HHS Tackles Obesity

About 2 out of 3 U.S. adults are overweight or obese, according to the Centers for Disease Control and Prevention (CDC). That's roughly 129 million people who are at increased risk for developing type 2 diabetes, heart disease, some forms of cancer, and other disabling medical conditions.

The CDC also estimates that 15 percent of children and adolescents ages 6 to 19 are overweight--almost double the rate of two decades ago. Overweight and obesity disproportionately affect racial and ethnic minority populations and people of lower socioeconomic status. The total economic cost of obesity in the United States is about $117 billion per year, including more than $50 billion in avoidable medical costs.

A new CDC study shows that deaths due to poor diet and physical inactivity rose by 33 percent over the last decade, and may soon overtake tobacco as the leading preventable cause of death among Americans.

"The fact that more than a third of deaths in America each year are related to smoking, poor eating habits, and physical inactivity is both tragic and unacceptable, because these are largely preventable behaviors," says CDC Director Julie Gerberding, M.D., M.P.H.

Health and Human Services Secretary Tommy G. Thompson says the findings should motivate all Americans to take action. "Americans need to understand that overweight and obesity are literally killing us," Thompson said in announcing an HHS initiative to fight obesity in March 2004. "We need to tackle America's weight issues as aggressively as we are addressing smoking and tobacco."

Body mass index (BMI) and waist circumference provide useful estimates of overweight, obesity, and body fat distribution. The location of fat on your body is significant. If you carry fat mainly around your waist, you are more likely to develop health problems than if you carry fat mainly in your hips and thighs. This is true even if your BMI falls within the normal range. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches may have a higher disease risk than people with smaller waist measurements because of where their fat lies.
Source: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2000.
Infographic: FDA/Renée Gordon

Small Steps

"Healthy Lifestyles and Disease Prevention" is a national educational campaign that encourages long-term weight control through public service announcements (PSAs) and an interactive Web site. Nongovernmental partners in the HHS initiative include Lifetime Television, Sesame Workshop, and the United Fresh Fruit & Vegetable Association.

Consumers don't have to join a gym or take part in the latest diet plan to be healthy. This campaign shows Americans that they can take small, achievable steps. "Each small step does make a difference, whether it's taking the stairs instead of an elevator or snacking on fruits and vegetables," Thompson says.

Designed for all media outlets, the PSAs provide tongue-in-cheek examples of the power of small steps. They show typical Americans finding "love handles," double chins, and other unwanted body parts in public places, apparently "lost" as people used the stairs, got active on the beach, or walked to the office. The ad agency McCann Erickson worked through the Ad Council to create the ads for HHS.

"We know that gloom and doom messages warning against weight don't work," Thompson said. "These messages are provocative and attention-getting, but they are also empowering and achievable."

Obesity Research

Thompson says that the National Institutes of Health (NIH) is developing a strategic plan for obesity research. NIH director Elias A. Zerhouni, M.D., says the strategy coordinates the funding of obesity research across 25 institutes, centers, and offices at the NIH. The NIH budget request for obesity research for fiscal year 2005 is $440.3 million, a 10 percent increase from the current year's funding.

"There is no single cause of all human obesity," Zerhouni says, "so we must explore prevention and treatment approaches that encompass many aspects, such as behavioral, sociocultural, socioeconomic, environmental, physiologic and genetic factors."

The NIH also is reviewing public comments on a draft plan and preparing the final version. The NIH plan is organized into four major themes related to obesity prevention and treatment:

lifestyle modification
pharmacologic, surgical, or other medical approaches
the link between obesity and its associated health conditions
crosscutting research topics, including health disparities and technology.

Calories Count

Another critical element in HHS' comprehensive obesity strategy is a new report by the FDA's Obesity Working Group. The recommendations in the report are centered on the scientific fact that weight control is primarily a function of caloric balance, so the main message is "calories count."

"Our report concludes that there is no substitute for the simple formula that 'calories in must equal calories out' in order to control weight," says Acting FDA Commissioner Dr. Lester M. Crawford.

The FDA's recommendations highlight various approaches the agency can use to help consumers make wise food choices at home, at supermarkets, and in restaurants. The recommendations include:

Evaluating how the "Nutrition Facts" panel on food labels can be revised to highlight the critical role calories play in consumers' diets. This could involve increasing the size of type and adding a column to list amounts of calories as a Percent Daily Value (%DV) for the entire package.
Considering the authorization of health claims on certain foods that meet the FDA's definition of "reduced-calorie" or "low-calorie." An example might be "Diets low in calories may reduce the risk of obesity, which is associated with type 2 diabetes, heart disease, and certain cancers."
Encouraging manufacturers to use dietary guidance statements, such as "To manage your weight, balance the calories you eat with physical activity; have a carrot, not the carrot cake; or have cherry yogurt, not the cherry pie."
Defining such terms associated with carbohydrate such as "low," "reduced," or "free," as well as giving guidance for use of the term "net" in relation to carbohydrate content of food.
Encouraging the restaurant industry to launch a national, voluntary effort to include nutritional information for consumers at the point of sale. The report recommends that the FDA seek restaurants to participate in a pilot program to study options for point-of-sale information.
Increasing the FDA's focus on enforcing accurate serving size declarations and advising manufacturers when the agency identifies errors in declared serving sizes. The FDA is issuing a letter to encourage the food industry to review its nutrition information for accuracy.
Revising and reissuing the FDA's 1996 draft "Guidance for the Clinical Evaluation of Weight-Control Drugs." This item reflects the fact that some obese people are likely to need medical intervention.
Strengthening the coordination of research into obesity and the development of foods that are healthier and lower in calories.

Thompson says that HHS has long spearheaded initiatives to motivate Americans of all ages to become more active and learn more about healthy living. He is calling on individuals to maintain a healthy weight and on corporations, communities, and others to join in this national effort to reverse the obesity epidemic.

The BMI ranges shown at right are for adults. They are not exact ranges of healthy and unhealthy weights. However, they show that health risk increases at higher levels of overweight and obesity. Even within the healthy BMI range, weight gains can carry health risks for adults.

Directions: Find your weight on the bottom of the graph. Go straight up from that point until you come to the line that matches your height. Then look to find your weight group. Obese people are also overweight.

For More Information

FDA's Obesity Working Group report

NIH draft strategic plan on obesity

CDC statistics on causes of death