SOLUTIONS: Eradicating America's obesity epidemic

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By Drs. Robert F. Kushner, Donna H. Ryan and Steven R. Smith

We believe that a national debate on obesity, similar to past campaigns in smoking and cholesterol, will be necessary to move us ahead. The public also needs to understand the consequences of obesity, such as an increased risk of diabetes, cardiovascular disease, breast and colon cancer, orthopedic problems and other common medical disorders, so that they can make informed decisions about their lifestyle and seek out evidence-based treatment.

• Increase access to professional treatment of obesity so that the more expensive and devastating consequences can be averted.

Reimburse professional care for obesity, including obesity drugs and surgery, where appropriate, just like antihypertensives and cholesterol-lowering medications. We believe the fact that these treatments are not widely covered is linked to the general bias that obesity is a problem of willpower, not a medical condition that needs scientifically grounded treatment.

• Incorporate nutrition education, lifestyle counseling, obesity diagnosis and obesity management into the curriculum of medical schools and other professional schools, and create and designate a cadre of obesity specialists within relevant professions.

Implement new educational, credentialing and mentoring programs to train and designate clinicians with expertise in the evidence-based management of obesity so that the public can seek out quality medical care for obesity.

• Change the national policies that make the problem worse.

We need to revisit our national food policies, especially our farm policies, that encourage the production of energy-dense foods with low nutritional value.

• Focus on preventing weight gain in adulthood and excess weight gain in childhood.

Teach healthy behaviors and lifestyles early in life, and encourage and provide healthy non-obesigenic school lunches. These should be part of a broad educational initiative that introduces healthy foods into the classroom and reinforces healthy food choices.

• Build environments that encourage healthier behaviors.

We need to build and rebuild our cities, work environments and schools to encourage healthy behaviors such as walking. These changes will need to occur through several avenues including regional and municipal planning, architectural processes and individual lifestyle choices. Given that most Americans spend a large portion of their days at workplaces argues for the inclusion of opportunities for a healthy active lifestyle at work.

• Fully understand the economic impact of obesity on medical expenditures and lost wages.

Obesity is expensive. Recent calculations put a dollar estimate on the obesity epidemic at $140 billion a year in extra medical costs. Obese people spend on average $1,500 a year more for medical care on average than a person of healthy weight.

A broad understanding of the economics of obesity will allow market forces to act. For example, employers paying the increased medical costs associated with obesity may choose to implement work-based prevention programs or redesign workspaces to incorporate healthy food choices and increased opportunity for physical activity into the workplace.

• Support research at a level commensurate with the magnitude of the problem.

There is a large imbalance between the disease burden and the current level of research dollars as compared to other diseases. We believe that a doubling of funding for obesity research from federal agencies including the National Institutes of Health, the United States Department of Agriculture, and the federal Centers for Disease Control and Prevention will be needed.

This is the research that will determine the genetic and environmental factors that make some susceptible to our unhealthy environment. The research effort should also develop novel treatments so that science, not myth and personal beliefs, can drive our policy forward.

• Dr. Robert F. Kushner is a professor at Northwestern University Feinberg School of Medicine in Chicago and president of the Obesity Society. Dr. Donna H. Ryan is an associate executive director for clinical research at Pennington Biomedical Research Center in Baton Rouge, La., and president-elect of the Obesity Society. Dr. Steven R. Smith is executive director of the Clinical Research Institute at Florida Hospital-Burnham Institute in Orlando, Fla., and chairman of the Obesity Society's public affairs committee.