Here are some thoughts from Dr. Hans Krueger regading the ongoing problems related to smoking and obesity. The link to a review of their recent book in the New England Journal of Medicine can be found here.
 

Background

·         Establishment of the British Columbia Healthy Living Alliance in February of 2003 with a mission “to improve the health of British Columbians through leadership that enhances collaborative action to promote physical activity, healthy eating and living smoke-free”.

·         Vancouver/Whistler awarded the 2010 Winter Olympics.

·         B.C. Premier publically states that one of the governments goals was to “be the healthiest jurisdiction to ever host an Olympics”.

·         Provincial election in May of 2005.

 

Scope of the Obesity Problem

·         In Canada, 14.7% of population (14% of females and 16% of males) is obese (based on self-reported data).

·         Ranges from a low of 12.6% in British Columbia to a high of 22.8% in Newfoundland.

·         Increase from 6.1% in 1985.

 

Surprise Findings

·         Early research suggested that it was “unhealthy” to lose weight. Need to separate out ‘intentional’ from ‘unintentional’ weight loss. Unintentional weight loss is often associated with an adverse health event.

·         Even ‘attempts’ to lose weight (without actually losing weight) leads to improved health, likely to the adoption of healthier eating and more physical activity during the weight loss attempts.

·         A body mass index (BMI) of 25.0 to 27.5 is not associated with a statistically increased health risk.

 

How Was Success in the Tobacco Wars Achieved (and Can This Be Applied in Addressing Obesity)?

  1. Increase the price of tobacco products
  2. Reduce opportunities to promote tobacco products
  3. Create smoke-free public places
  4. Counter-advertising
  5. Primary care based cessation programs

From a economic perspective, the cost per quality adjusted life year (QALY) saved is approx $350, only 1/100th of the average cost per health care intervention.

 

Lessons Learned

          No single intervention can account for the successes seen since the 1960s

          Each intervention is enhanced synergistically by other components

          Required systemic changes (ban on advertising, price increases, legislated smoke-free places) and social ‘denormalization’

          Governments and communities must work together with adequate financial and organizational resources over the long haul

          Interventions must be available for individuals who seek to make a lifestyle change

 

Similarities and Differences

1.       Differences

a.       Food and activity are essential; tobacco is not

b.      Possible negative consequences (disordered eating)

c.       Underlying genetic/disease conditions

d.      Limited research on effective interventions

2.       Similarities

a.       Social influences and advertising pressures influence what we eat

b.      Environmental constraints can lead to limitations on physical activity

c.       ‘Obesogenic environment’

 

The Four Fundamentals for Any Risk Factor Reduction Plan

1.       A comprehensive approach

a.       No single intervention ‘works’, there is no magic bullet

b.      E.g. Nova Scotia elementary school experience

2.       Innovation

3.       “A Long Obedience in the Same Direction” – commitment

a.       Reducing smoking prevalence from 50% to 20% in Canada took 40+ years

b.      North Karelia experience changing eating habits took 20+years

4.       The Dance between the Personal and Environmental

a.       Most important but often forgotten

b.      In the absence of changes to the ‘obesogenic’ environment, encouraging individual choice and goal-setting will not get you very far. Individuals must be supported in their behavioral change attempts.

c.       E.g. urban planning, safe and appropriately designed communities (for walking), availability of quality vegetables and fruits.

d.      But individuals also need to take initiative, beginning with small steps (take the stairs, park the car further from your destination and walk, eat one more serving of veggies and fruit a day, prepare more home cooked meals, avoid processed foods when possible, etc.)

e.      E.g. example of the B.C. Ministry of Health encouraging individuals to take the stairs in their building.