Introduction: While studies have demonstrated efficacy of anti-obesity policy in small-scale studies (ie, at the local or communal level), there is little evidence of a significant association between implementation of these policies and change in obesity rates on a larger scale. The study was designed to review the impact of federal, state, and local anti-obesity policies on obesity growth rates.
Methods: The authors examined enacted anti-obesity policies between 1997 and 2010 and data from the Centers for Disease Control and Prevention on obesity rates. They divided anti-obesity policies into the following 3 categories: taxation of sugared beverages/snacks, physical education/activity in schools, and funding for bicycle trails.
Results: None of the 3 categories of anti-obesity policies were correlated with a change in obesity growth rates. For example, a meta-analysis of 15 physical education interventions in schools showed no significant effect on BMI, possibly because of a lack of intensity or frequency of activity, the authors noted. In addition, while over 40 states implemented taxes on sugar-sweetened beverages by 2009, the daily caloric intake from sugar-sweetened beverages increased by nearly 30% in the last decade, and the largest proportion of caloric intake in the United States comes from soft drinks.
The obesity growth rate remained relatively consistent between 1997 and 2010 in the United States. When the authors analyzed the data between state policy and concavity in the obesity growth rate (ie, the change in growth rate between 1997 and 2001 and between 2001 and 2010), they found that state policy interventions did not show an immediate correlation with a reduction on obesity growth rate.
Conclusion: Anti-obesity policies have not reduced the obesity growth rate on a state or federal level. The focus of these policies should be expanded to improve dietary patterns and physical activity level, as well as to promote greater supply-side regulation of food and interventions to target obesogenic inflammatory mechanisms that underlie the relationship between high-fat, processed foods and obesity, the authors concluded.
Trivedi NJ, Fields J, Mechanick CH, Klein M, Mechanick JI. Lack of correlation between antiobesity policy and obesity growth rates: review and analysis. Endocr Pract. 2012;18(5):737-744.
Commentary by J. Michael Gonzalez-Campoy MD, PhD, FACE
Overweight and obesity has gone from being considered a condition, to be defined as a disease. The American Medical Association, The Obesity Society, the American Society of Bariatric Physicians, The Endocrine Society, and the American Association of Clinical Endocrinologists/American College of Endocrinology, have all issued statements that call for a change of medical practice to include weight management as a primary treatment target. Clearly, the burden of disease, as documented by public health agencies, more than justifies this position.
Public health continues to play an important role in improving human health and prolonging life. Yet, two-thirds of the American population has overweight or obesity despite existing awareness campaigns and calls to action. Although this epidemic has continued unabated, there must be societal change to finally stop the increasing rates of excess fat mass. As reviewed by Trivedi and colleagues, interventions that target populations have not been successful to date.
The regulation of energy balance and fat stores in humans is very complex. It involves afferent signals to the brain from the viscera and the senses, circulating fuels, and hormones from the gut, the pancreas, the adrenal glands and adipose tissue. There is central integration of these signals in the hypothalamus and related brain regions. And there are efferent signals that regulate the set points for hunger, satiety and basal metabolic rate. Altogether energy balance (caloric intake vs caloric expenditure) is the single common determinant of fat mass. In turn, the major determinants of energy balance are environmental—the availability of food and calories, and the lack of requirements for physical activity.
While public health measures continue, we must take care of individuals who are already affected. Each patient needs to have their health risk evaluated, and each must have comorbidities addressed. Overweight, obesity, and adipose tissue dysfunction need to be treated aggressively. This involves effective lifestyle changes, but also pharmacotherapy.