The debate over weight and health in America has reached a new tipping point.
Analyzing the health of 186,000 nonsmoking Americans over the age of 50 who were tracked from 1995 to 2005, a group of researchers at the National Cancer Institute recently reached a disturbing conclusion. First, weighing in as even moderately overweight raised the risk of death by 20 percent to 40 percent. Obesity — a well known killer — doubled or tripled the risk of mortality.
The researchers at the NCI wanted to determine the health risk that was linked to being overweight for a long period of time. And they were particularly careful to screen out smokers from the group to exclude the harsh physical consequences of tobacco use.
"BMI at age 50 gives a more accurate representation of the amount of excess fatness a person was exposed to over decades," said Dr. Michael F. Leitzmann, senior author of the NCI study.
Leitzmann's conclusion is likely to come as more bad news for the two out of three adults in the United States who are at least overweight, if not obese. And the downside is much more complex than an increased risk of a heart attack.
"Any associations between mortality and being overweight have important clinical and public health implications, including risk of cancer," said NCI director Dr. John E. Niederhuber. Tackling the issue, he added, could make a significant impact on health trends.
New data, though, doesn't give people who are overweight or obese — or their physicians — new ways to counter the health effects of weight.
There are only a limited number of options for most overweight adults to choose from, said Anthony Fabricatore, PhD, an assistant professor of psychology at the University of Pennsylvania School of Medicine and Dentistry. You can start with self-help books, graduate to programs like Weight Watchers and then move up to hospital-based clinics and their regime of behavior modification, exercise and diet. Drugs are an option, noted Fabricatore, but only two are approved for long-term use. And finally you can opt for the most extreme approach: bariatric surgery to reduce the size of the stomach and force people to eat less.
But there's also another option that involves primary care physicians. Concerned by the widespread evidence that doctors rarely take a direct role in pushing patients to lose weight, one of Fabricatore's colleagues at Penn — Dr. Tom Wadden — conducted a study that took a look at whether physicians who spent 10 to 15 minutes to counsel patients could make a dent in their weight. Patients were asked to keep food records to list what they ate. And by that simple mechanism, their weight dropped by a statistically significant amount.
"I think the best bang for your buck strategy is keeping food records," said Fabricatore. "It's tedious, it's not fun, but it's a great predictor of weight loss."
There are significant racial and ethnic disparities that affect obesity rates as well, said Monica Baskin, PhD, an assistant professor at the University of Alabama in Birmingham. African American women and girls along with Mexican American males, particularly boys, suffer from higher rates of obesity.
"Some of the suggested reasons have to do with cultural preferences," said Baskin about African American females, a group she's studied. They include cultural foods that demand plenty of oils and animal fats, a pronounced lack of physical activity, as well as a general belief that being "a little overweight" is OK. The problem, she said, becomes more pronounced when a little overweight becomes obese — and doesn't get recognized.
To counter those trends, some in the field are counseling more dramatic actions to force a change.
"We need to change the environment," said Gary Foster, PhD, a prominent expert in obesity at Temple University. "I think the time has passed where we preach at people. People know the difference between a banana and a banana split."
As a scientist, said Foster, he's spent his career focusing on the data. But all the independent studies that have come out regarding weight and health in America haven't changed the trends. People in this country, despite knowing better, continue to gain weight.
So maybe, he added, the time has come to mandate changes in an effort to change the environment and get the trend toward better health on track. Does that mean requiring sidewalks in every community? Perhaps. But sidewalks by themselves won't work. So maybe society needs five or six new mandates that people believe will make it easier to shed weight and stay slim. That could also include subsidies for healthy food to encourage people to eat better.
These ideas may not fit the rigid scientific standards that Foster has always abided by, but with these weight trends, something needs to happen soon.
January 2007
