História da obesidade na classificação internacional de doenças (CID): de 1900 a 2018 / History of obesity in the international classification of diseases (ICD): 1900 to 2018

O presente artigo teve como objetivo descrever o histórico da inserção da condição clínica denominada atualmente de "obesidade" nas onze revisões da Classificação Internacional de Doenças (CID), publicadas pela Organização Mundial da Saúde (OMS), entre os anos 1900 e 2018. Para tanto, buscou-se pela palavra-chave "obesity" nos documentos, realizando, posteriormente, uma descrição e uma análise da presença, modo de inserção e as mudanças ocorridas ao longo do tempo. Os resultados demonstraram que a condição já foi e continua sendo inserida como sintoma, morbidade, coREVSmorbidade, causa de mortalidade e/ou doença. Concluiu-se que há uma grande inconsistência lógica nos princípios que regem a classificação.

This article aimed at describing the history of insertion of the clinical condition currently referred to as "obesity" in the eleven revisions of the International Classification of Diseases (ICD) published by the World Health Organization (WHO) between 1900 and 2018. For this purpose, a search for the keyword obesity was performed in the documents, with subsequent description and analysis of the presence, mode of insertion, and changes occurring over time. The results demonstrated that the condition has been and continues to be inserted as symptom, morbidity, comorbidity, cause of mortality and/or disease. It can be concluded that there is a massive logical inconsistency in the principles that govern the classification.

Framing the Latin American nutrition transition in a historical perspective, 1850 to the present / A constituição da transição nutricional latino-americana em uma perspectiva histórica, 1850 até o presente

Abstract This paper argues that many of the foundations and trends that led to the rise in obesity and other diet-related health problems in Latin America began to develop in the late nineteenth century. The tendency towards presentism in the nutrition transition literature provides a much abbreviated and limited history of changes in diet and weight. Whereas medical and nutrition researchers have tended to emphasize the recent onset of the crisis, a historical perspective suggests that increasingly global food sourcing prompted changes in foodways and a gradual "fattening" of Latin America. This paper also provides a methodological and historiographic exploration of how to historicize the nutrition transition, drawing on a diverse array of sources from pre-1980 to the present.

Resumo Este trabalho argumenta que fundamentos e tendências que levaram ao aumento da obesidade e de outros problemas de saúde relacionados à alimentação na América Latina começaram a surgir no final do século XIX. A propensão ao presentismo na literatura sobre transição nutricional produz uma história abreviada e limitada das mudanças em alimentação e peso. Embora pesquisadores médicos e nutricionistas enfatizem a recente instalação da crise, uma perspectiva histórica sugere que fontes alimentares crescentemente globalizadas resultaram em mudanças na alimentação e em gradual "aumento de gordura" na população latino-americana. O artigo propõe ainda a exploração metodológica e historiográfica de como historicizar a transição nutricional recorrendo a fontes pré-1980 até o momento.

Diffusion of scientific concepts on obesity in the global context: a historical review / Difusão de conceitos científicos sobre obesidade no contexto mundial: análise histórica

ABSTRACT This article aimed to carry out a historical analysis of the dissemination of the scientific concepts on obesity, overweight and excess weight in the field of nutritional epidemiology in the world. The methodological procedures comprised: (1) Systematic search in the PubMed® database using single keywords and without date filter; (2) Documentary analysis of normative instruments on the websites of the World Health Organization, the Centers for Disease Control and Prevention and the World Obesity Federation; and (3) Analysis of the scientific production of scientists participating in the obesity classification of the International Obesity Task Force. The historical analysis showed that, considering the volume of publications on obesity, it appears that in the 1940-1949 decade the problem of obesity emerged on the world scenario. From the number of publications issued in the last 20 years, which corresponds to 85% of the investigated period, we can deduct that scientists' concern to investigate the subject as a phenomenon coincides with the World Health Organization declaration of obesity as a global epidemic issued in the year 2000. In accordance with normative procedures established by international organizations, there has been a hegemonic use of the concepts of obesity and overweight, in this order of priority, by scientists worldwide. The concept of excess weight has experienced a relative rise since the year 2000, but its use has been very restricted, expressing dissonance in face of the recommendations of international standardization organizations, a fact that suggests discussion and review of its use by the world scientific community.

RESUMO O artigo teve por objetivo realizar uma análise histórica da difusão dos conceitos científicos sobre obesidade, sobrepeso e excesso de peso no campo da epidemiologia nutricional no contexto mundial. Os procedimentos metodológicos compreenderam: (1) Busca sistemática na base PubMed® utilizando unitermos isolados e sem filtro temporal para data; (2) Busca e análise documental de instrumentos normativos nas páginas eletrônicas da Organização Mundial de Saúde, do Centers for Disease Control and Prevention e da World Obesity Federation e (3) Análise da produção científica de cientistas participantes da classificação de obesidade da International Obesity Task Force. A análise histórica mostrou que, pelo volume de publicações sobre obesidade, a emergência da problemática no cenário universal ocorreu na década de 1940-1949. Pelo número de publicações dos últimos 20 anos, que corresponde a 85% do período investigado, pode-se deduzir que a preocupação dos cientistas em investigar a temática é um fenômeno coincidente com a declaração de obesidade como epidemia global feita pela Organização Mundial de Saúde no ano 2000. Em concordância com procedimentos normativos estabelecidos pelas organizações internacionais, verificou-se uma hegemonia do uso dos conceitos de obesity e overweight, nessa ordem de prioridade, pelos cientistas no contexto internacional. O conceito de excess weight experimentou relativa ascensão desde os anos 2000, mas teve seu uso bem restrito, expressando dissonância frente às recomendações das organizações internacionais de normatização - o que sugere uma discussão e revisão de seu uso pela comunidade científica global.

[Obesity as a global challenge of the 21st century: clinical medical nutrition, prevention and therapy].

The article presents modern data on the prevalence of overweight and obesity, provides updated information on personalized programs for managing body weight, individual recommendations for a healthy diet, adequate physical activity and long-term lifestyle changes. It is shown that dietary therapy is the basic treatment method in weight loss programs and is aimed at long-term maintenance of a negative energy balance in the patient's organism by limiting the calorie intake. A significant place in the article is devoted to the use of diets modified by calorie value and macronutrient content which are recommended for obese patients. A strategy for the prevention of obesity and its associated diseases is presented.

Denis Burkitt and the origins of the dietary fibre hypothesis.

For more than 200 years the fibre in plant foods has been known by animal nutritionists to have significant effects on digestion. Its role in human nutrition began to be investigated towards the end of the 19th century. However, between 1966 and 1972, Denis Burkitt, a surgeon who had recently returned from Africa, brought together ideas from a range of disciplines together with observations from his own experience to propose a radical view of the role of fibre in human health. Burkitt came late to the fibre story but built on the work of three physicians (Peter Cleave, G. D. Campbell and Hugh Trowell), a surgeon (Neil Painter) and a biochemist (Alec Walker) to propose that diets low in fibre increase the risk of CHD, obesity, diabetes, dental caries, various vascular disorders and large bowel conditions such as cancer, appendicitis and diverticulosis. Simply grouping these diseases together as having a common cause was groundbreaking. Proposing fibre as the key stimulated much research but also controversy. Credit for the dietary fibre hypothesis is given largely to Burkitt who became known as the 'Fibre Man'. This paper sets out the story of the development of the fibre hypothesis, and the contribution to it of these individuals.

[Scientific contributions of Jules Hirsch regarding the physiopathogenesis of obesity]. / Contribuciones científicas de Jules Hirsch sobre la fisiopatogenia de la obesidad.

Jules Hirsch was born in New York City and died at age 88 after a long illness. He was considered notorious leader in the study of human metabolism mainly in the area of lipids and obesity. His research at The Rockefeller University helps establish the mechanism of obesity and lipids metabolism. Hirsch joined Rockefeller´s faculty in 1954 and remained there for the rest of his career. Hirsch´s research helped to support the idea of dynamic interactions among diet, physical activity, general metabolism and obesity. At that time most scientific considered adipose tissue to be biologically inert such as a passive insulator in which the body reserved energy in the form of triglycerides. Hirsch had a natural characteristic of showing a nice smile and greeting for everyone he worked with at the university. Another important contribution was there relationship between diet and cardiovascular ailments as well as metabolism disturbance.

Jules Hirsch nació en la ciudad de Nueva York y murió en Julio 23 de 2015, a la edad de 88 años. Es considerado como un notable y eminente líder en el estudio del metabolismo; particularmente centró su interés en la obesidad ocasionada por un acumulo excesivo de grasa por exceso de alimento y falta de actividad física. Hirsch ingresó a la facultad como profesor en la Universidad Rockefeller en 1954 y permaneció por el resto de su carrera como investigador clínico hasta su jubilación como emérito. Los estudios de Hirsch apoyaron la idea de que existía una interrelación entre la dieta, la actividad física, el metabolismo y la obesidad. En ese tiempo la mayor parte de los científicos pensaba que el tejido adiposo era simplemente una reserva inerte en donde se almacenaba la grasa en forma de triglicéridos para proporcionar energía al organismo. Una de las características personales de Hirsch era una agradable sonrisa y el buen trato a todas las personas que trabajaban en la universidad. Hirsh también advirtió, y esta es otra contribución importante, que la obesidad, la falta de actividad física y el exceso de lípidos contribuyen al desarrollo de trastornos metabólicos y enfermedad cardiovascular.

O nascimento do discurso patologizante da obesidade / El nacimiento del discurso patologizante de la obesidad / The birth of pathologizing discourse of obesity

Com o intuito de explorar a emergência do conceito de obesidade, o presente estudo histórico teve como referência teórico-metodológica a análise de discurso arqueogenealógica de Michel Foucault, concentrando-se nas inflexões estéticas, ético-morais, religiosas e biológicas nos primórdios da patologização do excesso de gordura corporal. De meados do século XVII ao XIX, os discursos médicos investiram na patologização da feiura dos corpulentos, da gula dos pecadores e do vício dos intemperantes. Desde a enunciação como doença da feiura até a medicalização do discurso, a patologização da condição caracteriza-se como um acontecimento relativamente recente no Ocidente, diferentemente do que alguns historiadores propõem.

In order to explore the emergence of the concept of obesity, this historical study is theoretically and methodologically referenced on Michel Foucault’s archaeo-genealogical discourse analysis, focusing on the aesthetic, ethical, moral, religious and biological inflections in the early pathologization of excess body fat. From the mid-17th to the 19th century, medical discourses invested in pathologizing ugliness of the corpulent, the gluttony of sinners and the vice of the intemperant. From enunciation of ugliness as disease to medicalization of discourse, pathologization of that condition is a relatively recent development in the West, as opposed to some historians’ views.

Con el fin de explorar la aparición del concepto de la obesidad, este estudio histórico tuvo referencia teórico-metodológica el análisis de discurso arqueológico y genealógico de Michel Foucault, concentrándose en las inflexiones estéticas, éticas, morales, religiosas y biológicas en los inicios de la patologización del exceso de grasa corporal. Desde mediados del siglo XVII y hasta el siglo XIX, los discursos médicos invirtieron en la patologización de la fealdad de los corpulentos, de la glotonería de los pecadores y de los vicios de los intemperados. Desde la enunciación de la fealdad como una enfermedad hasta la medicalización del discurso, la patologización de la condición se caracteriza como algo relativamente reciente en Occidente, a diferencia de lo que proponen algunos historiadores.

Isaac Albeniz (1860-1909): Spanish musician who died of chronic renal disease.

Isaac Albéniz was a Spanish musician and pianist who was best known in France and England. One of his last works for piano, the suite Iberia, is well-known and identifies his country of origin. He died with terminal uraemia following longstanding chronic intestinal and kidney symptoms. Suggestions as to pathology include amyloidosis complicated by kidney stones and hypertension that sometimes manifested itself in the form of hypertensive crisis, accompanied by obesity.

[A trip through the history of obesity]. / Vom Schönheitsideal zur Krankheit - eine Reise durch die Geschichte der Adipositas.

The origins of obesity can be traced back at least 25 000 years. In the Stone Age, in the Middle Ages, and in the 17th century overweight indicated prosperity,power, and fertility, but already Hippocrates described obesity as a disease in the Antique. The first academic papers dealing with adiposity were published in the times of the Industrial Revolution.In the 19th century a pharmaceutical treatment boom against overweight emerged- people had to deal with quackery and dangerous remedies like amphetamines that flooded the market.Bariatric surgery was introduced in the 20th century- to days gold standard is the RYGB operation. Dealing with morbid obesity and its comorbidities is nowadays one of the serious problems in the field of public health.

A socioecological framework to understand weight-related issues in Aboriginal children in Canada.

Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.