Discerning the Obesity Epidemic

The World Health Organization has stated that obesity will be the single biggest public health challenge for the 21st century. Obesity is a marker of unhealthy lifestyle behaviors that lead to numerous chronic diseases such as diabetes, heart disease and cancer. Obesity follows in the footsteps of economic development, and it is the need to increase the standards of living that makes it a particular challenge to address — can we be both prosperous and healthy — can we have our cake and eat it too?

The Colorado Center has made obesity a research focus because it is the single biggest public health challenge we face as a nation and as a global civilization. And, because 50 years of scientific study so far have not revealed any simple solutions to the problem. We simply must attack this issue at multiple levels, from the basic science of understanding why some people become obese and others stay lean in the same environment, what are the best strategies for achieving permanent weight loss maintenance, how do we prevent obesity in the first place, and how can we do this in a way that allows our economy to grow and provide the prosperity that most people strive for.

Our approach is unique because it is vertically integrated, all the way from “creating new thinking space” for how to attack such a multi-factorial problem, to the basic science that provides the foundation, to the clinical science that demonstrates its utility in real people, to the community programs that create the models of what a “future state” might look like where obesity is not the norm and a “culture of health” becomes the new “business as usual.”

Leaders of the Colorado Center have an established track record in each of these areas that provide a blueprint for how to accomplish this vertical integration:

1. New thinking space was created over a decade ago with the creation of a new social ecological model for how to better understand the interaction of individuals and the intrinsic determinants of their behavior with the larger environment in which they live, the behavior settings where they live, work, play and shop, and the rules that determine what those settings look like, and the “tectonic” forces that affect those rules such as the national and global economies and the media.

This was followed by another ground-breaking event that provided an initial framework for considering how economics (the allocation of limited resources) affects personal choice … at the moment of decision making. Whether it is a choice about food or physical activity in life there are economic factors (time, access, cost, effort) that affect the outcome. This work has catalyzed a wide range of new scientific study into the factors that affect healthy lifestyle decision-making. The relatively new field of behavioral economics is now beginning to focus on lifestyle behaviors and the influence of our innate human wiring to often make “irrational decisions” because of how the “choice architecture” might be designed.

2. Center scientists continue to do cutting edge science spanning a range of disciplines from understanding the basic physiology and biochemistry of energy balance to human studies of how brain metabolism responds to the sight and sensory properties of food to intervention studies examining the amount and intensity of physical activity required to promote weight loss and prevent weight gain.

One of the landmark areas of research for the Center involves developing the science of weight maintenance — how can people maintain weight in an environment that constantly tempts them to gain more? Dr. James Hill co-founded the National Weight Control Registry in the mid-1990s in an attempt to understand if there were people who had successfully lost weight and maintained it for the long term … and how did they do that? Thousands of people who had lost at least 30 pounds and kept it off for at least a year came forward, shared their data and became part of the Registry. Since then, dozens of scientific studies have been conducted and published documenting “what success looks like”. And, the findings from these studies have led to nationally prominent guidance on how to successfully manage body weight for the long term.

3. The Center has developed many different clinical programs, including Colorado Weigh, a weight loss program that provides the knowledge, skill and behavioral techniques to manage weight for a lifetime. In addition, the Center has participated in numerous large scale intervention studies aimed at understanding the benefits of lifestyle modification and weight loss to overall health and to treatment and prevention of chronic diseases like diabetes.

4. America On the Move continues to enroll worksites, schools and individuals in an inspirational challenge to modify one aspect of nutrition and one aspect of physical activity to prevent weight gain and chronic disease. This website-based program provides motivational messaging, healthy-living tips, tracking tools, and evidenced-based content.

Addressing prediabetes

Millions of Americans are at high risk of developing type 2 diabetes. There are initiatives by the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA) to promote awareness of prediabetes as a treatable condition and that treatment can prevent or delay development of diabetes. One 3rd-party payer – United Health Care – is already reimbursing for treatment of prediabetes. Treatment of prediabetes is weight loss. Thus the Colorado Center is in a unique position to apply its expertise in weight management to individual with prediabetes. Dr. Hill is chair of the Prevention Committee of the ADA and is leading efforts to promote awareness of prediabetes and to identify treatment programs. The CDC is working to certify program for treatment of prediabetes. Addressing prediabetes is a perfect example of how to apply the operating system for weight maintenance.