Prognosis in obesity: Obstacles must be removed to prevent obesity through increased physical activity

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7514.452-a (Published 18 August 2005) Cite this as: BMJ 2005;331:452
  1. Erik Hemmingsson, health educator (erik.hemmingsson{at}medhs.ki.se)
  1. Obesity Unit, Karolinska University Hospital, SE-141 86 Stockholm, Sweden

    EDITOR—In his editorial Lean proposes that we all eat a little less (0.418 mJ/day) and walk a little more (0.418 mJ/day, equivalent to 2000 steps) to prevent 90% of obesity.1 If such recommendations work, they may seem a reasonable sacrifice for individual people and therefore could work in practice. To promote physical activity, however, we as a society face ever larger obstacles, mainly increased stress and an increasingly hostile environment (car clogged streets, threat of crime, and lack of parks and bicycle lanes). Moreover, we now have more calorie saving machines than ever—cars, lifts, computers, electric toothbrushes, etc—with more labour saving gadgets being developed and marketed on a seemingly daily basis.

    Today the average adult in western Europe walks about 8000-9000 steps daily. Among the Amish people in North America, who refrain from using electricity and cars, men accumulate 18 425 steps daily (0% obesity) and women 14 196 (9% obesity).2 The promotion of lifestyle physical activity, carried out as a routine part of daily living as practised by the Amish, is critical for long term adherence. A similar but more realistic strategy for promoting longstanding physical activity routines is physically active transport, such as walking to and from the bus stop or bicycling to and from work. The current trend, however, is that we drive shorter and shorter distances, with public transport services deemed too unreliable and slow.

    We need to provide people with a realistic chance of achieving the necessary lifestyle change—for example, by creating car free areas where people live; safe and well lit parks and bicycle lanes, especially between the home and school or work; reliable public transport; shower facilities at work; and reduced perceived time pressures. We also need careful analysis of lifestyle change recommendations—is their efficacy established, can they be converted into practice?


    • Competing interests None declared.


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