ABSTRACT
Magnitude of the Obesity/Overweight Problem ............................................................................ 833 Financial Burden of Obesity/Overweight ...................................................................................... 834 Problem Is Fat, Not Weight ............................................................................................................ 834 Body Mass Index ≠ Body Fat ........................................................................................................ 835 Improving Body Composition: A Litmus Test of Safety and Efcacy .......................................... 836 Physical Activity ............................................................................................................................ 837 Health Literacy ...............................................................................................................................840 Assessing Body Composition with Dual Energy X-Ray Absorptiometry ..................................... 841
Precision and Reliability ........................................................................................................... 841 Assessment of Visceral Fat ........................................................................................................ 841 Safety Considerations................................................................................................................ 842 Benets of DXA Testing ........................................................................................................... 842
Paradigm Shift in the Conceptualization of Obesity Interventions ................................................ 842 Impact of Inclusion/Exclusion Criteria .......................................................................................... 843 Pay for Tracking/Reporting Instead of Paying Incentives ............................................................. 843 Compliance/Adherence: Making Lemonade from Lemons ...........................................................844 Use of a Trustee .............................................................................................................................844 Challenges to Using Blood Chemistries as Safety Measures ........................................................ 845 Placebo Challenges ........................................................................................................................ 845 Concluding Remarks ......................................................................................................................846 References ...................................................................................................................................... 847
shown to consistently achieve true weight control. Although the precise reason for the high relapse rate is not known, the stunning uniformity of these ndings, which now extend over nearly ve decades, should give pause to anyone who proposes to treat, much less cure, obesity” [2]. Little has changed since Bennett’s observation. It is not only the fact that rates are not declining, but a number of studies have suggested that the rates of obesity and overweight have been steadily increasing for the past ve decades and have more than doubled in the past 30 years [3-10]. In June 2010, the Trust for America’s Health and the Robert Wood Johnson Foundation concluded that adult obesity rates increased in 28 states in the past year and declined only in the District of Columbia (DC) [11]. The report concluded that more than two-thirds of states have adult obesity rates above 25%, whereas in 1991, no state had an obesity rate above 20%. Another study found similar increases in rates and concluded that the predictions concerning the future of obesity are even more sobering. For example, in 2007, the U.K. Government Ofce for Science’s Foresight Report estimated that by 2050, 60% of men and 50% of women will be clinically obese. Other analyses project that obese adults in the United States will increase by 65 million, and in the United Kingdom, by 11 million, resulting in approximately 7 million cases of diabetes, 6 million cases of heart disease and stroke, 492,000-669,000 additional cases of cancer, and 26-55 million quality-adjusted life years forgone for the United States and the United Kingdom combined [12]. Even more troubling, a U.S. researcher extended the current trends into future projections suggesting that by 2015, 75% of all U.S. adults will be overweight or obese; by 2030 that number will be 86.3%, and by 2048 all American adults will be overweight or obese [13].
