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Family Health Care Center, Royal Oak, Mich

To the Editor: The international pandemic of obesity poses a serious threat to the well-being of society in terms of adverse public health and economic consequences.¹ As we continue the battle against obesity, public health authorities should heed the lessons learned in the successful campaign against smoking and the tobacco industry and apply those same principles (eg, shifts in public behavior prompted by tax and regulatory policies) in efforts against obesity.² Simply issuing warnings to the public about the ravages of obesity and throwing more money at the problem has not been working.^3,4

The preponderance of scientific evidence suggests that obesity, once established in an individual or a population, is extremely difficult to control by conventional methods of intervention, such as diet and exercise.¹ Although physicians must continue intervention efforts for those patients who are overweight, there needs to be a stronger public policy directed toward primary prevention of obesity.^2-4

A thorough international public health strategy to prevent obesity would address prevailing attitudes and norms and disparities in health and economics within society. Policymakers should encourage radical changes in the health-related behaviors of the public in order to produce substantial shifts in food production, marketing, and consumption.^2-4

Although lifestyle changes by individuals are an important part of efforts to reduce obesity, stronger and more effective public health policies should be enacted to support beneficial changes in the health-related behaviors of adults.^2-4 Among the public policies and actions that could be taken to address the obesity pandemic are the following:

• increased taxation on "junk" food (eg, candy, snacks, fast food)
  
• bans on advertisements for fast foods
  
• financial incentives to food manufacturers that market smaller-sized portions
  
• overall policy framework to encourage a healthier environment for food consumption and to discourage the insidious daily food excesses that lead to overweight and obesity
  

It is no longer acceptable for physicians to remain silent on the obesity pandemic. I urge you to contact your local, state, and federal representatives and demand that they enact strong legislation to fight obesity—similar to the legislation that is currently leading to smoke-free environments across the United States.⁵ The quality and longevity of our lives and those of our children depend on having the will to act against obesity as we have already acted against smoking.

Footnotes
Editor's Note: For more information on this topic, readers are encouraged to read the February 2008 Supplement to the JAOA, Getting a Grip on Girth and Cardiometabolic Risk, which is available at: http://www.jaoa.org/content/vol108/suppl_1/. The document is a consensus report of the American Osteopathic Association, the American College of Osteopathic Internists, the American College of Osteopathic Family Physicians, the American Academy of Physician Assistants, and the Diabetes Consortium, Inc.

References
1. Chopra M, Darnton-Hill I. Tobacco and obesity epidemics: not so different after all [review]? BMJ. 2004;328:1558-1560. Available at: http://www.bmj.com/cgi/content/full/328/7455/1558. Accessed December 21, 2007.

2. Yach D, McKee M, Lopez AD, Novotny T. Improving diet and physical activity: 12 lessons from controlling tobacco smoking. BMJ. 2005;330:898-900. Available at: http://www.bmj.com/cgi/content/full/330/7496/898. Accessed December 21, 2007.

3. Mendoza M. AP: Nutrition education ineffective. USA Today. July 6, 2007. Available at: http://www.usatoday.com/news/health/2007-07-04-fightingfat_N.htm. Accessed December 21, 2007.

4. Davey RC. The obesity epidemic: too much food for thought? Br J Sports Med.2004 :38:360 -363.[Abstract/Free Full Text]

5. United States: public place smoking bans in states, 2007. KaiserFamilyFoundation/statehealthfacts.org Web site. Available at: http://www.statehealthfacts.org/profileind.jsp?ind=86&rgn=1&cat=2. Accessed December 21, 2007.

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