'EPIDEMIC OF OBESITY': SCIENTISTS AND NUTRITION PROFESSIONALS BATTLE A PUBLIC HEALTH CRISIS THAT AFFECTS EVERYONE

Scientists and health-care professionals now call it an epidemic, a public health crisis that is having an increasing impact on every aspect of health care in America.

Obesity contributes to more than 300,000 potentially avoidable deaths each year. Health-care costs attributable to obesity amount to nearly $70 billion per year. Half the population is overweight and a third is obese, according to the latest federal guidelines. Obesity is a major risk factor for a heart attack. Children are affected, as are the elderly and everyone in between.

Health professionals from physicians and psychologists to geneticists and dietitians are fighting "the war on obesity"--and increasingly they’re working together on new approaches and treatment programs. It’s not surprising, therefore, that lectures, panels and research reports on obesity are among the most significant sessions here in Kansas City this week.

A special supplement to the October issue of The Journal of The American Dietetic Association titled "The Epidemic of Obesity" contains nearly a dozen articles focusing on prevention and treatment. Registered dietitian and ADA president Ann Coulston calls for "a rethinking" of current programs to "include a variety of health professionals to deal with the lifestyle changes needed to treat this condition." Copies of the supplement will be available at the Annual Meeting.

At a two-part session on the future of obesity treatment--Is Obesity a Disease? at 1:30 p.m. today, and New Treatment Paradigms at 9:30 a.m. Wednesday, Oct. 21--some of the nation’s leading obesity researchers will give up-to-the-minute reports on genetic and environmental factors underlying obesity; its psychological dimensions; obesity in children and the elderly; drug treatments; exercise programs and ways health professionals can work together on effective multidisciplinary approaches.

Speakers today included:

Dr. Xavier Pi-Sunyer, director of the obesity research center at St. Luke’s/Roosevelt Hospital, New York City, who discussed the federal obesity guidelines issued in June by the National Institutes of Health. Dr. Pi-Sunyer chaired the expert panel that developed the guidelines, which indicate that 97 million adult Americans--more than half the adult population--is overweight or obese.

Dr. William Dietz, director of the division of nutrition and physical activity at the Centers for Disease Control’s National Center for Chronic Disease Prevention and Health Promotion, who discussed the latest developments in treating obesity in children.

Kelly Brownell, professor of psychology and epidemiology and director of the Yale Center for Eating and Weight Disorders at Yale University. Brownell, a nationally known authority on psychological aspects of eating disorders, obesity and body weight regulation, discussed "behavioral challenges" to treating obesity.

Research by Susan Lutz, a registered dietitian and researcher in nutrition and food science at the University of Missouri-Columbia, and her colleagues indicates that "modifiable factors in the family environment", such as television watching and parenting styles, can contribute to development and treatment of obesity in children. Lutz discussed her work at a session at 11 am. today.

Other speakers covered the use of television commercials to promote "social messages", such as simple nutrition messages to encourage healthful eating by children.

HEART DISEASE RISK IN OLDER ADULTS: ARE DIETARY RESTRICTIONS EFFECTIVE?
11 am.

Speakers: Richard A. Kronmal, PhD, University of Washington - Seattle
Donald J. McNamara, PhD, Egg Nutrition Center, Washington, D.C.
Lorraine E. Matthews, MS, RD, Philadelphia Department of Public Health

As many as 25 percent of older adults in the US are at risk for malnutrition as a result of insufficient calories and inadequate vitamin and mineral intakes. Seniors consume less cholesterol than current dietary recommendations. This session examined the latest research findings and determined how the nutrition community can help seniors individualize current nutritional guidelines to ensure optimal health and well-being.

WINNING AT WEIGHT CONTROL: WHAT WE CAN LEARN FROM MAINTAINERS
11 am.

Speakers: Anne M. Fletcher, MS, RD, Mankato, Minn.
Linda K. Thacker, Norfolk, Va.
Jim Vitagliano, Wollaston, Mass.

It is time for discouraged and burned-out weight-loss practitioners to switch gears and start focusing on success. This session presented new findings and summarized the literature on individuals who have maintained weight loss, examining their eating habits, psychological strategies and exercise patterns. The emphasis was on applying strategies of maintainers to facilitate lifestyle changes in those still seeking their ideal weight.

NUTRITION AND ARTHITIS
1:30 pm.

Speakers: Margaret D. Smith, MD, St. Vincent’s Medical Center, New York
Joel M. Kremer, MD, Albany Medical College

To prevent irreversible damage to joints and surrounding tissues, arthritis research reveals the need for early diagnosis and treatment. This session addressed the significance of nutrition in treatment and identified sources of reliable information and services for people with arthritis.

ETHNICALLY ORIENTED NUTRITION EDUCATION: INFLUENCING AFRICAN-AMERICANS

"We really haven’t tended to look at our clients’ or patients’ cultural sensitivities in our practices," said Baton Rouge, La., registered dietitian Barbara Dixon, one of three experts speaking at a 1:30 pm. session.

"But as we see changes in the way Americans look today, we have to see changes in the way we as dietitians operate. The same principles apply to any ethnic group. We have to know who our customers are." Dixon attributes the continued prevalence of such conditions as hypertension and obesity among blacks--or ethnically related health problems among other groups--despite decades of health education to "a communication gap that does not take culture into account."

African-Americans’ overall diet is "of particularly poor quality," according to a recent report from the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. According to the USDA’s Healthy Eating Index, which measures overall diet quality on a scale of zero to 100, the mean score for African-Americans was 59, compared with 64 for whites and 65 for the group including Asian- and Native Americans.

"African-Americans can benefit from research and nutrition recommendations only if the messages are culturally inspired," Dixon said. "Unless we understand that, we’re missing the boat as educators."

ARE YOU A FOOD BIGOT? EXPLORING CULTURAL FLAVOR SYSTEMS

A 4 p.m. session Are You a Food Bigot? Exploring Cultural Flavor Systems, explored the idea that dietetics professionals have "flavor biases" like everyone else--biases that can impair their efforts at nutrition counseling, patient care or food preparation.

"We’re all born into a little box of food families, and whatever is outside our box is unfamiliar so we don’t embrace it," said Suzanne Vieira, a registered dietitian and associate professor in the food service academic studies department at Johnson and Wales University.

"Where you drop on this earth is where your flavor system develops. Italians, for example, might find it difficult to use curry when they’re used to oregano".

"But dietitians must be open to understanding every flavor system, the meanings of foods within a culture, the factors that combine to make a culture’s food its own. A person on the receiving end of counseling, therefore, may be more apt to pay attention. They’ll think, ‘This person understands me and identifies with the world I live in.’ "

Antioxidants, phytochemicals, lycopene, complex carbohydrates, the Human Genome Project...Is this the outline of a college chemistry course? Or is it dinner?

Nowadays, the answer may be: both.

Scientific developments in food and nutrition are routine occurrences and phrases like "functional foods" are entering people’s everyday vocabularies. The role of nutrition in treating diseases with genetic components, such as obesity, is increasingly understood by consumers and health professionals alike.

But how can an average person--or a professional--separate the nutrition science from science fiction or "junk science" and know what to believe?

Americans’ interest, knowledge and desire for information about concepts like functional foods and antioxidants is expanding rapidly, says Lisa Katic, food safety program manager at the International Food Information Council, who spoke at a 4 p.m. session Antioxidants: Scientific Status, Consumer Attitudes.

IFIC conducted focus groups to gauge peoples’ attitudes toward functional foods, defined as "foods that provide a health benefit beyond basic nutrition." Prompted for examples of foods with a health benefit for specific health concerns, many people volunteered calcium (for osteoporosis), dietary fiber (colon cancer) and cranberry juice (urinary tract infections). Increasing numbers of consumers are aware of the potential benefits of the antioxidant lycopene (found in tomatoes, cereals and dairy products, among others) in protecting against diseases and cancer.

"Consumers believe that foods contribute directly to their health," said Katic, a registered dietitian. "This is a very significant trend that is here to stay."

"Children can obtain information in ways previously only dreamed by parents and educators," said registered dietitian Doris Derelian, president of Health Professions Training and former ADA president. "But will they use these new delivery systems to learn the messages we want them to, or will they change their behaviors as a result of this newly created access?"

Derelian saID research shows young children are more likely to understand and act on some types of information--especially "static" information, such as facts and dates--that they receive from a teacher in school than from a computer. "It tends to level out with older children, but the imprinting of the classroom experience is still very powerful."

Registered dietitian Jean Ragalie, vice president for nutrition and health communications at the National Dairy Council, spoke at the same session on ways that corporations and non-profit organizations use mass media communications to reach children and their parents, and discussed the types of nutrition information being conveyed in TV shows and commercials.