Nia S. Mitchell

Obesity: overview of an epidemic.

The obesity epidemic in the United States has proven difficult to reverse. We have not been successful in helping people sustain the eating and physical activity patterns that are needed to maintain a healthy body weight. There is growing recognition that we will not be able to sustain healthy lifestyles until we are able to address the environment and culture that currently support unhealthy lifestyles. Addressing obesity requires an understanding of energy balance. From an energy balance approach it should be easier to prevent obesity than to reverse it. Further, from an energy balance point of view, it may not be possible to solve the problem by focusing on food alone. Currently, energy requirements of much of the population may be below the level of energy intake than can reasonably be maintained over time. Many initiatives are underway to revise how we build our communities, the ways we produce and market our foods, and the ways we inadvertently promote sedentary behavior. Efforts are underway to prevent obesity in schools, worksites, and communities. It is probably too early to evaluate these efforts, but there have been no large-scale successes in preventing obesity to date. There is reason to be optimistic about dealing with obesity. We have successfully addressed many previous threats to public health. It was probably inconceivable in the 1950s to think that major public health initiatives could have such a dramatic effect on reducing the prevalence of smoking in the United States. Yet, this serious problem was addressed via a combination of strategies involving public health, economics, political advocacy, behavioral change, and environmental change. Similarly, Americans have been persuaded to use seat belts and recycle, addressing two other challenges to public health. But, there is also reason to be pessimistic. Certainly, we can learn from our previous efforts for social change, but we must realize that our challenge with obesity may be greater. In the other examples cited, we had clear goals in mind. Our goals were to stop smoking, increase the use of seatbelts, and increase recycling. The difficulty of achieving these goals should not be minimized, but they were clear and simple goals. In the case of obesity, there is no clear agreement about goals. Moreover, experts do not agree on which strategies should be implemented on a widespread basis to achieve the behavioral changes in the population needed to reverse the high prevalence rates of obesity. We need a successful model that will help us understand what to do to address obesity. A good example is the recent HEALTHY study. This comprehensive intervention was implemented in several schools and aimed to reduce obesity by concentrating on behavior and environment. This intervention delivered most of the strategies we believe to be effective in schools. Although the program produced a reduction in obesity, this reduction was not greater than the reduction seen in the control schools that did not receive the intervention. This does not mean we should not be intervening in schools, but rather that it may require concerted efforts across behavioral settings to reduce obesity. Although we need successful models, there is a great deal of urgency in responding to the obesity epidemic. An excellent example is the effort to get menu labeling in restaurants, which is moving rapidly toward being national policy. The evaluation of this strategy is still ongoing, and it is not clear what impact it will have on obesity rates. We should be encouraging efforts like this, but we must evaluate them rigorously. Once we become serious about addressing obesity, it will likely take decades to reverse obesity rates to levels seen 30 years ago. Meanwhile, the prevalence of overweight and obesity remains high and quite likely will continue to increase.

Determining the Effectiveness of Take Off Pounds Sensibly (TOPS), a Nationally Available Nonprofit Weight Loss Program

Obesity is a major public health issue in the United States. Many commercial weight loss programs are available, but their costs prohibit some people from participating. This study evaluated the effectiveness of Take Off Pounds Sensibly (TOPS), a low‐cost, nonprofit weight loss program. Longitudinal mixed‐effects repeated‐measures modeling of the TOPS national database was used to model changes in weight for TOPS participants who joined in 2005, 2006, and 2007 and had at least one annual renewal between 2006 and 2008. Separate analyses were performed on individuals with consecutive annual renewal and those with nonconsecutive annual renewal. During the study period, 42,481 individuals renewed their membership at least once, including 2,427 individuals with nonconsecutive renewals. Individuals with consecutive renewals in TOPS lost 5.9–7.1% of their initial weight over a period of 1–3 years. People who remained in the program lost ∼6% of initial weight in the first year and maintained that weight loss for up to 3 years. TOPS participants with nonconsecutive renewal generally lost less weight than those with consecutive renewal. TOPS is associated with moderate weight loss among participants who remain in the program for at least 1 year. This degree of weight loss is likely to be clinically important for many individuals. TOPS is available at substantially lower cost than commercial weight loss programs, with similar results. Head‐to‐head trials of TOPS and popular commercial programs are needed.

In situ analysis of protein chromatography and column efficiency using magnetic resonance imaging

Magnetic resonance imaging has been used to visualize size-based protein separations inside operating chromatography columns. The effects of flow nonuniformity have been observed and analyzed quantitatively through concentration profiles of tracers measured inside the column. Analysis of these profiles provides local and averaged intracolumn plate height values for characterization of dispersion and flow nonuniformity. The magnetic resonance measurements compare favorably with conventional chromatographic measurements of column efficiency and provide more detailed insights into nonideal column performance.

Time to RE-AIM: Why Community Weight Loss Programs Should Be Included in Academic Obesity Research.

Despite decades of efficacy-based research on weight loss interventions, the obesity epidemic in the United States persists, especially in underserved populations. We used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework to describe the limitations of the current paradigm of efficacy-based research for weight loss interventions. We also used RE-AIM to propose that existing weight loss interventions (community-based programs) such as Jenny Craig, Take Off Pounds Sensibly (TOPS), and Weight Watchers be studied to supplement the efficacy-based research approaches to achieve population-level impact on obesity.

Innovative Care Delivery Model to Address Obesity in Older African-American Women: Senior Wellness Initiative and Take Off Pounds Sensibly Collaboration for Health (SWITCH)

To determine the feasibility and acceptability of integrating Take Off Pounds Sensibly (TOPS), a national nonprofit weight‐loss program through which people have lost a clinically significant amount of weight, into a community program that serves African Americans (AAs) and to determine weight change.

Outcomes of biomarker feedback on physical activity, eating habits, and emotional health: from the Americans in Motion-Healthy Intervention (AIM-HI) study.

Purpose: The purpose of this article was to test whether physical activity, healthy eating, and emotional well-being would improve if patients received feedback about biomarkers that have been shown to be responsive to changes in weight and fitness. Methods: Patients were randomized to limited feedback (weight, body mass index [BMI], and blood pressure at 4 and 10 months) or enhanced feedback (weight, BMI, blood pressure, homeostatic insulin resistance, and nuclear magnetic resonance lipoprotein profiles at 2, 4, 7, and 10 months). Repeated measures mixed effects multivariate regression models were used to determine whether BMI, fitness, diet, and quality of life changed over time. Results: Major parameters were similar in both groups at baseline. BMI, measures of fitness, healthy eating, quality of life, and health state improved in both patient groups, but there was no difference between patient groups at 4 or 10 months. Systolic blood pressure improved in the enhanced feedback group, and there was a difference between the enhanced and limited feedback groups at 10 months (95% confidence interval, −6.011 to −0.5113). Conclusions: Providing patients with enhanced feedback did not dramatically change outcomes. However, across groups, many patients maintained or lost weight, suggesting the need for more study of nondiet interventions.

Weight Change in Pediatric TennCare Recipients Referred to a Commercial Weight Loss Program

BACKGROUND The epidemic of overweight and obesity in the United States is not limited to adults but also affects children and adolescents. Low-income children are disparately affected because they have an elevated risk for developing obesity. Effective interventions are urgently needed to prevent and treat obesity in children. In 2006, Tennessee Medicaid (TennCare) and Weight Watchers formed the TennCare Weight Watchers Partnership Program, which allowed pediatric recipients to attend Weight Watchers with no out-of-pocket cost. METHODS This study is a nonconcurrent prospective analysis of administrative data from the TennCare Weight Watchers Partnership Program. It examined the weight change of TennCare beneficiaries between the ages of 10 and 17 who participated in the program from January 2006 to January 2009 and compared the weight change to the recommendations of the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Childhood and Adolescent Overweight and Obesity. RESULTS Fifty-three percent of participants either met or exceeded the recommendations of the panel on childhood obesity at the end of their involvement in the program. Participants who attended the program for more than 12 weeks and those who attended 10 or more meetings had a 5% decrease in their body mass index z score. CONCLUSIONS The TennCare Weight Watchers Partnership Program was successful in helping a majority of children and adolescents who participated to meet or exceed the Expert Committees recommendations. This type of partnership can give children in low-income families the opportunity to participate in a structured program with a good chance of success.

Perspectives of Older African-American Women on a Community-Based Weight Loss Program: Qualitative Findings from the Senior Wellness Initiative and Take Off Pounds Sensibly (TOPS) Collaboration for Health

We are grateful to Mrs. Jessica Suna for assistance with patient screening. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. The study was supported by funding from the Royal Australasian College of Physicians and the Royal Brisbane and Women’s Hospital Research Foundation. Author Contributions: Mudge A.M.: conceptualized the study and conducted the analysis. All authors contributed to study and model design and delivery. Lloyd S. and Kasper K.: collected data. All authors provided comments on the draft manuscript and approved the final version. Sponsor’s Role: The Royal Australasian College of Physicians and the Royal Brisbane and Women’s Hospital Research Foundation had no role in study design, analysis, or publication.

Can we talk about your weight for a few minutes, mr. Jones?.

The 5A approach can be used by primary care physicians to briefly counsel patients about weight management. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.