WIN Notes

Winter 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:

Research Notes

1. Physicians Have Negative Attitudes Towards Obese Patients

2. Seizure Medication Undergoes First Test for Treatment of Obesity

3. Exercise Effective for Weight Management in Young Adults

4. Positive Thinking Helps Young Women Take Off Pounds

5. Dieters Who Exercise More Lose More Weight Over Long-term

NIDDK News

1. NIDDK Launches Longitudinal Assessment of Bariatric Surgery

Cyber Notes

Resource Notes

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Research Notes

Physicians Have Negative Attitudes Towards Obese Patients

People who are obese often avoid routine medical care in part because they fear being treated with disrespect by their health care providers. One new study confirms that many primary care physicians have negative attitudes toward obese patients. Another identifies descriptive terms used by providers—such as fatness or obesity—that may be offensive to these patients, effectively cutting off further discussion of weight management.

A team of researchers led by the University of Pennsylvania School of Medicine gathered questionnaires from 620 primary care physicians across the country about their attitudes toward obesity and its treatment. They found that, although negative physician attitudes have decreased slightly over the last two decades, more than 50 percent of the doctors surveyed viewed patients who are obese as awkward, unattractive, ugly, and noncompliant. One-third of them characterized these patients as weak-willed, sloppy, or lazy.

The researchers speculate that, because physicians view the causes of obesity as primarily behavioral (e.g., lack of physical activity, overeating), they may not be comfortable addressing these “non-medical” issues. In addition, many believe that obesity treatment is ineffective.

With nearly one-third of adult Americans considered obese, primary care physicians will be increasingly called on to play an active role in the management of obesity. A second study may help physicians overcome the first hurdle of obesity treatment—broaching the subject with patients. The researchers queried 324 obese women and men about the desirability of 11 terms their doctors might use to describe excess weight of 50 pounds or more.

The results were clear. All groups found the terms “fatness,” “excess fat,” and “obesity” to be undesirable. The women also rated the term “large size” as undesirable. The preferred term among all groups was “weight.”

The authors of both studies acknowledge the limitation of small sample sizes. Nevertheless, they agree that a respectful approach to helping patients manage their weight is an important first step in addressing the obesity epidemic.

The full report, “Primary care physicians’ attitudes about obesity and its treatment,” appears in the October 2003 issue of Obesity Research. “What’s in a name? Patients’ preferred terms for describing obesity” appears in the September 2003 issue.

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Seizure Medication Undergoes First Test for Treatment of Obesity

Two medications, sibutramine and orlistat, are currently approved for the treatment of obesity by the U.S. Food and Drug Administration (FDA). Researchers are now investigating a third—topiramate. The first clinical trial of topiramate in treating obesity shows promise, but investigators still need to determine optimal dosing and length of treatment.

Topiramate is FDA-approved for seizure disorders. Treatment of seizure patients with the drug often results in 18 months of weight loss, followed by a plateau—but exactly how topiramate promotes weight loss is unknown. Weight loss in patients taking topiramate led to the notion of treating obese patients, who are otherwise healthy, with the drug.

In the first clinical trial of topiramate, 385 adults with an average BMI of about 37 kg/m2 received one of four different doses of the drug or placebo for 6 months. In addition, all subjects took part in a 6-month behavioral modification weight management program. The majority of subjects were white, middle-aged women.

At the end of 6 months, participants receiving topiramate lost more weight than those receiving placebo. The two lower doses of topiramate produced the same weight loss, about 6 percent of body weight. The two higher doses produced losses of about 8 percent of body weight. Weight loss continued throughout the 6 months and did not reach a plateau.

Seventy-three participants reported adverse events while participating in the trial, resulting in a drop-out rate of 11 percent in the placebo group and 21 percent in the topiramate groups. The most common side effects were difficulty with memory, concentration, and attention; feeling a burning or prickling sensation; and drowsiness. Participants receiving lower doses of topiramate reported fewer adverse events. Study authors suggest that additional clinical trials focusing on the lower doses be undertaken.

The full report, “A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity,” appears in the June 2003 issue of Obesity Research.

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Exercise Effective for Weight Management in Young Adults

Adopting a regime of regular physical activity prevents weight gain in women and promotes weight loss in men. These are the findings of a recent study of overweight, previously sedentary, college students.

In this study, 41 participants completed a 16-month program of regular physical activity and were matched with 33 control subjects who remained sedentary. Both groups ate what they wanted to.

Students in the exercise group walked on treadmills for 45 minutes a day, 5 days a week. All exercise sessions were supervised. During sessions, research personnel used heart rate monitors to ensure that participants reached and maintained the target heart rate—75 percent of maximum. Men burned an average of 3,300 calories a week through physical activity and women burned an average of 2,200 calories.

After 16 months, men in the exercise group lost an average of 11 pounds. They also saw declines in visceral fat, subcutaneous fat, and total fat. Women who exercised stayed at the same weight. However, women in the sedentary group gained an average of 6 pounds during the study. Exercising women reduced visceral fat by 5 percent while the sedentary women had a 5 percent increase. Assessment of diet intake showed no significant differences between the active and sedentary groups in the number of calories they consumed over the course of the study.

Researchers conclude that exercise has a significant effect on body weight. They also suggest that an even greater amount of physical activity may be needed to promote weight loss in overweight women.

The full report, “Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women,” appears in the June 9, 2003 issue of the Archives of Internal Medicine.

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Positive Thinking Helps Young Women Take Off Pounds

When young women feel confident that they can lose weight, they take off more pounds. This is the conclusion of a recent study that tested the effects of self-efficacy on weight loss. Self-efficacy is a person’s confidence in her or his ability to do something, such as change eating patterns or lose weight.

In the study, 66 overweight college-age women participated in 12 weekly 1-hour weight management classes. Forty-eight of these students also took part in activities designed to promote self-efficacy for weight loss. Such activities included keeping a food diary, recording feelings, and keeping a weekly calendar that included grocery shopping and physical activity time. These women also chose a “life change” partner who would support their weight loss efforts in ways such as sharing workouts.

After 12 weeks, women who improved their self-efficacy adopted healthier eating habits and lost more weight. This is compared to students who felt less confident about their ability to change behaviors.

Study results confirm a link between increased self-efficacy and better weight loss outcomes. Health care providers may consider using behavioral techniques to promote self-efficacy among patients and clients to help them achieve desired weight losses.

The full report, “Using self-efficacy to predict weight loss among young adults,” appears in the October 2003 issue of the Journal of the American Dietetic Association.

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Dieters Who Exercise More Lose More Weight Over Long-Term

Commonly, weight-control programs advise people to exercise for 30 minutes a day on most days of the week. A recent study, however, concludes that telling people to do more physical activity improves long-term weight loss.

In this study, 202 overweight men and women took part in an 18-month behavior therapy weight loss program. All participants sought to reduce their calorie intake to 1,000 to 1,500 calories a day and limit fat to 20 percent of calories. Half of participants set a physical activity goal of burning 1,000 calories a week (walking about 30 minutes a day). The other half set a goal of burning 2,500 calories a week (walking more than 75 minutes a day).

To meet the higher physical activity goal, high exercise group members were given extra support. They could ask friends or family to take part in the study with them and meet with an exercise coach. They were also given $3 a week when they met the goal of burning 2,500 calories.

After 18 months, participants who exercised more took off more weight. High exercisers weighed, on average, almost 15 pounds less than when the study began. Those exercising less lost about 9 pounds. Both groups reporting eating similar amounts of calories and fat, suggesting that the differences in weight loss were not due to differences in food intake. The study authors concluded that meeting high physical activity goals can improve long-term weight loss.

Results also come with two cautions from the study authors. First, the risk for exercise-related injuries may go up with increasing levels of physical activity. Participants doing more physical activity reported more exercise-related injuries and illnesses. Second, even relatively heavy physical activity may not fully protect against weight regain. After 6 months of losing weight, all participants began to regain weight—although those doing more physical activity regained at a slower rate.

The full report, “Physical activity and weight loss: Does prescribing higher physical activity goals improve outcome?” appears in the October 2003 issue of the American Journal of Clinical Nutrition.

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NIDDK News

NIDDK Launches Longitudinal Assessment of Bariatric Surgery

With the rapid rise in the prevalence of extreme obesity (BMI ≥ 40 kg/m2) in the U.S., bariatric surgery has become increasingly common as a means of attaining substantial and sustained weight loss. Yet research into the effectiveness of this approach has been difficult due to a lack of standardization in definitions and surgical procedures. The National Institute on Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) recently established the Longitudinal Assessment of Bariatric Surgery (LABS) to provide infrastructure for and facilitate coordinated clinical, epidemiological, and behavioral research in bariatric surgery.

LABS, consisting of six clinical centers and a data coordinating center, will develop common clinical protocols and a bariatric surgery database. LABS seeks to increase understanding of the risks and benefits of bariatric surgery; standardize definitions and data collection instruments; and explore the mechanisms by which surgery affects factors such as obesity-related co-morbid conditions, energy expenditure, appetitive behaviors, and psychosocial factors. The LABS steering committee held its first meeting in November 2003.

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Cyber Notes

HealthierUS

This site at www.healthierus.gov is designed to help Americans live healthier lives by offering credible and accurate information on physical fitness, nutrition, prevention, and avoiding risky behaviors. Sponsored by the Executive Office of the President and the U.S. Department of Health and Human Services, it provides links to publications produced by a variety of Federal health agencies.

Fitday

Online diet and fitness journals are highlights of http://fitday.com, a source of free weight management tools that help users track daily physical activities, dietary intake, and weight loss goals. The site also offers a database of calorie and nutrition values for many foods, provides information on recommended dietary allowances (RDA), and includes a link to the Federal Dietary Guidelines for Americans.

Fitness Jumpsite

This non-commercial site at http://primusweb.com/fitnesspartner offers a “library” of information on Getting and Staying Active, Nutrition Made Easy, Managing Your Weight, Fitness Equipment, Lifestyle Focus, and Book Reviews. Each category includes articles written by weight-loss, nutrition, and fitness professionals. Many are adaptations or direct reprints of existing publications, including those from health-related Government agencies. The site also offers an activity calorie calculator for 158 different activities.

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Resource Notes

New Materials from the U.S. Department of Health and Human Services

Helping the Student with Diabetes Succeed: A Guide for School Personnel. 2003. This 78-page guide provides school personnel, parents, and students with a framework for managing diabetes effectively in the school setting. The guide helps to ensure that students with diabetes are medically safe and have access to all educational opportunities and activities. Developed by the U.S. Department of Health and Human Services’ (DHHS) National Diabetes Education Program (NDEP), the guide includes user-friendly tools, copier-ready action plans, a diabetes primer, and a review of school responsibilities under federal laws.

To obtain a copy of the guide, visit www.ndep.nih.gov/get-info/children.htm or call 1-800-438-5383.

Materials from Other Sources

Thin for Life: 10 Keys to Success from People Who Have Lost Weight and Kept It Off. Ann M. Fletcher, M.S., R.D., Houghton Mifflin, 2003. This revised and updated second-edition book includes science-based information on weight loss and maintenance, as well as well as anecdotes from interviews with over 200 people who have successfully lost weight and maintained that loss for an average of 11 years. It includes guidelines for individualizing weight-management plans, setting a comfortable body weight, cognitive restructuring, realistic exercise goals, a “non-dieting” option, and finding support.

It also includes recipes and resources for additional information. Thin for Life and two companion books, Eating Thin for Life: Food Secrets and Recipes from People Who Have Lost Weight and Kept It Off and Thin for Life Daybook: A Journal of Personal Progress, are available in bookstores.

Underage and Overweight: America’s Childhood Obesity Crisis—What Every Family Needs to Know. Frances M. Berg, Hatherleigh Press, 2003. This book addresses the causes and consequences of childhood obesity, and presents a 7-step plan for raising healthy-weight children. It encourages families to promote a more active lifestyle and provide healthier food choices, rather than prescribing diets and exercise regimens, in order to help children and teens develop healthy habits for life. Available in bookstores.

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.

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