MEDICAL MATTERS: America may be the land of the free and the home of the brave, but it is also the land of the fat and the home of the big writes Dr Charles Daly.
A friend who was in Orlando recently noticed a vastly overweight woman unable to walk and confined to a motorised buggy, munching a submarine sandwich the size of a small animal, washed down by a large Coke.
Since 1970 the number of obese Americans has doubled from 15 per cent to nearly one in three today.
On this side of the Atlantic we should not be so complacent. About two-thirds of the English are overweight or obese, in France it's 32 per cent, and in the EU as a whole an estimated 18 per cent of children are overweight.
The pattern is similar in Ireland. A survey done by the South Eastern Health Board in August estimated that 8 per cent of children in the region were obese and a third overweight. What is most worrying is that children and adolescents who are overweight are being set up for a lifetime of obesity-related disorders.
Some doctors are suggesting that an epidemic of so-called "metabolic syndrome" - obesity, hypertension, high cholesterol and type II diabetes - is already in full swing.
Even in the third world, traditionally a by-word for starvation and malnutrition, it is estimated that for the first time there are now as many obese people as there are malnourished because of the advent of western diet and fast food outlets.
A convenient way of assessing one's level of obesity is to calculate what's known as the Body Mass Index (BMI). Take your weight in kilograms and divide by your height in metres squared.
For instance, a man who weighs 70kgs and is 1.68m tall has a BMI of 24.8 which is in the normal range. If your BMI is between 25 and 30, you are overweight, between 31 and 35 you are obese, and a BMI of over 35 spells trouble.
Fat deposition is often random but if it is mostly around the waist and hips this is seen as a marker of significant obesity.
History has shown that empires began to crumble when the territory acquired became over-extended for the central administration to be able to cope.
The Roman Empire became too unwieldy and cumbersome to be run efficiently and collapsed from internal corruption and external invasion.
Similarly, the human body cannot cope indefinitely with excessive strain caused by too much weight.
Systems break down with the strain and cardiovascular disease such as heart attacks and stroke, respiratory difficulty, endocrine problems like diabetes and musculoskeletal disorders such as osteoarthritis, can be attributed in part to obesity. There is also thought to be a positive association between some cancers such as those of the breast and prostate with obesity.
The cause of obesity is very simple: intake of energy (food) exceeds output (exercise, exertion). Patients often blame obesity on glands. Apart from some very rare endocrine disorders and tumours, the only glandular activity implicated in obesity is over-stimulation of the salivary glands.
Doctors who see children who are overweight despite "eating nothing" at meal times can usually elicit a history of inappropriate gorging with sweets, biscuits and chocolate in between meals. Fad diets come and go but the only reliable way to lose weight is to eat less.
Animals generally eat only when they are hungry. A wildebeest in the presence of a sated lion is far safer than a human walking down O'Connell Street late at night.
Since we evolved from hunter-gathers and no longer have to hunt to survive, eating has become more of a cultural than a survivalist event and we tend to eat far more than is necessary.
We get less exercise, drive everywhere, rely on labour-saving devices to do traditional physical chores, eat too much fast food and processed foods and are seduced by BOGOF offers at supermarkets (buy one, get one free). Children do not seem to play any more unless the play is part of a Playstation.
There is nothing wrong with an occasional indulgence in junk food within the context of a balanced diet, but for many people the chipper and Chinese takeaway are significant contributors to their weekly diet.
In an extreme example of suffering in the cause of research, Morton Spurlock in his documentary Super Size Me describes the effects of eating nothing but McDonald's produce for a month. His weight went up considerably, his cholesterol went through the roof, he lost his libido and his doctors warned him that his liver was turning into paté with fatty deposits.
Dr Charles Daly is a GP in Co Waterford