Chapter 7 – Energy Balance and Obesity

7.4 Overweight: When Extra Weight Begins to Affect Health

Is being overweight simply a matter of appearance, or can it affect your health? As body weight increases beyond a healthy range, the risk of developing certain chronic diseases generally rises. While not everyone who is overweight experiences health problems, excess body fat can affect many aspects of physical health and well-being.

Both underweight and overweight are associated with health risks. Research shows a J-shaped relationship between BMI and mortality risk, with the lowest risk occurring in the normal BMI range and higher risks at both extremes (Figure 7.19). [1]  (Notice that mortality risk is greatest with BMI 35 to 40, or type III obesity.)

A bar graph depicts a J-shaped curve representing higher risk of mortality when BMI is in the underweight range or in the overweight or obese ranges.
Figure 7.19.  The relationship between body mass index and mortality forms a J-shaped curve, demonstrating higher rates of death associated with underweight and obese, with the lowest rates of death associated with normal weight. (Image from “Clinical Problems Caused by Obesity” by Ioannis Kyrou, M.D., PhD, Harpal S Randeva, MD, PhD, FRCP, Constantine Tsigos, MD, PHD, Grigorios Kaltsas, MD, FRCP, and Martin O Weickert, MD, FRCP.)

What are the specific risks associated with being overweight or underweight? Let’s take a closer look at each of these situations.

Health Risks of Being Overweight

 Excess body fat affects health in several ways. Fat tissue produces hormones and inflammatory compounds that may contribute to chronic diseases such as type 2 diabetes, cardiovascular disease, and some cancers. [2]

Childhood obesity is also a growing concern. Obese children are more likely to become obese adults and are at greater risk of developing chronic diseases such as type 2 diabetes and cardiovascular disease earlier in life.[3] Weight bias can affect people of all body sizes and may contribute to stigma, social isolation, and avoidance of health care. The figure below highlights common sources of weight stigmatization, including family members, peers, workplaces, and health care providers.

 

A chart is shown listing 5 categories of weight stigmatization identified in a focus group study. First is family (nagging about weight, hurtful nicknames). Second is social environment (lack of dating opportunities, dirty looks, harassment when out in public). Third is work environment (trouble at job interviews, workplace teasing). Fourth is service providers (poor treatment by health care provider or waitperson or salesperson). Fifth is generalized feelings of mistreatment (subtle feelings of judgment).
Figure 7.21.  Common sources of weight stigmatization identified by individuals who are overweight or obese [footnote]Cossrow, N. H., Jeffery, R. W., & McGuire, M. T. (2001). Understanding weight stigmatization: A focus group study. Journal of Nutrition Education, 33(4), 208-214.[/footnote]  (“Sources of Stigmatization” by Heather Leonard licensed CC BY 4.0.)

Addressing weight bias requires greater awareness, education, and efforts to reduce discrimination in schools, workplaces, health care settings, and society. The HBO documentary The Weight of the Nation explores the human and societal costs of obesity through personal stories and expert perspectives. Although produced in 2012, it remains a highly regarded resource for understanding the complex factors that contribute to obesity and the challenges faced by those affected. 

Video: "Weight of the Nation: Stigma—The Human Cost of Obesity" by HBO Docs, YouTube (May 14, 2012), 18:54. This is an excellent video to help increase awareness of weight stigma, humanizing the pain and damage caused by weight bias and discrimination.

 

Review Questions

 

attributions

This section is an adaptation of "Overweight and Underweight-What are the Risks?" in Nutrition: Science and Everyday Application, v. 1.0 by Alice Callahan, PhD; Heather Leonard, MEd, RDN; and Tamberly Powell, MS, RDN licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

  1. Di Angelantonio, E., Bhupathiraju, S. N., Wormser, D., Gao, P., Kaptoge, S., de Gonzalez, A. B., ... & Lewington, S. (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet, 388(10046), 776-786. ↵
  2. Obesity and Hormones. Victoria's (Au) Better Health Channel. https://www.betterhealth. Retrieved January 25, 2022, from https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-and-hormones ↵
  3. Obesity and overweight. World Health Organization. Accessed June 2026. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight[/footnote]

    Obesity is a complex condition influenced by many factors, including diet, physical activity, genetics, and the environments in which people live, work, and learn.[footnote]Obesity and overweight. World Health Organization. Accessed June 2026. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight[/footnote]

    [caption id="" align="aligncenter" width="664"]Six young women standing in a row wearing black leotards. The women are of varying body shape and size. They have positive phrases written in large letters on their arms and legs, such as patience, tolerance, be supportive, and be positive. Figure 7.20.  "Stop Bullying" by Lucky Lynda licensed CC BY 2.0.[/caption]

    Economic and Societal Costs of Being Overweight

    Overweight and obesity affect not only health but also society and the economy. People living with obesity often have higher medical expenses because of obesity-related conditions such as type 2 diabetes, heart disease, and hypertension. As obesity rates have increased, so have health care costs and workplace productivity losses.[footnote]The economic impact of obesity increased to $1.4 trillion. Milken Institute. Retrieved January 24, 2022, from https://milkeninstitute.org/article/economic-impact-obesity-increased-14-trillion-says-milken-institute[/footnote]

    The social and emotional consequences can be equally significant. Individuals with obesity may experience depression, anxiety, lower quality of life, and discrimination in schools, workplaces, health care settings, and social situations.[footnote]Obesity consequences. Harvard T.H. Chan School of Public Health. Retrieved November 4, 2019, from https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/.[/footnote]

    A particular concern is weight bias, which refers to negative attitudes, assumptions, and judgments based on a person's body weight.[footnote]Alberga AS, Russell-Mayhew S, von Ranson KM, McLaren L. Weight bias: a call to action. J Eat Disord. 2016;4:34. ↵

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Introduction to Nutrition and Wellness, 2nd Edition Copyright © 2026 by Janet Colson and Sarah Harris is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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