The Surgeon General's Vision for a Healthy and Fit Nation

In 2001, former Surgeon General David Satcher released his “Call to Action to Prevent and Decrease Overweight and Obesity.”¹ In it, he warned us about the negative effects that weight gain and unhealthy lifestyles were having on Americans' health and well-being. I have now followed up on his report with “The Surgeon General's Vision for a Healthy and Fit Nation.”² In this publication, I lay out ways in which to respond to the public health issues that were raised nine years ago.

Although we have made some strides since the 2001 report, the number of Americans who are struggling with their weight—and the health conditions related to overweight and obesity—remains much too high. Many of you probably know that in the U.S. more than two-thirds of adults and one in three children are overweight or obese. We see the sobering impact of these numbers in the high rates of chronic diseases, such as diabetes and heart disease, which are starting to affect more and more of our children.² I was pleased to join the First Lady for the launch of her “Let's Move!” initiative to solve the problem of childhood obesity within a generation. Both my “Vision for a Healthy and Fit Nation” report and the First Lady's “Let's Move!” campaign take a comprehensive approach that engages families and communities, as well as the public and private sectors.

Public health professionals are well aware of upward trends in recent weight statistics and the disproportionate occurrence of obesity among different racial/ethnic groups and geographic regions of the United States. If we do not reverse these trends, many of our children will be seriously afflicted in early adulthood with medical conditions such as diabetes and heart disease. To help our children, our families, and our nation become healthy and fit, we must refocus our educational and intervention strategies as health-care professionals. The real goal can no longer be just a number on a scale—it must be optimal health for all Americans at every stage of life.

Healthy choices are influenced by multiple people in multiple settings: home, child care, school, workplace, health care, and community. To support individual and family changes, we must create healthy child care settings and schools that identify and implement approaches that reflect healthy lifestyle recommendations. Children should engage in regular physical activity (150 minutes per week for elementary school students and 225 minutes per week for secondary school students) and have access to good nutrition through appealing and healthful food choices.²

We must also redesign our communities. Americans need to live and work in environments that help them practice healthy behaviors. Neighborhoods and communities should come together to create healthier environments. Specifically, they should consider geographic availability of supermarkets, improve residents' access to outdoor recreational facilities, limit advertisements of less healthful foods and beverages, build and enhance infrastructures to support more walking and bicycling, and improve the safety of neighborhoods to facilitate outdoor physical activity.

We must create healthy worksites. Employers are becoming increasingly aware of the need to promote health within the workplace to improve productivity and decrease health-care costs. Scheduling time for physical activity—such as at lunch—is essential to overall health. Adults should engage in at least 150 minutes of moderate-intensity physical activity per week. Aerobic activity such as brisk walking should be conducted in episodes of at least 10 minutes, preferably spread throughout the week.² Employers can support individual lifestyle changes by implementing wellness programs that promote healthy eating in cafeterias, encouraging physical activity through group classes and stairwell programs, and creating incentives for employees to participate. Breastfeeding should also be encouraged, and clean, private spaces should be made available for mothers who want to breastfeed.

Public health clinicians are often the most trusted source of health information and are powerful role models for healthy lifestyle habits. We must remember that Americans will be more likely to change their behavior if they have a meaningful reward—something more than just reaching a certain weight or dress size. The real reward has to be something that each person can feel, enjoy, and celebrate.

Public health clinicians should make it a priority to teach patients about the importance of good health, rather than just weight loss. So, when discussing a patient's body mass index (BMI), explain the connection between BMI and increased risk for chronic diseases. When appropriate, refer patients to resources that will help them meet their physical, nutritional, and psychological needs, and include referrals to physical trainers.

Remember that the overarching reward for making lifestyle changes is invigorating, energizing, and joyous health! It allows people to embrace each day and live their lives to the fullest, without disease, disability, or lost productivity.

I ask you to join me in promoting healthy choices. Together, we can reverse the negative health-related trends in one generation. We can become a healthy and fit nation.

VADM Regina M. Benjamin, Surgeon General