What's more important in the obesity battle -- physical activity or medical treatment?

May 25, 2010, British Medical Journal

Experts disagree in the British Medical Journal today about the best way to tackle the obesity crisis. While Professor Louise Baur and colleagues 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 says that it would be wrong to only focus on this and ignore the problem of obesity.

Baur and colleagues argue that physical inactivity is just one marker and that there is substantial evidence that unhealthy diets low in fibre and high in sugar and large portion size are also responsible for obesity and the diseases associated with it.

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

Weiler and colleagues maintain that "physical inactivity is one of the greatest health threats facing developed nations today" and they are concerned that 95% of the populations in England and the United States do not meet the recommended guidelines of doing 30 minutes moderate to vigorous physical activity on at least five days a week or equivalent.

They say this is alarming given that physical inactivity rather than obesity per se is an actual cause for many illnesses including obesity, heart disease, , problems, and dementia.

Spending huge amounts on treating obesity is not the right way forward, they argue. Weight loss drugs and surgery are risky and the long-term benefits are limited and they certainly do not have the associated health benefits linked to physical activity. They conclude that it is time for health policy and healthcare professionals to focus on fighting , 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 believes that obese people need access to high quality treatment provided by well-trained professionals to deal with their weight and any linked health problems.

In conclusion, Professor Baur and colleagues advocate tackling obesity with a range of strategies, for example, increasing physical activity, improving diet and lifestyles. They say urban planning should be developed to encourage people to use their car less and cycle more and public transport should be made more accessible and affordable.

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