The researchers described this study as an "intensive" behavioral intervention. It included the use of meal replacement shakes and supplemental foods, ongoing classes on nutrition, exercise and weight-management strategies, and behavioral support as needed. Over a nine-year period, 118 of the 656 people enrolled in the study achieved a weight loss of 100 pounds or more. The University of Kentucky report focused on those 118 successful losers.

Participants were given a choice of dietary options. They could choose to drink five meal replacement shakes or have three shakes and two meal entrees each day. Or, they could select three shakes, two meal entrees and five or more servings of fruit and vegetables daily. About 80% of participants chose to drink only shakes in week 1, and this tapered down to about 50% by week 40. The proportion choosing shakes plus entrees grew from 17% in week 1 to 33% by week 40. Only 3% chose shakes, entrees and fruits and vegetables in week 1, and that proportion grew to only 13% by week 40. Supplemental foods (nutrition bars and soup) were encouraged to manage hunger and were used by 77% of adults by week 40. Participants attended core classes for 12 weeks and then ongoing classes until they reached their weight goal or entered maintenance.

Energy intake was estimated at about 860 calories a day in week 1 and slowly increased to 1400 calories a day by week 40. Physical activity was about 1700 calories a week (242 calories a day or walking about 2.5 miles daily) in week 1 and increased to 3150 calories a week (450 calories a day, walking 4.5 miles daily) by week 40.

As expected, weight regain occurred over the following five years and many participants were lost to follow-up. Of the 50 people remaining, average weight loss was 66 pounds after five years—a remarkable accomplishment—although there is no way of knowing what the loss was in those lost to follow-up.

Medications were discontinued in two-thirds of the participants, which translated into a cost savings of $100 a month per person. Improvements were seen in LDL cholesterol, triglycerides, blood glucose and blood pressure. Side effects were described as mild. The most common side effects were constipation (31% of participants), dizziness (32%) and hair loss (18%). Less common complaints were nausea, abdominal pain, diarrhea and headaches. Two people had side effects that were severe (abdominal pain) or serious (gall bladder surgery).

The following factors helped promote long-term maintenance of weight loss:

• Greater initial weight loss
• Physical activity
• Low-fat diet
• Generous consumption of vegetables and fruit
• Regular use of meal replacements
• Self-monitoring (weighing oneself and/or monitoring waist measurements, etc.)
• Ongoing treatment or coaching

A major limitation of this study is that it did not include the costs of treatment. Those costs should be considered and compared to the costs of surgery and long-term follow-up, as well as to the costs of higher rates of illness and even death in untreated obesity. However, this study does show that intensive behavioral treatment can be effective with little risk in people with severe obesity. The challenge is to identify those individuals who are willing to apply themselves to such a program—a topic of great importance since participation is not without cost.

The extensive use of technology has drastically reduced the need for physical activity in order to earn a living. Additionally, adults spend much of their leisure time in sedentary activities, such as watching TV. Consequently, as shown below, not enough people meet current physical activity recommendations.¹ Furthermore, the proportion meeting recommendations declines with age.

Percent Meeting Physical Activity Recommendations, by Age, 2005

The American College of Sports Medicine has joined the American Heart Association to update the physical activity recommendations for adults.² Recommendations for seniors will be covered in Part II of this series.

To promote good health, the new physical activity recommendations for adults are:

• Aerobic Activity - Moderate-intensity physical activity for a minimum of 30 minutes five days a week OR vigorous-intensity aerobic activity for a minimum of 20 minutes three days a week OR a combination of the two approaches. If preferred, three 10-minute bouts can be used to accumulate 30 minutes of activity. Moderate-intensity activity means a brisk walk or other activity which noticeably increases the heart rate. Vigorous activity includes jogging or any other aerobic activity that causes rapid breathing and a substantial increase in heart rate. Note: This recommended level of physical activity is to be ADDED TO activities of daily living.

• Muscle-Strengthening Activity - This type of activity is also known as weight training or resistance exercise and is recommended a minimum of two nonconsecutive days a week. A well-rounded program would insure that 8-10 exercises covering the major muscle groups are included each week. Use enough weight to permit the completion of 8-12 repetitions in good form before fatigue is reached. After weeks or months, progressively more weight should be added. Good form should be maintained at all times.

• Greater Amounts of Activity - More activity than the minimum recommended above yields greater health dividends and can contribute to greater physical fitness and greater protection from chronic health conditions. For example, aerobic activity can be pursued more than the five-day minimum recommended here, or more frequent vigorous activity is acceptable. Weight-bearing activity and higher-impact activity (e.g., stair-climbing, high-impact aerobics, jogging) benefit bone health.

• Prevention of Weight Gain - More activity, meaning the same activity recommended above but of longer duration, may be needed to prevent unhealthy weight gain. Additionally, other factors such as reducing food intake may have to be considered to maintain weight loss. Most of the studies on preventing weight gain focus on weight regain after significant weight loss. Those studies suggest that 60-90 minutes of moderate-intensity activity daily may be necessary for weight maintenance after such large weight losses. However, to prevent weight gain in the first place, more research is needed to determine appropriate calorie restrictions and the types, amounts and combinations of activity that are recommended.

Children, parents, teachers and community leaders are encouraged to join together for a day, week or month of walking. For more information and tips on how to organize, promote and register for International Walk to School events, go to www.walktoschool.org.

I have always been one of those people who sees the glass half full. My optimism was put to a test 18 years ago when I went to bed for the night a healthy and energetic woman and woke up a handicap. The body I lived in for 39 years suddenly didn't know who I was and refused to work. The world as I knew it had come to an end. After numerous medical tests I was diagnosed with rheumatoid arthritis.

>From then on my life became very unpredictable. Will I make it to work or to my daughter's school play? Simple things like washing my hair and getting dressed became Herculean tasks. They say that you don't appreciate something until you lose it. Let me tell you, when you have to go to the bathroom and can't unzip your pants, you gain a whole new respect for your body and its functions.

I managed to control the flare-ups as much as possible with medications (which sometimes created adverse reactions), a positive attitude and a Trust in the Infinite Power we call God. Still, after 10 years of inactivity and with bad eating habits, I was faced with another health problem—obesity. The sedentary living had put 30-plus pounds on my 5'3" body, making it almost impossible to move around and take care of myself and my family. I became depressed and sank into an ocean of self-pity. Read More…

If you would like to share your personal success story and be an inspiration to others who desire to lose weight, simply use our story submission system on the SUA website.

INGREDIENTS:

• Non-stick cooking spray, as needed
• 4 medium chicken breast halves, skinned, boned, and cut into 1-inch strips*
• 1 can (14 oz) tomatoes, cut up**
• 1 cup chili sauce, low-sodium
• 1½ cups green peppers, chopped (1 large)
• 1½ cups celery, chopped
• ¼ cup onion, chopped
• 2 cloves garlic, minced
• 1 Tbsp fresh basil or 1 tsp dried
• 1 Tbsp fresh parsley or 1 tsp dried
• ¼ tsp crushed red pepper
• ¼ tsp salt

DIRECTIONS:

1. Spray a deep skillet with non-stick spray coating. Preheat pan over high heat.
2. Cook chicken in hot skillet, stirring, for 3 to 5 minutes, or until no longer pink. Reduce heat.
3. Add tomatoes and their juice, low-sodium chili sauce, green pepper, celery, onion, garlic, basil, parsley, crushed red pepper, and salt. Bring to boiling; reduce heat and simmer, covered, for 10 minutes.

*For convenience, you can use uncooked boneless, skinless chicken breasts.
**To cut back on sodium, try low-sodium canned tomatoes.

Nutritional analysis per serving: 274 calories, 5 grams total fat, 1 gram saturated fat, 73 grams cholesterol, 30 grams carbohydrate, 30 grams protein, 4 grams dietary fiber, 383 milligrams sodium.

Source: A Healthier You: Based on the Dietary Guidelines for Americans, US Department of Health and Human Services, 2005 http://www.health.gov/dietaryguidelines/dga2005/healthieryou/html/recipes.html