The scales are not lying: too many Americans, adolescents as well as adults, are simply not at a healthy weight. Americans are not balancing food energy intakes with physical activity.
One-third of people aged 20 years and older are overweight; prevalence varies by race/ethnicity, socioeconomic status, sex, and age. Minority populations, especially minority women, are affected disproportionately--nearly one-half of African-American, Mexican-American, and Native American adults are overweight. The prevalence of overweight adolescents aged 12-19 is 21 percent, up 6 percentage points from 1976-1980 to 1988-1991.
Overweight Costs Are Burdensome
Excess pounds are costly to the health of individuals and to the Nation. The Food and Nutrition Board of the Institute of Medicine estimates the annual health care costs of obesity at over $70 billion, stating the total would top $100 billion by adding the $33 billion spent annually on weight-reduction products. The board's estimate does not include psychosocial costs ranging from lowered self-esteem to eating disorders to depression.
Overweight Is a Weighty Risk Factor
The odds of adverse health outcomes--most notably cardiovascular diseases, hypertension, noninsulin-dependent diabetes mellitus, and certain cancers weigh heavily against overweight people. Risk increases with higher relative weight. Rates of hypertension and diabetes are nearly triple for people 20 percent or more overweight.
Metabolic and functional alterations associated with overweight may lead to increased rates of gout, gallbladder disease, colorectal cancer, hip fracture, and osteoarthritis. Obese women are at increased risk of endometrial and ovarian cancer. Studies show that patients have negative attitudes about overweight and may not seek or receive necessary preventive care such as pelvic examinations; similar attitudes can keep health care providers from delivering such services.
Overweight in childhood increases morbidity and mortality in adulthood. One of the biggest risk factors for children is having an overweight parent. This influence is strongly genetic and partially environmental, for example, in modeling, the availability and preparation of food, and physical activity patterns and habits.
Americans seem to know they should maintain a healthy weight, and many undertake weight-loss efforts. Although perceptions of weight are culturally induced and may be unrelated to actual overweight, as many as 58 percent of adults report themselves overweight. More than 1 in 10 admits to being more than 20 pounds overweight. Only 1 in 10 adults believes his or her diet is as healthy as it could possibly be. Many consumers do not make the link between diet and physical activity--both are important to healthy weight.
What Is Healthy Weight?
Some confusion comes from the lack of an answer to the question: what is healthy weight? The definitional problem is complex and differs for adolescents and adults. Because of changes in body composition with growth, weight is a less reliable measure of fatness for children and adolescents than for adults. Health professionals are reluctant to stigmatize youth as overweight when they already are undergoing the stress of adolescence and may, in fact, be laying down fat in preparation for a growth spurt. Indeed, some children may not be getting enough calories.
The most common measure of overweight is body mass index (weight in kilograms divided by height in meters squared). This definition does not distinguish between fat and muscle tissue or body shape although the distribution of fat affects risk. Persons having "spare tires," or large amounts of abdominal fat, are at increased risk for diabetes, hypertension, and other conditions.
Balancing the Energy Equation
What causes overweight? Fundamentally, an imbalance exists in the energy equation between what a person takes in and what he or she expends. Biological and behavioral factors affect this balance.
Recent studies of biological factors show that multiple genes affect the body's mechanism for controlling its weight and that specific genetic defects may vary from one person to another. More research is needed to understand the role of genetic defects. In the meantime, researchers stress that lifestyle and diet can make a difference for most people, regardless of the existence of the "obesity gene." Behaviorally, Americans are simply too sedentary and need to increase their physical activity levels: 58.1 percent of adults report irregular or no leisure-time physical activity. The proportion of 9th through 12th grade students engaged in daily school physical education has declined, as has the proportion of school physical education time that students spend being physically active. Nearly two-thirds of 9th through 12th graders engage in 20 minutes of vigorous physical activity three or more times per week, while 35 percent watch television 3 or more hours every school day. Unfortunately, a sedentary lifestyle is both a cause and a consequence of overweight.
Americans consume too many calories, with too many of those calories from fat, and not enough fiber. Genetic, cultural, and environmental factors influence Americans' diets.
Solutions for Achieving Healthy Weight
Many public and private organizations are waging battles of the bulge. The Dietary Guidelines for Americans Committee from the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (DHHS) has been examining consumer data on nutrition awareness, knowledge, and behavior. The committee expects to place increased emphasis on physical activity when presenting revised guidelines later this year.
The Centers for Disease Control and Prevention has established the Nutrition and Physical Activity Communications Team (NuPAC) to promote physical activity and healthy eating. NuPAC recently completed focus group discussions with men and women aged 29-54 to identify strategies and messages for effectively linking physical activity and nutrition to promote health. Later this year, NuPAC will kick off a health communications campaign and sponsor a conference to share scientific and consumer research findings among agencies.
The DHHS Head Start program, reaching some 740,000 children aged 3-5 and their parents, combines nutrition and physical activity in developmentally appropriate ways. Individual Head Start projects offer nutrition counseling plus nutritious breakfasts, lunches, and snacks. Preliminary results of a recent evaluation show parents consider nutrition one of the most important benefits of the program.
Head Start has launched Padres Hispanos En Ación, a special multimedia nutrition education program for Hispanic parents. One of the program's objectives is to teach parents how to prepare more nutritious meals.
By summer USDA will have regulations in place governing the nutritional contribution of breakfasts and lunches delivered by 90,000 schools to 25 million students. School meal nutrition standards will be updated and expanded to include the Dietary Guidelines for Americans with standards for fat and saturated fat as well as required nutrients.
Under a cooperative agreement, USDA has worked with Scholastic Magazine on four "Team Nutrition" kits for pre-kindergarten through 12th grades, with physical activity components, posters, videotapes, and other materials for teachers and food service personnel. With the goal of "empowering youth to make healthy food choices," the Team Nutrition program also features public service commercials with characters from the Disney movie "The Lion King."
Activities of the Food and Drug Administration (FDA) include food labeling, consumer research, and nutrition education. (See Spotlight.) Recognizing that consumers must know the nutrient content of food in order to make healthy choices, FDA has set forth definitions and limits on food claims. For example, a "low-fat" product must contain 3 or fewer grams of fat per serving; "fat free" means 0.5 gram per serving. Through the new Nutrition Facts food label and associated educational efforts, FDA is giving consumers much needed guidance.
The National Task Force on Prevention and Treatment of Obesity supports doubling the current obesity research funding of $34 million, with particular focus on the preventative and therapeutic programs of the National Institute of Diabetes and Digestive and Kidney Diseases; the National Heart, Lung, and Blood Institute; the National Institute of Child Health and Human Development; and the National Cancer Institute. Another proposed $10 million a year initiative would study the prevention of obesity.
The private sector is both a Federal partner and an active independent promoter of healthy eating. The President's Council on Physical Fitness and Sports, the International Food Information Council, and the Food Marketing Institute often are collaborators. The Sugar Association, Dairy Association, and the National Livestock and Meat Board are among the many trade associations providing information and materials targeted to adults and children as well as health professionals. Voluntary organizations like the American Cancer Society and the American Heart Association offer menu plans and other help. Manufacturers are involved, too. Dole Corporation has produced the Five-A-Day Adventures program, a multimedia interactive CD-ROM, for 3rd and 4th graders.
Prevention, Prevention, Prevention
There has never been a better case for prevention--to keep excess weight off; or for those overweight, to keep from gaining more; or for those who have lost weight, to maintain it. A little loss can mean a big gain in terms of health: an individual can lose merely 2 pounds, yet decrease blood cholesterol 20 points.
Prevention must start early in childhood, ideally with healthy habits ingrained by age 5. Health professionals must provide information and counseling on nutrition and physical activity, especially to parents, children, adolescents, and young adults so they learn to "eat and exercise for health." Behavior and attitude changes are essential. So is peer and family support.
New technology is supporting prevention in several ways. Support groups, long considered important in weight loss, now operate as electronic forums. Online access to information increases every minute--the International Food Information Council Foundation's World Wide Web page offers materials for children and adults. Software programs enable users to plan menus and track nutrition and physical activity. Multimedia interactive programs engage children and adults in learning about nutrition and physical activity.
Conclusion
Information about nutrition and overweight is omnipresent--on cereal boxes and other packaged products, fast food tray liners and restaurant menus, displays in bakeries and ice cream parlors. The challenge is getting consumers to use that information to change their lifestyles and get out of the fat lane. Changing behavior is indeed complex but must begin with this message: balance the energy equation and maintain a healthy weight.
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