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WIN Notes

Summer 2004

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 (HHS). 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:

WIN Travels the Country

Cyber Notes

Resource Notes

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Research Notes

Blood Pressure on the Rise in Children and Teens

A recent study comparing the change in blood pressure levels in children and adolescents between 1988 and 2000 shows that both systolic and diastolic blood pressure have increased. The study, conducted by Tulane University and the National Heart, Lung, and Blood Institute (NHLBI), suggests that at least part of this trend is due to higher levels of overweight among youngsters in the U.S.

The study compared blood pressure levels gathered in two National Health and Nutrition Examination Surveys (NHANES) for children and adolescents aged 8 to 17 years. In the 1988-94 survey, average systolic blood pressure was 104.6 mm Hg (millimeters of mercury) and average diastolic pressure was 58.4 mm Hg. In 1998-2000, average systolic pressure rose 1.4 mm Hg to 106 mm Hg, and diastolic rose 3.3 mm Hg to 61.7 mm Hg. Blood pressure increased among both boys and girls, and among all racial/ethnic groups studied.

Increased blood pressure levels in childhood strongly predict hypertension in young adulthood. According to Jeffery Cutler, M.D., Senior Advisor, NHLBI Division of Epidemiology and Clinical Applications and one of the study authors, “for each 1- to 2- millimeter of mercury rise in their systolic blood pressure, children face a 10 percent greater risk of hypertension as a young adult.” Hypertension is a risk factor for cardiovascular disease and stroke, and overweight contributes to hypertension.

From 1988 to 2000, the prevalence of overweight in children and adolescents grew from 11.7 percent to 16.3 percent. After adjusting for the increase in body mass index (BMI), the researchers found that a significant increase in blood pressure remained—1.0 mm Hg and 2.9 mm Hg for systolic and diastolic pressure respectively. They concluded that other factors, such as diet composition or physical activity, contribute to the rise in blood pressure among this group and recommended further research.

The full article, “Trends in Blood Pressure Among Children and Adolescents,” appears in JAMA (2004;291:17, 2107-13).

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Weight-loss Dieting Lowers Inflammation, Could Lower Disease Risk

A growing number of research studies point to chronic inflammation in the body as a risk factor for several diseases, including heart disease, stroke, and diabetes, and for death. A recent study looked at the effects of weight-loss dieting and physical activity on inflammation. It found that eating to lose weight decreased inflammation.

Inflammation can be detected by measuring levels of certain substances in the blood. Researchers measured levels of these inflammatory biomarkers in subjects before, during, and after study participation. Subjects included 316 overweight or obese sedentary men and women over the age of 60. All subjects had osteoarthritis of the knee, which confirmed that inflammation was present in their bodies.

Men and women participating in the study were randomly assigned to one of four treatment groups for 18 months. The dietary weight-loss group tried to achieve and maintain a weight loss of 5 percent of body weight. Subjects were educated about how to eat fewer calories through a balanced, low-fat, nutritious diet. Help with goal setting and problem solving was also provided.

The exercise group worked out 3 days a week for 45 minutes and did a combination of aerobic and resistance training.

Participants in the dietary weight-loss and exercise group received the same nutrition education and support as subjects in the weight-loss group. They also participated in aerobic and resistance physical activities 3 days a week.

The control group met monthly to discuss topics relating to general health, including osteoarthritis, obesity, and physical activity.

Results showed that eating fewer calories had the greatest effect on lowering levels of inflammatory biomarkers in the body. Subjects in the weight-loss group showed decreased concentrations of c-reactive protein, interleukin 6, and soluble tumor necrosis factor alpha receptor 1. Even when weight loss was not achieved, eating fewer calories still lowered levels of some biomarkers.

Contrary to several earlier studies, results showed that exercise did not have a significant effect on inflammatory biomarkers, and working out did not enhance the effects that weight loss dieting had on inflammation. The study authors recommend further research in this area.

The full report, “Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial” appears in the American Journal of Clinical Nutrition (2004;79:544-51).

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Overweight Kids Lose More Weight When Parents Do Too

When families enroll in a weight-control treatment program, parent weight loss predicts child weight loss. Kids not only lose weight when parents do, they lose more when their parents lose more.

This finding is the result of analyzing body mass index (BMI) changes in parents and children participating in one of three family-based behavioral weight-control studies. One hundred forty-two obese children (defined in this study as BMI greater than 85 th percentile) aged 8 to 12 years old participated in the study, along with at least one parent who was not necessarily obese but whose BMI was above the 70 th percentile for adults. Most participating parents were mothers (81 percent) and most families (95 percent) were white.

Parents were asked to adopt healthy eating and physical activity habits, and to change their home environments.

Dietary changes were based on the Traffic Light Diet. This eating plan categorizes foods based on their nutritional value as “green,” “yellow,” or “red.” Green foods are low in fat and high in nutrients; eating green foods was encouraged. Yellow foods have between 2 and 5 grams of fat per serving and some nutritional value, and should be eaten in moderation. Red foods have 5 or more grams of fat per serving, lots of sugar, and little nutritional value. Families were encouraged to decrease the red foods they eat.

All families were provided with a physical activity program. In addition, families were encouraged to alter home environments to support healthy eating and physical activity habits. For example, families were asked to keep fewer red foods in the house and to have green foods readily available.

Parent and child BMI measures were taken at the beginning of the study period, and after 6, 12, and 24 months. After 2 years, results of BMI analysis showed that the amount of weight a parent lost predicted the amount of weight her or his child lost. Parents who lost the most weight had kids who lost the most weight.

Study authors reason that parents who are more successful at weight loss have made larger changes to eating and physical habits and created a healthier home environment. In addition, these parents may model more healthy behaviors.

The full report, “Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment” appears in the Archives of Pediatric and Adolescent Medicine (2004;158:342-347).

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Liposuction Does Not Lower Risk for Heart Disease

Liposuction may help to get rid of some body fat, but it does not improve health like losing weight does. This is the conclusion of a study that looked at liposuction’s effects on factors that measure risk for heart disease.

The study looked at 15 middle-aged women with obesity centered around their waists who underwent liposuction. Abdominal obesity is associated with insulin resistance, which is a risk factor for heart disease. Seven of the women had type 2 diabetes with severe insulin resistance; the other eight had normal glucose tolerance and moderate insulin resistance.

Measures of insulin sensitivity in muscle, liver, and fat tissue were taken before surgery and 10 to 12 weeks after liposuction. Other factors related to heart disease were also measured, including blood pressure, blood sugar, blood cholesterol levels, and blood serum markers of inflammation.

Although the women lost approximately 21 pounds of body fat, about the same amount that would accompany a weight loss of 12 percent of body weight, their insulin sensitivity did not change. Other measures for heart disease risk did not improve either.

Normally, when individuals lose 12 percent of their body weights through weight loss, they improve their insulin sensitivity and lower their risk for heart disease considerably. Such weight loss methods include eating less, using weight loss medication, or undergoing gastrointestinal (bariatric) surgery.

The study authors note that weight loss decreases fat in the organs and muscles, as well as fat-cell size and the rate of release of fatty acids from fat tissue. Liposuction, on the other hand, only removes fat under the skin. The authors suggest that taking in fewer calories than are used creates changes in the activities of tissues, cells, and substances in the body, which in turn can benefit health. Liposuction, the most common cosmetic surgery done in the U.S., does not convey these benefits.

The full report, “Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease” appears in The New England Journal of Medicine (2004;350:2549-2557).

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Link Between Polycystic Ovary Syndrome and Obesity Involves Insulin

Polycystic ovary syndrome (PCOS) is a common health problem that affects 5 to 10 percent of women of reproductive age. How the disorder starts and progresses are not completely understood. Half of women with PCOS are obese, and obesity makes some PCOS symptoms, including infertility, more severe. Scientists are working to uncover the links between obesity and PCOS. The strongest link seems to involve the hormone insulin.

Women who have PCOS do not process insulin efficiently (insulin resistance) and have high insulin levels in their blood (hyperinsulinemia). Obese women with PCOS usually have central obesity (apple shape), which carries a higher risk for diabetes and insulin resistance than peripheral obesity. When a woman with PCOS is obese, excess weight seems to worsen her problems with insulin resistance and hyperinsulinemia.

Hyperinsulinemia affects the way the ovaries work. It makes the ovaries grow and form cysts. Hyperinsulinemia also stimulates the ovaries to make more male hormones (testosterone and androstenedione) and lowers the liver’s ability to clear these hormones from the blood. Higher blood levels of male hormones contribute to PCOS symptoms including acne, male-pattern hair growth (on face or body) or balding, and lack of ovulation.

Research has shown promise in helping women with PCOS through treatments that have been used in individuals with diabetes or insulin resistance. Weight loss in obese women with PCOS has been shown to lower insulin levels, improve insulin sensitivity, and help normalize hormone levels and menstrual cycles. Treatment with the diabetes drug metformin has shown similar effects. Physical activity, even without weight loss, also shows some benefits.

The full report, “Pathogenesis of polycystic ovary syndrome: What is the role of obesity?” appears in Metabolism (2004;53:358-376).

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New Obesity Statistics Show U.S. Weights Remain High

The U.S. obesity crisis is not going away. New numbers from the Government’s National Health and Nutrition Examination Survey (NHANES) confirm that overweight and obesity are still a major public health concern.

According to 1999 to 2002 data, 65.1 percent of adults aged 20 or older were overweight or obese. The rate of obesity was 30.4 percent, and 4.9 percent of U.S. adults were extremely obese. Overweight is defined as having a body mass index (BMI) of 25 or more. Obese is having a BMI of 30 or more. Having a BMI of 40 or more is extreme obesity.

In 2001 and 2002, 4,390 adults and 4,258 children had their heights and weights measured as part of the NHANES survey. These measures remained the same as measures taken of U.S. adults and children in 1999 and 2000. Looking at measures from all 4 years (1999 to 2002) together gives a more accurate estimate of the number of overweight and obese people in the U.S.

The 1999 to 2002 numbers show that rates of obesity were highest for non-Hispanic black women – 49 percent were obese. Obesity rates were lowest for non-Hispanic white women (30.7 percent). Rates for Mexican American women were in-between (38.4 percent).

Obesity rates were higher for women than for men. Men of different racial/ethnic groups showed no differences in rates of overweight and obesity.

Among children 6 to 9 years old, 31 percent were at risk for overweight or were overweight, and 16 percent were overweight. Children’s rates of at risk for becoming overweight or being overweight (BMI at 85 th percentile or higher on growth chart) were lowest for non-Hispanic white girls (27 percent). Mexican American boys had the highest rates of overweight (BMI at 95 th percentile or higher).

The full report, “Prevalence of overweight and obesity among U.S. children, adolescents, and adults, 1999-2002,” appears in the Journal of the American Medical Association (2004;291:2847-2850).

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Program Notes

Sisters Together Expands Locally and Nationally

In 2001, WIN launched the national Sisters Together: Move More, Eat Better initiative to encourage Black women to adopt healthier eating habits and become more physically active. Over 300 women attended the kickoff event in Washington, DC, a health and fitness fair that included a 1.8-mile walk led by fitness expert Donna Richardson.

Since that time, Sisters Together has actively promoted women's health in the Washington, DC, metropolitan area and communities across the country. Sisters Together participates in national and local health fairs and provides technical assistance in the form of information and materials to a wide variety of organizations and individuals. These include bookstores, public libraries, universities, high schools, hospitals, hair salons, public health departments, YWCAs, sororities, community health care providers, and others who want to spread the Sisters Together message through their own programs.

One such spin-off was the 12-week Women’s Health and Wellness program sponsored by the YWCA of Greensboro, North Carolina. Launched in October 2003, the program began with seven participating sites, including the University of North Carolina’s Center of Women’s Health and Wellness, Bennett College, United Way Greensboro Chapter, and local community partners. Program components ranged from indoor classes in the winter to outdoor activities during the summer months, and included such activities as aerobics, nutrition seminars, and cooking classes for women with diabetes.

The YWCA started a second program in February 2004 at three additional sites. Nicole Barker, Women’s Health Wellness program coordinator, noted that as a result of strong interest among community members and local leaders, the number of people wanting to participate in or develop a program based on Sisters Together continues to grow. A new site joined the YWCA’s efforts in April 2004 and more sites will be added throughout the summer.

Visit the Sisters Together website at http://win.niddk.nih.gov/sisters/index.htm to view our brochures, or order them from WIN at 1-877-946-4627.

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NIH News

Strategic Plan Sets Obesity Research Agenda

More than 65 percent of adults in the U.S. are overweight. Thirty-one percent of adults – over 61 million people – are obese. Excess weight puts people at risk for many health problems, including diabetes, heart disease, high blood pressure, and some types of cancer. The National Institutes of Health (NIH) is working to stop the growing obesity epidemic. It now has a blueprint for helping to address this major public health problem, the Strategic Plan for NIH Obesity Research.

The Strategic Plan looks toward the future. It sets short-, intermediate-, and long-term goals for four research themes. These themes are:

Preventing and treating obesity through lifestyle modification, such as promoting healthy eating and physical activity habits
Preventing and treating obesity through drugs, surgery, or other medical means
Breaking the link between obesity and health problems, such as learning how hormones released by fat cells cause high blood pressure
Making sure certain issues are given focus across all research themes. These issues include improving technology, creating interdisciplinary research teams, and educating the public about new research discoveries. Another focus issue is looking at how obesity affects different groups of people such as children, racial/ethnic groups, women, older adults, those with disabilities, and those living in poverty.

As goals are reached and new discoveries are made, new goals will be set. The Strategic Plan is meant to be an ever-changing document and will be updated as more is learned.

NIH obesity experts developed the Strategic Plan with input from non-Government authorities. Meetings and workshops allowed NIH staff to get planning advice from researchers in the field. Additionally, more than 70 individuals from outside the Government commented on a draft of the Strategic Plan. These individuals included scientists, health professionals, and leaders of health-related groups.

The final Strategic Plan for NIH Obesity Research will be available later this year. A draft form is currently available on the NIH Obesity Research Task Force website, www.obesityresearch.nih.gov

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Small Steps. Big Rewards. Multicultural Campaign Leaps Forward

Taking action against the diabetes epidemic, the National Institutes of Health (NIH) National Diabetes Education Program (NDEP) developed the first nationwide multicultural diabetes prevention campaign.

Small Steps. Big Rewards. Prevent Type 2 Diabetes. takes the positive messages of manageable lifestyle choices directly to Americans most affected by diabetes: African Americans, Hispanic and Latino Americans, Native Americans and Alaska Natives, Asian Americans and Pacific Islanders, and older adults.

The campaign targets people with pre-diabetes—those who have higher than normal blood glucose levels but who are not yet diabetic. The message is simple. Losing a modest amount of weight—for example, 10-15 pounds for a 200-pound person—can help prevent type 2 diabetes. This can be accomplished by building up to 30 minutes of physical activity a day, 5 days a week, and following a low-calorie, low-fat eating plan. Preventing type 2 diabetes lowers the risks of heart disease, stroke, blindness, kidney failure, and amputations.

Educating the public about these small steps with big rewards calls for a campaign that carries positive messages across cultures through the following components:

Public service advertising for television, radio, and print increase awareness. Radio and print ads are tailored for high-risk groups.
Publicity and events at the local level promote community-based weight loss and lifestyle change programs.
Health care provider “GAME PLAN” toolkit provides the latest research findings and practical tips communicated through information, posters, and booklets to use with patients.
Consumer “GAME PLAN” includes specially tailored booklets that give people at risk what they need to start and stick with a weight loss program. Motivational tip sheets are tailored toward older adults and ethnically diverse audiences (in English, Spanish, and 15 Asian and Pacific Islander languages).
Speaker’s Kit is a slide-script presentation that reviews the key findings from the Diabetes Prevention Program and provides an overview of Small Steps. Big Rewards.

All program components are available on NDEP’S website. Take a step: Go to www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htm.

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NIEHS Holds Conference on the “Built Environment”

How is overweight and obesity related to the presence of sidewalks in communities? Does the proximity of parks and grocery stores to people’s homes affect their waistlines? Do schools contribute to adolescent obesity?

These are just some of the questions posed at “Obesity and the Built Environment: Improving Public Health Through Community Design,” a May 2004 conference sponsored by the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH). Researchers, health professionals, city planners, and others came together to develop research and practice agendas to examine the relationship between the built environment and obesity and to foster interagency coordination.

The built environment is defined as all of the buildings, spaces, and products created or modified by people. Examples include buildings (housing, schools, workplaces), land use (industrial or residential), public resources (parks, museums), zoning regulations, and transportation systems.

With more than 64 percent of Americans overweight or obese and inactivity a contributor to weight status, finding ways to better understand how to create communities and workplaces that promote health and well-being is essential. Three plenary sessions focused on schools and children, communities and families, and employers and employees, respectively. Breakout groups discussed current science, developing a research agenda, and intervention strategies.

Suggested interventions range from small changes, such as encouraging employees to take lunchtime walks, to broader community planning efforts, such as building housing and parks in close proximity so residents have easier access to outdoor activities.

These are among the many ideas and issues generated during the conference that will help shape future research into this new field. Full meeting proceedings will be available at www.niehs.nih.gov by late summer.

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HHS News

Building a Healthier US

Health providers, educators, and policymakers gathered with community and industry leaders in April for the 2nd National Steps to a HealthierUS Summit to focus on four key prevention objectives: more physical activity, healthier eating, increased use of preventive screenings, and healthy choices concerning smoking, drugs, and safety.

Building on the growing body of research that shows small simple steps can prevent or control many chronic diseases, the U.S. Department of Health and Human Services (HHS) Steps to a HealthierUS initiative seeks to reach Americans through action steps that target specific issues such as overweight and obesity, diabetes, and health literacy. Prevention: A Blueprint for Action, unveiled by HHS Secretary Tommy G. Thompson at the summit, outlines steps for individuals and families, communities, schools, employers, insurers, educators, and health care providers.

Action steps for combating overweight and obesity include initiatives targeting specific populations such as breastfeeding mothers, children and adolescents, women, minorities, the elderly, and the disabled. Researchers are studying the effectiveness of enhancing food labels to display calorie counts and servings, interventions to address the needs of special populations, and risks associated with weight loss in the elderly, who are at high risk for osteoporosis.

These action steps are part of what Secretary Thompson calls “a bold shift in our approach to the health of our citizens, moving us from a disease care system to a health care system.”

For more information on building a HealthierUS, go to www.healthierus.gov/steps. The Blueprint for Action is available at http://aspe.hhs.gov/health/blueprint.

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Calories Count!

Last August, Mark B. McClellan, M.D., Ph.D., former Commissioner of the U.S. Food and Drug Administration (FDA), charged his newly formed Obesity Working Group with preparing a report of recommended actions to help address the Nation’s obesity problem from FDA’s perspective. “Calories Count,” released in March, focuses on the simple premise that “calories in” must be balanced with “calories out” to control weight.

“This new report highlights FDA’s overall strategy for getting consumers accurate, helpful information that allows them to make wise food choices at home, at supermarkets, and in restaurants,” said HHS Secretary Tommy G. Thompson. To accomplish this, the report recommends revising food labels to make serving size, calorie, and nutrient information simpler and more accurate. It endorses increased enforcement of accurate serving size labeling and against weight-loss products that have false or misleading claims. The report also recommends consumer education through partnerships with private and public sector organizations to relay the message that calories count.

Other recommendations include: encouraging the restaurant industry to voluntarily provide nutrition information to consumers; continuing to explore medical interventions for obese and extremely obese individuals; and pursuing research into the development of healthy foods and into consumer behavior, motivation, and weight-management decisions.

The full report is available at www.cfsan.fda.gov/~dms/owg-toc.html.

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WIN Travels the Country

WIN will be exhibiting at the following professional conferences this summer and fall:

American Association of Diabetes Educators
August 11-14, 2004
Indianapolis, IN

American Society of Bariatric Physicians
September 28-October 2, 2004
Orlando, FL

American Dietetic Association
October 2-5, 2004
Anaheim, CA

American Public Health Association
November 6-10, 2004
Washington, DC

Stop by to talk with our staff and pick up free copies of our publications.

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Cyber Notes

GoGirlGo!

The goal of the 3-year GoGirlGo! campaign, sponsored by the Women’s Sports Foundation, is to improve the lives of girls ages 8-18 through physical activity. Its website at www.gogirlgo.com has a section for girls, one for adults, and a third for coaches and group leaders. The girls’ section offers motivation for physical activity through message boards, encouraging comments from girl athletes, quizzes, links to other sites, and more. The section for adults explains the importance of physical activity for girls’ health and self-esteem and encourages adults to help a girl get active. The coach and leader section includes a guide for conducting a 12-week program with girls that addresses topics ranging from body image to values to nutrition.

Child Care Nutrition Resource System

The website of the Child Care Nutrition Resource System at www.nal.usda.gov/childcare provides child care providers with recipes, resources, and information on preparing nutritious meals. Sponsored by the U.S. Department of Agriculture (USDA), National Agricultural Library, and University of Maryland, it includes information on food safety and offers a section for providers who participate in USDA’s Child and Adult Care Food Program. Links to sites addressing a variety of children’s heath issues round out the site.

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Resource Notes

Updated WIN Publications

WIN has updated the following fact sheets and brochures to incorporate the latest research and development in the field:

Active at Any Size

Helping Your Overweight Child

Sisters Together: Celebrate the Beauty of Youth

Sisters Together: Energize Yourself and Your Family

Weight Loss for Life

Weight-loss and Nutrition Myths

Call us at 1-877-946-4627 to order copies or view WIN’s publications online at www.win.niddk.nih.gov.

Materials from Other Organizations

Managing Obesity: A Clinical Guide,Gary D. Foster, Ph.D, Cathy A. Nonas, M.S., R.D., C.D.E., eds. American Dietetic Association, 2004. Written primarily for non-physician clinicians, this 247-page book offers science-based, peer-reviewed clinical guidelines and practical applications for treating overweight and obese patients using a team approach. Topics include assessment, medical monitoring, diets, pharmacotherapy, surgery, physical activity, behavior modification, and maintenance of weight loss. It includes a list of resources for patients and providers. Available at www.eatright.org for $58.50 or $45.00 for ADA members.

Childhood and Adolescent Overweight: The Health Professional’s Guide to Identification, Treatment and Prevention, Mary Catherine Mullen, M.S., R.D., Jodie Shield, M.Ed., R.D. American Dietetic Association, 2004. This 217-page book provides science-based, peer-reviewed information on the assessment and management of childhood and adolescent overweight, including counseling and behavioral change strategies. It includes tools for health professionals such as growth charts, assessment and care plan forms, and sample food and activity diaries. Available at www.eatright.org for $58.50 or $45.00 for ADA members.

Editor's Note

Please send questions or comments, including information you would like to see included in future issues of WIN Notes, to Lorrie Fritz, Editor, Weight-control Information Network, 1 WIN Way, Bethesda, MD 20892-3665; telephone 202-828-1025 or toll-free 1-877-946-4627; fax 202-828-1028; email: WIN@info.niddk.nih.gov. Educational Services, Inc., operates WIN for the Department of Health and Human Services, Public Health Service, National Institute of Diabetes and Digestive and Kidney Diseases under Contract No. N01-DK-0-2402.

WIN publications are not under copyright restrictions. Readers may make unlimited copies. To view WIN publications, visit our website at www.win.niddk.nih.gov.