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CDC's Battle of the Bulge: Escalating Obesity in U.S.


WASHINGTON — So many Americans crossed into obesity last year--ending a decade that saw an unprecedented 60% increase in the number of overweight Americans--that worried federal health officials now are calling for a vigorous attack on the fat epidemic.

In a letter to be published today in the Journal of the American Medical Assn. calling obesity "a critical public health problem," officials at the national Centers for Disease Control and Prevention urged sweeping new policies that they believe could make a difference. Among them:

* Doctors make weight counseling an integral part of their practices.

* Employers stock "healthy food choices" in their workplace cafeterias and give employees opportunities to exercise during working hours.

* Schools retool their physical education programs in a way that inspires kids to make fitness a lifelong habit.

* Urban decision-makers provide more alternatives to cars, such as sidewalks and bike paths.

* Parents turn off the TV and computer and send kids outdoors to play.

"This isn't just a cosmetic problem. This is a serious medical problem," said Barbara Bowman, one author of the letter. "If this were some infectious disease epidemic, we'd be going all out."

Obesity, defined as being more than 30% above ideal body weight, is a known major risk factor for diabetes, which also surged among adults during the 1990s. Obesity also is known to cause heart disease, and it is associated with other conditions, including certain cancers.

Each year, an estimated 300,000 Americans die of causes related to obesity, according to the CDC.

Most experts attribute the accelerating trends to a plentiful food supply, including the widespread availability of junk food, particularly in school vending machines. Other factors include fewer family-time dinners--people grab food and snacks whenever they can--technology that promotes the increasing use of labor-saving devices and a society in which Americans "used to pay for leisure-time activities, but now we pay for fitness, such as sports clubs and personal trainers," Bowman said.

Obesity jumped 6% overall among adults from 1998 to 1999, with across-the-board increases in both sexes, in all sociodemographic groups and in all regions of the country.

The increases were especially startling among whites and those 30 to 39 years old, with rates higher than the national average. That age group experienced a 10% increase from 1998 to 1999, while whites had a 7% increase, the largest jump in the racial/ethnic breakdown.

Researchers also found a 10% increase among individuals with some college education, compared with a 6% increase among those with a high school diploma only.

Overall, obesity has climbed nearly 60% during this last decade, from 12% in 1991 to 18.9% last year. In California, the number of obese individuals grew from 10.9% in 1991 to 18.1% last year, just slightly below the national figure.

The numbers are probably conservative, the agency added, because these studies are conducted by phone surveys, "and most people tend to underestimate, rather than overestimate, when it comes to weight," Bowman said.

Today's report comes in the aftermath of recent studies that show similar escalating obesity among children.

The CDC recommendations seem daunting because they require action from many different sectors of society--and because Americans still have failed to "come to grips" with the health consequences of obesity, Bowman said.

But she and others predicted changes will occur as public awareness increases, much as what happened with smoking.

Over time, as medical evidence against tobacco mounted and public opinion shifted, public and private restrictions on smoking were implemented, and millions of Americans quit.

Also, experts pointed out that studies have shown less absenteeism, higher productivity and lower health care costs among workers who exercise, an economic incentive for employers to establish fitness-friendly policies.

"It's going to take continued gnawing at the public consciousness," said Morgan Downey, executive director of the American Obesity Assn. "Think about how pervasive smoking was--and how cool it was. It took a response from both the private and public sectors to . . . make smoking less desirable and to highlight the health effects."

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