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    放大字体  缩小字体 发布日期:2009-11-24  浏览次数:846
    核心提示:Exercise more. Avoid junk food. Such common-sense health advice has proved no match against the temptations of modern life, which have sent obesity rates around the world soaring. Now, government officials in a number of countries are pursuing an ag

        Exercise more. Avoid junk food. Such common-sense health advice has proved no match against the temptations of modern life, which have sent obesity rates around the world soaring. Now, government officials in a number of countries are pursuing an aggressive new strategy: enlisting entire communities to insulate people from these temptations and make healthier choices easier.

        Instead of hoping that individuals can muster the self-discipline on their own to avoid processed foods, fast food and days without physical exercise, the idea is that governments must actively work to change environments and reduce the menu of harmful options available in everyday life.

        As a result, hundreds of towns in Europe and elsewhere have adopted a version of this strategy, aimed particularly at preventing children from becoming overweight and obese. They hired dietitians to counsel children and their families in schools, organized walk-to-school days, hired sports educators and built new sporting facilities.

        The U.S. government, meanwhile, is increasing its funding for cities and towns to pursue so-called community-based obesity prevention, in an effort to gather data about which kinds of tactics work best.

        'People are finally acknowledging that the obesity problem is so pervasive that it isn't just because people are making bad choices,' says Laura Kettel Khan, an obesity expert at the U.S. Centers for Disease Control and Prevention, which makes grants to states for community obesity-prevention programs.

        The move toward this new strategy comes as governments are beginning to grapple with the enormous fiscal costs of obesity, which are expected to grow as younger people develop diseases such as Type 2 diabetes and some forms of cancer later in life that are linked to obesity. A study released in July by the CDC estimates that obesity may cost the U.S. alone as much as $147 billion annually in additional health-care costs.

        The European program, which is known as Epode -- a French acronym for Together Let's Prevent Childhood Obesity -- began in France, based on the experience of two towns in the north of the country, Fleurbaix and Laventie, that instituted a community-based obesity-prevention program aimed at children between 1992 and 2004.

        The result: The percentage of overweight and obese children in the two towns fell to 8.8% in 2004 from 11.2% in 1992, according to a study published earlier this year. The rates of overweight and obese children in two nearby towns that didn't adopt the strategy rose to 17.8% from 12.6%.

        Epode has since been recruited to help administer its program in more than 220 towns in France and dozens of others in Spain, Belgium and Greece. Towns in Australia have also adopted Epode's program, and a few in Mexico are considering doing so.

        One of the towns is St. Amand-les-Eaux, in northern France near the Belgian border. The cuisine here has always been rich: plenty of butter and cheese, often with a helping of french fries on the side. But rising consumption of soft drinks and processed food, combined with less physical exercise, have helped to push the rate of obese and overweight children there to over 25%.

        For the past two years, dietitians have worked in the local schools. Children are encouraged to participate in a long menu of sports activities. Chefs come to nursery schools to help the kids prepare healthy snacks and let them taste vegetable dishes, with the goal of getting children accustomed to the taste. Sodas and junk food are sharply limited in the schools.

        'There have of course been innumerable obesity treatments and diets, and the sad thing is people by and large go back to their original weight,' says Martijn Katan, professor of nutrition at Vrije Universiteit Amsterdam, who has followed Epode. 'The essential difference with this strategy is that almost all other programs are aimed at an obese individual -- he's still left within his environment, which bombards him from all sides with food.'

        Experts caution that it's too soon to say whether Epode and other community strategies are effective in the long term. The CDC in July published its first list of recommended community obesity-prevention strategies, with the caveat that data on their effectiveness are incomplete.

        'The whole concept of environmental and policy changes for obesity prevention is relatively new, so the evidence base is not very deep,' says the CDC's Ms. Khan.

        Still, a community-based approach to fighting obesity is probably the most promising policy available, experts say.

        'What works is durable, long-lasting changes in habits,' says Monique Romon, a professor of medicine at Universite Lille 2 and the lead researcher of the study on Fleurbaix and Laventie. 'That's why community action is so important.'





        美国疾病控制与预防中心(U.S. Centers for Disease Control and Prevention)的肥胖症专家劳拉?罕(Laura Kettel Khan)表示,人们终于认识到,肥胖问题的无处不在意味着,其症结已不仅仅在于人们正在做出错误的选择。美国疾控中心负责向美国各州拨款用于社区预防肥 胖项目。

        美国采取这一新举措之时,正值各国政府开始努力应对肥胖导致的巨额财政开支问题。随着年轻人在晚年患上与肥胖有关的2型糖尿病以及某些癌症,这一开支预计 将逐渐增加。美国疾病防控中心7月份发布的一项研究估计,肥胖给美国一个国家造成的额外医疗成本每年可能高达1,470亿美元。

        被称为"Epode"的欧洲项目始于法国。Epode是法语中"共同预防儿童肥胖"(Together Let's Prevent Childhood Obesity)的首字母缩略。该项目基于法国北部小镇Fleurbaix和Laventie的经验而展开。这两个小镇在1992-2004年针对孩子们 开展了一项基于社区的预防肥胖项目。



        St. Amand-les-Eaux就是开展该项目的一个市镇。该市镇位于法国北部,接近比利时边境。那里的烹饪一向以油腻着称:菜肴里加入了很多黄油和奶酪, 通常配菜里还会有炸薯条。软饮料和加工食品的日渐流行,再加上缺少锻炼,让当地的肥胖超重儿童比例超过了25%.


        一直跟踪Epode项目的阿姆斯特丹自由大学(Vrije Universiteit Amsterdam)营养学教授卡坦(Martijn Katan)说,市面上当然有许许多多的肥胖疗法和减肥食谱,但令人遗憾的是,人们大多还是反弹回了从前的体重。而这种策略的不同之处在于,几乎所有其他 项目针对的都是肥胖者个人──这个人仍旧在过去的环境里生活,各种各样的食物仍然把他包围。




        里尔二大(Universite Lille 2)医学教授罗蒙(Monique Romon)说真正有效的是人们习惯持久而长期的变化,这就是为什么社区的行动如此重要,她也是Fleurbaix和Laventie两地研究的课题组组长。

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