Saturday, April 23, 2011

Fight against obesity needs to model the one against smoking, key federal official says at Appalachian Health Summit

By Tara Kaprowy and Al Cross
Kentucky Health News

Obesity is linked to so many other health problems that Americans need to see it as deadly as smoking cigarettes, the federal government's point man on the subject said at the first Appalachian Health Summit in Lexington Thursday.

"People don't see TV as a threat to public health nor do they see sugar drinks or fast food as threats," but all contribute to obesity, said Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity in the Center for Chronic Disease Prevention and Health Promotion, part of the federal Centers for Disease Control and Prevention.

"We are at the corner where tobacco was in the 60s, but we have not turned the corner," Deitz said. While increases in national obesity rates may have hit a plateau, "That doesn't mean we can become complacent," he said, "because this is a terribly costly problem."

That is especially true in Appalachian Kentucky and the rest of Central Appalachia, where four-fifths of counties have an obesity rate higher than the national average, so the University of Kentucky expanded its annual Clinical and Translational Science Conference to a program titled "Appalachian Health Summit: Focus on Obesity" and involved other universities in and near the region. The event drew more than 600 professionals to the Lexington Convention Center.

The battle against obesity is particularly difficult to win in Appalachia because it is so connected to social determinants like low education and income, said the leadoff speaker, Randy Wykoff, dean of the College of Public Health at East Tennessee State University. "Most people don't understand how strong these associations are," he said.

Complicating the problem are bad eating habits, limited access to healthy foods and a lack of safe, convenient places to exercise or even take a long walk, especially in rural communities far from county seats.

"We don't have a lot of recreational facilities out there," said William Betz, senior associate dean for osteopathic medical education at the Pikeville College School of Osteopathic Medicine. "In Pikeville, we have a Y, but that's it. . . . Where are the neighborhood parks in the hills of Appalachia? Where are the sidewalks?"

Deitz concurred: "You can't make a healthy choice if there's not a healthy choice to make."

Given such obstacles, and the difficulty in changing adults' behavior, some researchers think the fight against obesity should focus on children. Wykoff noted that in 60 percent of Central Appalachian counties, one in four children live in poverty, "and there is evidence this is getting worse."

In Pike County, Ohio, students are taking the "30-day Sodabriety Challenge," in which they pledge to stop drinking sugary drinks, including sports drinks, for a month. The project is being run by Laureen Smith, an assistant professor at Ohio State.

With 71 percent of adults and 44 percent of children in the area either overweight or obese — and diabetes rates high in turn — Smith turned to Pike County's high school to see if she could effect change. She found the average boy was drinking nearly four and a half sugar drinks a day, and girls were drinking more than three — some of which they were getting from a "secret" snack room in the school, despite state law prohibiting sugar drinks in school vending machines.

By getting a council of 10 students and two teachers together, they came up with a plan to get students aware of their consumption and its consequences. Students designed materials with the logo "What's in your cup?" They set up a Sodabriety Facebook page, delivered daily announcements and recruited more than half of the 100 students in the high school to take the challenge. As of Thursday, Smith said the students are halfway through the challenge, but are already remarking on weight loss.

Research in the community

More researchers are heading to Appalachian counties to come up with answers, and many were at the summit. "We believe if the problem is in the community, the solution is in the community," said UK's Mark Dignan, director of the Appalachia Community Cancer Network, repeating a maxim of Dr. Gil Friedell, founding director of UK's Markey Cancer Center.

Dignan said researchers should tackle such projects gingerly. "Appalachians have lots of experience with researchers," he said, and some "are very suspicious" that most of the money poured into such problems remains at research universities.

"It's all about the relationships," said UK's Nancy Schoenberg, who is working on Faith Moves Mountains, an obesity project based largely in Letcher County churches. She and her workers volunteer at church and community events, but must also gather data using standard research methods.

The scientific method calls for a control group that doesn't get the intervention received by the experimental group, but close-knit communities see the denial of a service to their neighbors as offensive, so Schoenberg's project involves every church that wants to participate — but involves some later to serve as a control group.

Researchers are also working with community collaboratives. In Ohio's Adams County, Farrah Jacquez, assistant professor at the University of Cincinnati, nurse practitioner Becky Basford and a host of community stakeholders worked together to build a fitness trail between two schools. "The community has knowledge of what needs to be done and know their community in a way I can't," Jacquez said. "Like, who knew in Adams County Zumba is a big deal?"

Disconnect at the doc's

One of the first places to start losing weight is a local doctor's office, but Stephanie Rose, an assistant professor at UK, found there is a disconnect between what physicians feel they're doing to counsel their patients about weight and what patients are hearing.

Though 92 percent of physicians in Rose's study said they felt it was their responsibility to talk to their patients about being overweight, only 42 percent of patients of normal weight and 78 percent of obese patients said their doctors had raised the subject. Further study showed just 55 percent of physicians said they felt they had time to talk to their patients about the issue and "a lot of primary care providers don't feel comfortable" talking about it, Rose said.

Betz said he's witnessed the phenomenon. "As physicians we dig our heads in the sand," he said. "We don't want to offend, we don't have the time."

Yet what a doctor tells his or her patients matters, Rose's study showed, indicating there was a "positive significant correlation" between a doctor counseling a patient about being overweight and that patient consequently trying to lose it.

Researchers have also found Americans do not recognize or acknowledge that they're overweight. "People will say, 'I have a weight problem, but I'm not obese'," said Deitz, of the CDC.

Betz said, "People look at themselves and think their weight is normal." He referred to a study that found 23 percent of women and 48 percent of men who are overweight think they have normal weight. "We have a 'norming up' situation," he said. "We're making the normal heavier. . . . What constitutes normal changes and so does the acceptance of it."

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