticket to CVD and blocked arteries, especially with being obese. So how can we fix this fast food and junk food habit for the better? How can we shop and eat so someone with obesity can lose weight and lower their risk for chronic diseases? Let’s dive into it!
The Diet: What to Eat
As I said before, we need to trick our minds into eating our favorite foods and healthier options. Substitutions are an excellent way to do this. I’m not talking about drinking diet soda instead of regular soda, but more about subbing out foods with improper nutrition with foods with proper nutrients. For example, going by the grocery list I made in the example above, instead of getting snack cakes and cookies, switch it out with fruit. It’s completely normal to have sugar cravings after eating a meal; this is called appetite, but your body isn’t necessarily craving snack cakes and pastries; your body is craving sugar after a meal; we just go for snack cakes and pastries because it’s an obvious form of sugar that will satisfy your cravings. Try eating a banana or some yogurt with blueberries instead and watch your cravings indeed are satisfied. Substituting fruit with sugary snacks, will ultimately reduce your refined sugar and high fructose corn syrup intake, along with carbohydrates as well. By eliminating these unwanted sugars, blood glucose will be reduced, and the pancreas will not secrete as much insulin as it once did. When sweetening teas and other items, try using honey. Honey is a natural sweetener that offers better benefits than refined sugar.
For fats, try substituting butter with a bit of olive oil. Olive oil is the best kind of oil to consume because it’s high in monounsaturated fats. I would also substitute mayonnaise, cream cheese, and sour cream with plain Greek yogurt; plain Greek yogurt is a great source of calcium and protein; by substituting mayonnaise, cream cheese, and sour cream with this, you reduce your lipid intake drastically. Also, try to limit cheese to little to none. I will admit cheese tastes deliciously. However, the fat content in cheese is rather high. When using cheese, try to stick with white cheeses because yellow cheeses have a higher fat content. Instead of frying food, start baking or broiling foods; this will help decrease over-consuming unnecessary fats. Also, with choosing protein, leaner meats such as chicken, turkey, fish (salmon and tuna), and lean ground beef are 90% lean. Try to limit processed foods such as frozen foods and lunchmeats to little to none. I recommend taking a rotisserie chicken or baked chicken and shred it into little pieces for a sandwich with lunchmeat. Doing this will reduce unwanted chemical consumption along with excess sodium consumption.
When eating carbohydrates, It’s best to eat foods with fiber because it’ll help make you feel full after eating and prevents you from overeating. When shopping for bread, look for items that have fiber between 3-5 grams per slice. Also, limit other bread like a baguette, sourdough, etc. Be careful with foods with a starch like potatoes and corn; instead, you can eat sweet potatoes or even moderate these foods.
With spicing up your foods, try to limit the amount of salt you use—Sub out garlic salt for garlic powder. I even recommend using the brand Mrs. Dash because it has no sodium. It’s ok to have some salt, but not too much.
Physical Activity
It can be quite challenging to perform any physical activity. Mobility is reduced when obese because the blood flow is restricted to the heart, causing their heart rate to go up and get them out of breath. It’s important to start with small steps and consistently work your way up. No one expects someone with obesity to run a mile at first. I would recommend walking around the park for 10-30 minutes at a time. Also, do a few bodybuilding exercises with light to no weights; it’s important to get the body moving and build up the habit. If you have access to a pool, that is fantastic; I would definitely recommend doing some aerobics in the pool or even just swimming around; swimming works every muscle in the body; swimming will also strengthen the legs and help people who are obese build muscle. You can also make working out fun, like buying a dancing game you can move to; even if you don’t stand and dance, you can still dance while sitting down to get your body moving. Do this for about thirty days to build a routine; if you can extend the exercises’ time, do so, but be careful not to strain yourself.
Once you build a routine and your body is ready, it’s time to start extending cardio’s speed and time. I don’t expect you to run or even power walk just yet, but try to walk a little faster to get the heart rate up. Don’t overextend your heart rate though, if it reaches up to 175-180, then slow it down a bit and take a breath; once it’s down again, then keep going. Try going for a longer distance or time; if you’re used to walking for 30 minutes, try walking for 45 minutes. I recommend not doing anything less than you did before. For example, once you hit a 45-minute walk, don’t go back to 30 minutes; keep pushing for the 45 minutes. Eventually, you’ll start building stamina and start dropping the fat.
I have to note, though, that this will not be an easy task. It will take a lot of work and dedication to drop the weight because your body is not used to moving around. What should help is to think of a motivation to lose it. Whether you want to prevent any future chronic diseases, want to be healthy in general, want to live longer, or just want to look good and be more confident, having that motivation will help you keep going. Treat every workout like it’s your first work out, but try to push yourself a bit farther. I say this because you would think that the hardest part is to start, but in reality, the hardest part is to keep it going and staying motivated. Also, go on a different route when walking every day and do different exercises for different body parts, keeping it from boring and discouraging. When you’re about to go exercise, stay away from saying “I have to go exercise” and say things like “I get to exercise today” and “I get to make me healthier today than yesterday.” By doing this, you wire your brain to make exercising a positive rather than a negative, keeping you from being discouraged. Lastly, appreciate yourself more. I know it’s hard to be confident while being obese, but try to appreciate what kind of person you are and love yourself more. Think to yourself, once I lose this weight, I will look good sure, but I’m still the same good person as I once was. I deserve to live longer and to be healthy; my body deserves to feel great.
Example Diet Plan for a Week
Monday
Breakfast: Two eggs, two wheat toast pieces, a bowl of oatmeal with blueberries, and a banana.
Snack: A granola bar.
Lunch: Tuna sandwich (Tuna, plain Greek yogurt, mustard, and relish) and a serving size of chips (I recommend sun chips or baked chips).
Snack: Peanut butter and honey sandwich.
Dinner: Baked chicken, desired vegetables (broccoli, asparagus, etc.), and a cup of quinoa. Add a salad with vinaigrette dressing.
Dessert: Banana.
Tuesday
Breakfast: Two eggs, a bowl of oatmeal with blueberries, and a banana.
Snack: Yogurt with granola or berries.
Lunch: Baked Chicken salad with an oil or vinaigrette dressing and a whole-wheat roll.
Snack: Serving size of trail mix.
Dinner: Baked salmon, side of desired vegetables, and a baked potato (try using olive oil, plain Greek yogurt, and pepper).
Dessert: Banana.
Wednesday
Breakfast: Veggie omelet (2 eggs, desired veggies such as tomato, spinach, onion, etc.) and a banana.
Snack: Carrots and peanut butter.
Lunch: Rotisserie chicken sandwich and a serving size of chips.
Snack: A bowl of grapes.
Dinner: Shredded baked (or crockpot) chicken tacos (chicken, pico de gallo, plain Greek yogurt, and if desired Monterey Jack cheese with corn tortillas; limit to three tacos), Spanish brown rice with quinoa, and whole black beans.
Dessert: Peanut and butter sandwich and a glass of milk.
Thursday
Breakfast: 2 eggs, 2 pieces of toast, a bowl of oatmeal with berries, and a banana.
Snack: Serving size of chips.
Lunch: Turkey wrap (turkey, romaine lettuce, tomato, and onion; try adding avocado as well!) and a kale salad.
Snack: carrots and celery with peanut butter.
Dinner: Lean burger (Whole wheat bun, 90% lean ground beef or turkey, romaine lettuce, tomato, onion, and mustard with ketchup), and baked fries.
Dessert: Banana.
Friday
Breakfast: 2 eggs, a bowl of oatmeal, and a banana.
Snack: Whey protein isolate shake (you should be exercising).
Lunch: Salmon power bowl (1 cup quinoa, mixed vegetables, 5 oz salmon, garnished with sprouts; feel free to use a low calorie and low sodium soy-ginger glaze).
Snack: Hummus with carrots and celery.
Dinner: Grilled chicken sandwich (Tenderized chicken breast, sautéed on a skillet with a serving size of olive oil, romaine lettuce, tomato, plain Greek yogurt, and a whole wheat bun) and a kale salad.
Dessert: Peanut butter and banana sandwich.
Saturday
Breakfast: 2 eggs, a bowl of oatmeal, and a banana.
Snack: Whey protein isolate.
Lunch: Bean burger (Bean burger, Whole wheat bun, avocado, tomato, romaine lettuce, and plain Greek yogurt infused with a type of salsa) baked fries.
Snack: Hummus with celery and carrots.
Dinner: Turkey dinner (baked turkey), baked potato, asparagus or broccoli, and a whole-wheat roll.
Dessert: Yogurt with blueberries or granola.
Sunday
Breakfast: Breakfast omelet and a banana.
Snack: Smoothie (spinach, kale, desired berries, banana, and oats).
Lunch: Baked chicken, kale, and spinach salad.
Snack: Carrots and peanut butter.
Dinner: Spaghetti squash and meatballs (ground turkey, organic tomato sauce; cooked in the crockpot on high for 4 hours. Spaghetti squash brushed with olive oil and spices; baked at 400 degrees for 45 minutes to an hour).
Dessert: Banana.
It’s important to have fun with your diet and exercise regime to become a sustainable lifestyle. The sample diet’s goal is to eat 4-6 times a day to build up your metabolism. Switching out soda for sparkling water or tea, sometimes juice, is a great way to start limiting the sugar in one’s diet.
Drinking a glass of water right when you wake up is a healthy start to the day to rehydrate your body and organs. Drinking water before and during meals can help curb satiety as dehydration can lead us to think we are hungry rather than need a glass of water. For dessert, switching from sugary processed foods to fruits like berries or bananas, for example, can satisfy your sweet tooth while incorporating natural sugars into your diet. All in all, a healthy diet can look different for each person; however, balance and a healthy relationship with food are most important. With this in mind, review and extract what stands out to you, and good luck!
We Can! (Way’s to Enhance Children’s Activity & Nutrition) is a national movement created by the NIH dedicated to helping set a foundation for a healthy diet and lifestyle in children. The following link highlights programs and resources across the country and within each state.: https://www.nhlbi.nih.gov/health/educational/wecan/community/find-a-program.htm.
Media Attributions
- obese-3011213_1280 © Mohamed Hassan is licensed under a Public Domain license
- CLip art one
- Assorted Sliced Fruits in White Ceramic Bowl © Trang Doan is licensed under a Public Domain license
- “Adult Obesity Causes & Consequences.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Sept. 2020, www.cdc.gov/obesity/adult/causes.html.Enter your footnote content here. ↵
- Ndumele, Chiadi E., et al. “Obesity and Subtypes of Incident Cardiovascular Disease.” Journal of the American Heart Association, 28 July 2016, www.ahajournals.org/doi/10.1161/JAHA.116.003921.Enter your footnote content here. ↵