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Overweight and Obesity Threaten
U.S. Health Gains; Physical Activity is Critical
Problems
related to overweight and obesity will reverse many
of the health gains achieved in the U.S. in recent decades
unless communities help address those prob- lems, according
to a "call to action," issued by the Surgeon General
on December 13, 2001.
The report, entitled "The
Surgeon General's Call to Action to Prevent and Decrease
Overweight and Obesity," outlined strategies that
communities can use in addressing the problems. Those
options included requiring physical education at all
school grades, turning off vending machines at schools
during mealtimes, pro- viding safe and accessible recreational
facilities for resi- dents of all ages, and increased
education about the benefits of breastfeeding.
"Overweight and obesity are among
the most important new health challenges we face today,"
HHS Secretary Tommy G. Thompson said. "Our modern environ-
ment has allowed these conditions to increase at alarming
rates and become highly pressing health problems for
our nation. By confronting these conditions, we have
tremendous opportunities to prevent the unnecessary
disease and disability they portend for our future."
Surgeon General David Satcher said,
"Left unabated, overweight and obesity may soon cause
as much preventable disease and death as cigarette smoking.
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 U.S. deaths
a year are currently associated with obesity and overweight,
compared to more than 400,000 deaths a year associated
with cigarette smoking. The total direct and indirect
costs attributable to overweight and obesity amounted
to $117 billion in the year 2000.
In 1999, an estimated 61 percent of
U.S. adults were overweight, along with 13 percent of
children and adolescents. Only 3 percent of all Americans
meet at least four of the five federal Food Guide Pyramid
recommendations for the in- take 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 percent
of adults engage in no leisure-time physical activity
at all.
While the prevalence of overweight
and obesity has increased for both genders across all
races, ethnicities and age groups, disparities exist.
In women, over- weight 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
preva- lence than those from higher-income families.
These trends already are associated
with dramatic increases in asthma and Type 2 diabetes
among children across the country. But Dr. Satcher said
failure to address overweight and obesity "could wipe
out some of the gains we have made in areas such as
heart disease, several forms of cancer, and other chronic
health problems."
In preparing the report, 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.
They were organized under the categories of communication,
action, research and evaluation (CARE).
Those strategies include:
- Ensuring 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.
- Enforcing existing U.S. Department
of Agriculture regulations that prohibit serving foods
of minimal nutritional value during mealtimes in school
food service areas, including vending machines.
- Educating all expectant parents
about the benefits of breastfeeding, because studies
show that breastfed infants may be less likely to
become overweight as they grow older.
Making community facilities available
for physical activity for all people, including on the
week-ends.
- Creating more opportunities for
physical activity at worksites.
- Reducing time spent watching television
and other sedentary behaviors. In 1999, 43 percent
of high-school students reported watching two hours
of TV or more a day.
- Changing the perception of obesity
so that the primary concern is one of health, not
of appearances.
- Increasing research on the behavioral
and biological causes of overweight and obesity, their
prevention and treatment, and disparities.
- Educating health care providers
and health profession students on the prevention and
treatment of overweight and obesity across the lifespan.
"Communities have their share
of responsibility when it comes to health promo- tion
and disease prevention," Dr. Satcher said. "When there
are no safe places for children to play, or for adults
to walk, jog, or ride a bike, that's a community responsibility.
When school lunchrooms or workplace cafeterias don't
offer healthy and appealing food choices, that is a
community responsibility. When new or expectant parents
are not educated about the benefits of breastfeeding,
that's a community responsibility. And when we do require
daily physical educa- tion in our schools, that is also
a community responsibility."
NOTE: The National Institutes of Health
define obesity and overweight through the use of 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. 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. In children and adolescents,
overweight is defined as a sex-and- age specific BMI
at or above the 95th percentile, based on
revised growth charts by the Centers for Disease Control
and Prevention. There is no generally accep- ted definition
for obesity in children and adolescents.
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 percent increased
risk of pre- mature 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
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