Small Changes in Dietary Sugar and Physical Activity as an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study

OBJECTIVE:To estimate lifetime cost effectiveness of lifestyle interventions to treat overweight and obese children, from the UK National Health Service perspective. DESIGN: An adaptation of the National Heart Forum economic model to predict lifetime health service costs and outcomes of lifestyle interventions on obesity-related diseases. SETTING: Hospital or community-based weight-management programmes. POPULATION: Hypothetical cohorts of overweight or obese children based on body mass data from the National Child Measurement Programme. INTERVENTIONS: Lifestyle interventions that have been compared with no or minimal intervention in randomized controlled trials (RCTs). MAIN OUTCOME MEASURES: Reduction in body mass index (BMI) standard deviation score (SDS), intervention resources/costs, lifetime treatment costs, obesity-related diseases and cost per life year gained. RESULTS: Ten RCTs were identified by our search strategy. The median effect of interventions versus control from these 10 RCTs was a difference in BMI SDS of À0.13 at 12 months, but the range in effects among interventions was broad (0.04 to À0.60). Indicative costs per child of these interventions ranged from d108 to d662. For obese children aged 10 --11 years, an intervention that resulted in a median reduction in BMI SDS at 12 months at a moderate cost of d400 increased life expectancy by 0.19 years and intervention costs were offset by subsequent undiscounted savings in treatment costs (net saving of d110 per child), though this saving did not emerge until the sixth or seventh decade of life. The discounted cost per life year gained was d13 589. Results were broadly similar for interventions aimed at children aged 4 --5 years and which targeted both obese and overweight children. For more costly interventions, savings were less likely. CONCLUSION: Interventions to treat childhood obesity are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life.

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“…28,32 For the group-based interventions, planned contact time with professionals ranged from 10 (ref. 24) to 128 (ref.…”

Section: Resultsmentioning

confidence: 99%

“…The smallest favourable effect size observed was À0.03. 28 Therefore, in our model we evaluated interventions with minimal (À0.03), median (À0.13) and maximal (À0.60) reductions in BMI SDS.…”

Section: Resultsmentioning

confidence: 99%

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

et al. 2012

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“…in contrast to studies showing an increase in food intake to maintain energy balance with the addition of exercise, a study has suggested that adding small amounts of activity to daily lifestyles reduces the weight gain that many people in the uS are experiencing year after year. 30 in summary, there are clear benefits associated with increasing physical activity among the sedentary. a healthy weight is best maintained with a relatively high level of physical activity and a high energy intake.…”

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confidence: 94%

The Importance of Energy Balance

Hill

Wyatt

Peters

2010

European Endocrinology

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Globally, bodyweight and obesity are rising in both the developing and developed world. To maintain a stable bodyweight, energy intake must, over time, exactly equal energy expenditure, a state known as energy balance. an understanding of the physiologic control of energy balance may be useful for designing interventions to tackle the obesity epidemic worldwide. obesity occurs when the body's energy balance is positive (i.e. when energy intake exceeds energy expenditure). human physiology is biased towards maintaining energy balance at high levels of energy intake and expenditure. as a result, strategies to combat obesity should include a focus on increasing physical activity along with strategies for modifying food intake. an understanding of energy balance leads to the conclusion that prevention of weight gain should be easier than treatment of obesity. components of energy balance are interdependent, and weight loss requires major behaviour changes, which trigger compensatory decreases in energy expenditure that facilitate weight regain. Prevention of weight gain can be accomplished by smaller behaviour changes. in addition to being easier to sustain than larger behaviour changes, smaller ones produce less compensation by the energy balance regulatory system. it has been estimated that relatively small changes in energy intake and expenditure totaling 100 kcal per day could arrest weight gain in most people. interventions that advocate small changes have shown promising levels of success. KeywordsEnergy balance, obesity, physical activity The Concept of Energy BalanceThe concept of energy balance is based on the fundamental thermodynamic principle that energy cannot be destroyed, and can only be gained, lost, or stored by an organism. Energy balance is defined as the state achieved when the energy intake equals energy expenditure. This concept may be used to demonstrate how bodyweight will change over time in response to changes in energy intake and expenditure. When the body is in energy balance, bodyweight is stable. 9,10 humans take in energy through the intake of food and drink, and expend energy through the resting metabolic rate (RMR)-the thermic effect (TEF) of food and physical activity. The RMR is the energy expenditure required for maintaining normal body functions and homeostasis. The RMR is proportional to body mass, in particular fat-free mass. TEF refers to the energy required to absorb, digest, and metabolise the food consumed and typically accounts for 8-10 % of daily energy expenditure. The energy expended due to physical activity (EEact) accounts for energy that is expended in addition to the RMR and TEF, including voluntary exercise, shivering, postural control, and voluntary movement. it is calculated by multiplying the energy expenditure of an activity by the time spent performing it, and is the most variable component of energy expenditure. 10 The more sedentary the individual is, the lower the effect of physical activity. This may be as low as 100 calories per day, whereas elit...

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“…Efforts to move US adults toward a more Mediterranean diet pattern to improve health outcomes are vital, but perhaps smaller modifications that lead to better dietary patterns gradually should also be considered. Previous interventions to treat obesity and prevent weight gain have demonstrated that small, incremental changes to lifestyle behaviors can be effective, sustainable, and can lead to broader changes over time [15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of Walnut and Extra Virgin Olive Oil Supplementation in Older Adults

Vitolins¹,

Blackwell²,

Williamson³

et al. 2017

IJFNS

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Researchers in Spain provided randomized, controlled trial evidence that adding extra virgin olive oil (EVOO) and nuts to diets of older adults lowered cardiovascular disease risk. Supplementing these foods may represent a simple and straightforward approach to favourable dietary change with potential for dissemination to the broader public. This was an 8-week feasibility trial in which all participants were asked to supplement their ad libitum diets with both walnuts and EVOO to determine their interest in participating and to assess retention and adherence once enrolled. Inclusion criteria were broad: Adults ≥ 55 years old treated for hypertension with medication; exclusions included walnuts/EVOO allergies, homebound or diagnosis of dementia. Recruitment was assessed as number of weeks to accrue 25 participants. Adherence was assessed by participant self-report using a daily diary. Blood pressure (BP), body weight, and HDL cholesterol were measured to estimate the variability of outcomes. Results: Twenty-seven participants were recruited in 2 ½ weeks; 26 of the 27 participants remained in the study for a retention rate of 96% (95% CI: 78% -100%). Of 216 possible diaries, 185 were returned (86%). On average, weight increased over 8 weeks by 0.8 pounds. Mean systolic BP dropped by 0.25 mmHg while mean diastolic BP decreased by 1.0 mmHg. Mean HDL increased by 1.96 mg/dL. A full scale walnut/EVOO trial in older adults with hypertension seems realistic given our high rates of recruitment, retention, and adherence, coupled with minimal weight gain and favorable trends in BP and HDL.

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Small Changes in Dietary Sugar and Physical Activity as an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study

Abstract: The small-changes approach advocated by America on the Move could be useful for addressing childhood obesity by preventing excess weight gain in families.

Cited by 147 publications

References 24 publications

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

The Importance of Energy Balance

The Feasibility of Walnut and Extra Virgin Olive Oil Supplementation in Older Adults

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