2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

Jensen, Michael D.; Ryan, Donna H.; Apovian, Caroline M.; Ard, Jamy D.; Comuzzie, Anthony G.; Donato, Karen A.; Hu, Frank B.; Hubbard, Van S.; Jakicic, John M.; Kushner, Robert F.; Loria, Catherine M.; Millen, Barbara E.; Nonas, Cathy; Pi‐Sunyer, F. Xavier; Stevens, June; Stevens, Victor J.; Wadden, Thomas A.; Wolfe, Bruce M.; Yanovski, Susan Z.

doi:10.1161/01.cir.0000437739.71477.ee

Cited by 2,288 publications

(1,245 citation statements)

References 163 publications

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“…Recent clinical trials have shown that lifestyle interventions using behavioural counseling to induce weight loss and increase physical activity can have important health benefits 1, 2. The Diabetes Prevention Program (DPP), e.g.…”

Section: Introductionmentioning

confidence: 99%

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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SummaryObjectiveThe Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention.MethodsThe ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars.ResultsDuring the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares.ConclusionsThe sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data.

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Section: Introductionmentioning

confidence: 99%

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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“…This single week may have been unrepresentative of normal activity (from normal week‐to‐week variation in activity, unexpected changes in schedule or reactivity to a week of wearing the armband) which may have introduced additional variance between assessment tools. A final limitation is that newer, weight‐management specific PA guidelines have been released recommending ≥250 min per week 25, perhaps suggesting the need for a modified version of the L‐Cat for weight‐management; however, recent empirical evidence suggests the release of weight‐management specific guidelines may have been premature 26. Despite these study limitations, study strengths included concurrent use of the L‐Cat and objective MVPA measurement at two time points during an intervention and excellent adherence to objective MVPA measurement.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Stanford Leisure‐Time Activity Categorical Item (L‐Cat) using armband activity monitor data

Ross

Leahey

Kiernan

2018

Obesity Science & Practice

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SummaryObjectiveAccurate assessment of physical activity (PA) in public health and healthcare settings remains a challenge given limitations of existing brief assessment tools. The Stanford Leisure‐Time Activity Categorical Item (L‐Cat), a single item with six categories, has previously demonstrated excellent reliability and adequate validity relative to pedometer steps. However, pedometers cannot assess key dimensions of PA intensity or duration.MethodsWe evaluated the L‐Cat's criterion validity and sensitivity to change relative to objectively measured Sensewear armband activity monitors among 76 adults with overweight/obesity (mean age 50.8 ± 11.9 years, BMI = 33.1 ± 3.4 kg m−2) at baseline and end of a 6‐month behavioural weight management pilot trial.ResultsAt baseline, L‐Cat category was associated with armband‐measured daily steps (Spearman's ρ = 0.41, p < 0.001), total weekly minutes of moderate/vigorous‐intensity PA (MVPA) (ρ = 0.40, p < 0.001) and weekly minutes of MVPA accumulated in bouts ≥10 min (ρ = 0.47, p < 0.0001). Participants increasing ≥1 L‐Cat category from baseline to 6 months had greater increases in steps (1,110.1 ± 1,852.1 vs. −18.0 ± 2,005.6 steps/d, p = 0.032), total minutes of MVPA (145.7 ± 180.6 vs. −2.1 ± 215.8 min/week, p = 0.007) and greater weight losses (−7.4 ± 7.7% vs. −3.1 ± 4.8%, p = 0.013) than those who stayed the same/decreased L‐Cat categories.ConclusionThe L‐Cat demonstrated adequate criterion validity and excellent sensitivity to change relative to objectively measured PA among behavioural weight management pilot trial participants. The L‐Cat may be particularly useful for identifying individuals at lower activity levels and when using all six categories.

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“…These new treatment options have enabled the development of more robust approaches to medical care that not only optimize the benefit–risk balance and improve outcomes but also are cost‐effective 1, 12, 13, 14, 15.…”

Section: New Tools and The Role Of Primary Care Providersmentioning

confidence: 99%

“…The long‐term follow‐up will give the PCP an opportunity to address small weight gains by reinstituting the lifestyle intervention and to assess the need for weight‐loss medications or bariatric surgery 12. Several models have been developed to help PCPs manage obesity and provide behaviour support to promote sustained weight loss (Box 4) 1, 14, 15.…”

Section: Medical Models and Guidelinesmentioning

confidence: 99%

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Weight maintenance: challenges, tools and strategies for primary care physicians

2015

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SummaryObesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long‐term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer‐reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5–10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification – although challenging – is possible but requires long‐term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.

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2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

Cited by 2,288 publications

References 163 publications

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Validation of the Stanford Leisure‐Time Activity Categorical Item (L‐Cat) using armband activity monitor data

Weight maintenance: challenges, tools and strategies for primary care physicians

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