In a study of the management of obesity 43 patients were randomly assigned to behavior therapy, will power, and no-treatment control groups. The behavioral treatment involved contingency contracting, stimulus control, self-monitoring, energy expenditure, and group reinforcement procedures over an 18-week period. The will power patients were told to do the same thing as the behavior therapy patients; however, instead of having formal contingencies and meeting regularly, they were told to apply "will power" on their own, as this was the most important aspect of losing weight. The third group was a standard no-treatment control group. Analyses of covariance indicated that (a) the behavior therapy group lost significantly more weight than the will power (p less than .05) and no-treatment control (p less than .01) groups, and (b) the will power and no-treatment control groups did not differ significantly from each other. An 18-week maintenance follow-up of the behavior therapy group indicated that there was no significant weight gain from the end of treatment to follow-up. Also, an analysis of time spent per patient suggested that the behavioral treatment employed in this study was more efficient than previous treatments.
In a study extending over five years 35 of 70 excessively overweight patients with subclinical diabetes mellitus who had not significantly changed their weight, demonstrated a further deterioration in glucose tolerance, and manifest diabetes occurred in ten. In the remaining 35 patients who had achieved 20% weight reduction from the initial level glucose tolerance had become normal. The two groups were similar as to age, initial weight, and original degree of glucose intolerance. There was a significant correlation between loss of weight and increased glucose tolerance. No such correlation occurred with subgroups of patients whose initial overweight was more than +100 relative percentage and who had been over 50 years old at the start of the study.
In 2005, more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese. Both Blacks and Hispanics in the state are more likely than whites to be both overweight and obese, whereas Asians are the least likely to be overweight or obese. Nationally, rates of overweight and obesity are even higher. Obesity is a risk factor for multiple serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, stroke, diabetes, muscle and bone disorders and gallbladder disease. In Massachusetts, it is estimated that direct costs for obesity-related medical expenditures came to a total of $1.8 billion (4.7% of total medical expenditures) in 2003. Medical expenditures for obese people are estimated to be 25-27% higher than normal weight people, and 44% higher among people who are very obese. Costs are largely attributed to higher rates of coronary heart disease, hypertension and diabetes, and longer hospital stays. Indirect costs associated with obesity approached $3.9 billion in 1995 reflecting 39.2 million lost workdays, 239 million restricted activity days, 89.5 million hospital bed-days, and 62.6 million physician visits. Causes of obesity include the wide availability of unhealthy foods, increased consumption, changing eating habits, high-calorie beverages, advertising and lack of physical activity. Although a number federal, state and local programs, policies and initiatives aimed at curbing the obesity epidemic have been implemented, more needs to be done. What is the responsibility of government in curbing the obesity epidemic, and how much of the burden should be left up to the individual? These important questions will be discussed at the Massachusetts Health Policy Forum on January 23, 2007. Overweight and obesity continue to climb steadily in the United States among both adults and children, increasing the risk for a host of physical, psychosocial and economic problems. This paper details the issues associated with being overweight or obese, with a focus on Massachusetts. The discussion begins with a general description and definition of this public health epidemic. Next, an examination of factors that contribute to overweight and obesity and associated costs to individuals, families and society is given, followed by a discussion of programs and policy options, both nationally and in the Commonwealth that are aimed at addressing this crisis.