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Special Article |

The Escalating Pandemics of Obesity and Sedentary Lifestyle:  A Call to Action for Clinicians

JoAnn E. Manson, MD,DrPH; Patrick J. Skerrett, MS; Philip Greenland, MD; Theodore B. VanItallie, MD
Arch Intern Med. 2004;164(3):249-258. doi:10.1001/archinte.164.3.249.
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Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention by physicians and other health care professionals. These intricately linked conditions are responsible for an enormous burden of chronic disease, impaired physical function and quality of life, at least 300 000 premature deaths, and at least $90 billion in direct health care costs annually in the United States alone. Clinicians are on the front line of combat, yet these conditions receive minimal attention during a typical office visit. Clinicians often feel overwhelmed by these challenges and point to an absence of clear guidelines and practice tools, minimal training in behavior modification strategies, and lack of time as reasons for failing to confront them. This report provides a "call to action" with step-by-step guidelines specifically directed at the pivotal role of physicians and other health care professionals in curbing these dangerous epidemics. This blueprint for action, which requires only a few minutes of a clinician's time to implement, will facilitate more effective intervention related to obesity and inactivity and should favorably impact public health.

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Figure 1.

Percentage of US adults classified as obese (body mass index [calculated as weight in kilograms divided by the square of height in meters] ≥30) in health surveys from 1960-2000. NHES indicates National Health Examination Survey; NHANES, National Health and Nutrition Examination Survey. Data from Flegal et al.6

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Figure 2.

Lack of leisure-time physical activity among US adults (source: Healthy People 201017).

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Figure 3.

Trends in overweight among US children and adolescents, 1963-2000. Overweight in these age groups is defined as a body mass index for age at the 95th percentile or higher based on body mass index distribution in the initial survey. NHES indicates National Health Examination Survey; NHANES, National Health and Nutrition Examination Survey. Data from Ogden et al.18

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Figure 4.

Association between body mass index (calculated as weight in kilograms divided by the square of height in meters) and the relative risk of several diseases among women in the Nurses' Health Study followed up for 18 years (A) and men in the Health Professionals Follow-up Study followed up for 10 years (B). Reprinted with permission from Willett et al.33(p430,Fig2)

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Figure 5.

Flowchart for the evaluation and counseling of an individual regarding weight and physical activity during the patient encounter. BMI indicates body mass index (calculated as weight in kilograms divided by the square of height in meters).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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