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A New Year's resolution: Tackle the problem of obesity

From the January-February ACP Observer, copyright 2005 by the American College of Physicians.

By Charles K. Francis, FACP

As the winter holiday season winds down, we'll remember the gatherings of family and friends, and the joy of giving and receiving gifts.

But all that merriment has a darker side: For many of us, the holidays also mean overeating and an intemperate use of alcohol. Even as we savor the season's festivities, the specter of holiday weight gain—whether or not most of us actually put on extra pounds—underscores the threat that obesity poses to our personal and public health.

Obesity in the United States has reached epidemic proportions, a fact all too familiar to internists. The problem of obesity—which is defined as having a body mass index (BMI) of 30 or more, with overweight defined as BMI of 25 to 29.9—has become one of the nation's most critical health care problems. According to the American Heart Association, about two-thirds of American adults are obese or overweight, along with an estimated 8.8 million children ages 6-19.

Adult obesity rates have jumped 60% between 1991 and 2000. And even though a recent study from the Centers for Disease Control and Prevention (CDC) overestimated the number of deaths attributed to obesity in 2000, the fact is that 300,000 adults in this country die of obesity-related causes every year.

A growing problem

The National Health and Nutrition Examination Survey (NHANES), which is sponsored by the CDC, is the country's prime data source for monitoring American waistlines. A NHANES study published last fall provides a disturbing snapshot of a growing national problem.

NHANES data reveal that overweight and obese patients are common in both genders and across all age groups. The average American man or woman has put on more than 24 pounds between 1960 and 2002, NHANES data report, with equally dramatic weight gains found among children of every age group.

And despite national and local efforts to address health care disparities, racial and ethnic health disparities are prevalent in obesity and overweight. Non-Hispanic black women post significantly higher obesity rates than non-Hispanic white women. And African and Hispanic American men likewise have higher mean BMIs than their white counterparts. Most disturbing of all, the mean BMIs for all ethnic groups are on the rise: Black women age 20 and over in the NHANES III 1988-94 report had a mean BMI of 29.1—a figure that has now risen in 2004 data to 31.1.

The Healthy People 2010 initiative, which has been designed by the Department of Health and Human Services to encourage healthy living and disease prevention, has identified the problem of obesity and overweight as one of this country's 10 leading health issues. The initiative established targets to be achieved by 2010, including one of having 60% of American adults at a healthy weight.

According to NHANES data reported in the June 16, 2004, Journal of the American Medical Association, however, only 33% of American adults have thus far reached that goal.

Fact or fiction?

So are our patients—and we ourselves—heavier than we were two months ago? The consumer press certainly treats holiday weight gain as an established fact, putting out countless tips between Thanksgiving and New Year's to help us avoid overindulging.

In fact, the five pounds of holiday cheer everyone is sure he has gained turns out to be a myth for most of us. In "A prospective study of holiday weight gain" published in the March 23, 2000, New England Journal of Medicine, the authors reported both good and bad news.

The good news is that most of the study's participants gained only 0.37 kg during the holiday season, with less than 10% gaining 2.3 kg or more. But here's the bad news: Whatever weight participants did put on during the pre-holiday and holiday seasons, they kept on into the new year, helping boost the country's rising rates of obesity and overweight.

As the new year begins, the medical community is increasingly preoccupied with how best to implement meaningful models to improve chronic care. That need is particularly crucial in tackling one of our foremost health care problems.

At their fall meeting, ACP's Board of Regents approved a new Clinical Efficacy Assessment Subcommittee guideline on the pharmacological and surgical management of obesity; look for that to be published soon. In the meantime, the issue of holiday weight gain—even if it's only slight—may serve to open a discussion with our patients that we must strive to continue yearlong.

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