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Big battles and small victories

BMJ 2012; 345 doi: (Published 14 December 2012) Cite this as: BMJ 2012;345:e8500
  1. Edward Davies, US news and features editor
  1. edavies{at}

In 1912, the BMJ did not publish a single article on obesity. Fifty years later, in 1962, we published just three. By 1987 that figure was seven, and with 2012 now drawing to a close we have so far published 25 articles on the subject this year alone.

There are of course myriad confounders and influences on these figures that I have conveniently ignored, but there can be little doubt that obesity is a particularly modern scourge.

So it was good news this week when the New York Times reported on a fall in child obesity rates after decades of steady rises ( The reductions have occurred in several cities around the country, and various researchers are cautiously excited about them. But the more cautious interpretation is that this is just one set of figures for a few cities, not a battle being won.

Meanwhile, research that tries to track and understand this thoroughly modern scourge continues to be the best way to formulate a defense against it, and Hooper and colleagues’ meta-analysis of research into fat reduction on body weight does exactly that (doi:10.1136/bmj.e7666).

But in spite of grabbing all the headlines, obesity is far from the only problem facing modern US healthcare. Michael McCarthy’s feature this week on opioid misuse looks at turning the tide on another serious epidemic—one that is in some ways older than civilization but also seems to be an ever growing modern problem (doi:10.1136/bmj.e8340).

Figures from the US Centers for Disease Control and Prevention put rates of death from prescription painkillers at about 1.5 per 100 000 people in 1999. By 2009 that figure was around 5 per 100 000 people (

Washington State has been right in the middle of this epidemic since it relaxed its rules on the regulation of the prescription of opioids in the late 1990s, but it is now leading the way in solving the problem, and McCarthy outlines how the battle is being won there.

Although some ground is being made in the areas of obesity and opioid misuse, there is still a long road ahead for the US healthcare system.


Cite this as: BMJ 2012;345:e8500


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