San Francisco Burden of Disease & Injury Study:
Determinants of Health
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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.


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):

  1. Families and Communties
  2. Schools
  3. Health Care
  4. Media and Communications
  5. 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.  




Contribution to overall disease burden in SF

Downstream (health consequences)

Upstream causes

What can be done?

Web resources

MEDLINE strategies

Updated May 27, 2003

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