Pilot Program

I. Abstract

Obesity is a problem for all levels of American Society. Billions of dollars are spent annually to treat this epidemic while thousand die due to its devastating effects on the body. Current diet plans are proving to be failures as many are promising quick fixes for a long-term problem.

Food Fitness First™ was developed to help in the fight of this increasing problem. A pilot study was conducted at Wheeler County Hospital evaluating individual’s success to reduce weight and increase physical activity and improve health based upon a total health score. Thirty individuals began the program and nine participants completed the program. Results showed an increase in the health scores as well as better food choices, weight loss, increased physical activity and improved laboratory data.

II. Introduction

Obesity in the United States: Obesity is defined as the “abnormal increase of fat in the subcutaneous connective tissues.” 18 Clinically, obesity is defined as a Body Mass Index

(BMI) over 29.9 and overweight as 25.0-29.9. Obesity rates have sky-rocketed in the past few years. 9,10 It was termed as a chronic disease in 1985 and obesity rates have doubled between the years of 1980 and 2002.12 Sixty-five percent or about fifty-nine million Americans over the age of twenty years old are obese or overweight . Thirty-one percent of Americans are obese.7,16 Gender shows very little difference with twenty-eight percent of males and thirty-two percent of females are obese. 20 The largest group of obese American’s is found within the African American group at fifty percent but the other ethnicities are not very far behind.

Financial Burden of Obesity

In the year 2003, seventy-five billion dollars was spent on obesity and obesity related diseases. Half of this money was paid through Medicaid or Medicare- a direct payment from the American taxpayer’s pocket.8,13 In 1998, obesity costs exhausted ninety-one percent of American medical expenditures which constitutes about six percent of the total expenditure of that year. 6,13 American’s spend about thirty three billion dollars per year on weight loss programs, drugs, supplements, products, etc. 19

Health Implications

Three hundred thousand deaths are linked to obesity every year.1,5,13 Obesity is directly related to over thirty medical conditions.1 Some of these conditions include but are not limited to: (1) Cancers, (2) Hypertension/Stroke, (3) Cardiovascular Disease, (4) Type II Diabetes Mellitus, (5) Gallbladder Disease, (6) Osteoarthritis, and (7) Birth Defects. Obesity can become co-morbidity to other diseases as well. Some of these diseases include abdominal hernias, endocrine problems and edema in the lower extremities.1,4 Data shows that as little as a 5% weight loss can reduce the risk of hypertension and diabetes by as much as half.14

Current Diet Programs

Many current diet plans are nothing more than fad diets. They promote quick fixes and cure-alls with no lasting value. Successful programs involve lifestyle modification.2,3,11,12,15,17,21 This allows for realistic goals and nutrition education.

One of the new and up-coming ways to endorse lifestyle changes to a large audience is through Internet-based programs. These programs are relatively inexpensive to the user and have a higher success rate than many current diet strategies. 2

Food Fitness First ™

The Food Fitness First Pilot Study Program is a longitudinal study evaluation subjects over a five-month period. Independent variables studied include weight, body circumference, exercise levels, and diet. Dependent variables include laboratory values, medications taken and disease states. All subjects signed a confidentiality form before beginning the program. Confidentially was strictly maintained throughout the program. All procedures were performed in an ethical and appropriate manner.

III. Methods

Our goal in this study was to identify the correlation between the Food Fitness First Program and weight loss, increased physical activity, regulated laboratory values, decreased use of medication and lifestyle modification to reduce medical costs and increase health.

Participants were chosen on a strictly volunteer basis. The administrative staff of Wheeler County Hospital approved the program and the use of their facility. A letter explaining the program and its requirements was sent to the staff of the hospital and nursing home adjacent to the hospital. Others who wished to participate in the community were permitted as well. Individuals who wished to participate were given an initial screening tool developed by the Food Fitness First staff at the initial class. This tool included criteria based upon:

  1. Dietary Intake;
  2. Upper arm, chest, hip, and thigh circumferences;
  3. Weight, height;
  4. Laboratory values;
  5. Medications taken;
  6. Physical Activity levels;
  7. Family medical history;
  8. Past and current medical history; and
  9. Substance abuse.

Each category was scored according to a preset standard developed by the Food Fitness First ™ Dietitians. The total possible score is 100%. This score this called the Favorable Fitness Factor ™. This numeric system allows the individual to grade their current status like a report card of health. They can then choose areas that need improvement. Once the area(s) are identified educational materials are distributed. Materials include personalized disease information, diet and exercise logs, recipe book, and a grocery store book.

Individualized menus and diets were dispersed according to their Food Factor. The Food Factor is a portion of the Favorable Fitness Factor ™ that is derived from food intake, weight, and body measurements. Diets were based upon the Food Factor and the Food Spiral ™, which is a colorful way to choose the best choices of food. Each participant was given the instructor’s email address, fax and address for further information throughout the program. Each participant was evaluated based upon the change in Favorable Fitness Score, comparing the initial score verses the final score and each component.

Each participant was evaluated based upon the weight change over time: Final Weight –Initial Weight = Total Weight Change.

Each participant was also evaluated upon personal lab values and how these values changed over the five-month time period: Final Lab Value – Initial Lab Value = Lab Value Change.

Statistical Analysis was determined by use of a t-test, mean and standard deviation on the individual’s lifestyle modifications in diet, exercise, preventative exams, laboratory values, substance abuse and medication use.

IV. Results and Discussion

Thirty participants began this program. Nine individuals successfully completed the five month program. The mean initial Favorable Fitness Factor score was 60%. The final score increased by 12% leading to a score of 72% out of a possible score of 100%. All areas increased from the initial score to the final score with the exception of the substance abuse category (diet 20 to 22%, exercise 2 to 9%, and diseases and labs 12 to 17% respectively). Participants demonstrated:

  1. Increased understanding of a healthy diet.
  2. Increase in better food choices.
  3. Increased physical activity levels.

Initially the program began with one Diabetic patient (fasting blood sugar >126 mg/dL), five participants with Hypertension (HTN) (blood pressure > 140/80), and four individuals with elevated total cholesterol levels (>200 mg/dL). Results confirmed:

  1. Total cholesterol decreases of up to 10 points.
  2. Drop in Triglyceride levels of up to 15 points.
  3. Improved blood pressures.
  4. Improved blood sugars.
  5. Decreased HTN medication use.

V. Implications, Conclusions, & Applications

The Food Fitness First ™ program was developed with a goal of improving health and all the components that constitute a healthy lifestyle. Upon review of this pilot program, it can be clearly seen that FFF has reached its goal. This program leaves lasting impression for better health to its participants but also shows the health care community what must be done to fight obesity.

Food Fitness First ™ can help pave the way to lower obesity rates and in-turn lower health care costs. Like FFF, obesity must be combated at all levels, not just diet. Individuals must have a clear understanding of how diet directly affects health and well-being. Individuals must be treated as just that, individuals, with different needs and goals and not just as some statistic.

VI. References

  1. American Obesity Association. AOA Fact Sheets: Health Effects of Obesity. Available at: http://www.obesity.org/suns/fastfacts/Health_Effects.shtml. Accessed: 10/20/05.
  2. Berkel, LA et al. (5/05). Behavior Interventions for Obesity. JADA. 105(5): S35-43.
  3. Blackburn, GL., Waltman, BA. (5/05). Expanding the Limits of Treatment-New Strategic Initiatives. JADA. 105(5): S131-135.
  4. Bray, GA., Champagne, CM. (5/05). Beyond Energy Balance: There is More to Obesity than Kilocalories. JADA. 105.5: S17-23.
  5. Carmona, RH. (5/05). Improving Health Literacy: Preventing Obesity with Education. JADA. 105(5): S9.
  6. CDC. Overweight and Obesity: Economic Consequences. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm. Accessed: 10/20/05.
  7. CDC. Overweight and Obesity: Obesity Trends: US Obesity Trends 1985-2004. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/trend/map/index.htm. Accessed: 10/20/05.
  8. CDC Chronic Disease Press Office. (1/21/04). Obesity Costs States Billions in Medical Expenditures. CDC Media Relations. Available at: http://www.cdc.gov/od/oc/media/pressrel/r040121.htm. Accessed: 10/20/05.
  9. CDC. National Center for Health Statistics. Prevalence of Overweight Among Adults: United States, 1999-2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm. Accessed: 10/20/05.
  10. CDC. National Center for Health Statistics. Prevalence of Overweight Among Children and Adolescents: United States, 1999-2002. Available at: http://www.cdc.gov/nchs/ products/pubs/pubd/hestats/overwght99.htm. Accessed: 10/20/05.
  11. Diabetes Prevention Program Research Group. (2/7/02). Reduction in the Incdence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. 346(6): 349-403.
  12. Greenway, F. (6/05). Another Type of Intervention: Treating Obesity with Medication. JADA. 105(6): 895-898.
  13. Hellmich, N. (1/20/02). Weighing the Cost of Obesity. USA Today. Available at: http://www.usatoday.com/news/health/2002-01-2-obesity.htm. Accessed: 10/20/05.