Clock ticking on growing problem of obesity

When they look into a mirror, many Americans don’t like what they see. The image staring back presents not only an unhealthy personal predicament, but increasingly is a reflection of the nation’s losing battle fought on the scale and at the waistline.

About one in three U.S. adults is obese. The epidemic is leading to more obesity-related illnesses such as cardiovascular disease and diabetes. That physical toll comes at an enormous cost — more than $190 billion a year, according to the Institute of Medicine.

The news about the country’s fight with flab appears to be only getting worse. By the year 2030 — if the current trend is unchecked — an estimated 42% of adults will be obese, and the percentage of severely obese will more than double the 2010 figure to 11%, according to a study published online May 7 in the American Journal of Preventive Medicine.

Many of them will have started young. Obesity among children and adolescents has increased from 6% in 1980 to 17%, says the Centers for Disease Control and Prevention. Yet even the obvious can be hard to see. The Archives of Pediatrics & Adolescent Medicine May theme issue on nutrition and health included a study showing that mothers of overweight toddlers often had an inaccurate perception of their child’s body size.

The weight problem and exploring ways to tip the scales toward better health and nutrition were the focus of the three-day Weight of the Nation conference hosted by the CDC May 7-9 in Washington. The Preventive Medicine study findings were presented at the gathering, as were an HBO documentary about obesity’s impact on health care and a new IOM report that explores possible solutions.

The IOM report, issued May 8, calls for a comprehensive approach across society to help Americans select healthier food choices and integrate regular physical activity into their lives. The report’s recommendations include mandating 60 minutes of physical education daily at schools, making healthier food and beverage options available and affordable, and expanding workplace wellness programs.

The report says physicians should play a key role in this effort and urges them to take a patient’s body mass index regularly, ask about exercise, and provide guidance on improving diet and physical activity. Doctors also can work at the community level by supporting policies that boost nutrition resources and physical activity. Medical schools should include instruction on obesity prevention, screening and treatment. And insurers should consider innovative approaches to pay for screening and prevention services in clinical practice, the report recommends.

The report notes that many health professionals already focus on helping patients adopt healthy lifestyles, but consistent counseling is lacking. In addition to being pressed for time, some doctors are uncomfortable broaching the topic, especially if they have weight problems of their own. A survey of 498 physicians in the May issue of Obesity showed that 30% of doctors with a healthy BMI talked to patients about losing weight, compared with 18% of overweight or obese doctors.

The American Medical Association has a long history of helping doctors and patients combat obesity and lead healthier lives. Most recently, the Association launched the Healthier Life Steps program in 2008 to provide doctors with resources to tackle issues such as lack of physical activity and poor nutrition. In June 2011, the AMA House of Delegates adopted policy saying nutritious foods should be priced similarly to less-healthy options. In January, a free iTunes and Android app was offered to encourage patients to set and follow healthy nutrition and exercise goals.

The AMA in February released a new continuing medical education tool for all doctors that gives tips about talking with patients about their weight and making healthy food choices. And while overeating understandably gets the most attention, there are serious health risks at the other end of the dietary spectrum. In April, the AMA started offering CME to help doctors screen for and manage eating disorders such as bulimia nervosa and other unhealthy eating behaviors that cause physical and psychological harm. Both online training modules have been certified for AMA PRA Category 1 Credit.

With these and other AMA materials, doctors should be better able to have meaningful discussions with patients to put them on the right path. A study in the Feb. 28, 2011 Archives of Internal Medicine found that overweight and obese patients were more likely to try to lose weight if they spoke with their doctor about their weight. The evidence on where the nation is heading suggests there has never been a better time to have that conversation.