SG CTA-Obesity

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 95^th 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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