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It is commonly perceived that obesity has only recently been recognized as a public health issue and its potential impact on population health is still yet to be completely acknowledged. However, in his book titled “Fat in the Fifties,” Rasmussen [2] describes a period in post‐World War II America when obesity was being described as the greatest threat to public health. During the 1940s, heart disease replaced infectious diseases as the major cause of death in the United States. At the same time, data from insurance companies identified that higher body weight (relative to height) was associated with an increased risk of premature death, including those from heart disease, and thus obesity was defined as the major public health concern to be addressed. In the 1950s, research by Keys and his colleagues suggested that the three major risk factors for coronary heart disease (CHD) were smoking, high blood pressure, and a high plasma cholesterol level. These findings were seized upon and promoted by vested interests such as the sugar industry that were threatened by the suggestion that excess calories were driving the rise in heart disease and cancer. Although it was recognized that weight gain increased both blood pressure and blood cholesterol levels but obesity per se did not seem to be nearly as important as an independent predictor; in Key’s analysis, the olive oil eating, fatter Greek men had one of the lowest CHD rates. As a consequence, obesity lost its prominence as a key public health issue and was buried by the avalanche of concern around what was then described as the “true” risk factors for heart disease.

Obesity was again raised as a serious public health issue in the early 1970s. One author (W.P.T. James) was involved in producing the UK report on obesity for the UK Department of Health and Social Services and the Medical Research Council [3]. At that stage, obesity was being defined as a percentage excess weight above the desirable weight for height listed by the US Metropolitan Life Insurance Company in complex tables with weights in clothes for three personally chosen frame sizes. These figures relating to pre‐Second World War mortality statistics that were collected on millions of insurance‐eligible Americans. The UK report wanted a standardized measure of body weight that would account for people of different sizes and adopted the approach of the Belgian mathematician Quetelet’s from 1835, who recommended that this could be best achieved deriving the index W/H² in metric units; a unit now termed the body mass index (BMI). It became apparent that when taking the insurance tables and then considering only the lower limits of the small frame size and the upper limit of the large frame size that the derived Quetelet index was almost the same across a huge range in heights. This ideal body weight from the insurance tables translated into an index of 19.1–24.6 for women and to 19.7–24.9 for men after adjusting for the weight of light clothing and shoe heights. John Garrow, a member of the committee, then rounded these numbers for clinical use to BMI of 20–25. Based on the insurance company’s approach of specifying obesity when weights were 20% above ideal, obesity cut‐off was set at BMI 30.