Girth control: a big fat failure


RECENTLY we learned the latest bad news about the girth of America, complete with more warnings that the "epidemic" of corpulence is killing us.

The experts keep saying that being overweight increases the risks of diabetes, heart disease, hypertension and cancer, yet Americans keep larding it on. Obesity - being extremely overweight - soared nearly 50 percent during the 1990s to 18 percent of the adult population, according to federal data featured in the Journal of the American Medical Association.

Losing the war

C'mon. Isn't it time we admit that as publichealth campaigns go, the battle against the bulge is a big fat failure? Isn't it time for new approaches? More and more experts think so.

"You have the government exhorting individuals to lose weight and eat more vegetables," said Morgan Downey, executive director of the 4yearold American Obesity Association in Washington. "We've tried that for 15 or 20 years, and it hasn't worked."

Echoed Steven Blair, an obesity researcher at the Cooper Institute for Aerobics Research in Dallas: "I think our strategy is completely wrong. We have proof that it doesn't work."

That strategy, spelled out in National Institutes of Health guidelines and other publichealth initiatives, preaches weight loss through lifestyle change - good old diet and exercise.

Public-health weight loss initiatives say that only the very fat or sick should resort to weightloss drugs. People should strive for a body mass index, or BMI, of less than 25 (think 5foot4, 146 pounds). A higher BMI means overweight, and 30 or more (think 5foot4, 175 pounds) means obese.

BMI, a ratio of weight to height that is correlated to health problems, has become the Holy Grail of weight research even though it does not work for children and athletic men.

"I'm annoyed by the emphasis on BMIs," Mr. Blair said. Given that the tried and tried and tried and true strategy is failing, new schools of thought are emerging.

One school contends it is OK to be fat as long as you are fit. Another says that if you cannot change the individual, change the world.

Fit but fat

Mr. Blair is an advocate of the fatbutfit school. His research, including an article in a recent issue of JAMA, shows that being sedentary increases death risk, regardless of weight.

"I think lack of activity is a far more important health risk than obesity," he said. "I don't mean to leave diet out completely. Big portions and highfat foods are a problem. But let's not obsess so much about our weight and focus on getting exercise."

The second school of thought shifts the emphasis from the individual to society. It postulates that people cannot be expected to stop making bad food choices and being couch potatoes while they are being seduced by computers, television, cars and junky food.

Psychologist Kelly Brownell, an obesity researcher at Yale University, calls the food environment "toxic." "We have the worst food environment in the world," he said. "If we don't change it, I bet every penny we'll have more obesity in 10 years."

Among the proposals for social change: Slap a sin tax on fatty foods, with the revenues going to subsidize healthy foods and fitness centers, Ms. Brownell said.

Taxing situation

Ditto, says the Center for Science in the Public Interest. But the tax also should be on TVs and cars, and the revenues also should be used for a media campaign promoting fitness.

Center director Michael Jacobson also advocates a governmentsponsored MustNotSee TV Week, a ban on junkfood advertising on children's television, calorielabeling on fast foods and federal testing of diets on the bestseller list.

Quack diets would get a stamp of disapproval. Make weightloss treatment involving prescription drugs or reputable diet centers tax deductible, just like smoking cessation programs, says the American Obesity Association, which has filed a petition with the IRS.

Mandate daily physical education, which has been a casualty of school budget cuts and new academic requirements, in schools, says Art Campfield, an obesity researcher at the University of Colorado Health Sciences Center.

Encourage exercise through everything from making stairwells more attractive to retrofitting communities with sidewalks and bike trails, says William H. Dietz of the Centers for Disease Control and Prevention.

Anti-fat campaign

Most socialchange advocates take a cue from the publichealth campaign against smoking. That campaign has succeeded not only by raising awareness of the health risks of smoking but also by making the habit inconvenient, expensive and socially unacceptable.

The problem is that a social campaign to discourage being fat could be twisted to encourage fat discrimination. Civil libertarians shudder at the idea of "food police" interfering with consumer choice.

"Smoking can be viewed as evil, but you need to eat to live," Mr. Campfield said.

So far, experts say, the proposed strategies are mostly rhetoric because leaders in government, business and other institutions have lacked the will to take action.

Said Mr. Jacobson: "It may be that we enjoy our slothful, gluttonous lifestyle so much that we'll just remain overweight until we come up with a drug to cure it."

Marie McCullough is a staff writer for the Philadelphia Inquirer.

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