Thursday, January 24, 2008

In Response to Obesity: A National Crisis

Rich, a friend of mine who is seeking his Master's of Public Health wrote a post entitled, Obesity: A National Crisis. Rich asked for my feedback and so I wrote the following. Feel free to respond to either Rich's or my comments concerning this serious issue that we all face.

Excellent post, Rich! You have accurately identified much of the underlying causes of the nation’s overweight and obesity epidemic.

Dr. Steven Aldana, one of my professors, used to say that Americans’ problem is that we have hypoactive feet and hyperactive forks, thus leading to the energy balance issue.

According to data collected by the National Weight Control Registry (NWCR), adults successful at losing weight and maintaining their weight loss exhibit a few behavioral common denominators:

Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity.
78% eat breakfast every day.
75% weigh them self at least once a week.
62% watch less than 10 hours of TV per week.
90% exercise, on average, about 1 hour per day.

(Source: http://www.nwcr.ws/Research/default.htm)

I agree that programs need to target adults, and that by doing so a trickle-down effect should occur and result in improved health habits of children. My personal opinion is that adults with children should pick physical activity and exercise options (if at all possible) which align with what I like to call the three F’s of fitness: Fun, Frequent, and Family.

If an activity is fun then the reward is embedded within the activity itself, thus negating the need of extrinsic motivation and incentives. A person who is having fun while exercising will naturally seek to repeat the experience which leads one to the second F.

The key to experiencing the long-term results of regular physical activity and exercise is to engage in them frequently. Those registered with the NWCR who experience enduring success were those who participated daily in some form of exercise. More and more we are also realizing the benefits of unstructured physical activities such as walking to work, taking the stairs instead of escalators, gardening and more.

The third F is Family. The family is the basic unit of society. At the risk of sounding cliché let me say that “the family that plays together stays fit together.” Children naturally copy the behavior modeled by their parents, so if a child grows up in a home where frequent, fun physical activity and exercise occur that child is more likely to establish healthy living patterns for life.

The temptation to create incentive programs to stimulate adults’ interest in increasing physical activity and exercise patterns is strong. We naturally get excited about winning fancy prizes. I read a book recently that challenges this paradigm and I think that it’s worth looking into. It’s called Why We Do what We Do, and it’s written by Edward L. Deci. Deci’s primary thesis is that change is long lasting when it comes from within oneself, that is, if one changes because of the intrinsic value of the change not due to any external motivation. Therefore, do I exercise to win a prize or do I exercise because I enjoy it? In which situation will I most likely continue exercising in the long term? Deci would submit that I would most likely persist in my routine if I genuinely like it over the former alternative.

If lasting change is what we want in Americans, then teaching correct principles and letting them govern themselves is likely the best approach. Of course strong social support is good but it should be provided in a manner that is autonomy supportive. Hence, education is the way to increase awareness and knowledge and, hopefully, Americans’ desire to change.

That brings me to another point. Those of us who are in the know, so to speak, are responsible for the dissemination of good information concerning the overweight and obesity problem. Our greatest challenge, in my opinion, is unscrupulous individuals and organizations which prey on the ignorance of the masses. The fight against misinformation is real, the question is, who is winning the fight?

Lastly, I would like to submit a program. May I add it to your list and call it program #3? I propose that city planners expend a little more time and energy planning and re-planning our cities to naturally foster outdoor recreation, physical activity, and exercise. Take Happy Valley for instance. The roads in this region are not conducive to bicycling as a form of transportation. I have friends who bike from Spanish Fork or Springville to Provo and have a heck of a time doing it because this area is so automobile focused. What we need are ubiquitous and wider bike lanes. We need more park space in more areas of town, and on and on the list could go regarding improvements that could be made.

The problem is real and we can’t give up the fight. Good work, Rich.

1 comment:

Sedwick Family said...

I love the hypoactive feet and hyperactive forks saying. SO TRUE. I'll try to do my part in getting the word out. It is amazing to me that a significant portion of patients that come to the doctor get the response that the single most important thing they can do is improve their diet and excercise.