NYTimes.com > Health

Some Extra Heft May Be Helpful, New Study Says

By GINA KOLATA

Published April 20, 2005

26.088

0

0.5

1

1.5

<19.0 19.0-21.9

22.0-24.9

25.0-28.9

27.0-28.9

29.0-31.9

>32

CHl for trend =3.27

P = 0.001

All Women, 1976-1992 (4726 Deaths)

Body-Mass Index

(Manson et al, 1995)

Ag

e-A

dju

sted

Rel

ativ

e R

isk

23.012

0

0.5

1

1.5

2

2.5

<19.0 19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9 >32

==3.2 3.4

Women Who Never Smoked and Had Stable Weight, 1980-1992 (531 Deaths)

Mu

ltiv

ari

ate

Rel

ati

ve

Ris

k

Body-Mass Index

Chi for trend = 4.67

p<0.001

(Manson et al., 1995)

23.015

29.027

Women

Diabetes

Hypertension

Gallstones

Coronary Heart Disease

0

1

2

3

4

5

6

21 22 23 24 25 26 27 28 29 30

Body Mass Index

Rel

ativ

e R

isk

Obesity in the USA, 1991-98Educational Level

0%

5%

10%

15%

20%

25%

30%

1991 1998

Per

cen

tag

e O

bes

e

College grad: +63%

Some college: +68%

<High school: +46%

High school: +46%

29.022(Mokdad et al. JAMA 1999)

Obesity in the USA, 1991-98Region

0%2%4%6%8%

10%12%14%16%18%20%

1991 1998

Per

cen

tag

e O

bes

e

New England: + 46%Pacific: + 67%

Midwest: + 36%Mid-Atlantic: +32%

Southeast: + 67%

29.023 (Mokdad, et al. JAMA 1999)

Controlling the Obesity Epidemic

– Strategies

– Examples

29.034

Experiences with Other Public Health Problems Related to Human Behavior:

– smoking– not wearing seat belts– drunk driving– poor immunization rates

29.036

Features of Past Successful Public Health Campaigns:

(WHO)

– Adequate duration and persistence– A slow and staged approach– Legislative action– Education– Advocacy– Shared responsibility by consumers,

communities, food industry, and governments

29.037

In theory, control is simple:

calories eaten = calories burned

29.035

21.004

Low-Fat Weight Loss Trials

-10

-5

0

5

10

0 6 12 21

Length of Follow-up (months)

Wei

ght

Los

s D

iffe

renc

e (k

g)

NDH (1968) (35 vs 30% E)

Boyd (1990) (37 vs 21% E)

Jeffery (1995) (33 vs 26% E)

Black (1994) (40 vs 21% E)

Sheppard (1991) (38 vs 20% E)

Kasim (1993) (36 vs 17% E)

Simon (1997) (34 vs 18% E)

Knopp (1997) (27 vs 22% E)

McManus (2001) (35 vs 20% E)

Bray and Popkin(10% E) (1998)

Bray and Popkin prediction

26.063

WEIGHT CHANGE

-13

-12 -11

-6

-11

-14-15

-10

-5

0

Baseline 6 12 18

Wei

ght C

hang

e (L

bs.)

HIGH FAT

LOW FAT

Months

29.045

McManus K et al, 2001Int J Obes 25:1503

Obesity as the Target Weight Control as a Life Skill

- Promotes stigmatization - Inclusive- Ignores much of risk - Consistent with scientific evidence- Focus on treatment - Focus on prevention- Likely to involve expensive - Requires a supportive drugs and surgery environment

29.074

New England Strategic Plan forWeight Control (NECON 2004)

Schools Health Care Providers Work Sites Media Physical Environment Food Environment Data for Action Economic Analysis

29.075

www.neconinfo.org

Worksites:

– Encourage physical activity and weight control

– Exercise areas at work, shower facilities

– Financial incentives to walk, cycle, or use public transportation

29.049

Governments & Community Organizations:

– Urban design to provide safe walking areas, bikeways

– Building codes to encourage use of stairs

– Financial incentives to use bikes and walk

29.048

Is it Possible To Control the Epidemic?

– Socioeconomic example

– Swedish and Japanese women (examples)

29.052

School-based Intervention in Singapore(Toh CM, Br Med J, 2004)

Program (1992 to 2000)• nutrition education integrated into curriculum• foods and drinks in schools controlled• provision of plain drinking water• trim and fit awards to schools

Outcome: Change in prevalence of obesity• primary schools: 16.6% to 14.6%• secondary schools: 15.5% to 13.1%

29.125

Conclusions

• The focus on low fat/high carbohydrate diets has been, at best, a lost opportunity to improve the health of Americans.

• To address the epidemic of obesity engulfing our country, a comprehensive approach will be needed that includes nearly all members and institutions of our society. We should not assume that this will be without costs.

29.091