American Medical News
By — Posted July 22, 2013
Having physicians prescribe exercise is considered essential to turning around the nation’s obesity epidemic, but physical activity alone will not resolve the country’s weight problem, a study shows.
A substantial number of U.S. counties reported men and women becoming more physically active between 2001 and 2009, said a study posted online July 10 in Population Health Metrics. But the overall percentage of obese adults continued to increase nationwide during that period, according to the study, which was conducted by the Institute for Health Metrics and Evaluation at the University of Washington.
“Around the country, you can see huge increases in the percentage of people becoming physically active, which research tells us is certain to have health benefits,” said Christopher J.L. Murray, MD, IHME director and an author of the study.
Those benefits include reducing one’s risk of cardiovascular disease, certain cancers, diabetes and stroke.
To turn the rising tide of adult obesity, however, boosts in physical activity have to be coupled with improved diet, said Ali H. Mokdad, PhD, lead author of the study and professor of global health at the institute.
Physicians should explain to patients that losing weight is “about a balance between the [calories] the patient is consuming and expending through physical activity,” he said. Unless exercise and diet are both addressed, “we’re not going to see the benefits of physical activity on obesity.”
Mokdad said more aggressive strategies to prevent and control the epidemic are needed. Those strategies should include local policies to develop safe places for people to exercise, including parks and trails. He urged communities to continue taking steps to make nutritious food, such as fruits and vegetables, more accessible and to increase physical activity for students in schools.
A key component of such a strategy is that physicians discuss exercise and nutrition with patients and counsel them on practical ways to shed pounds or maintain a healthy weight, Mokdad said.
“People respect physicians and listen to them and take their advice seriously,” he said. “They have a big role.”
To ensure that patients stick with the exercise that doctors prescribe, physicians should help them identify an activity they enjoy, said Jonathan S. Kirschner, MD. He is an assistant professor of rehabilitation medicine at Icahn School of Medicine at Mount Sinai in New York.
“I ask patients, ‘What do you like to do?’ And then I find a way to turn that into exercise,” Dr. Kirschner said.
For instance, he encourages patients who like to garden to spend more time engaged in the activity and to do more digging. He recommends that patients who live in apartments take the stairs instead of the elevator. He also encourages everyone who takes public transportation to get off one or two stops early and walk to their destination.
This “might sound silly, but trying to be more physically active in daily activities is a nice way to sneak exercise in,” Dr. Kirschner said.
The nation’s obesity epidemic has reached epic proportions with more than a third of adults and 17% of children age 2 to 19 considered obese, says the Centers for Disease Control and Prevention. Researchers project a dramatic increase in adult obesity and related health care costs by 2030 if the trend continues.
The seriousness and broad scope of the problem led the American Medical Association to declare obesity a disease at its Annual Meeting in June.
For the Population Health Metrics study, researchers assessed data on about 3.7 million adults 20 and older who participated in the Behavioral Risk Factor Surveillance System from 2000-11. They also examined information on 30,000 adults 20 and older who engaged in the National Health and Nutrition Examination Survey between 1999 and 2010.
They calculated participants’ self-reported physical activity as well as body mass index, from the adults’ self-reported weight and height. Researchers used the data to estimate obesity and physical activity prevalence for each county annually between 2001 and 2011.
They found levels of physical activity were generally worse for adults along the Texas-Mexico border, the Mississippi Valley, parts of the Deep South and West Virginia.
The good news, however, was that some of the most significant gains in activity were seen among Southern counties, particularly those in Florida, Georgia and Kentucky, Dr. Murray said.
Among those areas was Morgan County, Ky., which reported the nation’s biggest gain in sufficient physical activity for women. In 2001, 25.7% of the residents reported participating in such activity compared with 44% in 2009, the study said. Sufficient physical activity was defined as engaging in 150 total minutes of moderate activity each week or 75 minutes of vigorous activity weekly.
Concho County, Texas, had the greatest increase in such activity for men, climbing from 41.4% in 2001 to 58.2% in 2009, data show. The study didn’t assess what steps counties took to boost exercise.
Dr. Murray was encouraged by the exercise-related findings. “You can motivate people to change physical activity as is evidenced by huge changes in some communities,” he said.
Yet, obesity remains a problem nationwide. In Lewis, Ky., obesity prevalence among men increased by 15.8% from 2001-11, the study said. The most significant increase in obesity prevalence among women was reported in Berkeley County, S.C., where unhealthy weight climbed by 16.4% from 2001-11.
Because of the uptick in obesity during the past two decades, elevated BMI is the third-leading risk factor to health problems in the U.S. in terms of disability-adjusted life-years, data show. Elevated BMI was preceded only by dietary risk and tobacco smoking. The findings were part of another IHME study posted online July 10 in The Journal of the American Medical Association.
Researchers used the Global Burden of Disease Study 2010 to identify the leading diseases, injuries and risk factors associated with the burden of disease in the U.S. They assessed how the health burdens changed during the past two decades and compared the U.S. with other wealthy countries.
The authors said U.S. life expectancy increased from 75.2 years in 1990 to 78.2 years in 2010. But even though life expectancy at birth was up in the U.S., it did not keep pace in a ranking of 34 wealthy nations and dropped from 20th to 27th. Morbidity and chronic disability account for nearly half of the nation’s health burden, the authors said.
“This study is … a wake-up call about the need to reduce the burden of chronic disease for America’s patients,” said AMA President Ardis Dee Hoven, MD.
The AMA is addressing chronic diseases with the first phase of an initiative to improve health outcomes by preventing cardiovascular disease and type 2 diabetes. As part of that effort, the AMA is partnering with the YMCA of the USA to increase physician referrals of patients with prediabetes to evidence-based diabetes prevention programs.