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An introduction to a weight loss program

Table Abstract Despite decades of efficacy-based research on weight loss interventions, the obesity epidemic in the United States persists, especially in underserved populations.

We attribute the lack of progress in reducing overweight and obesity to the current system, which favors efficacy-based studies of weight loss programs, that is, those that are proven in randomized controlled trials RCTs.

We suggest a parallel approach that includes studies that investigate existing community-based weight loss programs to augment the current system in order to have a larger effect on the obesity epidemic. The purpose of this article is twofold: RE-AIM is used to evaluate interventions intended to have an impact on public health 5 and suggests that efficacious and effective programs will have minimal real-world impact if they an introduction to a weight loss program poor reach into target populations, inadequate adoption in different settings, insufficient implementation because of poor program fidelity, or minimal maintenance because of lack of sustainability.

We used examples of efficacy-based approaches and community-based approaches. Jenny Craig, Weight Watchers, and TOPS, are examples of national commercial or nonprofit weight loss programs that could help achieve a population-level impact on obesity Table. Because weight loss and physical activity are essential components of all weight loss programs, we included NDPP in our evaluation.

Unlike the DPP trial, which consisted of a one-on-one intervention with participants, NDPP is administered in group settings and requires that participants meet in weekly sessions for the first 6 months and then in monthly sessions for the next 6 months.

NDPP comprises several components, including training and a registry. The training is coordinated through the Diabetes and Technical Assistance Center at Emory University and includes in-person sessions, webinars, and conference calls. Payment for the program is sometimes provided through partnerships with insurance providers, community organizations, 6 and government agencies so that participants do not necessarily bear the costs.

Jenny Craig Jenny Craig is a national commercial weight loss program that provides prepackaged meals to participants. The average daily calorie allowance is based on a daily deficit of to calories. The program recommends minutes of activity per week for weight loss and to minutes of activity per week for weight maintenance.

Fitness & Weight Loss

Participants get individual weekly sessions with a Jenny Craig counselor, either in person or by telephone. The program includes online tools for monitoring weight, activity, and calories L. Weight Watchers Weight Watchers is a national commercial weight loss program that uses a proprietary PointsPlus system, which assigns point values to foods.

Values are based on the fat, carbohydrate, fiber, and protein content per serving. Participants are allowed a specific number of PointsPlus per day based on their height, weight, sex, and age. The new system uses the calories, saturated fat, sugar, and protein content of foods to assign a SmartPoints value to foods, and participants have a daily and weekly SmartPoints allowance.

Participants choose their goal weight. However, they can only attain lifetime status if their an introduction to a weight loss program weight corresponds to a body mass index BMI in the normal range Weight Watchers offers 3 membership options, which all include online digital tools and applications: Weight Watchers also recommends increased physical activity. The initial recommendation is that participants eat 20 to 25 calories per kilogram of actual body weight or an adjusted body weight while they are in the weight loss phase.

TOPS recommends minutes of moderate-intensity physical activity per week and requires that members consult a health care provider to determine a goal weight. When a participant reaches her goal weight, she becomes a KOPS Keep Off Pounds Sensibly member, which is the maintenance portion of the program, and she continues to attend weekly meetings.

Reach Reach is the number or proportion of people who are willing and able to participate in an intervention 7. The initial reach of efficacy-based weight loss programs is limited because minimal infrastructure is available to support dissemination.

Time to RE-AIM: Why Community Weight Loss Programs Should Be Included in Academic Obesity Research

For example, an efficacious weight loss intervention at one institution may not be available to someone who lives miles away, and it can take years to develop the infrastructure necessary for widespread dissemination. Although the NDPP currently has programs listed on its website, only 41 have achieved full recognition as accredited programs; the rest are awaiting full recognition 8.

National commercial and nonprofit programs may have a more extensive reach. For example, Jenny Craig was founded in and currently has locations in the United States 9 ; TOPS was founded in and has 6, chapters in the United States oral and written communications, M. According to its website, Weight Watchers has more than 36, meetings worldwide each week, but it does not provide information about countries, states, cities, or locations.

  • Efficacy is usually tested under ideal conditions in an RCT with strict protocols and rigorous inclusion and exclusion criteria to determine if an intervention has achieved the intended outcomes, with meticulous instructions for intervention delivery by trained study personnel, and with outcome measurements at study visits for which participants may be paid;
  • Our doctor, Francis J.

An introduction to a weight loss program, all 3 programs have online tools, and Jenny Craig and Weight Watchers offer options for telephone counseling and coaching. Because infrastructure already exists in these community-based programs, their reach can be broader than new efficacy-based programs, and thus community-based programs can have a broader impact. Efficacy is usually tested under ideal conditions in an RCT with strict protocols and rigorous inclusion and exclusion criteria to determine if an intervention has achieved the intended outcomes, with meticulous instructions for intervention delivery by trained study personnel, and with outcome measurements at study visits for which participants may be paid.

Effectiveness is usually tested in real-world conditions, which may involve all eligible patients in a clinic receiving a modified version of an intervention which may have been tested in an RCT delivered by a medical assistant with follow up at routine clinic visits.

Efficacy trials tend to have better outcomes than effectiveness trials. The efficacy of RCT-based weight loss programs may be impressive. In the intensive lifestyle intervention of the DPP, adults with prediabetes were given a week curriculum delivered in one-on-one sessions with subsequent monthly individual and group sessions. NDPP is a modification of the DPP to make the program accessible to wider audiences by changing to a group format, adding facilitators with less formal training, and tailoring the program for specific groups Adoption Adoption is the extent to which representative groups eg, clinics, community groups or individuals undertake an intervention 7.

Efficacy RCT-based studies typically occur in settings that are not necessarily designed for broad population uptake. However, if interventions that were originally studied as efficacy-based RCTs are not widely adopted, they cannot have a population-level an introduction to a weight loss program on obesity. Furthermore, the more training or equipment that is required to administer a program, the more difficult widespread adoption will be. Accordingly, it is difficult for low-resource groups, such as rural communities, to adopt efficacy RCT-based interventions delivered by specialists eg, dieticians, nutritionists or interventions that require resources such as costly fitness equipment.

NDPP training is coordinated through the Diabetes and Technical Assistance Center at Emory University and consists of in-person sessions, webinars, and conference calls. Adoption of commercial programs varies because of geographic limitations, and such programs may not be available in low-income or rural areas that cannot sustain a commercial endeavor. TOPS is a peer-led program that does not require special expertise for its leaders; therefore, it has the potential to be adopted in low-resource settings.

Implementation The implementation of an intervention is the degree to which it is delivered as originally intended, which includes consistency of delivery, time, and cost 7.

Fitness & Weight Loss

Consistency is also called program fidelity. The fidelity of efficacy-based weight loss interventions delivered in one-on-one or group settings may be high because of the quality of training the facilitators receive. However, these interventions may be impractical to deliver at community sites because of high costs.

Jenny Craig is delivered one-on-one, so it can be tailored for each individual, but the main components of the program may be delivered consistently to all participants. Program costs, but not meal replacements, are sometimes covered by insurance.

Fitness & Weight Loss

The Weight Watchers program is conducted by trained facilitators, and the same material is presented at all of its locations around the country each week; therefore, the fidelity is likely to be high. It can cost hundreds of dollars per year per participant, a portion of which may be covered by health insurance. TOPS is also designed for group settings.

  • Although the NDPP currently has programs listed on its website, only 41 have achieved full recognition as accredited programs; the rest are awaiting full recognition 8;
  • The program includes online tools for monitoring weight, activity, and calories L;
  • Am J Prev Med ;49 2:

TOPS allows individual chapters to adapt the intervention to fit their needs by choosing from more than available programs. Each program has instructions about how it should be presented, but the quality of program delivery is not assessed. Maintenance Maintenance is the sustainability of an intervention at individual and program levels 7.

In weight loss interventions, the longer people remain in treatment, the longer they maintain prescribed behavior changes and sustain their weight loss Maintenance of efficacy in RCT-based weight loss interventions can be limited because each is designed for a finite duration; therefore, it is difficult for participants to internalize behavior changes.

Secrets for dropping extra pounds—no matter your age

The NDPP, our efficacy RCT-based example, is administered in 2 phases — a weight loss phase, which meets weekly for 6 months, and a maintenance phase, which meets monthly for 6 months.

Commercial weight loss interventions, such as Weight Watchers and Jenny Craig, are designed with weekly contact during the weight loss phase and monthly contact during the maintenance phase. Regaining weight can occur when contact frequency decreases. In TOPS, people are expected to attend weekly meetings during the weight loss and maintenance phases, so weight regain may be attenuated.

  • Top References National Institutes of Health;
  • Obesity Silver Spring ;15 4;
  • Diabetes Care ;37 6:

Top Discussion Committing all research resources to development and study of the efficacy of new weight loss programs in RCTs would be unwise. From a public health standpoint, we must also focus on dissemination of existing programs with evidence of efficacy or effectiveness to reverse the obesity epidemic. The reach of research focused on scaling up, repurposing, and redesigning efficacy-based weight loss interventions is limited for several reasons: To have a population-level impact on obesity, we must use weight loss interventions that have a national infrastructure.

Programs should meet the following criteria: Of these 3 programs, only TOPS is designed for low-resource settings. Jenny Craig and TOPS have flexible curricula that can withstand various levels of implementation, but the cost of participating in TOPS is more affordable for the general population.

Weight Watchers has a less flexible curriculum, an introduction to a weight loss program it is implemented by trained employees in different settings across the country with high program fidelity, and it is moderately priced. We do not suggest that academic institutions discontinue efficacy RCT-based obesity research. Many nonacademic weight loss interventions are based on information derived from RCTs.

Of note, the Diabetes Prevention Recognition Program has a registry of programs whose curricula and outcomes meet its requirements but may not use specific DPP materials, and both Weight Watchers and Jenny Craig are pending recognition by the Diabetes Prevention Recognition Program, which indicates their curricula have been approved and evidence of outcomes is pending 8.

TOPS plans to apply for recognition oral communication, S. These developments further support our case that such commercial and nonprofit weight loss programs should be studied. Development of new strategies to improve obesity management should continue. However, to have a population-level impact on obesity, funding agencies should also invest in studying existing programs that 1 have national infrastructure with a wide reach, 2 can be adopted broadly in low-resource settings, 3 have flexible curricula that can withstand variable levels of implementation with low to moderate cost, and 4 are sustainable.

Top Author Information Corresponding Author: Top References National Institutes of Health. Strategic plan for NIH obesity research. Prevalence of childhood and adult obesity in the United States, — Epidemiol Rev ;29 1: Prevalence of obesity among adults from rural and urban areas of the United States: J Rural Health ;28 4: Evaluation approaches for dissemination and implementation research.

Dissemination and implementation research in health: Oxford University Press; Preventing type 2 diabetes in communities across the US: Am J Prev Med ;44 4, Suppl 4: Virginia Polytechnic and State University.

Accessed September 1, Centers for Disease Control and Prevention.