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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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WEIGHING THE OPTIONS

Criteria for Evaluating Weight-Management Programs

Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity

Food and Nutrition Board

Paul R. Thomas, Editor

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1995

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This study was supported through internal funds of the National Academy of Sciences.

Library of Congress Cataloging-in-Publication Data

Weighing the options : criteria for evaluating weight-management programs / Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity, Food and Nutrition Board, Institute of Medicine ; Paul R. Thomas, editor.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-05131-2

1. Reducing diets—Evaluation. 2. Weight loss. I. Thomas, Paul R., 1953- . II. Institute of Medicine (U.S.). Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity.

RM222.2.W2967 1995

613.2'5—dc20 94-44625

CIP

Copyright 1995 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

National Academy Press
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×

COMMITTEE TO DEVELOP CRITERIA FOR EVALUATING THE OUTCOMES OF APPROACHES TO PREVENT AND TREAT OBESITY

JUDITH S. STERN (Chair),

Departments of Nutrition and Internal Medicine, University of California, Davis

JULES HIRSCH (Vice Chair),*

Rockefeller University, New York, New York

STEVEN N. BLAIR,

Cooper Institute for Aerobics Research, Dallas, Texas

JOHN P. FOREYT,

Nutrition Research Clinic, Baylor College of Medicine, Houston, Texas

ARTHUR FRANK,

Obesity Management Program, George Washington University, Washington, D.C.

SHIRIKI K. KUMANYIKA,

College of Medicine, Pennsylvania State University, Hershey

JENNIFER H. MADANS,

Division of Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland

G. ALAN MARLATT,

Addictive Behaviors Research Center, University of Washington, Seattle

SACHIKO T. ST. JEOR,

Nutrition Education and Research Program, University of Nevada School of Medicine, Reno

ALBERT J. STUNKARD,*

Department of Psychiatry, University of Pennsylvania, Philadelphia

Food and Nutrition Board Liaison

DENNIS M. BIER,

Children's Nutrition Research Center, Houston, Texas

Staff

PAUL R. THOMAS, Project Director

SHEILA A. MOATS, Research Associate

SUSAN M. KNASIAK, Program Assistant

*  

Member, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×

FOOD AND NUTRITION BOARD

JANET C. KING (Chair),

Department of Nutritional Sciences, University of California, Berkeley

EDWIN L. BIERMAN (Vice Chair), *

Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle

JOHN W. ERDMAN, JR. (Vice Chair),

Division of Nutritional Sciences, University of Illinois, Urbana

CUTBERTO GARZA (Vice Chair),

Division of Nutritional Sciences, Cornell University, Ithaca, New York

PERRY L. ADKISSON,

Department of Entomology, Texas A&M University, College Station

LINDSAY H. ALLEN,

Department of Nutrition, University of California, Davis

DENNIS M. BIER,

Children's Nutrition Research Center, Houston, Texas

FERGUS M. CLYDESDALE,

Department of Food Science and Nutrition, University of Massachusetts, Amherst

HECTOR F. DeLUCA,

Department of Biochemistry, University of Wisconsin, Madison

MICHAEL P. DOYLE,

Department of Food Science and Technology, University of Georgia, Griffin

JOHANNA T. DWYER,

New England Medical Center Hospital and Tufts University Schools of Medicine and Nutrition, Boston, Massachusetts

SCOTT M. GRUNDY,

Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas

K. MICHAEL HAMBIDGE,

Center for Human Nutrition, University of Colorado Health Sciences Center, Denver

LAURENCE N. KOLONEL,

Cancer Center of Hawaii, University of Hawaii, Honolulu

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio

ALFRED SOMMER,*

School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland

VERNON R. YOUNG,*

School of Science, Massachusetts Institute of Technology, Cambridge

STEVE L. TAYLOR (Ex Officio),

Department of Food Science and Technology, University of Nebraska, Lincoln

*  

Member, Institute of Medicine

  

Member, National Academy of Sciences

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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ARTHUR H. RUBENSTEIN (Institute of Medicine Council Liaison),*

Department of Medicine, The University of Chicago, Chicago

Staff

ALLISON A. YATES, Director (from July 1994)

BERNADETTE M. MARRIOTT, Acting Director (January–June 1994)

CATHERINE E. WOTEKI, Director (through December 1993)

MARCIA S. LEWIS, Administrative Assistant

GAIL E. SPEARS, Administrative Assistant

SUSAN M. WYATT, Financial Associate (through October 1994)

JAMAINE L. TINKER, Financial Associate (from October 1994)

The Food and Nutrition Board (FNB) was established in 1940 to study issues of critical national importance pertaining to the safety and adequacy of the nation's food supply, to establish principles and guidelines for adequate nutrition, and to render authoritative judgment on the relationships among food intake, nutrition, and health. The FNB responds to requests from federal agencies and others to initiate studies concerning food and nutrition, assigns them to standing or ad hoc committees, then oversees the work of these committees. The FNB is a unit of the Institute of Medicine, part of the National Academy of Sciences.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Preface

For several years, the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM), National Academy of Sciences (NAS) has wished to develop criteria that could be used by others to evaluate the effectiveness of various approaches to preventing and treating the problems of overweight and obesity. Nearly one-third of adults in the United States are obese. Individuals wanting to lose weight have a wide variety of programs, services, and advice from which to choose, ranging from over-the-counter diet aids and community-based classes to commercial weight-loss centers and treatment by individual health-care providers. To date, however, few carefully derived sets of criteria have been available for evaluating the plethora of programs and approaches for the treatment and prevention of obesity in a systematic, comprehensive, and consistent manner.

Given the need to develop such criteria, the NAS provided the FNB with funding to conduct a 1-year study with the following objectives:

  • Identify direct measurements of outcomes of obesity treatment and prevention programs as well as their priorities and special uses.

  • Identify program characteristics that should be specified and measured in program evaluation.

  • Identify appropriate uses of indirect measurements of outcomes (especially risk of specific diseases) of large-scale weight-loss programs.

  • Identify characteristics that contribute to clients' choices of programs and their outcomes with these programs.  

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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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  • Identify the degree of weight loss needed to improve various health outcomes.

  • Where information concerning these topics is limited, develop a specific agenda for research.

The Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity (hereafter termed the Obesity Committee), whose members wrote this report, consists of 10 scientists, most of whom are recognized leaders in obesity research and management. They work in a variety of settings, including public and private universities, medical schools, research centers, the federal government, and private practice. Brief biographies of the committee and project director can be found in Appendix E.

The committee met four times during the course of this study. Our draft report was formally reviewed under the auspices of the National Academy of Sciences' Report Review Committee by a panel of experts whose identities have not been revealed to the committee. In addition, members of the FNB reviewed the draft. The reviewers provided thoughtful, constructive critiques, and we have incorporated many of their suggestions in this report.

The focus of the report has been defined by the charges to the committee and our interpretation of them as well as the usual limits of time and resources. This report does not provide comprehensive descriptions and assessments of the various approaches to weight loss, nor does it discuss eating disorders such as anorexia or bulimia. In addition, we focused our work on obesity in adults and on obesity treatment rather than prevention. We have not neglected adolescent obesity and the prevention of obesity, but these are large topics that deserve special study by other committees.

This report has been prepared for a large audience, including biomedical researchers, clinicians, and public health specialists; individuals involved in the development, manufacture, or sale of weight-loss products and services; educators; federal, state, and local policymakers; and interested consumers. For the general public, a separate book on obesity and health, based on this report, is needed. That book would help readers evaluate the nature and causes of weight problems and help determine which, if any, type of weight-loss approach might be best for them and whether they need professional help.

ACKNOWLEDGMENTS

This report would not have been possible without the help of the IOM staff. Special thanks go to our colleague Paul R. Thomas. Dr. Thomas

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×

served as Project Director and editor of this report, and we relied heavily on his in-depth knowledge of nutrition and his excellent writing and editing skills. We also appreciate the help provided by Project Assistant Susan M. Knasiak, whose substantial computer, technical, and organizational skills facilitated the preparation of this manuscript and arrangements for our meetings, travel, and conference calls, and Sheila A. Moats, Research Associate, for her skills at reference identification and verification and help with planning a workshop and drafting a section of the report. Catherine E. Woteki, former director of the FNB, was instrumental in developing the proposal that led to this study and in efforts to obtain funding. We are very grateful to the Executive Committee of the Governing Board of the National Research Council, NAS, for agreeing to provide the necessary financial support.

During the course of this study, several nutrition professionals, biomedical scientists, government representatives, and representatives of the weight-loss industry contributed to discussions about the content of this report. Some provided material or advice at our invitation, some participated in a workshop held at our second meeting, and others responded to specific questions we posed. We are very thankful for their help and carefully considered all comments. We wish to single out the following individuals by name:

Representatives of government agencies: Joan M. Conway, U.S. Department of Agriculture; Karen A. Donato, National Institutes of Health (NIH); Katherine M. Flegal, National Center for Health Statistics (NCHS); Van S. Hubbard, NIH; Richard Kelly, Federal Trade Commission; Barbara J. Moore, NIH; and the Division of Health Examination Statistics, NCHS.

Representatives of the private sector: L. Arthur Campfield, Hoffmann-La Roche; Linda Webb Carilli, Weight Watchers International, Inc.; David J. Goldstein, Eli Lilly & Company (also affiliated with the Indiana University School of Medicine); Karen Miller-Kovach, Weight Watchers International, Inc.; Bruce F. Trumm II, Abbott Laboratories; and Brenda L. Wolfe, Jenny Craig, Inc.

Academics: Kelly D. Brownell, Yale University; Sally M. Davis, University of New Mexico School of Medicine, Albuquerque; Robert W. Jeffery, University of Minnesota, Minneapolis; and Rena R. Wing, University of Pittsburgh School of Medicine.

Others: Gail L. Kaye and Francis J. Peterson.

Very special thanks are due the three nutrition scientists who prepared background papers for the committee's use. George L. Blackburn, Chief of the Nutrition/Metabolism Laboratory at New England Deaconess

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Hospital in Boston, prepared an algorithm of whom to treat for obesity and categories of treatment intensity. F. Xavier Pi-Sunyer, Chief of the Division of Endocrinology, Diabetes, and Nutrition at St. Luke's/Roosevelt Hospital Center in New York City, prepared a paper on the treatment of obesity with drugs; we used it to develop our statements and recommendations on the subject at various places in the report. Beatrice S. Kanders, an obesity specialist and now a private consultant in Atlanta, prepared a background paper on the prevention and treatment of obesity in childhood and adolescence. Because pediatric obesity is a very important subject that we were not able to address owing to time constraints, we have included an edited version of Dr. Kanders' paper in Appendix C.

We appreciate the assistance provided by the IOM's Reports and Information Office. Claudia Carl steered this report through formal review, and Mike Edington helped prepare the final manuscript for publication. Andrea Posner and Florence Poillon served ably as copy editors. Thanks are also due to the staff of the National Academy Press, particularly Sally Stanfield, Barbara Kline Pope, and Christine Chirichella, for their help in publishing and marketing the report and for their patience with us. Our acknowledgments would not be complete without thanking Kenneth I. Shine, IOM President; Enriqueta C. Bond, former IOM Executive Officer; Joseph S. Cassells, Interim IOM Executive Officer; Bernadette M. Marriott; Allison A. Yates; and the members of the FNB for their support, advice, and encouragement throughout the short life of this fast-track study.

Finally, as chair, I would like to thank my fellow committee members for their hard work and good cheer in meeting what often seemed to be impossible deadlines.

Judith S. Stern, Chair

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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WEIGHING THE OPTIONS

Criteria for Evaluating Weight-Management Programs

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
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Nearly one out of every three adults in America is obese and tens of millions of people in the United States are dieting at any one time. This has resulted in a weight-loss industry worth billions of dollars a year and growing. What are the long-term results of weight-loss programs? How can people sort through the many programs available and select one that is right for them? Weighing the Options strives to answer these questions.Despite widespread public concern about weight, few studies have examined the long-term results of weight-loss programs. One reason that evaluating obesity management is difficult is that no other treatment depends so much on an individual's own initiative and state of mind.

Now, a distinguished group of experts assembled by the Institute of Medicine addresses this compelling issue. Weighing the Options presents criteria for evaluating treatment programs for obesity and explores what these criteria mean--to health care providers, program designers, researchers, and even overweight people seeking help.

In presenting its criteria the authors offer a wealth of information about weight loss: how obesity is on the rise, what types of weight-loss programs are available, how to define obesity, how well we maintain weight loss, and what approaches and practices appear to be most successful.

Information about weight-loss programs--their clients, staff qualifications, services, and success rates--necessary to make wise program choices is discussed in detail.

The book examines how client demographics and characteristics--including health status, knowledge of weight-loss issues, and attitude toward weight and body image--affect which programs clients choose, how successful they are likely to be with their choices, and what this means for outcome measurement. Short- and long-term safety consequences of weight loss are discussed as well as clinical assessment of individual patients.

The authors document the health risks of being overweight, summarizing data indicating that even a small weight loss reduces the risk of disease and depression and increases self-esteem. At the same time, weight loss has been associated with some poor outcomes, and the book discusses the implications for program evaluation.

Prevention can be even more important than treatment. In Weighing the Options, programs for population groups, efforts targeted to specific groups at high risk for obesity, and prevention of further weight gain in obese individuals get special attention.

This book provides detailed guidance on how the weight-loss industry can improve its programs to help people be more successful at long-term weight loss. And it provides consumers with tips on selecting a program that will improve their chances of permanently losing excess weight.

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