Origin and Purpose

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health launched the Obesity Education Initiative (OEI) in January 1991. The overall purpose of the initiative is to help reduce the prevalence of overweight and obesity along with the prevalence of physical inactivity in order to reduce the risk of coronary heart disease (CHD) and overall morbidity and mortality from CHD. In addition, reducing the prevalence of overweight/obesity will help reduce the prevalence and severity of sleep apnea.

The OEI is coordinated by the Office of Prevention, Education, and Control (OPEC), which also coordinates the Institute's other cardiovascular risk factor education programs: the National High Blood Pressure Education Program and National Cholesterol Education Program. Because of the association of obesity and physical inactivity with the various risk factors for cardiovascular disease (CVD) as well as impaired lung function, the OEI helps to enhance and integrate education activities related to both weight and physical activity across the Office's other program areas.

Overview

The first “Surgeon General's Report on Nutrition and Health,” published in 1988, declared overweight and obesity to be one of the most prevalent diet-related problems in the United States. According to data from the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES III), overweight and obesity affect more than one-half of the U.S. adult population (59.4 percent of men and 50.7 percent of women). Overweight is defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity is defined as a BMI of 30 kg/m2. Over 2 decades, the number of cases of obesity alone has increased more than 50 percent—from 14.5 percent of the adult population to 22.5 percent. Approximately 25 percent of U.S. adult females and 20 percent of U.S. adult males are obese.

Overweight and obesity contribute to the CVD burden of the Nation. Heart disease remains the number one killer of Americans, and obesity and overweight are known to influence the impact of this disease on the population. Obesity and overweight are associated with an increased risk for hypertension, diabetes, hypertriglyceridemia, low levels of HDL-cholesterol, and high levels of total and LDL-cholesterol. Sleep apnea, as well as impaired lung function, gall bladder disease, gout, and degenerative joint disease or osteoarthritis, can occur with more severe obesity. Obesity is also an independent risk factor for CHD. In some studies even mild to moderate overweight is associated with a substantial elevation in CHD risk.

Another important independent risk factor for CHD appears to be a sedentary lifestyle. Physical inactivity not only increases the risk of CHD but also is likely to influence the degree of overweight in the population. Research increasingly suggests that even moderate levels of physical activity, if done daily, can help decrease the risk of CHD, especially among sedentary individuals. More vigorous aerobic activity is known to improve cardiovascular fitness of the heart and lungs.

The OEI Task Force

The OEI Task Force is comprised of representatives from OPEC and the research divisions of the NHLBI. The mission of the task force is to: consider the latest scientific research on the relationships between overweight, physical inactivity, heart disease, and lung impairment; translate that research to help educate all Americans about the relationship of overweight and physical inactivity to heart disease and lung impairment; and recommend areas of future research related to weight and physical activity. Many task force members play important roles in other NHLBI education programs, thereby helping to ensure the development of consistent messages about weight and physical activity.

The Goals of the OEI

The primary goal of the OEI is to encourage the adoption of heart-healthy eating patterns and physical activity habits that will not only help prevent or reduce the prevalence of overweight and obesity and their related CHD risk factors along with sleep apnea, but also help reduce morbidity and mortality from CHD.

The OEI also supports programs and activities related to the Healthy People 2010 objectives regarding the prevalence of overweight, obesity, and physical inactivity. Examples of some of the objectives are listed below.

• Objective 19-1. Increase the proportion of adults who are at a healthy weight. (42 percent of adults aged 20 years and older were at a healthy weight [defined as a BMI equal to or greater than 18.5 and less than 25] in 1988-94 [age-adjusted to the year 2000 standard population]). 2010 target: 60 percent.

• Objective 19.2. Reduce the proportion of adults who are obese. (23 percent of adults aged 20 years and older were identified as obese [defined as a BMI of 30 or more] in 1988-94 [age-adjusted to the year 2000 standard population]). 2010 target: no more than 15 percent.

• Objective 19.3. Reduce the proportion of children and adolescents who are overweight or obese (10-11 percent of children and adolescents ages 6 to 19 years are considered overweight or obese). 2010 target: no more than 5 percent, and uses the gender- and age-specific 95^th percentile of BMI from the year 2000 National Center for Health Statistics/Centers for Disease Control and Prevention (NCHS/CDC) growth charts.

• Objective 22-1. Reduce the proportion of adults who engage in no leisure-time physical activity. (40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997 [age-adjusted to the year 2000 standard population]). 2010 target: 20 percent.

• Objective 22.2. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at lease 30 minutes per day. (15 percent of adults aged 18 years and older were active for at least 30 minutes, 5 or more days per week in 1997 [age-adjusted to the year 2000 standard population]). 2010 target: 30 percent.

• Objective 22-6. Increase the proportion of adolescents who engage in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days. (20 percent of students in grades 9 through 12 engaged in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days in 1997). 2010 target: 30 percent.

The OEI Strategy

The OEI has adopted a two-pronged strategy for educating professionals and the public on the relationship of overweight and physical inactivity to cardiovascular and pulmonary disease: a high-risk strategy and a population-based strategy. Both strategies are important in the management of overweight and obesity and in promoting physical activity.

The population approach focuses on the prevention of overweight, obesity, and physical inactivity in the general population. Public education objectives and messages defined at the Strategy Development Workshop held in September 1992 have become the basis for devising a population-based strategy. This meeting brought together representatives from 37 professional organizations and Federal agencies, communication specialists, and leading experts in the field of obesity research. Population approaches have encompassed a variety of activities that include dissemination of the physical education and nutrition curriculum developed in the Child and Adolescent Trial for Cardiovascular Health (CATCH), and promotion of the materials from the SPARK trial to elementary school officials and teachers nationwide. Other population approaches have included development of programs and materials for recreation and park professionals that encourage them to promote heart-healthy eating and increased physical activity in summer day camps, after-school programs, senior centers, and community outreach centers.

The high-risk approach targets individuals who are experiencing, or who are at high risk for, the adverse health effects and medical complications associated with overweight and obesity. In implementing the high-risk strategy, an expert panel issued the “Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report” in June 1998. It is the first Federal clinical practice guidelines to deal with overweight and obesity issues. The guidelines provide the scientific evidence behind the recommendations for weight loss and weight maintenance as well as practical strategies for implementing the recommendations. Efforts are underway to translate the clinical guidelines into a variety of formats important to address the needs of the different health care practitioners, including physicians in primary care, nutritionists, nurses, pharmacists, health maintenance organizations, and patients.

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