Evolutionary medicine (EM) is a growing field focusing on the evolutionary basis of human diseases and their changes through time. To date, the majority of EM studies have used pure theories of hominin macroevolution to explain the present-day state of human health. Here, we propose a different approach by addressing more empirical and health-oriented research concerning past, current and future microevolutionary changes of human structure, functions and pathologies. Studying generation-to-generation changes of human morphology that occurred in historical times, and still occur in present-day populations under the forces of evolution, helps to explain medical conditions and warns clinicians that their current practices may influence future humans. Also, analyzing historic tissue specimens such as mummies is crucial in order to address the molecular evolution of pathogens, of the human genome, and their coadaptations.

Worldwide rise of obesity may be partly related to the relaxation of natural selection in the last few generations. Accumulation of mutations affecting metabolism towards excessive fat deposition is suggested to be a result of less purging selection. Using the WHO and UN data for 159 countries there is a significant correlation (r = 0.60, p30kg/m²). This correlation remains significant (r = 0.32., p<0.01) when caloric intake and insufficient physical activity prevalence are kept statistically constant (partial correlation analysis, N = 82). The correlation is still significant when gross domestic product per capita is also kept constant (r = 0.24, p <0.05, N = 81). In the last decades, prevalence of both obesity and underweight has increased in some countries despite no change in caloric intake nor in physical inactivity prevalence. Relaxed selection against genes affecting energy balance and metabolism may contribute to the increase of fatness independent from commonly considered positive energy balance. Diagnoses of individual predispositions to obesity at an early age and individual counselling on diet and behaviour may be appropriate strategies to limit further increases in body mass.

The explanation of obesity as a simple result of positive energy balance fails to account for the scope of variable responses to diets and lifestyles. It is postulated that individual physiological and anatomical variation may be responsible for developing obesity. Girls in poor families develop greater adiposity than their male siblings, a trend not present in richer environments. This indicates strong influence of estrogen on fat accumulation irrespective of poor socioeconomic conditions. Obesity rates in males and females of developed nations are similar, while in poorer nations obesity is much more prevalent in females. Female to male ratio of obesity correlates inversely with gross domestic product. Therefore, the parity of male and female obesity in developed countries may result from male exposure to environmental estrogen-like substances associated with affluence. These hormonally driven mechanisms may be equally active within both sexes in more developed areas, thereby increasing overall obesity.