April 22, 2010

Beating Obesity

The Atlantic magazine's May 2010 issue features a very well written obesity article that I thought to share on here. As a recent graduate of a public health program the statistics and overall rates are not surprising, albeit, difficult to see and when placed in the context of future population growth and medical expenditures, still overwhelms.

It seems to me, that nutrition and physical activity policies are a great place to start. In the article, obesity and healthy weight legislation is often compared to anti-tobacco legislation and policies.  In the US, at least, these policies (along with state and federal regulation) have reduced smoking rates.  It then would seem that policies really are a smart way of targeting the many issues that pop up when discussing overweight and obesity, at least it provides some regulatory power both to states and at the federal level.  Tackling the weight issue is going to be best pursued with healthy weight legislation (which I think sounds better than obesity legislation) and above all is going to have to be based on so many more factors.

For example, their are rigorous debates in shifting the blame towards the individual, and by extension also blames these enablers: big agriculture, food marketing, and the medicalization of treatments for overweight and obesity.  Other issues of course discussed in the article include:  calorie labeling, point of purchase calorie labeling, food deserts, food marketing to young children (and this definition really should be extended to include 0-18 years), school nutrition reform, taxation of junk foods, zoning laws and restrictions, and promoting access to healthy foods in low-income areas, among many others.  Its difficult to link any one of these reasons as being the sole cause of  overweight, and obesity, but there is stronger evidence linking multiple factors as risks in becoming overweight, which the article did a good job of explaining.

I think the outcomes of good policies weren't discussed as well in the article; it provided more the view of "single issue" policies such that taxation of sugar-sweetened beverages will reduce childhood overweight, instead of focusing on nutrition policies and programs currently in place, and that are working towards improving nutritional status among the population and reducing chronic diseases, and overweight and obesity.  Further these "single issue" policies take greater blame, receive more media attention and coverage, and detract away from the issues at hand.  I would like to see policies in place that address multiple issues, but that also work to support the current nutrition programs and policies that are already in place such as but not limited to...WIC the Women, Infants and Children Program, a supplemental food and nutrition program for low-income pregnant women and children up to the age of 5, the Centers for Disease Control's Preventative Health and Health Services Block Grants which provide yearly funding to every state and allows them to target their health issues (!), multiple Federal Food Programs which include the National School Lunch Program, the Fresh Fruit and Vegetable Program, the Child and Adult Care Food Program among others all working to increase access to healthy foods through public schools and other centers.  These programs are never free from criticism, but they operate on federal and state budgets, and could be improved and supported by additional national and state policies. Overall these would increase momentum in changing the social norms associated with nutrition, health, and weight.

The US is the heaviest country in the industrialized world! The health care debate has certainly brought up health indicators within our population as being worse off than many other industrialized countries, of which many fall in Europe. The article really focused on increasing medical costs (which I think is a key issue in the obesity debate). There is this notion that Europe is more progressive and stricter with it's policies and regulatory powers. However the EU is also disjointed in many ways, having multiple cultures and languages represented in which social norms vary (food culture, access to health, smoking and tobacco use, and exercise). Comparing these indicators to US indicators seems futile, although not without merit, it seems inappropriate to use indicators for weight when comparing populations with very different governmental programs and oversight.

One thing I would like to see more of in the US is the built environment. There is plenty of healthy debate on zoning laws, and removing fast food, and limiting food advertising, but we really need to be thinking of how to rebuild physical activities into daily life. Biking and walking are HUGE forms of physical activity that have been replaced by cars, sprawl, urban decay, and poor mass transit. The overall amount of calories burned (and if those calories are from highly junk processed foods) by 1-2 hours stints in the gym is never going to reverse weight gain. This is the worst uphill battle of our generation.  Without infrastructure that is provided by local, state and federal governments, policies that are put in place to improve nutrition and physical activities are going to stagnate. Which is also another great reason we need these policies in the first place!

Finally, the health care debate. Let's hope there is more universal access to those that really need it - to those that could not afford or maintain coverage, and that it drives preventative medicine further. Part of health care is being able to go to a doctor or health care professional when you need it, and having it be available to you at a clinic or within the community, at a reasonable cost. Escalating costs in chronic disease management exacerbate the problem, and as is, there isn't much available to those that really need it (as the author of the article points out having undergone bariatric surgery). Another factor driving medical costs upwards is going to a doctor or hospital when your symptoms are past the manageable phase and require immediate medical supervision. There needs to be access and support of chronic disease management at all levels of the population. Overweight and obesity are linked to many other metabolic disorders, ones that can be reversed or managed with modest, 5-10%, reductions in body weight. This is a realistic goal, but one that cannot be executed or maintained without medical and nutrition support. As a community health advocate and public health dietitian it is not appropriate to assume that task fall solely to the individual. There are great programs within communities that operate at the local public health department level that need further support, need further funding, need competent health professionals and political advocates that can vouch for their positive contributions in assessing and addressing their population-level health.

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