August 14, 2019
By Bharti Shetye, MD, FOMA
In June 2013, the American Medical Association (AMA) House of Delegates voted to recognize obesity as a disease state requiring treatment and prevention efforts. The prevalence of obesity was 39.8% and affected about 93.3 million of U.S. adults in 2015-2016. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer – some of the leading causes of preventable, premature death. The estimated annual medical cost of obesity in the United States was $147 billion in 2008; the medical cost for people who have obesity was $1,429 higher than those of normal weight.
Needless to say, effective obesity prevention programs are urgently required to change the rising trajectory of the obesity epidemic. We are obligated to brainstorm strategies to prevent obesity during different time periods of life.
Primary Prevention of Obesity
During the prenatal time period, an unborn child in the womb is exposed to nutrients and toxins consumed by the mother. An effective obesity prevention strategy during this time would hinge on the OB team. The journey toward successful obesity prevention would include education and recommendations at every visit for a well-balanced diet (high in protein, fruits, vegetables, and fiber; avoidance of foods high in preservatives, refined sugars, and flours) and regular exercise, monitoring for adequate weight gain, and preventing excessive weight gain.
Primary prevention of obesity starts in the infancy, childhood, and adolescent time period. Parents, pediatricians, and schools play a crucial role in this part of the journey.
Parents play a key role in preventing obesity by modelling healthy eating patterns and consistency in exercise behaviors. Some examples of healthy behaviors with respect to nutrition are:
- Engaging children in shopping at farmers markets and grocery stores
- Cooking most meals at home
- Sharing meals at family dinner tables
- Eliminating TV during mealtimes
- Planning and cooking meals instead of unplanned fast food or restaurant dinners
- Choosing water over sweetened beverages
What about leisure time activity? These are a few examples of an at-home obesity prevention program:
- Encourage children to participate in outdoor activities over TV and video games
- Choose outdoor adventure vacations over vacations focused around food (cruises, for example)
- Introduce and prioritize new holiday traditions, such as walking or exercising before eating and choosing to spend money on family gym memberships
The pediatrician is an equal partner in raising a healthy child. An astute pediatrician will screen for eating disorders and psychiatric ailments, monitor the growth trajectory of their patients, and intervene early or refer to an obesity specialist if the child's weight curve is greater than the 95th percentile.
Schools and school boards have the power to facilitate efforts toward primary prevention of obesity. A curriculum that reinforces healthy nutrition, routine exercise, and prevention of obesity is necessary. Availability of healthy school meal options and mandatory PE time at school lays the foundation for a healthy lifestyle. Inviting healthcare professionals and trainers to campus for education can instill life-long learned behaviors and prevent adolescent obesity.
Prevention of Obesity in Adults
Our next obligation is primary prevention of obesity in the adult population. Adults have a primary responsibility to prevent obesity in themselves and a secondary responsibility to prevent obesity in the next generation by modelling healthy behaviors. Obesity prevention hinges on three pillars: nutrition, exercise, and behavior modification. Efficient ways to prevent obesity include:
- Shopping at farmers markets and grocery stores for natural foods free of preservatives
- Eating a diet high in meats, seafood, dairy, fruits, vegetables, and nuts
- Avoiding sweetened beverages
- Engaging in daily scheduled exercise that combines cardio and strength training.
- Seeing your primary care provider for preventive checkups to track weight, BMI, blood pressure, sugars, and fasting lipid panels and help prevent chronic diseases linked with obesity
Workplace Obesity Prevention
Are there effective obesity prevention program strategies that employers can help with? Availability of healthy options in the cafeteria and in vending machines aligns with a good nutritional plan, and availability of gyms in the workplace or gym memberships aligns with a good exercise plan, two of the important pillars for primary prevention of obesity. Other ideas include reinforcing healthy behaviors during team-building and educational events, and inviting healthcare professionals or trainers to the office to educate and evaluate compliance with healthy behaviors.
Government Policies for Obesity Prevention
Last but not the least, we need our local, state, and national government invested in our health.
Examples of steps for governments to help prevent obesity include:
- Policies and regulations to ban additives and preservatives in our food
- Making neighborhoods safe and amenable for exercise (bike baths, walking or running trails, availability of safe playground equipment, exercise zones in parks and playgrounds)
- Helping schools provide healthy lunches and healthier options in vending machines
- Organizing and planning community events
The strategies outlined here by no means eliminate the genetic element of obesity or obesity arising from diseases like hypothyroidism or adrenal insufficiency; neither does it address the inflammatory state of obesity and treatment strategies. These are possible practical approaches to aid in the primary prevention of obesity on a day-to-day basis.