Employer-Sponsored Weight Management Programs

O verweight and obesity contribute $93 billion to the nation’s annual medical bill,

and bariatric surgery is growing in popularity every year.1 Employer healthcare

expense continues to outpace inflation by more than 2:1,2 driven in large part by

soaring rates of overweight and obesity. Employers need a long-term solution.

The evidence is in: Consistent, simple changes — healthy eating and exercise —

are proven methods for removing excess pounds, while boosting heart health and

overall well-being. Driving these changes can make a dramatic impact on employee

health — and on the bottom line. Helping employees adopt and maintain a healthier

lifestyle, along with the resulting weight loss, can significantly reduce the demand

for healthcare.

Although the changes necessary to lose weight are simple, most people aren’t

able to maintain weight loss long term. Many programs produce weight loss;

however, most participants regain a significant amount of weight within 1 year,

and almost all is regained within 5 years.3, 4

Promoting behavior changes that are difficult

or unreasonable to maintain results, at best,

in short-term weight loss and eventual regain.

For any program to result in permanent

weight loss, the changes must be sustainable

for a lifetime.

Encouraging employees to eat

healthfully and increase their

activity requires only a modest

investment, yet can lead to

savings from reduced insurance

costs and increased productivity.

Copyright © 2007 Health Enhancement Systems1

Copyright © 2007 Health Enhancement Systems 2

The High Costs of Obesity

Costs associated with overweight and obesity are described below:

nObesity costs employers more than $12 billion each year in increased

healthcare utilization, reduced productivity, and higher absenteeism5

nObesity-related disabilities cost employers an average $8720 for each

claimant6

nAmong women, obesity is linked to depression — another major medical claim

cost driver for employers7

nAnnual healthcare costs are 11% higher among obese vs. nonobese people8

(36% higher inpatient and outpatient costs, 45% more inpatient days, and

77% higher medication costs).

One study of obesity in the workplace showed that 3-year medical care costs were

52% higher for participants with an “at-risk” BMI (27.3 or higher for women, 27.8

or higher for men); in addition, the average 3-year absenteeism cost for at-risk

participants was $863 greater than that of lean participants.9

Inactivity, a primary contributor to overweight and obesity, costs $670-$1125 a

person annually. If the more than 88 million inactive adult North Americans were

to increase regular, moderate physical activity, annual healthcare costs could be

reduced by as much as $76.6 billion.10

*BMI > 27.8 kg/m2 in men; 27.3 kg/m2 in women. The Obesity Society. Secondary source,Burton et al. Journal of Occupational and Environmental Medicine 1998; 40:786.

Healthcare

$8000

$6000

$4000

$2000

$0 Absenteeism

$1600

$1200

$800

$400

$0

Economic Effect of Obesity on Business: 3-Year Costs

Lean Obese*

$4496

$6822

$683

$1546


There’s no doubt about it — helping employees start and maintain a regular activity

program while encouraging healthy eating habits is the right thing to do — for their

health and for the organization.

Obesity’s Impact on Health

Nearly 2 out of 3 US adults are overweight or obese; chances are, so are most of

any given organization’s employees.13 Overweight and obese employees are at

increased risk for many conditions, including:14, 15

nHeart disease

nMusculoskeletal problems (back, knees, hips)

nType 2 diabetes

nDepression and other psychological problems

nHigh blood pressure

A sustained reduction of just 10% in an overweight or obese

person’s body weight can lead to signifi cant health and

economic benefi ts. 11,12

Services

80

60

40

20

0

Cost Increase Associated With Overweight, Obesity, and Smoking

Obese Smoking Overweight

Medication

Per

cent

Cha

nge

Sturm, RJ, Health Affairs Vol 21 (2).


nDyslipidemia (high total cholesterol or high levels of triglycerides)

nStroke

nGallbladder disease

nArthritis

nSleep apnea and respiratory problems

nSome cancers (endometrial, breast, and colon)

nFertility problems

nPregnancy complications.

Most employers’ highest-cost claim categories are on this list.

Becoming more active can help employees lose weight, reduce symptoms, and

improve overall health.16 Regular physical activity, good nutrition, and a healthier

weight also will help keep low- to moderate-risk employees from moving into the

more expensive high-risk health category.

Healthy Eating for Weight Loss

Many weight loss programs tout drastic reductions or increases in a certain type

of food; rigid calorie counting and fat gram tabulating may be necessary to follow

the program. While either of these tactics may result in immediate weight loss, they

aren’t sustainable habits for permanent weight loss.

Eating patterns to maintain for a healthy weight long term are described below:

nBreakfast helps control eating throughout the day. A study determined

that people who eat breakfast consume fewer overall calories and impulse

snacks as well as less fat compared to those who skip breakfast.18

nEating fruits and vegetables helps those wanting to lose weight stay

on track. A 2004 study showed that participants who ate 5 or more fruit and

vegetable servings a day had twice the odds of sticking to their activity and

nutrition goals.20

Research shows that obese individuals suffer 30%-50%

more chronic medical problems than people who smoke

or drink heavily.17

78% of National Weight Control Registry

participants eat breakfast every day.19


nWhole grain products promote weight management. High-fiber foods

provide a long-lasting feeling of satiety. A 2002 study revealed that whole grain

intake had a positive effect on body weight and fat distribution, helping to

prevent weight gain or promote weight loss.21

nWater is the best choice for reducing thirst and doesn’t lead to excess

calorie intake. Total food intake is greater for study participants who

consume sucrose-sweetened drinks with meals than for those who have water

or no drink. In addition, water is more effective in reducing thirst than sugar-

sweetened drinks.22

Walking for Weight Loss

While any sustained (45-60 minutes or more) aerobic activity supports weight

loss, walking is a good choice. It’s an inexpensive activity to promote as well as

accessible and easy for most participants. As a weight loss tool, walking is hard to

surpass; the benefits follow.

nPromotes weight loss. Walking boosts both mood and metabolism,

increasing calorie output and facilitating weight loss by:

− Reducing fat and increasing lean mass. A study of inactive, overweight

men and women ages 40-65 found that 30 minutes a day of walking

helped them lose weight, decrease waist size, and increase lean body

mass — even without any special dietary changes.23

− Burning about the same number of calories as running. Walking 1 mile

briskly in 15 minutes burns about as many calories as jogging the same

distance in 8.5 minutes.24

Ene

rgy

Inta

ke (k

cal)

*P<1.01 vs other groups.The Obesity Society. Secondary source, Rolls et al. Physiology & Behavior 1990;48:19.

*

Effect of Sucrose-Sweetened Drinks on Total Energy Intake

No Drink

1500

1250

1000

750

500

250

0

Food Drink

16oz Water

16oz Water w/Sucrose


nEncourages high participation. As the most popular leisure-time activity in

North America,26 walking is more likely to engage a workforce than any other

program:

− It appeals to all ages. Walking is the only activity where participation rates

remain steady as people reach middle age and older.

− Walking is inexpensive and easy. All a person needs is the right shoes

and motivation. Employers can encourage employees to walk regularly —

without a large investment — through walking clubs, charity walk teams,

or walking incentive programs.

− It’s a natural activity that can be added to any lifestyle; examples include

walking to school, meeting with a coworker while walking, pacing during

phone calls, and walking to complete certain errands.

− Walking is a low-impact, safe form of exercise — even for those who are

overweight, obese, or have arthritis.

nIs enjoyable — especially with a partner or in a group. Research supports

the value of the buddy system when trying to establish a habit of physical

activity.27 In the workplace, an organized walking program can heighten

morale and strengthen the sense of teamwork.

nBecomes a stepping-stone to other forms of exercise. Walking holds

particular appeal for people who are inactive and overweight, yet self-

conscious about exercise — the right population to target for reducing medical

claim costs.

Maintaining a Healthy Weight

Avoiding weight gain with age is diffi cult even for those currently at a healthy weight,

and sustaining weight loss is challenging for even the most committed individuals

— making it important to promote activity and nutrition habits that will last a lifetime.

Healthy eating choices and regular activity can help prevent weight regain for those

successful at weight loss — and keep low-risk employees from gaining weight in

the fi rst place.

nThe National Weight Control Registry is a study of over 4000 men and

women who have lost at least 30 pounds and kept it off for at least 1 year.

Participants’ average level of exercise is about 1 hour a day of moderate-

intensity activity, such as brisk walking. In a review of studies on 5-year

weight loss maintenance, additional fi ndings note regular exercise is a critical

component of long-term weight loss success.28

76% of National Weight Control Registry participants report

walking as their most common activity.25


nStudies have shown that regular exercise plays an important role in successful

long-term weight loss (maintaining the loss for over a year). In one study, 90%

of women who maintained their weight loss exercised regularly.29

n89% of registry participants report that the combination of healthy eating and

exercise is critical for weight maintenance.30

nMany studies agree that regular activity expending roughly 2500 kilocalories/

week is necessary for long-term weight maintenance. This level of activity can

be achieved with 60-75 minutes/day of moderate activities such as walking or

30 minutes/day of vigorous activities such as cycling.31, 32, 33, 34

nStudies also indicate a modest increase in fi tness, refl ecting regular exercise,

can help prevent weight gain. 36, 37

Health Benefi ts of an Active Lifestyle

Regular physical activity provides health benefi ts independent of weight control.38

In addition to healthy eating and exercise, National Weight

Control Registry participants report frequent monitoring of

their weight — 44% weigh themselves once a day and 31%

step on the scale at least once a week.35

Am Journal of Clinical Nutrition 1990;52:800-7* Coping skills and social support also contributed

to maintenance of weight loss.

Relationship Between Physical Activity* and Maintenance of Weight Loss

Not Maintained

100

80

60

40

20

0 Maintained

Sub

ject

s E

xerc

isin

g (%

)


Whether or not overweight and obese employees lose pounds, they can improve

health-related outcomes through activity such as walking:

nProtects against heart attack and stroke. An 8-year study of 84,000

female nurses ages 40-65 found those who walked 3 or more hours a week

had a 40% lower risk of heart attack and stroke than the nurses who didn’t

walk. More brisk walking produced greater benefits.39

nLowers risk of diabetes. The Diabetes Prevention Program, a national study

promoting dietary changes and regular physical activity, saw a 58% reduction

in the incidence of diabetes among participants.40A study of 2900 adults with

diabetes found those who walked at least 2 hours a week had a 39% lower

risk of death from any cause than adults who did not walk. Those who walked

more — at least 3 hours each week — had a 54% lower risk of death from any

cause.41 Another study found walking 30 minutes a day was more effective

than the prescription drug metformin in preventing diabetes.42

nDecreases risk of gestational diabetes. Other study results report that

women who were physically active in the year before pregnancy and during

pregnancy had a 69% reduced risk of gestational diabetes compared to

inactive women.43

nReduces symptoms of depression. Increases in consistent physical activity

and cardiorespiratory fitness level are associated with lower depression

symptoms and greater emotional well-being.44

nLowers overall mortality. Male study participants ages 61-81 who walked

more than 1 mile a day had 1/3 fewer deaths in a 12-year follow-up period

compared with men who did not walk.45 The beneficial effects were evident

even after taking into account other activities and risk factors. Another study

revealed those who burned 2000 or more calories a week by walking lived 1-2

years longer than men who burned fewer than 500 calories a week through

exercise.46

Benefits of Eating Healthfully

Good nutrition also promotes health and well-being beyond weight loss.

nVegetable and fruit consumption reduces heart disease risk. A 5-year

study of female health professionals showed a 20%-30% reduction in risk of

cardiovascular disease and myocardial infarction when fruit and vegetable

consumption increased.47


nWhole grains reduce risk of Type 2 diabetes and cardiovascular

disease. A diet rich in whole grains lowers insulin concentrations and LDL

cholesterol, resulting in a decreased risk of Type 2 diabetes and cardiovascular

disease.48

nWhole grains may lower blood pressure. Subjects showed signifi cant

reductions in systolic and diastolic blood pressure after consuming whole

grains for 10 weeks. 49

Weight Loss Drugs

Prescription weight loss drugs are an expensive option for employers and

employees. Safety has not been studied beyond 1-2 years, and the modest

average weight loss results — under 11 pounds (5 kg) a year — are maintained only

with continuous use. Still, because these results represent a reduction of 1-2 Body

Mass Index (BMI) points, they’re medically signifi cant.50 The following statements

are based on available evidence:

nPrescription weight loss medication is not for everyone. These drugs

generally are approved for people who have:

− Tried other methods to lose weight without success

− A BMI of >30 (or >27 with comorbidities such as diabetes, heart disease,

sleep apnea, or high blood pressure).51

n Individuals must be fully informed before drug therapy. The American

College of Physicians recommends prescription drug therapy for individuals

only after a patient-physician discussion about potential side effects, lack

of long-term safety data, and the temporary nature of weight loss related to

medication use.

nFor results, lifestyle change must accompany prescription medicine.

Yet, in a large study of current weight loss prescription drug users, only 26.7%

reported both eating fewer calories and meeting recommended leisure-time

physical activity levels.53

Studies have shown that once a medication is stopped,

associated weight loss is typically regained.52

Sensible nutrition and regular physical activity are essential

components of any weight loss program, with or without

prescription medicine.54


Although a handful of prescription weight loss drugs are now on the market, orlistat

(Xenical®) and sibutramine (Meridia®) have been studied the most:

Conclusions

This paper highlights the enormous costs and risks associated with the increasing

overweight and obese population. Left unchecked, the nation’s growing girth

poses an ominous threat to health and productivity. Without significant employer

commitment, the 66% of the population that is overweight or obese will continue

to drive healthcare expense at more than twice the rate of inflation — further

handicapping industries that need every advantage to compete effectively in

the global marketplace. Organizations that recognize this fact and implement

appropriate weight loss and healthy weight maintenance strategies have the best

opportunity to stem the tide and remain competitive today and into the future.

Drug Target Population Method Effectiveness Common Side

Effects55,56

Orlistat 57

(Xenical)

• BMI of >30 (or >27 with diabetes, high blood pressure, or high cholesterol)58

• Willing to live with and manage unpleasant side effects

• Inhibits absorption of dietary fat through gastrointestinal tract

• Mean weight reduction of 5.7 pounds (2.59 kg) at 6 months and 6.4 pounds (2.89 kg) at 1 year59

• Oily spotting/discharge

• Gas with discharge • Urgent need to have

a bowel movement • Oily or fatty stools • Increased number of

bowel movements • Inability to control

bowel movements

Sibutramine60 (Meridia)

• BMI of >30 (or >27 with diabetes, high blood pressure, or high cholesterol)61

• Difficulty with appetite and/or cravings

• Inhibits norepinephrine and serotonin uptake to reduce appetite and cravings

• Mean weight reduction of 11 pounds (5 kg) at 1 year for drug alone

• Mean weight reduction of 26.4 pounds (12 kg) at 1 year for drug plus lifestyle therapy 62

• Anxiety/nervousness• Constipation• Dizziness• Dry mouth • Headache• Irritability or unusual

impatience • Stuffy or runny nose• Trouble sleeping


Where to Go From Here

In 2006 Health Enhancement Systems undertook an exhaustive review of the

scientifi c evidence defi ning successful weight loss program characteristics. We

discovered there are dozens of ways people lose weight. In fact, losing weight turns

out to be easy. But maintaining weight loss isn’t.

Commercial weight loss programs, specifi cally, have depressingly low success rates

when it comes to helping people sustain weight loss. That’s the bad news. The

good news is in numerous studies of thousands who have lost a signifi cant amount

of weight and kept it off for years. When we analyzed these results, it became clear

that certain daily habits are common to those who maintain weight loss.

Our analysis led to the development of NutriSum, a program that not only inspires

individuals to lose weight, but also supports the daily habits that add up to healthy

weight for life.

To learn how your organization can begin reversing the trend of overweight

and obesity with proven practices, visit www.NutriSum.com.

About Health Enhancement SystemsHealth Enhancement Systems has been designing award-winning health improvement solutions

for corporations, health plans, health systems, hospitals, government agencies, educational

institutions, nonprofi ts, and other groups since 1992. A leader in behavior change innovation,

we serve organizations in North America and throughout the world. For more information about

Health Enhancement Systems products and services, call 800.326.2317 (989.839.0852) or go to

www.HealthEnhancementSystems.com.


Resources

nAgency for Healthcare Research and Quality (www.ahrq.gov)

nAmerican College of Physicians (www.acponline.org)

nAmerican Heart Association (www.americanheart.org)

nAmerican Journal of Clinical Nutrition (www.ajcn.org)

nAmerican Journal of Epidemiology (http://aje.oxfordjournals.org)

nAmerican Journal of Public Health (www.ajph.org)

nAnnals of Internal Medicine (www.annals.org)

nArchives of Internal Medicine (http://archinte.ama-assn.org)

nCenters for Disease Control and Prevention (www.cdc.gov)

nCirculation, American Heart Association (http://circ.ahajournals.org)

nDiabetes Prevention Program (www.bsc.gwu.edu/dpp/index.htmlvdoc)

nHealth Affairs (www.healthaffairs.org)

nInternational Journal of Behavioral Nutrition and Physical Activity

(www.ijbnpa.org)

nJournal of Occupational and Environmental Medicine (www.joem.org)

nMayo Clinic (www.mayoclinic.org)

nMedicine and Science in Sports and Exercise (www.acsm-msse.org)

nNational Business Group on Health (www.wbgh.org)

nNational Center for Biotechnology Information (www.ncbi.nlm.nih.gov)

nNational Heart, Lung, and Blood Institute (www.nhlbi.nih.gov)

nNational Institute of Diabetes and Digestive and Kidney Diseases

(www.niddk.nih.gov)

nNational Institutes of Health (www.nih.gov)

nNational Weight Control Registry (www.nwcr.ws)

nPresident’s Council on Physical Fitness and Sports (www.fitness.gov)

nThe Obesity Society (www.obesityonline.org)

nUS Department of Health and Human Services (www.hhs.gov)

nUS Food and Drug Administration (www.fda.gov)

nWhole Grains Council (www.wholegrainscouncil.org)

13 Copyright © 2007 Health Enhancement Systems

Endnotes1 National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet.

2 Towers Perrin, 2007 Health Care Costs Survey, 2006, www.towersperrin.com/tp/jsp/masterbrand_webcache_html.jsp?webc=HT_Services/United_States/Press_Releases/2006/20060926/2006_09_26.htm.

3 The Obesity Society (www.obesityonline.org). Secondary source, Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. International Journal of Obesity 1989;13 (suppl 2):39-46.

4 NIH Technology Assessment Conference Panel. Methods for Voluntary Weight Loss and Control. Annals of Internal Medicine 1993; 119(7,2)764-770.

5 National Medical Spending Attributable to Overweight and Obesity: How Much and Who’s Paying? Health Affairs, Web Exclusive. Secondary source, National Business Group on Health.

6 UnumProvident, 2004, cited in National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet.

7 Stunkard AJ, Faith MS, Allison KC. Biol Psychiatry 2003 Aug 1;54(3)330-7.

8 Health Risks and Behavior: The Impact on Medical Costs, Control Data Corporation, 1987, cited in National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet.

9 Burton WN, Chen C-Y, Schultz AB, Edington DW. The economic costs associated with body mass index in a workplace. Journal of Occupational and Environmental Medicine 1998;40: 786-792.

10 US Department of Health and Human Services, Physical Activity Fundamental to Preventing Disease 2002.

11 National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: National Institutes of Health 1998.

12 Oster G, Thompson D, Edelsberg J, Bird AP, Colditz GA. Lifetime Health and Economic Benefits of Weight Loss Among Obese Persons. American Journal of Public Health 1999;89 (10): 1536-42.

13 National Business Group on Health Institute on the Costs and Health Effects of Obesity Primary Fact Sheet.

14 Centers for Disease Control and Prevention, 2006.

15 Peltonen M, Lindroos AK, Torgerson, JS. Musculoskeletal Pain in the Obese: a Comparison With a General Population and Long-Term Changes After Conventional and Surgical Obesity Treatment. Pain 2003 Aug;104(3):549-57.

16 American College of Sports Medicine, Position Stand on the Appropriate Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Medicine and Science in Sports and Exercise Vol. 33, No. 12, 2001.

17 Sturm RJ. Health Affairs 2002; March/April, Vol 21 (2)245-253.

18 Schlundt D, Hill J, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial. American Journal of Clinical Nutrition 1992;55:645-51.

19 Wing Rena R, Phelan Suzanne. Long-Term Weight Loss Maintenance, cited in American Journal of Clinical Nutrition 2005:82 (suppl)222S-5S.

20 Blanck HM, Khan LK, Serdula MK. Diet and Physical Activity Behavior Among Users of Prescription Weight Loss Medications. The International Journal of Behavioral Nutrition and Physical Activity 2004 Dec 23;1(1):17.

21 McKeown N, Meigs J, Liu S, Wilson P, Jacques P. Whole grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. American Journal of Clinical Nutrition 2002;76:390-8.

22 The Obesity Society (www.obesityonline.org). Secondary source, Rolls BJ, Kim S, Fedoroff IC. Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men. Physiology & Behavior 1990;48:19-26.

23 Archives of Internal Medicine, January 12, 2004. Secondary source, Cleveland Clinic.

24 President’s Council on Physical Fitness and Sports. Secondary source, Blue Cross Blue Shield of Nebraska Healthcare Fact Sheet on Walking.


14Copyright © 2007 Health Enhancement Systems

26 Rafferty AP, Reeves MJ, McGee HB, Pivarnik JM. Physical Activity Patterns Among Walkers and Compliance With Public Health Recommendations, Medicine and Science in Sports and Exercise 2002 Aug;34(8):1255-61.

27 Increasing Physical Activity — A Report on Recommendations of the Task Force on Community Preventive Services, October 1, 2001.

28 Anderson, J, Konz, E, Frederich, R, Wood, C, Long-Term Weight Loss Maintenance: a Meta-Analysis of US Studies, American Journal of Clinical Nutrition 2001;74:579-84.

29 Kaymon S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women: behavioral aspects. American Journal of Clinical Nutrition 1990:52:800-807.


31 The Obesity Society (www.obesityonline.org). Secondary source, Schoeller DA, Shay K, Kushner RF. How much physical activity is needed to minimize weight gain in previously obese women? American Journal of Clinical Nutrition 1997;66:551-556.

32 The Obesity Society (www.obesityonline.org). Secondary source, Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women. Journal of the American Medical Association 1999;282:1554-1560.

33 The Obesity Society (www.obesityonline.org). Secondary source, Jeffery RW, Wing RR, Thorson C, Burton LR. Use of personal trainers and financial incentives to increase exercise in a behavioral weight loss program. Journal of Consulting and Clinical Psychology 1998;66:777-783.

34 The Obesity Society (www.obesityonline.org). Secondary source, Wing RR, Tate DF. Lifestyle changes to reduce obesity. Current Opinion in Endocrinology, Diabetes, and Obesity 2000;7:240-246.


36 DiPietro L, Kohl HW, Barlow CE, Blair SN. Improvements in Cardiorespiratory Fitness Attenuate Age-related Weight Gain in Healthy Men and Women: the Aerobics Center Longitudinal Study. International Journal of Obesity 1998;22:55-62, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S.

37 Sherwood NE, Jeffery RW, French SA, Hannan PJ, Murray DM. Predictors of Weight Gain in the Pound of Prevention Study. International Journal of Obesity 2000;24:395-403, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S.

38 Paffenbarger RS, Hyde RT, Wing AL, Hsieh CC. Physical Activity, All-Cause Mortality, and Longevity of College Alumni. New England Journal of Medicine 1986;314:605-13, cited in American Journal of Clinical Nutrition 2005;82 (suppl)226S-9S.

39 Study presented at an American Heart Association meeting. Secondary source, St. Francis Hospitals.

40 The Diabetes Prevention Program, 2002.

41 Archives of Internal Medicine, June 23, 2003.

42 Study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, Diet and Exercise Delay Diabetes and Normalize Blood Glucose, February 6, 2002.

43 Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE, Luthy DA. Prospective Study of Gestational Diabetes Mellitus Risk in Relation to Maternal Recreational Physical Activity Before and During Pregnancy. American Journal of Epidemiology 2004 Apr 1;159(7):663-770.

44 Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB. Medicine and Science in Sports and Exercise 2006 Jan; 38(1):173-8.

45 Hakim, Amy L et al. Effects of Walking on Coronary Heart Disease in Elderly Men. American Heart Association, Circulation 1999;100:9-13.

46 Paffenbarger, Ralph et al. Associations of Light, Moderate, and Vigorous Intensity Physical Activity With Longevity. The Harvard Alumni Health Study. American Journal of Epidemiology 2000 Feb 1;151(3):293-9.

47 Liu S, Manson J, Lee I, Cole S, Hennekens C, Willett W, Buring J. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. American Journal of Clinical Nutrition 2000;72:922-8.

48 McKeown N, Meigs J, Liu S, Wilson P, Jacques P. Whole grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. American Journal of Clinical Nutrition 2002;76:390-8.

15

49 Whole Grains Council (www.wholegrainscouncil.org). Secondary source, Journal of the American Dietetic Association. September 2006, 106(9):1445-9.

50 Shekelle PG, Morton SC, Maglione M, et al. Pharmacological and Surgical Treatment of Obesity. Agency for Healthcare Research and Quality, Evidence Report/Technology Assessment, Number 103, July 2004.

51 Mayo Clinic. Weight Loss Drugs: Can a Prescription Help You Lose Weight? February 13, 2006.

52 Snow V et al. Surgical and Pharmacological Management of Obesity in Primary Care. A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 2005 Apr 5;142(7):525-31.

53 Blanck HM, Khan LK, Serdula MK. Diet and Physical Activity Behavior Among Users of Prescription Weight Loss Medications. The International Journal of Behavioral Nutrition and Physical Activity 2004 Dec 23;1(1):17.

54 Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. New England Journal of Medicine 2005 Nov 17;353(20): 2111-20.

55 US Food and Drug Administration. Xenical® Consumer Information. November 16, 2000.

56 National Institutes of Health. Drug Information: Sibutramine.

57 National Institutes of Health. Drug Information: Orlistat.


59 Snow V et al. Surgical and Pharmacological Management of Obesity in Primary Care. A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine 2005 Apr 5;142(7):525-31.

60 National Institutes of Health. Drug Information: Sibutramine.


62 Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. New England Journal of Medicine 2005 Nov 17;353(20): 2111-20.

Health Enhancement Systems

712 Cambridge Street

Midland MI 48642

800.326.2317

www.HealthEnhancementSystems.com For more white papers to support wellness at your organization, free from Health Enhancement Systems, go to:http://whitepapers.HealthEnhancementSystems.com.

For Wellness Resources, a guide to our suite of online and paper-based wellness products, go to:http://hesonline.com/catalog.aspx.

Copyright © 2011, Health Enhancement Systems. No part of this document may be distributed, reproduced, or posted without written permission from Health Enhancement Systems.

Date post:	07-May-2015
Category:	Business
Upload:	health-enhancement-systems
View:	982 times
Download:	1 times