"The two most important things people can do for their health is: not smoke and control their weight. Yet 65 percent of Americans are overweight," said Walter Willett, chair of the Department of Nutrition, who moderated a workshop on understanding and communicating the connection between extra weight and chronic disease held at the Longwood Galleria Conference Center on April 16.

No matter how good the evidence, studies that tell people they are getting too fat and that their weight gain may be bad for their health do not seem to motivate people to lose weight, or even stop gaining pounds. So a group of about 100 health professionals met at the workshop to brainstorm on simple, positive messages that might help tip the scales downward for millions of people. The workshop was the first step in a process to formulate messages for the public.

The event was sponsored by the Harvard Center for Cancer Prevention, the Prevention Research Center on Nutrition and Physical Activity, both at HSPH, and the Dana-Farber/Harvard Cancer Center Risk Reduction Program.

"We will be working with a lot of other groups and individuals to keep this agenda moving along," Willett said. "We hope to come up with an increasing consensus to work together to reinforce these messages."

The American public cannot digest complex, conflicting, and negative health messages, said William DeJong, professor of social and behavioral sciences, Boston University School of Public Health. The success of the "designated driver" campaign suggests effective messages should be simple, positive, and repeated often. They should address a concrete action step and not shame or scare people. He also advised people to look for motivators other than long-term health benefits.

Graham Colditz, director for education at the Harvard Center for Cancer Prevention, focused on the US problem of obesity. He described the link between chronic disease risk and increased adiposity, or fatness.

Research on diets has confused matters, said Frank Sacks, professor of cardiovascular disease prevention in the Department of Nutrition. Typically, diet studies suffer from short duration, bad design, and small samples, he said.

"Low-fat is the dominant paradigm in the nutrition world," Sacks said. "Researchers are shocked to see evidence that low-fat diets may not be as good as people thought, and that diets moderate in fat and high in protein might be beneficial."

Regardless of the diet types, large portion sizes are another big component of the problem, he said.

Among children, the prevalence of being overweight rises with increased television watching, reported Jean Wiecha, senior research scientist at the Prevention Research Center on Nutrition and Physical Activity. Children who watch a lot of TV are exposed to increased amounts of fast-food advertising and are engaged in a sedentary behavior, she said. Data is scarce on physical activity trends in children, said Wiecha, but, "We need to intervene on the TV issue even as we study it more."

Nevertheless, television is a major mode of mass communication for children, and Blue Cross Blue Shield of Massachusetts is using the vehicle to increase awareness of its "Jump Up and Go!" initiative. Co-sponsored by WBZ-TV 4 and Shaws/Starmarket, the "Jump Up and Go!" television campaign aims to increase physical activity and healthy food choices. The messages are targeted to middle school-aged children and parents. Headed by former television producer Sylvia Stevens-Edouard, director of community relations for Blue Cross Blue Shield of Massachusetts, the campaign advises eating five or more servings of fruits or vegetables every day, limiting TV and computer time to two hours or less a day, and participating in one hour of physical activity daily.

The Massachusetts Partnership for Healthy Weight of the Massachusetts Department of Public Health will be studying the effectiveness of the campaign in controlling weight.

The brainstorming session at the workshop resulted in several potential messages to address teen nutrition, adult nutrition, childhood physical activity, physical activity in adults, and adult weight gain. The upbeat slogans included: "Use your shoes" (exercise more). "Smaller is smarter" (eat less). "Undersize me" (eat smaller portions). "Lose, love, live" (lose weight, feel better about yourself, live a happier, longer life).

Workshop organizers plan to meet again to refine messages and to decide about the next steps to make the messages ready for public consumption. The organizers are seeking funding to conduct focus group interviews to help test the messages.

--Carol Cruzan Morton