{"id":654,"date":"2016-02-25T18:42:15","date_gmt":"2016-02-26T02:42:15","guid":{"rendered":"https:\/\/keck.usc.edu\/news\/a-weighty-issue-tackling-obesity-one-patient-at-a-time\/"},"modified":"2023-11-26T08:17:05","modified_gmt":"2023-11-26T16:17:05","slug":"a-weighty-issue-tackling-obesity-one-patient-at-a-time","status":"publish","type":"post","link":"https:\/\/keck.usc.edu\/news\/a-weighty-issue-tackling-obesity-one-patient-at-a-time\/","title":{"rendered":"A Weighty Issue: Tackling obesity, one patient at a time"},"content":{"rendered":"\n \n \n\n\n\n\n\n\n\n
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\n\n \n Press Release<\/span>\n\n\n\n<\/div>\n \n \n
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A Weighty Issue: Tackling obesity, one patient at a time<\/h1>\n\n\n<\/div>\n \n \n
\n \n February 25, 2016<\/span>\n <\/div>\n \n \n
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Some try to regulate it and some try to legislate it, but obesity remains a major health challenge without a one-size-fits-all solution<\/h3>\n

AT THE USC <\/span><\/strong>Fit Families program, there\u2019s glaring proof of America\u2019s obesity epidemic: broken scales.
\n\u201cMy new scale goes up to 1,000 pounds,\u201d says program director Cheryl Resnik, associate chair of the USC Division of Biokinesiology and Physical Therapy<\/a>. \u201cWe\u2019ve broken two that had a 500-pound weight limit.\u201d
\nKids, teens and parents keep tabs on their weight at Fit Families\u2019 free wellness clinic in east Los Angeles, where USC physical therapists and graduate students counsel Angelenos at high risk of Type 2 diabetes and other weight-related problems. Community-level programs like Fit Families are one way health professionals try to tackle obesity where it starts: through habits picked up at home.
\nThey\u2019re also where health advocates see firsthand just how difficult obesity is to beat.
\nMore than one in three adults and one in six children in the U.S. are obese, posing a long-term and serious health crisis. Medical problems prompted by excess weight account for as much as $210 billion in health care costs a year, with Californians responsible for perhaps a quarter of that, says Michael Goran, professor of preventive medicine and pediatrics at the Keck School of Medicine of USC, pointing to a study from the Trust for America\u2019s Health. In Los Angeles, one in three children in low-income neighborhoods is now obese, Goran adds.
\n\"ScreenBut that number tells only the financial price of weight gain, not the human toll. Obesity-related health problems like heart disease and stroke, Type 2 diabetes and certain cancers are among the leading causes of preventable death.
\nWhere dollars and lives are at stake, public policy follows. As economists publish white papers with titles like \u201cThe Health Risks of Obesity: Worse Than Smoking, Drinking or Poverty,<\/a>\u201d local governments attack obesity and try to change behavior through regulation and legislation. Former New York Mayor Michael Bloomberg famously tried to battle his city\u2019s bulge by prohibiting the sale of large sugary drinks\u2014a ban struck down in court in 2013. Last May, a legislative panel in California nixed the latest in a series of attempts to tax sweetened soda and fruit drinks. Policy changes have also hit schools and restaurants. More than two in five of the nation\u2019s school districts pulled junk food from their vending machines in the last few years, according to a government survey, and the federal government now mandates that chain restaurants publish calorie counts on their menus.
\nBut research shows that these steps have limited success, says Darius Lakdawalla, the Quintiles Chair in Pharmaceutical Development and Regulatory Innovation at the USC School of Pharmacy. People often ignore the warnings of a burger\u2019s 33 grams of fat or seek substitutes for banned products. \u201cIf you\u2019re unable to buy a Big Gulp of soda, you can still go to the caf\u00e9 next door and buy a massive Frappuccino,\u201d he says.
\nSo Americans\u2019 girth still grows.
\nThe problem is simple to solve on paper, says Goran, co-director of the USC Diabetes and Obesity Research Institute<\/a>. Eat less (consume fewer calories) and move around more (burn more calories). \u201cBut the fact of the matter is that simple solution doesn\u2019t translate to practice very well,\u201d he says.
\nNo, it doesn\u2019t. It\u2019s a conundrum that crosses scientific and societal bounds. As scientists learn more about obesity\u2019s causes and consequences\u2014why it can be so dangerous and how it affects people differently\u2014they realize it\u2019s so complex that there may never be what Goran calls a one-size-fits-all solution.
\n\u201cIt\u2019s going to be very personalized types of intervention to address individual metabolism, individual behaviors, individual environments, individual contexts,\u201d Goran says. \u201cThis will require broader changes in the food environment that would shift the balance from easier access to cheap, low-quality food toward better access to healthier food choices.\u201d
\nUSC researchers and their colleagues across the nation are committed to the fight, even if it has to happen one person at a time.<\/p>\n

Shaped by the Environment<\/h3>\n

The choices many Americans make every day can quietly sabotage their health. Take fountain drinks, for instance. Sugary beverages are the biggest calorie contributor to the American diet, according to the Centers for Disease Control and Prevention, or CDC. Drink more soda, gain more fat\u2014so says the research. On the other side of the equation, fewer than one in 10 Americans get the amount of vegetables and fruit they need for good nutrition.
\nPeople are increasingly eating on the go, too. Americans consume a third of their calories outside the home\u2014and more than 11 percent of their calories come from fast food, the CDC reports. It\u2019s a matter of convenience for families\u2014but what parents might not know is that fast-food meals are dense with calories, and excess calories add up over time and translate to weight gain.
\nEnvironment plays a part in these choices. People who live near supermarkets tend to eat more healthfully, according to research, but minority and low-income neighborhoods have fewer of these markets\u2014especially compared to convenience stories and burger joints\u2014and they may be tough to reach without a car. It\u2019s easy to see why researchers call these areas food deserts.
\nSome policymakers have tried to limit fast-food restaurants and encourage new grocery stores in these food deserts. LaVonna Blair Lewis, a teaching professor at the USC Price School of Public Policy <\/a>who studies the phenomenon, was a vocal supporter of a moratorium on new standalone fast-food restaurants in South Los Angeles passed seven years ago.
\n\"ScreenBut do these moratoriums work? The prohibition remains hotly debated, partly because obesity is still rampant in the area. Lewis pleads for patience, noting that it takes time to change a neighborhood\u2019s eating habits. The ban is a victory because it preserves space for healthier food options, she says. \u201cThe land available for new development in South Los Angeles is limited, so let\u2019s protect it.\u201d
\nLewis also backed a successful effort to require local farmers markets to accept EBT cards, which is how California distributes food-stamp benefits. Hosting farmers markets is a win for low-income areas, says her colleague David Sloane, a USC Price professor specializing in urban planning and community health. These markets\u2014and community gardens that build awareness about fresh fruit and vegetables\u2014have gradually crept into inner cities, representing signs of progress.
\n\u201cThe conversation about how we get people good, healthy food has completely changed,\u201d Sloane says.
\nThen there\u2019s the issue of culture. Immigrants in low-income areas often struggle with weight, the researchers say. Some newcomers are unfamiliar with the array of processed foods that are readily available\u2014and their detrimental health effects. Sometimes their children guzzle sodas and devour burgers in an effort to become more American.
\n\u201cThe research tells us that the longer people stay in this country, the more unhealthy they become,\u201d Lewis says.
\nSchools may be a key to changing behavior, because education about nutrition and exercise can help kids adopt good habits early, Lewis says. School-provided lunches that are healthful and tasty can help too, especially if children are involved in testing recipes and growing ingredients.
\nBut schools can also sabotage diet, she says: It\u2019s not unheard of for cash-strapped districts to accept vendors\u2019 incentives to keep sugar-sweetened beverages and other unhealthy options on campus\u2014while at the same time cutting physical education classes and extracurricular sports programs to meet tight budgets.
\nLewis is among those calling for an examination of procurement policies in public facilities. \u201cSoda companies have a lot more discretionary income than a local farm trying to get vegetables into a school or other public facility,\u201d she says.<\/p>\n

The Social Network<\/h3>\n

Sometimes you not only are what you eat\u2014you are what your friends eat. Research shows that obese people who feel marginalized socialize with other obese people, and that could reinforce unhealthy habits.
\nAt the same time, the social sphere echoes with so-called \u201cfat shaming.\u201d The public\u2019s unforgiving language about obesity is similar to past patterns of denigrating people who fall ill after years of smoking or those with HIV\/AIDS, Sloane says.
\nThe talk comes across as \u201cbad people making bad choices,\u201d he adds. In an image-conscious culture, people may believe that the obese deserve what\u2019s coming to them\u2014and this stigma can be tough for the overweight to overcome.
\nBut relationships and the voices of others can also help, rather than hurt. Group programs like Weight Watchers offer affirming support to the obese through caring relationships. Relationships are partly why USC\u2019s Fit Families shows promise: Families gel at the clinic by learning about nutrition and exercising together. \u201cWe\u2019ve got one mother-daughter combo that\u2019s actually begun to run races,\u201d says Resnik, the program\u2019s director.
\nMiles to the north, in the Antelope Valley, other USC researchers are using the power of social support in the home. The Childhood Obesity Prevention at Home program partners with registered nurses who serve at-risk, low-income families. The nurses visit one on one with mothers in the first few years of a child\u2019s life to deliver obesity prevention and health promotion education as part of the services they provide to families.
\nProgram director Sarah-Jeanne Salvy, research associate professor at the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy<\/a>, says the postpartum period is often pivotal for mothers to implement healthy changes. What frequently drives them to change their lifestyle is the thought of their children struggling similarly with weight as they grow older.
\nAlthough the researchers are only a few months into this study, preliminary findings show that the program can impact infants and mothers even after a short implementation, Salvy says. Women are receptive to change \u201cnot just for themselves, but also because they\u2019re establishing the health trajectory of their kids for life.\u201d<\/p>\n

Health or Happiness?<\/h3>\n

Call it the french fry effect. Some people just crave foods that they know are stuffed with empty calories or are even harmful. These foods might offer their own emotional, visceral rewards.
\n\"Screen\u201cYou might choose, reasonably, to weigh more than a doctor says is ideal because you enjoy drinking beer and eating steak,\u201d Lakdawalla says. \u201cFrom an economics standpoint, those are all contributing to your happiness. It would be paternalistic to say, \u2018People should care about maximizing their longevity at all costs,\u2019 even if it means giving up the things they love.\u201d
\nAnd that gets to a sticky problem: Where is the line separating obesity as a scientifically predetermined fate versus the result of harmful living? Perhaps some people are preprogrammed to eat unhealthful foods or to build up more fat from these foods.
\nAs Katie Page \u201994, MD \u201902, an assistant professor in the Keck School of Medicine\u2019s Division of Endocrinology<\/a>, puts it: \u201cSome people may consume the same amount of calories and exercise as much as the person next to them, but they just may be more prone to keep that energy stored in their body.\u201d
\nScientists are trying to figure that out in the lab, and it will take time. But in practice, public health researchers are seeing reason for a little optimism in the national data. While nearly 79 million American adults are considered obese, the obesity rate appears to be plateauing. Perhaps it\u2019s the beginning of a payoff from studies and interventions that cross boundaries.
\n\u201cIt\u2019s a really slow process,\u201d Page says. \u201cIt\u2019s not just genetics; it\u2019s not just environment\u2014it\u2019s both. Sorting through all that takes time, and it takes good questions and rigorous research.\u201d<\/p>\n\n\n\n<\/div>\n <\/div>\n\n\n <\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":168,"featured_media":655,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[6],"tags":[81],"class_list":["post-654","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-press-release","tag-department-of-population-and-public-health-sciences"],"acf":[],"yoast_head":"\nA Weighty Issue: Tackling obesity, one patient at a time<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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