In 1900, Henry Ford unveiled the first car made in Detroit, the International Ladies' Garment Workers Union was founded in New York, and San Francisco was placed under a federal quarantine to prevent the spread of bubonic plague. Infectious disease was a major concern, and the most common causes of death in the United States and in many parts of the world at the time were pneumonia and tuberculosis. Today, most individuals die of cardiovascular disease or cancer. This dramatic shift in the illnesses that cause the majority of death and disability has been divided into 4 stages known as the epidemiologic transition.1,2 In the last 2 decades, however, a fifth stage, marked by an alarming increase in overweight and obesity and continued decreases in physical activity, has emerged. This ongoing trend is addressed by 2 articles3,4 in this issue of JAMA.
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