In the United States, the prevalence of obesity increased from 12 percent in 1991 to nearly 18 percent in 1998.
A study of self-reported weight, weight goals and weight control strategies in Olmsted County (Minnesota) outlines the small percentage of people utilizing the recommended approach of combining food restriction with at least 150 minutes of exercise per week. It notes the efforts being undertaken by CardioVision 2020, a comprehensive program designed to reduce the burden of cardiovascular disease on the population of Olmsted County. It considers obesity as a risk factor for cardiovascular disease.
"Like the majority of people in the United States, the majority of people in Olmsted County desire to control their weight," said Thomas Kottke, M.D., cardiology, of Mayo Clinic and an author of the study. "The community has responded with plans to help residents meet their goals, although efficacy and outcomes remain to be determined."
A random-digit dial telephone survey of 1,224 Olmsted County residents from Feb. 28 to May 5, 2000, found that 65.6 percent of men and 47.9 percent of women reported that they were overweight or obese. Of the respondents, 72.6 percent of men and 85.1 percent of women reported that they were either trying to lose or not gain weight. The average weight loss goal for individuals trying to lose weight was 23.4 pounds for men and 28 pounds for women. Only one-third of individuals trying to lose weight and one-fifth of individuals trying not to gain weight reported using the recommended approach of combining food restriction with at least 150 minutes of exercise a week.
CardioVision 2020 has coordinated activities to aid people in their weight-loss efforts including a menu-labeling program, a campaign over the 2002 winter holiday season to help residents avoid weight gain at this time and a program to encourage daily physical activity.
Authors of the study include: Dr. Kottke, Matthew M. Clark, Ph.D., Lee A. Aase, B.S., Catherine L. Brandel, B.S.N., Stephen W. DeBoer, M.P.H., Sharonne N. Hayes, M.D., Rebecca S. Hoffman, B.A., Peggy A. Menzel, B.S., and Randal J. Thomas, M.D., all of Mayo Clinic, and Mark J. Brekke, M.A., and Lee. N. Brekke, Ph.D., of Brekke Associates, Inc., of Minneapolis.
In another article in the February issue, researchers found in their study of health behaviors of women after a breast cancer diagnosis that only a minority (39 percent) of the respondents reported consuming a diet low in fat and exercising at recommended levels, which suggests a need to improve both diet and exercise behaviors among women treated for breast cancer.
"Future work is needed in designing and implementing interventions that will promote adoption and maintenance of healthy dietary and exercise behaviors among breast cancer patients," said Bernardine M. Pinto, Ph.D., of the Centers for Behavioral and Preventive Medicine Miriam Hospital and Brown Medical School and an author of the study. "It is likely that these positive lifestyle changes may help these women to live longer, healthier lives and enhance their quality of life."
The study surveyed 86 women who had been treated for breast cancer. It found 54 percent were overweight or obese. Overweight and obese women reported low self-efficacy for exercise and eating, suggesting that interventions should focus on increasing self-efficacy for behavior change.
Other authors in the study include: Nancy C. Maruyama, M.D., of the Department of Consultation-Liaison Psychiatry and Behavioral Medicine, Beth Israel Medical Center in New York City, Matthew M. Clark, Ph.D., of the Department of Psychiatry and Psychology at Mayo Clinic, Dean G. Cruess, Ph.D., of the Department of Psychology at the University of Pennsylvania, Elyse Park, Ph.D., of the Department of Psychiatry and Medicine at Massachusetts General Hospital and Mary Roberts, M.S., of the Centers for Behavioral and Preventive Medicine Miriam Hospital and Brown Medical School.
Another article in Mayo Clinic Proceedings summarizes the benefits of undertaking daily physical activity and recommends that physicians include physical activity counseling into their practice.
"The health gain obtained by completely sedentary patients who undertake moderate physical activity is equal to or greater than the gains experienced by individuals who are already physically active and increase their level of activity," said Frank W. Booth, Ph.D., of the Department of Biomedical Sciences at the University of Missouri, and an author of the study. "Thus, physical activity counseling should become an integral component of routine practice in the primary care setting. It is difficult to imagine a more effective approach to improving our nation’s health."
Other authors are Manu Chakravarthy, M.D., Ph.D., of the Department of Internal Medicine at the University of Pennsylvania and Michael Joyner, M.D., of the Department of Anesthesiology at Mayo Clinic.
The authors found that despite the evidence supporting the numerous benefits of physical activity in preventing chronic health conditions, only 22 to 48 percent of patients receive advice from their physicians to increase their level of physical activity. Not only can physicians affect their patients’ activities, but the authors note that physicians can influence policies related to physical activity promotion in the community.
The Mayo Clinic Proceedings editorial by Steven N. Blair, and Milton Z. Nichaman, M.D., of The Cooper Institute in Dallas, Texas, says, "We believe that the evidence suggests that declines in physical activity are more likely than increases in food intake to be the explanation for the recent increase in obesity prevalence."
The editorialists note that intervention studies in recent years show that it is possible to help sedentary individuals become and stay more physically active and to make diet-related behavioral changes leading to weight loss.
A chart that accompanies the editorial includes comparisons of sedentary and active energy expenditures. The table outlines how conveniences in life account for fewer calories being burned. For instance, a few more calories can be burned by not using your garage door opener and getting out of the car and opening the door (<1 vs. 3), riding an elevator up three floors vs. walking up the stairs (0.3 vs. 15) or paying at the gas pump vs. walking inside to pay (0.6 vs. 5). Larger differences were noted when you choose to use a lawn service instead of doing the yard work yourself (0 vs. 360) and letting the dog out the back door vs. walking it for a half hour (2 vs. 125).
Effective strategies for dealing with the increasing prevalence of obesity depend on a better understanding of the causes. As those become better known, people can still engage in activities that will reduce the risk of unhealthy weight gain, including a plant-based diet with no more than 30 percent of food from fat and at least 30 minutes of moderate-intensity physical activity a day.
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.
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Monday, Feb. 11, 2002 Obesity
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