Policy-makers take aim at obesity rates

Washington -- A lot of people agree that obesity is on its way to becoming the world's No. 1 health problem. As a result, creating public policies to help guide healthy choices in diet and exercise is receiving more and more attention.

In the United States, members of Congress had, by last month, introduced more than 50 bills designed to address this weighty issue. And the World Health Assembly earlier in the spring adopted its first global diet, exercise and health strategy. That blueprint urges countries to develop prevention-oriented policies that make healthy choices the easy choices.

This level of activity reflects the fact that the stakes are high. National surveys indicate that 64% of Americans are overweight or obese and public health experts fear that an epidemic of heart disease, stroke and diabetes will inevitably follow. Rising obesity rates among children are particularly worrisome.

However, what will prove effective in reversing these disturbing trends is still a matter of debate because only limited scientific evidence exists to offer guideposts.

"I am unaware of any other large-scale public health problem for which we do not have best practices," said Derek Yach, a researcher for the World Health Organization. He spoke at a briefing in Washington, D.C., that highlighted studies published in the June 2 global health theme issue of the Journal of the American Medical Association.

"There are tobacco interventions, HIV has great success stories and we have great case study success stories for infectious diseases. But we do not have a success story in a large-scale community over five years for the reduction of obesity," he said.

Historically, obesity was viewed as a character flaw to be corrected by individual responsibility, said David S. Ludwig, MD, PhD, director of the obesity program at Boston Children's Hospital.

Now, though, a biological basis for body weight has been identified and that changes things, he said at a June 7 Capitol Hill briefing, "Reversing a Supersized Epidemic: Policy Options for Dealing with Obesity."

"Today's answers include intensive new treatments to compensate for inherent genetic weaknesses," said Dr. Ludwig. New drugs and bariatric surgery are among those options.

But since human genes haven't changed in the last three decades to parallel the growing heft of the population, environmental factors appear to also play a key role. "The invasion of our diet by soft drinks, fast foods and high calorie, poor quality snack food; replacement of physical activity by sedentary pursuits and the increasing stress on the family" have all played a role, Dr. Ludwig said.

To combat poor eating habits, he proposed a "common-sense approach" to public policy with roles for the federal government, the food industry, schools, communities, the health insurance industry and parents.

A multipart solution

Dr. Ludwig recommends that the federal government ban food advertising aimed at young children in accordance with policy adopted by the American Academy of Pediatrics. He also recommends shifting farm subsidies from products such as corn, used for high fructose corn syrup, to fruits and vegetables.

In addition, Dr. Ludwig favors shifting responsibility for the nation's nutritional policy from the U.S. Dept. of Agriculture to the Institute of Medicine. He reasons that the USDA's dual roles of promoting nutrition and the interests of commodity producers could result in a conflict of interest.

Meanwhile the Centers for Disease Control and Prevention is advancing programs to fight obesity, said George Mensah, MD, acting director of the CDC's National Center for Chronic Disease Prevention and Health Promotion.

For example, its nutrition and physical activity program, currently funded in 20 states, provides funds to hire staff to identify community improvements that could encourage residents to maintain a healthy weight.

The food industry is also involved in the fight against obesity and the epidemic won't be resolved overnight, said Alison Kretser, director of scientific and nutrition policy at the Grocery Manufacturers of America.

Food industry executives around the world are recognizing that they need to move to a place where public health and profitability can work together, said Yach at the JAMA briefing. Fear of litigation and resulting damage to a company's reputation may be driving factors, he said. "But don't underestimate the importance of a visionary CEO who believes it is the right thing to do."