There is an epidemic of obesity in this country affecting all ages, both genders and all ethnic groups. Thus, the report "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation" from the prestigious Institute of Medicine, adds to the decibel of beating drums calling for national action. However, close examination of the document raises a significant concern. Importantly, the report promotes the roles of increased physical activity and better nutrition as cornerstones of a strategy to combat obesity, but what about sleep?
A search of the document finds the word "sleep" written only four times, and all of these are in reference to sleep apnea. Did the authors of this report ignore the accumulating data implicating sleep deficiency as an important contributing factor to development of obesity? Moreover, did the Institute of Medicine ignore their own previous report, "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem," in which they cite evidence linking sleep loss to obesity? Unfortunately, the answer appears to be "yes."
What are the lines of evidence linking insufficient sleep to obesity? First, there is general agreement that time spent sleeping has declined over the past 30 years. This roughly approximates the rise in obesity. Second, a number of general population studies demonstrate that obesity is more common among those who sleep fewer than six hours per night. Furthermore, short sleep durations also are predictive of future weight gain. Third, basic research shows that short sleep durations increase levels of a hormone that stimulates appetite and simultaneously reduces the levels of a hormone that reduces appetite. Fourth, night shift workers generally sleep less than day shift workers but on average weigh more. Finally, on a personal level, have you felt hungry after staying up all night? I have, and my guess is that many of you have as well. Perhaps this is the best evidence of all linking inadequate sleep to obesity.
With the "weight" of the evidence implicating sleep deficiency as a risk factor for obesity and the indisputable fact that we should be spending one-third of our lives sleeping, can it be denied that sufficient sleep is the third pillar of health along with good nutrition and regular physical activity? Why the Institute of Medicine failed to come to this conclusion is unclear to me. However, the fight against obesity will be difficult to win unless all obstacles are addressed. A golden opportunity may be lost unless America recognizes that more sleep equals less weight.
For more by Stuart F. Quan, M.D., click here.
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