Obesity classification and treatment recommendations are the same for men and women (Table 1) (1); however, at any given BMI women throughout the world are more likely to have greater amounts of adipose tissue than men (9) and have higher rates of obesity owing to biological differences (10). In the United States, proportionate increases in obesity prevalence have occurred for both men and women 20 to 74 yr of age since 1960, and women have had higher prevalence rates in all age groups in each of the national surveys (Table 3).
Overall, in both men and women, there has been a general shift of the top half of the BMI distribution toward higher BMI levels, with the heaviest subgroup of the population becoming much heavier in NHANES III than II (11). For 20- to 49-yr-old men changes in the lower portion of the BMI distribution was less than 1 BMI unit, whereas there was a fairly large shift at the upper end among 50- to 74-yr-old men. For women a gradual increase across the entire BMI distribution occurred. Collectively these findings suggest that the entire spectrum is changing, with the most marked changes occurring at the upper end of the distribution.
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