Obesity in America (cont.)

Brownell: For people who are capable of losing weight by changing their diet and exercise, surgery should not be an option because it does carry some risk. But for the people who have not been able to lose weight on their own, surgery can be a life-saving procedure. I am working with a person now for whom the surgery has had an enormously beneficial impact. I believe it is a viable tool to consider as an option for people who have a great deal of weight to lose.

Member: My family had observed the weight distributions for normal, obese, and extreme obesity. We had to wonder where or how did they determine those numbers? As a family, my kids and I have been extremely active in multiple sports. My son, specifically, is considered quick, agile, and small as a baseball player, but yet is on your "obese" scale. He is stocky, but lean. Most people considered him heavy-boned to account for his weight, a deception to most people since his birth. I am the same way, although I feel I could lose maybe 20 pounds with a diet, but I don't consider myself extremely obese as the scales designate me. Medical checkups label me as very healthy. Should not this obesity scale contain a qualifier on the physical fitness of the person and not just weight alone? If you could run distances, participate in sports, are strong and agile, should the obesity scale slide some?

Brownell: You raise a very good point. In general, the weight tables, most recently the body mass index charts, are a helpful means for many people to find where they stand in comparison to an ideal weight. There are, however, many people who get misclassified by these tables, including people who are stocky for genetic reasons, people who are quite muscular, and people who may appear to be overweight but are quite physically fit.

Dr. Steven Blair, in Dallas, has done very interesting research on whether it is possible for people to be fat but fit. His research indicates that a person is at lower risk if they are heavy but fit, than if they are thin and unfit. Not all the research agrees with this point of view, but it is clear that one can greatly reduce risk for serious disease by being physically active. Congratulations to you and your family for having such a commitment to physical activity.

Member: Do you see the public education funding crisis as part of the issue with kids -- reductions in extracurricular activities, physical education classes, resources for educators to be trained, and to teach more about nutrition and physical activity?

Brownell: Absolutely. The funding problems affect diet, exercise, and weight in several important ways. Schools become vulnerable to invitations from the soft drink and snack food companies to sell products because the schools get a cut. Physical education is one of the first programs to suffer, and schools have a budget crisis. Schools cutting back on after-school activities are contributing as well.

In addition, the way new communities are being built, very few children have the opportunity to walk or bike to school. The trend is toward larger rather than smaller schools hence children have less opportunity to participate in sports teams. For instance, there will be only boy's soccer team or one girls swim team, so a larger school means less opportunity for an individual to participate.

In the fight against poor diet and obesity, schools are where I believe the first victories will occur. The victories will begin with schools cleansing themselves of soft drinks, snack foods, and fast foods. Subsequently, there will likely be important changes in opportunities for children to be physically active.

Moderator: Our thanks to Kelly Brownell, MD, for sharing his expertise with us today.

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