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OVERWEIGHT, OBESITY, DIABETES, HIGH BLOOD PRESSURE: (November 2003) Healthful Life has written repeatedly about the twin American health epidemics - overweight and diabetes. Some of the best analyses have come from the Centers for Disease Control (CDC) in Atlanta. An article in the Journal of the American Medical Association on New Year’s Day, January 1, 2003, from the same CDC group provides data from 2001 - and it is not good news. In 1990 -1991, 12 percent of American adults were obese and 5 percent had diagnosed diabetes. In 2001, 21 percent were obese and 8 percent had diagnosed diabetes. If overweight and obesity were considered together, 45 percent of adults were either overweight or obese in 1991; by 2001, that figure has increased to an extraordinary 58 percent. The percentages for everything - overweight, obesity, and diabetes have all gotten progressively worse since 1990. Furthermore, this was a telephone survey and that makes it likely that all the figures are underestimates. Other analyses suggest 30 percent of adults are obese. Overweight was defined by the body mass index (weight in kilograms divided by the height in meters squared). Normal is 25 or below; 25 to 29.9 is considered overweight; 30 to 34.9 is mild obesity (that corresponds to 20 to 40 percent overweight); 35 to 39.9 is moderately severe obesity, and above 40 is extreme obesity. In this study, body mass index (BMI) of 30 to 34.9 and 35 to 39.9 were combined. CLICK HERE for a table that allows you to find your own BMI Those who were overweight had a 60 percent increased risk of diabetes, an 80 percent increased risk of high blood pressure, and a 50 percent higher likelihood of elevated cholesterol levels. For those with moderate obesity, the risk of diabetes or high blood pressure was increased more than three fold, and the likelihood of a high blood cholesterol level or arthritis doubled. For those with severe obesity, everything was much worse with six to seven fold risk of diabetes or high blood pressure, and a four fold increased risk of arthritis. It is not a pretty picture, and it is getting worse every year in the United States. Overweight and obesity are the major cause of adult onset diabetes. What can be done about this awful health problem? The answer is plenty, but there are no simple, easy answers. We like to eat and there are hordes of very attractive, marvelous tasting high calorie foods and beverages. And, in this computer-television world of ours, we exercise far too little. Here is what Healthful Life recommends: 1. Everybody should have regular comprehensive prevention examinations with risk factor intervention and counseling. At those examinations, health care providers can focus on overweight, the complications of overweight (such as diabetes, high blood pressure), and insufficient physical activity. Those who are overweight or sedentary, once identified, can receive structured counseling and referral for health behavior modification modules designed to bring about healthy lifestyle changes. The biggest problem is getting people into a behavior change system run by competent health professionals carrying out standardized protocols so everyone can: (A) get involved as early as possible when they are overweight or even normal weight, but not obese (B) avoid the quick fix of irresponsible hucksters and entrepreneurs. There is, in our judgement, no better way to get people involved in their own health promotion than the comprehensive prevention examination. 2. Weight is, for the most part, calories in versus calories out. For overweight or obese people, that often means increased physical activity, in particular leisure time physical activity. The majority of adults are either sedentary or inadequately physically active. Physical activity intensity can be measured in METs. One MET is energy expenditure or calorie usage at rest. Two METs is activity that requires twice that energy expenditure (casual walking is 2 METs intensity). Three METs is three times the resting energy expenditure; walking at a one mile every 25 minutes pace achieves that intensity. Weekly physical activity is the sum of each activity intensity multiplied by the hours of that activity (so walking at a pace of one mile every 20 minutes for one hour four times a week is 3.5 MET-hours x 4 or 14 MET-hours per week. Healthful Life recommends a minimum of 12 MET-hours, and preferably 20 MET-hours per week of at least moderately vigorous physical activity. CLICK HERE for a table of physical activity intensities (in METs) The physical activity prescription will have to be tailored to the individual needs of each overweight person. Consideration will have to be given to age, associated or underlying conditions, amount of physical activity in the home, at work, etc. This can be discussed and worked out at the comprehensive prevention examination. 3. Caloric intake control. This is, of course, the hardest part. Counseling and health behavior modification may help. So can common sense, reducing portion size, choosing low fat food items. There are many approaches and, obviously, the plan of action has to be individualized. 4. We have to do a lot more for young people. Physical activity patterns have to be ingrained in junior high and high school students. That means more than just the usual mandatory gym or physical education. It requires a much greater investment in extracurricular individual and team athletics and a return to more non-varsity sports and intramural athletics. That, in turn, necessitates a much greater financial and time commitment than most communities or schools have been willing to make; indeed, the twenty-year progressive increase in overweight and obesity has been paralleled by a simultaneous reduction in expenditures on and commitment to extracurricular activities, including sports. The major point is that the overweight-obesity epidemic must be stopped. The critical component is getting adults involved in their own health at the comprehensive prevention examination. The earlier the involvement, the better; it is surely far better to attempt weight control when you are in the upper part of the normal weight range or are overweight, but not obese. Conversely, if you do not control your weight when you are in the overweight category, it is easy to slip into the obese category where it is much harder to get back to the normal range. One big problem is that the health insurers and HMOs do not want to pay for the comprehensive prevention examination. In their intransigence, they are not acting in the health interests of the American public, and they are making a mockery of their claim of focusing on health maintenance. That has to change. |
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