Wednesday, August 11, 2010

Obesity Epidemic: Let's move from media attention to action

We have covered numerous aspect of the obesity epidemic over the past 3 months. The report last week on rising obesity in America continues to point to the growing burden now and into the future that our lifestyle and social structures are  facilitating. Time (see article) covered a new research study showing weight gain during pregnancy increases risk of heavy weight babies – and previous studies show birth weight and childhood obesity lead to adult obesity. Are we programming the next generation for obesity and poor health?

Recent studies now suggest that diet around the time of conception can impact the genetic function of cells in the newborn – programming them to become overweight and obese adolescents.

Given the mounting evidence when will we move beyond simply reporting more studies and translate our enormous knowledge base to an action plan that is supported, implemented, and finally successful to turn the epidemic around and successfully prevent cancer and other chronic diseases like diabetes and heart disease that are driven by the excess weight gain we are seeing al around us?

Australia has launched a major campaign with strategies (see reports) that range from reshaping the food supply towards lower risk products and encouraging physical activity to protecting children and others from inappropriate marketing of unhealthy food s and beverages, to reshaping the urban environments towards healthy options (active commuting and the like) to strengthening the skills of primary cancer providers and the public health workforce to support people making healthier choices. All these changes must of course be implemented across all sectors of society to shift us to a healthier population with lower risk of cancer diabetes and heart disease.

Action steps:
We need to focus on steps we can take with our families, friends and workplaces; strategies that will change our environment to be healthier; and changes in the health care system place more skills and appropriate resources into bringing weigh control into the center of many interactions between patients and health care providers.


Tips for individuals

The basics
To achieve and maintain a healthy weight, you must find a balance between the calories you take in from food and the calories you burn during physical activity.  Eating more calories than you burn leads to weight gain; eating fewer calories or exercising more leads to weight loss.

To lose a pound of weight, you must burn 3,500 calories more than you take in.  This is possible by combining healthy eating with increased activity.   For example, eating 350 fewer calories and doing 30 minutes of moderate activity (burning 150 calories) leads to a 500 calorie reduction per day.  Over seven days, this results in a 3,500 calorie reduction and the loss of one pound.   Even small changes can make a big difference: cutting out one soda (about 150 calories) or taking a 30 minute brisk walk (also about 150 calories) on most days can lead to more than a 10-pound weight loss over a year.

Tips on diet and weight
The best way to lose weight is to make small changes in diet and exercise that can be maintained over time. 
  • Set reasonable goals.  First, avoid additional weight gain.  If you are overweight or obese, aim to lose 10% of your body weight, which can bring significant health benefits.
  • If you need to lose weight, do it gradually.  Work to lose 1/2 to 2 pounds per week, and keep it off permanently.
  • Motivation is key.  You are more likely to succeed when you believe you can and are willing to take steps to control your weight.
  • Avoid large, rapid changes in your diet.  Your body may react by slowing its basal metabolic rate, making it harder to shed extra pounds. It is better to make small changes that can be maintained over time.  Gradual weight loss can lead to decreased body fat, not just the temporary loss of water weight that can come with rapid weight change.
  • Avoid fad diets, which do not include a variety of nutritious foods or promise quick and easy weight loss.  Weight that is lost quickly is often regained quickly.
  • Make healthy food choices.  Focus on fruits, vegetables, and whole-grain foods.  Many high fiber foods provide nutrients and help you feel full.
  • Know your eating patterns.
  • Find ways to deal with stress other than eating.  Try exercise, support groups, meditation, or talking to friends
  • Eat a healthy breakfast, and don't skip meals.  Try to eat small meals throughout the day to keep from feeling too hungry.
  • Plan healthy snacks, and make them readily available.  For example, have carrots and celery sticks, or pretzels and popcorn around the house.  Leave a bowl of fruit on the table.  Bring healthy snacks to work.
  • Drink water to keep yourself well hydrated, and avoid high calorie sodas.
  • Avoid alcohol, which can add a lot of calories without any nutritional benefit.
  • Avoid snacking or eating meals in front of the television.
  • Eat smaller portions, and use a smaller plate if you like seeing a plate full of food.
  • Identify the barriers to healthy food choices and look for ways to overcome them.


When you shop 
  •  Don’t go food shopping when you are hungry.  Make a grocery list, and stick to it. 
  • Always read labels to learn how many calories and what types of nutrients are in different foods.
  • Go to the produce section of the store first to make sure you get enough fruits and vegetables.
  • Don’t buy “junk food” or drinks high in added sugar, like soda, fruit drinks and sports drinks.
  • Buy more chicken or fish instead of red meat.
  • If you like red meat, choose the leanest cuts (such as cuts called "loin" or "round").
  • Instead of whole-milk or 2%, choose low-fat dairy products, like 1% or fat free milk, cheese and yogurt to get the nutrients you need with less fat and fewer calories.
  • Choose lower calorie options if they are available.  Remember that low-fat options may be high in calories, and even low-calorie foods can lead to weight gain if eaten in large amounts.
  • Choose a squeeze margarine without any hydrogenated oils instead of butter or stick margarine.
When you prepare food
  •          Make fruits, vegetables, and whole grain foods the center of your meals.
  •  Always take the skin off chicken, trim the fat from meat, and drain the grease
  •  Bake or broil foods instead of frying them.
  •  If you cook or bake with oil, use it sparingly and choose the more healthy oils, like peanut, canola, or olive oil, rather than butter or shortening.
  • Avoid drenching salads in dressing. Use a smaller amount of dressing, and spread it evenly over your salad.  Use lemon juice or spices to add extra flavor.
  • Avoid adding large amounts of butter or margarine to foods, like bread, corn, potatoes, or vegetables.
When you eat out
  •   Choose salad instead of creamy soups, high-calorie appetizers, or dinner rolls.
  •  Select from the light menu if one is available.
  •  Choose chicken or fish instead of red meat.
  •  Ask for baked or broiled foods instead of fried foods.
  •  Order a half portion, or take extra food home in a doggy bag.
  • Order items without mayonnaise or cheese.
  • Don’t add extra butter, margarine, sour cream, or dressing to your food.
  • Skip dessert or share with a friend.
  • Drink water instead of high calorie soft drinks.
  • Limit alcohol.



Tips on exercise and weight
Physical activity does not need to be strenuous to be healthy.  Exercise not only burns calories, it also raises the body's metabolic rate (how fast the body burns calories even when you're not exercising). Exercise also decreases appetite, helps reduce stress, and lowers the risk of many chronic diseases.
  • Start slowly and build up the amount of physical activity that you do each day.
  • Even if your time is very limited, you can reach the recommended 30 minutes per day by  doing just a few minutes of exercise several times per day.
  • Decrease time spent doing sedentary activities like watching TV.
  • Plan family activities centered around fun and exercise.
  • Pick activities you enjoy.
  • Establish an exercise routine.
  • Make exercise a priority.
  • Find a friend to exercise with.
  • If you start getting bored, make an exercise log to check to progress, or consider adding other types of physical activity to keep up your interest.

Important reminders
Weight control is a lifelong effort, so don't get discouraged by temporary setbacks.  Losing weight can be very challenging; work to keep yourself motivated. 

  • Make healthy food choices and stay active.
  • Set short-term, realistic goals, and reward yourself for achieving them with non-food items, like a movie, a visit with a friend, or a new piece of clothing.
  • Keep a food diary and an exercise log to monitor your progress, identify barriers and improve your efforts.
  • Avoid weight gain over the holidays. If you do gain weight, take steps to lose it as soon as possible.  Even a few pounds gained each year can add up to a large weight gain over time.
  • Weight-loss diets should be lower in calories without compromising nutrition.
  • Always think about healthy substitutions, like having a baked potato instead of French fries, a bagel instead of a doughnut, fish instead of beef, pretzels instead of potato chips, fruit instead of cookies.
  • Don't deprive yourself.  Instead look for lower-fat or lower-calorie substitutes.  If there is no acceptable substitution available, have a smaller portion, or have it less frequently.
  • Ask for help if you need it: talk to family, friends, or your health care provider.  Also consider a weight loss support group in your neighborhood or at a health club.






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