Physical activity is up in the US but so too is obesityBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4504 (Published 12 July 2013) Cite this as: BMJ 2013;347:f4504
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10 Years ago on 2002-12-21 , the editorial of BMJ had this editorial which said "time to move beyond the mind-body split" http://www.bmj.com/content/325/7378/1433. Nothing changed, we still use the bio-medical model of disease (Virchow 1865) from the industrial age instead of the bio-psychosocial model (Engel, 1977) in our information age. We tend to ignore the effect of the mind on the body.
Obviously overeating or sedentary lifestyle is a contributing cause of obesity, especially in children in mainland China due to one child policy where the children are spoiled. However the most neglected cause of obesity (disease) is stress (dis-ease).
Under the biomedical model, stress is regarded as normal and good for goal achievement and only when excessive is it detrimental. We focus on finding and overdiagnosing asymptomatic physical disease, and we ignore already symptomatic psychological dis-ease. Cortisol damage to the body is gradual and slow and we regarded it as normal unless the body deteriorates to the extent we label it as disease.
Obesity is actually quasi-Cushing syndrome, but our society allows stress and its associated cortisol effect to accumulate by setting a very high abnormal level of cortisol. Most normal people are under stress, hence most cortisol levels are normal.
Stress is normal, but we treat obesity as merely intake output, with little regard as to the cortisol effect which may change absorption/metabolism/distribution of fat.
Unless we take stress into real consideration rather than just providng lip service by adopting the bio-psychosocial model of disease, we will have increasing stress associated obesity, hypertension, heart disease.....all arise from dis-ease/stress (http://www.medscape.com/viewarticle/704866_4 ).
I am afraid that the more we ask obese people to focus to do exercise after work twice a week, which can somehow relieve mental stress, the more they will become obese by continuing to produce cortisol at work every day. WE focus on release of stress more than teaching them how to lessen production of stress hormones. Public health focus on behaviour change rather than mind change. In 2011 the School of Medicine of UCSF publish a paper called "rewiring our stress response" ( http://www.hypothesisjournal.com/?p=955), which may be a panacea to all health problems, dis-ease and disease.
Competing interests: No competing interests
We read with much interest the article by Bob Roehr who reported the overall level of physical activity increased in US, however, the level of obesity still increased for the recent ten years1. And we agree with the explanation of Bob Roehr, increased physical activity alone has a small impact on obesity prevalence in the US. Indeed, although there is more progress in increasing physical activity for two decades in China, it would not decrease the rates of obesity.
Ten years ago, Chinese officials recognized that levels of physical inactivity are rising in China, especially for school children. To improve health by physical activity and public health policies, there are several major plans in China. In 2006, Chinese government formulated the “Hundreds of Millions Students’ Sunshine Sports” to promote physical and emotional wellbeing of students (over 210 million) by physical activity. In additional, the Chinese government conducted China’s 11th five-year plan and the “Hundreds of Millions Farmers’ Health Promotion Program” (a five-year action plan, 2006-2010) to improve health for rural residents, who are over 800 million.
In 2010, the 2010 China National Physical Fitness Monitoring Bulletin2 (once every five years starting from 2000) showed that the overweight rate of adults and elderly people were 32.1% and 39.8%, compared to 2005, increased by 3.0% and 4.2% respectively. And the obesity rate of adults and elderly people were 9.9% and 13.0% in 2010, compared to 2005, increased by 1.9% and 1.7% respectively. However, great progress has been made on various health issues by physical activity and public health policies in China. From 2005 to 2010, average life expectancy increased by 1.83 years3, and physical fitness standard rate of the Chinese population increased by 1.7%, town population increased by 1%, rural population increased by 2.1%, according to the monitoring bulletin 2.
Although increased physical activity alone has a small impact on obesity prevalence, strong evidence shows that physical inactivity causes many adverse health conditions, especially non-communicable diseases4. Ancient Chinese physicians recognized the role of physical activity for health in 2600 BC. And the life expectancy would increase by 0.61 years in China if physical inactivity were eliminated5.
As professionals working on public health, we think that it is not an individual problem for decreasing obesity prevalence and improving health by physical activity in China as it is a societal. Therefore it demands a population-based, multi-sectoral, multi-disciplinary, and culturally relevant approach.
Xue-Qiang Wang, Pei-Jie Chen*
Shanghai University of Sport, Shanghai, China.
Correspondence to: Pei-Jie Chen, firstname.lastname@example.org.
1. Roehr B. Physical activity is up in the US but so too is obesity. BMJ 2013; 347: f4504.
2. General Administration of Sport of China. 2010 National Physical Fitness Monitoring Bulletin. http://www.sport.gov.cn/n16/n1077/n297454/2052709_1.html
3. Ministry of Health of the People's Republic of China. White paper on medical and health services in China. http://www.moh.gov.cn/wsb/pwsyw/201301/6fbe5f5264d84e03960eb72dbd752d05.shtml.
4. World Health Organization, Global Recommendations on Physical Activity for Health, WHO Press, Geneva, Switzerland, 2010.
5. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219-29.
Competing interests: No competing interests