March 10, 2009

Toward Healthy Lifestyles…It Takes a Village

Let me begin where I left off discussing the study which asked: What's the Diet is Best?, published in the 2/27/09 issue of New England Journal of Medicine. In closing I noted that this study reinforces that people need continual and continued support to achieve and maintain weight loss.

The accompany editorial, Weight-Loss Diets for the Prevention and Treatment of Obesity, by Martijn B. Katan, Ph.D., is one of the more salient pieces I’ve read on this topic which begins with dishearting comments and ends with heartening notes:

On the dishearting side, Katan states:... “It is obvious by now that weight losses among participants in diet trials will at best average 3 to 4 kg after 2 to 4 years and that they will be less among people who are poor or uneducated, groups that are hit hardest by obesity. We do not need another diet trial; we need a change of paradigm.”

As for the heartening message, Katan details: “…A community-based effort to prevent overweight in schoolchildren began in two small towns in France in 2000. Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling. "

"Though this was not a formal randomized trial, the results were remarkable. By 2005 the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in the neighboring comparison towns, in line with the national trend. This total-community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l'obésité des enfants [Together, let's prevent obesity in children])."

Katan concludes: “…Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action…what works for small towns in France may not work for Mexico City or rural Louisiana. However, the apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environment approach that involves and activates entire neighborhoods and communities.”