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What Can Physicians Do About Obesity?

Ross E. Andersen, PhD


Obesity is a serious and very common health problem. In 192021, the American Heart Association announced the addition of obesity to its list of major risk factors that people can control to prevent death and disability from coronary heart disease (1).

Over the past decade, the prevalence of obesity has increased at an alarming rate in the United States and in other developed countries around the world. In fact, the World Health Organization has acknowledged that there is a "global epidemic of obesity." It was recently reported that from 1991 to 192021 the prevalence of obesity increased by 49% among US adults age 20 or older (figure 1) (2). The prevalence of obesity increased by 70% among 18- to 29-year-old adults, and 80% among Hispanics. Moreover, US children and adolescents seem to be following the same pattern (3,4). The reasons for this dramatic increase reflect a complex interaction of societal, behavioral, cultural, physiologic, and genetic factors.

[Figure 1]

Obesity and HP 2010

These alarming statistics have led the Centers for Disease Control and Prevention to include obesity among the top leading health indicators to address in the Healthy People 2010 report, and targets for reduction of obesity in our youth and adults older than 20 have been proposed (figure 2). Currently, 23% of adults are obese, and the Healthy People 2010 goal is to reduce this proportion to 15%. For children and adolescents, the goal is to reduce the prevalence of overweight or obesity from 11% to 5%. If these lofty goals were met, they would represent a 35% decrease in the prevalence of obesity in adults and a 55% reduction in children.

[Figure 2]

Activity, Diet, and Obesity

It is well known that an active lifestyle is important for both health and weight maintenance. Lee et al (5) have recently reported that unfit, lean men have a higher risk of all-cause and cardiovascular disease mortality than men who are fit and obese. They conclude that being fit may reduce the dangers of obesity.

Although exercise is widely regarded as a key component in obesity treatment, few overweight individuals seem able to adhere to exercise programs long term. In response, efforts have focused on developing new approaches to physical activity that may appeal to sedentary, overweight persons. For instance, research has shown that accumulating multiple, short bouts of vigorous exercise enhances both exercise adherence and weight loss (6). Moreover, accumulating moderate-intensity activity throughout the day may offer health and weight benefits comparable to that of a traditional exercise program (7). Public health recommendations now include the option of accumulating 30 minutes of moderate-intensity physical activity a day for health and well-being. These two new options may offer a viable alternative to those who dislike or cannot sustain continuous vigorous exercise programs and may provide a realistic starting point for obese patients. Patients who have been sedentary can begin slowly. For example, patients can take the stairs at work rather than using the elevator, or park their cars a bit farther away to begin walking more. As patients become more exercise tolerant, they can engage in longer sessions and higher-intensity activities.

The other primary environmental determinant of obesity is a high-fat and calorie-dense diet. One of the challenges facing physicians trying to help patients control their weight is the food that patients eat away from home. Families spend a high proportion of their food budget on restaurant meals that tend to be higher in fat, saturated fat, and calories than meals eaten at home. Teaching patients how to make healthier food choices in restaurants and with carry-out meals will help them to consume a healthier, balanced diet. Patients can change their diet by eating leaner cuts of meat, eliminating high-fat snacks, reducing the amount of sugar consumed, and eating more fruits and vegetables. In addition, many restaurants offer low-calorie or "heart healthy" meals that fulfill many of these suggestions.

The Prescription for Obesity

In short, reducing the proportions of obese children and adults as outlined in the Healthy People 2010 guidelines represents a big challenge. If physicians are to help in meeting these targets, they must convey the health implications of obesity to their overweight patients and offer them strategies to lose weight. It is particularly important to intervene when patients are gaining weight and to encourage them to maintain or lose weight when they are only moderately overweight. Finally, physicians should inform obese patients who are not ready to lose weight that they can improve their health—independent of weight loss—by adopting a more active lifestyle.


  1. Eckel RH, Krauss RM: American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 192021;97(21):2099-2100
  2. Mokdad AH, Serdula MK, Dietz WH, et al: The spread of the obesity epidemic in the United States, 1991-192021. JAMA 1999;282(16):1519-1522
  3. Troiano RP, Flegal KM, Kuczmarski RJ, et al: Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149(10):1085-1091
  4. Ogden CL, Troiano RP, Briefel RR, et al: Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics 1997;99(4):E1
  5. Lee CD, Blair SN, Jackson AS: Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 1999;69(3):373-380
  6. Jakicic JM, Winters C, Lang W, et al: Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA 1999;282(16):1554-1560
  7. Andersen RE, Wadden TA, Bartlett SJ, et al: Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA 1999;281(4):335-340

Dr Andersen is a professor in the division of geriatric medicine and gerontology at the Johns Hopkins School of Medicine in Baltimore. Address correspondence to Ross E. Andersen, PhD, Division of Geriatric Medicine and Gerontology, 4940 Eastern Ave, Suite 025, Baltimore, MD 21224; e-mail to [email protected].