Preventing obesity: strategies and interventions

¶ … Prevention Epidemiology Provide a Framework Health Professional Intervene Prevent Disease, Injury Disability

Levels of prevention in epidemiology: Obesity

Obesity is responsible for an estimated 3,000,000 premature deaths every year and the numbers of obese persons in the U.S. are increasing (Nammi et al. 2004). In the field of epidemiology, it is recognized that it is not enough to merely treat the symptoms of a disease: in fact, when the disease is fully manifested is often the least effective stage to intervene. Prevention is often the best cure, particularly for chronic health conditions like obesity. The Centers for Disease Control (CDC) has identified three distinct levels of public health promotion: primary, secondary, and tertiary, all of which are necessary to address the problems generated by obesity.

"Primary prevention reduces both the incidence and prevalence of a disease" (Three levels of prevention, 2007, CDC). In the case of obesity, this might include physical education in schools; reducing the caloric amounts in school lunches and improving the nutritional profile of such lunches; reducing the number of 'food deserts' where fresh fruits and vegetables are not readily accessible; and educating the public about healthier food choices. The philosophy behind primary prevention of obesity-specific diseases rests upon the acknowledgement that we live in an obesity-promoting environment where it is easier and more tempting to consume large amounts of highly caloric, sugary foods and the fact it is often challenging for people to find time to exercise.

Unfortunately, the obesity crisis in America has grown to such proportions that primary prevention is not enough. Statistics indicate that more than one-third of the adult population is obese. The rates of obesity skyrocketed between the years 1990-2010, so the increase cannot be explained by genetics alone (Overweight and obesity, 2013, CDC). Americans are consuming too many calories and not burning enough of those calories up through physical activity [DIETARY HABITS OF AGGREGATE]. According to the CDC, only 48.4% of all adults meet the minimum standards for aerobic physical activity; 24.0% meet the minimum standards for muscle-building activities and only 20.6% meet both standards (Exercise or physical activity, 2013, CDC) [HOW OFTEN AGGREGATE PHYSICALLY EXERCIZES]

Secondary prevention strategies are needed to help those who already suffer from obesity. "Secondary prevention is used -- after the disease has occurred, but before the person notices that anything is wrong" (Three levels of prevention, 2007, CDC). Although the cliche is that 'everyone knows' when he or she is overweight, that is not always the case. Because the weight may increase slowly with time, it may not be immediately noticeable. As more and more people are overweight, the condition may become less stigmatized. Also, parents tend to underestimate the weight of their children and may be reluctant to admit that their children need to be put on a diet. Physicians must be encouraged to have the frank but difficult conversations with their patients about obesity.

To increase awareness about obesity, many schools are including BMI (body mass index) of students' report cards to highlight to parents that weight is an issue that may need to be addressed (Schocker 2011). For overweight students, including aspects of gym class that are fitness-related rather than competitive can encourage them to participate. For adults as well, awareness of how many calories they are taking in is essential, which is one reason there has been a push to increase the number of calorie labels at fast food restaurants, introduce fitness programs even at the workplace, create safe areas to play and work in low-income communities where people cannot afford gyms. There have even been attempts to pass legislation to make it more difficult to sell extremely unhealthy foods such as large sodas. Public health campaigns to inform people about correct portion sizes and to give them information about how to fit exercise into their day can be useful. The recently-passed Affordable Care Act has specific provisions to improve people's ability to maintain a healthy weight who are on Medicaid, the state-provided health insurance for the poor: "For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services. For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment" (Quality of care: obesity, 2014, Medicaid).