Controlling Obesity: School, Work, and Leisure

The Centers for Disease Control and Prevention’s (CDC’s) Task Force on Community Preventive Services reviewed school- and worksite-based strategies for the short-term prevention and control of overweight and obesity. The full report, “Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings,” was published in the October 7, 2005, issue of Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5410a1.htm.

The task force found insufficient evidence to make recommendations on school-based interventions. However, the report suggests interventions that result in small but positive changes may be useful, such as programs that combine nutrition and physical activity elements, allocation of additional time for physical education during the school day, inclusion of noncompetitive sports such as dance, and reduction of sedentary activities such as watching television.

For worksite-based strategies, the task force recommends the use of combined nutrition and physical activity programs, and it suggests that employers be given evidence on the effectiveness and cost-effectiveness of worksite interventions to control overweight and obesity. Cost-effectiveness data can be found on the Community Guide Web site at http://www.thecommunityguide.org/obese.

The task force concluded that much more research is needed to enable the control and reversal of obesity trends. Topics for potential study include parental involvement, outcomes of environmental changes such as making stairs more accessible and providing easy access to nutritious food, the combination of work and community-based interventions, and strategies for maintaining initial weight-loss success.

Leisure-Time Inactivity

According to another CDC report, participation in physical activity outside the workplace has improved in the past decade. The report, “Trends in Leisure-Time Physical Inactivity by Age, Sex, and Race/Ethnicity—United States, 1994–2004,” was published in the October 7, 2005, issue of MMWR and is available online at http://www. cdc.gov/mmwr/preview/mmwrhtml/mm5439a5.htm.

The report states that the percentage of the U.S. population that participates in no physical activity outside of regular work decreased between 1994 and 2004 in every age group. However, more than 30 percent of adults 70 years or older are inactive, and the CDC recommends that public health messages focus on raising awareness of opportunities for physical activity. The report also suggests that community programs be made more accessible to racial minorities to reduce disparities among ethnic groups.

Emergency Contraception: AAP Review

In a statement published in the October 2005 issue of Pediatrics, the American Academy of Pediatrics (AAP) recommends that education and counseling about emergency contraception be incorporated into the annual preventive visits of adolescent patients when issues of sexuality are addressed. Physicians also should provide community-specific guidance on access and availability of emergency contraception and consider writing an advance prescription. The full policy statement, “Emergency Contraception,” is available online at http://www.pediatrics.org/cgi/content/full/116/4/1026.

Emergency contraception is approximately 80 percent effective for preventing pregnancy when the first dose is taken within 72 hours of sexual intercourse. Two medications have been approved by the U.S. Food and Drug Administration (FDA) for use as emergency contraception—a combination estrogen/progestin pill (Preven) and a progestin-only formulation (Plan B). In addition, the off-label use of combination oral contraceptives at higher dosages (e.g., two doses taken 12 hours apart, each containing at least 100 mcg of ethinyl estradiol and at least 0.50 mg of levonorgestrel) has been declared safe and effective by the FDA Reproductive Health Advisory Committee.

Emergency contraception is indicated when unprotected or inadequately protected sex has taken place within the previous 72 to 120 hours (although the FDA approves the use only within 72 hours). The AAP states that progestin-only emergency contraception may be prescribed over the telephone, but an office visit should be scheduled for 10 to 14 days after use to exclude pregnancy and to provide contraceptive advice and screening for sexually transmitted diseases.

The AAP report suggests that an antiemetic agent taken one hour before estrogen-containing medication may decrease the risk and severity of nausea. The progestin-only method is better tolerated and may be more effective than combination methods. Because of the short duration of use, combination emergency contraception may be offered to patients with chronic conditions in whom estrogen-containing oral contraceptives are contraindicated. There are no contraindications for the use of progestin-only emergency contraception. Almost all patients menstruate within three weeks of taking emergency contraception; patients who have not menstruated within three weeks should be tested for pregnancy.