Reducing the high rate of obesity in the United States requires a comprehensive, population-based strategy, says a new American Heart Association (AHA) scientific statement.
The AHA also recommends a wide range of approaches to help people adopt healthy behaviors, such as eating right and being physically active.
About 67 million Americans are obese, and an additional 75 million are overweight, according to the 2001-04 National Health and Nutrition Examination Survey.
"Almost all of our current eating or activity patterns are those that promote weight gain using the least possible amount of energy or maximizing quantity rather than quality in terms of food," Shiriki Kumanyika, chair of the statement working group, said in a prepared statement. "People haven't just made the decision to eat more and move less; the social structure has played into people's tendencies to go for convenience foods and labor-saving devices."
Making policy and environmental changes at the local, state and federal levels could help boost healthy eating and physical activity without requiring deliberate action by individuals.
"We're not talking about creating a dieting society but looking at choices people make in day-to-day living that affect their ability to manage their weight and then trying to change the environment to facilitate healthier choices," said Kumanyika, a professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia.
The statement outlines the following areas to identify targets for change:
· Locations of fast-food restaurants.
· Restaurant portion sizes
· Availability of high-fat, low-fiber foods and sweetened drinks.
· Community design and infrastructure, which involves assessing land-use mix and walkability of neighborhoods, including: adequate sidewalks and areas for physical activity; accessibility of jobs, schools and recreation by walking or cycling; availability of public transportation.
"The concept of population-level interventions to change contexts for individual behavior is well-known from the experience with tobacco regulations," Kumanyika said. "Changes in these areas can eventually become 'normal' and displace the current 'normal' ways of doing things. Right now, you have to be pretty single-minded to make some of these choices, such as walking or riding a bike instead of driving. We advocate changes that will move the social norm to where physical activity is the custom."
The statement was published in the current issue of Circulation.
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