Surgeon General Asks Communities To Address Obesity

Health problems resulting from overweight and obesity could overturn many of the improvements achieved in the health of Americans in recent decades, according to US Surgeon General David Satcher, MD, PhD. "Overweight and obesity may soon cause as much preventable disease and death as cigarette smoking," Dr. Satcher says. "People tend to think of overweight and obesity as strictly a personal matter, but there is much that communities can and should do to address these problems."

Approximately 300,000 US deaths each year are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking). The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the year 2000.

Community-Based Strategies
In his report entitled "The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity," Dr. Satcher outlined strategies that communities can use in helping to address the problems. In preparation of the report, Dr. Satcher convened a listening session in December 2000 and held a public comment period to gather ideas from clinicians, researchers, consumers and advocates. These sessions generated a number of community-based strategies that were subsequently reviewed for their proven scientific effectiveness. The strategies were organized under the categories of communication, action, research and evaluation (CARE). (See end of story for detailed list of strategies.)

Statistics Differ by Gender, Ethnicity
While the prevalence of overweight and obesity has increased for both genders and across all races, ethnic and age groups, disparities do exist. In women, overweight and obesity are higher among members of racial and ethnic minority populations than in non-Hispanic white women. In men, Mexican-Americans have a higher prevalence of overweight and obesity than non-Hispanic men, while non-Hispanic white men have a greater prevalence than non-Hispanic black men. Members of lower-income families generally experience a greater prevalence than those from higher-income families.

Already, these trends are associated with dramatic increases in conditions such as asthma, and in Type 2 diabetes among children. Dr. Satcher said failure to address overweight and obesity "could wipe out some of the gains we've made in areas such as heart disease, several forms of cancer, and other chronic health problems."

More Children and Teens Overweight
In 1999, an estimated 61% of US adults were overweight, along with 13% of children and adolescents. Obesity among adults has doubled since 1980, while overweight among adolescents has tripled. Only 3% of all Americans meet at least four of the five federal Food Guide Pyramid recommendations for the intake of grains, fruits, vegetables, dairy products, and meats. And less than one-third of Americans meet the federal recommendations to engage in at least 30 minutes of moderate physical activity at least five days a week, while 40% of adults engage in no leisure-time physical activity at all.

Findings from the Centers for Disease Control and Prevention's (CDC) National Health and Nutrition Examination Survey (NHANES) show that more and more children and teens are overweight, continuing the pattern the survey documented over the past two decades when the number of overweight children and teens nearly doubled. Initial results for 1999 showed that 13% of children ages 6-11 years are overweight, up from 11% in the previous NHANES survey conducted from 1988 to 1994. The number of overweight teenagers 12-19 years increased from 11 to 14% in the same time period.

"Overweight children are at risk for cardiovascular diseases, diabetes, and other serious health problems. They are part of an epidemic of overweight and obesity that must be addressed so that they can lead healthier lives," said Dr. Jeffrey P. Koplan, Director of the Centers for Disease Control and Prevention (CDC). "This survey provides the critical information we need on overweight, diet, and physical activity to help develop the strategies for healthier children and families."

Find Your Body Mass Index
The National Institutes of Health define obesity and overweight using a Body Mass Index (BMI), which is a calculation of a person's weight in kilograms divided by the square of their height in meters. To determine your BMI, go to HealthLink’s BMI Calculator. An overweight adult is defined as one with a BMI between 25 and 29.9, while an obese adult has a BMI of 30 or higher. The risk of death, although modest until a BMI of 30 is reached, increases with an increasing BMI. Obese adults have a 50 to 100 % increased risk of premature death compared to adults with a BMI of 20 to 25. But even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years.

Planning Strategies for Communities
In "The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity," Dr. David Satcher outlined strategies that communities can use in helping to address the problems of overweight and obesity. These strategies include:

• Institute daily, quality physical education for all school grades. Currently, only one state in the country – Illinois – requires physical education for grades K-12, while only about one in four teenagers nationwide take part in some form of physical education.
• Ensure that more food options that are low in fat and calories, as well as fruits, vegetables, whole grains, and low-fat or non-fat dairy products, are available on school campuses and at school events. A modest step toward achieving this would be to enforce existing US Department of Agriculture regulations that prohibit serving foods of minimal nutritional value during mealtimes in school food service areas, including in vending machines.
• Make community facilities available for physical activity for all people, including on the weekends.
• Create more opportunities for physical activity at work sites.
• Reduce time spent watching television and in other sedentary behaviors. In 1999, 43% of high-school students reported watching two hours of TV or more a day.
• Educate all expectant parents about the benefits of breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.
• Change the perception of obesity so that health becomes the chief concern, not personal appearance.
• Increase research on the behavioral and biological causes of overweight and obesity. Direct research toward prevention and treatment, and toward ethnic/racial health disparities.
• Educate health care providers and health profession students on the prevention and treatment of overweight and obesity across the lifespan.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.