It takes a village to impact obesity epidemic

french-village

The results of the latest (and so far best) research on diets are in:  most people won’t stick to them. The New England Journal of Medicine (2/26/09) published the study which has now been widely reported in the news.  Over 800 men and women were followed on various diets for 2 years; the average weight loss was modest (about 9 pounds) and those who attended counseling sessions (an indirect measure of motivation) lost the most.  No one adhered to the diet closely, despite frequent monitoring and much support.  The conclusion is that eating less (calories) is what matters, not the specific content of the diet (in terms of low fat, high protein, low carbohydrate, etc).

These findings are not surprising, but what is most interesting is the accompanying editorial which describes a study in France where entire villages were used to counteract the obesity epidemic.  Here is the summary from the NEJM editorial:

A community-based effort to prevent overweight in schoolchildren began in two small towns in France in 2000. Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.

Though this was not a formal randomized trial, the results were remarkable. By 2005 the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in the neighboring comparison towns, in line with the national trend.11 This total-community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).12

Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action. Evidence for the efficacy of the EPODE12 approach is only tentative,11 and what works for small towns in France may not work for Mexico City or rural Louisiana. However, the apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environment approach that involves and activates entire neighborhoods and communities. It is an approach that deserves serious investigation, because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery.

The NEJM research article is here: http://content.nejm.org/cgi/content/full/360/9/859.

The editorial is here: http://content.nejm.org/cgi/content/full/360/9/923.

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