This is “Dietary, Behavioral, and Physical Activity Recommendations for Weight Management”, section 11.4 from the book An Introduction to Nutrition (v. 1.0).
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We have just considered the gravity of the obesity problem in America and worldwide. How is America combating its weight problem on a national level and have the approaches been successful?
Successful weight loss is defined as individuals intentionally losing at least 10 percent of their body weight and keeping it off for at least one year.Wing, R. R. and J. O. Hill. “Successful Weight Loss Maintenance.” Annu Rev Nutr 21 (2001): 323–41. Accessed October 8, 2011. http://www.ncbi.nlm.nih.gov/pubmed/11375440?dopt=Abstract. Results from lifestyle intervention studies suggest fewer than 20 percent of participants are successful at weight loss. An evaluation of successful weight loss, involving more than fourteen thousand participants published in the November 2011 issue of the International Journal of Obesity estimates that more than one in six Americans who were overweight or obese were successful in achieving long-term weight loss.Kraschnewski, J. L. et al. “Long-Term Weight Loss Maintenance in the United States.” Int J Obes 34, no. 11 (2010): 1644–54. http://www.ncbi.nlm.nih.gov/pubmed/20479763. However, these numbers are on the high end because many similar studies report fewer than 10 percent of participants as successful in weight loss.
The National Weight Control Registry (NWCR) tracks over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year. Their research findings are that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking.)The National Weight Control Registry. “Research Findings.” Accessed October 8, 2011. http://www.nwcr.ws/Research/default.htm. Although there are a great variety of approaches taken by NWCR members to achieve successful weight loss, most report that their approach involved adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day). Moreover, most members eat breakfast every day, watch fewer than ten hours of television per week, and weigh themselves at least once per week. About half of them lost weight on their own and the other half used some type of weight-loss program. In most scientific studies successful weight loss is accomplished only by changing the diet and by increasing physical activity. Doing one without the other limits the amount of weight lost and the length of time that weight loss is sustained. On an individual level it is quite possible to achieve successful weight loss, as over ten thousand Americans can attest. Moreover, losing as little as 10 percent of your body weight can significantly improve health and reduce disease risk.National Heart, Lung, and Blood Institute. “Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.” Obes Res 6 supplement (1998): 51S–210S. http://www.ncbi.nlm.nih.gov/books/NBK2003/. You do not have to be overweight or obese to reap benefits from eating a healthier diet and increasing physical activity as both provide numerous benefits beyond weight loss and maintenance.
The 2010 Dietary Guidelines for Americans offers specific, evidence-based recommendations for dietary changes aimed at keeping calorie intake in balance with physical activity, which is key for weight management. These recommendations include:US Department of Agriculture. 2010 Dietary Guidelines for Americans. 2010. Accessed October 7, 2011. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines 2010.pdf.
In addition to the dietary recommendations, the 2010 Dietary Guidelines for Americans offers specific evidence-based recommendations that address behavioral changes aimed to keep calorie intake in balance with physical activity. The recommendations include:
The other part of the energy balance equation is physical activity. The 2010 Dietary Guidelines are complemented by the 2008 Physical Activity Guidelines for Americans issued by the Department of Health and Human Services in an effort to provide evidence-based guidelines for appropriate physical activity levels. The 2008 Physical Activity Guidelines provide guidance to Americans aged six and older about how to improve health and reduce chronic disease risk through physical activity. Increased physical activity has been found in scientific studies to lower the risk of heart disease, stroke, high blood pressure, Type 2 diabetes, colon, breast, and lung cancer, falls and fractures, depression, and dying early. Increased physical activity not only reduces disease risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance. The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" and Chapter 13 "Nutrition through the Life Cycle: From Childhood to the Elderly Years"):US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Accessed October 8, 2011. http://www.health.gov/paguidelines/guidelines/chapter2.aspx.
The 2008 Physical Activity Guidelines broadly classify moderate physical activities as those when “you can talk while you do them, but can’t sing” and vigorous activities as those when “you can only say a few words without stopping to catch your breath.”US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Accessed October 8, 2011. http://www.health.gov/paguidelines/guidelines/chapter2.aspx.
Table 11.6 Moderate and Vigorous Physical Activities
|Moderate Activities||Vigorous Activities|
|Ballroom/line dancing||Aerobic dance|
|Biking on level ground||Biking (more than 10 miles per hour)|
|Canoeing||Heavy gardening (digging, hoeing)|
|Baseball, softball, volleyball||Fast dancing|
|Tennis (doubles)||Jumping rope|
|Walking briskly||Martial arts (karate)|
|Water aerobics||Race walking|
|Using hand cyclers||Jogging or running|
|Sports with running (basketball, hockey, soccer)|
Source: US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. http://www.health.gov/paguidelines/.
To get started on ramping up your physical activity or following a new exercise program use the toolkit, “Be Active Your Way” available from HHS:
On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the recent past (2007–2011) several newly created initiatives and organizations are actively reinforcing strategies aimed to meet the challenge of improving the health of all Americans.
In 2010 the national campaign to reduce obesity was reinforced when First Lady Michelle Obama launched the “Let’s Move” initiative, which has the goal of “solving the challenge of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight.”The White House, Office of the First Lady. “First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise a Healthier Generation of Kids.” February 9, 2010. http://www.whitehouse.gov/the-press-office/first-lady-michelle-obama-launches -lets-move-americas-move-raise-a-healthier-genera. Another campaign, “Campaign to End Obesity,” was recently established to try to enable more Americans to eat healthy and be active by bringing together leaders from academia and industry, as well as public-health policy-makers in order to create policies that will reverse the obesity trend and its associated diseases (Note 11.40 "Video Link 11.2"). It remains to be seen whether these new initiatives will finally help improve American health.
Campaign to End Obesity
View this brief video on the Campaign to End Obesity.
Currently, most people are not obese in this country. The gradual rise in overweight is happening because, on average, people consume slightly more calories daily than they expend, resulting in a gradual weight gain of one to two pounds a year. In 2003 the idea was first published that promoting small lifestyle changes to reduce weight gain occurring over time in all age groups may better reduce obesity rates in the American population.Hill, J. O. “Can a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.” Am J Clin Nutr 89, no. 2 (2009): 477–84. http://www.ajcn.org/content/89/2/477.long. Scientific studies have demonstrated that asking people to increase the number of steps they take each day while providing them with pedometers that count the steps they take each day successfully prevented weight gain. A “small-changes” study published in the October 2007 issue of Pediatrics evaluated whether families that made two small lifestyle changes, which were to walk an additional two thousand steps per day and to eliminate 100 kilocalories per day from their typical diet by replacing dietary sugar with a noncaloric sweetener, would prevent weight gain in overweight children.Rodearmel, S. J. et al. “Small Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.” Pediatrics 120, no. 4 (2007): e869–79. http://pediatrics.aappublications.org/content/120/4/e869.long. The results of this study were that a higher percentage of children who made the small changes maintained or reduced their BMI in comparison to children of families given a pedometer but not asked to also make physical activity or dietary changes.Rodearmel, S. J. et al. “Small Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.” Pediatrics 120, no. 4 (2007): e869–79. http://pediatrics.aappublications.org/content/120/4/e869.long. Several more studies funded by the National Institutes of Health and USDA are ongoing and are evaluating the effectiveness of the “small-changes” approach in reducing weight gain.
In 2009, a report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council proposed that the “small-changes” approach when supported at the community, industry, and governmental levels will be more effective than current strategies in gradually reducing the obesity rate in America.Hill, J. O. “Can a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.” Am J Clin Nutr 89, no. 2 (2009): 477–84. http://www.ajcn.org/content/89/2/477.long. The HHS encouraged the approach and launched a “Small Step” website in 2008.