November 2000 • Volume 6 Number 11
Diet, exercise
Look to lifestyle changes to battle obesity, these FPs say
BY SHERI PORTER
There's no arguing with statistics that show Americans are bulking up. But there is a lot of discussion about how to deal with it.
Researchers pursue the perfect weight-loss drug as if it were the Holy Grail -- yet for mostoverweight Americans, the current choices are the familiar twosome: what you put in your mouth, and how much you move your body.
It makes sense that if we're not burning up calories at our jobs, then we're going to have to plan other times for physical activity. Yes, enter that dreaded concept so many Americans avoid -- exercise. And it's not just adults who need it. Too many children spend too much time indoors. Remember when kids played outside until sundown -- or some adult -- made them come in?
Izabela Riffe, M.D., of Jacksonville, Fla., is one FP worried about the lack of exercise in children. Her concern led her to submit a resolution from the Women Physicians Constituency that was adopted by the 2000 AAFP Congress of Delegates Sept. 18-20 in Dallas. The resolution encourages Academy support of a public health initiative to provide and promote exercise education to the general public and to school-age children.
Why is an initiative needed? Look at the school curriculum in your hometown, Riffe says. In her district, physical education requirements for high-school students have dropped to an all-time low.
"How can we approach this topic in a positive way? I would like to see us emulate Tar Wars," she says, referring to the popular and successful anti-tobacco education program supported by the Academy. Train FPs to go into neighborhood schools and talk to kids about exercise, Riffe urges.
It's not punishment
No matter what their age, when you give heavy patients a prescription for exercise, the prescription shouldn't sound punitive, says Raul Zimmerman, M.D. He's co-director of the weight management program at Halifax Medical Center in Daytona Beach, Fla., and director of the center's family practice residency.
Instead, says Zimmerman, be upbeat and realistic when discussing the issue of exercise with these patients. Ultimately, you want that patient to exercise five to seven days a week, but start small. "For some individuals, that may mean as little as sitting in a chair and moving their arms around for five minutes," he says.
If you ask Zimmerman, who is a runner, to recommend the best exercise, his stock response is, "What will you stick with?" For example, he says, "If the patient wants to swim, but the nearest pool is 12 miles away, it's just not going to happen."
Promote healthy eating
Another Academy member taking a positive approach to combating obesity is Javette Orgain, M.D., of Chicago, the immediate past president of the National Medical Association and current chair of the Illinois AFP's urban health committee. Orgain laments the poor nutritional choices schoolchildren encounter every day.
"They have hamburgers, nachos, pizza and very few vegetables, very little fruit," Orgain says. "Any child who wants an alternative diet has to bring it to school. School officials are catering to the popular taste buds of the children."
Orgain actively supports Healthy School Nutrition, a plan endorsed by five leading medical associations, including the AAFP, and the U.S. Department of Agriculture.
Coming in the December FP Report: the link between obesity and diabetes, an update on treatments for obesity and how a poor reimbursement track record hurts everyone. The national initiative, unveiled this past summer, challenges schools and communities to promote healthy eating in America's schools. To view the 10 key elements highlighted in the Healthy School Nutrition plan, go to http://www.aafp.org/news/tenkeys.html.
"We need to put some pressure on those who are providing the food, to provide nutritious, delectable meals, something that is attractive to the children," says Orgain. Then she goes one step further: "We need to remove those vending machines that sell junk foods in schools."
Unfortunately, many parents don't do much better at home, Orgain says: "Parents provide children with junk food -- they're buying it as part of the daily staple when they go grocery shopping."
And don't discount the power of advertising. It's hard to combat clever marketing by fast food companies, says Zimmerman. "My kids are offered the latest Disney toy to buy a Happy Meal, but nobody ever offers my kids anything to eat steamed broccoli -- and that's a national problem."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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