I.O.M. pushes for progress in obesity prevention

by Jay Sjerven
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After evaluating more than 800 prevention recommendations, the Institute of Medicine, in a report titled “Accelerating progress in obesity prevention” issued May 8, identified five general strategies to reduce the incidence of obesity in the United States. The strategies included the integration of physical activities into people’s daily lives; making healthful food and beverage options available everywhere; transforming marketing messages about nutrition and activity; making schools gateways for healthy weights; and encouraging employers and health care professionals to support healthy lifestyles.

Specific recommendations included in the report concentrated on industry-wide guidelines regarding which foods and beverages may be marketed to children, requiring at least 60 minutes per day of physical education in schools, expanding workplace wellness programs, having physicians play a larger role in advocating obesity prevention measures with patients, and increasing the availability of low-calorie, healthier children’s meals in restaurants.

The recommendations were made by a committee appointed by the I.O.M. at the request of the Robert Wood Johnson Foundation, which was seeking catalysts to speed progress in obesity prevention.

“As the trends show, people have a very tough time achieving healthy weights when inactive lifestyles are the norm and inexpensive, high-calorie foods and drinks are readily available 24 hours a day,” said I.O.M. committee chairman Dan Glickman, executive director of congressional programs, Aspen Institute, Washington, and former U.S. Secretary of Agriculture. “Individuals and groups can’t solve this complex problem alone, and that’s why we recommend changes that can work together at the societal level and reinforce one another’s impact to speed our progress.”

The report’s proposed action
steps aim to support individuals’ and families’ abilities to make healthy choices where they work, learn, eat and play. For example, healthy food and beverage options should be available at competitive prices everywhere that food is offered, and an effort should be made to reduce unhealthful products, according to the committee. Fast-food and chain restaurants could revise their recipes and menus to ensure that at least half of their children’s meals comply with federal dietary guidelines for moderately active children and charge little or no more for these options. In addition, shopping centers, convention centers, sports arenas, and other public venues that make meals and snacks available should offer a full variety of foods, including those recommended by the dietary guidelines.

Noting that Americans are surrounded by messaging that promotes sedentary activities and high-calorie foods and drinks, the report added that the food, beverage, restaurant, and media industries need to quicken and enhance their voluntary efforts to develop and implement common nutritional standards for marketing aimed at children and adolescents up to age 17. The I.O.M. committee said government agencies should consider setting mandatory rules if a majority of the industries have not adopted suitable standards within two years.

The report also said in an effort to increase positive messaging about physical activity and nutrition, government agencies, private organizations, and the media could work together to develop a social marketing campaign that encourages people to pursue healthy activities and habits. 

Sugar-sweetened beverages in the crosshairs
Among the specific recommendations of the study “Accelerating progress in obesity prevention” was the adoption of fiscal policies aimed at reducing overconsumption of sugar-sweetened beverages.

Specifically, the study advocated pricing and other incentives to make healthier beverage options recommended by the Dietary Guidelines for Americans more affordable. It also called for governments to implement “substantial and specific excise taxes on sugar-sweetened beverages (for example, cents per ounce of liquid, cents per teaspoon of added sugar), with the revenues being dedicated to obesity prevention programs.”

A “tax” on sugar-sweetened beverages has long been a goal of some consumer advocate organizations, who were heartened by the I.O.M. proposal.

“Congress should fund a multi-billion-dollar, multi-year anti-obesity program that includes national and local community and social-marketing campaigns,” said Michael Jacobson, executive director of the Center for Science in the Public Interest. “That program could be funded with a significant tax on sugary beverages.”

But the American Beverage Association said advocating “discriminatory policies” that focus on sugar-sweetened beverages is the wrong approach.

“In fact, government data show that sugar-sweetened beverages account for only 7% of the calories in the average American’s diet, and have been declining for more than a decade while obesity continued to rise,” the A.B.A. asserted. “Focusing on a small and declining source of calories in the diet is a wrong-headed approach that distracts from meaningful solutions that promote healthier diets overall, as well as increased physical activity.”

The A.B.A. said the beverage industry was doing its part to help consumers make beverage choices that are right for them. The association said the beverage industry was providing more beverage options than ever before, with a wide array of calorie and portion size options. Beverage manufacturers have developed no-calorie and low-calorie drinks that have helped to reduce average calories per serving by 23% from 1998 to 2010. And the industry has voluntarily agreed to advertise only water, juice and milk-based drinks on programming targeted to children less than 12 years of age.

Further, the A.B.A. pointed out it worked with President Clinton on national school beverage guidelines that removed full-calorie soft drinks from all K-12 schools and replaced them with lower-calorie choices in age-appropriate portion sizes, which drove an 88% reduction in beverage calories shipped to schools since 2004. And the beverage industry was supporting First Lady Michelle Obama’s ‘Let’s Move!’ campaign with its Clear on Calories initiative to display calorie information on the front of every beverage bottle and can.

C.D.C. forecasts 42% of adult
Americans will be obese in 2030
DURHAM, N.C. — Today, just more than a third of U.S. adults are obese, but by 2030 that figure will be 42%, according to a forecast released May 7 by researchers at the Centers for Disease Control and Prevention, Duke University and RTI International. Somewhat encouraging was the fact that earlier forecasts based on unabated increases in obesity suggested obese individuals would comprise 51% of the adult population by 2030. The researchers noted new evidence suggested that obesity prevalence may be leveling.

The number of individuals with severe obesity, which is defined as a body mass index over 40 or roughly 100 lbs overweight, in 2030 was forecast at 11%, up from about 5% currently.

The goal, researchers said, was to keep obesity levels from increasing. If the United States proved able to keep obesity at 2010 levels, the combined savings in medical expenditures during the next two decades would be nearly $550 billion, the researchers said.

“We know more than ever about the most successful strategies that will help Americans live healthier, more active lives and reduce obesity rates and medical costs,” said William H. Dietz, M.D., Ph.D., director of the C.D.C.’s Division of Nutrition, Physical Activity and Obesity. “People need to make healthy choices, but the healthy choices must first be available and accessible in order to make them.”

The findings were part of a study based on data from the Behavioral Risk Factor Surveillance System and state-level data from the Bureau of Labor Statistics and other organizations. They were published in the American Journal of Preventive Medicine on May 7.

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