Dec. 10, 2007 — Although there is general agreement that the United States faces an obesity crisis, public efforts to combat rising obesity rates throughout the country — and in Virginia — have been largely ineffective because they lack sound scientific analysis and careful evaluation.

That is the conclusion of Tanya Wanchek, a research associate in the business and economics section of the University of Virginia's Weldon Cooper Center for Public Service.

In an article in the December edition of The Virginia News Letter, a Cooper Center publication, Wanchek lays out current data and examines several of the existing programs that have been established to tackle obesity.

"We are creating government programs based on very little evidence about causes obesity in the first instance, and then we are not monitoring the effectiveness of the programs that are created," says Wanchek, whose article is titled "Why We Are Losing the Fight Against Obesity."

Obesity is a medical term defined by body mass index, or BMI, calculated as a ratio of weight to height. Those with a BMI of 30 or higher are classified as "obese," while persons with a BMI between 25 and 30 are "overweight." (To calculate your BMI, visit nhlbisupport.com/bmi/.)

In her article, Wanchek notes that one in four Virginians are classified as obese, and those rates have been rising sharply. About 16 percent of Virginians were obese in 1996, compared with 25 percent today.

Virginia's obesity profile mirrors the nation's. Since the percentage of overweight individuals has changed little, more people are probably moving from the overweight range to the obesity range and fewer are staying in the healthy weight range.

Within Virginia, there is not a clear regional pattern in the combined overweight/obesity rates. The Eastern and Southside regions have the highest combined rate of overweight and obese adults at 61 percent. The Northern, Southwest, Valley and West Central regions have the lowest rates.
   
"The variation does not appear to be distributed along rural/urban or income lines," writes Wanchek. "The Valley region has the third-lowest population density, while Northern and Hampton Roads have the highest density. Yet, combined overweight and obesity rates are among the lowest in the Northern and Valley regions, with Hampton Roads ranking slightly above the state average.

"Similarily, the Southside and Southwest region have the lowest levels of income in the state, but they diverge in obesity and overweight rates."

Wanchek notes that there is no shortage of theories about the causes of obesity, but scientific findings have been ambiguous and unclear.

"The problem with viewing obesity purely as a personal choice, rather than a public health issue, is that obesity imposes large costs on society," Wanchek says. "Being obese increases one's risk of a variety of life-threatening diseases, including diabetes, hypertension, heart disease, stroke and some forms of cancer. These diseases result in large medical costs and lost worker productivity."

The Centers for Disease Control and Prevention estimated that obesity-related medical costs in the state in 2003 were $1.64 billion, with Medicare or Medicaid paying 42 percent.

A number of programs have been established by Virginia's state government to tackle obesity, and local communities and organizations have also initiated various efforts. Wanchek notes that many of these programs have been based more on conventional wisdom than on science, and have not evaluated their results.
   
Wanchek argues that the focus must shift to scientific evidence and evaluation about obesity-reduction programs in order to "discard unproductive policies and replicate effective ones."

Programs specifically designed to gather data will cost more, Wanchek writes, but the scope of the problem makes it essential to conduct "careful assessments to find cost-effective solutions to the obesity epidemic."

One example of a program that gathered data through surveys and sales records, both before and after implementation, in order to measure its effectiveness was piloted at the University of Virginia Medical Center. The system, called "Signals for Health," ranks the foods into the three color categories based on the food's calorie, fat and sodium content. In cafeterias and vending machines the color tags provide a visual cue to the food's value.

Wanchek concludes that "crash programs on such a complex socio-economic problem may delay our ability to find affordable and effective solutions. A balanced program of continued scientific inquiry into the causes of obesity, along with policy initiatives based on the best available evidence and designed for evaluation of outcomes, will give us the greatest chance of ultimate success."