Weight Management

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Contents

Introduction

Obesity is the presence of excess amount of body fat and a person is considered to be obese if his/her weight is 20% or more above the normal weight. The Body Mass Index or the BMI is the measure used to determine overweight and obesity. If The BMI is in between 25-29.9, the person is said to be overweight whereas if the BMI is more than 30, the person is considered to be obese. In America, 127 million adults are overweight and 60 million obese with obesity being cited as the second leading cause of preventable death. (Obesity in America.org). The elderly population also shows an alarming trend of increase in this condition with 32.1% of the male population and 37.9% of the female population aged 65-74 yrs considered obese in 2001-2004 according to the CDC [1].

Public awareness of the obesity epidemic and its role as a predisposing factor for several chronic diseases has led to an increasing interest in losing weight. Almost 30-40% of the American population is currently using diet to lose weight [2]. There is growing evidence to suggest that e health behavioral interventions especially tailored interventions have the potential to lead to long lasting weight loss and weight maintenance behavioral changes [3]. This is essentially true in the case of the elderly population where successfull weight management and weight maintenance may be an important aspect of reducing the incidence of chronic diseases thereby prolonging independent high quality community living.

Issues

  • Attrition: Research shows that online health programs including those that deal with weight management are notorious for their rates of attrition; reasons being lack of motivation, technical problems unrelated to the intervention e.t.c.
  • Awareness and computer literacy: People in the geriatric age group are definitely interested in learning and using online programs related to health to improve their quality of life. However, more studies are required to gauge the extent of awareness and interest among vulnerable sections in this age group viz. people living in remote areas, ethnic minority groups etc.
  • System issues: Installation and maintenance issues related to the system has to be looked into as these are important reasons for discontinuation/lack of interest in adopting e weight management programs.
  • Usability issues: Age related specific issues such as small font size, lot of information in a single web page, lack of proper instructions for use need to be solved [4].
  • Privacy and security: These are emerging as major concerns not only for the end user population but for all the stakeholders involved.
  • Affordability: System affordability as well as membership fees required for access to the various sites needs to be tackled so as to arrive at a satisfactory solution to all those concerned namely,the end user, manufacturers/vendors as well as the third party payors.


Justification

Obesity is a risk factor for hypertension, atherosclerotic heart disease, type 2 diabetes and several other chronic illnesses like cancer, COPD, musculoskeletal disorders, sleep apnea, gall bladder disease and many more.[5] [6] [7]. Visceral fat accumulation is associated with insulin resistance and hypertension. Thus Obesity is a major cause of mortality and morbidity in the world increasing theexpectations from an already overburdened health care system.

Obese (BMI- 30 to 34.9) and severely obese (BMI > 35) individuals have 14% and 25% more physician visits as compared to normal weight individuals and 34% and 74% more in patient days as compared to normal weight individuals [8]. The average annual medical costs associated with obesity in the United states are between 5-7% of annual health expenditures [9]. Moreover, since obese individuals are covered by both medicare and Medicaid, the government finances half the annual medical costs due to obesity. The taxpayer bears around $175 /yr which goes toward obesity related expenditures [10].

Thus it is exceedingly clear that obesity related problems cost billions of dollars to the government, industries and the tax payers. This does call for a urgent and ubiquitous requirement for efficient, effective and proactive tools for health behavior change.Thus the e health weight management program has the potential to effectively maintain health, improve quality of life and reach millions of people at a relatively low cost [11].

Enabling Technologies

Research

There is evidence to support the fact that well designed weight loss programs delivered through the internet produces significant weight loss [12]. Moreover, Kaiser permanente's large scale randomized controlled trial showed that web based tailored weight management program has the potential to effect significantly greater weight loss as compared to an infomration only weight management programs. Participants of this trial also reported that the tailored program was personally relevant, helpful and easy to understand [13]. However, the efficacy of such online programs in long term maintenance of weight still remains ambiguous [14]. A Phase 11 clinical trial sponsored by Robert wood johnson foundation began in 2004 with the aim of evaluating the efficacy of MiDieta e health portal for weight loss among the Hispanic community with the results expected shortly [15].

Commercial Products

  • Weight watchers online [16] - This website allows instant access to state-of-the-art and easy-to-use interactive weight-loss tools and advice. Some of the features of this program are the plan information is accessible at all times, availability of 1500 recipes and meal ideas, 60 workout demonstrations, easy access to food and exercise habits with new interactive tools, continuous weight monitoring for progress, provision of personalized goals on weight maintenance, access to resource library of articles and expert advice and message board for support with high privacy standards.
  • E-Health fitness[17] - This website provides easy access to plain language health and fitness information, support and resources and has the following features; health and fitness information on physical and mental illnesses, addiction, cancer, weight, elder care and nutrition, aerobics, anaerobics, walking, lifting, stress and weight loss exercise; Articles/Books reviews and book lists realted to health and fitness;Forums/Blog where people can talk to the site coordinators or each other for support and encouragement and a health Shop.
  • Revolution Health [18] - This website is dedicated to healthtopics and healthy living, one such topic being weight management. Some of the features include weight management guide including weight and diet options, motivation, exercise, challenges and maintenance; weight management topics including nutrition, metabolism, diets, weight maintenance; Forums, blogs for discussions and social support. Moreover, Revolution health and Spark people in partnership have the following weight management tools;
    • Sparkdiet- four stages that combine healthy tips and tools with motivation and confidence to improve lifestyle
    • Calorie counter- customized tools for determining calorie intake
    • Exercise demos- easy demos targeting major muscles
    • Workout generator- personalized workout
  • eDiets [19] - eDiets is a leading provider of online weight loss services, online diets and customized fitness plans and weight loss information and products based in Fort Lauderdale, Florida.It provides access to nutrition and fitness expert; community groups for social support and encouragement including success stories, support boards and support from certified experts; custom fitness plans; list of healthy recipes and e tools to track progress.
  • My Diet[20] - This is a personalized weight control program with the following features;
    • Daily, customized menus
    • Personalized exercise program
    • A weekly grocery shopping list
    • NutriNews- newsletter on diet, fitness, and healthy living
    • Health news and daily tips
    • Online recipe library
    • Support from the MyDiet Community
  • eHealth companion [21] - This product website provides proactive healthcare. Their wellness, Prevention & Fitness programs offer guidance, practical resources and encouragement to help people selecting healthier lifestyle. Resources include health assessments, effective weight-loss strategies, extensive exercise library and personalized tele-coaching by trained experts.
  • Traineo [22] - Weight management site that helps track workouts as well as sends weekly progress reports via email to 4 motivators of the clients choice; easy-to-use software allows client to choose what they'd like traineo to report to the motivators so they can provide the encouragement, social support and accountability needed to achieve specific goals. Traineo tools include;
    • Determination of calories burnt at the gym/workouts
    • Training diet rating
    • Visualization of progress (graphs)
    • E mails with traineo motivators
    • Meet others in traineo community for social support and encouragement
    • Personalized traineo.com page
  • e Weight Loss Center [23] - e Weight Loss Center features nutritional information, interactive tools, support groups to help members.The website offers interactive tools that helps members customize a program to achieve their specific goals as well as providing a variety of information on nutrition, fitness and health at the click of a mouse. Tools include;
    • 24 hr support thru private chat room,
    • Message boards,
    • Buddy system,
    • Regular online meetings,
    • Motivational emails from personal weight loss coach
  • Twitter

Recently some weight loss tracking applications have been developed for Twitter. These include 'Weight Loss Charts'[24] and 'Twackit'[25]

Gaps

  • Technology - Gaps in technology mainly involve systems needing to be more user friendly (especially geared for easy use by elderly and first time users)
  • Basic Science - Gaps in the basic science include some of the following;
    • dearth of research of applicability and feasibility of online programs in the elderly, various ethnic groups and socioeconomically disadvantaged.
    • dearth of studies focusing on efficacy of online weight management programs for long term weight maintenance.
    • dearth of studies on cost effectiveness and feasibility of inclusion of such programs in insurance plans.

Gaps in Implementation

The major gap here involves the lack of feasibility studies for large scale implementation in the general population.

Future Vision

Online, home/work based , low cost, tailored, effective, long term, weight loss management programs at affordable prices,appropriate for various subpopulations with regards to age, ethnicity and socio econoomic status so as to improve lifestyle and motivate behavior change leading to a healthier population enjoying good quality of life.


Related Aspects of Ageing in CAPSIL:



Related Enabling Technologies in CAPSIL:

References

  1. ↑ http://www.cdc.gov/nchs/data/hus/hus07.pdf#074
  2. ↑ Phillips, S. (2008). Obesity, Weight Loss, and cardiovascular Health: Is Oxidative Capacity a Missing Link? American Journal of Hypertension, 21 (12), 1277
  3. ↑ Tufano, J. (2005). Mobile eHealth Interventions for Obesity: A Timely Opportunity to Leverage Convergence Trends
  4. ↑ Nahm,E., Preece, J., Resnick, B., Mills, M., (2004). Usability of health websites for older adults: a preliminary study.Comput Inform Nurs, 22 (6), 326-34
  5. ↑ Phillips, S. (2008). Obesity, Weight Loss, and cardiovascular Health: Is Oxidative Capacity a Missing Link? American Journal of Hypertension, 21 (12), 1277
  6. ↑ Franssen, F., O’Donnell, D, Goossens, G., Blaak, E., Schols, A., (2008). Obesity and Lung. 5 Obesity and COPD, Thorax, 63 (12), 1110-1117
  7. ↑ Finkelstein, E., Ruhm, C., Kosa, K., (2005). Economic causes and consequences of obesity. Annu Rev public Health, 26, 239-57
  8. ↑ Finkelstein, E., Ruhm, C., Kosa, K., (2005). Economic causes and consequences of obesity. Annu Rev public Health, 26, 239-57
  9. ↑ Finkelstein, E., Ruhm, C., Kosa, K., (2005). Economic causes and consequences of obesity. Annu Rev public Health, 26, 239-57
  10. ↑ Thompson D, Edelsberg J, Kinsey KL, Oster G. 1998. Estimated economic costs of obesity to U.S. business. Am. J. Health Promot. 13(2):120–27
  11. ↑ Rothert, K., et al (2006). Web-based weight management programs in an integrated health care setting: a randomized, controlled trial. Obesity (Silver Spring). 2006 Feb;14(2):266-72
  12. ↑ Glasgow, R., et al (2007). Reach, engagement, and retention in an Internet-based weight loss program in a multi-site randomized controlled trial. J Med Internet Res. 2007 May 9;9(2):e11
  13. ↑ Rothert, K., et al (2006). Web-based weight management programs in an integrated health care setting: a randomized, controlled trial. Obesity (Silver Spring). 2006 Feb;14(2):266-72
  14. ↑ Weinstein, P., (2006). A review of weight loss programs delivered via the Internet. J Cardiovasc Nurs. 2006 Jul-Aug;21(4):251-8; quiz 259-60
  15. ↑ http://clinicaltrials.gov/ct2/show/NCT00372606
  16. ↑ http://www.weightwatchers.com/index.aspx
  17. ↑ http://www.e-health-fitness.com/
  18. ↑ http://www.e-health-fitness.com/
  19. ↑ http://ediets.com/
  20. ↑ http://christus.mydiet.md/support/default.asp
  21. ↑ http://www.ehealthcompanion.com/
  22. ↑ http://www.traineo.com/
  23. ↑ http://www.eweightlosscenter.com/
  24. ↑ http://weightlosscharts.org/
  25. ↑ http://www.twackit.com/


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