Curbing Obesity

Obesity is the number one health threat facing America. An estimated 67 million American adults are obese, and an additional 75 million are overweight. Approximately 4.2 million children aged 6 to 11 and 5.7 million adolescents 12 to 19 are also overweight. Experts predict that if nothing changes by 2015, two in every five adults and one in every four children in the U.S. will be obese. "We need to be very concerned," said Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine in New York. "Obesity is a gateway to many of our chronic health problems."

Obesity can lead to a long list of complications, such as heart disease, diabetes and several forms of cancer. It can also lead to lower self-esteem, cause depression and discomfort in social situations, and can significantly impact a person's quality of life. Opinions differ on the cause of obesity, with some arguing that "super-sized" restaurant portions and aggressive food industry advertising are to blame; others fault heredity and lifestyle. While genetics does play a part in deciding who is fat and who is thin, the sedentary lifestyle led by most Americans is making it increasingly difficult for them to suppress the hunger gene.

"Almost all of our current eating or activity patterns are those that promote weight gain—using the least possible amount of energy or maximizing quantity rather than quality in terms of food," said Dr. Shiriki Kumanyika, professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia. "People haven't just made the decision to eat more and move less; the social structure has played into people's tendencies to go for convenience foods and labor-saving devices." She says the solution is to ensure that those who need to lose weight do not have to do it alone. Dr. Kumanyika is the chair of the working group at the American Heart Association (AHA) who recently composed a statement outlining their strategy.

The statement, published in the current issue of the journal Circulation, proposes population-based initiatives to prevent excess weight gain in adults and children, including clinic-based prevention and treatment programs that would complement individually oriented strategies. "We're not talking about creating a dieting society, but more about looking at the choices in front of people daily," said Dr. Kumanyika. Instead, preventing weight gain needs to be integrated into everyday life. She notes that this means creating opportunities for healthful eating and physical activity for the whole population through environmental and policy changes. "By doing things at the policy level-such as healthier meals in schools, smaller food portion sizes in restaurants, sidewalks in communities, et cetera-you reach more people faster."

The statement indentifies key areas that should be targeted, such as decreasing restaurant portion sizes, making sweetened drinks, high-fat and low-fiber foods less readily available, and modifying the environment in which people live by creating more walkable neighborhoods with sidewalks and areas for physical activity as well as accessibility of jobs, schools and recreation by walking or cycling. "Changes in these areas can eventually become ‘normal' and displace the current ‘normal' ways of doing things. Right now, you have to be pretty single-minded to make some of these choices, such as walking or riding a bike instead of driving. We advocate changes that will move the social norm to where physical activity is the custom," said Dr. Kumanyika.

Dr. David Katz, director of the Prevention Research Center at the Yale University School of Medicine, says he agrees with the approach. "While individuals need to be responsible for their feet and forks, given the level of obesity in the country it would be silly to think that the environment doesn't play a role." He also noted that "if we are to combat this epidemic, we need to create a modern world where the path of least resistance leads to physical activity and healthy eating."

Release of the statement closely coincided with the beginning of a trans fat ban in New York City which officially began on July 1. Philadelphia plans to follow suit in September.