Overeating season signals time to face unhealthy habits

A message to all physicians from AMA President Peter W. Carmel, MD.

By Peter W. Carmel, MDis a pediatric neurosurgeon in Newark, N.J., and is immediate past president of the AMA. Posted Oct. 31, 2011.

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A column on healthier lifestyles would seem to be more appropriate for summer or early fall, when people are outdoors and fresh produce is plentiful.

Not so.

This time of year, as we approach the so-called binge season, (Thanksgiving through New Year's) is when we all need to pay attention to what we eat and how active we are.

Who doesn't like pumpkin pie with whipped cream? Or candied sweet potatoes? Or holiday cocktails with high-calorie canapés?

Or good old-fashioned comfort foods? Unfortunately, the American population is far too comfortable.

Americans like to eat and drink. The food companies make fast, high-fat foods cheaper and more available this time of year. And there are fewer opportunities to be physically active, so the easier choice is to sit inside and watch television.

The AMA has been concerned about obesity -- especially childhood obesity -- for more than a decade, ever since then-Surgeon General David Satcher, MD, PhD, issued the first public warning about the problem.

Since then, of course, the problem has only gotten worse:

  • Adult obesity in this country doubled between 1980 and 2004.
  • Fewer than half American adults get their recommended amount of physical activity.
  • Even more concerning, the percentage of young people who are obese has tripled since 1980.
  • Today, two-thirds of adults and nearly one in three children are overweight or obese.

These numbers are no longer news, but they are still shocking -- and unless the trend turns around they portend an unhealthy population the country simply will not be able to support.

Back in 2004, because of our concerns, the AMA hosted a National Summit on Obesity to bring awareness to this situation.

In 2008 the AMA launched its "Healthier Life Steps" program to give physicians resources to talk with patients about the four behaviors and addictions that are associated with the leading causes of chronic diseases and preventable death: tobacco use, alcohol use, poor nutrition and lack of physical activity (link).

We support and collaborate with first lady Michelle Obama on her "Let's Move" initiative.

In Newark, N.J., where I practice, I am involved personally in a program where we're sending physicians and medical students into the school system to counsel children on healthier lifestyles and to do body mass index measurements. We call the program "Physicians against childhood obesity in Newark." We are working closely with Newark Mayor Cory Booker as well as "Let's Move" efforts in the area.

In Chicago, the AMA is working with the city's Dept. of Public Health and the U.S. Dept. of Health and Human Services Office of the Regional Health Administrator on a collaborative program called "Building a Healthier Chicago."

The AMA Foundation, with support from the AMA Alliance, has a Healthy Living Grant Program (link). Based on the belief that local leaders can find the best solutions, this initiative supports grassroots organizations on the front lines in their communities.

The foundation recently awarded grants to 37 nonprofits, including medical student groups such as the Bronx Obesity, Diabetes and You group, who are focusing on a community garden project. The grant will fund exercise, gardening education and community-building activities.

This past June, during its annual policymaking meeting, the AMA House of Delegates tackled childhood obesity issues. Delegates adopted a policy calling for the AMA to support and encourage corporate social responsibility in the use of marketing incentives that promote healthy childhood behaviors. The action comes as food companies spend about $2 billion a year marketing foods and beverages to children.

Since then, I've spent a lot of time speaking out about obesity, telling groups how the AMA is addressing the problem and encouraging them to get on board to save our children.

Most recently, I addressed the leadership meeting for the Trust for Public Land. This was an important meeting because the trust supports preservation of green space in this country -- and our public parks are an obvious link to healthier lifestyles.

Another speaker at that program was Reed Tuckson, MD, of UnitedHealth Group. That organization has recently joined with the New England Revolution professional soccer team to raise awareness about the benefits of healthy living to prevent chronic diseases, especially diabetes and childhood obesity. Soccer players are going into schools to talk to kids about physical activity.

The truth of the matter is that all these well-intentioned programs can take us only so far. They can increase awareness, but change will come only when individuals begin to think for themselves, when they begin to envision healthy lifestyle goals they know they can reach -- and begin to act on them.

We physicians probably are best placed to help empower people to get on with it. But that's not easy. All too often doctors see their duty, they tell patients to lose weight -- something the patients already know -- and that is the end of the discussion. Further talk can be difficult.

Now, though, the AMA is pilot-testing a new program focused totally on addressing unhealthy weight.

The "Weigh What Matters" program is a clinic-based obesity prevention initiative that gives physicians a framework to talk about the benefits of healthy weight, healthy eating habits and increased physical activity (link).

Tools and instructions tell physicians how to discuss body mass index and then counsel patients on behavior change. "Weigh What Matters" was created with an eye to the important role that parents and parents' health plays in the eventual health of the child. What parents need to learn, and what this program can teach, is that by taking small steps, a person can make a big difference in his or her own health and the health of their family.

The AMA partnered with medical societies in Albuquerque, N.M.; Memphis, Tenn.; and Newark, N.J., to implement and evaluate "Weigh What Matters." They plan to roll out the program nationally sometime in 2012.

As doctors, we can support broad efforts to raise awareness about American obesity. We also can speak out. But it is in those one-on-one situations with our patients where we have the greatest opportunity to initiate important changes that will improve our patients' lives dramatically.

Because in the end, they have to take ownership of their own health.

And that's what the "Healthier Life Steps" and "Weigh What Matters" programs are so important for all of us -- and our patients.

Obesity kills more Americans every year than AIDS, accidents and all cancers combined. It is causing problems in children that were unthinkable 30 years ago. That is why the American Medical Association is working to halt the spread of obesity.

Especially during this time of year.

Peter W. Carmel, MD is a pediatric neurosurgeon in Newark, N.J., and is immediate past president of the AMA.

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