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Although Americans recognize that excess weight increases their risk for disease and premature death, public awareness has not yet translated into a reduction in the rates of obesity, according to a study by RTI International, a not-for-profit research organization based in Research Triangle Park, N.C.
Just over 1,000 U.S. adults of varying weights took part in a 2004 randomized telephone survey regarding their expected lifespan and likelihood of developing obesity-related diseases. Principal researcher Eric Finkelstein, PhD, a health economist with RTI, presented the results at the 2005 Annual Scientific Meeting of NAASO, The Obesity Society (formerly the North American Association for the Study of Obesity), held October 15–19 in Vancouver, British Columbia.
The survey shows that overweight people are aware of their personal health risks, yet the rate of obesity continues to rise. Overweight respondents predicted a lifespan 2.5 years shorter than that predicted by people with normal weight (75.8 vs. 78.2 years). The lifespan predicted by obese respondents was 4 years shorter (74.3 years) than the estimates of those with normal weight.
Compared with normal-weight people, overweight respondents thought they were more likely to develop diabetes, cancer, heart disease, or stroke. Obese people thought they were much more likely to develop these diseases.
"The actual data say the risk of disease goes up as weight goes up. People seem to recognize this as well," Finkelstein says. "They know that they're obese or overweight, and they know that makes them less healthy."
A previous study, which found that subjects appeared to underestimate the mortality risks of excessive weight, concluded that "knowledge campaigns about the risks of obesity should remain a top priority."1 But Finkelstein argues that repeatedly telling people that obesity is bad for their health isn't particularly helpful. He says he would like to see the same concerted approach that successfully reduced smoking rates used to combat obesity.
"What got smoking levels down from 50% to 25% [of the U.S. population] was not messages; it was taxation and regulation," Finkelstein says. Policymakers must consider alternatives that promote healthy lifestyles and weight loss rather than just public awareness campaigns aimed at health risks, he continues. "It takes changing the incentive structure so it is easy to engage people in healthy lifestyles. We need to re-engineer the environment."
For example, Finkelstein points out that efforts to focus attention on the
marketing of sugary, high-calorie drinks to young people are paying off.
"Now you're seeing bans on soda vending machines in the schools and
beverage companies changing their products," he says. "Things will
change but, as we saw with smoking, they take time." 
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