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Rising obesity rates show need for bold, new approaches to tackling this major public-health problem

The emphasis must be on prevention — and not just on preventive efforts that focus on individual responsibility, say JAMA editors in a commentary. “Families need help,” they stress.

The emphasis must be on prevention — and not just on preventive efforts that focus on individual responsibility.
REUTERS/Soo Hoo Zheyang

More disheartening news on the obesity front: America’s obesity epidemic continues to grow, led primarily by small but significant increases in the obesity rates among women and adolescents.

Some 35 percent of men, 40 percent of women and 17 percent of children and adolescents are now obese in the United States, according to a pair of studies published this week in the Journal of the American Medical Association (JAMA).

The obesity rate for men is up only slightly from a decade ago, but the rate for women is up 13 percent, while that for 12- to 19-year-olds also continues to rise. The obesity rate among teens has climbed almost 50 percent over the past 25 years, a steady — and startling — trend that has not abated in recent years. 

In addition, some 5.5 percent of men and 9.9 percent of women are now morbidly obese, and 5.8 percent of children and adolescents are considered extremely obese.

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Obesity is defined in adults as a body mass index (BMI) of 30 or more, while morbid obesity is a BMI of 40 or more. In children and adolescents, obesity (and extreme obesity) is determined a bit differently, by using age- and gender-specific percentiles for BMI. Young people with BMIs that fall at or above the 95th percentile for their age and gender are considered obese, and those whose BMIs fall at or above the 99th percentile are considered extremely obese.

If there’s any good news in these new findings, which are based on data collected from the annual National Health and Nutrition Examination Survey (NHANES), it’s that the obesity rate in children aged 6 to 11 has leveled off in recent years, while the rate for children age 2 to 5 has actually declined.

Still, more than 1 in 6 (17.4 percent) of U.S. children aged 6 to 11 and almost 1 in 10 (9.4 percent) of those aged 2 to 5 are obese.

In other words, we have nothing to really celebrate.

Very little success

As Dr. Jody Zylke, deputy editor of JAMA, and Dr. Howard Bauchner, editor-in-chief of JAMA, note in a commentary accompanying the two studies, this latest news about the country’s obesity rates “is neither good nor surprising.”

But it is discouraging, as they explain:

Numerous foundations, industries, professional societies, and governmental agencies have provided hundreds of millions of dollars in funding to support basic science research in obesity, clinical trials and observational studies, development of new drugs and devices, and hospital and community programs to help stem the tide of the obesity epidemic. In addition, communities, schools, places of worship, and professional societies have become active in attempting to counteract obesity, emphasizing exercise, better dietary choices, and nutritional content labeling of foods.

Although it is impossible to know what the extent of the obesity epidemic would have been without these efforts, the data reported by [the two new studies] certainly do not suggest much success.

New drugs, procedures and treatments are not going to solve the problem, say Zylke and Bauchner. The emphasis must be on prevention — and not just on preventive efforts that focus on individual responsibility.

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“Families need help,” they stress.

Everybody is culpable

But society and its institutions have failed to provide that help, or they have provided help that has been counterproductive.

Here is what Zylke and Bauchner have to say about some of the groups who are most culpable in this massive failure:

Scientists and physicians: “[They] have not been particularly helpful, often communicating confusing an conflicting advice about nutrition. For example, after years of advice to only drink skim milk, including by the National School Lunch Program, a recent study suggests whole milk may be associated with less weight gain in children.”

The food and restaurant industry: “Farmers and the agricultural community produce fruit and vegetables that can survive being shipped long distances but at the expense of taste, reducing consumers’ desire to eat produce. Restaurants offer all-you-can-eat specials or do not include vegetables on the menu. Packaged foods may be high in sugar and salt and low in fiber.”

Policymakers and politicians: “Some data have emerged reporting that [taxing sugar-sweetened beverages] could be successful, but it is likely the political process in the United States will limit widespread adoption of such taxes. Many organizations and public health departments have suggested that high-fructose corn syrup and sugar should be regulated, but the U.S. Food and Drug Administration has not yet required this action.”

‘Time for an entirely new approach’

As the writers suggest in their commentary — and as the findings in the two new studies make depressingly evident — we’re going to need new, bold ideas if we’re going to have any success in tackling the U.S.’ obesity epidemic, one of the most serious public-health challenges facing the country.

“Perhaps new incentives are needed to encourage the food industry to work with families and the medical community to prevent obesity,” write Zylke and Bauchner. “Could some form of tax credits be used to ensure that if food company profits decline with the phrase-out of unhealthy products and failure or slow adoption of new products, the industries will be protected from shareholders’ concerns? Are partnership between medical organizations and the food industry feasible, such as a local health eatery providing nutrition or cooking classes at a medical clinic?”

“The obesity epidemic in the United States is now 3 decades old, and huge investments have been made in research, clinical care, and development of various programs to counteract obesity,” they add. “However, few data suggest the epidemic is diminishing. Perhaps it is time for an entirely different approach, one that emphasizes collaboration with the food and restaurant industries that are in part responsible for putting food on dinner tables.”

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It’s clear that the approach we’re taking now — which is mainly to put most of the responsibility on the individual (essentially a “blame and shame” tactic) without demanding much accountability from our private or public institutions — is just not working.

FMI: Both studies can be read in full at JAMA’s website. The commentary, however, is behind a paywall.