Dispute over data rights forces retraction of obesity paper …

bmcresnotesA group of researchers in South Africa has lost their 2012 article in BMC Research Notes after one of the author’s institutions evidently pulled rank and sought to claim the data as its own.

The article, “Association of body weight and physical activity with blood pressure in a rural population in the Dikgale village of Limpopo Province in South Africa,” appeared last February. Its first author was Seth Mkhonto, who listed two affiliations, the Human Sciences Research Council, in Pretoria, and the University of the Limpopo.

But the latter institution seems not to have given Mkhonto approval to publish the data — a rather strange state of affairs given the whole “publish or perish” ethos of academia.

According to the retraction notice:

This article has been retracted by the Editor because the authors do not have ownership of the data they report. A formal investigation conducted by the University of Limpopo, South Africa, has concluded that the data reported in this article are the sole property of the University of Limpopo.

The abstract of the paper doesn’t shed any light on why it might have been controversial:

Africa is faced with an increasing burden of hypertension attributed mainly to physical inactivity and obesity. Paucity of population based evidence in the African continent hinders the implementation effective preventive and control strategies. The aim of this study was to determine the association of body weight and physical activity with blood pressure in a rural black population in the Limpopo Province of South Africa.

Methods

A convenient sample of 532 subjects (396 women and 136 men) between the ages 20-95 years participated in the study. Standard anthropometric measurements, blood pressure, and physical activity were recorded by trained field workers.

The paper has been cited once, according to Thomson Scientific’s Web of Knowledge.

Extreme Obesity, And What You Can Do About It

Too much weight can take a toll on your body, especially your heart. The good news is that there are steps you can take to get healthier — and even losing a little body weight can start you on the right path.

Why lose weight?
If you’re extremely obese, losing weight can mean “less heart disease, less diabetes and less cancer,” said Robert Eckel, M.D., past president of the American Heart Association. “Metabolic improvements start to occur when people with extreme obesity lose about 10 percent of their body weight.”

Losing weight can reduce your risk of heart disease and stroke; risk factors like high blood pressure, plasma glucose and sleep apnea. It can also help lower your total cholesterol, triglycerides and raise “good” cholesterol — HDL.

Understanding Extreme Obesity
A healthy BMI ranges from 17.5 – 25 kg/m2. If your body mass index is 40 or higher, you are considered extremely obese (or morbidly obese.) Check out the American Heart Association’s BMI calculator for adults to determine if your weight is in a healthy range. (Note: BMI in children is determined using a different BMI calendar from the CDC.)

A woman is extremely obese if she’s 5 feet, 4 inches tall and weighs 235 pounds, making her BMI 40.3 kg/m2. To reach a healthy BMI of 24.8, she would have to lose 90 pounds to reach a weight of 145 pounds.

A man is extremely obese if he’s 6 feet, 2 inches tall and weighs 315 pounds, making his BMI 40.4 kg/m2. To reach a healthy BMI of 25.0, he would need to lose 120 pounds to reach a weight of 195 pounds.

Doctors use BMI to define severe obesity rather than a certain number of pounds or a set weight limit, because BMI factors weight in relation to height.

How to Get Healthier
If you’re extremely obese, taking action to lose weight and improve your health may seem overwhelming. You may have had trouble losing weight or maintaining your weight loss, been diagnosed with medical problems and endured the social stigma of obesity.

“The key to getting started is to find a compassionate doctor with expertise in treating extreme obesity,” said Dr. Eckel, who is also professor of medicine and Charles A. Boettcher II Chair in Atherosclerosis at the University of Colorado Anschutz Medical Campus in Aurora, Colo. “Bonding with your physician is the best way to get past first base and on the path to better health.”

If you’re extremely obese, Dr. Eckel recommends that you become more active, but not to start a vigorous workout program without getting physician advice and not until you’ve lost about 10 percent of your body weight.
“You can continue the level of physical activity that you’re already doing, but check with your physician before increasing it,” Dr. Eckel said. “Some people with extreme obesity may have health issues like arthritis or heart disease that could limit or even be worsened by exercise.”

Treatment Options
Talk to your doctor about the health benefits and the risks of treatment options for extreme obesity:

  1. Change your diet. You may be referred to a dietician who can help you with a plan to lose one to two pounds per week. To lose weight, you have to reduce the number of calories you consume. Start by tracking everything you eat.

    “You have to become a good record-keeper,” Dr. Eckel said. “Reduce calories by 500 calories per day to lose about a one pound a week, or cut 1,000 calories a day to lose about two pounds a week.”
     

  2. Consider adding physical activity after reaching a minimum of 10 percent weight-loss goal.
     
  3. Medication. Some people can benefit from medication to help with weight loss for extreme obesity. Keep in mind that medication can be expensive and have side effects.
     
  4. Surgery. If changing your diet, getting more physical activity and taking medication haven’t helped you lose enough weight, bariatric or “metabolic” surgery may be an option. The American Heart Association recommends surgery for those who are healthy enough for the procedure and have been unsuccessful with lifestyle changes and medication. Risks can include infections and potentially dangerous blood clots soon after the operation, and concerns about getting the right amount of vitamins and minerals long-term.

Get The Social Or Medical Support You Need
Although some people can modify their lifestyle and lose weight on their own, many need extra help. A social support system can help encourage your progress and keep you on track. Decide what support best fits your needs — either a weight-loss support group or one-on-one therapy.

Some people with extreme obesity suffer from depression. Talk to your doctor about the best treatment, as some anti-depressant medications can cause weight gain.

Learn more:

  • BMI Calculator
  • BMI in Children
  • 5 Goals to Losing Weight
  • Losing Weight With Life’s Simple 7 Infographic
  • Preventing Childhood Obesity: Tips for Parents and Caretakers
     

Why schools shouldn't report obesity

Most of us know schools as institutions of learning, usually associated with “the three Rs,” but now schools in 19 states are reporting progress on another subject: “BMI” — body mass index.

These schools are measuring the heights and weights of students to determine BMI, a measure of weight based on height, then sending home letters to inform parents of their children’s BMI status. As a pediatric nutritionist, I am not pleased.

Child obesity is at near epidemic proportions, with nearly one in three children overweight or obese. Obesity is a gateway disease to many chronic health problems, including type 2 diabetes, hypertension, heart disease and joint problems.

I don’t want to see kids struggle with obesity or become obese. Not only for those reasons but also because it adds to their physical discomfort. Most importantly, I don’t want children saddled with chronic health problems that they should not encounter for decades and that might be prevented altogether.

What? A specialist in child nutrition who doesn’t want parents to be aware of their children’s abnormal weight? No, I didn’t say that.

I spend a good portion of my clinical time counseling motivated parents (and often unmotivated parents, but that’s for another blog post) about making positive changes to normalize their children’s weight. The key word here is “school.”

Schools these days seem to be tasked with doing just about everything related to raising kids: feeding them breakfast and lunch, teaching them (not just general knowledge, but good habits, manners, social skills, etc.), helping them with homework after school and, often, administering medication.

So what’s the problem with these BMI letters? Several things:

  • Parents should be taking their children for physical exams at least annually. The BMI is part of a standard pediatric physical, so in all likelihood, this information is known to the children’s pediatricians. Let’s hope that better access to affordable insurance will make this even easier for parents to do. However, while such access may get children to see a pediatrician, it won’t solve the issue of childhood obesity. Read on.
  • Parents of under- or overweight children will likely need some sessions with a registered dietitian skilled in working with kids and parents. Few health plans currently cover weight management. If they do, it is often for fewer hours or visits than are needed to make permanent dietary and lifestyle changes. The schools are not referring parents to helpful resources or making help available—just telling parents that they need to get some help. That’s not the same.
  • This is a perfect trigger for bullying. The kids know they’re being screened and they also know who the fat kids are. (Even at that age, the eyeballs are a keen assessment tool.) You can almost hear the taunts directed at the heavier kids once parents start receiving the letters. This just draws more attention to the issue. Bad idea.

I heartily applaud the intent of this initiative by the schools (as long as the intent is truly to help children, and not just the work of some politician or school board wanting to score points with constituents). But schools should get out of this business and get back to what they do well: teaching children, feeding them properly during the school day (school meals have improved tremendously) and providing structure.

Schools have an important role in children’s lives; this just isn’t it.

And if politicians or school boards really want to fight obesity, they can make physical education a daily activity for all kids, kindergarten through grade 12.

Keith-Thomas Ayoob is director, nutrition clinic, Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.

Health Tip: Help Prevent Childhood Obesity – WebMD

Health Tip: Help Prevent Childhood Obesity

By Diana Kohnle

HealthDay Reporter

(HealthDay News) — Almost 18 percent of children and adolescents in the United States are obese, according to the U.S. Centers for Disease Control and Prevention. That number has almost tripled since 1980.

The agency offers these suggestions for parents to help prevent the problem:

  • Limit screen time for your child at home, school and child-care facilities.
  • Check with the child-care center to make sure that healthy snacks and drinks are served, and that there’s plenty of physical activity.
  • Offer your child plenty of fruits and vegetables, and limit foods high in fat and sugar.
  • Serve your child water instead of sugary drinks.
  • Encourage your child to get physical activity every day.

Exercise As Effective As Drugs For Treating Heart Disease, Diabetes

102199055exercise12-14-10crop
Zia Soleil

Forget the pills — there’s new evidence that exercise may be as effective as medications in treating heart disease and diabetes.

Doctors now advise everyone, from young children to older adults, to become more physically active. It’s the best way to maintain a healthy weight, keep the heart muscle strong, and improve your mental outlook. But can exercise be as good as drugs in actually preventing disease and treating serious chronic illnesses?

That’s what researchers from the London School of Economics, Harvard Medical School and Stanford University School of Medicine wanted to find out. They compared the effect of exercise to that of drug therapy on four different health outcomes: heart disease, recovery from stroke, heart failure treatment and preventing diabetes.

The scientists pooled the results of 305 trials involving 339,274 people who were randomly assigned to either an exercise program or a drug-based therapy and found that there were no detectable differences between the two groups when it came to preventing diabetes and keeping additional events at bay for heart patients. And the physical activity was most powerful for participants who experienced a stroke. The only group that didn’t benefit from the exercise over drugs were patients with heart failure, likely because the strain of the physical activity wasn’t recommended for their condition.

(MORE: Exercise Alone Can Melt Away Dangerous Belly Fat in Diabetics)

The findings involving diabetes patients confirmed previous trials that documented how effective physical activity can be in bringing blood sugar levels down.

So why do most doctors prescribe drugs over exercise? There are more rigorous studies testing the effectiveness of drug therapies to treat common diseases, say the study authors, than there are studies that test the power of exercise. With these results, however, the researchers hope to see more work on how exercise can be a significant part of a treatment program for diseases ranging from heart problems to diabetes.

Those studies will need to analyze physical activity in the same way that drugs are studied, to determine how much exercise is needed to trigger beneficial changes in the body that can treat or prevent disease.

Currently, to maintain optimum health, federal experts recommend that people exercise at a moderate intensity for about 2.5 hours a week. But fewer than half of Americans meet that recommendation, and a third of Americans don’t get any exercise at all. The latest findings should encourage even those who aren’t active, however, since research shows even just talking a brisk walk can help lower the risk for high blood pressure, high cholesterol and diabetes, and be as powerful as medications in keeping the body healthy.

Preventing Childhood Obesity: Tips for Parents and Caretakers

Balance is key in helping your child maintain a healthy weight. Balance the calories your child eats and drinks with the calories used through physical activity and normal growth.

Overweight and obese children and teens should reduce the rate of weight gain while allowing normal growth and development. Don’t put your child on a weight-reduction diet without talking to your health care provider.

Balancing calories: Help Kids Develop Healthy Eating Habits
Offer your kids nutritious meals and snacks with an appropriate number of calories. You can help them develop healthy eating habits by making favorite dishes healthier and by reducing calorie-rich temptations.

  1. Encourage healthy eating habits. Small changes can lead to a recipe for success!
    • Provide plenty of vegetables, fruits and whole-grain products.
    • Include low-fat or non-fat milk or dairy products.
    • Choose lean meats, poultry, fish, lentils and beans for protein.
    • Serve reasonably sized portions.
    • Encourage your family to drink lots of water.
    • Limit sugar-sweetened beverages, sugar, sodium and saturated fat.
       
  2. Make favorite dishes healthier. Some of your favorite recipes can be healthier with a few changes. You can alsotry some new healthy dishes that might just become favorites too!
     
  3. Remove calorie-rich temptations. Treats are OK in moderation, but limiting high-fat and high-sugar or salty snacks can also help your children develop healthy eating habits. Here are examples of easy-to-prepare, low-fat and low-sugar treats that are 100 calories or less:
    • A medium-size apple
    • A medium-size banana
    • 1 cup blueberries
    • 1 cup grapes
    • 1 cup carrots, broccoli, or bell peppers with 2 tbsp. hummus
       
  4. Help your kids understand the benefits of being physically active. Teach them that physical activity has great health benefits like:
    • Strengthening bone
    • Decreasing blood pressure
    • Reducing stress and anxiety
    • Increasing self-esteem
    • Helping with weight management
       
  5. Help kids stay active.
    Children and teens should participate in at least 60 minutes of moderate-intensity physical activity most days of the week, and every day if possible. You can set a great example! Start adding physical activity to your own daily routine and encourage your child to join you. Some examples of moderate-intensity physical activity include:
    • Brisk walking
    • Playing tag
    • Jumping rope
    • Playing soccer
    • Swimming
    • Dancing
       
  6. Reduce sedentary time. Although quiet time for reading and homework is fine, limit “screen time” (TV, video games, Internet) to no more than two hours a day. The American Academy of Pediatrics doesn’t recommend TV for kids age 2 or younger.12 Encourage your children to find fun activities to do with family members or on their own that simply involve more activity.

Learn more:

  • Childhood Obesity
  • BMI in Children
  • Making a Healthy Home

Weight Discrimination Linked To Obesity

Childhood obesity

Matt Cardy/Getty Images

See Also

One-third of American adults are obese, a health crisis that is typically linked to eating too much food, eating the wrong kind of foods, and not getting enough exercise.

But there are also psychological factors at play. 

New research from Florida State University shows that making people feel bad about their bodies actually increases the risk of obesity, rather than encouraging people to lose pounds.

Weight discrimination, also known as fat-shaming, includes teasing, bullying someone to lose weight, and other biases that appear in the workplace or relationships linked to weight.

More than 6,000 men and women from the U.S. participated in the four-year survey to test whether weight discrimination is associated with becoming obese or staying obese.

Subjects reported their experiences with weight and other types of discrimination that had been directed toward them between 2006 and 2010, and their body mass index was recorded at the start and end of the study.

Participants who were overweight at the beginning of the study were about 2.5 times more likely gain weight and become obese by follow-up if they reported weight discrimination, according to research published in the journal PLOS One on July 24.

Weight discrimination was equally harmful to participants who were already obese. These participants “were over three times more likely to remain obese at follow-up, rather than drop below the obesity threshold, than those who did not experience such discrimination,” according to the study.

“Weight discrimination is associated with behaviors that increase risk of weight gain, including excessive food intake and [lack of] physical inactivity,” the researchers conclude. “Heightened attention to body weight is associated with increased negative emotions and decreased cognitive control.”

SEE ALSO: 
Maine’s Top Chef Shows Us The Right Way To Steam And Eat A Lobster

Is obesity a laughing matter? | Tom Shone | Film | theguardian.com

“Nine out of 10 of the guys I fuck are black guys!” yells Melissa McCarthy merrily from her car window in the new comedy The Heat. The film is one of those cop-buddy flicks like 48 Hours, in which an uptight pencil-pusher finds himself partnered with a slovenly renegade in order to solve a crime, the twist being that both pencil-pusher and renegade here are both women: the former played by Sandra Bullock, who cannot disguise her disgust at her new partner detective Mullins (Melissa McCarthy), a Red Sox fan in plus-size sweatpants and a T-shirt dating back to 1978, with hair like a haystack, who sits munching on red-hot chili peppers, as if to heat up the torrents of filth that spill from her mouth. “What is this,” asks a bewildered Bullock. “Training Day?”

No, just a follow-up of sorts to director Paul Feig’s 2010 hit, Bridesmaids, which starred McCarthy as a lusty gun-loving hip-thrusting man-eater in a newsboy cap, sandwiched in with all the stick-thin bridesmaids as if nothing was amiss.

“Megan was a cartoon of aggressive sexuality, wildly, crudely lusty,” said Time critic Mary Pols. “She’s two parodies at once – the butch girl and the man everyone runs from at a cocktail party – braided together with the joke of a plus-sized figure.”

Although not everyone was as alert to the nuance of McCarthy’s schtick. “Melissa McCarthy is a gimmick comedian who has devoted her short career to being obese and obnoxious with equal success,” wrote Rex Reed in a review of a subsequent film of McCarthy’s, Identity Thief, which called McCarthy a “female hippo” and “tractor-sized”.

Responding to those comments in the New York Times last week, McCarthy said:

I felt really bad for someone who is swimming in so much hate. I just thought, that’s someone who’s in a really bad spot, and I am in such a happy spot. I laugh my head off every day with my husband and my kids who are mooning me and singing me songs.

Reed then came back with this:

My point was that I object to using health issues like obesity as comic talking points … [McCarthy] is basing her career on being obnoxious and being overweight. And I don’t think that’s funny. I have too many friends that have died of obesity-related illnesses, heart problems and diabetes, and I have actually lost friends to this. I have helped people try to lose weight, and I don’t find this to be the subject of a lot of humor. I have a perfect right to say that. My review was really more about the movie and about the character she plays in the movie than it is about her. I don’t care how much she weighs.

Reed’s initial comments were vile, and his attempts to spin them as concern for the obese is laughable, but his wriggling does inadvertently shed light on a thorny matter. Weight has traditionally been comic fodder – even, and sometimes especially, by those who wield it. The fat man as comic figure goes all the way back to Fatty Arbuckle, although a lot of that ‘fat’ was actually muscle. Arbuckle was extraordinarily graceful in the way he moved, refusing gags in which he got stuck in windows or doorways, instead seeking out skits of physical liberation – a ballet sequence in which he pirhouettes across the stage (Back Stage), or a dance in which he juggles pots and pans before spinning pies like discus across the room (The Cook).

Director Mack Sennett, recounting his first meeting with Arbuckle, said he “skipped up the stairs as lightly as Fred Astaire” and, “without warning went into a feather light step, clapped his hands and did a backward somersault as graceful as a girl tumbler”.

It’s a curious paradox of the fat clown – and one missed entirely by the modern phenomenon of “fat suits” – that he must have more control, more balance, more understanding of their plumb-lines than a skinny one, not less. Oliver Hardy was revealed as a graceful dancer in the Laurel and Hardy shorts. John Belushi executed a perfect series of cartwheels and backflips in The Blues Brothers. John Candy showed off his martial arts prowess in Delirious. Jack Black gave a remarkable display of body-popping in High Fidelity, spinning like a human top. The reason should be obvious, even to someone as lethargic in his critical perceptions as Reed: comedy, even physical comedy, is not a form that favors heaviness of effect. It is an art of precisely calibration, Quartz watch timing and gymnastic balance. It aspires to a state of weightlessness.

By that measure, The Heat is not much. It is too long, for one thing, the scenes burrowing into themselves to turn up good bits of improv, and relying on one too many jokes that do trade on McCarthy’s weight: wriggling her way out of a parked car through the window, spewing profanity all the way, for example. But what was true of Arbuckle is also true of McCarthy: she is remarkably lithe, as that vertical leg hoist in Bridesdmaids first told us, and there are a number of scenes here – most notably one in which she leads Bullock onto the dancefloor in a sting operation – that showcase that nimbleness.

And needless to say, when she opens her mouth and lets loose with one of those geysers of obscenity – on everything from her boss’s tiny balls to her new partner’s vagina – you just sit back and enjoy the ride. In those moments alone, the movie achieves take-off.

How Asiad Colony battled diabetes rise by building a park

Sriram Balakrishnan: The pavement outside the office of the Assistant Engineer, Corporation of Chennai located at Brindavan Street, Mylapore has been encroached upom by hutments with full knowledge of Corporation officials since this is right outside the Assistant Engineer's office. Are Corporation officials endorsing encroachments? These hutments have been there for over a year.

  Readers’ clicks – July 10

Walk to be healthy: so we’ve been told. But is there actual evidence to prove walking is an intervention that will lead to positive health outcomes?

Yes, there is. And, in our own backyard, too. The World Health Organisation’s 2005 publication, ‘Preventing chronic diseases, a vital investment,’ showcased how local efforts to create enabling environments for walking had borne positive results for the community. It was showcased also because it was an instance of a community taking ownership, advancing and executing an agenda for the welfare of the community.

Since then, it has come to be called the Asiad Colony experiment. An epidemiological study done in 1998-99 indicated there was a 12.5 per cent prevalence of diabetes among residents of the Tiruvanmiyur colony. “After the study, we built awareness about the need for physical exercise, and urged the residents to do something about it,” says V. Mohan, of Dr. Mohan’s Diabetes Specialities Centre, who conducted the study.

Convinced, the residents decided they would create an environment that would have the potential to increase physical activity patterns. They mobilised resources to build a park in the area. A piece of land was identified and the civic authorities’ permission was sought and received for constructing a park. The park was completed in 2002. The residents contributed a nominal annual fee for the maintenance of the park.

When Dr. Mohan went back for a follow up, he was surprised by the results, he says. There was a threefold increase in people undertaking physical activity (from less than 15 per cent in 1998-99 to 45 per cent in 2006-08) and in the interim, the prevalence of diabetes had increased from 12.4 per cent to 15.4 per cent, as against the more dramatic rise in prevalence — from 6.5 per cent to 15.3 per cent — in a community where no intervention was in place.

Inspired by the Asiad Colony experience, another residential community in Chennai took up the task of building themselves a park.

“The big thing here is how public effort resulted in changing environments to aid the cause of residents. Subsequently, a big movement started to renovate and create more parks in Chennai, an initiative that was spearheaded by the then Corporation commissioner M.P. Vijayakumar. It’s an indication of the power of the community and what it can achieve,” Dr. Mohan says.

Talk Back

We invite readers to participate in this campaign. You can email pictures of bad pavements (size not more than 1.5 MB) to myright@thehindu.co.in

Please send a picture of yourself.

In the email, please give your name, contact information, location of the pavement, description of the issue and action required.

Your pictures will be posted on www.facebook.com/chennaicentral and will also be considered for publication in the newspaper.

Website: http://thne.ws/mychennai

Exercise Up in U.S., But So Is Obesity: Report – WebMD

Exercise Up in U.S., but So Is Obesity: Report

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, July 10 (HealthDay News) — Although Americans are exercising more, the obesity epidemic continues to expand, University of Washington researchers report.

Their nine-year study of data from two U.S. health surveys suggests that physical activity alone is not enough to combat the problem.

“While physical activity has improved noticeably in most counties, obesity has also continued to rise in nearly all counties,” said lead researcher Laura Dwyer-Lindgren, from the university’s Institute for Health Metrics and Evaluation.

The obesity problem is directly related to how much Americans eat, said senior author Ali Mokdad, a professor of global health at the Institute for Health Metrics and Evaluation.

“Americans are not doing enough to control what they eat,” he said. They still consume more energy than they burn off through exercise, he said.

According to the U.S. Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese, and obesity contributes to serious chronic illnesses, high medical costs and premature death.

“We have to face the reality that obesity is affecting our health,” Mokdad said. “We need to take care of ourselves by watching what we eat and how much we exercise.”

From 2001 to 2009, the percentage of adults meeting recommendations for physical activity — 150 minutes of moderate activity or 75 minutes of vigorous activity a week — increased in most counties in the United States, the researchers report July 10 in Population Health Metrics.

But the percentage of adults considered obese also increased significantly. “In some counties, this increase was greater than 15 percentage points,” Dwyer-Lindgren said.

There was very little correlation between change in obesity and change in physical activity, the researchers noted.

Large disparities existed in 2011 between the best- and worst-performing counties. Less than 20 percent of men were obese in some counties, while nearly half were obese elsewhere, the report shows. For women, the gap was even larger — from less than 20 percent in some places to almost 60 percent in another.

Physical activity also bounced around, ranging from roughly one-third to about three-quarters, depending on county, for both men and women.

Big gains in physical activity were seen in counties in Kentucky, Georgia and Florida, but Kentucky’s Lewis County also had the biggest increase in male obesity — from about 29 percent in 2001 to about 45 percent in 2009. Western states claimed some of the most active counties, with residents of Wyoming’s Teton County the most active of all — with about 78 percent meeting recommended exercise guidelines.

Six of the eight least active counties were in Mississippi.

Increases in physical activity suggest that many communities have successfully adopted healthier lifestyles, likely through policies that promote physical activity, Dwyer-Lindgren said.