|"Weight Loss—What Works and What Doesn’t" By Allen Weiss, MD, MBA, President and CEO|
May 1, 2009 - We are the fattest nation in the history of civilization. What can we do about this? What diet is best? How can we best motivate people to lose weight, keep it off, or—better still—not become overweight in the first place?
Statistics show that in 2004, 71% of the U.S. adult population was considered overweight. Obesity is the second most common cause of preventable death in our country, ranked just after smoking.
Recently, articles in the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) addressed the above questions concerning effective weight control. The results will surprise you, as will another conclusion that suggests what might work for our society.
The conclusion of the NEJM article is that there is no clinically meaningful difference in diets—high or low fat, high or low carbohydrate, high or low protein. The content of the diet is irrelevant. Total calorie count is all that matters with the exception that certain diseases do require special restrictions such as diabetes or hyperlipidemia (high cholesterol or triglycerides). Studies indicate that those people whose attendance in group sessions was the highest were the most successful in losing weight. The other relevant factor for weight loss is physical activity. The participants were encouraged to do 90 minutes of moderate exercise per week. This was self monitored and is known to be very effective; nonetheless, it is difficult—and requires will power—to begin and sustain.
In America today we are being seduced by multitudes of high calorie foods and labor saving devices. Having people involved in group therapy is the most important motivator. The “team approach” seems to be the most effective tool to lose weight.
What happens if you pay people to lose weight? JAMA reported on a sixteen week study using behavioral economics, i.e., paying overweight people to lose weight. Dieters were paid $400 if they met or exceeded their daily and overall goals during the study. These folks were compared to another matched group who were not paid. Overall, the paid group did better during the study and continued better after seven months. Further studies are needed to see how well this program works in the long term.
An accompanying NEJM editorial reviewed a community based educational program designed to help school aged children avoid becoming overweight. The program started in 2000 with everyone in town -- from local political leaders, to store owners, to teachers, to health care professionals -- cooperating in the effort to have children eat responsibly and move around more. The two participating towns built playgrounds and parks. Walking was encouraged. Active sports activities were supported, while being just a spectator was discouraged. Watching others exercise, being glued to the TV or being otherwise inactive were viewed by everyone as being unattractive.
The results are astounding. The prevalence of overweight children fell 8.8% while nearby towns with the same demographics but not the focused program had an increase of 17.8% in overweight children. As evidenced in this study, as well as the one above concerning group diet and exercise therapy, social pressure works!
Now the surprise—the two towns that were successful are in France. The total community approach is now being copied in 200 towns in Europe. Should we become more motivated as a society? I think so. We live in a global community as indicated by the spread of things both good and bad, such as worldwide conservation and economic concerns.
We should be able to adopt the successful programs of others. Instead of growing bigger we should be growing healthier.
Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.