The Right Goal

Posted: Aug 24, 2008 12:01 AM
The Right Goal

Two recently released reports have left me a bit confused. 

The reason for my confusion, one study says more Americans than ever are fat, and the other study says that being fat may not determine disease risks.

The first study, by the Trust for America’s Health, was called  “F as in Fat: How Obesity Policies are Failing in America 2008” and was released August 19.

“F as in Fat” uses data from the federal government’s Behavioral Risk Factor Survellance System, and categorizes people based on Body Mass Index.  A BMI for someone of normal weight is less than 25, overweight from 25 to 30 and obese is 30 or over.

Body Mass index is calculated as: [weight in pounds/ (height in inches X height in inches)] X 703

For a 5’ 8” person, normal weight is up to 163 lbs, overweight 164-190 lbs, obese 197 lbs or more.

The “F as in Fat” report notes that, “Adult obesity rates have doubled since 1980, from 15 percent to 30 percent. Two-thirds of adults are now either overweight or obese. Childhood obesity rates have nearly tripled since 1980, from 6.5 percent to 16.3 percent.” 

It concludes that a national strategy should be created to address the obesity epidemic, and calls for “a comprehensive, realistic plan that involves every agency of the federal government, state and local governments, businesses, communities, schools, families, and individuals.  It must outline clear roles and responsibilities and demand accountability.  Our leaders should challenge the entire nation to take responsibility and do their part to help improve our nation’s health.”

But two days, later, the Archives of Internal Medicine published “The Obese without Cardiometabolic Risk Factor Clustering and the Normal Weight with Cardiometabolic Risk Factor Clustering,” (Dr. Rachel Wildman, Albert Einstein College of Medicine, New York).

The title may be a mouthful, but the study itself was simple. In it, 5,440 participants were divided into categories based on their BMI and then tested for six indicators of cardiometabolic health. The basis for this test was the “recognition that the disease risks associated with obesity may not be uniform.”

The results?  “Among U.S. adults 20 years and older, 23.5 percent (approximately 16.3 million adults) of normal-weight adults were metabolically abnormal, whereas 51.3 percent (approximately 35.9 million adults) of overweight adults and 31.7 percent (approximately 19.5 million adults) of obese adults were metabolically healthy.”  What does this mean?  That BMI alone does not determine a person’s health.    

So what else determines health?  The controllable item that affected cardiometabolic health was the level of physical activity. 

The obesity “epidemic” has been in the news for years - but is this the right focus?  Maybe not. “There is too much emphasis on weight and not nearly enough on physical activity,” said Dr. Steven Blair, an authority on the health benefits of exercise at the Arnold School of Public Health at the University of South Carolina in Columbia.  “People should focus on healthful behaviors, 30 minutes of activity per day, eight to 10 servings of fruit/vegetables, focus on whole grains, restrict highly processed foods.”

Asked if the “F as in Fat” report is sending the wrong message, Blair responded that “another report hyping the obesity epidemic and how awful it is will not move us very far towards a solution.  In my opinion there is too much emphasis on soda, snacks, fast foods, etc; when the evidence that these things are important causes of the problem is lacking.

Blair recommends we “focus on objective measures of activity and fitness, and on healthful diets.  Let the focus be on healthful behaviors rather than weight.” 

So here is an idea that might seem radical: instead of measuring what we don’t want (obesity), how about focusing on what we do want? HEALTH!

My first pass at an acronym HEALTH -- Healthy Eating Active Learning Targeting Humans -- might not be the best, but it underscores that health is a process, not a destination, achieved through activities that provide impact over time.

“F is for Fat” recommended a national strategy involving all government agencies.  I cannot imagine any organization that includes every agency of federal, state and local governments would be effective.  What I can imagine is the president, national and state leaders using the “bully pulpit” to focus on the right behaviors: healthy eating and activity. 

Instead of just talking about policy, we should try something new.  For instance, the Republican Governors Association and the Democratic Governors Association could challenge states to see which could increase by the greatest amount the average activity per resident.

If it is true that a clear goal creates a better, clearer path to success, then let us clearly define the goal - Health, and move to a behavior that makes sense - Activity.

How about measuring A for Active?