All levels of society urged to join fight against obesity

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.