Making progress against obesity

Date: 1/19/2009

By Denise Rollinson, M.D.



In 2001, then-U.S. Surgeon General David Satcher issued a "call to action" on overweight and obesity, saying both conditions "may soon cause as much preventable disease and death as cigarette smoking." Nearly a decade later, despite many studies, policies, programs and good intentions, we're still falling short in curtailing what many now consider an epidemic.

The Center for Disease Control estimates that two-thirds of adults and one in five children are now overweight or obese. A study this year by the Trust for America's Health and the Robert Wood Johnson Foundation showed that obesity rates have increased in 37 states and that no state recorded a decline. Another study from the Johns Hopkins School of Public Health even projected that, if current trends continue, 86 percent of Americans will be obese by 2030.

The personal and public health ramifications of obesity are widespread. High blood pressure, heart disease, arthritis, cancer, diabetes and many other debilitating and costly chronic medical conditions are firmly linked to obesity.

Physicians and health professionals must continue to re-emphasize the value of good nutrition and physical activity. They go hand in hand, and are essential factors in reducing obesity and achieving and maintaining good health.

A key phrase to remember is "calories in, calories out." The equation is simple. To lose weight, you must burn more calories than you consume. Conversely, if you consume more than you burn, you will gain weight.

Your diet: not any particular "plan," but rather what you eat is the "calories in" part of the equation. It's the cornerstone of controlling your weight. Suggestions for a healthy diet include:

Control the quantity of food. The quantity of what you eat is critical. Have some idea of how many calories are in that muffin, burger or beverage. Practice "portion control" so you don't overeat at one sitting (especially at restaurants, which tend to serve larger amounts of food than you would have at home).

Consider the quality of food. Examine the content of what you eat, and avoid saturated fat, trans fat, sugar and salt. Learning to read nutrition labels is a good way to determine the quality of the foods you eat.

Eat more nutrient-dense foods. These foods, like fruits, vegetables and those with whole grains, are packed with vitamins, minerals and fiber and tend to be lower in calories.

Avoid eating "because it's there." For most of us, food is abundant and readily available. We eat at home, in restaurants, in our cars, in front of the television and computer. We often eat from habit, not because we're hungry.

Make changes in small steps. You need not dive into deprivation. Small changes over time can reap big rewards.

Your activity is the "calories out" part of the equation. To burn the calories you consume by eating, you must be active. (Remember to check with your physician before starting an exercise program if you've been inactive for some time.) To help get people moving, the U.S. Department of Health and Human Services has published its first-ever Physical Activity Guidelines for Americans, offering details on the types and amounts of activity that provide health benefits. The comprehensive guidelines include information for individuals six years and older, including children, adults, seniors and the disabled; a toolkit for organizations and communities; and discussions for policymakers and health professionals. You can download it free at www.health.gov/paguidelines. HHS offers these starting points:

Some physical activity is better than none, and the best one is the one enjoyable enough to do regularly.

More health benefits occur with more intensity, frequency and duration of activity or exercise.

Aerobic (endurance building) exercise and strength-training are both important.

Benefits of exercise outweigh the risks of injury.

Americans should be as physically active as their age, abilities and conditions allow.

Nutrition and physical activity should be lifelong endeavors to maintain good health, so continued learning is important. A good place to begin is MyPyramid.gov. This site from the U.S. Department of Agriculture offers facts for adults and children and tips and tools to assess both food intake and physical activity.

Denise Rollinson, M.D., a diplomat of the American Board of Physician Nutrition Specialists and a registered and licensed dietician, is chair of the Massachusetts Medical Society's Committee on Nutrition and Physical Activity. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.