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Wednesday, March 10, 2004 - Page updated at 12:41 A.M.

Obesity now rivals smoking as killer

By The Washington Post and The Associated Press

Dr. Julie Gerberding, CDC director
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WASHINGTON — Americans' sedentary lifestyle and poor eating habits are poised to overtake cigarette smoking as the nation's leading cause of preventable deaths, federal health officials reported yesterday.

Although tobacco remains the top cause of avoidable deaths, the combination of physical inactivity and an unhealthful diet is gaining rapidly because of the resulting epidemic of obesity, officials said.

"Obesity is catching up to tobacco as the leading cause of death in America. If this trend continues, it will soon overtake tobacco," said Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention, which conducted the study.

Based on current trends, obesity will become No. 1 by 2005, with the toll surpassing 500,000 deaths a year, rivaling the annual deaths from cancer, the researchers found.

"This is a tragedy," Gerberding said. "We are looking at this as a wake-up call."

In response, the Bush administration announced a new public-education campaign, including a humorous advertising effort that encourages Americans to take small steps to lose weight. In addition, the National Institutes of Health proposed an anti-obesity research agenda.

Tomorrow, a special task force will present the Food and Drug Administration with formal recommendations on what it can to do to help reverse the public-health crisis.

The FDA has been considering whether to require restaurants to provide more nutrition information and whether to change nutrition labels on food sold in groceries and other outlets to help consumers.

"Americans need to understand that overweight and obesity are literally killing us," Health and Human Services Secretary Tommy Thompson said in a statement.

"To know that poor eating habits and inactivity are on the verge of surpassing tobacco use as the leading cause of preventable death in America should motivate all Americans to take action to protect their health. We need to tackle America's weight issues as aggressively as we are addressing smoking and tobacco."

Critics called the moves inadequate, saying the administration should take tougher steps to encourage more healthful eating and force the food industry to improve products and stop advertising junk food to children.
 
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"If the government said, 'You really ought to cut back on soft drinks and juice drinks,' those lobbyists would go berserk. They don't want to take on the food industry," said Marion Nestle, a professor of nutrition and public health at New York University. "The focus is all on physical activity. It's perfectly safe. It's totally uncontroversial. But it's not enough to keep weight under control."

The new estimates of the rising toll of obesity come in the first update of a landmark paper that ranked the nation's preventable causes of death in 1990.

Cigarette smoking, which increases the risk for a variety of illnesses, including lung cancer, emphysema and heart disease, topped that list. But anti-smoking campaigns have led to a steady decline in the number of Americans who use tobacco, slowing the rise in the resulting toll of illness and death.

In the new analysis, which is being published in today's Journal of the American Medical Association, Gerberding and her colleagues reviewed the medical literature and analyzed preventable deaths for 2000.

Tobacco still topped the list, accounting for 435,000 deaths, or 18.1 percent of the total. But poor diet and physical inactivity were close behind and gaining rapidly, causing 400,000 deaths, or 16.6 percent. That represented a dramatic change from 10 years earlier, when tobacco killed 400,000 Americans (19 percent) and poor diet and physical inactivity killed 300,000 (14 percent).

"There's been a big narrowing of the gap," said Ali Mokdad, who heads the CDC's behavioral research branch. It's particularly striking because the toll of every other leading cause of preventable death — including alcohol, infections and accidents — steadily decreased during the same period, Mokdad said.

For example, in 1990, the third leading cause of preventable death, alcohol, was responsible for 100,000 deaths. By 2000, that number had dropped to 85,000.

But despite intense public concern, the number of Americans who are overweight or obese has continued to rise, reaching epidemic proportions. In 1990, about 15 percent of adult Americans were obese. By 2000, that number had climbed to 30 percent, with 65 percent being overweight.

"Physical inactivity and poor diet is still on the rise. So the mortality will still go up. That's the alarming part; the behavior is still going in the wrong direction," Mokdad said.

Being overweight or obese makes people much more likely to be stricken by a variety of health problems, including diabetes, heart disease and cancer.

The new findings come a day after another study concluded that if current trends continue, one of every five dollars spent on health care in the United States will go toward obesity-related treatment by 2020.

The trend was not surprising, given the skyrocketing obesity rates, said Richard Atkinson, president of the American Obesity Association. But the problem calls for a more intensive, innovative response, he said.

"There has been an explosion in obesity," Atkinson said.

"If we just count on the American population to change their eating habits and exercise habits, we're going to continue to have obesity. What we're doing is not working."

The government should consider more innovative strategies than simply encouraging people to eat better and exercise, such as subsidizing the cost of healthful foods such as fresh fruits and vegetables to make it more affordable to eat well, he said.

Kelly Brownell, director of Yale University's Center for Eating and Weight Disorders, criticized the government for failing to be more aggressive long ago.

"The USDA (Department of Agriculture) has the power to get rid of soft drinks and snack foods in the schools and they're not. The FTC (Federal Trade Commission) could deal with the tidal wave of unhealthy food advertising aimed at children. The government could change agriculture policy to subsidize the industry making healthy foods instead of unhealthy ones," he said.

The House will debate a bill today that would shield restaurants and fast-food franchises from lawsuits seeking to blame them for obesity and health problems related to it. The bill was prompted by the fast-food industry's complaints about a rash of lawsuits that fault its food for Americans' bulging bellies.

Meanwhile, McDonald's has announced it will end supersize fries and drinks in its more than 13,000 U.S. restaurants by year's end, except for special promotions.

Several soft-drink makers also have announced steps to offer a larger number of more healthful products.

Many states are trying to slow the increase in obesity among children. About 24 are considering bans or limits on vending-machine products in schools. Roughly 20 states restrict students' access to junk food until after lunch.

The Texas Agriculture Department is revamping rules on what foods public schools in the state can serve to their 4.2 million students, cutting out deep-fried foods and reducing fat and sugar in menus.

Copyright © 2004 The Seattle Times Company

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