Weighing the Options Criteria for Evaluating Weight-Management Programs (1995) / Chapter Skim
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These figures point to the fact that obesity is one of the most pervasive public health problems in this country, a complex, multifactorial disease of appetite regulation and energy metabolism involving genetics, physiology, biochemistry, and the neurosciences, as well as environmental, psychosocial, and cultural factors. Unfortunately, the lay public and health-care providers, as well as insurance companies, often view it simply as a problem of willful misconduct-eating too much and exercising too little.
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The scientific evidence summarized in Chapter 2 suggests strongly that obese individuals who lose even relatively small amounts of weight are likely to decrease their blood pressure (and thereby the risk of hypertension) , reduce abnormally high levels of blood glucose (associated with diabetes)
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. Nonclinical programs are popular and are often commercially franchised.
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The scientific evidence summarized in Chapter 2 suggests strongly that obese individuals who lose even relatively small amounts of weight are likely to decrease their blood pressure (and thereby the risk of hypertension) , reduce abnormally high levels of blood glucose (associated with diabetes)
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We recommend that the definition of success that is applied in evaluating weight-loss programs be broadened and made more realistic based on the research findings that small weight losses can reduce the risks of developing chronic diseases. Specifically, the goal of obesity treatment should be refocused from weight loss alone, which is often aimed at appearance, to weight management, achieving the best weight possible in the context of overall health.
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In some cases, it is possible to identify mismatches of individuals with weight-loss programs, at least in the sense of excluding people from particular options. For example, a healthy young woman with a BMI of 28 is no candidate for gastric surgery, whereas a very obese male with a BMI of 40 and hypertension who has not lost weight despite many attempts is not likely to be helped by a do-it-yourself diet book or exercise video.
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Be evaluated by a health-care provider (or have been in recent past) before undertaking a do-it-yourself or nonclinical program.
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Nonclinical programs should encourage clients with obesity-related comorbidities or other health problems to maintain contact with their health-care provider for the duration of the program. Both nonclinical and clinical programs should obtain some information on the state of health and weight-loss goals of potential clients to determine if they are appropriate for a specific program and what types of individualized attention they may require.
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Generally, weight loss requires decreasing total energy intake and utilizing, as much as possible, a variety of available foods. The federal government's dietary guidance plan, the Food Guide Pyramid, is a useful tool to help individuals meet dietary recommendations.
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This is important not only because we believe that all adults should assume some responsibility for their health care, but because this selfassessment should help them determine which programs might be best for them. Many nonclinical programs screen potential clients by measuring height and weight and asking questions about health status.
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Generally, weight loss requires decreasing total energy intake and utilizing, as much as possible, a variety of available foods. The federal government's dietary guidance plan, the Food Guide Pyramid, is a useful tool to help individuals meet dietary recommendations.
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Do-it-yourself and nonclinical programs should strongly encourage individuals who have one or more of these risk factors to be under the care of a health-care provider. These programs should develop simple checklists for clients to highlight the importance of rou
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Clients in nonclinical and clinical programs should have their diets and physical activity patterns evaluated at least at the beginning and end of the treatment phase of the program and every 6 months during any maintenance phase (various assessment tools are described in Appendix A)
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Improvement in obesity-related comorbidities: One or more associated risk factors (e.g., high blood pressure; elevated blood concentrations of cholesterol, triglycerides, or glucose; and non-insulin-dependent diabetes mellitus) , if present, should be improved to a degree considered clinically significant.
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Clients in nonclinical and clinical programs should have their diets and physical activity patterns evaluated at least at the beginning and end of the treatment phase of the program and every 6 months during any maintenance phase (various assessment tools are described in Appendix A)
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Improvement in obesity-related comorbidities: One or more associated risk factors (e.g., high blood pressure; elevated blood concentrations of cholesterol, triglycerides, or glucose; and non-insulin-dependent diabetes mellitus) , if present, should be improved to a degree considered clinically significant.
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Choose programs that focus on long-term weight management; provide instruction in healthful eating, increasing activity, and Improving self-esteem; and explain thoroughly me potential health risks from weight loss. Look for programs mat devote considerable effort to helping people change their behaviors Trough information, guidance, and skills training.
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improving health behaviors, and discuss potential health risks from weight loss in general and their program in particular.
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At the current fume, it is difficult to compare different programs, In part TABLE 4 Program Disclosure of Information All potential clients of weight-management programs should receive information such as the following: · A truthful, unambiguous, and nonmisleading statement of the approach and goals of the program. Part of such a statement might read, for example, "We are a program that emphasizes changes in lifestyle, with group instruction in diet and physical activity." · A brief description of the credentials of staff, with more detailed information available on request.
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3. Average weight, height, body mass index (BMI)
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At the current fume, it is difficult to compare different programs, In part TABLE 4 Program Disclosure of Information All potential clients of weight-management programs should receive information such as the following: · A truthful, unambiguous, and nonmisleading statement of the approach and goals of the program. Part of such a statement might read, for example, "We are a program that emphasizes changes in lifestyle, with group instruction in diet and physical activity." · A brief description of the credentials of staff, with more detailed information available on request.
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3. Average weight, height, body mass index (BMI)
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SUMMARY 25 more, dieters should stay away from programs that claim more than they can substantiate or state that their unique methods ensure permanent weight loss. For its part, the scientific community must continue research to provide a fundamental understanding of the causes of obesity, leading to the design of maximally successful treatments and means to more effectively prevent this disease.
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The genetic and environmental determinants of obesity and its associated comorbidities vary among population groups, and the variation and reasons for this variation are important areas of research. In addition, research is needed on cOO~nitive-behavioral approaches to increase success at long-term weight loss and maintenance and to further understand the contributions of diet and physical activity in achieving successful weight management.
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