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No, we’re not talking about the economy, or about last fall’s Presidential campaign. We are talking about some grim news about the epidemic of childhood obesity, as well as a new way of thinking about the problem that should give all of us a great deal of hope.

First, the grim news. A large study published in last week’s British Medical Journal found that young men who were overweight at the age of 18 were as likely to die by age 60 as light smokers. For teens who were obese, they had the same risk of dying early as heavy smokers i.e., more than twice the risk of non-obese or non-smoking teens.

The study tracked the death rates of over 45,000 Swedish men over a 38-year period. “We know that health behaviors are established early on in life,” said Martin Neovius, the study’s first author and a postdoctoral fellow at the Karolinska Institute in Stockholm. He said the message for teenagers today was that if you are a smoker, or if you are overweight – and particularly if you are a heavy smoker, of if you are obese – it would be a good idea for your future health to try to make a change now.

In a report on the study in the New York Times, Dr. David F. Williamson, a professor of public health at Emory University noted that “it’s fairly dramatic when you say something is as lethal as smoking. We know of very few things from a health perspective that are as lethal as smoking.”

As the vast majority of the public and private efforts to combat the epidemic of childhood obesity are public health-oriented (for example, ad campaigns regarding the importance of a healthy diet and lifestyle), it was especially dismaying to read a new University of Illinois study in the journal Obesity that suggests that public health campaigns that promote exercise seem to cause people to eat more.

In the study, people who viewed posters suggesting that they join a gym or take a walk ate more food after looking at the posters than people who saw similarly designed posters prompting them to make friends or be in a group, the researchers found. Subliminal words about being active had a similar effect on study participants, said Illinois psychology professor Dolores Albarracín, who led the study.

“Viewers of the exercise messages ate significantly more (than their peers, who viewed other types of messages),” she said. “They ate one-third more when exposed to the exercise ads.” Those exposed to subliminal words about activity during a computer task ate about 20% more than those exposed to neutral words, she said.

Those designing public health campaigns are in the habit of trying to change one behavior at a time, Albarracín said. They should be aware that “whatever they communicate is likely to influence not only the behavior they had in mind but other behaviors that might be somewhat remotely linked,” she said.

It is precisely the attempt to effect lifestyle change (i.e., change multiple behaviors simultaneously) that lies at the heart of a promising new model outlined in this month’s issue of the journal Obesity Management.

An attempt to develop a new standard of care for childhood obesity, a team of experts led by researchers and clinicians from Northwestern, UCLA and other institutions, the “Seven Steps to Success” defines a stepwise intervention strategy of increasing intensity for health care professionals and parents. The steps are:

  1. medical management
  2. education
  3. environmental changes
  4. support groups;
  5. cognitive-behavior therapy I: clinical or short-term immersion
  6. cognitive-behavior therapy II: long-term immersion
  7. bariatric surgery.

James Hill of University of Colorado Denver, and one of the leading researchers in the field, noted that “This 7 Step Model makes it easy to understand the treatment options available for childhood obesity. This logical approach may help parents and providers choose the right treatment for the child.”