Obesity, What Can Be Done Now?

Examining Environment and Lifestyle  

Executive Summary  

As increasing numbers of studies are published linking obesity to heart disease, cancer, diabetes, and other serious health conditions, COSSA focused its first congressional briefing of the year on the epidemic.  Before a large, standing-room only audience, the March 21 session, entitled Obesity, What Can be Done Now?:  Examining Environment and Lifestyle, featured discussion of the economic and health affects on Americans of overweight and obesity and best methods of fighting the problem.

 Drs. Thomas Wadden, Barry Popkin, and Sally Davis

Environmental Causes and Approaches

Barry Popkin, an economist and Professor of Nutrition at the University of North Carolina’s School of Public Health, focused his presentation on the environmental trends that have fostered the growing obesity epidemic in America and changes that can promote better health.  He explained that “we’ve had an enormous increase in overweight and obesity in the U.S. population” in the last 15 years.  Popkin further noted that obesity rates have increased rapidly for children and adolescents in the last decade.  

This disease has impacted all racial, ethnic, socioeconomic, and education-level groups but it has affected blacks, Hispanics, and lower-income and lower-education brackets disproportionately.  It is also causing great alarm because health problems, such as diabetes, that typically affected people in their 60s and 70s are now affecting individuals in their teens and 20s with regularity.     

To explain this trend, Popkin listed the problems related to diet:  we eat more often, we are eating bigger portions, and we are eating out more.  As a result, caloric intake has increased in the last decade.  Compounding the problem is that portion sizes have particularly increased among unhealthy items:  soft drinks, fruit drinks, and fast food products.  Snacking has also increased rapidly in recent years; as a consequence Popkin asserted that “the average child is eating an extra half a meal a day . . . and that’s the same for young adults and adults in the 20 to 40 (age) group.”

Diet, however, is only part of the problem.  Physical activity levels have also declined greatly in the last few decades.  Popkin noted that technological advances, including e-mail and remote controls, have decreased activity greatly, saying, “So we have really worked very hard to create a society that’s sedentary, and one of the products of that is this energy imbalance between what we eat and what we do.”  Perhaps most troubling is the high inactivity level among kids and adolescents.  As school budgets have been diminished, physical education classes and instruction have been seriously cut back in many schools and eliminated in others.

So what can we do to reverse these trends and limit obesity?  Popkin discussed several environmental approaches to the problem.  First, the public infrastructure (sidewalks, streets, building designs…) could be designed or revamped to encourage physical activity.  Second, the number of vending machines, especially in schools, can be cut back.  Third, food price structures and government subsidies can be revised to make healthy foods cheaper and unhealthy products more expensive.  Taxation could also be used to discourage certain food and drink purchases.  Finally, TV advertising could be monitored to discourage ads for high-fat foods at certain times (such as during Saturday-morning cartoons).

Preventing Childhood Obesity in Underrepresented Communities

Sally Davis, Department of Pediatrics at the University of New Mexico Health Sciences Center, discussed her work on interventions designed to prevent obesity in children and adolescents in underrepresented communities in New Mexico.  She noted at the outset that in the last 30 year years, “I have seen lifestyle diseases, such as obesity and diabetes, increase at alarming rates and in younger ages than ever before.”  Davis attributed this to the same diet and physical activity problems that Popkin listed in his presentation. 

The Checkerboard Cardiovascular Curriculum was the first intervention project she discussed.  Funded by a National Heart, Lung and Blood Institute (NHLBI) grant, the project “was a culturally and developmentally appropriate classroom intervention that focused on eating a healthful and balanced diet and being physically active.”  Traditional stories, for example, were used on Navajo reservations to encourage the consumption of native vegetables.  Tribal elders, in their role as grandparents, were also involved to encourage the children to be more physically active. 

Pathways, a program that was designed by university researchers, Indian nation leaders, and NHLBI officials, is Davis’s most recent intervention approach.  As she explained, “the four components of Pathways include classroom curriculum, family activities, physical activities, and school food service.”  The program includes opportunities for children of different tribes to correspond to share ideas and information, school food service workers to learn how to make healthier meals, and teachers to bring physical activity games to their classroom.  The Centers for Disease Control and Prevention has funded the program so that it can be disseminated more widely.

Davis also discussed her efforts to evaluate food supplies available on reservations.  By conducting an inventory of trading posts and convenience stores, recommendations can be made to families and store managers about which foods to purchase and stock.  She concluded her presentation by noting that confronting obesity is especially difficult in underrepresented communities.  A lack of resources limits the food supply and its diversity and also limits opportunities for physical activity. 

The Treatment of Obesity

Tom Wadden, a psychologist at the University of Pennsylvania School of Medicine, addressed the treatment and prevention of obesity.  He opened with a discussion of weight reduction therapy, noting that in the past decade, the goals of this intervention have shifted from reducing a patient to an “ideal weight” to focusing on losing 10 percent of body weight.  Wadden explained that this is because “the best therapies today . . . generally produce a weight loss of about 8-10 percent of body weight.”  This reduction is “associated with marked improvements in health complications.”

Wadden also discussed pharmacotherapy and gastric surgery treatments for obesity before turning to the social factors that affect obese and overweight individuals.  He noted that obese individuals achieve lower levels of education, earn less, and are less likely to get married than their peers with a comparable IQ.  He explained that this may be due in part to the social stigmas that affect obesity treatment.  Obesity is considered by many to be the result of a lack of individual discipline rather than a disease and/or genetic predisposition. 

Wadden continued by asserting that prevention efforts will only be successful if obese individuals can be discouraged from turning to risky over-the-counter products such as ephedra.  In addition, primary care physicians need to be better equipped to treat obesity.  Doctors should be better educated about the disease and interventions, but this is hindered by a lack of time and typical medical school curricula.  Wadden stressed that “we really need to do some demonstration projects to see if primary care physicians can learn to assess and potentially treat obesity, and if not, can they at least . . . send patients to other providers within the health system?”  In closing, he noted that more money needs to go to prevention efforts.

COSSA will prepare edited transcripts of the seminar, which included a question and answer period.  These should be available by June.  If you would like a copy, please e-mail cossa@cossa.org.