Exercise more. Avoid junk food. Such common-sense health advice has proved no match against the temptations of modern life, which have sent obesity rates around the world soaring. Now, government officials in a number of countries are pursuing an aggressive new strategy: enlisting entire communities to insulate people from these temptations and make healthier choices easier.

    Instead of hoping that individuals can muster the self-discipline on their own to avoid processed foods, fast food and days without physical exercise, the idea is that governments must actively work to change environments and reduce the menu of harmful options available in everyday life.

    As a result, hundreds of towns in Europe and elsewhere have adopted a version of this strategy, aimed particularly at preventing children from becoming overweight and obese. They hired dietitians to counsel children and their families in schools, organized walk-to-school days, hired sports educators and built new sporting facilities.

    The U.S. government, meanwhile, is increasing its funding for cities and towns to pursue so-called community-based obesity prevention, in an effort to gather data about which kinds of tactics work best.

    'People are finally acknowledging that the obesity problem is so pervasive that it isn't just because people are making bad choices,' says Laura Kettel Khan, an obesity expert at the U.S. Centers for Disease Control and Prevention, which makes grants to states for community obesity-prevention programs.

    The move toward this new strategy comes as governments are beginning to grapple with the enormous fiscal costs of obesity, which are expected to grow as younger people develop diseases such as Type 2 diabetes and some forms of cancer later in life that are linked to obesity. A study released in July by the CDC estimates that obesity may cost the U.S. alone as much as $147 billion annually in additional health-care costs.

    The European program, which is known as Epode -- a French acronym for Together Let's Prevent Childhood Obesity -- began in France, based on the experience of two towns in the north of the country, Fleurbaix and Laventie, that instituted a community-based obesity-prevention program aimed at children between 1992 and 2004.

    The result: The percentage of overweight and obese children in the two towns fell to 8.8% in 2004 from 11.2% in 1992, according to a study published earlier this year. The rates of overweight and obese children in two nearby towns that didn't adopt the strategy rose to 17.8% from 12.6%.

    Epode has since been recruited to help administer its program in more than 220 towns in France and dozens of others in Spain, Belgium and Greece. Towns in Australia have also adopted Epode's program, and a few in Mexico are considering doing so.

    One of the towns is St. Amand-les-Eaux, in northern France near the Belgian border. The cuisine here has always been rich: plenty of butter and cheese, often with a helping of french fries on the side. But rising consumption of soft drinks and processed food, combined with less physical exercise, have helped to push the rate of obese and overweight children there to over 25%.

    For the past two years, dietitians have worked in the local schools. Children are encouraged to participate in a long menu of sports activities. Chefs come to nursery schools to help the kids prepare healthy snacks and let them taste vegetable dishes, with the goal of getting children accustomed to the taste. Sodas and junk food are sharply limited in the schools.

    'There have of course been innumerable obesity treatments and diets, and the sad thing is people by and large go back to their original weight,' says Martijn Katan, professor of nutrition at Vrije Universiteit Amsterdam, who has followed Epode. 'The essential difference with this strategy is that almost all other programs are aimed at an obese individual -- he's still left within his environment, which bombards him from all sides with food.'

    Experts caution that it's too soon to say whether Epode and other community strategies are effective in the long term. The CDC in July published its first list of recommended community obesity-prevention strategies, with the caveat that data on their effectiveness are incomplete.

    'The whole concept of environmental and policy changes for obesity prevention is relatively new, so the evidence base is not very deep,' says the CDC's Ms. Khan.

    Still, a community-based approach to fighting obesity is probably the most promising policy available, experts say.

    'What works is durable, long-lasting changes in habits,' says Monique Romon, a professor of medicine at Universite Lille 2 and the lead researcher of the study on Fleurbaix and Laventie. 'That's why community action is so important.'

    多鍛煉、遠(yuǎn)離垃圾食品──事實證明，這樣的健康常識根本難以抵擋現(xiàn)代生活的諸多誘惑，而這些誘惑已經(jīng)讓世界各國的肥胖率大幅飆升。眼下，許多國家的政府官員們正在采取一種全新的激進策略：爭取整個社區(qū)的支持來幫助人們遠(yuǎn)離這些誘惑，做出健康的選擇。

    在羅馬尼亞Rabagani的山村，專家們正在推廣以社區(qū)為基礎(chǔ)的應(yīng)對肥胖癥策略。他們的計劃是：政府必須努力改變環(huán)境，減少日常生活中有損健康的食品種類；而不是寄希望于個人能夠靠自制來避免食用加工食品和快餐，并且每天堅持鍛煉。

    結(jié)果是，歐洲和世界上其他一些地方數(shù)百個市鎮(zhèn)都采納了這一策略的精神，將重點放在了預(yù)防兒童超重和肥胖的問題上。這些市鎮(zhèn)聘用了營養(yǎng)學(xué)家在學(xué)校為孩子和他們的家庭提供咨詢，組織"走路上學(xué)日",聘用體育教員，并修建了新的體育設(shè)施。

    與此同時，美國政府正在增加對市鎮(zhèn)的資金投入，開展基于社區(qū)的預(yù)防肥胖項目，為的是收集數(shù)據(jù)，從而決定哪種方式收效最好。

    美國疾病控制與預(yù)防中心（U.S. Centers for Disease Control and Prevention）的肥胖癥專家勞拉？罕（Laura Kettel Khan）表示，人們終于認(rèn)識到，肥胖問題的無處不在意味著，其癥結(jié)已不僅僅在于人們正在做出錯誤的選擇。美國疾控中心負(fù)責(zé)向美國各州撥款用于社區(qū)預(yù)防肥 胖項目。

    美國采取這一新舉措之時，正值各國政府開始努力應(yīng)對肥胖導(dǎo)致的巨額財政開支問題。隨著年輕人在晚年患上與肥胖有關(guān)的2型糖尿病以及某些癌癥，這一開支預(yù)計 將逐漸增加。美國疾病防控中心7月份發(fā)布的一項研究估計，肥胖給美國一個國家造成的額外醫(yī)療成本每年可能高達1,470億美元。

    被稱為"Epode"的歐洲項目始于法國。Epode是法語中"共同預(yù)防兒童肥胖"（Together Let's Prevent Childhood Obesity）的首字母縮略。該項目基于法國北部小鎮(zhèn)Fleurbaix和Laventie的經(jīng)驗而展開。這兩個小鎮(zhèn)在1992-2004年針對孩子們 開展了一項基于社區(qū)的預(yù)防肥胖項目。

    結(jié)果是：今年早些時候公布的一項研究顯示，這兩個市鎮(zhèn)的超重肥胖兒童比例從1992年的11.2%下降到了2004年的8.8%.而沒有開展該項目的兩個臨近市鎮(zhèn)的超重肥胖兒童比例從12.6%增加到了17.8%.

    從那以后，法國220多個市鎮(zhèn)以及西班牙、比利時和希臘的其他一些市鎮(zhèn)都運用Epode來幫助管理其項目。澳大利亞的一些市鎮(zhèn)也采用了Epode的項目，而墨西哥的一些市鎮(zhèn)也在考慮實施。

    St. Amand-les-Eaux就是開展該項目的一個市鎮(zhèn)。該市鎮(zhèn)位于法國北部，接近比利時邊境。那里的烹飪一向以油膩著稱：菜肴里加入了很多黃油和奶酪， 通常配菜里還會有炸薯條。軟飲料和加工食品的日漸流行，再加上缺少鍛煉，讓當(dāng)?shù)氐姆逝殖�重兒童比例超過了25%.

    在過去的兩年里，營養(yǎng)學(xué)家一直在當(dāng)?shù)貙W(xué)校工作。孩子們被鼓勵參與一系列的體育活動。廚師們來到幼兒園幫助孩子們準(zhǔn)備健康的小零食，讓他們品嘗蔬菜食品，為的是讓孩子們習(xí)慣新口味。蘇打飲料和垃圾食品在校內(nèi)被嚴(yán)厲禁止。

    一直跟蹤Epode項目的阿姆斯特丹自由大學(xué)（Vrije Universiteit Amsterdam）營養(yǎng)學(xué)教授卡坦（Martijn Katan）說，市面上當(dāng)然有許許多多的肥胖療法和減肥食譜，但令人遺憾的是，人們大多還是反彈回了從前的體重。而這種策略的不同之處在于，幾乎所有其他 項目針對的都是肥胖者個人──這個人仍舊在過去的環(huán)境里生活，各種各樣的食物仍然把他包圍。

    專家們警告說，Epode和其他那些社區(qū)策略是否長期有效，現(xiàn)在下斷言還為時過早。美國疾病防控中心在7月份公布了第一份社區(qū)預(yù)防肥胖策略推薦名單，不過該中心也警告說，有關(guān)這些策略有效性的數(shù)據(jù)并不完整。

    美國疾病防控中心的罕女士說，有關(guān)預(yù)防肥胖的環(huán)境和政策變化這個概念相對還很新，因此證據(jù)并不是十分充分。

    專家表示，不管怎樣，基于社區(qū)的預(yù)防肥胖方式或許是現(xiàn)有政策里最有前途的一個。

    里爾二大（Universite Lille 2）醫(yī)學(xué)教授羅蒙（Monique Romon）說真正有效的是人們習(xí)慣持久而長期的變化，這就是為什么社區(qū)的行動如此重要，她也是Fleurbaix和Laventie兩地研究的課題組組長。