As Americans grow fatter and suffer more ill health as a result, a former surgeon general and the first lady are launching a campaign to get people out of the refrigerator and off their backsides.
Shape Up America, a nationwide program to promote better eating habits, more exercise and a raised consciousness about obesity, will get its official start tomorrow in a White House press conference with Hillary Rodham Clinton and C. Everett Koop.
Being overweight is not only a problem of looks, it's also a serious national disease that contributes to more than 300,000 deaths a year, Koop said Friday.
More than a third of all adults are obese, he said - 32 million women and 26 million men - up dramatically from 25 percent in 1980.
Similar to Koop's war on smoking, which beefed up warnings on cigarette packs and helped push smokers out of offices and airplanes, the Shape Up campaign will focus on the workplace, schools, doctors' offices and even on cereal boxes.
Most researchers categorize people as "obese" when they are 20 percent or more above the ideal weight for their age and height.
The Koop campaign kicks off the same day that the National Academy of Science Institute of Medicine releases its report on weight-loss methods.
That report analyzes and evaluates various ways of dealing with obesity, including diets, exercise, appetite-suppressing drugs and surgery.
Titled "Weighing the Options" and compiled by a committee of obesity researchers, the report recommends that all weight-loss programs should inform consumers of their total cost, the credentials of their staff and how much weight clients can expect to lose, as well as the program's success rate.
Obesity is not just a health risk. The cost to Americans adds up to more than $100 billion a year, Koop said, including $45.8 billion in direct expenses such as hospital and doctors' bills and $33 billion more in weight-reduction products and services. He puts the indirect costs at $18.9 billion in lost output caused by death and disability from weight-related diseases.
Hillary Clinton endorses the Shape Up program because it can reduce disease and lessen the demand for health care, Koop said.
Among the reasons for the huge increase in obesity the past decade is the increasingly sedentary nature of American life, Koop said.
"TV is the No. 1 culprit, but working at your computer is almost the same," he said. "Then people watching TV are eating food they shouldn't. It's high in fat and calories. People don't even move in their own homes."
The food industry also deserves some blame.
"This country has a marvelous overabundance of exciting food," Koop said. "Whether it's TV or glossy magazines, there is a constant urging to eat. And portion size has increased."
Much more academic than the Koop campaign, the Institute of Medicine analysis defines three categories of weight-loss plans: Do-it-yourself programs such as Overeaters Anonymous, Take Off Pounds Sensibly (TOPS) and community or workplace efforts; nonclinical programs, such as Diet Center, Jenny Craig, Nutri/System and Weight Watchers, and clinical programs, such as Health Management Resources, Medifast, New Direction and Optifast.
Many of the programs lack standardized data on the number of participants and success rates, the report says, warning that some use only anecdotal claims of success in their promotional literature.
"Current available obesity treatments are not producing the desired long-term outcomes for most dieters," the report says. This makes it hard to predict what leads to success.