I was recently asked what I would advise the next President to make his number one public health priority. I said exercise, and here’s why:
Increasing the physical activity of Americans will have tremendous public health benefits, since it will fundamentally help address many conditions that significantly reduce overall public health, including obesity, diabetes, cardiovascular disease, cancer, arthritis, and mental illnesses. In addition, exercise initiatives can be constructed as public-private partnerships, built collaboratively with a number of advocacy groups, and would require minimal Federal spending.
I was reminded about the importance of exercise when I recently ran across a reference to a December 2006 Archives of Internal Medicine article reporting on a study that found weight loss in overweight 50-60 year old men and women would lead to significant bone loss in the hip and spine if it was accomplished through dieting, but not when exercise was the primary route for the weight loss.
What do you think the next President should make his highest priority for public health?
Mike, I think you have made an excellent choice. Exercise is very important and most people do not do enough of it. Even more important than that, it is not controversial! I am not a Washington insider, but I can’t imagine that anyone in power would disagree with encouraging exercise. (Well, maybe companies that want people to watch TV or sit at a computer would object….)
My own belief is that diet is even more important than exercise. So many diseases that are epidemic in our country — including many of the ones you cited — can be reversed with a healthy diet. The problem is that there are a lot of vested interests regarding food (read “Food Politics” by Marion Nestle for more on that). There is just no money in encouraging people to eat more fruits and vegetables…and a lot of money in encouraging them to do otherwise. Even if a President were to prioritize diet, I don’t think he/she could get very far at the current time.
I am not sure what to make of the article you cited. I think of bone density as a surrogate measure; would a 2% decrease in intertrochanteric bone density, in the setting of an 11% weight loss, really lead to increased hip fractures? Or is it statistically significant but not clinically significant? I guess that would have to be another (more expensive) study.
In any case, I think your answer was a good one, and I hope the next President was listening.