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AJCN July Supplement, 2005: Science-based solutions to obesity

This is an amazing symposium. It is an effort by Harvard University and the National Institutes of Health to determine the best practices to address the epidemic of obesity in the US. Just the table of contents demonstrates the wonderful information contained in this issue. Rather than abstracting every article, I have simply noted some of the most relevant findings. I encourage you to review the abstracts you find most interesting. They can all be accessed from the Table of Contents page.

1. Science-based solutions to obesity: what are the roles of academia, government, industry, and health care? Obesity causes about 1-400,000 deaths per year and costs $117 billion. Nine million children over 6 yrs of age are obese. How do we get nutrition information beyond doctors to patients?

2. Executive summary of the Strategic Plan for National Institutes of Health Obesity Research - 65% of US adults are overweight or obese. The solution may seem simple: "get people to eat less and exercise more." The reality is that this change is very difficult to accomplish.

3. Genetics of common forms of obesity: a brief overview
4. Teaching, learning, doing: best practices in education - The tables in this article give current ideas about how we change behavior. Can be applied to weight loss, taking supplements, eating healthier foods, any behavior change.

Table 1: Principles of Learning

Prior knowledge is basis for future knowledge
Prior knowledge must be activated to connect to new stuff.
Learners must be actively involved.
Links to prior knowledge make new knowledge useful. More links, more useful!
Learning must occur in context of your personal system of knowledge.
Motivation is key. You need to be interested to benefit.
The goal is to eliminate the teacher, to be able to learn on your own.

Table 2: Levers of Change

Reason: facts, logic, rhetoric to convince or persuade
Research: appeal to the intellect
Resonance: frame message so it feels right
Redescriptions: Repeats view in different forms to reinforce message
Resources and rewards: gives value for reaching objectives
Real-world events: Uses emotions and events to shift perspective
Resistances: defuses barriers to change

Table 3: Stages of change model

Precontemplation not ready to change
Contemplation thinking about change
Preparation getting ready, planning
Action making the change
Maintenance sustaining and integrating the change
Relapse/Recycling slipping up and beginning again

5. Long-term weight loss maintenance - PEOPLE DO SUCCEED! 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity (1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2–5 y, the chance of longer-term success greatly increases.

6. Physical activity considerations for the treatment and prevention of obesity - Although there is evidence that 30 min of moderate-intensity physical activity may improve health outcomes, the amount of physical activity that may be necessary to control body weight may be >30 min/d. There is a growing body of scientific literature suggesting that at least 60 min of moderate-intensity physical activity may be necessary to maximize weight loss and prevent significant weight regain.

7. Behavioral treatment of obesity - Studies suggest that behavioral treatment produces weight loss of 8–10% during the first 6 mo of treatment. Structured approaches such as meal replacements and food provision have been shown to increase the magnitude of weight loss.

8. The influence of food portion size and energy density on energy intake: implications for weight management - EATING LARGER INITIAL SERVINGS CAUSES OVEREATING! EAT SMALL PORTIONS TO LOSE WEIGHT.

9. Protein, body weight, and cardiovascular health - HIGH PROTEIN INTAKE APPEARS MOST EFFECTIVE DIET [VS. LOW FAT OR ATKIN'S DIETS]. SPECIFIC PROTEINS: Red meat is hazardous. Poultry, fish, eggs are fine. Dairy consumption reduces body weight, hypertension, and insulin resistance, so eat dairy!!! Nuts are fantastic for you. Soy looks great too.

10. Solutions in weight control: lessons from gastric surgery - Surgical therapy is the most effective modality for treatment of severe obesity. Roy-en-Y gastric bypass is the gold standard.

11. Now and again: the food and beverage industry demonstrates its commitment to a healthy America

12. When science met the consumer: the role of industry

13. Solutions to obesity: perspectives from the food industry

14. Government perspective: food labeling

15. The economics of obesity: dietary energy density and energy cost




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