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Objective: Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN) study, a community-based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/m 2 relative to a group-based health education (HE) intervention. We sought to determine the incremental cost-effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the "next-best" strategy ranked by increasing lifetime cost., Methods: We used the Osteoarthritis Policy Model to project long-term clinical and economic benefits of the WE-CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE-CAN trial. Our outcomes included quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs)., Results: In a cohort with mean age 65 years, BMI 37 kg/m 2 , and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0-100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY., Conclusion: The community-based D + E program for persons with knee OA and BMI >27kg/m 2 could be cost-effective for willingness-to-pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community-based D + E programs into OA care may be beneficial for public health., (© 2024 American College of Rheumatology.)

Objective: We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study., Design: A literature search of the impact of dietary counselling on BMI was performed to source the 'best' effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate., Setting: New Zealand (NZ)., Participants: We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million)., Results: Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval -70, 560 QALY) over the population's lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Māori (Indigenous population) than for non-Māori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %., Conclusions: The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.

While commercial dietary weight-loss programs typically advise exercise, few provide actual programing. The goal of this study was to compare the Curves Complete 90-day Challenge (CC, n = 29), which incorporates exercising and diet, to programs advocating exercise (Weight Watchers Points Plus (WW, n = 29), Jenny Craig At Home (JC, n = 27), and Nutrisystem Advance Select (NS, n = 28)) or control (n = 20) on metabolic syndrome (MetS) and weight loss. We randomized 133 sedentary, overweight women (age, 47 ± 11 years; body mass, 86 ± 14 kg; body mass index, 35 ± 6 kg/m 2 ) into respective treatment groups for 12 weeks. Data were analyzed using chi square and general linear models adjusted for age and respective baseline measures. Data are means ± SD or mean change ± 95% confidence intervals (CIs). We observed a significant trend for a reduction in energy intake for all treatment groups and significant weight loss for all groups except control: CC (-4.32 kg; 95% CI, -5.75, -2.88), WW (-4.31 kg; 95% CI, -5.82, -2.96), JC (-5.34 kg; 95% CI, -6.86, -3.90), NS (-5.03 kg; 95% CI, -6.49, -3.56), and control (0.16 kg, 95% CI, -1.56, 1.89). Reduced MetS prevalence was observed at follow-up for CC (35% vs. 14%, adjusted standardized residuals (adjres.) = 3.1), but not WW (31% vs. 28% adjres. = 0.5), JC (37% vs. 42%, adjres. = -0.7), NS (39% vs. 50% adjres. = -1.5), or control (45% vs. 55% adjres. = -1.7). While all groups improved relative fitness (mL·kg -1 ·min -1 ) because of weight loss, only the CC group improved absolute fitness (L/min). In conclusion, commercial programs offering concurrent diet and exercise programming appear to offer greater improvements in MetS prevalence and cardiovascular function after 12 weeks of intervention.

Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware may modulate how much is eaten and help with portion control. We examined the experience of using a guided crockery set (CS) and a calibrated serving spoon set (SS) by individuals trying to manage their weight. Twenty-nine obese adults who had completed 7-12 weeks of a community weight-loss programme were invited to use both tools for 2 weeks each, in a crossover design, with minimal health professional contact. A paper-based questionnaire was used to collect data on acceptance, perceived changes in portion size, frequency, and type of meal when the tool was used. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed using logistic regression. Mean acceptance, ease of use and perceived effectiveness were moderate to high (3·7-4·4 points). Tool type did not have an impact on indicators of acceptance, ease of use and perceived effectiveness (P>0·32 for all comparisons); 55 % of participants used the CS on most days v. 21 % for the SS. The CS was used for all meals, whereas the SS was mostly used for evening meals. Self-selected portion sizes increased for vegetables and decreased for chips and potatoes with both tools. Participants rated both tools as equally acceptable, easy to use and with similar perceived effectiveness. Formal trials to evaluate the impact of such tools on weight control are warranted.

Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers. It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives. This randomized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake, weight outcomes, and the home food environment among older adults. A secondary aim was to compare frequent coupon users (FCU) and non-coupon users (NCU) on weight status, home food environment, and grocery shopping behavior. FCU (n = 28) and NCU (n = 26) were randomly assigned to either an incentive or a control group. Participants in the incentive group received $1 for every healthy food or beverage they purchased. All participants completed 3-day food records and a home food inventory and had their height, weight, and waist circumference measured at baseline and after 3 months. Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake (P = 0.04). Participants in both groups showed significant improvements in their home food environment (P = 0.0003). No significant changes were observed in daily energy intake or weight-related outcomes across groups (P < 0.12). FCU and NCU did not differ significantly in any anthropometric variables or the level at which their home food environment may be considered 'obesogenic' (P > 0.73). Increased consumption of vegetables did not replace intake of more energy-dense foods. Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Despite the benefits of fruit and vegetable consumption on weight and decreased risk for chronic disease, Americans' intake of fruits and vegetables is well below the recommended daily servings. While previous studies have assessed fruit and vegetable consumption and the influence of educational interventions on fruit and vegetable intake, no studies to date have examined the effects of nutrition education combined with provision of fruits and vegetables on changes in fruit and vegetable consumption among overweight and obese adults. The objectives of this study were to evaluate fruit and vegetable consumption patterns, including intake of antioxidant-rich fruits and vegetables, provide education about benefits of consuming fruits and vegetables, expose participants to different varieties of fruits and vegetables, and improve fruit and vegetable consumption. Fifty-four adults (19 men/35 women; 44.7 ± 12.1 y) were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons focused on benefits of fruit and vegetable consumption, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Intake of fruits and vegetables was assessed using semi-quantitative food frequency questionnaires and three-day food records. Findings suggested that while the majority of participants failed to consume the recommended number of servings of fruits and vegetables per day, nutrition education was helpful in improving the consumption frequency of antioxidant-rich fruits and vegetables among overweight and obese adults., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Prader-Willi Syndrome (PWS) is a genetic disorder caused by the lack of expression of paternal alleles in the proximal region of the long arm of chromosome 15. Low inhibitory control and hyperphagia are two of the most severe neurobehavioral symptoms of the syndrome. The aim of the present study was to assess the efficiency of nutritional training program with the use hypocaloric diet for weight control in a group of five children and adolescents with PWS. The intervention program consisted of 10 sessions for parents' orientation during 8months. Patients had their anthropometric measures assessed (weight, height and body mass index - BMI). The main results indicate weight maintenance, height increase, and BMI decrease after intervention. These results were considered indicators of the program's efficiency., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk., Purpose: To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs., Data Sources: Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015., Study Selection: English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes., Data Extraction: Dual abstraction and assessment of relevant study details., Data Synthesis: Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified., Limitation: Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited., Conclusion: Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings., Primary Funding Source: None.

Description: Community Preventive Services Task Force recommendation on the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in persons at increased risk., Methods: The Task Force commissioned an evidence review that assessed the benefits and harms of programs to promote and support individual improvements in diet, exercise, and weight and supervised a review on the economic efficiency of these programs in clinical trial, primary care, and primary care-referable settings., Population: Adolescents and adults at increased risk for progression to type 2 diabetes., Recommendation: The Task Force recommends the use of combined diet and physical activity promotion programs by health care systems, communities, and other implementers to provide counseling and support to clients identified as being at increased risk for type 2 diabetes. Economic evidence indicates that these programs are cost-effective.

Background: Food insecurity is hypothesized to influence mothers' use of parenting strategies to regulate children's eating. Little is known about the parenting practices directed toward adolescents in food-insecure households., Objective: Our aim was to examine the differences in use of eating- and weight-related parenting practices among mothers of adolescents by household food-security status., Design: This was a cross-sectional study., Participants/setting: A sociodemographically diverse sample of mothers and adolescents from the Minneapolis/St Paul, MN, metropolitan area who participated in the Eating and Activity Among Teens 2010 and Project Families and Eating and Activity Among Teens studies in 2009 to 2010 (dyad n=2,087). Seventy percent of mothers identified as nonwhite., Main Outcome Measures: We examined mother-reported use of parenting practices, including pressuring children to eat, restricting high-calorie foods, and encouraging dieting., Statistical Analyses Performed: Logistic regression models were used to determine the predicted probabilities of parenting practices among food-secure, low food-secure, and very-low food-secure households. Sociodemographic characteristics, mothers' body mass index, and adolescents' body mass index-for-age percentile were examined as confounders., Results: In unadjusted models, food-insecure mothers were more likely than food-secure mothers to frequently encourage their children to diet, comment on their child's weight, be concerned about their child's weight, use restrictive feeding practices, and use pressured feeding practices. After adjustment for sociodemographic characteristics and mothers' and children's body mass index, compared to food-secure mothers, mothers with low food security were more likely to frequently comment on their sons' weight (41.5% vs 32.9%, prevalence difference=8.6; 95% CI 0.9 to 16.3) and mothers with very low food security were more likely to be concerned about their sons' weight (48.8% vs 35.1%; prevalence difference=13.7; 95% CI 3.5 to 23.9). Mothers with very low food security were more likely to frequently use restrictive feeding practices with their daughters compared to food-secure mothers (33.0% vs 20.5%; prevalence difference=12.4; 95% CI 4.2 to 20.7)., Conclusions: Interventions to improve food-insecure adolescents' eating behaviors may benefit from supporting mothers' use of health-promoting parenting practices., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers., Methods: Eighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control., Results: After 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (-2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: -3.2 kg, 95% confidence interval -6.2 to -0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up., Conclusions and Implications: Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities., (Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services., Objective: The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base., Data Sources: Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted., Review Methods: Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis., Results: From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two linked reports, and 22 qualitative studies were included. Men were more likely than women to benefit if physical activity was part of a weight-loss programme. Reducing diets tended to produce more favourable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise programme -3.2 kg, 95% CI -4.8 kg to -1.6 kg). The type of reducing diet did not affect long-term weight loss. A reducing diet plus physical activity and behaviour change gave the most effective results. Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training gave the most effective long-term weight change in men [-5.2 kg (standard error 0.2 kg) after 4 years]. Such trials may prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men joined weight-loss programmes, once recruited they were less likely to drop out than women (difference 11%, 95% CI 8% to 14%). The perception of having a health problem (e.g. being defined as obese by a health professional), the impact of weight loss on health problems and desire to improve personal appearance without looking too thin were motivators for weight loss amongst men. The key components differ from those found for women, with men preferring more factual information on how to lose weight and more emphasis on physical activity programmes. Interventions delivered in social settings were preferred to those delivered in health-care settings. Group-based programmes showed benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assisted weight loss in some studies. Generally, men preferred interventions that were individualised, fact-based and flexible, which used business-like language and which included simple to understand information. Preferences for men-only versus mixed-sex weight-loss group programmes were divided. In terms of context, programmes which were cited in a sporting context where participants have a strong sense of affiliation showed low drop out rates and high satisfaction. Although some men preferred weight-loss programmes delivered in an NHS context, the evidence comparing NHS and commercial programmes for men was unclear. The effect of family and friends on participants in weight-loss programmes was inconsistent in the evidence reviewed - benefits were shown in some cases, but the social role of food in maintaining relationships may also act as a barrier to weight loss. Evidence on the economics of managing obesity in men was limited and heterogeneous., Limitations: The main limitations were the limited quantity and quality of the evidence base and narrow outcome reporting, particularly for men from disadvantaged and minority groups. Few of the studies were undertaken in the UK., Conclusions: Weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content. Future studies should include cost-effectiveness analyses in the UK setting., Funding: This project was funded by the NIHR Health Technology Assessment programme.

Background: The production of xylitol from lignocellulosic material is of great interest around the world. It can be used as bulk sweetener and its possible lower energy value has increased acceptance for discerning consumers. Xylitol was produced from indigenous agricultural by-product (mung bean hulls) through Candida tropicalis fermentation. Further, xylitol incorporation at different concentrations (0, 100 and 200 g kg⁻¹) was carried out with the purpose of appraising the suitability and claimed health benefits of this dietetic ingredient in food products. Asserted biochemical perspectives of the xylitol intake were evaluated through biological studies for normal and streptozotocin-induced diabetic rats., Results: The addition of xylitol significantly affected feed intake, weight gain, liver and cecum weight in both normal and diabetic rats. The biochemical profile of serum was improved with xylitol incorporation in the diet. Serum glucose, cholesterol and triglycerides levels were decreased depending on xylitol intake level., Conclusion: The results of the present study demonstrated that mung bean hulls have high potential as a new feedstock for xylitol production. In addressing the current concerns of obesity and diabetes, xylitol extracted from such agricultural waste should be considered in diet-based therapies for weight loss programmes.

Background: Few studies have investigated the diet quality of consumers of low-calorie-sweetened (LCS) and calorie-sweetened (CS) beverages., Objective: The objective was to examine the dietary quality and adherence to dietary purchasing and consumption patterns of beverage consumers from 2000 to 2010., Design: We analyzed purchases for 140,352 households from the Homescan longitudinal data set 2000-2010 and dietary intake from NHANES 2003-2010 (n = 34,393). We defined mutually exclusive consumer profiles as main exposures: LCS beverages, CS beverages, LCS & CS beverages, and non/low consumers. As main outcomes, we explored dietary quality by using total energy and macronutrients (kcal/d). We performed factor analyses and applied factor scores to derive dietary patterns as secondary outcomes. Using multivariable linear (NHANES) and random-effects (Homescan) models, we investigated the associations between beverage profiles and dietary patterns., Results: We found "prudent" and "breakfast" patterns in Homescan and NHANES, "ready-to-eat meals/fast-food" and "prudent/snacks/LCS desserts" patterns in Homescan, and "protein/potatoes" and "CS desserts/sweeteners" patterns in NHANES. In both data sets, compared with non/low consumers, both CS- and LCS-beverage consumers had a significantly higher total energy from foods, higher energy from total and SFAs, and lower probability of adherence to prudent and breakfast patterns. In Homescan, LCS-beverage consumers had a higher probability of adherence to 2 distinct patterns: a prudent/snacks/LCS dessert pattern and a ready-to-eat meals/fast-food purchasing pattern., Conclusions: Our findings suggest that overall dietary quality is lower in LCS-, CS-, and LCS & CS-beverage consumers relative to non/low consumers. Our study highlights the importance of targeting foods that are linked with sweetened beverages (either LCS or CS) in intervention and policy efforts that aim to improve nutrition in the United States.

Objective: Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone)., Design and Methods: Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups., Results: Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person., Conclusions: Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach., (Copyright © 2013 The Obesity Society.)

Background: Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant., Methods: We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY., Results: Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219-$437). The short-term incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (≥ 10 years)., Conclusions: A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.

Background: Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings., Objective: We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP)., Design: This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m(-2)) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY)., Results: The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31,663, 24,996 and 51,571., Conclusion: The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem.

Intensive obesity treatment is mandated by federal health care reform but is costly. A partial subsidy for obesity treatment could lower the cost of treatment, without reducing its efficacy. This study sought to test whether a partial subsidy for obesity treatment would be feasible, as compared to a fully subsidized intervention. The study was a pilot randomized trial. Participants (n = 50) were primary care patients with obesity and at least one comorbid condition (diabetes, hypertension, dyslipidemia, or obstructive sleep apnea). Each participant received eight weight loss counseling visits as well as portion-controlled foods for weight loss. Participants were randomized to full subsidy or partial subsidy (2 vs. 1 meal per day provided). The primary outcome was weight change after 4 months. Secondary outcomes included changes in blood pressure, waist circumference, and health-related quality of life. Participants in the full and partial subsidy groups lost 5.9 and 5.3 kg, equivalent to 5.3% and 5.1% of initial weight, respectively (P = 0.71). Changes in secondary outcomes were similar in the two groups. A partial subsidy was feasible and induced a clinically similar amount of weight loss, compared to a full subsidy. Large-scale testing of economic incentives for weight control is merited given the federal mandate to offer weight loss counseling to obese patients.

Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: The primary objective was to investigate the feasibility and cost-effectiveness of weight reduction using very low calorie diet (VLCD) in groups. The secondary objective was to investigate whether subsequent corset treatment could maintain the weight reduction long term., Design: Participants, consecutively included in groups of 8-14 subjects, underwent three months of VLCD with lifestyle advice at group meetings. Subjects attaining > or = 8 kg reduction were randomized to corset (A) or no corset (B) treatment for nine months. Weight was registered at all meetings and after 24 months. Costs were calculated using current salaries and anti-obesity drug prices as at 2008., Settings: Primary care in Skaraborg, Sweden. Subjects. A total of 26 men and 65 women aged 30-60 years with BMI > or = 30-< 45 kg/m2., Main Outcome Measures: Weight changes and costs of treatment., Results: VLCD (dropout n = 14) resulted in a mean weight reduction of 20.1+/-6.6 kg (20 men) and 15.7+/-4.7 kg (57 women). These 77 subjects were randomized to treatment A (n = 39) or B (n = 38). Compliance with corset was only 20% after three months. After one year (dropout n = 17) weight loss was 11.7+/-8.1 kg (A) and 9.3+/-6.9 kg (B), p = 0.23 and after two years (dropout n = 22) 6.1+/-7.0 kg and 4.4+/-7.3 kg respectively, p = 0.94. Serum glucose and lipids were altered favourably. The cost per participant of treatments A and B was SEK 4440 and SEK 1940 respectively., Conclusions: VLCD in groups was feasible and reduced weight even after one year. The cost of treatment was lower than drug treatment. Corset treatment suffered from poor compliance and could therefore not be evaluated.

Obesity is an epidemic and, thereby, represents one of the central challenges for the German health-care system. A weight-reducing treatment should be started at a body mass index (BMI) >or= 30 kg/m(2) or at a BMI >or= 25 kg/m(2) if clinically significant comorbidities are present. Currently, a broad range of evidence-based treatment options for weight reduction is available. The primary treatment aims at lifestyle modification by adopting an energy-reduced diet and a higher level of physical activity. In the escalation strategy, other options such as very-low-calorie diets, weight-reducing drugs and - in morbidly obese patients - bariatric surgery should be considered. All treatment measures should be tailored to the individual requirements, wishes and facilities of the patient. In addition, the patient should be encouraged to take responsibility for his/her weight management. However, there is urgent need to improve the structural preconditions for effective obesity management in Germany.

Objective: Diets of lower energy density are associated with higher diet quality, lower body weights, and better health outcomes. This study examined associations among dietary energy density, energy-adjusted diet costs, and socioeconomic indicators of study participants., Design: In this cross-sectional study, energy and nutrient intakes for 164 men and women aged 25 to 65 years were obtained using a food frequency instrument between June 2005 and September 2006. Dietary energy density (kcal/g) was calculated with and without beverages. Energy-adjusted diet costs ($/2,000 kcal) were calculated using food prices in Seattle, WA. Tertile splits of energy density and energy cost were analyzed using tests for linear trend. Linear regression models tested the association between education, income, and dietary variables, adjusting for age and sex., Results: Diets of lower energy density were associated with higher absolute nutrient intakes. Diets of lower energy density were also associated with higher energy-adjusted diet costs. Conversely, highest energy density diets were associated with lower intakes of micronutrients and fiber and lower costs. Education and household income showed a negative association with dietary energy density in regression models. Education and household incomes showed a positive association with the energy-adjusted cost of the diet. Education was a stronger predictor of both energy density and energy cost than was household income., Conclusions: Higher-quality diets were not only more costly per kilocalorie but were also consumed by persons of higher educational level. The influence of diet quality on health, observed in some epidemiologic studies, might be modulated by unobserved indexes of socioeconomic status.

Research suggests that children from low-income households are particularly at risk for pediatric obesity. In treating these youth, practitioners must understand the unique obstacles to making health-related behavioral changes. Both limited access and cost of many foods high in nutritive value are prohibitive for many families. Furthermore, the poor safety of neighborhoods preclude walking programs and the limited access or excessive cost of other physical activity options also present barriers. It is critical for practitioners to understand the potential economic barriers that may limit success in treating overweight patients, and this article presents some options that circumvent these barriers.

Traits used for identification of replacement beef heifers and feeding levels provided during postweaning development may have major financial implications due to effects on maintenance requirements and level of lifetime production. The current study evaluated the effects of 2 levels of feeding during the postweaning period on growth, G:F, and ultrasound carcass measurements of heifers, and the associations among these traits. Heifers (1/2 Red Angus, 1/4 Charolais, and 1/4 Tarentaise) born in 3 yr were randomly assigned to a control (fed to appetite; n = 205) or restricted (fed at 80% of that consumed by controls adjusted to a common BW basis; n = 192) feeding during a 140-d postweaning period. Heifers were individually fed a diet of 68% corn silage, 18% alfalfa, and protein-mineral supplement (DM basis) in pens equipped with Calan gates. Ultrasound measurements of LM area, intramuscular fat, and subcutaneous fat thickness over the LM were made on d 140 (382 +/- 0.8 d of age). Average daily DMI was 4.1 and 5.6 kg/d for restricted and control heifers, respectively (P < 0.001). Feed restriction decreased (P < 0.001) BW (292 vs. 314 kg), ADG (0.52 vs. 0.65 kg/d), LM area (55 vs. 59 cm2), intramuscular fat (3.2 vs. 3.5%), and subcutaneous fat thickness over the LM (3.2 vs. 3.9 mm), but increased G:F (0.12 vs. 0.11) when compared with control at the end of the 140-d study. The magnitude of the associations of DMI with ADG (r = 0.32 vs. 0.21), 140-d BW (r = 0.78 vs. 0.36), hip height (r = 0.57 vs. 0.17), LMA (r = 0.30 vs. 0.18), and BCS (r = 0.17 vs. 0.11) was greater in restricted- than control-fed heifers. Variance of residual feed intake, calculated within each treatment, was greater (P < 0.01) in control (0.088) than restricted (0.004) heifers, and magnitude of association between residual feed intake and average DMI was greater in control (r = 0.88) than restricted (r = 0.41) heifers. Pregnancy rate tended (P = 0.11) to be reduced in heifers that had been developed on restricted feeding (86.3 +/- 2.3 vs. 91.5 +/- 2.3%). However, ADG was greater (P < 0.001) in restricted than control heifers (0.51 vs. 0.46 kg/d) while grazing native range in the 7 mo after restriction. In summary, restricted heifers consumed 22% less feed on a per-pregnant-heifer basis during the development period and had a greater magnitude of association between DMI and several growth-related traits at the end of the 140-d postweaning feeding period, which is indicative of improved efficiency.

Background: Low-energy-density diets are associated with higher diet costs per 10 MJ. Are diets of higher nutritional quality also associated with higher costs per 10 MJ?, Objective: The objective was to determine the relations between energy-adjusted diet costs, dietary energy density, and nutritional quality of diets., Design: This was a cross-sectional study of a nationally representative sample of 1332 French adults in the 1999 Enquête Individuelle et Nationale sur les Consommations Alimentaires (INCA) data set. Analyses were based on data from 7-d food records. The monetary cost of each diet was estimated by using mean retail prices for 620 foods. Nutritional quality was estimated by calculating the mean adequacy ratio (MAR), based on 23 nutrients. Energy density was based on solid foods only., Results: In a bivariate analysis, low-energy-density diets were of higher nutritional quality but also cost more. Participants in the highest tertile of MARs had the lowest dietary energy density and the highest diet costs, calculated both per day and per 10 MJ. In a multivariate model, dietary energy density was negatively linked to diet costs (euro/10 MJ), whereas MAR values were positively linked to diet costs after adjustment for age and energy intake. For a given energy intake and energy density, each 10% increase in MAR led to a 13% increase in estimated diet costs per 10 MJ., Conclusions: In this study of self-selected diets of French adults, lower energy density and higher nutritional quality were associated with higher energy-adjusted diet costs. Higher-quality diets cost more not only because they have a low energy density but also because they are nutrient rich.

Low-energy-density diets are often recommended for weight control. Such diets have a higher nutrient content than do high-energy-density diets. This study tested the hypothesis that energy-dense diets have a relatively low monetary cost, whereas less energy-dense diets are more expensive. In this cross-sectional study, dietary intakes of 1,474 French adults (672 men, 802 women), aged 15 to 92 years, were assessed using 7-day diet records. Dietary energy density (kcal/g) was calculated by dividing total dietary energy by the edible weight of foods and caloric beverages consumed. Diet cost ($/7 days or $/2,000 kcal) was estimated using mean national food prices for 895 foods. The relationship between dietary energy density and diet cost was examined in a linear regression model. Within each quintile of energy intakes, the more energy-dense diets were associated with lower diet quality and with lower diet costs (r(2)=0.38 to 0.44). In a regression model, the more energy-dense diets cost less, whereas low-energy-density diets cost substantially more, adjusting for energy intakes, sex, and age. The finding that energy-dense diets cost less per 2,000 kcal may help explain why the highest rates of obesity are observed among groups of limited economic means. The finding that low-energy-density diets are associated with higher diet costs suggests that lasting improvements in diet quality may require economic as well as behavioral interventions.

Background and Aims: Despite the benefits of modest weight reduction for overweight patients with chronic liver disease, long-term maintenance of weight loss is difficult to achieve in clinical practice. The aims of this study were to determine if a nutrition research protocol could be translated into clinical practice and meet the demand for dietetic service, to evaluate the effectiveness and resource implications of intensive lifestyle intervention for weight loss, and to assess the effectiveness of standard dietetic therapy as a treatment option for patients unable to attend the program., Method: Using a modified research protocol, an intensive weight reduction program was introduced into standard clinical care for overweight patients attending a tertiary hospital liver outpatient clinic. An audit of weight loss and cost outcomes was conducted., Results: Ninety-three patients were referred to the dietetic service for weight management. Of these, 50 enrolled in an intensive lifestyle intervention, 18 received standard dietetic therapy and 25 refused any intervention. After 6 months, 83% of patients in the intensive intervention achieved weight loss with a significant decrease in weight (P < 0.001) and waist circumference (P < 0.001). In contrast, only 24% of patients receiving standard dietetic therapy achieved weight loss with no significant change in mean weight or waist circumference. Cost per kilogram weight loss after intensive intervention was $AU31 and continuation of lifestyle intervention was calculated to be less than $AU100 per patient per year., Conclusions: A clinically based, intensive lifestyle intervention is a feasible treatment option for outpatient weight management in overweight patients with chronic liver disease. Providing patients who are unable to participate in intensive programs with standard dietetic therapy is not cost-effective.

This paper presents a behavioral economics model with bounded rationality to describe an individual's food consumption choices that lead to weight gain and dieting. Using a physiological relationship determining calories needed to maintain weight, we simulate the food consumption choices of a representative female over a 30-year period. Results show an individual will periodically choose to diet, but that diet will reduce weight only temporarily. Recurrence of weight gain leads to cyclical dieting, which reduces the trend rate of weight increase. Dieting frequency is shown to depend on decision period length, dieting costs, and habit persistence.

Objective: To evaluate the cost-effectiveness and safety of two distinct low calorie diets (LCD)., Design: Prospective controlled study., Methods: 67 obese patients [body mass index (BMI) 40 kg/m2] were included in two study groups. Group A: 26 patients followed a 458 kcal diet given in three meals for 1 month. Group B: 41 patients followed a 800 kcal diet for 3 months and with outpatient control., Measurements: Anthropometric, cardiovascular risk and nutritional profile changes were evaluated, as well as total direct and indirect costs, and the incidence of complications., Results: No significant initial differences were observed between the two study groups. Eighty-six point two per cent of the patients completed the therapy correctly. After treatment a significant decrease was observed in the following variables for both groups, but no differences were detected between Groups A and B: mean weight loss (A= 9.28 kg, B= 8.7 kg), ponderal loss percentage (A/B= 7.2/6.8%), glycemia (A/B= 18.6/12.1 mg/dl), systolic blood pressure (SBP) (A/B= 11.8/6.5 mmHg), diastolic blood pressure (DBP) (A/B 5.9/6.8 mmHg), and final insulin-resistance (IR) index (A= 4.4, B= 4.3). Group A had the highest drop in total cholesterol (37.7 vs 8.1 mg/dl) and triglycerides (54.4 vs 2.5 mg/dl). No changes were observed in ureic acid, renal function and serum albumin. Thirty-six patients (55.3%) suffered trivial complications associated to the VLCD (16.9% gastrointestinal, 20% anxiety), with no differences between groups. Group A patients were on sick leave due to asthenia, and two patients in this group had serious complications (transient ischemic attack and atrial fibrillation). The total cost of Group A treatment was 3018.9 against 582.6 euros for Group B., Conclusions: The 3-month 800 kcal/day VLCD was more cost-effective and safer than the 1-month 458 kcal/day diet.

Objective: To conduct a clinical and economic evaluation of outpatient weight loss strategies in overweight and obese adult U.S. women., Research Methods and Procedures: This study was a lifetime cost-use analysis from a societal perspective, using a first-order Monte Carlo simulation. Strategies included routine primary care and varying combinations of diet, exercise, behavior modification, and/or pharmacotherapy. Primary data were collected to assess program costs and obesity-related quality of life. Other data were obtained from clinical trials, population-based surveys, and other published literature. This was a simulated cohort of healthy 35-year-old overweight and obese women in the United States., Results: For overweight and obese women, a three-component intervention of diet, exercise, and behavior modification cost 12,600 US dollars per quality-adjusted life year gained compared with routine care. All other strategies were either less effective and more costly or less effective and less cost-effective compared with the next best alternative. Results were most influenced by obesity-related effects on quality of life and the probabilities of weight loss maintenance., Discussion: A multidisciplinary weight loss program consisting of diet, exercise, and behavior modification provides good value for money, but more research is required to confirm the impacts of such programs on quality of life and the likelihood of long-term weight loss maintenance.

Background: Each year millions of Americans enroll in commercial and self-help weight loss programs. Health care providers and their obese patients know little about these programs because of the absence of systematic reviews., Purpose: To describe the components, costs, and efficacy of the major commercial and organized self-help weight loss programs in the United States that provide structured in-person or online counseling., Data Sources: Review of company Web sites, telephone discussion with company representatives, and search of the MEDLINE database., Study Selection: Randomized trials at least 12 weeks in duration that enrolled only adults and assessed interventions as they are usually provided to the public, or case series that met these criteria, stated the number of enrollees, and included a follow-up evaluation that lasted 1 year or longer., Data Extraction: Data were extracted on study design, attrition, weight loss, duration of follow-up, and maintenance of weight loss., Data Synthesis: We found studies of eDiets.com, Health Management Resources, Take Off Pounds Sensibly, OPTIFAST, and Weight Watchers. Of 3 randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at 2 years. One randomized trial and several case series of medically supervised very-low-calorie diet programs found that patients who completed treatment lost approximately 15% to 25% of initial weight. These programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss., Limitations: Because many studies did not control for high attrition rates, the reported results are probably a best-case scenario., Conclusions: With the exception of 1 trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal. Controlled trials are needed to assess the efficacy and cost-effectiveness of these interventions.

Why? Because they're finding that obesity is a significant factor involved with many costly chronic diseases, and financial decision-makers are concluding that bariatric surgery--while successful in many cases--is simply too expensive and too risky to cover for the large numbers of individuals who are morbidly obese. See how one EAP is attempting to meet this challenge by designing a program that incorporates the psychological and medical components of weight management.

Objective: Family-based, behavioral treatment has been shown to be an effective intervention for the management of pediatric obesity. The goal of this study was to compare the cost-effectiveness of two protocols for the delivery of family-based behavioral treatment., Research Methods and Procedures: Thirty-one families with obese children were randomized to groups in which families were provided mixed treatment incorporating both group and individualized treatment vs group treatment only. Cost-effectiveness of treatment was defined as the magnitude of reduction in standardized BMI and percentage overweight per dollar spent for recruitment and treatment. Anthropometric data were assessed at baseline, 6 months and 12 months post-randomization., Results: Results for the 24 families with complete data showed the group intervention was significantly more cost-effective than the mixed treatment. This was due to the similarity between the two groups in Z-BMI or percentage overweight change for children and their parents, while the mixed treatment was significantly more expensive to deliver than the group treatment., Discussion: These findings suggest that a family-based, behavioral intervention employing group treatment alone is a more cost-effective approach to treating pediatric obesity than a mixed group plus individual format.

Objective: To explore the use of the very-low-calorie formula diet (VLCD) in the indigent population of Newark, NJ, with the goal of achieving 10% weight loss within a relatively short period of 10 weeks., Research Methods and Procedures: We accepted 131 morbidly obese indigent women into our study program. The study was limited to women only and the average starting weight was 292.3 +/- 5.9 lbs (+/- SE; 50.3 +/- 0.9 body mass index [kg/m(2)]). We used three treatment paradigms: total cost-free program for 10 weeks; cost-free, but compliance requirements; and a weekly charge of $25. The results obtained were compared with two control populations: women enrolled during the same recruitment period in a comparable suburban VLCD program and a historical control population of suburban women treated from 1985 through 1995., Results: In group A (total cost-free), 79% of patients completed the 10-week program, but only 18% of patients achieved the goal of 10% weight loss. In group B when attendance and weight loss requirements were imposed, the dropout rate accelerated such that only 37% of patients completed the 10-week course, and 16% of the women were successful with their weight loss. In group C, imposing $25/wk financial outlay also accelerated dropouts but had little effect on weight loss success, which was 10% of the starting group. By comparison, the suburban patients and the historical control group exhibited 67% and 76% attendance rates after 10 weeks, and 33% and 55% success rates, respectively, in achieving the weight loss goal., Discussion: We conclude that inner-city patients exhibit great interest in weight loss when financial barriers are removed. Successful weight loss was achieved in 10% to 18% of patients using the VLCD approach, approximately one-half of that obtained in affluent suburban women. Imposing financial or compliance restrictions to the inner-city patients served only to enhance dropouts.

It is relatively well accepted that weight gain, even within the range of normal weight, is detrimental for health. The claimed long-term benefit of intentional weight loss is mainly based on a few observational trials, confounding intentional and non-intentional weight loss. The few data on obesity-related diseases prevented by intentional weight reduction have not been replicated. Thus, for lack of level-one evidence it is to date doubtful whether voluntary weight loss should be intensively recommended to obese individuals rather than other lifestyle-interventions, e.g. exercise training. The aim of this overview is to discuss some of the contraindications to intentional weight loss often ignored in recent debates. There is no intention to question the increased risk of overweight on morbidity and the need for preventing weight gain in our population. Besides well-known consequences secondary to rapid weight loss, e.g. gallstones and electrolyte disorders, some new aspects or more debated issues are discussed. Recent compelling data indicate a significant bone density loss after weight loss of a few kilograms. Knowledge on the impact of weight cycling mainly relies on cross-sectional data. So far there is no concluding evidence of adverse pathophysiological effects from weight cycling. Repeated dieting has been associated with eating disorders, although the cause-effect relationship has not been well established. At least on an empirical basis there seems to be a tolerance effect after repeated weight losing efforts. Pharmacotherapy tends more and more to be part of weight loss interventions. Although the currently available drugs are designed for long-term treatment, in practice they are rarely used longer than a few months, and therefore their use can be entirely questioned. Nonetheless, if employed properly for weight loss and weight maintenance, i.e. "for life", additional data on long-term effects on health are needed. Such risks can then be weighed against the risk of remaining obese. Even a limited detrimental effect on blood pressure, such as known for sibutramine, could compromise the beneficial effect of the drug on weight loss and maintenance. Further, the financial burden of weight loss is not to be underestimated. Besides diets and weight loss programs being a multi billion dollar business, the cost of patient care in cases of surgery for gallstones has, among other economic implications, to be considered. Finally, with the example of the recently investigated impact of fitness level on health, exercise training may be an alternative to weight loss. Whether obese or not, cardiovascular fitness is a strong, independent predictor of cardiovascular mortality and overall mortality. Most obese being unfit, a greater preventive impact might come from becoming more fit than from losing weight. This should only illustrate that there is still a long way to go until we have sufficient scientific data to be able to tell whether in the management of obesity weight loss or other interventions are of higher priority. In part, current recommendations to lose weight are biased by societal pressure, which overrules simple scientific evidence.

Background: Morbidly obese patients enrolled in a rapid weight reduction program are at a high risk of developing gallstones. Two multicenter, placebo-controlled, randomized, double-blind trials have demonstrated that the prophylactic use of ursodiol in males and females 18 to 70 years of age is effective for the prevention of gallstone formation in this patient population. This study examines the cost consequences associated with the prophylactic use of ursodiol., Methods: A medical decision analysis model for the prophylactic administration of ursodiol in morbidly obese patients undergoing rapid weight reduction by either gastric bypass surgery or very-low-calorie-diet, was developed through the use of data from two clinical trials and review of the related literature. The expert opinion of clinicians from the fields of internal medicine, gastroenterology and surgery were solicited. Financial data for the charges associated with cholecystectomies, physician fees and ursodiol were obtained from current financial databases., Results: The model demonstrates that the prophylactic administration of ursodiol, in morbidly obese patients undergoing rapid weight reduction, results in cost savings. Sensitivity analysis was performed to illustrate that the cost savings achieved by the prophylactic use of ursodiol were valid over a realistic range of charges and assumptions., Conclusion: The decision model may allow health care decision makers to apply their own data to the model to determine the cost savings obtainable through the prophylactic use of ursodiol in patients undergoing rapid weight reduction.

Background: We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-calorie diet plus weekly behavioral modification) for obese patients., Methods: A successful outcome was defined as the loss of at least one third of excess weight that was maintained for the duration of the study. A minimal cost was assigned: $3000 for medical and $24,000 for surgical treatment. A cost per pound of weight lost for all patients successfully monitored was calculated. The Federal Trade Commission recently asked all weight loss programs to report this cost for patients at least 2 years after therapy., Results: A total of 201 patients entered surgical and 161 entered medical therapy. The surgical group was initially heavier (mean body mass index [kg/m2] +/- SE = 49.3 +/- 0.6 versus 41.2 +/- 0.7, p < 0.01), but each group's lowest mean body mass index was similar (31.8 versus 32.1, respectively). A significantly higher percentage of patients in the surgical versus the medical group were still successful at year 5: 89% versus 21%. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth posttreatment year (both more than $250/pound)., Conclusions: Surgical treatment appears to be more cost-effective at producing and maintaining weight loss. It is imperative that long-term follow-up studies be funded to definitely establish this finding.

Background: Thirty-three percent of the adult American population over the age of 20 is obese. Many attempts to treat this increasingly occurring problem have had poor results. Both achieving weight loss and maintaining weight loss are difficult; however, current treatments appear more effective in achieving weight loss than in maintaining weight loss. The current study followed a cohort of patients to analyze weight maintenance and predictors of weight maintenance in a 26-week, formula-based, very low calorie diet program., Methods: The study population consisted of a consecutive sample of 145 overweight patients who entered a very low calorie diet program and were contacted at 54 months after program entry., Results: For men, the average initial weight loss at program termination was 27.2 kg (22% of original weight) and for women, 19.3 kg (18.8% of original weight). At 54 months after program entry, the average maintained loss was 5.1 kg (4.3% of original weight), at a cost of $630 per kg of long-term weight loss. There was no significant difference in maintained weight loss between men and women. Twenty-six percent of patients maintained a medically significant weight loss of 10% of entry weight. Subjects who exercised regularly maintained an average of 9.6 kg compared with 1.3 kg for nonexercisers. Those who attended the program for a longer period, and exercised more, maintained their weight better. The 54-month weight loss was similar to that seen at 30 months but markedly less than that at 18 months., Conclusions: Very low calorie diet programs have limited long-term success that may not justify the risk of adverse effects and high costs. Longer program attendance and continued exercise are associated with improved weight maintenance. Evaluation of dietary programs should be based on a sample of consecutive patients followed for a minimum of 2 years after program completion.

Since their publication in 1974 the recommendations of the "German Society for Public and Private Welfare" are regarded as competent guideline for the allocation of grants concerning the diet for diabetic subjects according to section 23 part 4, position 2 BSHG (Federal German Law for Social Security). The former nutrition concepts are compared to the current international conceptions regarding the diet of diabetic individuals. Possible variations concerning food plans are shown in model plans considering realistic habits of consumption. Our analysis justifies additional expenses limited to about 20 to 30% for insulin-dependent diabetic subjects compared to an isocaloric regular diet. Additional expenses for obese non-insulin-dependent diabetic subjects are not necessary. There is an extremely slim portion allocated for food within the social security benefit according to section 22 BSHG. That will require an comprehensive supply of education for the realisation of the current recommendations for nutrition. The education programmes for compiling suitable food plans to remain within the scheduled cost limits need to be organized by regional carriers of social welfare, whereby public Health offices could make an important contribution.

Background: The cost of diabetes mellitus can be defined in both medical and economic terms. Although there is an abundance of literature concerning the medical management of diabetes, few studies have assessed the financial impact of its treatment. This study examined the savings in prescription costs associated with a weight reduction program for obese men and women with non-insulin-dependent diabetes mellitus (NIDDM)., Research Design and Methods: Forty subjects ages 40-70 years who had body mass indexes of 30-40 kg/m2 and NIDDM of more than 1 year duration were assigned to one of two 800-kcal weight-loss programs for 12 weeks. A cost analysis was done on the 32 subjects who were taking anti-hypertensive and/or anti-diabetes medications. A list of medications and monthly amounts was obtained at the start, upon completion, and 1 year following completion of the diet. The average out-of-pocket cost for a month's supply of each prescription was calculated by polling 16 retail pharmacies in Lexington, Kentucky., Results: Subjects lost an average of 15.3 kg (33.7 lb) over the 12 weeks. At 1-year follow-up, subjects maintained a mean 9.0-kg (19.8 lb) weight loss. The average monthly prediet out-of-pocket cost for anti-hypertensive and anti-diabetes medications and supplies was $63.30 per subject. Following completion of the diet, this cost per month decreased to $20.40 and at 1-year follow-up the average monthly cost per subject was $32.40. The estimated average savings in prescription costs per subject over the year was $442.80., Conclusions: Significant short- and long-term savings in prescription costs were obtained following a 12-week hypocaloric weight reduction program for obese individuals with NIDDM.

Objective: To analyze weight maintenance, cost, and predictors of weight maintenance in a formula-based very-low-calorie diet program., Design and Setting: Consecutive sample of patients evaluated at 30 months after program entry at a community hospital in Orange Park, Fla., Patients: Consecutive sample of 306 patients who entered a very-low-calorie diet program. Of these, 255 met inclusion criteria., Intervention: Patients entered a 26-week very-low-calorie diet program. At 30 months after program entry, questionnaires were mailed. Data were collected via telephone interview, as needed., Main Outcome Measures: Initial and maintained weight loss, and association of weight loss to the following factors: insurance coverage, continued exercising, weeks attended, exit weight in relation to ideal weight, and cost per kilogram of weight loss., Results: Medically significant weight loss of 10% was initially achieved by 90% of patients and maintained by 33%. The average initial weight loss was 21.4 kg and the maintained weight loss was 6.5 kg for all patients. For those who remained in the program 19 weeks (61%), the initial weight loss was 25.6 kg and the maintained weight loss was 9.2 kg. Exercisers maintained more than twice as much weight loss as nonexercisers. Men lost a larger percentage of weight (22% vs 19%) and maintained more of that loss (29.5% vs 8.3%). Maintenance was not associated with insurance coverage and at how close patients came to achieving ideal weight. The cost was $396 per kilogram of weight loss maintained. An improved sense of well-being was expressed by 71% of patients., Conclusions: Very-low-calorie diet programs can be effective in maintaining a medically significant weight loss in some patients at 30 months after program entry. Longer attendance and regular exercise help weight maintenance. The high costs and rate of weight regain indicate the need to find a more affordable and effective strategy for weight loss and maintenance.

Thirty-four million adult Americans are obese (greater than 30% above ideal body weight). 1990 national Health Objectives state that 50% of all adults should adopt weight-loss and exercise regimes. This recommendation has caused a dramatic surge in the number and variety of weight-loss programs currently available. A parallel surge has occurred in the cost of these weight-loss programs. This wide variation in personal expenditure (and treatment provided) necessitates a review of the programs and their cost to the participant. The cost of a 12-week outpatient commercial weight-loss program can range from $2,120 for the most expensive very low-calorie diet program to $108 for the least expensive nutrient-balanced hypocaloric diet program. This article reviews 11 commercial diet programs in the Boston area and analyzes the out-of-pocket cost paid to the clinic by the participant to lose 1 kg on each program. Given the complexity of treatment to achieve long-term weight control, knowledge of financial obligations is important.