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PubMed1997

Physical fitness and psychological benefits of strength training in community dwelling older adults.

Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise. In the present study, psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults (mean age = 68 years). The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a) muscular fitness, b) psychological affect, and c) neurocognitive functioning. Subjects were randomly assigned to high intensity/low volume (EXH: 2 sets of 8 to 10 repetitions for 75 to 85% of 1 RM), low intensity/high volume (EXL: 2 sets of 14 to 16 repetitions for 55 to 65% of 1 RM), or no exercise control programs. Prior to and following the 12-week program, subjects underwent comprehensive physiological and psychological evaluations. Physiological assessment included measurements of blood pressure, heart rate, arm and leg muscle strength, body composition, and oxygen consumption (VO2max). Psychological measures included evaluations of mood, anxiety, and physical self-efficacy as well as cognitive functioning. The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning. Specifically, subjects in the strength training programs increased overall muscle strength by 38.6% and reduced percent body fat by 3.0%. Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood, trait anxiety, and perceived confidence for physical capability. The treatment effects of neurocognitive functioning were not significant. In summary, this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness, mood, and physical self-efficacy in older adults while cognitive functioning remains constant.

Activities of Daily Living↗
PubMed2004

Addressing multiple behavioral risk factors in primary care. A synthesis of current knowledge and stakeholder dialogue sessions.

BACKGROUND: Addressing behavioral risk factors in primary care has become a pressing concern due to the increasing burden of behavioral risk factors on disease, healthcare costs, and public health. Risk factors considered include smoking, risky drinking, sedentary lifestyle, and unhealthy diet-singly or in combination. The already burdened primary care system needs a practical approach to efficiently and effectively address any combination of multiple risk factors. Multiple perspectives and broad insight are urgently needed to gain a deeper understanding of the interacting scientific, systems, and policy issues associated with multiple risk factor interventions (MRFIs). PURPOSE: This paper synthesizes findings from literature reviews, epidemiologic analyses, and structured interactive dialogue sessions, and includes a set of recommendations designed to stimulate further action. METHODS: Several papers were produced to document current knowledge, research evidence, and salient issues related to multiple risk factor assessment and intervention. Structured interactive dialogue sessions were then conducted with clinician, health system, and health policy leaders regarding what advantage or energy would be liberated by a multiple risk factor approach (rather than separate single risk factor approaches), and how to build a policy framework or constituency for MRFIs. This information is synthesized in this paper. RESULTS: There is a clear need to address MRFIs among multiple stakeholders, including patients, purchasers, payers, clinicians, health system leaders, and policy-level stakeholders. MRFIs need to bring with them a compelling value proposition for all stakeholders, and a vision of practical and systematic ways to make it a reality in already-pressed primary care practices. Involving stakeholders in dialogue aimed at helping them see the world through each other's eyes helps overcome discouragement and generates energy for jointly designing new approaches. Recommendations for further action include the creation of multistakeholder dialogue, creation of a policy agenda, development of a translation or integration agenda that connects researchers and practitioners in a two-way exchange, initiation of a series of demonstration projects around MRFIs, and support for research on multiple (rather than only single) risk factor interventions. CONCLUSIONS: The need to address multiple behavioral risk factors in primary care is increasingly urgent. Whereas stakeholders by themselves may be willing to address multiple risk factors, they agree that it can only be done successfully with a collaborative approach. Findings based on evidence reviews, hypotheses generation, and stakeholder dialogue provide guidance for appropriate further action that, based on what is known already, can be initiated right away.

Adult↗
PubMed2000

Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial.

INTRODUCTION: The Activity Counseling Trial (ACT) was designed to compare the effectiveness of physician advice alone with physician advice plus behavioral counseling, provided by ACT-trained health educators, to increase levels of physical activity in healthy, sedentary patients. The objective was to determine health care providers' adherence to the ACT protocol for delivering initial "physician" advice on physical activity and to determine providers' satisfaction with the protocol. METHODS: Fifty-four physicians or physician assistants from 11 primary care practices located in California, Texas, and Tennessee volunteered to participate as ACT-trained physicians. Providers were trained to integrate 3 to 4 minutes of initial physical activity advice into the routine office visits of sedentary patients, aged 35 to 75 years, with no acute or serious chronic conditions. This advice included assessment of current physical activities, advising the patient about an appropriate physical activity goal, and referring the patient to the health educator. Providers initialed forms to document delivery of advice, and ACT health educators recorded their advice on a computerized tracking system. A provider survey measured length of time spent advising patients about physical activity and provider satisfaction with the program. RESULTS: Ninety-nine percent of patients received the initial physician advice about physical activity. Eighty-three percent of the providers spent less than 5 to 6 minutes, and 46% spent the recommended 3 to 4 minutes providing advice. Sixty-three percent said the advice resulted in little or no increase in the length of an office visit, and 83% said participation was an asset to their clinics. CONCLUSIONS: Providers incorporated brief physical activity advice into routine primary care visits with little disruption. Their response to the ACT advice protocol was positive and participation in the study was viewed as beneficial.

Adult↗
PubMed2002

The relationship of age and cardiovascular fitness to cognitive and motor processes.

Older and younger aerobically trained and sedentary adults participated in an S1-S2-S3 paradigm designed to elicit event-related potential (ERP) and behavioral responses to determine the influence of cardiovascular fitness on cognitive and motor processes. The paradigm provided warning (S1) as to the difficulty level of an upcoming decision task (S2). Participants had to decide the taller of two bars on presentation of S2 but hold their response until S3, to which they indicated their choice motorically. Results revealed age-related differences for ERP measures as older participants showed increased amplitude of the stimulus preceding negativity (SPN) prior to S2, and longer latencies and equipotentiality of P3 in response to S2. Fitness effects were also observed for the contingent negative variation (CNV) with decreased amplitude for fit relative to sedentary individuals. Age interacted with fitness for P3 latency to S2 as older sedentary individuals showed the longest latency followed by older fit and both younger groups. No significant group differences were observed for reaction time (RT) to S3. Therefore, physical fitness is associated with attenuation of cognitive decline in older individuals and greater economy of motor preparation for both young and older participants.

Adolescent↗
PubMed2002

Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender.

Television (TV) viewing has been associated with overweight, decreased physical activity, and unhealthy dietary behavior among children and adolescents, and may represent a modifiable cause of childhood obesity. This study examined race, ethnic, and gender-specific differences in these associations among high school students in the United States. The study analyzed data from the 1999 national Youth Risk Behavior Survey, a representative sample (N = 15,349) of US high school students. Logistic regression tested for significant associations. TV viewing on an average school day exceeded 2 hours/day among 43% of students; it was greater among Black (74%) and Hispanic (52%) than White (34%) students. Overall, 11% of students were overweight, 31% of students were sedentary (i.e., did not participate in moderate or vigorous physical activity at recommended levels), and 76% ate less than five servings/day of fruits and vegetables. Watching TV more than 2 hours/day was associated with being overweight, being sedentary, and eating insufficient fruits and vegetables among White females, and with being overweight among Hispanic females. No significant associations were found among Black females. TV viewing was associated with being overweight and eating insufficient fruits and vegetables among White males. No significant associations were found among Hispanic males. Among Black males, TV viewing was associated with greater participation in physical activity. These findings suggest the presence of cultural factors to consider when developing interventions to promote physical activity, healthy eating, and healthy weight through reduced TV viewing among adolescents.

Adolescent↗
PubMed2001

Articular area responses to mechanical loading: effects of exercise, age, and skeletal location.

How reliable are reconstructions of body mass and joint function based on articular surface areas? While the dynamic relationship between mechanical loading and cross-sectional geometry in long bones is well-established, the effect of loading on the subchondral articular surface area of epiphyses (hereafter, articular surface area, or ASA) has not been experimentally tested. The degree to which ASA can change in size and shape is important, because articular dimensions are frequently used to estimate body mass and positional behavior in fossil species. This study tests the hypothesis that mechanical loading influences ASA by comparing epiphyses of exercised and sedentary sheep from three age categories: juvenile, subadult, and adult (n = 44). ASA was measured on latex molds of subchondral articular surfaces of 10 epiphyses from each sheep. Areas were standardized by body mass, and compared to diaphyseal cross-sectional geometrical data. Nonparametric statistical comparisons of exercised and control individuals found no increases in ASA in response to mechanical loading in any age group. In contrast, significant differences in diaphyseal cross-sectional geometry were detected between exercised and control groups, but mostly in juveniles. The conservatism of ASA supports the hypothesis that ASA is ontogenetically constrained, and related to locomotor behavior at the species level and to body mass at the individual level, while variations in diaphyseal cross-sectional geometry are more appropriate proxies for individual variations in activity level.

Age Factors↗
PubMed2004

Sensitivity to the effects of a kappa opioid in rats with free access to exercise wheels: differential effects across behavioral measures.

It is well established that chronic exercise decreases sensitivity to mu opioid agonists; however, it is less clear what effects it has on kappa opioids. The purpose of the present study was to examine sensitivity to the effects of the selective, kappa opioid spiradoline in rats with free access to exercise wheels. Rats were obtained at weaning and randomly assigned to either standard polycarbonate cages (sedentary) or modified cages equipped with exercise wheels (exercise). After approximately 7 weeks under these conditions, sensitivity to the effects of spiradoline on tests of antinociception, locomotor activity, conditioned place preference, and diuresis were examined in both groups of rats. Sedentary rats were more sensitive than exercising rats to the antinociceptive effects of spiradoline, and this effect was observed at both low and high nociceptive intensities. In contrast, exercising rats were more sensitive than sedentary rats to the diuretic effects of spiradoline, and slightly more sensitive to spiradoline's effects in the conditioned place preference procedure. No differences in sensitivity were observed to the effects of spiradoline on locomotor activity. Sensitivity to the antinociceptive effects of spiradoline nonsignificantly increased in exercising rats that were reassigned to sedentary housing conditions, and changes in spiradoline sensitivity were correlated with exercise output in individual subjects. Collectively, these data suggest that exercise alters sensitivity to the behavioral effects of kappa opioids, but that the direction and magnitude of this effect depends on the behavioral measure examined.

Animals↗
PubMed1998

The prevalence of risk factors among women in the United States by race and age, 1992-1994: opportunities for primary and secondary prevention.

OBJECTIVE: To analyze the prevalence of 11 modifiable behavioral risk factors, including multiple risk factors, among white, black, Asian and Pacific Islander, American Indian, and Hispanic women in the United States. DESIGN: We used Behavioral Risk Factor Surveillance System (BRFSS) data for 1992 to 1994 to examine risk factors (smoking; obesity; diabetes; heavy alcohol consumption; sedentary lifestyle; and inadequate use of seat belts, pap smears, consumption of fruits or vegetables, mammography and colorectal screening, and immunization), among women age 18 to 49, 50 to 64, and 65 and older. We also conducted a multiple regression analysis, comparing the odds of having either 1-2 versus 0 or 3 or more versus 0 risk factors among racial/ethnic groups, controlling for education and family income, to see if racial/ethnic differences can be attributed to socioeconomic differences. RESULTS: US women engage in a variety of behaviors that place them at risk for many causes of morbidity and mortality. Risk profiles vary substantially among racial/ethnic populations: Pacific Islanders have relatively low prevalences of most major risk factors, while blacks and American Indians have relatively high prevalences of many major risk factors. Prevalence differences among racial/ethnic populations are diminished but not eliminated when socioeconomic factors are accounted for. CONCLUSIONS: Appropriately designed programs to help women reduce their behavioral risk factors are needed. Action by health care providers, communities, and policy makers can substantially improve the health of women in the United States.

Adolescent↗
PubMed1989

The impact of previous athleticism on exercise habits, physical fitness, and coronary heart disease risk factors in middle-aged men.

A longitudinal study was performed to determine differences in physiologic variables, health behaviors, risk factors, or clinical status between former athletes (FA) (N = 345) and nonathletes (NA) (N = 75). The subjects, 420 self-referred white males aged 25-60 years old, were examined for prior athleticism and health. Athleticism was determined through self-reported high school or college athletic history. Baseline physiologic and health behavior characteristics were not different between the two groups. Of those study participants (N = 203 FA, 48 NA) who were sedentary at baseline, 208 (N = 167 FA, 41 NA) voluntarily began an exercise program during the followup period (average followup = 56 months). These numbers correspond to exercise adoption rates of 82 and 85% for FA and NA respectively, and were not statistically different (95% CI FA = 0.76, 0.88, NA = 0.73, 0.97). Repeated measures analysis of covariance was performed to determine if physiologic responses to adoption were different between FA and NA. No statistically significant difference was found between the two groups, time effects were similar in the two, and no significant interaction of time by group was observed. We conclude that prior athleticism has little apparent impact on health and health behaviors, thus suggesting that contemporaneous exercise has more impact on clinical variables.

Adult↗
PubMed1999

Prevalence and correlates of physician recommendations to exercise among older adults.

BACKGROUND: This study explored the prevalence of and factors associated with physician suggestions to exercise in a sample of older adults. METHODS: We conducted telephone interviews of a random sample of members of two Medicare health maintenance organizations (HMOs) in Northern California. Participants were 893 community-dwelling older adults of whom 63% were women, 52% were married, and 12% were in a minority group. Mean years of education was 14.8 +/- (2.6) and mean years of age was 74.9 +/- (6.5). The associations between patient self-reports of ever receiving physician recommendations to exercise and the following categories of variables were assessed: demographics, health-related quality of life, medical conditions, health/risk behaviors, and health knowledge/interest/satisfaction. RESULTS: The prevalence of older adults in this study ever receiving a physician suggestion to exercise was 48.2%. In a multivariate logistic regression model, being younger, sedentary, and having a higher body mass index were independently (p < or = .05) and positively associated with increased reports of having ever received a physician's advice to exercise. Those who were precontemplators (not thinking about changing physical activity behavior), and those who reported greater frequency of endurance exercise were less likely to report receiving a physician recommendation to exercise (p < or = .05). CONCLUSIONS: Although physician advice appeared to be targeted to subgroups that could benefit, physician advice on exercise could be particularly increased for patients over 75 years of age, those currently not thinking about an increase in physical activity, and those currently active patients who may benefit from ongoing physician advice to promote maintenance.

Aged↗
PubMed2005

Correlates of physical activity among women with fibromyalgia syndrome.

BACKGROUND: Fibromyalgia (FMS) is a chronic pain syndrome of unknown origin that lacks standardized treatment. However, participation in physical activity (PA) benefits people with FMS. Despite the psychosocial and health benefits that can be gained through PA, the correlates of PA among people with FMS remain poorly understood. PURPOSE: The purpose of this study was to identify and compare the effects of cross-sectional and longitudinal correlates of PA among women with FMS. METHODS: Participants were 187 female members of a HMO with a confirmed diagnosis of FMS. They were administered a battery of questionnaires assessing potential correlates of PA. These correlates were suggested by social cognitive theory and the transtheoretical model, and have been repeatedly associated with PA among the general population. RESULTS: Multivariate analyses indicated that self-efficacy for PA and the behavioral processes of change were the strongest discriminators among PA adopters, maintainers, quitters, and those who were sedentary. Enjoyment of PA, barriers to PA, the impact of FMS, and the environment also significantly discriminated among these groups. Longitudinally, changes in self-efficacy were significantly associated with changes in PA. CONCLUSIONS: These findings suggest that self-efficacy may play a critical role in both the present and long-term PA of women with FMS. They also lend additional support to the role of social cognitive and transtheoretical variables in discriminating among levels of PA.

Aged↗
PubMed2004

Effects of beta-adrenoreceptor blockade during chronic exercise on contextual fear conditioning and mRNA for galanin and brain-derived neurotrophic factor.

The authors examined the effects of activity wheel running (AWR) and propranolol on contextual fear conditioning (CFC) and messenger RNA (mRNA) for galanin (GAL) in the locus coeruleus (LC) and brain-derived neurotrophic factor (BDNF) in the hippocampal formation (HF) in rats. Freezing behavior during the testing session of the CFC protocol was elevated in the AWR-placebo group compared to sedentary-placebo and AWR-propranolol groups. AWR increased GAL mRNA in the LC. CFC increased BDNF mRNA in the HF. These results suggest that exercise enhances CFC and that antagonism of the beta-adrenoreceptors attenuates this effect. The exercise-related induction of GAL gene expression in the LC may influence noradrenergic transmission to facilitate CFC.

Adrenergic beta-Antagonists↗
PubMed2005

Exercise duration and intensity in a weight-loss program.

OBJECTIVE: To examine the effect of duration and frequency of exercise on weight loss and cardiorespiratory fitness in previously sedentary, overweight, women. DESIGN: Randomized, controlled, 4-arm trial of 12-months duration. SETTING: A university-based behavioral weight loss program during the years 2000 and 2001. PARTICIPANTS: Eligibility criteria were: women, 21 to 45 years of age, body mass index (BMI) 27 to 40, reporting exercise <3 days/week for <20 minutes/day during the previous 6 months. Exclusion criteria were: a history of myocardial infarction, taking medication that would alter the heart rate response during exercise or that would affect metabolism or weight loss, being treated for psychologic conditions, pregnant, recently pregnant, or planning pregnancy, having a medical condition that could affect metabolism or body weight (eg, diabetes) or that would limit exercise participation. INTERVENTION: All 201 participants were assigned to a standard behavioral weight loss program, which included regular group meetings and telephone calls, and caloric and dietary fat restrictions. Participants were given meal plans and kept weekly food diaries. The women were assigned to 1 of 4 exercise groups based on energy expenditure of 1000 kcal/wk or 2000 kcal/wk and exercise intensity (moderate versus vigorous). Exercise intensity was prescribed according to percentage of age-predicted maximal heart rate and rating of perceived exertion. Energy expenditure was converted to minutes of exercise per week. The groups were vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration. All 4 groups started the program at moderate intensity and moderate duration (100 min/week of walking) and increased the vigor and duration of exercise to set targets of 200, 300, 200, and 150 min/week, for the groups respectively. Treadmills were provided to the participants, and feedback on their weekly exercise logs was given. MAIN OUTCOME MEASURES: At 6 and 12 months, changes in body weight and BMI were measured. Cardiorespiratory fitness was measured by a graded exercise treadmill test and expressed as percent change in oxygen consumption from baseline. Excluding 5 women who left the study (because of pregnancy or death) the data were analyzed by the intention-to-treat method (completion rate 184/196 = 94%). MAIN RESULTS: Attendance at group sessions and reported dietary intake and exercise adherence suggested that all groups complied similarly with their dietary and exercise prescriptions. Mean weight loss after 1 year was 8.9, 8.2, 6.3, and 7.0 kg, for the vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration groups, respectively, but there was no effect of exercise duration or exercise intensity on changes in body weight or in BMI. Cardiorespiratory fitness increased for all groups; 22%, 14.9%, 13.5%, and 18.9%, for the vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration groups, respectively, but the groups did not differ in effect of exercise intensity (P = 0.11) or exercise duration (P = 0.35). When participants were divided by their reported average weekly duration of exercise at months 6 and 12, the group which averaged > or =200 min/week at both time points lost more weight than the groups which averaged <150 min/week of physical activity or whose activity duration was inconsistent (difference among groups, P = 0.01). They also had a greater percent increase in cardiorespiratory fitness than those who averaged <150 min/week of physical activity (P = 0.007) and those whose activity was inconsistent (P = 0.003). CONCLUSION: Sedentary overweight women lost weight and improved cardiorespiratory fitness in a year-long combined dietary and exercise regimen. Duration of exercise (at least 150 min/week of walking) was more important than vigorous versus moderate intensity in achieving these goals.

Comment↗
PubMed2005

Physical activity of Aboriginals with type 2 diabetes: an exploratory study.

Given the magnitude of the diabetes epidemic among Canadian Aboriginals and the corresponding need to develop physical activity interventions, the aims of this study were to: 1) examine the meaning of physical activity; 2) assess physical activity behavior levels; and 3) examine the association of key Social Cognitive Theory (SCT) constructs with physical activity behavior. Thirty-four Aboriginals with diabetes completed a survey composed of questions regarding: 1) the perceived meaning of physical activity; 2) physical activity behavior; and 3) SCT constructs. An emerging theme revealed that some participants perceived physical activity leisure-time activities as appropriate across the lifespan, while the majority perceived leisure-time activities to be only for youth. Based on the reported energy expenditure estimates, 61.5% of participants were categorized as sedentary. However, when occupational and household activities were taken into account, 33.0% were categorized as sedentary. Bivariate correlations revealed that no SCT constructs were significantly associated with energy expenditure scores. Results suggest that specific SCT construct items may help understand physical activity behavior change.

Adolescent↗
PubMed2003

Rationale, design, and baseline data for Commit to Quit II: an evaluation of the efficacy of moderate-intensity physical activity as an aid to smoking cessation in women.

BACKGROUND: Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control. METHODS: Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation. RESULTS: Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial. CONCLUSIONS: Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study.

Administration, Cutaneous↗
PubMed1997

Lipid, lipoprotein, and apolipoprotein profiles in active and sedentary men with tetraplegia.

OBJECTIVE: To investigate whether the risk profile of coronary heart disease (CHD) is more favorable in physically active men with tetraplegia compared with sedentary men with tetraplegia. DESIGN: Using a cross-sectional design, the lipid and (apo)lipoprotein concentrations of 11 active and 13 sedentary men with tetraplegia were compared. Regression analysis was applied to investigate the influence of subject characteristics and behavioral factors on the risk profile of CHD. MAIN OUTCOME MEASURES: Total plasma cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein-A1 (ApoA1), and apolipoprotein-B (ApoB) concentrations were determined. Low-density lipoprotein cholesterol (LDL-C) and the ratios TC/HDL-C, LDL-C/HDL-C, ApoA1/ApoB, and HDL-C/ApoA1 were calculated. RESULTS: A significantly higher HDL-C and ApoA1/ApoB and lower TC/HDL-C were found in the active group. Age and body mass index were important determinants of the lipids and (apo)lipoproteins. Sport activity was the only significant determinant of HDL-C. CONCLUSIONS: Results suggest a positive influence of sport activity on HDL-C in men with tetraplegia, which may reduce the risk of CHD.

Activities of Daily Living↗
PubMed2002

Position of the American Dietetic Association: weight management.

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Guidelines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated.

Body Weight↗