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Solutions for the Obesity Epidemic

For most people, behavioral change is difficult, and the forces contributing to the obesity pandemic are diverse and strong. Solutions must also be diverse and strong.
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Some epidemiologists believe that excess weight will soon rival tobacco as the world’s leading cause of preventable premature deaths—the obesity pandemic’s health effects may wipe out the gains in life expectancy achieved through decreasing smoking rates.
 

Globally, at least 1.3 billion adults and more than 42 million children are overweight or obese.

The consequences are considerable. Excess weight increases the risk of a wide range of illnesses, including diabetes, heart disease, and certain cancers; an estimated 2.6 million people die each year as a result of being overweight or obese.

Health Care Spending

The obesity pandemic also has significant economic consequences. The World Health Organization estimates that in many developed countries, obesity now accounts for 2 percent to 7 percent of all health care spending. Yet medical costs are only a small fraction of the pandemic’s total costs.

Economic Impacts

Among its other adverse economic effects are

  • heightened absenteeism rates
  • reduced worker productivity
  • increased food and clothing costs

Causes of Obesity

Although poor dietary choices and physical inactivity are important contributors to the pandemic, they are far from the only causes.

Evolution has left us with a biological susceptibility to weight gain. Our bodies appear to be more finely attuned to food scarcity than food abundance. Hormonal feedback loops encourage us to seek food when we are hungry and to conserve energy when food is scarce; we do not seem to have comparable feedback loops to prevent us from overeating or to burn extra calories when food is abundant.

Energy expenditure depends on physical-activity levels, and modern life has drastically reduced the amount of physical activity most of us get.

Psychological forces: Many people use food not merely for sustenance but also as a reward (even after exercise), for emotional comfort, or as a way to relieve stress. Several mental disorders, including depression, increase the risk of obesity.

Decisions about food are made rapidly, at times when people are distracted or pressed for time. Food manufacturers, grocery stores, and restaurants take advantage of this fact by appealing to our desires for convenience.

Marketing strategies provide a variety of external stimuli (sights, smells, tastes, and even the simple availability of attractive food) can activate specific neural networks that increase our appetites sufficiently to override the few innate mechanisms to curb food intake that we do have.

Social acceptance from theobesity  pandemic also appears to have made it psychologically easier for people to accept their own increasing weight. Studies have shown that a person’s chances of becoming obese increase by 57%  if he or she has a friend who has recently become obese.

Advances in food production and marketing  have markedly reduced the cost of many types of food, which has made it easier for people to overindulge. For example, the availability of inexpensive food enables many people to dine out frequently and at most restaurants diners are highly unlikely to be able to determine the calorie content of what they are eating but, given typical portion sizes, highly likely to overeat.

Cost of healthy foods (fresh fruits and vegetables, for example) are often more expensive than unhealthy choices; most inexpensive food is nutrient-poor but full of sugar, salt, and fat. The adoption of a Western diet full of nutrient-poor processed foods helps explain the coexistence of obesity and malnutrition.

Community policies and infrastructures obstruct good health practices.

Many schools, for example, feed students fast food  and make revenue from vending machines with high-calorie snacks.

Many employers require their staff to work long hours at sedentary jobs yet permit vending machines with high-calorie snacks in the workplace.

Many employers also have maternity-leave policies that make it difficult for new mothers to breast-feed (a practice that decreases the risk that their children will become obese).

Few employers make it easy for their staff to bicycle or walk to work or to get regular exercise in other ways.

Town planners often widen streets for cars but fail to include bike lanes or sidewalks. Land-use policies may make it difficult for people to get to supermarkets and other sources of healthy food or to find open areas for recreation.

Health officials have also inadvertently helped promote the pandemic. If, for example, they impose restrictions on pregnant women’s access to prenatal care and counseling, they increase the likelihood that both the women and their children will become obese.

Factors that contribute to the obesity pandemic, are interconnected and often mutually reinforcing. Unless effective actions are taken soon, the pandemic could become self-perpetuating.

Obesity Solutions

Rhe best results are achieved when entire communities join together to address multiple causes of obesity simultaneously. The communities create social movements that make healthy eating and exercise the norm.

To be successful, these social movements require the involvement of a wide range of stakeholders, including health professionals, payors, schools, employers, transportation authorities, food production and distribution companies, and the media.

Researchers believe that only governments—national, regional, and local—have the scope, scale, and mandate to ensure the participation and collaboration of all stakeholders. Governments are in a uniquely powerful position to encourage local organizations to undertake initiatives to promote healthy weights and to lay the foundation required to allow those efforts to succeed.

Many developing countries now face yet another health dilemma: obesity rates are increasing even though many people remain significantly malnourished.

The consequences of rising obesity rates are considerable. Excess weight increases the risk of

  • diabetes
  • heart disease
  • stroke
  • osteoarthritis
  • several forms of cancer (including esophageal, colorectal, breast, endometrial, and kidney cancer)
  • and many other illnesses.

BMI is the Key Metric

Calculations reveal that medical costs are directly proportional to BMI; in the United States, every point of BMI above 30 is associated with about an 8 percent increase in a person’s annual health care expenses

Research revealed that single-intervention programs, such as low-calorie diets and exercise regimens, generally produce only modest weight loss.

The best results are achieved with multipronged programs that involve an entire community.

Better results are obtained when several interventions are used together.

In addition to diet and exercise, the interventions can include

  • nutrition classes
  • one-on-one counseling
  • drug therapy
  • bariatric surgery
  • financial incentives

Workplace Case Study of Obesity Results

The Dow Chemical Company, for example, randomly assigned half its work sites to a multipronged health-promotion program; the other half served as controls.7 At the intervention sites, employees were offered health assessments, educational materials, and online behavioral-change programs; in addition, they were given easier access to exercise (walking trails were built, for example) and provided with much healthier food choices in cafeterias and vending machines. At both one- and two-year follow-up, the company found that employees at the intervention sites had maintained their weight and BMI, whereas the employees at the other sites had increases in both metrics. Significant differences between the intervention and control sites were also found in average blood pressure and cholesterol levels.

Community Case Study

Towns in northern France (Fleurbaix and Laventie) undertook a regional initiative to reduce childhood obesity rates.8

  • They began by educating children about the consequences of obesity and the importance of healthy eating habits.
  • They improved the food offerings in school cafeterias, provided nutritional family breakfasts at the schools, and started cooking classes for children and their parents.
  • After a few years, Fleurbaix and Laventie expanded their efforts by hiring dieticians and a sports educator to create programs on nutrition and physical activity in the schools.
  • They also built new sports facilities, launched walk-to-school groups, and developed family activities to promote exercise.
  • They encouraged general practitioners to identify all overweight and obese children and refer them to the initiative’s dieticians, who then put the children on programs to help them lower their BMI.
  • The towns also undertook an aggressive social-marketing campaign to promote healthy behaviors.

The results were striking. The prevalence of childhood obesity in Fleurbaix and Laventie decreased substantially—but it rose in nearby towns.

The initiative was so successful that more than 200 other towns in France have adopted it; many of them have already reported marked decreases in the prevalence of children who are overweight or obese.

Lessons learned

The McKinsey research confirms that successful weight-management programs, like most successful public-health efforts,

  • Have clear goals and clear ways to measure progress against those goals.
  • They predefine their target population (children, adults, or both) and their objectives (whether to reduce the prevalence of obesity or to prevent further weight gain).
  • They also carefully assess how well the various interventions are being used and what results are being achieved.

Three other important lessons can be drawn from successful programs to help people lose weight or maintain a healthy weight.

First, there is no “silver bullet,” and short-term efforts have little impact. Successful programs use multipronged approaches that are sustained over several years.

Second, customization is important, because the specific factors contributing to the obesity pandemic vary from area to area.

Third, broad engagement is crucial—the program must involve a wide range of stakeholders throughout the community. For most people, behavioral change is difficult, and the forces contributing to the obesity pandemic are diverse and strong. As a result, a program will not succeed without widespread support.

REFERENCE: Read the full, detailed report at McKinsey:   McKinsey Quarterly



Editor, Carolyn Allen

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Publication Date: 11/16/2010
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