Fighting the obesity epidemic in the U.S. will require changes at both the individual and societal level, according to a review paper published Sept. 17 in the Journal of the American College of Cardiology (JACC).

As part of the JACC focus seminar looking at behavioral factors that impact cardiovascular health, Carl J. Lavie, MD, FACC, et al., focus on "healthy weight" with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion.

They note that although some people are genetically predisposed to obesity, the most common causes are poor diet and especially a lack of physical activity. Rising obesity rates have paralleled the increasing consumption of refined carbohydrates and added sugars and increasing sedentariness and a decreasing physical activity. Recent dietary recommendations have shifted away from dietary restriction or elimination tactics and instead have moved to focusing on overall dietary composition and patterns, such as the Mediterranean diet. This method allows for greater flexibility and smaller changes, making diets more effective and easier to adhere to. When lifestyle modifications alone are not enough, pharmacotherapy and bariatric surgery may be used to intensify therapy for obesity.

Community interventions are key to reaching broader and more vulnerable populations. Implementation of more policy-, system- and environmental-wide interventions can transform environments and remove barriers that may hinder healthy decision making. These changes include creating more walkable communities, increasing the affordability and availability of healthy foods, increasing access to health services and implementing wellness programs in schools.

Other topics discussed by the authors include the controversial topics of metabolically healthy obesity and the obesity paradox, as well as the need to better train health care professionals in the delivery of healthy living medicine, or lifestyle counseling.

"While there is debate over whether responsibility for curbing the current obesity trends should fall on individuals or policymakers and lobbyists, it is clear that stronger initiatives are needed," said Carl J. Lavie, MD, FACC, lead author of the paper. "Ultimately, reconciling the obesity crisis will require a greater commitment from both sides to create a proactive culture of health and wellness that aspires to prevent chronic disease rather than treating it."

This paper is the sixth in an eight-part cardiovascular health promotion JACC focus seminar, where each paper focuses on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; tobacco-free lifestyle; cholesterol; blood pressure; psychological health; healthy weight; exercise and physical activity and blood sugar.

Keywords: Weight Gain, Diet, Mediterranean, Blood Glucose, Tobacco, Blood Pressure, Caregivers, Vulnerable Populations, Obesity, Body Weight, Life Style, Exercise, Health Promotion, Bariatric Surgery, Cholesterol, Counseling, Chronic Disease, Cardiovascular System, Decision Making

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