Obstacles to reversing the obesity epidemic

If you go to the website of the U.S. Centers for Disease Control and Prevention, you can download a colorful slide presentation that illustrates with stunning clarity how much worse the problem of obesity has become in the past twenty years. In 1990, every one of the 50 states could boast that fewer than 15 out of every 100 adults had an unhealthy weight; by 2008, more than 25 out of every 100 adults in 32 states were classified as obese. So who’s to blame, and what can be done about it?

The standard answer, that obesity results from a failure in willpower, is reinforced by popular television shows such as “The Biggest Loser,” where overweight contestants are removed from their natural environments and placed on super-intensive dietary and exercise regimens that lead to, in some cases, hundreds of pounds of weight loss over several weeks. But as Atlantic correspondent Marc Ambinder noted in a recent magazine article, this type of program is out of reach for all but the wealthiest individuals who can afford celebrity personal trainers.

Family doctors can certainly provide support and assistance to patients who want to lose weight, but there are limits to what we can do, given the time we have to devote to counseling and the extremely limited training we receive on practical strategies to assist with weight loss. For an increasing number of obese people (including Ambinder himself), bariatric (weight loss) surgery has achieved what medicine can’t – but even the recent explosion of bariatric surgery centers can’t possibly come close to treating one quarter of the adult population.

Obesity is as much a public health problem as a medical problem. Obstacles to living a healthy lifestyle include rising serving sizes and television screen time, combined with a lack of access to nutritious foods and safe places to be physically active in many towns and cities. The announced intention of U.S. First Lady Michelle Obama to tackle obesity in children shows how difficult and sustained an effort will be necessary to reverse the overall obesity epidemic. In May, the President’s Task Force on Childhood Obesity made a series of recommendations for wide-ranging action in institutions such as hospitals, restaurants, schools, grocery stores, and parks. Most of these changes will require more than just exhortation, but policy changes in local and national levels.

So I encourage you think about this question: what can you do to fight obesity in your family, friends, and community?

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This post was first published on my CommonSense MD blog at Family Health Guide.