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Suggested Citation:"4 Weighing the Options." 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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4
Weighing the Options

Criteria for evaluating weight-management programs should relate to what the programs are attempting to achieve (i.e., their stated aims), what they might be expected to achieve (i.e., the standards to which they should be held), what impact they have on an individual's health and behavior in the short run (i.e., the process and short-term outcomes), and their ultimate long-term outcomes (i.e., their impact on the individual over time). We developed criteria by first studying a simple conceptual overview of decisionmaking and its consequences. In this overview, an individual decides to go with one of a number of options and, as a result, experiences a specific outcome (see Figure 4-1).

This conceptual overview is so basic that it can be applied widely to

FIGURE 4-1

Suggested Citation:"4 Weighing the Options." 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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TABLE 4-1 Criteria for Evaluating Weight-Management Programs

Criterion 1: The Match Between Program and Consumer

Program

Person

Who is appropriate for this program?

Should I be in this program, given my goals and characteristics?

Criterion 2: The Soundness and Safety of the Program

Program

Person

Is my program based on sound biological and behavioral principles, and is it safe for its intended participants?

Is the program safe and sound for me?

Criterion 3: Outcomes of the Program

Program

Person

What is the evidence for success of my program?

Are the benefits I am likely to achieve from the program worth the effort and cost?

almost any situation requiring a decision, such as selecting a book at the library or choosing from among the many weight-loss options. Nevertheless, each of the three components of the overview suggests a criterion specific to evaluating obesity-treatment programs. Our three criteria for evaluating such programs are listed in Table 4-1, and their link with the conceptual overview is presented in Figure 4-2. We have presented each criterion from the point of view of the person (since it is the individual who is at the center of decisionmaking) and of the program (which can use the criteria, for example, to ensure quality control and conduct research on program effectiveness).

The following three chapters detail our three criteria. Chapter 5 focuses on Criterion 1, the match between the program and consumer. We present a number of published methods for matching in the obesity field and identify several factors that influence the decisions made by individuals. In Chapter 6, we focus on Criterion 2, the soundness and safety of the program, describing critical areas that need to be addressed by all obesity-treatment programs. Chapter 7, which addresses Criterion 3, outcomes of the program, provides a literature review on predictors of weight loss and maintenance. It also presents a new concept of weight that refocuses the goal of losing weight from weight loss alone to achieving and maintaining good health through weight management. In Chapter 8, we synthesize the information in this and the next three chapters to provide practical advice for programs and consumers to increase the probability of successful weight-management outcomes.

Suggested Citation:"4 Weighing the Options." 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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FIGURE 4-2

Suggested Citation:"4 Weighing the Options." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×
Page 91
Suggested Citation:"4 Weighing the Options." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×
Page 92
Suggested Citation:"4 Weighing the Options." Institute of Medicine. 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press. doi: 10.17226/4756.
×
Page 93
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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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