Overweight/Obesity:
What Can Be Done?
For those who are
already overweight/obese, see the NIH's Clinical
Guidelines on The Identification, Evalaution, and Treatment of Overweight
and Obesity in Adults (link is to full text of book)
The current epidemic
of obesity is caused largely by an environment that promotes excessive
food intake and discourages physical activity. Interventions can be
divided into those aimed an increasing physical
activity, and those aimed at improving diet:
Physical
Activity
The CDC-supported
Task Force on Community Preventive Services has reviewed interventions
to increase physical activity and identified public health interventions
that work. Their report, Increasing
Physical Activity, was published in MMWR in 2001 and is available
on the Web. The following interventions were recommended (see the report
itself for details):
- two informational
approaches,
- communitywide
campaigns and
- point-of-decision
prompts to encourage using stairs;
- three behavioral
and social approaches,
- school-based
physical education,
- social support
interventions in community settings (e.g., setting up a buddy
system or contracting with another person to complete specified
limits of physical activity), and
- individually
adapted health behavior change; and
- one environmental
and policy approach,
- creation
of or enhanced access to places for physical activity combined
with informational outreach activities.
Diet
Although a variety
of dietary interventions have been recommended (see below), evidence
for effectiveness is generally lacking. Because systematic reviews suggest
that behavioral approaches are not effective, environmental approaches
should be given preferrence. Also, any effective approach needs to include
physical activity. To conduct a pre-formulated MEDLINE search to find
systematic reviews on the prevention of obesity, click
here.
Healthy People
2010 (Chapter
19) recommends:
- Inclusion of
nutrition education in school curricula
- Improve the quality
of dietary choices in school settings (currently, USDA standards do
not apply to a la carte foods, to foods sold in snack bars or school
stores, or to foods sold in vending machines).
- Worksite nutrition
or weight management classes.
- Dietary counseling/education
upon physician diagnosis of cardiovascular disease, diabetes, or hyperlipidemia.
The Surgeon
General's Call To Action To Prevent and Decrease Overweight and Obesity
offers suggestions by setting (follow links to each):
- Families
and Communties
- Schools
- Health
Care
- Media
and Communications
- Worksites
Some
specific interventions, drawn from HHS's Steps
to a HealthierUS initiative, are as follows (please send suggestions
for the right-hand column):
| HHS
Recommendations, Steps to a HealthierUS |
San
Francisco Interventions or Resources |
| Assist
health care systems in using Body
Mass Index (BMI) as a vital sign beginning at age two years
and continuing through adulthood. |
The
CHN's Lifetime Clinical Record has the capacity for automatic caluclation
of BMI. |
| Train
providers to use current recommendations in screening, assessing,
and managing overweight children and adolescents. |
|
| Assist
health care systems and providers in establishing effective, intensive,
behavioral counseling for adult patients with known risk factors
for diet-related chronic disease. |
|
| Implement
lifestyle interventions for high-risk adults from the Diabetes Prevention
Program Lifestyle Change Program. |
|
| Also
see school health, physical
inactivity and poor diet. |
|
