Employer-Sponsored Weight Management Programs
 

Employer-Sponsored Weight Management Programs

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The Business Case ...

The Business Case
- Obesity’s negative impact on health, productivity, and the bottom line
- How helping employees adopt and maintain a healthier lifestyle, along with resulting weight loss, can significantly reduce the demand for healthcare
- Proven strategies for changing nutrition and activity patterns that lead to healthy weight for life.

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    Employer-Sponsored Weight Management Programs Employer-Sponsored Weight Management Programs Document Transcript

    • Overweight and obesity contribute $93 billion to the nation’s annual medical bill, and bariatric surgery is growing in popularity every year.1 Employer healthcare expense continues to outpace inflation by more than 2:1,2 driven in large part by soaring rates of overweight and obesity. Employers need a long-term solution. The evidence is in: Consistent, simple changes — healthy eating and exercise — are proven methods for removing excess pounds, while boosting heart health and overall well-being. Driving these changes can make a dramatic impact on employee health — and on the bottom line. Helping employees adopt and maintain a healthier lifestyle, along with the resulting weight loss, can significantly reduce the demand for healthcare. Although the changes necessary to lose weight are simple, most people aren’t able to maintain weight loss long term. Many programs produce weight loss; however, most participants regain a significant amount of weight within 1 year, and almost all is regained within 5 years.3, 4 Promoting behavior changes that are difficult or unreasonable to maintain results, at best, in short-term weight loss and eventual regain. For any program to result in permanent weight loss, the changes must be sustainable for a lifetime. Encouraging employees to eat healthfully and increase their activity requires only a modest investment, yet can lead to savings from reduced insurance costs and increased productivity. Copyright © 2007 Health Enhancement Systems1
    • Copyright © 2007 Health Enhancement Systems 2 The High Costs of Obesity Costs associated with overweight and obesity are described below: n Obesity costs employers more than $12 billion each year in increased healthcare utilization, reduced productivity, and higher absenteeism5 n Obesity-related disabilities cost employers an average $8720 for each claimant6 n Among women, obesity is linked to depression — another major medical claim cost driver for employers7 n Annual healthcare costs are 11% higher among obese vs. nonobese people8 (36% higher inpatient and outpatient costs, 45% more inpatient days, and 77% higher medication costs). One study of obesity in the workplace showed that 3-year medical care costs were 52% higher for participants with an “at-risk” BMI (27.3 or higher for women, 27.8 or higher for men); in addition, the average 3-year absenteeism cost for at-risk participants was $863 greater than that of lean participants.9 Inactivity, a primary contributor to overweight and obesity, costs $670-$1125 a person annually. If the more than 88 million inactive adult North Americans were to increase regular, moderate physical activity, annual healthcare costs could be reduced by as much as $76.6 billion.10 *BMI > 27.8 kg/m2 in men; 27.3 kg/m2 in women. The Obesity Society. Secondary source, Burton et al. Journal of Occupational and Environmental Medicine 1998; 40:786. Healthcare $8000 $6000 $4000 $2000 $0 Absenteeism $1600 $1200 $800 $400 $0 Economic Effect of Obesity on Business: 3-Year Costs Lean Obese* $4496 $6822 $683 $1546
    • Copyright © 2007 Health Enhancement Systems3 There’s no doubt about it — helping employees start and maintain a regular activity program while encouraging healthy eating habits is the right thing to do — for their health and for the organization. Obesity’s Impact on Health Nearly 2 out of 3 US adults are overweight or obese; chances are, so are most of any given organization’s employees.13 Overweight and obese employees are at increased risk for many conditions, including:14, 15 n Heart disease n Musculoskeletal problems (back, knees, hips) n Type 2 diabetes n Depression and other psychological problems n High blood pressure A sustained reduction of just 10% in an overweight or obese person’s body weight can lead to significant health and economic benefits. 11,12 Services 80 60 40 20 0 Cost Increase Associated With Overweight, Obesity, and Smoking Obese Smoking Overweight Medication PercentChange Sturm, RJ, Health Affairs Vol 21 (2).
    • Copyright © 2007 Health Enhancement Systems 4 n Dyslipidemia (high total cholesterol or high levels of triglycerides) n Stroke n Gallbladder disease n Arthritis n Sleep apnea and respiratory problems n Some cancers (endometrial, breast, and colon) n Fertility problems n Pregnancy complications. Most employers’ highest-cost claim categories are on this list. Becoming more active can help employees lose weight, reduce symptoms, and improve overall health.16 Regular physical activity, good nutrition, and a healthier weight also will help keep low- to moderate-risk employees from moving into the more expensive high-risk health category. Healthy Eating for Weight Loss Many weight loss programs tout drastic reductions or increases in a certain type of food; rigid calorie counting and fat gram tabulating may be necessary to follow the program. While either of these tactics may result in immediate weight loss, they aren’t sustainable habits for permanent weight loss. Eating patterns to maintain for a healthy weight long term are described below: n Breakfast helps control eating throughout the day. A study determined that people who eat breakfast consume fewer overall calories and impulse snacks as well as less fat compared to those who skip breakfast.18 n Eating fruits and vegetables helps those wanting to lose weight stay on track. A 2004 study showed that participants who ate 5 or more fruit and vegetable servings a day had twice the odds of sticking to their activity and nutrition goals.20 Research shows that obese individuals suffer 30%-50% more chronic medical problems than people who smoke or drink heavily.17 78% of National Weight Control Registry participants eat breakfast every day.19
    • Copyright © 2007 Health Enhancement Systems5 n Whole grain products promote weight management. High-fiber foods provide a long-lasting feeling of satiety. A 2002 study revealed that whole grain intake had a positive effect on body weight and fat distribution, helping to prevent weight gain or promote weight loss.21 n Water is the best choice for reducing thirst and doesn’t lead to excess calorie intake. Total food intake is greater for study participants who consume sucrose-sweetened drinks with meals than for those who have water or no drink. In addition, water is more effective in reducing thirst than sugar- sweetened drinks.22 Walking for Weight Loss While any sustained (45-60 minutes or more) aerobic activity supports weight loss, walking is a good choice. It’s an inexpensive activity to promote as well as accessible and easy for most participants. As a weight loss tool, walking is hard to surpass; the benefits follow. n Promotes weight loss. Walking boosts both mood and metabolism, increasing calorie output and facilitating weight loss by: − Reducing fat and increasing lean mass. A study of inactive, overweight men and women ages 40-65 found that 30 minutes a day of walking helped them lose weight, decrease waist size, and increase lean body mass — even without any special dietary changes.23 − Burning about the same number of calories as running. Walking 1 mile briskly in 15 minutes burns about as many calories as jogging the same distance in 8.5 minutes.24 EnergyIntake(kcal) *P<1.01 vs other groups. The Obesity Society. Secondary source, Rolls et al. Physiology & Behavior 1990;48:19. * Effect of Sucrose-Sweetened Drinks on Total Energy Intake No Drink 1500 1250 1000 750 500 250 0 Food Drink 16oz Water 16oz Water w/Sucrose
    • Copyright © 2007 Health Enhancement Systems 6 n Encourages high participation. As the most popular leisure-time activity in North America,26 walking is more likely to engage a workforce than any other program: − It appeals to all ages. Walking is the only activity where participation rates remain steady as people reach middle age and older. − Walking is inexpensive and easy. All a person needs is the right shoes and motivation. Employers can encourage employees to walk regularly — without a large investment — through walking clubs, charity walk teams, or walking incentive programs. − It’s a natural activity that can be added to any lifestyle; examples include walking to school, meeting with a coworker while walking, pacing during phone calls, and walking to complete certain errands. − Walking is a low-impact, safe form of exercise — even for those who are overweight, obese, or have arthritis. n Is enjoyable — especially with a partner or in a group. Research supports the value of the buddy system when trying to establish a habit of physical activity.27 In the workplace, an organized walking program can heighten morale and strengthen the sense of teamwork. n Becomes a stepping-stone to other forms of exercise. Walking holds particular appeal for people who are inactive and overweight, yet self- conscious about exercise — the right population to target for reducing medical claim costs. Maintaining a Healthy Weight Avoiding weight gain with age is difficult even for those currently at a healthy weight, and sustaining weight loss is challenging for even the most committed individuals — making it important to promote activity and nutrition habits that will last a lifetime. Healthy eating choices and regular activity can help prevent weight regain for those successful at weight loss — and keep low-risk employees from gaining weight in the first place. n The National Weight Control Registry is a study of over 4000 men and women who have lost at least 30 pounds and kept it off for at least 1 year. Participants’ average level of exercise is about 1 hour a day of moderate- intensity activity, such as brisk walking. In a review of studies on 5-year weight loss maintenance, additional findings note regular exercise is a critical component of long-term weight loss success.28 76% of National Weight Control Registry participants report walking as their most common activity.25
    • Copyright © 2007 Health Enhancement Systems7 n Studies have shown that regular exercise plays an important role in successful long-term weight loss (maintaining the loss for over a year). In one study, 90% of women who maintained their weight loss exercised regularly.29 n 89% of registry participants report that the combination of healthy eating and exercise is critical for weight maintenance.30 n Many studies agree that regular activity expending roughly 2500 kilocalories/ week is necessary for long-term weight maintenance. This level of activity can be achieved with 60-75 minutes/day of moderate activities such as walking or 30 minutes/day of vigorous activities such as cycling.31, 32, 33, 34 n Studies also indicate a modest increase in fitness, reflecting regular exercise, can help prevent weight gain. 36, 37 Health Benefits of an Active Lifestyle Regular physical activity provides health benefits independent of weight control.38 In addition to healthy eating and exercise, National Weight Control Registry participants report frequent monitoring of their weight — 44% weigh themselves once a day and 31% step on the scale at least once a week.35 Am Journal of Clinical Nutrition 1990;52:800-7 * Coping skills and social support also contributed to maintenance of weight loss. Relationship Between Physical Activity* and Maintenance of Weight Loss Not Maintained 100 80 60 40 20 0 Maintained SubjectsExercising(%)
    • Copyright © 2007 Health Enhancement Systems 8 Whether or not overweight and obese employees lose pounds, they can improve health-related outcomes through activity such as walking: n Protects against heart attack and stroke. An 8-year study of 84,000 female nurses ages 40-65 found those who walked 3 or more hours a week had a 40% lower risk of heart attack and stroke than the nurses who didn’t walk. More brisk walking produced greater benefits.39 n Lowers risk of diabetes. The Diabetes Prevention Program, a national study promoting dietary changes and regular physical activity, saw a 58% reduction in the incidence of diabetes among participants.40 A study of 2900 adults with diabetes found those who walked at least 2 hours a week had a 39% lower risk of death from any cause than adults who did not walk. Those who walked more — at least 3 hours each week — had a 54% lower risk of death from any cause.41 Another study found walking 30 minutes a day was more effective than the prescription drug metformin in preventing diabetes.42 n Decreases risk of gestational diabetes. Other study results report that women who were physically active in the year before pregnancy and during pregnancy had a 69% reduced risk of gestational diabetes compared to inactive women.43 n Reduces symptoms of depression. Increases in consistent physical activity and cardiorespiratory fitness level are associated with lower depression symptoms and greater emotional well-being.44 n Lowers overall mortality. Male study participants ages 61-81 who walked more than 1 mile a day had 1/3 fewer deaths in a 12-year follow-up period compared with men who did not walk.45 The beneficial effects were evident even after taking into account other activities and risk factors. Another study revealed those who burned 2000 or more calories a week by walking lived 1-2 years longer than men who burned fewer than 500 calories a week through exercise.46 Benefits of Eating Healthfully Good nutrition also promotes health and well-being beyond weight loss. n Vegetable and fruit consumption reduces heart disease risk. A 5-year study of female health professionals showed a 20%-30% reduction in risk of cardiovascular disease and myocardial infarction when fruit and vegetable consumption increased.47
    • Copyright © 2007 Health Enhancement Systems9 n Whole grains reduce risk of Type 2 diabetes and cardiovascular disease. A diet rich in whole grains lowers insulin concentrations and LDL cholesterol, resulting in a decreased risk of Type 2 diabetes and cardiovascular disease.48 n Whole grains may lower blood pressure. Subjects showed significant reductions in systolic and diastolic blood pressure after consuming whole grains for 10 weeks. 49 Weight Loss Drugs Prescription weight loss drugs are an expensive option for employers and employees. Safety has not been studied beyond 1-2 years, and the modest average weight loss results — under 11 pounds (5 kg) a year — are maintained only with continuous use. Still, because these results represent a reduction of 1-2 Body Mass Index (BMI) points, they’re medically significant.50 The following statements are based on available evidence: n Prescription weight loss medication is not for everyone. These drugs generally are approved for people who have: − Tried other methods to lose weight without success − A BMI of >30 (or >27 with comorbidities such as diabetes, heart disease, sleep apnea, or high blood pressure).51 n Individuals must be fully informed before drug therapy. The American College of Physicians recommends prescription drug therapy for individuals only after a patient-physician discussion about potential side effects, lack of long-term safety data, and the temporary nature of weight loss related to medication use. n For results, lifestyle change must accompany prescription medicine. Yet, in a large study of current weight loss prescription drug users, only 26.7% reported both eating fewer calories and meeting recommended leisure-time physical activity levels.53 Studies have shown that once a medication is stopped, associated weight loss is typically regained.52 Sensible nutrition and regular physical activity are essential components of any weight loss program, with or without prescription medicine.54
    • Copyright © 2007 Health Enhancement Systems 10 Although a handful of prescription weight loss drugs are now on the market, orlistat (Xenical® ) and sibutramine (Meridia® ) have been studied the most: Conclusions This paper highlights the enormous costs and risks associated with the increasing overweight and obese population. Left unchecked, the nation’s growing girth poses an ominous threat to health and productivity. Without significant employer commitment, the 66% of the population that is overweight or obese will continue to drive healthcare expense at more than twice the rate of inflation — further handicapping industries that need every advantage to compete effectively in the global marketplace. Organizations that recognize this fact and implement appropriate weight loss and healthy weight maintenance strategies have the best opportunity to stem the tide and remain competitive today and into the future. Drug Target Population Method Effectiveness Common Side Effects55,56 Orlistat57 (Xenical) • BMI of >30 (or >27 with diabetes, high blood pressure, or high cholesterol)58 • Willing to live with and manage unpleasant side effects • Inhibits absorption of dietary fat through gastrointestinal tract • Mean weight reduction of 5.7 pounds (2.59 kg) at 6 months and 6.4 pounds (2.89 kg) at 1 year59 • Oily spotting/ discharge • Gas with discharge • Urgent need to have a bowel movement • Oily or fatty stools • Increased number of bowel movements • Inability to control bowel movements Sibutramine60 (Meridia) • BMI of >30 (or >27 with diabetes, high blood pressure, or high cholesterol)61 • Difficulty with appetite and/or cravings • Inhibits norepinephrine and serotonin uptake to reduce appetite and cravings • Mean weight reduction of 11 pounds (5 kg) at 1 year for drug alone • Mean weight reduction of 26.4 pounds (12 kg) at 1 year for drug plus lifestyle therapy62 • Anxiety/nervousness • Constipation • Dizziness • Dry mouth  • Headache • Irritability or unusual impatience • Stuffy or runny nose • Trouble sleeping 
    • Copyright © 2007 Health Enhancement Systems11 Where to Go From Here In 2006 Health Enhancement Systems undertook an exhaustive review of the scientific evidence defining successful weight loss program characteristics. We discovered there are dozens of ways people lose weight. In fact, losing weight turns out to be easy. But maintaining weight loss isn’t. Commercial weight loss programs, specifically, have depressingly low success rates when it comes to helping people sustain weight loss. That’s the bad news. The good news is in numerous studies of thousands who have lost a significant amount of weight and kept it off for years. When we analyzed these results, it became clear that certain daily habits are common to those who maintain weight loss. Our analysis led to the development of NutriSum, a program that not only inspires individuals to lose weight, but also supports the daily habits that add up to healthy weight for life. To learn how your organization can begin reversing the trend of overweight and obesity with proven practices, visit www.NutriSum.com. About Health Enhancement Systems Health Enhancement Systems has been designing award-winning health improvement solutions for corporations, health plans, health systems, hospitals, government agencies, educational institutions, nonprofits, and other groups since 1992. A leader in behavior change innovation, we serve organizations in North America and throughout the world. For more information about Health Enhancement Systems products and services, call 800.326.2317 (989.839.0852) or go to www.HealthEnhancementSystems.com.
    • Copyright © 2007 Health Enhancement Systems 12 Resources n Agency for Healthcare Research and Quality (www.ahrq.gov) n American College of Physicians (www.acponline.org) n American Heart Association (www.americanheart.org) n American Journal of Clinical Nutrition (www.ajcn.org) n American Journal of Epidemiology (http://aje.oxfordjournals.org) n American Journal of Public Health (www.ajph.org) n Annals of Internal Medicine (www.annals.org) n Archives of Internal Medicine (http://archinte.ama-assn.org) n Centers for Disease Control and Prevention (www.cdc.gov) n Circulation, American Heart Association (http://circ.ahajournals.org) n Diabetes Prevention Program (www.bsc.gwu.edu/dpp/index.htmlvdoc) n Health Affairs (www.healthaffairs.org) n International Journal of Behavioral Nutrition and Physical Activity (www.ijbnpa.org) n Journal of Occupational and Environmental Medicine (www.joem.org) n Mayo Clinic (www.mayoclinic.org) n Medicine and Science in Sports and Exercise (www.acsm-msse.org) n National Business Group on Health (www.wbgh.org) n National Center for Biotechnology Information (www.ncbi.nlm.nih.gov) n National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov) n National Institute of Diabetes and Digestive and Kidney Diseases (www.niddk.nih.gov) n National Institutes of Health (www.nih.gov) n National Weight Control Registry (www.nwcr.ws) n President’s Council on Physical Fitness and Sports (www.fitness.gov) n The Obesity Society (www.obesityonline.org) n US Department of Health and Human Services (www.hhs.gov) n US Food and Drug Administration (www.fda.gov) n Whole Grains Council (www.wholegrainscouncil.org)
    • 13 Copyright © 2007 Health Enhancement Systems Endnotes 1 National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet. 2 Towers Perrin, 2007 Health Care Costs Survey, 2006, www.towersperrin.com/tp/jsp/masterbrand_webcache_html.jsp?webc=HT_ Services/United_States/Press_Releases/2006/20060926/2006_09_26.htm. 3 The Obesity Society (www.obesityonline.org). Secondary source, Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. International Journal of Obesity 1989;13 (suppl 2):39-46. 4 NIH Technology Assessment Conference Panel. Methods for Voluntary Weight Loss and Control. Annals of Internal Medicine 1993; 119(7,2)764-770. 5 National Medical Spending Attributable to Overweight and Obesity: How Much and Who’s Paying? Health Affairs, Web Exclusive. Secondary source, National Business Group on Health. 6 UnumProvident, 2004, cited in National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet. 7 Stunkard AJ, Faith MS, Allison KC. Biol Psychiatry 2003 Aug 1;54(3)330-7. 8 Health Risks and Behavior: The Impact on Medical Costs, Control Data Corporation, 1987, cited in National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet. 9 Burton WN, Chen C-Y, Schultz AB, Edington DW. The economic costs associated with body mass index in a workplace. Journal of Occupational and Environmental Medicine 1998;40: 786-792. 10 US Department of Health and Human Services, Physical Activity Fundamental to Preventing Disease 2002. 11 National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: National Institutes of Health 1998. 12 Oster G, Thompson D, Edelsberg J, Bird AP, Colditz GA. Lifetime Health and Economic Benefits of Weight Loss Among Obese Persons. American Journal of Public Health 1999;89 (10): 1536-42. 13 National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet. 14 Centers for Disease Control and Prevention, 2006. 15 Peltonen M, Lindroos AK, Torgerson, JS. Musculoskeletal Pain in the Obese: a Comparison With a General Population and Long- Term Changes After Conventional and Surgical Obesity Treatment. Pain 2003 Aug;104(3):549-57. 16 American College of Sports Medicine, Position Stand on the Appropriate Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Medicine and Science in Sports and Exercise Vol. 33, No. 12, 2001. 17 Sturm RJ. Health Affairs 2002; March/April, Vol 21 (2)245-253. 18 Schlundt D, Hill J, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial. American Journal of Clinical Nutrition 1992;55:645-51. 19 Wing Rena R, Phelan Suzanne. Long-Term Weight Loss Maintenance, cited in American Journal of Clinical Nutrition 2005:82 (suppl)222S-5S. 20 Blanck HM, Khan LK, Serdula MK. Diet and Physical Activity Behavior Among Users of Prescription Weight Loss Medications. The International Journal of Behavioral Nutrition and Physical Activity 2004 Dec 23;1(1):17. 21 McKeown N, Meigs J, Liu S, Wilson P, Jacques P. Whole grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. American Journal of Clinical Nutrition 2002;76:390-8. 22 The Obesity Society (www.obesityonline.org). Secondary source, Rolls BJ, Kim S, Fedoroff IC. Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men. Physiology & Behavior 1990;48:19-26. 23 Archives of Internal Medicine, January 12, 2004. Secondary source, Cleveland Clinic. 24 President’s Council on Physical Fitness and Sports. Secondary source, Blue Cross Blue Shield of Nebraska Healthcare Fact Sheet on Walking. 25 Wing Rena R, Phelan Suzanne. Long-Term Weight Loss Maintenance, cited in American Journal of Clinical Nutrition 2005:82 (suppl)222S-5S.
    • 14Copyright © 2007 Health Enhancement Systems 26 Rafferty AP, Reeves MJ, McGee HB, Pivarnik JM. Physical Activity Patterns Among Walkers and Compliance With Public Health Recommendations, Medicine and Science in Sports and Exercise 2002 Aug;34(8):1255-61. 27 Increasing Physical Activity — A Report on Recommendations of the Task Force on Community Preventive Services, October 1, 2001. 28 Anderson, J, Konz, E, Frederich, R, Wood, C, Long-Term Weight Loss Maintenance: a Meta-Analysis of US Studies, American Journal of Clinical Nutrition 2001;74:579-84. 29 Kaymon S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women: behavioral aspects. American Journal of Clinical Nutrition 1990:52:800-807. 30 Wing Rena R, Phelan Suzanne. Long-Term Weight Loss Maintenance, cited in American Journal of Clinical Nutrition 2005:82 (suppl)222S-5S. 31 The Obesity Society (www.obesityonline.org). Secondary source, Schoeller DA, Shay K, Kushner RF. How much physical activity is needed to minimize weight gain in previously obese women? American Journal of Clinical Nutrition 1997;66:551-556. 32 The Obesity Society (www.obesityonline.org). Secondary source, Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women. Journal of the American Medical Association 1999;282:1554-1560. 33 The Obesity Society (www.obesityonline.org). Secondary source, Jeffery RW, Wing RR, Thorson C, Burton LR. Use of personal trainers and financial incentives to increase exercise in a behavioral weight loss program. Journal of Consulting and Clinical Psychology 1998;66:777-783. 34 The Obesity Society (www.obesityonline.org). Secondary source, Wing RR, Tate DF. Lifestyle changes to reduce obesity. Current Opinion in Endocrinology, Diabetes, and Obesity 2000;7:240-246. 35 Wing Rena R, Phelan Suzanne. Long-Term Weight Loss Maintenance, cited in American Journal of Clinical Nutrition 2005:82 (suppl)222S-5S. 36 DiPietro L, Kohl HW, Barlow CE, Blair SN. Improvements in Cardiorespiratory Fitness Attenuate Age-related Weight Gain in Healthy Men and Women: the Aerobics Center Longitudinal Study. International Journal of Obesity 1998;22:55-62, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S. 37 Sherwood NE, Jeffery RW, French SA, Hannan PJ, Murray DM. Predictors of Weight Gain in the Pound of Prevention Study. International Journal of Obesity 2000;24:395-403, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S. 38 Paffenbarger RS, Hyde RT, Wing AL, Hsieh CC. Physical Activity, All-Cause Mortality, and Longevity of College Alumni. New England Journal of Medicine 1986;314:605-13, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S. 39 Study presented at an American Heart Association meeting. Secondary source, St. Francis Hospitals. 40 The Diabetes Prevention Program, 2002. 41 Archives of Internal Medicine, June 23, 2003. 42 Study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, Diet and Exercise Delay Diabetes and Normalize Blood Glucose, February 6, 2002. 43 Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE, Luthy DA. Prospective Study of Gestational Diabetes Mellitus Risk in Relation to Maternal Recreational Physical Activity Before and During Pregnancy. American Journal of Epidemiology 2004 Apr 1;159(7):663-770. 44 Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB. Medicine and Science in Sports and Exercise 2006 Jan; 38(1):173-8. 45 Hakim, Amy L et al. Effects of Walking on Coronary Heart Disease in Elderly Men. American Heart Association, Circulation 1999;100:9-13. 46 Paffenbarger, Ralph et al. Associations of Light, Moderate, and Vigorous Intensity Physical Activity With Longevity. The Harvard Alumni Health Study. American Journal of Epidemiology 2000 Feb 1;151(3):293-9. 47 Liu S, Manson J, Lee I, Cole S, Hennekens C, Willett W, Buring J. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. American Journal of Clinical Nutrition 2000;72:922-8. 48 McKeown N, Meigs J, Liu S, Wilson P, Jacques P. Whole grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. American Journal of Clinical Nutrition 2002;76:390-8.
    • 15 49 Whole Grains Council (www.wholegrainscouncil.org). Secondary source, Journal of the American Dietetic Association. September 2006, 106(9):1445-9. 50 Shekelle PG, Morton SC, Maglione M, et al. Pharmacological and Surgical Treatment of Obesity. Agency for Healthcare Research and Quality, Evidence Report/Technology Assessment, Number 103, July 2004. 51 Mayo Clinic. Weight Loss Drugs: Can a Prescription Help You Lose Weight? February 13, 2006. 52 Snow V et al. Surgical and Pharmacological Management of Obesity in Primary Care. A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 2005 Apr 5;142(7):525-31. 53 Blanck HM, Khan LK, Serdula MK. Diet and Physical Activity Behavior Among Users of Prescription Weight Loss Medications. The International Journal of Behavioral Nutrition and Physical Activity 2004 Dec 23;1(1):17. 54 Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. New England Journal of Medicine 2005 Nov 17;353(20): 2111-20. 55 US Food and Drug Administration. Xenical® Consumer Information. November 16, 2000. 56 National Institutes of Health. Drug Information: Sibutramine. 57 National Institutes of Health. Drug Information: Orlistat. 58 Mayo Clinic. Weight Loss Drugs: Can a Prescription Help You Lose Weight? February 13, 2006. 59 Snow V et al. Surgical and Pharmacological Management of Obesity in Primary Care. A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine 2005 Apr 5;142(7):525-31. 60 National Institutes of Health. Drug Information: Sibutramine. 61 Mayo Clinic. Weight Loss Drugs: Can a Prescription Help You Lose Weight? February 13, 2006. 62 Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. New England Journal of Medicine 2005 Nov 17;353(20): 2111-20. Health Enhancement Systems 712 Cambridge Street Midland MI 48642 800.326.2317 www.HealthEnhancementSystems.com For more white papers to support wellness at your organization, free from Health Enhancement Systems, go to: http://whitepapers.HealthEnhancementSystems.com. For Wellness Resources, a guide to our suite of online and paper-based wellness products, go to: http://hesonline.com/catalog.aspx. Copyright © 2011, Health Enhancement Systems. No part of this document may be distributed, reproduced, or posted without written permission from Health Enhancement Systems.