All levels of society urged to join fight against obesity

Recommendations from an advocacy group are called sound by physicians, but some doubt their feasibility.

By Victoria Stagg Elliott — Posted Sept. 18, 2006

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Who is responsible for America's ever-expanding waistlines?

We all are, according to the third annual report on the subject, issued last month by the public health nonprofit group, Trust for America's Health.

"This is something we all have to address," said Jeffrey P. Koplan, MD, MPH, former director of the Centers for Disease Control and Prevention. He spoke at the news conference marking the report's release.

Acknowledging that this shared problem may require a shared solution, "F as in Fat: How Obesity Policies are Failing in America" makes 20 recommendations for individuals, families, communities, schools, health professionals, the food industry and government.

For example, people should be concerned about how obesity affects their health. Physicians should routinely assess patients' exercise histories. Community infrastructures should encourage physical activity. And the federal government should take a leadership role and fund obesity research and programs to combat it.

"Individual behavior change doesn't work in isolation. It must be supported by all stakeholders," said Jeff Levi, PhD, the TFAH's executive director. "And it's not just about eating and it's not just about physical activity. It's about the interaction of the two."

This report is the latest salvo in the war against skyrocketing obesity rates. Obesity has increased from affecting 15% of the adult population in 1980 to 32% in 2004.

During the same period, pediatric obesity increased from 5% to 17%.

Those working to reverse these trends complimented the message.

"We have so many barriers to exercise and healthy eating," said Mott P. Blair IV, MD, a family physician in Wallace, N.C., who has been working on obesity issues in his state. "We need a societal change in the way we structure our communities and make living a healthy lifestyle a little bit easier."

Many of the recommendations are in line with those likely to be included in an upcoming Institute of Medicine report on childhood obesity, due out this month. They are also in step with many of the policies of the American Medical Association.

"[Obesity] is a multifactorial problem that's been evolving over several decades," said AMA President-elect Ronald Davis, MD. "Our efforts to turn this epidemic around need to be multifactorial as well."

The AMA has also been working on this public health problem. The organization, for instance, has in recent years hosted a National Summit on Obesity and published "Assessment and Management of Adult Obesity" as part of its Roadmaps for Clinical Practice series.

No simple fix

But while the TFAH report was widely praised, experts said it highlights how challenging the solutions are. Many communities have implemented some of the suggestions, but none have utilized them all.

"Standing alone, these recommendations are not going to do much," said Matt Longjohn, MD, MPH, executive director of the Consortium to Lower Obesity in Chicago Children, which is based at Children's Memorial Hospital. "Put it all together and that's obesity prevention.

Many also suspect that some of the recommendations, such as screening and counseling Medicaid recipients for obesity or providing this population with reimbursement for the costs of fitness programs, may not be economically possible.

"They're good ideas, but, if [Medicaid] cannot fund things like palliative care for people who are dying, the likelihood of funding counseling or exercise programs is very unlikely," said Melvyn Sterling, MD, an internist from Orange, Calif., who was the moderator of the AMA's Obesity Summit.

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Getting bigger

[download pdf]

The states, grouped by prevalence of adult obesity in 2005.

Below 20%: Colorado and Hawaii

Between 20% and 25%: Arizona, California, Connecticut, Delaware, District of Columbia, Florida, Idaho, Illinois, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, Nevada, Ohio, Oregon, Rhode Island, Utah, Vermont, Washington, Wisconsin and Wyoming

Between 25% and 30%: Alabama, Alaska, Arkansas, Georgia, Indiana, Iowa, Kentucky, Michigan, Missouri, Nebraska, North Carolina, North Dakota, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas and Virginia,

Over 30%: Louisiana, Mississippi and West Virginia

Source: "F as in Fat: How Obesity Polices are Failing in America," Trust for America's Health, August; Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System

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Working together

The Trust for America's Health advocates involving all levels of society in efforts to curb obesity. Suggestions include:

  • Local communities should build sidewalks and bike paths when creating new roads.
  • Schools should adopt higher nutritional standards than the U.S. Dept. of Agriculture and consider fund-raising options that do not involve sales of junk food.
  • The federal government should incorporate physical education into its education standards.
  • Employers should provide opportunities for workers to be active during the day and provide healthy options in vending machines and cafeterias.
  • Physicians should routinely take a patient's exercise history.
  • Food and beverage industries should provide consistent nutritional labeling and establish standards for marketing to children.
  • People should take advantage of options provided to maintain a healthy weight.

Source: "F as in Fat: How Obesity Polices are Failing in America," Trust for America's Health, August

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External links

"F as in Fat: How Obesity Policies are Failing in America," Trust for America's Health report, August (link)

"Recommendations for Physician and Community Collaboration on the Management of Obesity," American Medical Association Council on Scientific Affairs' report, June 2005 (link)

Institute of Medicine on childhood obesity (link)

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