Fat-fighting Beyond Schools


Its long list of intermediate goals -- to be met no later than June 2011 -- includes the promotion of bicycling and healthier restaurant food and the implementation of wellness policies in public schools.

Ultimately, planners hope those goals will help achieve long-term milestones. One of them: increasing the proportion of high-school students who consume five or more servings of fruits and vegetables a day.

"This will serve as a framework to guide individuals, communities, businesses and schools to reverse the trend toward obesity and, in turn, chronic diseases," said Dr. Michelle A. Gourdine, the state's deputy secretary for public health services.

She made the remarks to about 70 people celebrating the report's release with a continental breakfast of fresh fruit, bagels and juice at the Turf Valley Resort and Conference Center in Howard County.

The plan was the product of more than a year of work by representatives from academia, community groups, religious organizations, businesses and government. Its overarching goals are to encourage healthy eating and physical activity throughout life.

The plan is one of 28 such initiatives funded by the U.S. Centers for Disease Control and Prevention. Like yesterday's announcement that distributors will remove sugared soft drinks from schools, the Maryland proposal stems from concern over what is being described as an obesity epidemic.

The state estimates that 2.3 million, or 58.5 percent, of Maryland residents were overweight in 2004. Of those, 949,000 (nearly 24 percent) fall into the obese category. Only 16.3 percent were obese in 1995, the report notes, so the proportion has risen 47 percent in nine years.

Adults are considered obese if their body mass index (BMI) -- a measure of fat based on height and weight -- exceeds 30. Someone who is 5 feet, 6 inches tall and weighs 186 pounds, for example, has a BMI of 30 and is obese, according to the National Institutes of Health.

The state estimates that obesity-related medical costs totaled more than $1.5 billion for Maryland adults in 2003. Of those costs, $368 million was paid by Medicare and $391 million by Medicaid.

Of particular concern, officials said, is the link between obesity and many chronic diseases, including diabetes, stroke and heart disease.

"The evidence isn't there yet to know what specifically is impacting these obesity rates," said Claire Heiser, a CDC program project officer. "But we can't wait" to try fat-fighting strategies such as those in Maryland's plan.

Attacking the problem is challenging, partly because it disproportionately affects low-income people, said Wendy L. Johnson-Taylor, a public health nutrition and health policy adviser at the National Institutes of Health.

For them it's harder to implement strategies such as increasing consumption of fresh fruits and vegetables, which are relatively expensive and sometimes difficult to find in low-income neighborhood stores.

"The lower the income, the higher the weight," Johnson said, whipping through slides showing that the problem also disproportionately affects African-American girls and Mexican-American males.

The CDC's five-year, $450,000 annual grant to develop and implement the plan expires in June 2008. Some of the money will be used to make $22,000 grants to community health departments. In conjunction with workplaces, they will develop proposals to increase exercise or improve nutrition, said Teresa Moore, the state's nutrition and physical activity program coordinator.

Those involved in the effort acknowledged that the plan largely documents efforts already under way.

But gathering that information in one place will help the plans succeed, said Dr. David Stewart, who is chairman of both family medicine at the University of Maryland School of Medicine and the working group that developed the state's plan.

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