Dallas, TX - Think bigger: that's the thrust of the American Heart Association's new scientific statement on obesity prevention [1]. To have any meaningful impact on the obesity epidemic, physicians need to go beyond clinical prevention and treatments for obesity and use influence and advocacy to effect social and environmental change, authors of the statement say.

Dr Shiriki K Kumanyika

"The main point of the statement is that we need to place more emphasis on population-based and preventive approaches than we have to date," Dr Shiriki K Kumanyika (University of Pennsylvania School of Medicine, Philadelphia), lead author on the statement, told heartwire. "This point has been made in different ways before, in different kinds of documents, and it's being made globally, but we are still in the process of educating health professionals about what this actually means and why it's needed. . . . It's inefficient to put all your eggs in the basket of screening and treating the individual."

The statement, titled "Population-based prevention of obesity" includes an appendix listing all of the AHA's related statements dealing with obesity published between 2004 and 2006. "It turns out when we look at all the other statements, this is a missing piece," Kumanyika noted. "This statement is really putting the story of prevention together and pointing out that any prevention approach we take, in any population, still needs to be on a better platform," one that takes into account public policy and social and environmental factors."

So this is actually happening, it's a social movement. And we want cardiologists to know about it and put their weight behind it.

The statement emphasizes the need for changes that would help people make better food choices and be more physically active. Examples include things like limiting the availability of high-fat, low-fiber foods and sugary drinks, reducing restaurant portion sizes, reconsidering the location of fast-food restaurants, and thinking more creatively about community design and infrastructure to enhance "walkability" of neighborhoods and commutes between home, school, and recreation.

"In a way it's like the tobacco scenario, when people realized there were some broad policies that could be made that would change the options that people had," Kumanyika explained. "With food it's trickier, because food is not inherently harmful, so it's a much more complicated task. We're not trying to turn people against food, we're not trying to put the food industry out of business—where would we be if we did that? But we're trying to say that we've got to think more carefully about the health effects of a lot of the decisions we make about transportation, about community design, about food, about the school day, about what happens at a work site: that's the point about the comprehensive approach. We've got to go into the population and make it just easier for people to bump into the right choices."

Kumanyika agrees that these points have been made before, but she says the AHA's goal in wading into the fray was to make it clear to physicians that they have a bigger role to play.

"This statement is about putting the information in one place and telling people who don't think it's their business that the level of advocacy and awareness we need also applies to them. We can't afford to have anyone working on cardiovascular disease who, if asked by the person next to them on the golf course or next to them in the hospital, doesn't really get it that obesity is not just a bunch of people who overindulge."

At the very least, she says, cardiologists and physicians need to understand the political, social, and environmental underpinnings of the obesity epidemic and make sure that they don't "contradict" the efforts at meaningful change. "I've had cardiologist colleagues joke with me in the cafeteria line when they've got a pile of fried onion rings on their tray and they say, 'Oh don't worry, we'll get them in the cath lab,' " Kumanyika told heartwire. "We can't afford to have the people who are involved in treatment think that's the only solution. They also have to convince people to do things that are a lot harder, because they're getting right to the heart of how people live, they're getting into vested interests, and there's not necessarily a profit motive. But cardiologists are very, very authoritative and influential people. People will ask their cardiologist for an opinion, and we want them to know what they should say."

Kumanyika acknowledged that is it difficult for some physicians to connect the dots and appreciate how their actions can influence political decision-making, urban planning, etc, but she also emphasizes that major grassroots and community-based initiatives are already making headway in pockets around the US. She says physicians should not underestimate the importance of their own influence in helping these kinds of movements succeed.

"There was a time when people thought it wasn't possible to change the type of fat people eat or that you couldn't change smoking habits," she says. "So you have to start somewhere with that conversation, to begin to shift the expectation that these things can't be changed. There are people who are out there, working on the ground with community coalitions fighting for this, and physicians need to help reinforce what those people are doing by lending their authority and helping to support their message."

She continued: "There is a lot of grassroots activity, there is stuff going on all over the country with people taking on planning commissions, school boards, and advertisers. So this is actually happening, it's a social movement. And we want cardiologists to know about it and put their weight behind it."

No pun intended.