[Obesity Discussion]

Inside Medicine: Government must join efforts to cut obesity

By Dr. Michael Wilkes -

Published 12:00 am PST Saturday, February 17, 2007
Story appeared in SCENE section, Page K1


Sandy, Wendy, Robert and Huang are in high school, all on their way to college and all overweight -- at least 30 percent over their ideal body weight.
Robert is a football player with diabetes that runs in his family. Wendy is a dancer. The other two live moderately sedentary lives, but they both walk more than a mile to school.
Nearly every week, in the seminars that take place before the start of clinic work, doctors in training complain about their inability to treat obesity. When they meet with patients, they feel obligated to inform patients that they are overweight. (As if this were news to them. How many times a day must they look in the mirror wishing -- even praying -- they were thinner?)

The doctors admonish these patients to lose weight. We have taught doctors again and again all the medical dangers of obesity (high blood pressure, heart disease, diabetes, etc.), but we have not taught them effective ways to counsel around weight loss. Doctors, like many others, still associate being overweight with a lack of willpower, and many doctors advise patients simply to eat less and exercise.
Has anyone noticed this approach is not working? Today, most doctors do not know much about nutrition or weight loss other than that we should encourage it. The public is bombarded by companies selling useless and expensive gimmicks that only shrink the pocketbook, not the stomach. Advertising for foods and lifestyles that promote obesity is everywhere.
Obesity is not just an American phenomenon; people around the world are getting heavier. I just returned from Budapest, Hungary, where doctors and government officials report that after 40 years of communist rule ended, the most rapid health change has been obesity.
On nearly every corner in downtown Budapest, you will find a Burger King or McDonald's filled with people eating super-size meals rather than preparing and eating food at home in the traditional manner.
Experts point out that the French and Japanese are far slimmer than their American counterparts, despite nearly identical levels of physical activity. When the Japanese or French move to the United States, they gain weight. The smoking gun is clearly the American diet, based on high-calorie, high-fat and low-fiber foods.
Of course, we all share some responsibility for our health, but it is time for the government to develop an aggressive approach that recognizes obesity as a systemic national problem rather than a lack of individual willpower. If it doesn't, we will end up with a sicker, less-happy population whose life expectancy is shorter and whose health care is far more expensive than it needs to be.
Unfortunately, the U.S. government is not very good at implementing aggressive, comprehensive interventions to address major social problems. There is no question that preventing obesity is far more effective than treating it. Pills and surgery are just not the answer for society. But prevention requires diverse groups, who may not always have the same agenda, to work together. It will require the government to admit it has a responsibility to help and create programs that do not require great effort by the public, with built-in incentives for businesses, schools and individuals to do the right thing. It will require mandatory actions because voluntary actions are not working.

About the writer:

• Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality.

Obesity and the United States government