NYTimes'com Health

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NYTimes.com gt Health
Some Extra Heft May Be Helpful, New Study
Says By GINA KOLATA Published April 20, 2005
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All Women, 1976-1992 (4726 Deaths)
Age-Adjusted Relative Risk
CHl for trend 3.27 P 0.001
Body-Mass Index
(Manson et al, 1995)
23.012
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Women Who Never Smoked and Had Stable Weight,
1980-1992 (531 Deaths)
(Manson et al., 1995)
Multivariate Relative Risk
Chi for trend 4.67 plt0.001
Body-Mass Index
23.015
4
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Obesity in the USA, 1991-98Educational Level
ltHigh school 46
High school 46
Some college 68
Percentage Obese
College grad 63
(Mokdad et al. JAMA 1999)
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Obesity in the USA, 1991-98Region
Midwest 36
Mid-Atlantic 32
Southeast 67
Pacific 67
Percentage Obese
New England 46
(Mokdad, et al. JAMA 1999)
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• Controlling the Obesity Epidemic
• Strategies
• Examples

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• Experiences with Other Public Health Problems
  Related to Human Behavior
• smoking
• not wearing seat belts
• drunk driving
• poor immunization rates

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• 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

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In theory, control is simple calories eaten
calories burned
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21.004
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Bray and Popkin prediction
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McManus K et al, 2001 Int J Obes 251503
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• 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

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New England Strategic Plan forWeight Control
(NECON 2004)
Schools Health Care Providers
Work Sites Media Physical
Environment Food Environment Data
for Action Economic Analysis
www.neconinfo.org
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• Worksites
• Encourage physical activity and weight control
• Exercise areas at work, shower facilities
• Financial incentives to walk, cycle, or use
  public transportation

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• 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

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• Is it Possible To Control the Epidemic?
• Socioeconomic example
• Swedish and Japanese women (examples)

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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

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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.

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