Weight reduction at the work site: a promise partially fulfilled

Strategies to reduce attrition in weight loss interventions: A systematic review and meta-analysis

The primary objective of the study was to identify the effect of intervention strategies on attrition within a weight loss programme among adults aged 18 to 65 years. The secondary objective of the study was to assess the impact of such intervention strategies among female-only weight loss programmes. The literature search was performed in Ovid (CINAHL Plus, MEDLINE, EMBASE, Cochrane [Cochrane Database of Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register], and PsycINFO). Studies must have identified weight loss as the main aim and compared the primary weight loss programme alone (control) with the primary weight loss programme coupled with an additional intervention strategy (intervention). Papers must have had a mean participant age between 18 and 65 years and available in English. Fifty-seven trials met the inclusion criteria and were included in the meta-analysis. Strategies that successfully reduced attrition included the incorporation of financial incentives (n = 8), a multicomponent approach (n = 13), and use of self-monitoring technology (n = 4). The majority of studies were of low to moderate methodological quality because of insufficient reporting. A limited number of female-only trials were found (n = 13). Implementation of financial incentives, multicomponent interventions, and self-monitoring technology help reduce attrition among adult weight loss programmes. Further studies are required to identify the impact of intervention strategies on attrition in women.

State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health

Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.

The Heterogeneity of Obesity: Fitting Treatments To Individuals - Republished Article

Body weight is regulated by a complex interaction of biological, behavioral, and cultural factors. The population as a whole is at risk for obesity because of increased intake of dietary fat, the consumption of calories in fewer meals per day, striking accessibility to palatable foods, and decreased physical activity. This risk may become a reality in individuals with certain biological predispositions (genetic tendency, low metabolic rate, increased fat cell number), specific eating patterns, and susceptibility to the extreme cultural pressure to be lean. These factors must be considered in establishing goals for treatment, which fall into medical and psychosocial categories. This includes defining a "reasonable" as opposed to "ideal" weight. A three-stage process is proposed for identifying the best treatment for an individual. This involves a classification decision, a stepped care decision, and then a matching decision. Criteria are provided for a comprehensive assessment of the overweight individual, and treatment options are reviewed for programs of varying intensity, cost, and risk.

Volunteers as Providers of Heart Health Programs in Churches: A Report on Implementation

This project studies the use of church volunteers to reduce cardiovascular disease risk factors among their fellow church members. Our findings focus on the first 12 months of the project and address the following questions: 1) Can volunteers implement these programs with no on-site professional staff? 2) Are volunteer efforts facilitated by a local volunteer task force? and 3) Are implementation efforts aided by readily available professional staff involvement? In the intervention churches, 220 certified Risk Factor Leaders conducted 82 group programs with 740 registrants and 104 blood pressure screenings with 1,834 contacts. Our study shows volunteers to be effective implementers of heart health programs in churches. The involvement of a task force seemed to facilitate volunteer recruitment. Churches with a lower level of professional involvement had more blood pressure screenings. The effect of a task force or professional assistance on other volunteer efforts did not reach statistical significance.

Albert J. Stunkard: His Research on Obesity and Its Psychological Impact

Albert J. ("Mickey") Stunkard, MD, was a leader in the field of obesity research, with his work spanning more than five decades. He published several groundbreaking findings on the psychosocial influences of obesity, the genetics of obesity, and the relationship between obesity and factors such as socioeconomic status, stigma, and mood. He also helped establish two eating disorders associated with obesity-binge eating disorder and night eating syndrome. This paper highlights his work and its implications for the field.

Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance and Attrition

BACKGROUND

Regular aftercare attendance following laparoscopic adjustable gastric banding (LAGB) is associated with greater weight loss and fewer post-surgical complications. Despite high reported rates of attrition from LAGB aftercare, the reasons for non-attendance have not been previously explored. The present study aimed to explore patient-reported barriers to LAGB aftercare attendance, and the perceived helpfulness of potential attrition-reducing strategies, in both regular attendees and non-attendees of aftercare.

METHODS

One hundred and seventy-nine participants (107 regular attendees and 72 non-attendees) completed a semi-structured questionnaire, assessing barriers to attrition (101 items) and usefulness of attrition prevention strategies (14 items).

RESULTS

Findings indicate that both regular attendees and non-attendees experience multiple barriers to aftercare attendance. Non-attendees generally reported that barriers had a greater impact on their aftercare attendance. There was evidence for some level of acceptability for attrition-reducing strategies suggesting that LAGB patients may be receptive to such strategies.

CONCLUSIONS

Current findings highlight the importance of assessing barriers to treatment in both attendees and non-attendees. It is proposed that addressing barriers that differentiate non-attendees from attendees may be most effective in reducing attrition from aftercare.

Adding evidence-based behavioral weight loss strategies to a statewide wellness campaign: a randomized clinical trial

OBJECTIVES

We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign.

METHODS

We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program.

RESULTS

Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114).

CONCLUSIONS

Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.

A randomized controlled pilot study testing three types of health coaches for obesity treatment: Professional, peer, and mentor

Despite their popularity, empirical support for health coaches is limited.

OBJECTIVE

This study examined the feasibility and preliminary efficacy of three types of coaching models for obesity treatment.

DESIGN AND METHODS

Participants (N = 44) were randomized to 6 months of reduced intensity group behavioral weight loss (rBWL) plus one of three types of health coaches: (i) Professional (rBWL interventionist), (ii) Peer (group members randomly paired and coached one another), or (iii) Mentor (successful weight loser). Groups met weekly for the first 6 weeks, biweekly for the next 6 weeks, and monthly thereafter, for a total of 12 meetings. During weeks that group did not meet, participants emailed their weight loss information to their coach and received feedback. Coaches were trained on appropriate coaching strategies and feedback delivery.

RESULTS

Retention was 95%. Participants emailed their progress to their coach 10.8 ± 1.9 of the 12 weeks that there were no group meetings. Coaches responded with feedback 94% of the time. Percent weight losses at 6 months were 9.6 ± 8.1, 9.1 ± 5.0, and 5.7 ± 5.6 for the Professional, Peer, and Mentor conditions, respectively. More participants in the Professional and Peer conditions lost 10% of their initial body weight (Professional: 56% Peer: 50% and Mentor: 17%), with a statistically significant difference between the Professional and Mentor conditions (P = 0.03).

CONCLUSION

These preliminary data suggest that combining a rBWL program with health coaching may hold significant promise as a cost-effective obesity treatment paradigm. Larger trials are needed to conclusively determine whether adding coaches improves weight loss outcomes in reduced intensity treatments and to examine which type of coach is most effective.

Efficacy of a "small-changes" workplace weight loss initiative on weight and productivity outcomes

OBJECTIVE

The effect of weight reduction on workplace productivity is unknown. We have investigated a "small-changes" workplace weight loss intervention on weight and productivity outcomes.

METHODS

Overweight/obese employees at two New Zealand worksites (n = 102) received the 12-week intervention. One site received an extra 9-month weight-maintenance component. Magnitudes of effects on weight and productivity were assessed via standardization.

RESULTS

Both groups reduced weight at 12 weeks and maintained lost weight at 12 months. There were small possible improvements in productivity at one worksite and trivial reductions at the other by 12 weeks, with little subsequent change during maintenance in either group. At an individual level, weight change was associated with at most only small improvements or small reductions in productivity.

CONCLUSION

Workplace weight loss initiatives may need to be more intensive or multidimensional to enhance productivity.

A "small-changes" workplace weight loss and maintenance program: examination of weight and health outcomes

OBJECTIVE

To compare the effect of "small-changes" and "usual care" workplace interventions on weight loss and to investigate the effect of small changes with or without maintenance on weight and health outcomes.

METHODS

Overweight/obese employees at two New Zealand worksites received a 12-month usual-care intervention (n = 53), followed by a 12-month small-changes intervention (n = 102). Small changes comprised a 12-week component, followed by 9 months of maintenance, implemented at only one worksite. Magnitudes of effects were assessed via a threshold of -5% (weight loss) and standardization (health outcomes).

RESULTS

Small changes showed beneficial weight loss relative to usual care in both worksites. For small-changes interventions, worksites reduced weight (12 weeks) and maintained lost weight (12 months). One in every three participants lost 5% or more weight. Some improvements in health outcomes were shown.

CONCLUSION

Regardless of maintenance, the small-changes intervention was successful in sustaining weight loss.

A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care--an international randomised controlled trial

Background:

Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings.

Objective:

We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP).

Design:

This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m⁻²) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY).

Results:

The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31 663, 24 996 and 51 571.

Conclusion:

The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem.

A low-cost reinforcement procedure improves short-term weight loss outcomes

OBJECTIVE

Reinforcement-based treatments, based on behavioral economics models, can improve outcomes of medical conditions with behavioral components. This study evaluated the efficacy of a low-cost reinforcement intervention to produce initial weight loss.

METHODS

Overweight individuals (n=56) were randomized to one of two 12-week treatments: Lifestyle, Exercise, Attitudes, Relationships, Nutrition manual with supportive counseling or that same treatment with opportunities to win $1 to $100 prizes for losing weight and completing weight-loss activities.

RESULTS

Patients receiving reinforcement lost significantly more weight (6.0% ± 4.9% baseline bodyweight) than patients in the non-reinforcement condition (3.5% ± 4.1%; P=.04). Moreover, 64.3% of patients receiving reinforcement achieved weight loss of ≥ 5% baseline bodyweight versus 25.0% of those in the non-reinforcement condition (P=.003). Proportional weight loss was significantly related to reductions in total cholesterol and 24-hour ambulatory heart rate.

CONCLUSION

This reinforcement-based intervention substantially enhances short-term weight loss, and reductions in weight are associated with important changes in clinical biomarkers. Larger-scale evaluation of reinforcement-based treatments for weight loss is warranted.

Promising Practices for the Prevention and Control of Obesity in the Worksite

Purpose.

To identify worksite practices that show promise for promoting employee weight loss.

Data Source.

The following electronic databases were searched from January 1, 1966, through December 31, 2005: CARL Uncover (via Ingenta), CDP, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Library, CRISP, Dissertation Abstracts, EMBASE, ERIC, Health Canada, INFORM (part of ABI/INFORM Proquest), LocatorPlus, New York Academy of Medicine, Ovid MEDLINE, SPORTDiscus, PapersFirst, PsycINFO, PubMed, and TRIP.

Study Inclusion and Exclusion Criteria.

Included studies were published in English, conducted at a worksite, designed for adults (aged ≥18 years), and reported weight-related outcomes.

Data Extraction.

Data were extracted using an online abstraction form.

Data Synthesis.

Studies were evaluated on the basis of study design suitability quality of execution, sample size, and effect size. Changes in weight-related outcomes were used to assess effectiveness.

Results.

The following six promising practices were identified: enhanced access to opportunities for physical activity combined with health education, exercise prescriptions alone, multicomponent educational practices, weight loss competitions and incentives, behavioral practices with incentives, and behavioral practices without incentives.

Conclusions.

These practices will help employers and employees select programs that show promise for controlling and preventing obesity. (Am J Health Promot 2011;25[3]:e12–e26.)

Comparison of online and face-to-face dissemination of a theory-based after school nutrition and physical activity training and curriculum

This study was conducted to compare two different online delivery methods to train after school program leaders (ASPLs) to implement a nutrition and physical activity curriculum for children to each other and to a face-to-face (FTF) training model. A three-group design was used in which ASPLs from 12 states were randomized to either standard (n = 34) or an enhanced interaction (n = 31) online training, while a FTF group (n = 24) served as comparison. All ASPLs completed training and implemented curriculum lessons over 16 weeks from March to June 2007. Weekly evaluations and pre and post-intervention questionnaires compared number of lessons implemented, subjective ratings of lesson success, and pre and post leader nutrition and physical activity knowledge. Multivariate linear regression analyses were used for among-group comparisons, paired Ttests for within-group knowledge change. Knowledge scores increased significantly (p < .001) within each group. All ASPLs fulfilled the goal of conducting at least 9 lessons, and they rated 64% of lessons successful. After adjustment, knowledge change and success scores did not differ among groups. Implementation was significantly higher for FTF (+2.23 lessons, p = .013) than for enhanced interaction, but not for standard. Online training for ASPLs, such as the standard condition, are viable means of nutrition and physical activity education and program dissemination.

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review

This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers.

Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial

Background

The work setting provides an opportunity to introduce overweight (i.e., Body Mass Index ≥ 25 kg/m²) adults to a weight management programme, but new approaches are needed in this setting. The main purpose of this study was to investigate the effectiveness of lifestyle counselling by phone or e-mail on body weight, in an overweight working population. Secondary purposes were to establish effects on waist circumference and lifestyle behaviours, and to assess which communication method is the most effective.

Methods

A randomized controlled trial with three treatments: intervention materials with phone counselling (phone group); a web-based intervention with e-mail counselling (internet group); and usual care, i.e. lifestyle brochures (control group). The interventions used lifestyle modification and lasted a maximum of six months. Subjects were 1386 employees, recruited from seven companies (67% male; mean age 43 (SD 8.6) y; mean BMI 29.6 (SD 3.5) kg/m²). Body weight was measured by research personnel and by questionnaire. Secondary outcomes fat, fruit and vegetable intake, physical activity and waist circumference were assessed by questionnaire. Measurements were done at baseline and after six months. Missing body weight was multiply imputed.

Results

Body weight reduced 1.5 kg (95% CI -2.2;-0.8, p < 0.001) in the phone group and 0.6 kg (95% CI -1.3; -0.01, p = 0.045) in the internet group, compared with controls. In completers analyses, weight and waist circumference in the phone group were reduced with 1.6 kg (95% CI -2.2;-1.0, p < 0.001) and 1.9 cm (95% CI -2.7;-1.0, p < 0.001) respectively, fat intake decreased with 1 fatpoint (1 to 4 grams)/day (95% CI -1.7;-0.2, p = 0.01) and physical activity increased with 866 METminutes/week (95% CI 203;1530, p = 0.01), compared with controls. The internet intervention resulted in a weight loss of 1.1 kg (95% CI -1.7;-0.5, p < 0.001) and a reduction in waist circumference of 1.2 cm (95% CI -2.1;-0.4, p = 0.01), in comparison with usual care. The phone group appeared to have more and larger changes than the internet group, but comparisons revealed no significant differences.

Conclusion

Lifestyle counselling by phone and e-mail is effective for weight management in overweight employees and shows potential for use in the work setting.

Trial registration

ISCRTN04265725.

State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health

Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.

Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN)

OBJECTIVE

To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population.

DESIGN

Twelve-month randomized controlled trial comparing lifestyle case management to usual care.

SUBJECTS/SETTING

Health plan members (n=147) with obesity (body mass index >/=27) and type 2 diabetes.

INTERVENTION

Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material.

MAIN OUTCOME MEASURES

Medical and pharmaceutical health care costs reimbursed by the participant's primary insurance company.

STATISTICAL ANALYSIS

Total costs were modeled using the four-equation model using previous year cost as a predictor.

RESULTS

Net cost of the intervention was $328 per person per year. After incorporating program costs, mean health plan costs were $3,586 (95% confidence interval [CI]: -$8,036, -$25, P<0.05) lower in case management compared to usual care. The difference was driven by group differences in medical (-$3,316, 95% CI: -$7,829 to -$320, P<0.05) but not pharmaceutical costs (-$239, 95% CI: -$870 to $280, not statistically significant), with fewer inpatient admissions and costs among case management compared with usual care (admission prevalence: 2.8% vs 22.5% respectively, P<0.001).

CONCLUSION

Addition of a modest-cost, registered dietitian-led lifestyle case-management intervention to usual medical care did not increase health care costs and suggested modest cost savings among obese patients with type 2 diabetes. Larger trials are needed to determine whether these results can be replicated in a broader population. The findings can be judiciously applied to support that the addition of a registered dietitian-led lifestyle case-management program to medical care does not increase health care costs.

The development, implementation, and process evaluation of the REACH Detroit Partnership's Diabetes Lifestyle Intervention

PURPOSE

The purpose of this article was to describe the development, implementation, and process evaluation findings of a culturally tailored diabetes lifestyle intervention for African Americans and Latinos.

METHODS

African American and Latino adults with type 2 diabetes from 3 health care systems in Detroit, Michigan, participated in diabetes lifestyle intervention of the Racial and Ethnic Approaches to Community Health Detroit Partnership. The intervention curricula were culturally and linguistically tailored for each population. Trained community residents delivered the curricula in 5 group meetings aimed at improving dietary, physical activity, and diabetes self-care behaviors of study participants. The aims of the process evaluation were to assess participant satisfaction with the intervention, utility, and applicability of information and cultural relevance of intervention materials. Content analysis was used to analyze qualitative data. Matrices were developed along thematic lines, and common themes were determined by grouping responses by question.

RESULTS

Ninety-eight percent of participants attended 1 or more intervention classes; 41% attended all 5 meetings. Attendance rates ranged from 59% to 88% for individual meetings. Participants reported that program information and activities were useful, culturally relevant, and applicable to diabetes self-management. Participants also appreciated the convenient community location for meetings and the social support received from other participants.

CONCLUSIONS

A community-based, culturally tailored diabetes lifestyle intervention delivered by trained community residents was associated with high participant satisfaction and retention.

Systematic review of literature on the cost-effectiveness of nutrition services

Employers and health plan directors would like to know whether it is cost-effective to include outpatient nutrition services as a covered benefit. The purpose of this systematic review was to examine the strength of evidence on the cost-effectiveness of outpatient nutrition services from an economic perspective. All randomized controlled trials published between January 1966 and September 2001 that reported on costs and effectiveness of outpatient nutrition services for any indicated condition were identified and reviewed. Paired reviewers abstracted data from and assessed the quality of each eligible randomized controlled trial; 13 studies met the eligibility criteria. Relatively consistent evidence exists to support the cost-effectiveness of nutrition services in the reduction of serum cholesterol levels (eg, 20 dollars to 1,268 dollars per mmol/L decrease in serum low-density lipoprotein level), weight loss (2.40 dollars to 10 dollars per pound lost), and blood glucose (5 dollars per mmol/L decrease), and for target populations with diabetes mellitus and hypercholesterolemia. However, the randomized controlled trials had important limitations and used different cost perspectives. Limited evidence of economic benefit exists to support coverage of outpatient nutrition services for selected indications. More randomized controlled trials of nutrition services should be conducted, taking into consideration all potential candidates for nutrition therapy and all potential costs to patients, providers, and payers.

Work site, physician's office, or medical university clinic: the effect of setting on success in a multidisciplinary weight-loss program

The effect of treatment setting on success in a 16-week multidisciplinary cognitive-behavioral weight-management program was examined. Twenty-seven women and six men with an average initial weight of 198.13 lb (+/-39.10) participated in the program at a medical university (MU), their primary care physician's office (PCP), or their work site (WS). The average amount of weight lost, body mass index (BMI) decrement, and number of sessions attended were compared as measures of success between programs. Results supported the hypothesis that treatment setting affects program success [F(6,40)=0.54, P<.05]. WS was more effective than PCP [Wilk's lambda=0.59, P<.05] in promoting weight loss [F(1,2)=5.22, P<.05]. Results indicate that the ongoing contingencies in the WS environment promote weight loss through more consistent adherence to suggested weight-loss strategies.

What consumers want to know about commercial weight-loss programs: a pilot investigation

OBJECTIVE

In 1999, the Partnership for Healthy Weight Management recommended that providers of commercial weight-loss programs (and products) voluntarily disclose information concerning the safety, costs, and central components of their programs, as well as the credentials of program staff. These guidelines were drafted without the benefit of data from consumers concerning the specific information they desired. The present study provides such data.

RESEARCH METHODS AND PROCEDURES

Participants were 90 women with a mean age of 44.02 +/- 9.17 years and body mass index of 36.11 +/- 4.82 kg/m(2) who were participants in one of two randomized weight-control trials. Before treatment, respondents were asked to imagine that they were "looking for a weight-loss plan" and to rate how important each of 16 factors would be in helping them select a plan. Ratings were made using 5-point scales, anchored by "not at all important" and "extremely important," (scored 1 and 5, respectively). Participants also identified the five factors that they thought were the most important, as well as the single most important.

RESULTS

The mean rating for the importance of safety (4.57 +/- 0.60) was significantly greater than that for each of the 15 other variables (all p values < 0.05). In addition, significantly more respondents (27.8%) selected safety as the single most important factor than any other variable (all p values < 0.05). Other factors that were consistently judged as very important included information about diet (4.38 +/- 0.68), behavior modification (4.32 +/- 0.76), cost (4.19 +/- 0.92), and maintenance of weight loss (4.15 +/- 0.91). Staff credentials (3.88 +/- 0.83) were among the lowest rated items.

DISCUSSION

The results generally support the disclosure guidelines proposed by the Partnership for Health Weight Management. Consumers, however, seem to desire information about weight loss, in addition to that concerning safety, cost, and central program components.

Weight loss during 12 week's ad libitum carbohydrate-rich diet in overweight and normal-weight subjects at a Danish work site

The effect of 12 week's ad libitum carbohydrate-rich, low-fat diet on total body weight, lean body mass, and fat mass was studied in a group of healthy subjects at a Danish work-site (I) (n = 50, BMI = 28.4 +/- 0.7 kg/m2). Sixteen subjects served as controls (C) (BMI = 27.0 +/- 1.0 kg/m2). After 12 weeks the I subjects had decreased their fat intake from 39.0 +/- 1.1 energy-% (E%) to 28.0 +/- 1.2 E% and increased their carbohydrate intake from 46.0 +/- 1.1 E% to 56.4 +/- 1.1. E% (p < 0.05 vs. C). Moreover, a significant loss of body weight (4.2 +/- 0.4 kg) and fat mass (4.4 +/- 0.6 kg) was observed in I (p < 0.05 vs. C). The weight loss in I was not regained at 24 and 52 weeks' follow-up (82% of I participating) compared to baseline. The cost per kg lost weight amounted to $14.7 / person. In conclusion, instructions at a work site in ad libitum intake of a carbohydrate-rich, low-fat diet resulted in a significant loss of body weight and fat mass in overweight and normal-weight subjects.

Worksite intervention for weight control: a review of the literature

PURPOSE

Published research on worksite weight-control programs is reviewed with the objective of assessing success in (1) reaching populations in need, (2) achieving sustained weight loss, and (3) improving employee health and productivity.

SEARCH METHOD

Reviewed are 44 data-based articles published between 1968 and 1994. The initial search was part of a larger review on the health impact of worksite health promotion programs conducted by Centers for Disease Control and described in the introduction to this issue. We supplemented the resulting list with articles found in a search of our own reference files.

IMPORTANT FINDINGS

Methodologically the literature is relatively weak, consisting largely of uncontrolled case studies. Worksite interventions appear to be successful in reaching large numbers of people: the median participation rate among overweight employees was 39% in the six studies that provided this type of information. Worksite programs produced reasonable short-term weight loss: typically 1 to 2 pounds per week. Long-term weight loss, reductions in sitewide obesity prevalence, and health or productivity benefits have yet to be demonstrated.

MAJOR CONCLUSIONS

Recommendations for future research include improved methods, more attention to recruitment and secondary outcomes, more direct comparison of different programs, and more creative use of worksites as environments and social units in designing programs.

Binge eating disorder, retention, and dropout in an adult obesity program

OBJECTIVE

The purpose of this study was to identify factors associated with dropout in a weight reduction program among obese, nonpurging binge and nonbinge eaters.

METHOD

We categorized 156 obese, nonpurging women previously randomized to a behavior modification-based (BM) or a food addiction theory-based (FD) weight reduction intervention by binge status using the DSM-IV criteria for binge eating disorder (BED). Subjects were monitored prospectively for dropout during the 6-month intervention period.

RESULTS

Results of a Cox proportional hazards survival analysis indicated binge status had a statistically significant (p = .04) protective effect against dropout. Binge eaters were half as likely to dropout versus nonbinge eaters.

DISCUSSION

We conclude that (1) the DSM-IV criteria for BED is a useful method of classifying obese individuals in weight loss interventions and (2) the identification of subgroups among obese subjects is an important step in understanding retention in weight loss programs. Future research can confirm this finding.

Traditional treatment of obesity: does it work?

Obesity is the most important nutritional disorder in the developed world, since up to 10% of the population are obese. The place of physical activity and diet in the aetiology of obesity is discussed. The traditional treatment of obesity includes change in lifestyle, nutritional education and modification and increase in exercise. These changes are important for long-term success. There are a number of other treatment options including anorectic drugs, the use of very low calorie diets and surgical techniques which may have some clinical role. For the extremely obese patient with established complications surgery may be the most appropriate intervention and may be life-saving. Most studies of traditional treatment have demonstrated limited success. The prevention of obesity is therefore of great importance. Large-scale studies have shown that it is possible to modify behaviour and cardiovascular risk factors. The prevention of obesity requires a coordinated approach with targeting of children and their carers. Governmental involvement and legislation is essential. The future holds the promise of more imaginative and coordinated therapies for obesity using the skills of physicians, nutritionists, exercise physiologists and psychologists. Different forms of treatment may be appropriate for different groups of obese patients.

Participation in worksite health promotion: a critique of the literature and recommendations for future practice

One of the major rationales for conducting health promotion/disease prevention activities at the worksite is the potential to reach a high percentage of employees, including many who would otherwise be unlikely to engage in preventive health behaviors. Most studies of worksite health promotion do not report participation data, but among those that do, definitions of participation and participation rates vary dramatically. In general, men and blue-collar employees appear less likely to participate, but little is known about other employee variables related to participation. There have been few studies of worksite characteristics associated with participation and even fewer experimental evaluations of interventions to increase participation. In this paper we review what is known about participation in worksite health promotion programs and recommend procedures for defining participation for different types of programs, for reporting determinants of participation, and for increasing participation. We conclude that participation is both an important process measure and an outcome that should be reported routinely. Participation data have important implications for generalizability of results, feasibility of interventions, and health outcomes.

Weight loss competitions at the worksite: how they work and how well

Three studies were conducted to evaluate the effectiveness of competition as a method of weight loss at the worksite. Study 1 found team competitions more effective than either cooperation or individual competition for men, and more effective than individual competition for women. Study 2 replicated the effectiveness of team competitions at 10 worksites. The influence of four variables [gender, age, type of employment (blue-collar vs white-collar), and method of assignment to teams] upon four outcomes (recruitment, attrition, weight loss, and cost/effectiveness), was assessed. This study showed that the results of competition were robust and widely generalizable. Recruitment was high, attrition very low, weight losses large, and cost/effectiveness favorable. Study 3, however, found only limited maintenance of weight loss following competitions.

Development of a screening questionnaire to study attrition in weight-control programs

Several environmental, social, personal and demographic factors are related to the likelihood that an individual will drop out of a weight-control program. This paper identifies such factors and proposes a research instrument to study attrition in adult weight-control programs.

Comparison of three worksite weight-loss competitions

Competition is an effective means of promoting weight loss in worksite programs. This study was designed to determine the most effective structure of competition through a comparison of two kinds of competition within one worksite. Two competitions were between teams and one was among individuals. While all three competitions produced significant weight loss and lower attrition than previous worksite programs, the team competitions produced significantly lower attrition rates and significantly greater weight loss than the individual competition. Patterns of loss over time and the distribution of losses for groups also differed, with a smaller proportion of successful participants in the individual competition. The results suggest that team support as well as competition is a necessary component of effective worksite weight loss competitions.

A critical survey of scientific methods in two psychiatry journals

In a critical review of 29 analytical papers from the 1985 Australian and New Zealand Journal of Psychiatry and the American Journal of Psychiatry, examples of 10 methodological errors were found. Twenty-three papers contained at least one error. The commonest error in design was the failure to assess outcome independently of knowledge of the subjects' groups. The most frequent error in analysis was the failure to control for the increased type I error rate when multiple comparisons were made. The high frequency of statistical errors in published articles indicates a need for research methodology to be included in postgraduate psychiatry training. The limitations of statistical designs highlight the importance of alternative investigative models in psychiatric research.