Susan M. Zbikowski, PHD, Senior Vice President, Research, Training, & Evaluation 

I am pleased to announce that Alere Wellbeing had an important paper published this month in the Journal of Environmental and Public Health. Our article, “The 2009 US Federal Cigarette Tax Increase and Quitline Utilization in 16 States,” written by Terry Bush, Susan Zbikowski, Lisa Mahoney, Mona Deprey, Paul D. Mowery, and Brooke Magnusson, describes call volumes to 16 state quitlines, characteristics of callers, and cessation outcomes before and after the 2009 federal tax increase.

You may remember back to 2009 when smokers were once again hit with a large increase in the cost of their cigarettes. On February 4, 2009, the federal government enacted a 62-cent increase in the federal cigarette tax, along with increases in other tobacco taxes, to fund expansion of the State Children’s Health Insurance Program. The federal cigarette tax increased to $1.01 per pack on April 1, 2009. Right before the increase in cigarette tax was made public, tobacco companies sneaked in their own price increase on tobacco products. This dramatic increase in the costs of smoking was likely to be a tipping point for smokers to try to quit. With support from the Centers for Disease Control and Prevention (CDC), researchers at Alere Wellbeing decided to find out if these increased costs would result in more people calling state quitlines for help.

Results of this study were just released in the Journal of Environmental and Public Health. The study showed that the federal excise tax on cigarettes was associated with a 23.5% increase in calls to quitlines and attracted somewhat different types of smokers compared with the year before the tax. In particular, it seems that the tax had a greater impact on those who had less education and who were living with other smokers based on the increase in calls from this demographic. Although we also expected that more young smokers would call, this was not the case in this study.

Another important finding from the study was that quit rates among those who called after the tax increase did not differ from quit rates among those who called before the tax increase. The lack of a significant increase in quit rates is not surprising since the participating quitlines did not provide additional or different services to callers. Nonetheless, increasing the number of callers at the same quit rate means an increase in total number of successful quitters. In these 16 states, of the 19,911 additional tobacco users who called during the time of the tax an additional 5,714 would quit smoking (19,911 more callers after tax ∗ 28.7% quit rate).

If the money raised from increased taxation on cigarettes was put into cessation treatment, then it is likely the taxes would have an even greater effect on helping smokers to quit. Numerous studies have shown that quitlines increase ones chances for quitting, especially when multiple counseling calls plus nicotine replacement medications are made available. Unfortunately, states have been cutting back on the services they provide on order to contain costs. This study from Alere Wellbeing provides important data relevant to public health policy on tobacco control. Providing evidence-based cessation services combined with tax and price increases, smoke-free laws, anti-tobacco advertising, and bans on promoting tobacco use can increase quit rates and decrease the prevalence of tobacco use.

Apparently Honda has not gotten the message that we have an obesity epidemic, and that too much sitting is one of the major contributors to poor health in industrialized countries. This week, Honda introduced the Uni-Cub, an electric personal mobility device. While products like this can be a wonderful boon for people with disabilities, it’s very disturbing that the market for the Uni-Cub seems to be primarily the able-bodied – those of us who really need to be doing less sitting, not more. The design of the device is even reminiscent of the animated movie “WALL-E”, where humans have been in space so long they are unable to walk and are ferried around in robotic chairs – and everyone is severely obese as a result.

I’m a huge fan of the concept of “SPA” – Spontaneous Physical Activity. SPA is any movement you get during your day that is not formal exercise, including fidgeting, pacing, and walking to your co-worker’s office or cube. Studies have shown that, depending on body size, people can burn an extra 500-700 calories a day just from increasing SPA. This could equate to losing several pounds a month, without changing anything else in your lifestyle, which makes it a great “easy win”.

Apart from the calorie-burning benefits of SPA, getting up and moving throughout your day is also important to lower your risk for chronic disease. Research has clearly established that too much sitting – even in people who get regular exercise – is an independent contributor to chronic disease risk. In Harvard’s large, longitudinal Nurses’ Health Study, every additional 2 hours of sitting at work was associated with a 5% increase in risk for obesity and a 7% increase in risk for diabetes (Hu et al., JAMA. 2003;289:1785-1791). Similarly, in a British study, sitting at work >3 hr/d was associated with a significant decrease in “good” HDL-cholesterol and a significant increase in risk of pre-diabetes in men (Pinto Pereira et al. PLoS ONE 2012; 7: e31132).

In striking contrast to Honda’s latest offering to help us sit more at work, a few years ago Dr. James Levine at the Mayo Clinic started promoting the “treadmill desk”. One of the leading researchers on the benefits of SPA, Dr. Levine points out that the human body is meant to move, and to spend most of the day moving. Our modern environment, where almost everything involves being sedentary, is totally mismatched to our genes and biology. The treadmill desk is one solution for people who have desk jobs to avoid the inevitable health problems that come from too much sitting.

If you don’t want to go that far, it’s easy to incorporate other ways to increase SPA throughout your day. I don’t have a treadmill desk, but I do have a standing workstation so that when I’m at my computer working, I am standing rather than sitting. I also make a conscious effort to stand up and pace whenever I am on a phone call. Every 30 minutes, if I’ve been sitting continuously, I try to at least stand up briefly and stretch. And of course wearing a pedometer and striving to get 10,000 steps a day is a good way to ensure that you are not spending too much time sitting.

While I celebrate the development of convenient, affordable personal mobility devices for individuals who are truly mobility impaired, if you are blessed with healthy legs I hope you will stand up (pun intended!) and “just say no” to devices like the Uni-Cub.

Dr. Jennifer Lovejoy is Vice President of Clinical Development & Support at Alere Wellbeing and past president of the Obesity Society. Dr. Lovejoy’s clinical research program has been funded by grants from the National Institutes of Health, the American Diabetes Association, the U.S. Department of Agriculture, and NASA. Read other blog posts by Jennifer Lovejoy.

Marie Gahler, Senior Manager, Weight and Nutrition Education Services

Snacking has become a favorite American pastime! We munch in front of the TV and while searching the web. We grab something to go and eat in our cars as we zoom from work or school to yoga practice or basketball. And let’s not forget those late night ice cream cravings!

So, given our current snacking habits it is no surprise that a recent article in the New York Times indicated Kellogg, the company famous for its cereal, is interested in expanding their share of the snack market and hopes to add new snack options soon. They are currently working on a deal to purchase Pringles and the snack marketing experts that come with it. While I can’t blame Kellogg for wanting to grow their business, I find myself asking: Do we really need more snack products?

With the still growing number of overweight and obese children, adolescents, and adults in this country, we need to examine the role of snacking and our health. Whatever happened to just eating three square meals a day? Back a few decades ago, eating between meals was an exception, not a daily practice. People actually sat down and ate a breakfast that kept them full until noon rolled around. They then ate a good lunch and stayed satisfied until dinner time. As we all know the obesity rate was much lower back then too and families actually ate meals together!

Recent research published in the Journal of Nutrition found that, unlike meals, snacks don’t lead to a feeling of fullness. More concerning is that people did not eat less at the next meal when they had snacked. Thus, overall, those who snacked took in more calories than those who didn’t. Not surprisingly, other studies have found that snacking is associated with greater obesity.

My personal experience is that the habit of eating between meals or skipping meals and snacking instead, leads to a higher calorie intake than when I take the time to eat breakfast, lunch, and dinner. I find if I eat healthy meals I truly am not hungry in between and while snack foods may sound or look good, I can resist them. I wish Kellogg would stick to breakfast cereal which promotes a sit-down eating experience and stay out of the snack market.

Marie Gahler has more the 25 years experience in treating obesity and weight related health behaviors and continues to be inspired by the efforts and success of those who strive to improve their health and weight. She currently manages the Accomplish Bariatric Nutrition Services program and develops curriculum for Weight Talk®. Read more of Marie Gahler's blog posts.

Jennifer Lovejoy, PhD, Vice President, Clinical Development & Support

Employers are increasingly realizing the benefits of covering bariatric surgery for eligible employees through their health plans. Two new clinical trials, which have confirmed the pronounced benefits of bariatric surgery in improving metabolic control in patients with Type 2 diabetes, will likely provide increasing rationale for doing so, as the overall cost effectiveness is clear in spite of the high surgical costs.

The association between obesity and Type 2 diabetes is well known. Over 80% of individuals diagnosed with Type 2 diabetes (formerly called “adult onset diabetes”) are overweight or obese. Obesity causes insulin resistance, a condition where the hormone insulin is ineffective at moving sugar from the bloodstream into the cells. In genetically susceptible individuals, insulin resistance combined with too little insulin secretion leads to diabetes. Obesity also increases whole-body inflammation, which is a primary cause of many of the complications of diabetes, including cardiovascular disease, nerve damage and kidney disease.

Many studies have shown that weight loss is very beneficial for people with Type 2 diabetes. Weight loss of as little as 5-10% through lifestyle modification improves control of blood sugar and reduces other risk factors in people with Type 2 diabetes. One of the largest studies to look at behavioral weight loss in Type 2 diabetes is the LookAHEAD trial. In this study (which is still on-going), participants who received the intensive lifestyle intervention maintained a 6% weight loss at 4 years and had significant reductions in their hemoglobin A1c (HbA1c) levels (a marker of blood sugar control). They also had sustained reductions in blood pressure and triglycerides.

Bariatric surgery produces much more dramatic weight loss and, therefore, much greater benefits in terms of diabetes control. The two new studies demonstrating this effect were both published in the New England Journal of Medicine and report very similar findings. In an Italian study, 75% - 95% of bariatric surgery patients had their diabetes go into complete remission off medication compared with none who received conventional medical therapy. Average starting BMI was 45 kg/m2 and this dropped to 29 kg/m2 2 years post-surgery. The U.S. study, STAMPEDE, was interesting in that it looked at patients with a lower range of starting BMI: 27-43 kg/m2. U.S. guidelines recommend bariatric surgery for BMI of 35 and above with obesity-related comorbidities, but a third of patients enrolled in STAMPEDE had BMI<35. Whether because of the lower BMIs or because it was shorter than the Italian study, STAMPEDE found that only 42% of patients had normalized their HbA1c levels by 1 year post surgery. Weight losses were ~55-65 pounds. Type of surgery did not make a significant difference in the STAMPEDE trial, but in the Italian study, patients who had the biliopancreatic-diversion procedure saw better results than those who had gastric bypass.

Previous studies have found long-term benefits of bariatric surgery on diabetes. One of the largest and longest studies of bariatric surgery is the Swedish Obesity Study (SOS). To date, SOS has 20-year follow up date on over 2000 patients who had bariatric surgery. Study results show that 70% of patients experienced total remission of diabetes after two years of follow-up, and 30% are still in remission 15 years after bariatric surgery.

It is also important to note that patients and payors should protect their investment in bariatric surgery by supporting patients with a behavioral program post-surgery to help maintain the weight lost. Patients who are not good candidates for surgery should consider engaging in a behavioral weight loss program, too - as studies like LookAHEAD and others show, you don’t need to have huge weight losses to achieve big benefits in diabetes.

Dr. Jennifer Lovejoy is Vice President of Clinical Development & Support at Alere Wellbeing and past president of the Obesity Society. Dr. Lovejoy’s clinical research program has been funded by grants from the National Institutes of Health, the American Diabetes Association, the U.S. Department of Agriculture, and NASA. Read other blog posts by Jennifer Lovejoy.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Accomplish® Program, a nutritional and lifestyle counseling program exclusively for weight loss surgery patients.

Ken Wassum, Associate Director, Clinical Development & Support

The CDC, and specifically its Office of Smoking and Health, should be heartily congratulated on the graphic ad promotional campaign scheduled to launch today, March 19. We’ve greatly anticipated these ads, especially in light of a recent (misguided) court ruling that the government could not require the tobacco industry to put graphic warnings on cigarette packs to replace the tired old ineffective warnings that have been on cigarette packs since the 1970’s.

After seeing the ads some in the press have wondered if the ads are too graphic and too shocking. I would suggest that they are not too graphic and the reason is that the public has become immune to the current warnings on cigarette packaging. Here are the facts after over 40 years of text-based warnings on cigarette packs:

• Over 1,200 people die every day (443,000 per year) in the US as a direct result of smoking.
• One of every two smokers will die prematurely.
• The average smoker will die 14 years early.
• Cigarettes are the only product sold in the US that when used as recommended (needless to say advertised, promoted and discounted) by the manufacturer results in disease and death.

There is hope that the new ads will help shed light on the harrowing reality of tobacco-related diseases. Cancer of the throat is an abstract concept for those who do not have it. The "Tip From a Former Smoker" ad featuring Terrie makes it real – certainly not as real as it is for her, but certainly a lot more real than a text on a cigarette pack that says, “Smoking can cause cancer of the throat.”

In response to these ads, the Atria Group, the parent company of Philip Morris USA and U.S. Smokeless Tobacco, states, “We support a three-part approach to reducing the harm caused by cigarette smoking: preventing underage tobacco use, promoting quitting and a focus on the development of and appropriate communications about potentially lower risk tobacco products,” the company said in a statement. “We believe we can play an important role in this effort and will continue to work with the FDA and others in public health to help reduce the overall harm of tobacco products.”

Yet the tobacco industry does everything it can to sell their deadly products to youth in the US and especially in foreign countries (like Indonesia) and promote their deadly products to adults in the US and overseas (like Camel Orbs).

So hats off to the CDC for taking action. Hopefully the courts will come to their senses and reverse the decision by Judge Richard Leon banning implementation of graphic warnings on cigarette packs. Let’s hope these new ads cause smokers to pick up the phone and call their state tobacco quitline for help.

Ken Wassum has been treating tobacco users for over 17 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Sandi Kaplan, MS, RD, Associate Director, Clinical Development & Support

March is almost here. The daffodils outside my front door are getting ready to bloom and the kids and I are discussing seed choices for our raised vegetable bed. So it has been fun to see some fascinating gardening-related articles in the headlines. I've had read a little about how beneficial gardening can be from physical, mental, and emotional perspectives. But I had no idea that there is a burgeoning field called “horticultural therapy” which is researching the benefits of gardens in a wide variety of settings including prisons, secure mental health facilities and residential programs for troubled teens.

There are many obvious benefits to gardening either alone or in a group – we get the health benefits of physical activity when we garden and we also tend to eat more nutritiously when we harvest our own fruits and vegetables. Research has shown that gardening also provides cognitive benefits – enhanced mood, less anxiety and depression and improved concentration.

There are other benefits that are present when we garden together with others. It teaches cooperation and social skills and also builds a sense of social support and reduces feelings of loneliness and isolation.

One of the key pieces that is discussed in “horticultural therapy” is the phenomenon of hope. The ability to hope (believe in the possibility of a better future) is based on qualities like a sense of personal competence, an ability to cope and having a purpose in life. The very action of planting a seed in the soil requires hope. The research is showing that, for many people who feel hopeless, this involvement in gardening can encourage a sense of hope and healthy forward movement in life.

So how exciting, in the context of all of this research, to see a recent article on Seattle’s Food Forest.

The Food Forest is the first in the country and is set to break ground this summer. A seven acre plot of land will be planted with hundreds of different kinds of edibles: fruit and nut trees, berry bushes, vegetables, herbs and more. Anyone will be able to help with the planting as well as wander into the public park and eat whatever is available.

The planners have taken the whole environment into account so that soil, chosen plants, insects and bugs will be mutually beneficial and create a self-sustaining, perennial forest. The planners have also worked very hard to recruit community support and take the community’s design wishes into account.

I imagine that communities around the country will be copying this project in no time. Of course there are some anticipated challenges: What if one person takes all of the berries? What if the forest attracts many homeless people? But I think there is a bigger question – what if this forest provides “horticultural therapy” to a whole community? I think that’s worth taking a chance on.

Marie Gahler, Senior Manager, Weight and Nutrition Education Services

February is American Heart Health Month, a time to realize how prevalent and deadly heart disease is and learn whether our behaviors have us on the track to health or on the track to disease. On Valentine’s Day, we often think about our hearts in an abstract, romantic way, but it’s also a great time to take stock in our lifestyle and think about how our daily decisions affect our physical heart – the most important muscle in our body.

Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day. Though you may not have heart disease, many of us know someone who does or did and realize how devastating a disease it can be. For me it was my father who had high blood pressure and arthrosclerosis and died in his mid 60’s – an age that is not that far off for some of us.

As is the case with many health conditions, our genes do make a difference in our likelihood for developing heart disease. But there’s good news - there are many lifestyle behaviors that contribute significantly to the health of our heart and circulatory system. These behaviors mean that we actually have a significant amount of control over our heart health. For the first time, the American Heart Association has defined what it means to have ideal cardiovascular health, identifying seven health and behavior factors that impact health and quality of life. We know that even simple, small changes can make a big difference in living a better life.

Known as “Life’s Simple 7,” these steps can help add years to your life:

1. Don’t smoke
2. Maintain a healthy weight
3. Engage in regular physical activity
4. Eat a healthy diet
5. Manage blood pressure
6. Take charge of cholesterol
7. Keep blood sugar, or glucose, at healthy levels

As an Alere Wellbeing employee, it certainly feels good to know our programs address each of these 7 areas. Every day we talk with people who are working towards meeting these goals and we are able to help them. In September 2011 the Department of Health and Human Services launched the Million HeartsTM initiative that aims to prevent 1 million heart attacks and strokes in the U.S. over the next five years. They intend to do this by:

• Empowering Americans to make healthy choices such as avoiding tobacco use and reducing the amount of sodium and trans fat they eat. These changes will reduce the number of people who need medical treatment for high blood pressure or cholesterol—and ultimately prevent heart attacks and strokes.
• Improving care for people who do need treatment by encouraging a focus on the "ABCS"—Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation—four steps to address the major risk factors for cardiovascular disease and help to prevent heart attacks and strokes.

This second point – treatment - is something we as Alere employees can help with too. We commonly encourage our participants to follow all doctors’ orders. Many individuals with high blood pressure and high cholesterol don’t follow doctor’s orders and fail to take their medication or monitor their blood pressure. At our suggestion we can aid in making sure they understand the importance of getting regular medical treatment and taking all prescribed medication.

For more information on Alere Wellbeing's products and services,  visit www.alerewellbeing.com/our-services

Sandi Kaplan, MS, RD, Associate Director, Clinical Development & Support

My first grader is a sporty kid and so we move through the seasons with a variety of sports leagues. Coaches change, teams vary but one thing stays the same – the post-game snacks provided for the kids. They are consistently high in added sugars. Does a 45-minute, fast-paced basketball game really necessitate the provision of fruit juice, fruit roll ups, and dried fruit chips? At first glance, these seem like nutritious choices, but eating them all together means a lot of added sugar.

Drs. Robert H. Lustig, Laura A. Schmidt, and Claire D. Brindis have plenty to say about added sugar in the American diet. They are actually calling for added sugars (sucrose and high fructose corn syrup) to be regulated by governments in similar ways to tobacco and alcohol so that public health is protected.

That’s a highly controversial statement, so let’s take a look at the evidence they provide.

In 2003, four widely accepted criteria were adopted that justify government regulation of alcohol:

• Unavoidability (or pervasive throughout society)
• Toxicity
• Potential for abuse
• Negative impact on society

It’s not too hard to see how sugar meets these criteria, especially the first. In America today, sugar is added to nearly all processed foods and beverages – it is pervasive in our food supply.

Is it toxic? There is good evidence to suggest that consuming too much sugar is linked to high blood pressure, high triglycerides, insulin resistance and Type 2 diabetes. This is partly because sugar is adding excess, non-nutritious calories to the diet, promoting weight gain. In addition, sucrose and high fructose corn syrup increase uric acid which raises blood pressure. They also need to be metabolized by the liver and if too much is eaten, can actually cause fatty liver – a disease that is also caused by excessive alcohol consumption. A recent study also showed that added sugar consumption may cardiovascular risk factors because it increases visceral fat, the kind that accumulates around internal organs.

Can sugar be abused? There are now several studies that show that humans can become physically dependent on sugar. Sugar can mess with the functioning of our appetite hormones, grehlin and leptin, so we feel hungrier and are not satisfied as easily when we do eat. Sugar also plays havoc with dopamine signals in the brain. It reduces dopamine signaling in the brain’s reward center,  making us want to eat more so we can experience more pleasure from the food.

Does excessive sugar intake have a negative impact on society? Well, if we look at the US costs to deal with metabolic syndrome (that cluster of high blood pressure, high triglycerides and high blood sugar), the numbers are staggering. $150 billion annually on health care resources alone!

So, if we agree that sugar intake meets the criteria for government regulation, then how do we reduce sugar consumption on a national level?

Drs. Lustig, Schmidt, and Brindis have good ideas modeled on successful tobacco and alcohol interventions. They are proposing taxes on any processed foods that contain added sugars and would ideally like to ban television commercials for products with added sugar that are geared towards children. They propose tightening licensing requirements on vending machines and snack bars that sell sugary products in schools and workplaces. There is a strong sugar lobby that will make these kind of changes difficult – but not impossible -as proven by tobacco and alcohol interventions.

Whether or not you agree with these ideas, it does make logical sense to look at your own level of added sugar consumption. The American Heart Association recommends limiting added sugars to no more than 100 calories per day for women and no more than 150 calories per day for men. Remember that there is absolutely no health or nutritional benefit to added sugars, so the less the better. Take a look at your food labels, read ingredient lists and stay away from added sugars as much as you can.

Sandi Kaplan, MS, RD, Associate Director, Clinical Development & Support

By mid-January most people are hanging on to their weight loss resolutions by their fingertips. So it's good timing for the release of the US News & World 2012 report on the best diet plans to follow.

A panel of 22 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease rated each of 25 diets in seven categories: how easy it is to follow, its ability to produce short-term and long-term weight loss, its nutritional completeness, its safety, and its potential for preventing and managing diabetes and heart disease.

Here at Alere Wellbeing, we were happy but not at all surprised to see that the DASH Diet (Dietary Approaches to Stop Hypertension) took the top spot in the best diets overall category.

In our online and phone-based weight management programs, we use a Healthy Eating Plan which is based on the DASH diet. When we created our programs, we looked closely at the evidence base for healthy diets and found that the DASH diet came out on top.

The DASH diet started off as a diet to lower high blood pressure, but has also been shown to lower cholesterol, blood sugar, and weight. Most importantly, it is a sustainable lifestyle approach to weight loss. The DASH diet does not eliminate whole food groups or consist of rigid food rules. It is based on sensible principles like eating more fruit and vegetables, eating less processed food and boosting fiber intake by focusing on choices like whole grains and legumes. It encourages several nonfat or low fat dairy servings per day and fats that are included are heart healthy (like olives or avocadoes). Meat is used as more of a condiment than the central part of a dish.

Most people go on diets and then go off them. That roller coaster of dieting, losing weight, and then regaining the weight is physically, mentally, and emotionally draining. The key is to focus on realistic long-term changes. We find that our participants who incorporate DASH diet principles are able to maintain those changes more readily than those who are choosing overly restrictive diets to follow. The key is to make dietary changes that you can see yourself maintaining years from now.

One of our favorite techniques is to focus on what you can add to your diet instead of focusing on the things you are trying to avoid. For example, the DASH diet recommends eating lots of veggies each day. So a good starting point is to see if you can add a veggie serving to each meal and snack. I have had program participants eating baby carrots along with their vending machine chocolate bar. Over time, those veggies become an automatic habit and the chocolate bar tends to be easily replaced by healthier options.

So if you are feeling discouraged about your weight loss resolutions because the diet you have chosen feels like a diet you can’t wait to get off of, consider something more sustainable. The dietary changes you make only benefit your health for as long as you make them. Think long-term for 2012 and beyond.

Join us on  May 15 or May 22 for our latest Clear Insights webinar , Deconstructing DASH: How Your Workforce Would Benefit from America's #1 Rated Diet, presented by Robert F. Kushner, MD, Clinical Director of the Northwestern Comprehensive Center on Obesity and one of the 22 expert panelists who rated the Best Diets for 2012. Dr. Kushner will provide an overview of DASH, compare it to other top-ranked diets, and offer insights into the evidence behind their design. Dr. Kushner will also discuss the keys to sustainable weight loss and best practices for employers to choose an effective worksite weight loss plan.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Weight Talk®, an evidence-based personal coaching program built on the DASH Diet and designed to achieve measurable, sustainable weight loss.

Jennifer Lovejoy, PhD, Vice President, Clinical Development & Support:

The Centers for Medicare & Medicaid Services (CMS) announced last week that Medicare is adding coverage for preventive services to reduce obesity. This is very exciting news as it hopefully leads the way for broader coverage of weight loss treatment as part of the Affordable Care Act.

For many years, obesity experts and policy makers have been arguing for the importance of providing coverage for evidence-based weight loss treatments. It’s a sad reality that for millions of obese Americans, getting treatment is impossible because any nutritional or behavioral counseling services have to be paid for out of pocket. Over a third of Americans are currently classified as “obese” (meaning their Body Mass Index, a ratio of weight to height, is greater than 30 kg/m2). Weight losses of as little as 5-10% of body weight (20-30 pounds in most cases) can dramatically improve chronic conditions such as diabetes, heart disease, high blood pressure, high cholesterol, and sleep apnea, resulting in lower doctor and pharmacy bills. Weight loss also lowers risk for these conditions, meaning that those who haven’t developed the condition may never do so.

While the cost savings from weight loss treatment are very clear, and undoubtedly a large part of what convinced CMS to start covering treatment, the effects on quality of life, energy and self-esteem when people succeed in losing 5-10% of their weight are also huge benefits. I’ve talked to many people who can’t believe how much more energy they have after just losing 20 pounds. Or how much less knee or back pain they have after weight loss, enabling them to resume activities they once enjoyed.

I’m guessing that another factor that led to this decision is the recent evidence from large clinical trials that intensive lifestyle counseling for weight loss really works. Early studies suggested rather depressing statistics – lots of dropouts and weight regain. However, more recent research where obesity is treated more as a chronic disease, with long-term support and emphasis on skills to maintain weight loss have been much more successful. In several large NIH studies, weight losses of 5-10% have been achieved and maintained by a majority of participants involved in intensive lifestyle counseling, resulting in significant health improvements.

There is no reason for anyone who struggles with excess weight to try to “go it alone” if they need help. The latest decision from CMS is an extremely positive step, one I hope that private insurers and employers will be fast to copy.