Weight Management State of the Science and Opportunities for Military Programs (2003) / Chapter Skim
Currently Skimming:
Appendix A: Workshop Agenda Abstracts
Appendix A: Workshop Agenda Abstracts
Pages 179-240
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 179... ...
Yates, Director, Food and Nutrition Board 9:05 Welcome on Behalf of the Subcommittee on Military Weight Management Dr. Richard Atkinson, Chair, Subcommittee 9:15 Opening Comments on Behalf of the Military LTC Karl E
|
From page 180... ...
Dennis, Veterans Affairs Medical Center, University of MD School of Medicine Nutrition and Diet Aboard Submarines - LT Deborah White, Naval Submarine Medical Research Lab, Groton, CT The Army's LEAN Program: Current Update-LTC Larry James, Walter Reed Army Medical Center Army Weight-Management Instruction to Master Fitness Trainers - Dr. Lou Tomasi, LT Kerryn Davidson, Army Physical Fitness School, Ft.
|
From page 181... ...
Glenn Ram os, M.D., Fort Gordon, GA Use of Pharmacologic Aids in Weight Management Dr. Frank Greenway, Pe,~nington Biomedical Research Center Discussion 12:00 Lunch Physiology - Physical Activity (Moderator: Barbara Hansen)
|
From page 182... ...
John Jakicic' Miriam Hospital and Brown University Discussion Break Part V: Effective Strategies for the Military Setting (Moderator: Gail Butterfield) 4:00 Panel Discussion Military Speakers: CAPT Trisha Vorachek (USAF)
|
From page 183... ...
Beginning in 1987, the DOD revised Directive 1308.1 stating that the skinfold measurement test would no longer be used, and that only the "Tape" measurement method should be used to measure body fat. The Army Weight Control Program (U.S.
|
From page 184... ...
1995. DOD Physical Fitness and Body Fat Program Procedures.
|
From page 185... ...
Challenges to Military Weight Standards With current recruitment shortfalls, the number of overweight recruits (meeting accession standards but not the services retention standard for weight) may be increasing due to a smaller applicant pool.
|
From page 186... ...
Meeting Military Weight Standards: Lifestyle Change Programs Across the services there is a need to become more familiar with various programs available in local areas and encourage the use of these programs. Units that have used local lifestyle change (weight)
|
From page 187... ...
, taught the service member new information for weight management (96 percent) , and provided a comprehensive multidisciplinary program for weight reduction (91 percent)
|
From page 188... ...
These programs for the most part emphasized increased physical activity, modest calorie restriction, skill development in selecting and preparing healthy foods, and behavior modification techniques. At most sites, these programs could accommodate few participants.
|
From page 189... ...
The first four core classes are taken by all participants in The Sensible Weigh and provide a foundation of information and skills. The first class orients clients to the concept of lifestyle change, the diverse benefits of weight management, addresses relapse prevention and diet readiness, and encourages increased physical activity.
|
From page 190... ...
It takes a few weeks for many clients to become proficient in maintaining a food diary. Class three is taught by an exercise physiologist who covers the basic components of a personal fitness program targeted at reducing body fat.
|
From page 191... ...
1995. Physical activity, body weight, and adiposity: An epidemiological perspective.
|
From page 192... ...
weight management program (WMP) , most AF members identified as overeat received only a 2-hour nutrition class, taught by a registered dietitian or nutrition certified dietitian or medical technician, before officially entering the WMP.
|
From page 193... ...
It was the first AF program to provide members with increased education, skills and support in all the disciplines necessary for successful weight loss prior to official placement in the WMP. The success of the LEAN program was a key factor in the current AF policy of members receiving 3 months of weight-loss counseling prior to starting the WMP.
|
From page 194... ...
1998. Why Americans eat what they do: Taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption.
|
From page 195... ...
However, this remedial approach is not standardized and it typically fails to bring the majority of participants within weight standards (Trent and Stevens, 19931. In addition, over 80 percent of program time is devoted to physical activity even though 63 percent of enrollees are obese (Trent and Stevens, 1993)
|
From page 196... ...
interpersonal processes were designed to build camaraderie and group support as participants were guided to creatively problem solve and adopt a series of small, achievable steps that had a cumulative impact on body weight. The exercise program for the experimental group was the mandated program already being conducted for Command Level remediation (i.e., "Navy usual care")
|
From page 197... ...
Moreover, 10 men in the treatment group vs only 2 in the control group lost at least 10 kg of their initial body weight. Prior to treatment, most CVD risk factors reflected values that were within NCEP guidelines.
|
From page 198... ...
, formulated the cost-effectiveness analysis. The frequency and probability of medical events in the Navy active duty population, valued at Medicare cost rates, generated total inpatient and outpatient obesityrelated expected per person health care costs to calculate cost-saving from the effects of the innovative shipboard weight control and the current CommandLevel interventions.
|
From page 199... ...
The number of CVD admissions in that oldest age group drops markedly, which is consistent with military retirement and the number of personnel of that age who remain on active duty. Expected facility costs per obesity-related admission for active duty Navy personnel increased by age group from $3,328 for 18-24 year olds to $5,746 for 45-64 year olds.
|
From page 200... ...
The cost effectiveness of a shipboard weight control program. Bradham DD, South BR, Saunders HJ, Heuser MD, Pane KW, Dennis KE.
|
From page 201... ...
1992. Cardiovascular risk factors modification after dietary therapy of obese older men.
|
From page 202... ...
Benning, GA, Home of the US Army Infantry Training Center. The APFS is responsible for writing operational physical fitness doctrine, conducting physical fitness research, and providing physical training support to the Army.
|
From page 203... ...
The objectives include: meeting the physical demands of their duties under combat conditions and presenting a trim military appearance at all times. The commanders' responsibilities include the following: program implementation, personnel monitoring, exercise programs, and providing education programs to the soldiers enrolled in the Army Weight Control Program.
|
From page 204... ...
Nutrition in the MFT course is directly linked to weight management through the dietary guidelines; nutrients, class, characteristics, function; interpreting food labels, conducting a dietary recall; and calculating of per cent calories from carbohydrate, protein, and fat. Mandatory requirements for nutrition education prior to or shortly after enrollment in Army Weight Control Program includes instruction by a registered dietitian in which soldiers learn proper diet for weight control.
|
From page 205... ...
1986. The Army Weight Control Program.
|
From page 206... ...
In addition, segregation analysis of longitudinal changes in percent body fat over a 5-year period has yielded evidence for a major gene effect (Comuzzie et al., 1999~. Most recently the emphasis has shipped from the question of whether human obesity has a genetic component to the question of which specific genes are responsible.
|
From page 207... ...
Work to date suggests the existence of roughly a dozen genes with measurable effects of the expression of obesity-related phenotypes at the population level. As a result, there is now not only strong evidence for a genetic component in the variation of body weight across individuals, but we are beginning to identify specific genes with measurable effects.
|
From page 208... ...
1999. Evidence for genetic influences on the change in percent body fat over time in Mexican Americans.
|
From page 209... ...
Specifically, the goal of obesity treatment should be refocused Tom weight loss alone to weight management, achieving the best weight possible in the context of overall health. In contrast to weight loss, the primary purpose of weight management is to achieve and maintain good health.
|
From page 210... ...
The average weight loss is around 10 kg at 6 months. Studies of greater than 6 months are lacking with the exception of the combination Phen-Fen, which was studied out to 3.5 years, and will be discussed later.
|
From page 211... ...
Theoretically, the lateral hypothalmus of an individual taking Leptin would not realize that the body is losing weight, and compensatory mechanisms would not be put into effect. In animals it not only reduces food intake, but also increases basal metabolic rate with selective promotion of fat metabolism.
|
From page 212... ...
1995. Weighing the Options; Criteria for EYalz~ating Weight Management Programs.
|
From page 213... ...
USE OF PHARMACOLOGICAL AIDS IN WEIGHT MANAGEMENT Frank Greenway, MD Obesity is now recognized as a chronic disease. Although the NIH Consensus Conference declared such as early as 1985 (Anonymous, 1985)
|
From page 214... ...
The stated reasons for these standards are to maintain a trim military appearance. It could be argued that, like national guidelines for obesity treatment, military weight standards should be based upon medical risks rather than cosmetic considerations.
|
From page 215... ...
The longest study with this medication lasted 20 weeks and was small, but the phenylpropanolamine group lost 6.5 percent of their body weight (Schteingart, 1992~. Phenylpropanolamine has a remarkable record of safety.
|
From page 216... ...
· Caffeine and ephedrine give preferential fat loss and might deserve filrther consideration as a military obesity treatment if military weight standards are liberalized. · Calorie-controlled portions combined into a 1,200-calorie balanced diet may give better sustained weight loss than presently available obesity medi
|
From page 217... ...
lnt J Obes Relat Metab Disord 17:S69-S72. EFFECTS OF EXERCISE, DIET, AND WEIGHT LOSS ON LIPID METABOLISM IN WOMEN Marcia L
|
From page 218... ...
, physical activity, and behavior therapy, provide the most successful therapy for weight loss, (with a goal of losing 10 percent of body weight over a period of about 6 months) , and weight maintenance (NHLBI, 1998~.
|
From page 219... ...
Physical activity need not be of high intensity to reduce CHD risk substantially (HHS, 1996; Manson et al., 1999) and lower-intensity activity may result in better adherence over the long term (King et al., 1995~.
|
From page 220... ...
1997. Physical activity and mortality in postmenopausal women.
|
From page 221... ...
Most current research into the mechanism of menstrual disorders in exercising women is focused on two competing hypotheses. The energy availability hypothesis holds that the reproductive system is disrupted by an as yet undetermined mechanism when physically active women fail to consume enough dietary energy each day to match their daily energy expenditure (Wade and Schneider, 1992~.
|
From page 222... ...
By increasing dietary energy intake in compensation for exercise energy expenditure, we prevented the apparent disruptive effects of exercise stress on LH pulsatility. Second, in women the disruptive effects of low energy availability appear to occur at a threshold of energy availability between 20 and 30 kcal/kglean body mass (LBM)
|
From page 223... ...
1984. Relation between body weight, growth rate, chronological age, and puberty in male and female rats.
|
From page 224... ...
1998. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women.
|
From page 225... ...
Of 52 obese humans tested by agar gel-precipitation test, 10 had antibodies to SMAM-1 (Dhuran&ar et al., 1997~. These 10 individuals had a higher body weight and lower serum cholesterol and triglycerides compared with antibody-negative individuals (Dhurandhar et al., 1997~.
|
From page 226... ...
Chickens inoculated with AD-36 in experiments 1 and 2 had significantly greater visceral and total body fat and significantly lower serum cholesterol and triglycerides compared to the controls. For example, compared to the control, the AD-36 group in experiment 2 had 128 percent greater visceral fat (p < .0005)
|
From page 227... ...
The body weight was 15 percent greater after 12 months and 18 months after the first appearance of AD36 antibody, compared with the body weight 6 months prior to the first appearance of AD-36 antibody ~ < .03~. Serum cholesterol levels increased slightly in the 18 months before the appearance of AD-36 antibodies.
|
From page 228... ...
At each of the sites, the antibody-positive obese had significantly lower serum cholesterol compared with the antibody negative obese subjects from the respective site ~ < .002~. Conclusion Our data show that a human adenovirus causes adiposity in animals and is strongly associated with obesity in humans.
|
From page 229... ...
Estimates show that at any one time, approximately 25 percent of men and 45 percent of women are trying to lose weight (Williamson et al., 1992~. Of the participants who enter a behavioral weight-loss program, it is estimated that they will lose approximately 10 percent of their body weight over the course of 20-24 weeks (Shick et al., 1998~.
|
From page 230... ...
With the changing environment and the discouraging rates of weight regain, it is imperative that we take a closer look at long-term weight maintenance and the various methods successful maintainers utilize to prevent weight gain. To get a better perspective in this area, it is appropriate to review a portion of the longterm data provided by the National Weight Control Registry (NWCR)
|
From page 231... ...
One of the common findings observed in individuals who are successful at longterm weight loss is that maintainers report extensive use of behavioral strategies for reduction in dietary fat intake, self weighing, and physical activity (McGuire et al., 1 999a)
|
From page 232... ...
Conclusion Regardless of the weight-loss option selected, patients should strive to develop the skills that have been reported by successful weight-loss maintainers. These techniques include exercising regularly, monitoring weight frequently, eating a low-fat diet, recording food intake, and developing effective problem solving skills (Anderson and Wadden, 1999~.
|
From page 233... ...
FACTORS AFFECTING LONG-TERM MAINTENANCE OF WEIGHT LOSS AND WEIGHT REGAIN John M Jakicic, PhD, Assistant Professor, Brown University School of Medicine, Miriam Hospital Weight Control and Diabetes Research Center Obesity is a significant health problem in the United States, and it is estimated that in excess of 50 percent of adults are considered overweight (BMI > 25 kg/m2~.
|
From page 234... ...
Despite the debate over the optimal amount of activity that is necessary to maximize long-term weight loss, little debate exists as to the importance of physical activity for overweight adults. Data from the Center for Aerobics Research at the Cooper Institute have shown that physical fitness can have a significant impact on mortality rates independent of body weight.
|
From page 235... ...
showed that there was a significant correlation between physical activity and having home-exercise equipment. More recently, Jakicic and colleagues (1999)
|
From page 236... ...
We have shown that moderately overweight adult men left untreated will gain a significant amount of weight over a period of 16 weeks, whereas participation in a program to modify exercise behaviors and minimize fat intake appears to have a beneficial effect on body weight in these individuals (Leermakers et al., 1998~. Therefore, it may be important for the military to identify individuals that are moderately overweight and encourage changes in exercise and eating behaviors to prevent further weight gain.
|
From page 237... ...
Thus, providing opportunities for soldiers to maintain their newly developed exercise and eating behaviors may minimize body weight-regulation concerns in this population. Moreover, one factor that should be considered is the history of the soldier prior to entering the military.
|
From page 238... ...
1999. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness.
|
From page 239... ...
1997. How much physical activity is needed to minimize weight gain in previously obese women?
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.