State details a sharp rise in obesity and diabetes

The ranks of the obese increased dramatically during the past decade and a half in Massachusetts, with nearly one in five adults now dangerously overweight, according to a state public health report released yesterday.

Between 1990 and 2004, the number of obese adults rose 80 percent in the state, and the incidence of diabetes increased 50 percent. The numbers reflect a national trend and provide further evidence that obesity and diabetes have emerged as twin epidemics posing a serious threat to the nation's well being.

The findings are based on an annual telephone survey conducted by the state Department of Public Health, with adults asked about their weight and height, and whether they had been diagnosed with diabetes, among other health questions. While obesity rates are increasing in Massachusetts, they remain lower than the national average.

''We don't seem to be succeeding in getting people to eat less and exercise more," said Dr. Caroline M. Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center. ''No matter what we do, we seem to be trending toward the opposite. It's quite scary."

Campaigns attempting to reverse the dual trends have intensified in recent months, with state initiatives ranging from building more walking trails and playgrounds to encouraging companies to provide exercise options for workers. The state Legislature is expected to vote in as soon as two weeks on a measure that would banish most sugary soft drinks and junk foods from public schools.

''These are huge public health problems, and we need to address them in a very, very concerted effort on lots of different fronts -- through employers, through government, through communities -- and really focus on what we can do to prevent the conditions and their complications," said Dr. Stuart Chipkin, a consultant for the state's Diabetes Prevention and Control Program.

In recent years, the battle of the bulge has eclipsed antitobacco campaigns as a primary focus of public health advocates, a reflection both of the triumph in reducing smoking and the intractable challenges of obesity.

And battling obesity is far more complex than the single-focus war against smoking. There's conflicting evidence about what is most responsible for making people fat: ranging from supersized portions, to the lack of exercise, to the role played by genetics. There are also numerous contributing factors to diabetes, though it is clear that excess weight is a leading culprit.

As a result, a dizzying array of diets compete to lure the overweight, with the Ornish diet (ultra low fat), the Atkins diet (fat is good), and the South Beach diet (which emphasizes the right balance of certain fats, carbohydrates, and protein).

Perhaps most fundamental of all, while smoking is optional, eating isn't.

''Unlike smoking, where you can say, 'I'm never going to smoke again,' with eating, you are going to eat again," said Aviva Must, a specialist in the link between nutrition and disease at the Tufts University School of Medicine. ''When you think about the number of eating opportunities that confront every adult as they go through their life, it's a lot of little decisions, and the proliferation of choices and opportunities seems to be a little bit irresistible."

The report released yesterday, part of a national monitoring network called the Behavioral Risk Factor Surveillance System, surveyed 8,203 Massachusetts adults, providing a detailed portrait of the state's health status.

Participants were asked to provide information about their weight and height, which was then converted into a widely used measurement called Body Mass Index. Adults are considered overweight when their body mass index tops 25 -- the point at which they begin to be at increased risk of heart disease, diabetes, and some forms of cancer. Anyone with a BMI of 30 or higher is considered obese and at even higher risk. (To calculate BMI, go to: www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.)

The survey found that 55 percent of Massachusetts adults are either overweight or obese.

As troubling as the Massachusetts figures are, they're better than what many states report, as well as the national average: While 18 percent of Bay State adults are obese, the US figure stands at 23 percent.

The state study found that the burden of obesity is not shared evenly: Adults who failed to complete high school were more than twice as likely to be obese as college graduates, and obesity was more of a problem for African-Americans than it was for whites or Hispanics. And the central part of the state, where there are sizeable pockets of poverty, had an obesity rate twice as high as the neighboring, more affluent Metro West region.

That's why, for example, one initiative in Springfield aims to encourage walking among African-Americans.

And across the state, a coalition of health advocates has conducted an inventory of opportunities for exercise in cities and towns, with the results expected to be posted on a searchable website in May.

Last July, Blue Cross Blue Shield of Massachusetts representatives began calling patients whose medical records showed they were obese and offering them help with losing weight.

The insurer has found that with every 1-point increase in body mass index, annual health costs rise $120, said Dr. David Brumley, medical director for health management programs at Blue Cross. By intervening early, Brumley said, Blue Cross hopes ''we might have some impact down the road."

For David Arnold Ackerman, the crucial moment came when his doctor said he was on the cusp of becoming diabetic.

Ackerman, 50, who carried 222 pounds on his 5-foot-9-inch frame, said his great weakness was anything sweet: cakes, cookies, ice cream.

''But when they told me I was borderline diabetic, I stopped the sweets cold turkey," he said. ''It was a terrible addiction for me."

He started eating more vegetables, began spending time on a treadmill, and the pounds began melting away.

''It's a constant battle," he said. ''I have to be so vigilant."

But he sees success every day, when he hops on the scale.

His weight today: 165 pounds.

Stephen Smith can be reached at stsmith@globe.com.