Wednesday, October 05, 2005

Is Obesity Inevitable?

From an ongoing study, the Framingham Heart Study, newly released data suggests that as we age weight gain is inevitable. The results were just published in the journal, Annals of Internal Medicine. The 30-year continuous follow-up study found that most adults - 9 out of 10 men and 7 out of 10 women - were likely to be or became overweight as they grew older.

Some background - More than 4,000 participants, both male and female, were the offspring of the original Framingham Heart Study subjects, and were 30 to 59 years old when the next-generation study began in 1971 and have been followed ever since. The new data is based on follow-up through 2001.

As reported in Newsday, "National surveys and other studies have told us that the United States has a major weight problem, but this study suggests that we could have an even more serious degree of overweight and obesity over the next few decades," said Dr. Elizabeth Nabel, institute director. "These results may underestimate the risks for some ethnic groups," she added, noting other studies have shown that Hispanic and black individuals, especially women, have a greater prevalence of excess weight than white counterparts.

While the results are truly alarming, I don't think it is wise to conclude that becoming overweight or obese is inevitable. If that were true, this would be a global problem, evidenced by similar, parallel rises in the rates of overweight and obesity worldwide over the last thirty years. That simply has not happened. While the United States is not alone in its rising incidence of overweight and obesity, it remains one of a handful of countries globally that has experienced an alarming, steady rise over the last thirty years. An increase in the incidence of overweight and obesity that has resulted in 2 out of 3 Americans overweight and 1 of those 2 obese.

This follow-up study is indicative of our problem - something we're doing is placing us at a high risk for overweight and obesity over time. The participants of this study are average, everyday folks who live like most average Americans. There is nothing special about them, their diet or their lifestyle that distinguishes them from anyone else. They represent us. They show something is deeply flawed in our lifestyle of the past thirty years and predict that if we do nothing and fail to ask the right questions to find the solution, our fate will be growing fatter as we age.

A start would be to look to the 10% of men and 30% of women in the follow-up who did not gain weight to become overweight or obese. What did they do that was different from those who gained weight? Did the difference(s) change their health outcomes? How and why?

It is also time to start looking at the scientifically supported alternatives to the current dietary recommendations. We have our heels dug in with our public policy and clinical guidelines that only one dietary approach is healthy for all - a low-fat, high grain diet based on our Food Pyramid. Yet, on a global basis, few nations eat a diet that is within our guideline of 30% or less calories from fat and 10% of less from saturated fat. Industrialized nations with the lowest levels of obesity actually eat much higher amounts of fat, more protein as a percentage of calories and less carbohydrates - especially refined carbohydrates.

Rather than continuing on the path we are on, it is time to take a long hard look at those countries labeled "paradox" (France and Spain) along with countires that have maintained acceptable rates of overweight and obesity in their populations and understand what is right about their diet and lifestyle. We must think "outside the box" and start to really address the issue from more than a "calories in calories out" point-of-view.

That message has not and will not reverse the trend. It has not slowed the alarming rise in overweight and obesity in the United States. If we are going to reverse this trend, we must find solutions that work on an individual level and place every available tool in the toolbox for clinicians to help patients find a dietary approach that works for them - to not only lose weight but also optimize their health.

This is no longer a matter of what is a "politically correct" diet, but what is scientifically supported by evidence and can be tailored to an individual. While low-fat approaches work for some, we know they do not work for everyone. It is time to insist that evidence-based approaches be reviewed - everything from very low-carb diets to very low-fat diets - and clinical guidelines be developed now.

If we don't start now, obesity may very well be inevitable if we continue with what we know isn't working and hasn't worked for the last thirty years.

1 comment:

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