Obesity: Population Interventions for Adults

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Obesity Population Interventions for Adults

• Robert W. Jeffery, Ph.D.
• Division of Epidemiology
• School of Public Health
• University of Minnesota

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The Healthy Worker Project (HWP)

• A randomized trial of worksite interventions for
  weight loss.

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HWP Project Overview

• Thirty-two (32) worksites employing approximately
  20,000 people.
• Randomized to treatment or control
• Two years of intervention on weight
• Evaluation via cohort and cross-sectional surveys

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HWP Intervention

• 4 rounds
• 6 months duration
• No entry restrictions
• Self-selected goals
• Self-help manual
• Biweekly group instruction
• Payroll-based incentive system

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Participation and Short-term Weight Loss
Participants 2041 of all overweight
employees 38.3 Mean weight loss (lb) 4.8
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HWP Change in Mean BMI from Baseline to
Follow-up
Treatment Control Cross-section
-0.05 -0.05 NS Cohort -0.02 0.08 NS
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Minnesota Heart Health Program (MHHP)

• A 10-year research and demonstration project to
  evaluate the effectiveness of multicomponent
  interventions to reduce CVD incidence and
  mortality

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Description of MHHP

• Three matched community pairs
• Seven years of intervention including
• risk factor screening
• mass media
• adult education
• worksite intervention
• school intervention
• restaurant intervention
• etc.

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Mean BMI in MHHP Education and Comparison
Communities by Year Cross-sectional Surveys
BM I
B(3) B(2) B(1) B0 E1 E2 E3 E4
E5 E6 E7
B and E Years
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Pound of Prevention (POP)

• Randomized trial evaluating the effectiveness of
  a low cost educational approach in reducing the
  rate of weight gain with age

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POP Study Participants

• General recruitment through mass media (228 men,
  594 women)
• Special recruitment of 400 low income women
  through WIC
• Eligibility requirements
• Age 20 to 45 years
• Not pregnant in the last year
• No serious health conditions

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Treatments

• Control No contact
• Education Monthly newsletters emphasizing 5
  themes 1. Weigh yourself regularly
• 2. Eat 2 fruits/day
• 3. Eat 3 vegetables/day
• 4. Reduce fat intake
• 5. Increase exercise/walking
• Additional education offerings 2 times per year
  (e.g., classes, contests, correspondence course)
• Education Incentive Education program (above)
  lottery drawing monthly to encourage newsletter
  reading.

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Weight Change (lb) by Treatment Group by Year
Adjusted means, controlling for age, sex, type,
education, and D smoking.
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Summary Discussion

• Education has not been effective in treating or
  preventing obesity
• Why?
• Weak funding
• Weak message

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1997 Expenditures on Food Advertising and
Nutrition Education (Billions)

• Source Amount
• Total food industry 11.0
• Total USDA 0.3

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Summary Discussion (continued)

• Population strategies other than education to
  consider
• Price structure of eating and activity choices
• Availability of eating and activity choices

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Effect of Health Promotion on Low-Fat Snack Sales
Sales LF Snacks
Promotion
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Effect of Price on Low-Fat Snack Sales
Sales LF Snacks
Price
Increase in sales 9 39
93