Recently, a friend asked which health problem concerned me most. Without hesitation, I answered overweight, particularly among young adults and teenagers.

When she asked why, I explained my concerns. First, weight gain increases cancer risks. Some doctors, like Harvard epidemiologist Walt Willett, say cancer is a 99 percent certainty with overweight, involving a dozen different cancers. Breast cancer is one of the most likely cancers, due to increases in estrogens in older women. In addition, overweight increases the likelihood of pancreatic, kidney and colorectal cancers that are associated with increases in insulin levels with obesity. Older women with increases in both estrogen and insulin have 2.5 times the risk of cancer compared to those with lower estrogen levels. Another important concern is that excess weight can lead to chronic, low-level inflammation that increases cancer risk, such as adenocarcinoma of the esophagus (throat).

My second concern is that once new fat cells are formed, they are difficult to lose and some resist loss. Researchers found that rapid weight gain creates new fat cells. These new fat cells are added mostly in the abdomen, while some are added in the leg. When weight loss occurred by reducing calories and adding exercise, abdominal fat was lost, but leg fat remained. And, additional weight loss did not assure that leg fat was lost. Some fat cells are reduced in size with weight loss, however they remain in the body. This makes regaining weight much easier.

Thirdly, an oversized waist, even with a “healthy weight” can be a problem, especially among men. Most problematic are waists that increase by about two inches, even in people who are not overweight. An oversized waist is a sign of visceral fat storage (fat buried deep in the belly) that is more harmful than fat deposited just under the skin. Visceral fat is closely linked to developing Type 2 diabetes and coronary heart disease. There are other risks associated with severe overweight, but these are three important ones.

My concerns for overweight occurring in adolescence includes emotional entanglements that are hard to overcome. Overweight during the teen years is associated with self-image difficulties, adding unnecessary stresses to teenagers. Then, if dieting is too severe during the adolescent period of active growth, it can detract from the final growth in height. I worry that most youngsters have no idea of these serious risks of becoming overweight. And, sadly, they are frequent targets of fatty and sugary food sales that cause unhealthy and rapid weight gain. Eating saturated fat causes a gain of more visceral and liver fat. A high sugar consumption seems to increase liver and deep belly fat in teens. This can lead to non-alcoholic fatty liver disease and inflammation, over time. These risks are related to adolescent weight gain and obesity.

A reasonable goal is to stay close to your weight at about 20 years of age…provided you had an optimum body weight. Slight weight gains show how easy it is to gain weight. Unfortunately, the subject of personal weight gain and severe overweight are always sensitive subjects to discuss. By early adulthood, everyone should know reasons that overweight and severe overweight are to be avoided. Then, we can expect it to be our kuleana (responsibility) to maintain our health and control our weight. Kawena Pukui notes several fundamental points of importance related to life and one is, “rigorous concern for soundness of body is a primary consideration throughout physical life.” As parents, teachers and health care professionals, we must do our best to discuss maintaining a healthy weight throughout life with our children and young people within our personal reach, and for whom we have kuleana.