July 1, 2008 -- With obesity levels on the rise, a major medical association said on Monday that a new approach is needed to fight the country's growing weight problem.
A new American Heart Association scientific statement, published in the journal Circulation, urged a comprehensive approach to reducing obesity in the United States that incorporates population-based initiatives to prevent excess weight gain in adults and children.
"We're not talking about creating a dieting society, but more about looking at the choices in front of people daily," said Shiriki Kumanyika, professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia and chair of the working group that composed the statement.
"Society has changed in ways that [make it] hard to control your weight," Kumanyika said. "There is more technology, more labor-saving devices, more tasty food, larger portions and so on. The weight creeps on, and there isn't much opportunity to lose it."
The solution, Kumanyika said, is to ensure that those who need to lose weight do not have to go it alone. A population-based prevention of obesity approach would complement individually oriented strategies, including clinic-based prevention and treatment programs. According to the statement, a broad range of policy and environmental strategies at the local, state and federal levels can help people adopt healthy behaviors, such as being physically active and eating right.
The approach resonates with diet experts, who note that if nothing changes by 2015, two in every five adults and one in every four children in the U.S. will be obese. With these increases in obesity, many fear, chronic diseases such as diabetes and heart disease are also expected to increase.
"We need to be very concerned," said Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine in New York. "Obesity is the most pressing health problem for Americans because it is a gateway to many of our chronic health problems.
"The obesity problem has the potential to overload an already overburdened health system."
For this reason, health experts note, it makes sense that the government has a hand in fighting off the obesity surge.
"I completely agree with this approach," said Dr. David Katz, director of the Prevention Research Center at the Yale University School of Medicine. "While individuals need to be responsible for their feet and forks, given the level of obesity in the country it would be silly to think that the environment doesn't play a role.
"It stands to reason that if we are to combat this epidemic, we need to create a modern world where the path of least resistance leads to physical activity and healthy eating," he notes.
Passive Weight Loss -- a Possibility in the U.S.?
Preventing weight gain needs to be integrated into everyday life, Kumanyika said. What this means, she noted, is that whole-population approaches -- through environmental and policy changes -- need to be put in place to create opportunities for healthful eating and physical activity without requiring deliberate action by individuals.
Ayoob agreed. "It is a societal problem and there is plenty of blame to go around," he said. "But everyone has a role to play too -- industry, schools, the media, communities and consumers as well."
Recommendations made in the report included modifying the environment to affect people's choices, such as availability of high-fat, low-fiber foods and sweetened drinks, adequate sidewalks and areas for physical activity, availability of public transportation and more.
"For example, urban planners can play an important role by making cities that don't require so much driving," said Ayoob.
Create a Weight Loss Culture
Changes like these may take much of the burden off individuals struggling with obesity, giving them more of a chance to overcome their weight problems.
"Think about the alternative to a population-based approach; so far we don't have treatments that are really effective, and the number of obese is so high that you can't get to everyone soon enough," said Kumanyika. "By doing things at the policy level -- such as healthier meals in schools, smaller food portion sizes in restaurants, sidewalks in communities, et cetera -- you reach more people faster."
And a widespread approach could go a long way in creating a social environment in which healthy living is the norm.
"You need to create a culture where you are the odd man or woman out to take the elevator," says Katz.
Dr. Sami Bég is the Associate Medical Director of U.S. Preventive Medicine