You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Monday, September 20, 2010

What Can We Learn From Colorado?

It is health promotion fantasy land to think that the way to stop the nation’s obesity epidemic is to design and disseminate theory-based diet and exercise programs alone. What is required is much more complex. To illustrate, consider Colorado.

In the listings of obesity percent by state, Colorado leads the nation: about 18% of adults in the state are obese, compared with 34% for Mississippi, the most obese state, and 27% for the nation as a whole. How can this disparity be explained? Is it possible to take lessons from Colorado’s success and bring them to Mississippi and the rest of the nation?

Colorado is a little younger, on average, than Mississippi. Since obesity increases with age, a small age difference could contribute to more obesity in Mississippi. African Americans are more obese than whites or Hispanics: percent obese is 36%, 24%, and 29%, respectively. In Colorado, only 4.4% of the population is black, whereas in Mississippi the percent is 37%. More overweight blacks would make Mississippi’s obesity problem bigger, just from a demographic pattern. However, it is more complex than this. The District of Columbia is second only to Colorado in low obesity. Yet, 54% of the D.C. population is African American. These are very different populations, as D.C. blacks are much more likely to be educated and holding middle class jobs, while blacks in Mississippi are more likely to be undereducated and poor. These demographic patterns are critical influences in determining obesity prevalence and must be addressed in the long term.

National surveys (Behavioral Risk Factor Surveillance System) show that Colorado citizens do more recreational exercise than Mississippi residents. BRFSS determined that 81% of Coloradoans had any physical activity in the past month, while only 67% of Mississippi residents were equally active. This is certainly an important factor. The other side of the equation is diet.

From 1971 to 2000, average daily calorie consumption increased by 168 for men and 335 for women.. The change for women is 22%, proportionately high but in absolute terms, 335 calories is not such a huge amount. Consider the following list of foods with calorie content close to 335:

1 cup apricots, dried            310 calories
1 avocado                           340 calories
1 cup chile con carne           340 calories
2 oz. cashews, dry roasted   330 calories
1 cup hash brown potatoes   340 calories
1 slice pumpkin pie              320 calories

Adding any one of the above items to your daily diet would hardly seem excessive overeating, but a little added over a period of time leads to consistent weight gain, unless balanced by a proportionate increase in activity.

Some times exercise is just a matter of motivation and discipline: we make ourselves be active because we know it is a wise habit to nurture. On the other hand, environments can make a big difference in the amount of exercise we get. Colorado is a mountain state. Its average elevation is 6800 ft., and the difference between the highest and lowest point is in the top five of all the states. I think this means that the average person is more likely to be walking up or down a grade than in the flatter states, such as Florida, Delaware, and Mississippi. This doesn’t mean that Colorado residents spend all their time hiking on mountain trails, but the common ups and downs add just a little more exercise and opportunities to burn a few more calories.

So what are the lessons? Some of Colorado’s obesity advantage results from circumstances having little to do with health knowledge or motivation, but are related to geography and demographics. However, differences in race, education, or elevation do not explain the nationwide increase, since those things have not changed much over time.

The things that impact obesity are not dramatic. We did not get to 33% obesity overnight, and the average person did not double their calorie intake. Slow, small changes over time are responsible. Solutions will not be dramatic either.

If you want to lose 10% of your weight by next month’s wedding, extreme measures are required. If you want to change weight status for an individual or the community at large, slow, small steps are what will make it happen. That’s a lesson that applies to many weighty matters in life.


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