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Tackling Obesity: Cheers to the New Year -- Another Chance to Get It Right

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Advice on how to lose weight weighs heavily on us. Wherever we turn, we hear, see or read the depressing message that our health will suffer if we don't trim down. Diabetes, cancer, heart disease, stroke -- all are grim consequences of surplus pounds. Some experts have even calculated how overindulging shortens our lives. Eating a serving of red meat, for example, may knock 30 minutes off our last day.

Reality is intruding on any complacency we might otherwise enjoy. According to the annual statistical update from the American Heart Association, overweight or obese adults (age 20 and over) outnumber normal-weight or underweight adults by two to one. One in 3 Americans has high blood pressure, and among minorities, African-Americans are hardest hit with a rate of 44 percent. Over half of the adults in the United States have prediabetes, diabetes or undiagnosed diabetes. Only 1 in 5 Americans gets the recommended amount of daily exercise.

In our quest to be fit and achieve wellness, Americans receive advice gleaned from around the world. Adopt the Japanese hara hachi bu style of eating, where one stops eating when 80 percent full. Brew a cup of golden root tea like the Russians to destress and avoid compensating with food. Adopt the Greek habit of afternoon naps to avoid making bad choices about eating because of fatigue. Ride a bicycle to and from work and for shopping like the Dutch. The list goes on and on.

Most of us have absorbed some of these messages (sometimes the advice is conflicting), yet few of us understand how to trigger a shift in our behavior, one that we could sustain for the rest of our lives.

Despite being exhorted to eat less and move more, we've done the opposite -- eaten more and moved less. Today's average adult now sits for 50 to 70 percent of all waking hours. And on average, we eat 2,594 calories per person per day compared to 2,169 in 1970, an increase of 20 percent. A big share of our calories comes from soft drinks. According to a 2012 Gallup poll, almost half of Americans drink soda daily and of those who do, the average amount is 2.6 glasses. In 2011, this level of consumption translated into nearly 45 gallons per person, according to Advertising Age.

The paradoxical behavior of seeking to lose weight while gaining weight makes one wonder if, as some claim, rats are indeed smarter than humans. Boston Medical Center estimates that 45 million Americans are headed down the diet tunnel at any given time in a heroic effort to lose weight on their own.

Despite the reality that diets don't work and frequently trigger weight gain, according to UCLA researcher Traci Mann, Ph.D., millions more of us are likely to head down a similar solitary path at the start of the new year. When a rat repeatedly goes down a tunnel and fails to find cheese, it eventually chooses a different passageway. So between the two, which species is more intelligent?

Shifting the Spotlight

If telling individuals to take responsibility for their weight and medical fate has failed to produce more healthful behavior, shouldn't we consider another approach? Instead of putting the spotlight (and shame) on the individual, should we consider tackling the issue of obesity together as a community?

Although still unstudied, this radical yet sensible approach seems to be spreading. Without minimizing personal responsibility, the notion that we can shift whole cultures to adopt healthier habits, whether the culture is found in a school, a workplace, a city or an institution, is gaining acceptance.

One indication of the new realization that we must take a community approach is reflected in the choice of Dr. Donna Arnett as the new president of the American Heart Association. Unlike her predecessors who were, with one exception, medical doctors, Dr. Arnett brings the discipline of epidemiology to the leadership task. (Dr. Arnett chairs the department of epidemiology at the University of Alabama at Birmingham.)

Epidemiology focuses on health-related issues in whole populations and the application of solutions to control health problems. This is reflected in Dr. Arnett's recent statement: "We're focusing on population-based ways to improve health factors for all Americans. In this race against time, it will take nationwide efforts driven by communities and systems -- a patient-by-patient approach alone won't do it."

Ahead-of-the-curve communities have already figured out that the key to reducing obesity is collective action. Consider Michele Hughes, for example. Eight years ago, she reluctantly joined a community-wide eight-week weight-loss event. At the time, Michele was a nurse in a hospital cardiovascular who was 40 pounds overweight and an infrequent exerciser. She was also a wife and the mother of two young boys.

During her community weight-loss event, she caught the fitness bug -- she became more disciplined in her exercise program and prepared healthier meals for her family. Eight years later, Michele is 40 pounds lighter and has competed successfully in marathon events, including the Boston Marathon. She also is passionate about promoting healthful behavior among her cardiovascular patients.

Michele's example is just the tip of the iceberg in terms of healthful changes that occurred in her community after the consciousness-raising event. Even more impressive is the reduction in the number of elementary school children at risk for obesity: The percentage declined from the national average (around 33 percent) to 18 percent.

To achieve these results, community fitness and weight-loss events typically rely on peer support, an approach that was validated in a recent National Institutes of Health funded study. A randomized clinical trial led by Angela Marinilli Pinto, Ph.D., assistant professor of psychology at Baruch College, compared weight-loss results achieved with professionally-delivered behavioral treatment with results achieved using trained peer counselors who were were part of the Weight Watchers network. Contrary to expectations, inexpensive peer counseling -- a key component of community events -- was more effective than counseling provided by health-care professionals.

Employers are also taking a community approach. For example, in the past few weeks, 700 employees of the city of Phoenix, Ariz., and their spouses, helped each other lose 4,000 pounds.

Dozens of other examples of emerging group efforts can be cited. Some events are organized around geographic locations, others are employer initiated and still others are organized on a membership basis, such as YWCA membership. Some involve face-to-face interactions among members; others are found in online groups. What all participants have in common is a willingness to go public with their private needs -- their weight and level of fitness -- so they can give and receive support and encouragement in a community of like-minded peers.

Point of No Return or Winnable Battle?

At least one research study involving mice suggests that after an extended period of being overweight, the body cannot return to a normal weight. A more optimistic perspective is taken by Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), who considers the issue of obesity a "winnable battle." But again, his strategy won't be based on the one-person-at-a-time approach. Rather, he will focus the CDC's efforts on "developing policy, systems, and environmental initiatives that help make healthy choices available, affordable, and easy."

According to a recent Gallup poll, access to health care, the cost of health care and obesity are the top three concerns of Americans. Clearly, the three are inextricably linked. The Centers for Medicare and Medicaid Services reported that $2.6 trillion was spent on medical care annually in U.S. in 2010. According to the Centers for Disease Control, "more than 75 percent of our health care spending is on people with chronic conditions" and "chronic diseases are among the most preventable." Eating a healthful diet, exercising regularly and maintaining a normal weight could significantly reduce health-care costs: Trim and fit Americans require less medical care and take fewer prescription drugs.

Shift Happens

As for obesity, consciousness-raising weight-loss events that dramatically shift the culture of entire communities have been operating under the radar of national awareness for several years. Like the social epidemic phenomenon described by Malcolm Gladwell in The Tipping Point, "Things can happen all at once, and little changes can make a huge difference." If Gladwell is correct in his conclusions about social epidemics, we can look for a visible and badly needed outbreak of infectious, community-based weight-loss and fitness events in 2013.

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