The Agency for Healthcare Research and Quality is undertaking a comparative effectiveness review of approaches to weight maintenance in adults. Information is available at Approaches to Weight Maintenance in Adults: A Comparative Effectiveness Review | AHRQ Effective Health Care Program The paper cites a recent Cochrane review of workplace diet and physical activity which found a rather minimal decrease in weight of 2.8 pounds or .5 BMI unit at 6-12 months.
September 30, 2010
Perhaps the greatest gap between science and policy-making is the understanding of the causes of obesity. For most of the public and policy-makers, it is beyond discussion that obesity is caused by poor diets and lack of physical activity. Scientists, on the other hand, know that, without diminishing the roles diet and exercise play, they are not the whole story. Obesity is far more complex. This gap has significant implications. Billions of dollars have been spent on strategies which, to be kind, are simplistic. Not only is this wasteful, it distracts or delays our understanding and the development of more effective remedies. Probably no better description, in great detail, of the ‘putative’ causes of obesity is contained in this article by McAllister and a prestigious group of co-authors. Ten putative contributors to the obesity epidemic. [Crit Rev Food Sci Nutr. 2009] – PubMed result. Even if the article is a bit dense, it is worth it to make us all more humble in approaching this disease.
September 29, 2010
Look AHEAD, an NIH funded long term study of life style intervention on weight and cardiovascular risk factors has released its 4 year findings. One arm of the study received intensive lifestyle counseling; the other arm received usual dietary counseling. Averaged across the four years, body weight was reduced in the intensive group by 6.5% compared to 0 .88%, along with improvements in fitness, hemoglobin A1c, systolic and diastolic blood pressure, HDL cholesterol and triglycerides. Some of the gains decreased over time as one would expect but were still significantly better at the four year follow-up. See, Arch Intern Med — Abstract: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus: Four-Year Results of the Look AHEAD Trial, September 27, 2010, The Look AHEAD Research Group 170
George Washington University School of Public Health and Health Services has released new data on obesity coverage under the Medicaid program, state employee coverage and mandates for obesity coverage, as well as their new study on the personal costs due to obesity. See Health Policy | School of Public Health and Health Services | George Washington University
The American College of Physicians has released a paper, Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond. The paper addresses evolving wellness programs which involve “incentives” or “penalties,” depending on one’s point of view. The paper cautions, “”motivating behavior change is much more complex than can be accomplished with a single strategy and requires both an individual commitment to health as well as societal collaboration to eliminate barriers. The College adds that such programs “must be designed to allocate benefits equitably; must not include penalties.” See, http://www.acponline.org/running_practice/ethics/issues/policy/personal_incentives.pdf
On July 19, 2010, The Department of Health and Human Services issued ‘interim final regulations’ requiring insurers in the group and individual markets to include preventive services without any cost sharing as part of the the health care reform law signed by President Obama earlier this year. Preventive services include an important, sleeper provision regarding obesity. Here’s how it works.
The law defines “preventive services” as those with an A or B grade recommendation from the U.S. Preventive Services Task Force (USPSTF). The USPSTF has B grade recommendations for intensive behavioral counseling for adults with obesity and for screening and counseling for children. U.S. Preventive Services Task Force Recommendations
Coverage without cost sharing goes into effect on September 23, 2010. Interestingly, the regulations do not provide any limitations on the frequency, intensity or duration of such coverage. This represents a significant new benefit coverage affecting millions of Americans. Most of the USPSTF recommendations cover screening tests but counseling is covered for tobacco cessation, sexually transmitted infections, dietary counseling for persons with hyperlipidemia and related cardiovascular risk factors, and promote breast-feeding.
I call this a stealth provision because Congress assumed the USPSTF recommendations were screening tests and probably would have rejected this kind of coverage as a listed benefit.
The regulation background information discusses the low level of obesity counseling presently and the benefits to be expected from broader coverage.
Comments can be received for 60 days from July 14, 2010. The proposed regulation can be accessed at Federal Register Contents, Monday, July 19, 2010
The first thing to realize is how much exercise is needed to burn calories. Don’t get discouraged but it takes a lot of time. See: Lighten Up and Get Moving! | The Calorie Control Council
Physical activity patterns and prevention of weigh…[Int J Obes (Lond). 2009] – PubMed Result
Pedometer-based walking programs show modest weight loss A meta-analysis of pedometer-based walking interve…[Ann Fam Med. 2008 Jan-Feb] – PubMed Result
Using pedometers to increase physical activity and…[JAMA. 2007] – PubMed Result
Exercise alone of minimum use Effects of a popular exercise and weight loss prog…[Nutr Metab (Lond). 2009] – PubMed Result, especially it would seem, among women Exercise is not an effective weight loss modality …[J Am Coll Nutr. 1993] – PubMed Result
Exercise in weight management of obesity. [Cardiol Clin. 2001] – PubMed Result
American College of Sports Medicine position stand…[Med Sci Sports Exerc. 2001] – PubMed Result
Treatment and prevention of obesity: what is the r…[Nutr Rev. 2006] – PubMed Result
Physical activity considerations for the treatment…[Am J Clin Nutr. 2005] – PubMed Result
Exercise for overweight or obesity. [Cochrane Database Syst Rev. 2006] – PubMed Result
Regular exercise trumps metabolic drive to regain after weight loss Regular Exercise Attenuates the Metabolic Drive to…[Am J Physiol Regul Integr Comp Physiol. 2009] – PubMed Result
US self-reported physical activity Prevalence of Self-Reported Physically Active Adults — United States, 2007
Prevalence of adult physical activity Prevalence of Regular Physical Activity Among Adults — United States, 2001 and 2005
Physical activity may matter a lot less than you thought. Study compares energy expenditure between Chicago and Nigerian women Energy expenditure does not predict weight change …[Am J Clin Nutr. 2009] – PubMed Result
Physical activity is associated with risk factors …[J Am Diet Assoc. 2008] – PubMed Result
Physical activity decreases cardiovascular disease…[Am J Prev Med. 2004] – PubMed Result
Active Commuting Active commuting and cardiovascular disease risk: …[Arch Intern Med. 2009] – PubMed Result
Physical activity, obesity and cardiovascular dise…[Handb Exp Pharmacol. 2005] – PubMed Result
Economic research on obesity has increased sharply over the last ten years or so as the epidemic has increased.
An excellent place to start is the National Business Group on Health paper on obesity related health care costs http://www.businessgrouphealth.org/pdfs/NBGH%20WeightyMatters_Final.pdf
A September 2009 Rand study shows dramatic lifetime cost savings by adults 51-52 years of age from risk factor changes The Benefits of Risk Factor Prevention in American…[Am J Public Health. 2009] – PubMed Result
