Prevention of Overweight and Obesity
Prevention of overweight and obesity is as important as treatment. Prevention includes primary prevention of overweight or obesity itself, secondary prevention or avoidance of weight regain following weight loss, and prevention of further weight increases in obese individuals unable to lose weight (44, 64).
National and international observational data suggest that environmental and behavioral factors are likely to be important in the tendency of individuals within and between populations to be obese during childhood or to gain weight progressively with age during adulthood (65). These factors are also influenced by the genetic makeup of individuals. There has been a paucity of intervention research to demonstrate how these factors can be manipulated to prevent obesity (64). In two community studies, namely the Minnesota Heart Health Program and the Stanford Five City Study, multifaceted weight loss and weight control programs within the community were not associated with prevention of weight gain in longitudinally followed cohorts (66). In another community study, the Pawtucket Heart Health Program, BMI levels did not change in the intervention cities while they increased in the comparison cities (67). One obesity prevention study of American Indian children who are at high risk of becoming obese is under way (68).
Otherwise, the only long-term report suggesting an effective approach to obesity prevention is from follow-up of obese children in an experimental study in which they had been treated with or without a family-oriented treatment program. Long-term follow-up (10 years) of these children supported the importance of family involvement in reducing the progression of obesity (69).
One population-based randomized controlled pilot study of obesity prevention suggests that programs for weight gain prevention are feasible and effective in adults (34). Another study in China has shown that the prevention of weight gain through diet, physical activity, and their combination can help prevent diabetes (70).
It has been suggested that primary prevention of obesity should include environmentally based strategies that address major societal contributors to over-consumption of calories and inadequate physical activity such as food marketing practices, transportation patterns, and lack of opportunities for physical activity during the workday (71, 72). People at lower socioeconomic levels living in urban areas also lack access to physical activity sites. Such strategies will be essential for effective and long-term prevention of obesity for large numbers of individuals and for the community at large.
Research is needed to clarify the role of societal policies, procedures, laws, and other factors that serve as disincentives to lifelong caloric balance. The importance of obesity prevention needs to be brought to the attention of health care payors and practitioners, employers, educators, and public officials as an important priority to be addressed in policies, programs, and direct services to individuals and families. The development and implementation of appropriate policies and programs will require outcomes research that identifies effective weight gain prevention approaches. These programs must be useful for multiple settings, including health care facilities, schools, worksites, community and religious institutions, and be applicable to a broad population. In the end, efforts should be made to make the general public more aware of the need to prevent overweight and obesity.
Efforts to understand the genetic, developmental, environmental, and behavioral underpinnings of obesity and to mount successful prevention strategies are particularly critical for populations in which overweight and obesity and related health problems such as diabetes are disproportionately prevalent; for example, women in lower socioeconomic groups and women and sometimes men in many racial/ethnic minority populations.
Public health approaches for preventing obesity, that is, approaches designed to reduce the difficulty for any given individual of adopting healthful eating and activity patterns, will particularly benefit the socially disadvantaged, whocompared to the more advantagedmay have less access to preventive health services and fewer feasible options for making changes in their daily routines and lifestyles (73-75).
Primary care practitioners are an important element in preventing and managing obesity in the United States. Prevention of overweight and obesity in primary care settings is compatible with efforts to prevent their health consequences, through control of dyslipidemia, high blood pressure, and type 2 diabetes. Thus, both the quality and quantity of life may be enhanced through preventive strategies. As detailed elsewhere in this report, high blood pressure, high blood cholesterol, and type 2 diabetes should be aggressively treated in overweight patients and may be treated prior to and in conjunction with weight loss.