U.S. Department of
Health and Human Services

National Institutes of Health

WIN Notes

Summer 2007

WIN Notes is a quarterly newsletter produced by the Weight-control Information Network (WIN), a project of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). WIN provides consumers, health professionals, and the media with up-to-date, science-based information on obesity, weight control, physical activity, and nutrition.

In This Issue:

Cover Story

NIDDK Appoints Griffin P. Rodgers as Director

Griffin P. Rodgers, M.D. has been named Director of NIDDK. Dr. Rodgers’ appointment follows terms as Deputy Director and Acting Director of NIDDK and extensive experience as a clinician, researcher, and administrator.

NIDDK conducts and supports research on diabetes, nutrition, and endocrine, metabolic, digestive, kidney, urologic, and hematologic diseases. NIDDK also supports education programs for health professionals, patients, and the public.

Dr. Rodgers will oversee the Institute’s staff of 650 researchers, physicians, and administrators and its annual budget of $1.8 billion. NIDDK-supported research is conducted at research institutes and medical centers nationwide.

In 2001, Dr. Rodgers was appointed Deputy Director of NIDDK. He went on to serve as the Institute’s Acting Director in 2006. In addition, he is the chief of NIDDK’s Clinical and Molecular Hematology Branch.
Dr. Rodgers received his undergraduate, graduate, and medical degrees from Brown University. He is board certified in Internal Medicine, Emergency Medicine, and Hematology. Dr. Rodgers also holds a master's degree in business administration from Johns Hopkins University.

As a researcher, Dr. Rodgers is widely recognized for his contributions to the development of the first effective therapy for sickle cell anemia. He has received numerous awards including the 1998 Richard and Hinda Rosenthal Foundation Award, the 2000 Arthur S. Fleming Award, the Legacy of Leadership Award in 2002, and a Mastership from the American College of Physicians in 2005.

To read the NIDDK press release, visit www.nih.gov/news/pr/apr2007/niddk-02.htm.

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Research Notes

Even for Normal-Weight Individuals, Excess Fat Poses Risks

In an interesting twist in obesity research, a recent study revealed that women who are of normal weight but who have extra body fat have elevated levels of inflammatory proteins in their blood. This inflammation may be an early sign of coronary heart disease and metabolic disturbances.

Researchers recruited 60 White women age 20 to 35. The women were separated into three groups based on their body mass index (BMI) and their percentage of body fat. BMI is a measure of weight in relation to height. A BMI of 18.5 to 24.9 is considered healthy, a BMI of 25 to 29.9 is overweight, and over 30 is obese. The researchers also used a body fat percentage of 30 percent as a cutoff point for their classifications.

Thus, the three groups were: nonobese controls, who had a normal weight, a normal BMI, and less than 30 percent body fat; “normal-weight obese” women who had a normal weight and BMI, but greater than 30 percent body fat; and "preobese-obese" women, who had a BMI that was greater than 25 and whose body fat was greater than 30 percent.

All of the women were generally healthy. None had high blood pressure or heart disease, they did not smoke or abuse alcohol, and they were not taking any other drugs.

Researchers obtained the women’s weight, height, and waist circumference; measured their body composition (that is, their percentages of body fat and lean tissue); and drew blood samples.

Although the normal-weight obese women would be categorized as healthy based on their BMI alone, their level of inflammation suggested that they have an increased risk for future obesity, heart disease, and metabolic disorders.

The normal-weight obese women’s blood lipids, such as cholesterol and triglycerides, were the same as the nonobese controls. However, the normal-weight obese women had elevated levels of several inflammatory proteins.

The level of inflammation correlated with the percentage of body fat. It did not, however, correlate with body weight, BMI, or percent of lean tissue. These findings fit with research indicating that body fat itself may release inflammatory proteins.

The study underscores how important it is to screen for body composition when assessing disease risk, even among people with a normal BMI. From a practical standpoint, the study also provides more reason for everyone, regardless of body size, to eat well and exercise regularly.

Article Information

De Lorenzo A, Del Gobbo V, Premrov M, et al. Normal-weight Obese Syndrome: Early Inflammation?. American Journal of Clinical Nutrition. 2007;85(1):40–45.

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Obesity Increases Risk of Prostate Cancer Death

A large prospective study of adult men found that BMI is not associated with the development of prostate cancer, but having a high BMI or gaining weight in adulthood does increase the risk of fatality from prostate cancer once the disease has developed.

The study subjects were members of AARP who were enrolled in the NIH-AARP Diet and Health Study, which is supported by the National Cancer Institute. The average age at baseline was 62 years. Approximately 29 percent were classified as normal weight, 50 percent were overweight, and 21 percent were obese.

The subjects completed baseline questionnaires inquiring about demographics, dietary intake, current height and weight, other risk factors, prostate cancer screening in the past 3 years, and weight at age 18. Five years later, the researchers gathered follow-up information about the incidence of and mortality from prostate cancer.

BMI was positively associated with prostate cancer mortality—the higher the BMI, the greater the risk of death. Men with a BMI of 35 or greater had more than two times the risk of dying than normal-weight men.

In addition, weight gain during adulthood also significantly raised the mortality risk from prostate cancer. As with BMI, the risk of death increased as the amount of weight gain increased.

The study sheds light on yet another potential benefit of maintaining a healthy weight, especially since prostate cancer is a common cancer among American men.

Article Information

Wright M, Chang S, Schatzkin A, et al. Prospective Study of Adiposity and Weight Change in Relation to Prostate Cancer Incidence and Mortality. Cancer. 2007;109(4):675–684.

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Teens Not Following Diet and Activity Guidelines

Numerous studies have shown that adolescents participate in risky health behaviors. Most recently, a team of researchers from the University of California, San Diego; San Diego State University; Kaiser Permanente Medical Group; and the Primary Care Research Unit of Bizkaia in Bilbao, Spain, found that a mere 2 percent of teens meet combined dietary and physical activity guidelines.

The study examined four health behaviors among teens and identified factors that are associated with these behaviors. The four behaviors were physical activity, television viewing, percentage of calories from fat, and daily servings of fruit and vegetables.

The sample consisted of 878 ethnically diverse adolescents age 11 to 15. The subjects’ physical activity was assessed with an accelerometer, which is an advanced type of pedometer, for an average of 8 days. Subjects completed surveys asking about their TV habits and dietary intake. The teens’ parents completed surveys about their own health behaviors.

The researchers compared the teens’ data with national guidelines for each of the behaviors. The guidelines were as follows: 1) Be active for at least 60 minutes per day; 2) Watch less than 2 hours of TV per day; 3) Obtain less than 30 percent of daily calories from fat; and 4) Eat at least five servings of fruits and vegetables per day.

About 45 percent of teens met the guideline for physical activity, although boys were much more likely to do so than girls—a finding that is consistent with previous studies. Sixty-seven percent of all teens met the TV guideline, 32 percent met the fat guideline, and less than 12 percent met the fruit and vegetable guideline.

Only two percent of teens met all four guidelines, and 84 percent of teens had two or more risk behaviors. Girls had more risky behaviors than boys.

Several factors correlated with a failure to meet health guidelines. Parents’ risk behaviors appeared to be associated with their children’s behaviors. For girls, being older and being at risk for overweight were also linked with risk behaviors.

Adolescence is a time of increased independence, decision making, and life changes. If teenagers embrace healthy diet and physical activity behaviors, they may be solidifying a lifetime of healthy habits.

Article Information

Sanchez A, Norman G, Sallis J, et al. Patterns and Correlates of Physical Activity and Nutrition Behaviors in Adolescents. American Journal of Preventive Medicine. 2007;32(2):124–130.

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Exercise Helps Keep the Aging Brain Sharp

Exercise does a body good—that much we know for sure. Does it also benefit the brain? Current research is focusing on whether physical activity improves brain functioning, specifically as we age. Many animal studies have shown promise, and now a team of researchers from Columbia University and the Salk Institute in California have found evidence that exercise is beneficial to the human mind as well.

First, some background information. In 2006, a group of scientists reviewed decades worth of research on exercise and cognitive, or brain, functioning. The review included long-term epidemiological studies, long-term randomized controlled trials (RCTs), and experimental animal studies.

The epidemiological studies revealed that exercise is associated with a reduced risk of dementia and improved cognitive functioning later in life. The RCTs generally had older subjects participate in a specific fitness regimen, with pre- and post-testing of cognitive function. Exercise resulted in improved cognitive functioning, including concentration, multitasking, and memory. In addition, researchers were able to document that the exercisers retained brain volume and had increased neural activity compared with control subjects.

The animal studies provided insight into the reasons why exercise might have these benefits. As with humans, mice who exercised had sharper memory, better ability to learn new information, and reduced risk of age-related disease. By studying the brains of these animals, researchers learned that the exercisers had more newly formed neurons in the hippocampus (the area of the brain responsible for memory and memory loss) than sedentary mice. This was the case in old as well as young mice.

In addition to new neurons, the aged mice who ran on a treadmill also had higher levels of a chemical called brain-derived neurotrophic factor (BDNF) than their sedentary counterparts. BDNF facilitates the learning process by enabling nerve cells to connect and communicate with one another. Exercise also increases the brain’s uptake of a protein called IGF-1, which appears to be necessary in order for exercise to induce neural growth.

In the recent study, researchers wanted to test the theory that exercise spurs hippocampal nerve growth not only in mice, but also in people. First, they used magnetic resonance imaging (MRI) to measure blood flow to the brain in mice before, during, and after 2 weeks of exercise. Exercise stimulated blood flow to a region of the hippocampus called the dentate gyrus. The dentate gyrus is the only part of the hippocampus in which new nerves can grow. The mice’s brains were examined and researchers confirmed that new nerves did indeed develop.

In the second phase of the study, 11 healthy adults, age 21 to 45, underwent a 3-month aerobic fitness regimen. Researchers performed MRI scans, cognitive testing, and fitness testing before and after the exercise program.

Exercise increased blood flow to the dentate gyrus, as it had in the mice. Furthermore, the more fit the subjects became, the more blood flow increased. The parallels between the mice and human subjects indicate that exercise might improve cognition by the same mechanism—the formation of new neurons.

Researchers have many questions to answer in this relatively new area of study, but the current evidence suggests that exercise helps keep you mentally sharp as well as physically fit.

Article Information

Kramer A, Erickson K, Colcombe S. Exercise, Cognition, and the Aging Brain. Journal of Applied Physiology. 2006;101(4):1237-1242.

Pereira A, Huddleston D, Brickman A, et al. An In Vivo Correlate of Exercise-Induced Neurogenesis in the Adult Dentate Gyrus. Proceedings of the National Academy of Sciences. 2007;104(13):5638–5643.

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NIH to Examine Bariatric Surgery in Adolescents

NIH recently launched an NIDDK-sponsored study called the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) to help determine if bariatric surgery is an appropriate treatment option for extremely overweight teens. Bariatric surgery restricts stomach size and decreases the amount of calories and nutrients the body absorbs.

The study will collect observational data from 200 adolescents, age 14 to 19, over the next 5 years to evaluate the benefits and risks of bariatric surgery. Researchers will collect pre-operative and 2-year post-operative data about body composition, cardiovascular risks, diabetes indicators, quality of life, and eating habits, among other measures. This data will be compared to data from 200 adults who underwent bariatric surgery and were also obese as teenagers.

Teen-LABS is being conducted by researchers at the following medical centers: Cincinnati Children’s Hospital Medical Center; Texas Children’s Hospital, Houston; Children’s Hospital of Alabama, Birmingham; and University of Pittsburgh Medical Center.

The study is based on the adult LABS study, which was launched in 2003 and is slated to run through 2008.

To read the NIH press release about Teen-LABS, visit www.nih.gov/news/pr/apr2007/niddk-16.htm.

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Dietary and Obesity Reports

Childhood Obesity Linked to Gene Mutations

It is widely accepted among the medical community that genes play a role in the development of obesity. In a recent study, researchers further explored the genetic causes of obesity by identifying mutations in a gene involved with energy balance. The mutations were associated with the development of early-onset child obesity.

The Genetics of Obesity Study examined 300 British adults and children who had severe, early-onset obesity. Ninety subjects were blood-related family members, and all subjects had a history of overeating. Researchers performed preliminary gene sequencing to rule out several known genetic mutations in order to focus on a specific gene, the leptin-receptor gene (LEPR).

The leptin hormone helps regulate appetite and body weight. LEPR is the gene for the receptor on which the leptin hormone acts. Previous research has shown that leptin deficiency causes severe obesity.

Gene sequencing revealed that 3 percent of the subjects had mutations in their LEPR gene. The subjects with the mutation had early-onset obesity. In fact, their body weight was well above average within their first year of life. They also experienced delayed puberty or suppressed sexual characteristics and had impaired immune function.

Researchers pointed out that the prevalence of these LEPR mutations is likely lower among the general population. That is because the members of the study sample were very similar—they all experienced early-onset obesity, and many were related. Nevertheless, the researchers believe that these mutations should be considered in the diagnosis of children with severe obesity and problems with overeating.

Article Information

Farooqi I, Wangensteen T, Collins S, et al. Clinical and Molecular Genetic Spectrum of Congenital Deficiency of the Leptin Receptor. New England Journal of Medicine. 2007;356(3):237–247.

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Americans Fall Short on Fruit and Vegetable Consumption

Most people know they should eat more fruits and veggies. Most even know that these foods protect against a host of chronic diseases. And yet, a new study says, Americans are simply not following the U.S. Department of Agriculture (USDA) guidelines to eat at least two servings of fruit and three servings of vegetables a day.

Researchers from Johns Hopkins University reviewed data from the National Health and Nutrition Examination Survey (NHANES), which was administered from 1988 to 1994 and again from 1999 to 2002. Respondents included nearly 15,000 adults from 1988 to 1994 and nearly 9,000 adults from 1999 to 2002. In the first sample, about 77 percent were White, 11 percent were Black, and 5 percent were Mexican American. In the later sample, 72 percent were White, 10 percent were Black, and 7 percent were Mexican American.

NHANES is conducted by trained professionals who ask respondents to recall what they ate in the previous 24 hours. This data was used to estimate daily fruit and vegetable intake.

Fruit consumption did not change between the surveys. In the 1988 to 1994 survey, 26.7 percent met the guidelines; in the 1999 to 2002 survey, 28.5 percent met them.

Vegetable consumption declined slightly, with 35 percent meeting guidelines in the earlier survey and 32.5 percent doing so in the later survey. Furthermore, when fried potatoes were excluded from the analysis, only 29.9 percent met the guidelines in 1998 to 1994, and 27.4 percent met them in 1999 to 2002.

The numbers for combined fruit and vegetable intake were lower yet—only 11 percent of respondents, from each survey, met guidelines for both fruits and vegetables.

In the later survey, adults age 50 and older, those with average or high incomes, and those with at least a high school education were more likely to meet both guidelines. This reinforces the need for interventions targeting low socioeconomic groups.

The study authors noted that Americans did not improve their fruit and vegetable intake despite national initiatives such as the 5 A Day Program for Better Health, which was launched in 1991. Notably, the 5 A Day program was recently replaced with a new campaign, called Fruits & Veggies—More Matters™. You can read about this new campaign in the DHHS News section of this issue of WIN Notes.

Article Information

Casagrande S, Wang Y, Anderson C, et al. Have Americans Increased Their Fruit and Vegetable Intake?: The Trends Between 1988 and 2002. American Journal of Preventive Medicine. 2007;32(4):257–263.

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More Americans Undergoing Weight-loss Surgery

The number of weight-loss surgeries increased significantly between 1998 and 2004, a new study found. In addition, the death rate from these surgeries has fallen.

The Agency for Healthcare Research and Quality examined a national database of hospital inpatient procedures to identify trends in bariatric surgery.

The data revealed a ninefold increase in the total number of bariatric surgeries, with 13,386 in 1998 and 121,055 in 2004. Privately insured patients accounted for over 78 percent of all 2004 surgeries.

Adults age 18 to 54 accounted for the majority of the surgeries, at 85 percent. The fastest growth occurred in adults age 55 to 64.

The inpatient death rate declined by 79 percent, from 0.89 percent in 1998 to 0.19 percent in 2004. The average length of hospital stay after bariatric surgery also decreased, by 38 percent. These improvements were seen among all age and sex groups, but older patients had the longest average stay and the highest mortality rate. Additionally, although 82 percent of all bariatric patients were women, men had a longer length of stay and higher mortality rate.

Article Information

Zhao Y, Encinosa W. CT Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Statistical Brief #23. January 2007. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb23.pdf.

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NIH News

NIH Opens Metabolic Clinical Research Unit

NIH opened its new Metabolic Clinical Research Unit (MCRU) in January. The unit, which is funded by NIDDK, is the largest metabolic research facility in the country. It will be available to researchers from all NIH Institutes, enabling collaboration between experts in metabolism, endocrinology, nutrition, genetics, and other fields.

Clinical trials conducted at MCRU will examine the genetic, social, environmental, and behavioral influences of obesity. Its state-of-the-art technology allows researchers to precisely measure subjects’ nutritional intake, energy expenditure, body composition, and aerobic fitness. Researchers will perform genetic phenotyping, examine the role of sleep on body weight, and study the functions of thyroid hormones, among many other topics.

A unique feature of the MCRU is its three overnight “respiration suites.” These suites are self-contained rooms in which subjects spend 24 hours. Researchers measure the air composition of the rooms to determine subjects’ energy expenditure during all times of the day, including during sleep, eating, and exercise.

Other features include 10 inpatient rooms, a metabolic kitchen (a kitchen in which meals are carefully prepared and analyzed for precise nutritional content), special vending machines, and a dining room. The unit is built to accommodate persons who are over 400 pounds, though researchers will recruit subjects of all body weights.

To take a video tour of the MCRU, visit www2.niddk.nih.gov/Research/ClinicalResearch/MCRU/. For more information about volunteering for clinical trails, visit http://clinicalcenter.nih.gov/participate.shtml.

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National Diabetes Education Program Offers New Products

New consumer materials are available from the National Diabetes Education Program (NDEP). A CD/DVD called Movimiento for Hispanics and a CD/DVD called Step by Step for African Americans were created to encourage active lifestyles. Both include a music video and original songs. Single copies are free. Visit www.ndep.nih.gov/diabetes/pubs/catalog.htm for ordering information.

PowerPoint presentations illustrating recent information about diabetes prevalence, prevention, and treatment are available on NDEP’s website. The presentations are designed for health care professionals, diabetes educators, and students. They can be viewed at www.ndep.nih.gov/resources/presentations/presentations.htm.

An educational toolkit targeting American Indian and Alaskan Native youth called Move It! And Reduce Your Risk of Diabetes encourages more physical activity in schools. The kit contains posters, fact sheets, resource lists, success stories, and a CD–ROM. Single copies are free. To order, visit www.ndep.nih.gov/diabetes/pubs/catalog.htm#ndep-91a.

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DHHS News

CDC Launches New Fruit and Veggie Campaign

As indicated in this article, Americans are not meeting recommendations for daily fruit and vegetable intake. Eating a diet rich in these foods, however, is vital to good health.

Fruits & Veggies—More Matters™ is a new campaign of the Centers for Disease Control and Prevention (CDC) and the Produce for Better Health Foundation (PBH). The campaign replaces the CDC’s long-standing 5 A Day program. Gone is the advice to eat five to nine “servings” of fruits and veggies a day. The new message is to aim for a certain number of “cups,” which are easier to visualize and understand.

How many cups you should eat depends on your age, sex, and activity level. A new website—www.fruitsandveggiesmatter.gov—allows users to calculate how many they should aim for each day.

The campaign will feature a juggler icon on fruit, vegetables, and other products that contain them. The juggler is meant to attract consumers to these healthy products and remind consumers to, quite simply, eat more of them.

The icons will appear on all forms of fruits and vegetables—fresh, canned, frozen, dried, and liquid. In addition, products that contain at least one serving of fruits or vegetables may carry the icon, if the product meets other nutritional standards such as limiting sugar and fat and containing a set amount of fiber.

To find out more about the new CDC campaign and learn easy tips for eating more fruits and veggies, visit the site. You can also visit its sister website from PBH, www.fruitsandveggiesmorematters.org, which targets moms and “gatekeepers” of family nutrition.

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Program Notes

WIN Reaches Out to the Media

WIN contributed an article titled Step it Up to the Montgomery County, MD, African American Health Program’s newsletter in January. WIN contributed an article titled Spring Into Better Health to the Hair, Etc. Beauty and Health Magazine in March. In addition, WIN supplied publications to Hair, Etc.’s magazine release party for 1,000 people.

This June, WIN will reach out to sports radio stations to encourage men to eat healthier and be more physically active. A series of public service announcements will be sent to 135 radio stations nationwide.

WIN in the Community

WIN Participates at Local Events

WIN has been busy participating in community events. In February, WIN exhibited at the Women’s Heart Day Health Fair in Washington, DC. WIN distributed a variety of publications and giveaways, and in return received abundant appreciation from attendees! In March, WIN attended the Silver Spring Boys and Girls Club health fair, providing publications for kids, families, and parents, as well as water bottles and WIN bags.

WIN also attended the Northwestern High School health fair in Pikesville, MD, and the Gaithersburg Senior Center health fair, both of which were held in mid-May.

As these diverse health fairs show, WIN is working hard to reach as many different groups of people as it can with information about healthy eating and physical activity.

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Cyber Notes

Websites Offer Easy Ways to Track Exercise and Nutrition

Staying on track with healthy eating and physical activity is now easier, thanks to web-based tools that allow you to plug in your daily achievements and follow your progress. Two leading health organizations offer free online tracking programs, complete with nutrition and physical activity information.

The USDA offers a website called My Pyramid Tracker that allows users to create personalized accounts and keep online food and physical activity diaries. The program analyzes diet quality and physical activity expenditure and provides educational messages. It is available at www.MyPyramidTracker.gov.

The American Heart Association just launched a new exercise and nutrition program called MyStart! to promote walking and healthy eating. Users can record their progress online and view their daily “calories in” versus “calories out.” It is available at www.americanheart.org/start.

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Resource Notes

Materials From WIN

Updated WIN Publications

WIN has updated and reprinted several fact sheets and brochures. The publications listed below have been revised to include the latest scientific research.

Web-based Revisions:

Young at Heart: Tips for Older Adults
Physical Activity and Weight Control
Walking…A Step in the Right Direction
You Can Control Your Weight as You Quit Smoking
Medical Care for Obese Patients

Reprinted Publications:

Walking…A Step in the Right Direction

To obtain a free copy of these or other publications, contact WIN at 1–877–946–4627 or win@info.niddk.nih.gov. You can also download PDF copies at www.win.niddk.nih.gov.

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Materials From Other Organizations

Aetna African American History Calendar

Each year, Aetna produces an African American history calendar with a different theme. The 2007 calendar addresses obesity in African American communities, and the month of June features Sisters Together! More accurately, the calendar features both Sisters Together and a new program called Brothers Together.

In 2004, Mark Johnson of the Lexington-Fayette County Health Department in Kentucky implemented a Sisters Together program with great success. He took an innovative next step and decided to also create Brothers Together, a program tailored for Black men in his community.

The calendar highlights many other distinguished individuals and programs, including authors, researchers, nutritionists, and individual success stories.

The calendar may be viewed, downloaded, or ordered online at www.aetna.com/diversity/aahcalendar/2007/index.html. Single copies are $5.

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Materials From NIH

What I Need to Know About Eating and Diabetes

This recently updated brochure from NIDDK provides information to help people with diabetes manage their blood sugar through diet, exercise, and diabetes medication, if necessary. The 52-page publication is free and available in English and Spanish. It can be ordered at http://catalog.niddk.nih.gov/AlphaList.cfm?CH=NDIC or you may read it online at http://diabetes.niddk.nih.gov/dm/pubs/eating_ez/.

NIH Medline Plus

NIH, in partnership with the National Library of Medicine (NLM) and the Friends of the NLM, has a new full-color magazine called NIH Medline Plus. The magazine offers the latest medical news for patients and their families. The most recent issue featured articles on healthy aging, women’s heart health, and chronic obstructive pulmonary disease.

It is published quarterly and subscriptions are free. To subscribe or read NIH Medline Plus online, visit www.nlm.nih.gov/medlineplus/magazine.html.

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Editor’s Notes

Important Changes to WIN Orders

WIN is changing its order limits and fees, effective November 1, 2007.

The changes have been incorporated into the order form on the last page of WIN Notes and are described below. If you have any questions about ordering publications, please call 1–877–946–4627.

The new order limit is 100 total publications.

The new order fees are as follows:

Number of Items	Cost
1 – 25	FREE
26 – 50	$20
51 – 100*	$30

*New Maximum Quantity

In addition, reproducible masters will no longer be available to order individually. However, they will all be available on a new CD, and they will continue to be available on WIN’s website.

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Weight-control Information Network
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