What is the best way to tackle the obesity crisis? There appears to be some disagreement among experts in the British Medical Journal (BMJ) today. While Professor Louise Baur and team from the Children’s Hospital at Westmead and the University of Sydney in Australia acknowledge that “physical inactivity is a major contributor to the global burden of disease,” they say that it would be wrong to solely focus on this and disregard the problem of obesity.

Physical inactivity is just one marker, Baur and colleagues argue. They say there is substantial evidence that unhealthy diets low in fiber and high in sugar and large portion sizes are also responsible for obesity and the diseases linked to it.

However, Dr Richard Weiler, a specialist registrar in sport and exercise medicine at Imperial College Healthcare NHS Trust (UK) and general practitioner, and colleagues believe that inadequate cardio-respiratory fitness causes disease more than excess body fat, waist size and body mass index.

Weiler and colleagues stress that..

physical inactivity is one of the greatest health threats facing developed nations today

..and they are concerned that 95% of the populations in the UK and the USA do not meet the recommended guidelines of doing 30 minutes moderate to vigorous exercise on at least 5 days a week or equivalent.

They say this is disturbing, given that physical inactivity rather than just obesity is an actual cause for many illnesses including obesity, heart disease, diabetes type 2, mental health problems, high blood pressure and dementia.

They argue that spending enormous amounts on obesity is not right the way to go. Weight loss drugs and surgery are hazardous and the long-term benefits are imperfect and they certainly do not have the associated health benefits associated with physical activity. They conclude that it is time for health policy and healthcare professionals to concentrate on tackling physical inactivity, a “chronic disease that has an adult population prevalence of 95%.”

Professor Baur, on the other hand, believes that..

on its own, improving physical activity will have little impact on reducing overall levels of already established obesity.

She argues that obese individuals need access to top quality treatment provided by well-trained health care professionals to deal with their weight and any health problems linked to overweight.

In conclusion, Professor Baur and colleagues are in favor of attacking obesity with a range of strategies, such as improving lifestyle, diets, and increasing physical activity. They say urban planning should be designed to encourage people to use their cars less and cycle more, while public transport should be made more accessible and affordable.

Head to Head
“Should health policy focus on physical inactivity rather than obesity? No”
Timothy P Gill, Louise A Baur, Lesley A King
BMJ 2010;340:c2602
Published 25 May 2010, doi:10.1136/bmj.c2602

Head to Head
“Should health policy focus on physical activity rather than obesity? Yes”
Richard Weiler, Emmanuel Stamatakis, Steven Blair
BMJ 2010;340:c2603
Published 25 May 2010, doi:10.1136/bmj.c2603

Written by Christian Nordqvist