Overview: Evolving Research Into Treatment and Prevention of Obesity

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Overview Evolving Research Into Treatment and
Prevention of Obesity

• Jean Harvey-Berino, PhD, RD
• Behavioral Weight Control Research Program
• University of Vermont
• November 19, 2002

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Development of obesity
Energy Out
Energy In
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Genetic contribution

• Parental obesity alters risk of obesity in
  adulthood for obese and non-obese children
• adulthood is parents obesity status
• 3xs greater risk w/one obese parent 13xs
  greater risk with two

Whitaker, NEJM, 1997
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Evidence for Genes

• Twin studies BMI of MZ twins was correlated at
  0.81
• MZ twins reared apart have BMIs correlated at
  0.70 for men and 0.60 for women

Meyer Stunkard, ObesityTheory and Therapy, 1993
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Genes or Environment?

• ..genetic influences largely determine whether
  a person can become obese but it is environment
  that determines whether such a person does become
  obese, and the extent of that obesity

Meyer Stunkard, Obesity Theory and Therapy,
1993
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Environment??
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School-aged childrens mean 24-hour food energy
intake (1989-91 and 1994-96)



Percent of Recommended Energy Allowance
Source CSFII
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Food Energy

• Calorie increase driven by foods eaten for snacks
  and at dinner
• Vitamin/mineral intake did not increase
• Increase probably driven by increase in foods
  and drinks high in added sugar (fruit drinks and
  soft drinks)
• Fat intake decreased but fat intake has not.

Source CSFII
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Energy expenditure in adults
Percentage
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Environment Food Industry

• 1998 advertising expenditures
• 10-50 million for candy bars
• 115.5 million for soft drinks
• 1 billion for McDonalds
• NCI 5-A-Day Program 1 million
• NHLBI NCEP 1.5 million

Nestle Jacobson, Public Health Reports, 2000
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Toxic Environment
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Very Low Calorie Diets (VLCD)

• High protein/low carbohydrate
• Goal Increase initial weight loss

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Effectiveness of VLCDs
Weekly Treatment
Bi-weekly Treatment
VLCD
Weight loss (kg)
BDD
(Wadden, 1995)
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Innovation structured meals and menus
0
6
12
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Wt change (kg)
Jeffery, JCCP, 1993
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Weight Control Registry

• 66 lb. weight loss maintained for 5.5 years
• Calorie intake 1409
• calories from fat24

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Body Weight Change Low fat vs. low calorie diet
Harvey-Berino, Annals of Behav. Med, 1998
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Dietary innovations Calcium?
Zemel, Faseb Journal, 2000
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Weight loss by diet or exercise alone
Wood, NEJM, 1988
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Diet vs DietExercise
Wood, NEJM, 1991
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Exercise and Weight Maintenance
Percent exercising
Kayman, AJCN, 1990
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Weight Control Registry

• 2885 calories expended/week
• 813 calories expended in vigorous activity
• 28 miles walking/week
• 9 hours/week

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Innovations in exercise Lifestyle exercise vs.
Aerobic exercise

• Lifestyle exercise
• -2.39 Body Fat
• Aerobic exercise
• -1.85 Body Fat

Dunn, JAMA, 1999
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Innovations in exercise Intermittent exercise
and home exercise equipment
SBEQSB
Jakicic, JAMA, 1999
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Innovation Increase exercise or decrease
sedentary behavior?

• Reinforce for being more active or for being less
  sedentary?
• Increased exercise vs. decreased sedentary
  behavior vs. both
• Decrease sedentary group
• greater decrease in weight and body fat
• increased liking for high intensity exercise
• lower caloric intake

Epstein, Health Psych, 1995
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Reducing childrens TV viewing to prevent obesity
Baseline
Post-intervention
Robinson, JAMA, 1999
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Effective weight loss interventions

• Behavioral weight control
• Diet
• Exercise
• Behavior modification techniques
• Weight losses average 9 of baseline weight after
  6 months
• Weight losses average 4 of baseline weight after
  4 years

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Effective weight loss interventions

• Behavioral weight control
• Diet
• Exercise
• Behavior modification techniques
• Intensive
• Not widely available

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Successful weight maintenance

• Extended contact
• Social support
• Exercise
• Self-monitoring

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Extended maintenance programs

• 2 year lifestyle intervention for FH diabetes
• Diet vs. Dietexercise vs. Exercise vs. Control
• 61 attendance in 1st 6 months 27 later

Wing, Diabetes Care, 1998
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THE INTERNET Treatment Innovation??
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Supported by USDA Hatch Funds and the Office of
Patient Oriented Research at Fletcher Allen
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Internet Study II
Recruitment
Treatment
In-person 6 mo
Intensive Therapist Support
Internet Support
Minimal Therapist Support
Maintenance 12 mo
Supported by USDA Hatch Funds
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Weight change
Mean Body Weight (kg)
Time (months)
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The ultimate innovation The Twinkie Tax

• We cant ban junk food but we can regulate it.
• Advertise healthy food or counter-advertise junk
  food
• Subsidize healthy food (fruits and vegetables)
• Regulate food industry advertising
• Regulate location, density, or hours of junk-food
  outlets

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The ultimate innovation The Twinkie Tax

• Limit location and number of soft-drink vending
  machines
• Strengthen and enforce USDA regulation of foods
  sold in schools
• Require all neighborhoods to have sidewalks and
  bike paths
• Consider design of buildings to support stairs
  instead of elevators
• Increase PE in schools

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Afterward, the lesson was clear Society could
save lives not by teaching the dangers of filthy
water or personal hygiene, but by improving
living conditions so that people---educated or
not---would drink clean water. Or as British
preventive-medicine specialist Geoffrey Rose put
it, "The great public health reforms of the 19th
century which led to such dramatic improvements
were undertaken for people, rather than by
people."
Farley and Cohen, 2001