{"id":423,"date":"2019-03-11T19:00:42","date_gmt":"2019-03-11T19:00:42","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/?post_type=chapter&#038;p=423"},"modified":"2019-04-04T19:35:06","modified_gmt":"2019-04-04T19:35:06","slug":"9-5-dietary-behavioral-and-physical-activity-recommendations-for-weight-management","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/chapter\/9-5-dietary-behavioral-and-physical-activity-recommendations-for-weight-management\/","title":{"raw":"9.5: Dietary, Behavioral, and Physical Activity Recommendations for Weight Management","rendered":"9.5: Dietary, Behavioral, and Physical Activity Recommendations for Weight Management"},"content":{"raw":"<div id=\"skills\">\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Explain the complementary actions of dietary changes and increased physical activity level on health.<\/li>\r\n \t<li>Formulate an exercise plan that fits your lifestyle and that follows the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\nWe have just considered the gravity of the obesity problem in America and worldwide. How is America combating its weight problem on a national level and have the approaches been successful?\r\nSuccessful weight loss is defined as individuals intentionally losing at least 10 percent of their body weight and keeping it off for at least one year.<span id=\"zimmerman_1.0-fn11_016\" class=\"footnote\">Wing, R. R. and J. O. Hill. \u201cSuccessful Weight Loss Maintenance.\u201d\u00a0<em class=\"emphasis\">Annu Rev Nutr<\/em>\u00a021 (2001): 323\u201341. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11375440?dopt=Abstract\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11375440?dopt=Abstract<\/a>.<\/span>\u00a0Results from lifestyle intervention studies suggest fewer than 20 percent of participants are successful at weight loss. An evaluation of successful weight loss, involving more than fourteen thousand participants published in the November 2011 issue of the\u00a0<em class=\"emphasis\">International Journal of Obesity<\/em>\u00a0estimates that more than one in six Americans who were overweight or obese were successful in achieving long-term weight loss.<span id=\"zimmerman_1.0-fn11_017\" class=\"footnote\">Kraschnewski, J. L. et al. \u201cLong-Term Weight Loss Maintenance in the United States.\u201d\u00a0<em class=\"emphasis\">Int J Obes<\/em>\u00a034, no. 11 (2010): 1644\u201354.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20479763\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20479763<\/a>.<\/span>\u00a0However, these numbers are on the high end because many similar studies report fewer than 10 percent of participants as successful in weight loss.\r\n<p id=\"zimmerman_1.0-ch11_s05_p03\">The National Weight Control Registry (NWCR) tracks over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year. Their research findings are that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking.)<span id=\"zimmerman_1.0-fn11_018\" class=\"footnote\">The National Weight Control Registry. \u201cResearch Findings.\u201d Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.nwcr.ws\/Research\/default.htm\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.nwcr.ws\/Research\/default.htm<\/a>.<\/span>\u00a0Although there are a great variety of approaches taken by NWCR members to achieve successful weight loss, most report that their approach involved adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day). Moreover, most members eat breakfast every day, watch fewer than ten hours of television per week, and weigh themselves at least once per week. About half of them lost weight on their own and the other half used some type of weight-loss program. In most scientific studies successful weight loss is accomplished only by changing the diet\u00a0<em class=\"emphasis\">and<\/em>\u00a0by increasing physical activity. Doing one without the other limits the amount of weight lost and the length of time that weight loss is sustained. On an individual level it is quite possible to achieve successful weight loss, as over ten thousand Americans can attest. Moreover, losing as little as 10 percent of your body weight can significantly improve health and reduce disease risk.<span id=\"zimmerman_1.0-fn11_019\" class=\"footnote\">National Heart, Lung, and Blood Institute. \u201cClinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.\u201d\u00a0<em class=\"emphasis\">Obes Res<\/em>\u00a06 supplement (1998): 51S\u2013210S.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2003\/\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2003\/<\/a>.<\/span>\u00a0You do not have to be overweight or obese to reap benefits from eating a healthier diet and increasing physical activity as both provide numerous benefits beyond weight loss and maintenance.<\/p>\r\n\r\n<div id=\"zimmerman_1.0-ch11_s05_s01\" class=\"section\">\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 id=\"Evidence-Based_Dietary_Recommendations-599\">Evidence-Based Dietary Recommendations<\/h3>\r\n<p id=\"zimmerman_1.0-ch11_s05_s01_p01\">The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0offers specific, evidence-based recommendations for dietary changes aimed at keeping calorie intake in balance with physical activity, which is key for weight management. These recommendations include:<span id=\"zimmerman_1.0-fn11_020\" class=\"footnote\">US Department of Agriculture.\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>. 2010. Accessed October 7, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines2010.pdf\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines 2010.pdf<\/a>.<\/span><\/p>\r\n\r\n<ul id=\"zimmerman_1.0-ch11_s05_s01_l01\" class=\"itemizedlist \">\r\n \t<li><strong class=\"emphasis bold\">Increase intake of whole grains, vegetables, and fruits.<\/strong>\u00a0Scientific evidence demonstrates that adults who have a higher intake of whole grains, mainly those high in dietary fiber, have lower body weights compared to adults who eat a smaller amount of whole grains. Moreover diets incorporating more whole grains reduce chronic disease risk . A higher intake of fruits and vegetables is scientifically shown to protect against weight gain in adults and there is some evidence that this is also true for children and adolescents.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Reduce intake of sugar-sweetened beverages.<\/strong>\u00a0There is good evidence that reducing consumption of sugar-sweetened beverages, especially in children and adolescents, decreases body weight and reduces chronic disease risk.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Monitor intake of 100 percent fruit juice for children and adolescents, especially those who are overweight or obese.<\/strong>\u00a0There is some evidence that increased intake of 100 percent juice exacerbates weight problems in children and adolescents who are already overweight or obese.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Monitor calorie intake from alcoholic beverages for adults.<\/strong>\u00a0Drinking in moderation is not linked to weight gain; however, excessive intake of alcohol over time is associated with weight gain.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div id=\"zimmerman_1.0-ch11_s05_s02\" class=\"section\">\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 id=\"Evidence-Based_Behavioral_Recommendations-599\">Evidence-Based Behavioral Recommendations<\/h3>\r\n<p id=\"zimmerman_1.0-ch11_s05_s02_p01\">In addition to the dietary recommendations, the\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0offers specific evidence-based recommendations that address behavioral changes aimed to keep calorie intake in balance with physical activity. The recommendations include:<\/p>\r\n\r\n<ul id=\"zimmerman_1.0-ch11_s05_s02_l01\" class=\"itemizedlist \">\r\n \t<li><strong class=\"emphasis bold\">Focus on the total number of calories consumed.<\/strong>\u00a0Reducing calorie intake improves health and aids in weight management.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Monitoring food and caloric intake.<\/strong>\u00a0Being more aware of the calories in foods and beverages by reading the Nutrition Facts panel is helpful for consumers to monitor intake. Vigilant monitoring of food and caloric intake assists in weight management.<\/li>\r\n \t<li><strong class=\"emphasis bold\">When eating out, choose smaller portions or lower-calorie options.<\/strong>\u00a0As mentioned in an earlier section of this chapter, eating out more often, especially at fast food restaurants, contributes to weight gain. The\u00a0<em class=\"emphasis\">Dietary Guidelines<\/em>\u00a0advise people that when they are eating out to order smaller portions, share meals when possible, or take home part of the meal.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories.<\/strong>\u00a0Having less on your plate helps you eat less.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Eat a nutrient-dense breakfast.<\/strong>\u00a0The old adage that \u201cbreakfast is the most important meal of the day\u201d holds true when you consider that not eating breakfast is associated with higher body weights, especially among children and adolescents. Moreover, eating a nutrient-dense breakfast has in some scientific studies been shown to stimulate weight loss.<\/li>\r\n \t<li><strong class=\"emphasis bold\">Limit screen time.<\/strong>\u00a0In children, adolescents, and adults, the sedentary activities of watching television and spending time on the computer are linked to increased overweight and obesity. The\u00a0<em class=\"emphasis\">Dietary Guidelines<\/em>\u00a0recommend children and adolescents spend no more than one to two hours daily watching television, playing electronic games, or using the computer (other than for homework).<span id=\"zimmerman_1.0-fn11_021\" class=\"footnote\">US Department of Agriculture.\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>. 2010. Accessed October 7, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines2010.pdf\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines 2010.pdf<\/a>.<\/span><\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div id=\"zimmerman_1.0-ch11_s05_s03\" class=\"section\">\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 id=\"Evidence-Based_Physical_Activity_Recommendations-599\">Evidence-Based Physical Activity Recommendations<\/h3>\r\n<p id=\"zimmerman_1.0-ch11_s05_s03_p01\">The other part of the energy balance equation is physical activity. The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines<\/em>\u00a0are complemented by the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>\u00a0issued by the Department of Health and Human Services in an effort to provide evidence-based guidelines for appropriate physical activity levels. The\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines<\/em>\u00a0provide guidance to Americans aged six and older about how to improve health and reduce chronic disease risk through physical activity. Increased physical activity has been found in scientific studies to lower the risk of heart disease, stroke, high blood pressure, Type 2 diabetes, colon, breast, and lung cancer, falls and fractures, depression, and dying early. Increased physical activity not only reduces disease risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance. The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in\u00a0<a title=\"12: From Pregnancy to the Toddler Years\" href=\"https:\/\/med.libretexts.org\/Bookshelves\/Nutrition\/Book%3A_An_Introduction_to_Nutrition_(Zimmerman)\/12%3A_From_Pregnancy_to_the_Toddler_Years\" rel=\"internal\">elsewhere<\/a>):<span id=\"zimmerman_1.0-fn11_022\" class=\"footnote\">US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>. 2008. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx<\/a>.<\/span><\/p>\r\n\r\n<ul id=\"zimmerman_1.0-ch11_s05_s03_l01\" class=\"itemizedlist \">\r\n \t<li>Even small amounts of activity are beneficial to your health.<\/li>\r\n \t<li>More substantial health benefits are obtained by doing at least two hours and thirty minutes per week of moderate-intensity, or one hour and fifteen minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof. Aerobic activity has better benefits if performed for at least ten minutes at a time, spread throughout the week.<\/li>\r\n \t<li>More extensive health benefits occur when moderate aerobic physical activity is increased to five hours per week of moderate-intensity, or to two hours and thirty minutes of vigorous-intensity aerobic physical activity, or a combination thereof. Additional health benefits are gained by going beyond these recommended amounts of physical activity.<\/li>\r\n \t<li>Muscle-strengthening activities at moderate or high intensity involving all major muscle groups two or more days per week provides additional health benefits to aerobic exercise.<\/li>\r\n<\/ul>\r\n<p id=\"zimmerman_1.0-ch11_s05_s03_p02\">The\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines<\/em>\u00a0broadly classify moderate physical activities as those when \u201cyou can talk while you do them, but can\u2019t sing\u201d and vigorous activities as those when \u201cyou can only say a few words without stopping to catch your breath.\u201d<span id=\"zimmerman_1.0-fn11_023\" class=\"footnote\">US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>. 2008. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx<\/a>.<\/span><\/p>\r\n\r\n<div id=\"zimmerman_1.0-ch11_s05_s03_t01\" class=\"table block\">\r\n<table cellspacing=\"0\" cellpadding=\"0\"><caption><em><em><strong>Table\u00a0<span class=\"MJX_Assistive_MathML\" role=\"presentation\">9.5.1<\/span><\/strong><\/em><\/em><em><strong>:<\/strong>\u00a0Moderate and Vigorous Physical Activities<\/em><\/caption>\r\n<thead>\r\n<tr>\r\n<th><strong>Moderate Activities<\/strong><\/th>\r\n<th><strong>Vigorous Activities<\/strong><\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td>Ballroom\/line dancing<\/td>\r\n<td>Aerobic dance<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Biking on level ground<\/td>\r\n<td>Biking (more than 10 miles per hour)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Canoeing<\/td>\r\n<td>Heavy gardening (digging, hoeing)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Gardening<\/td>\r\n<td>Hiking uphill<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Baseball, softball, volleyball<\/td>\r\n<td>Fast dancing<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Tennis (doubles)<\/td>\r\n<td>Jumping rope<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Walking briskly<\/td>\r\n<td>Martial arts (karate)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Water aerobics<\/td>\r\n<td>Race walking<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Using hand cyclers<\/td>\r\n<td>Jogging or running<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><\/td>\r\n<td>Sports with running (basketball, hockey, soccer)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><\/td>\r\n<td>Swimming laps<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><\/td>\r\n<td>Tennis (singles)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><\/td>\r\n<td>Ice hockey<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"copyright\">\r\n<h5 class=\"para\">Source: US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans.<\/em>\u00a02008.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/<\/a>.<\/h5>\r\n<\/div>\r\n<\/div>\r\n<div id=\"zimmerman_1.0-ch11_s05_s03_n01\" class=\"callout \">\r\n<div class=\"note1\">\r\n<div class=\"textbox\">\r\n<p class=\"boxtitle\"><strong>INTERACTIVE 9.5.1<\/strong><\/p>\r\n\r\n\r\n<hr \/>\r\n<p id=\"zimmerman_1.0-ch11_s05_s03_p03\" class=\"para\">To get started on ramping up your physical activity or following a new exercise program use the toolkit, \u201cBe Active Your Way\u201d available from HHS:\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/adultguide\/activeguide.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/adultguide\/activeguide.aspx<\/a>.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div id=\"zimmerman_1.0-ch11_s05_s04\" class=\"section\">\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 id=\"Campaigns_for_a_Healthy-Weight_America-599\">Campaigns for a Healthy-Weight America<\/h3>\r\n<p id=\"zimmerman_1.0-ch11_s05_s04_p01\">On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the recent past (2007\u20132011) several newly created initiatives and organizations are actively reinforcing strategies aimed to meet the challenge of improving the health of all Americans.<\/p>\r\n<p id=\"zimmerman_1.0-ch11_s05_s04_p02\">In 2010 the national campaign to reduce obesity was reinforced when First Lady Michelle Obama launched the \u201cLet\u2019s Move\u201d initiative, which has the goal of \u201csolving the challenge of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight.\u201d<span id=\"zimmerman_1.0-fn11_024\" class=\"footnote\">The White House, Office of the First Lady. \u201cFirst Lady Michelle Obama Launches Let\u2019s Move: America\u2019s Move to Raise a Healthier Generation of Kids.\u201d February 9, 2010.\u00a0<a class=\"link external\" href=\"http:\/\/www.whitehouse.gov\/the-press-office\/first-lady-michelle-obama-launches-lets-move-americas-move-raise-a-healthier-genera\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.whitehouse.gov\/the-press-office\/first-lady-michelle-obama-launches -lets-move-americas-move-raise-a-healthier-genera<\/a>.<\/span>\u00a0Another campaign, \u201cCampaign to End Obesity,\u201d was recently established to try to enable more Americans to eat healthy and be active by bringing together leaders from academia and industry, as well as public-health policy-makers in order to create policies that will reverse the obesity trend and its associated diseases. It remains to be seen whether these new initiatives will finally help improve American health.<\/p>\r\n\r\n<div class=\"mt-video-widget mt-video-width-50\">\r\n<div>\r\n\r\n[embed]https:\/\/www.youtube.com\/embed\/R4yfFpKTbmU[\/embed]\r\n\r\n<\/div>\r\n<\/div>\r\n<h4 id=\"zimmerman_1.0-ch11_s05_s04_n01\" class=\"callout block\"><em><strong>Video\u00a0<\/strong><\/em>9.5.1: View this brief video on the Campaign to End Obesity.<\/h4>\r\n<\/div>\r\n<\/div>\r\n<div id=\"section_5\" class=\"mt-section\">\r\n<h3 id=\"The_.E2.80.9CSmall-Change.E2.80.9D_Approach-599\">The \u201cSmall-Change\u201d Approach<\/h3>\r\n<p id=\"zimmerman_1.0-ch11_s05_s05_p01\">Currently, most people are not obese in this country. The gradual rise in overweight is happening because, on average, people consume slightly more calories daily than they expend, resulting in a gradual weight gain of one to two pounds a year. In 2003 the idea was first published that promoting small lifestyle changes to reduce weight gain occurring over time in all age groups may better reduce obesity rates in the American population.<span id=\"zimmerman_1.0-fn11_025\" class=\"footnote\">Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d\u00a0<em class=\"emphasis\">Am J Clin Nutr<\/em>\u00a089, no. 2 (2009): 477\u201384.\u00a0<a class=\"link external\" href=\"http:\/\/www.ajcn.org\/content\/89\/2\/477.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span>\u00a0Scientific studies have demonstrated that asking people to increase the number of steps they take each day while providing them with pedometers that count the steps they take each day successfully prevented weight gain. A \u201csmall-changes\u201d study published in the October 2007 issue of\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0evaluated whether families that made two small lifestyle changes, which were to walk an additional two thousand steps per day and to eliminate 100 kilocalories per day from their typical diet by replacing dietary sugar with a noncaloric sweetener, would prevent weight gain in overweight children.<span id=\"zimmerman_1.0-fn11_026\" class=\"footnote\">Rodearmel, S. J. et al. \u201cSmall Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.\u201d\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0120, no. 4 (2007): e869\u201379.\u00a0<a class=\"link external\" href=\"http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long<\/a>.<\/span>\u00a0The results of this study were that a higher percentage of children who made the small changes maintained or reduced their BMI in comparison to children of families given a pedometer but not asked to also make physical activity or dietary changes.<span id=\"zimmerman_1.0-fn11_027\" class=\"footnote\">Rodearmel, S. J. et al. \u201cSmall Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.\u201d\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0120, no. 4 (2007): e869\u201379.\u00a0<a class=\"link external\" href=\"http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long<\/a>.<\/span>\u00a0Several more studies funded by the National Institutes of Health and USDA are ongoing and are evaluating the effectiveness of the \u201csmall-changes\u201d approach in reducing weight gain.<\/p>\r\n<p id=\"zimmerman_1.0-ch11_s05_s05_p02\">In 2009, a report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council proposed that the \u201csmall-changes\u201d approach when supported at the community, industry, and governmental levels will be more effective than current strategies in gradually reducing the obesity rate in America.<span id=\"zimmerman_1.0-fn11_028\" class=\"footnote\">Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d\u00a0<em class=\"emphasis\">Am J Clin Nutr<\/em>\u00a089, no. 2 (2009): 477\u201384.\u00a0<a class=\"link external\" href=\"http:\/\/www.ajcn.org\/content\/89\/2\/477.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span>\u00a0The HHS encouraged the approach and launched a \u201cSmall Step\u201d website in 2008.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_6\" class=\"mt-section\">\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways<\/h3>\r\n<ul id=\"zimmerman_1.0-ch11_s05_s05_l01\" class=\"itemizedlist\">\r\n \t<li>Successful weight loss is defined as when individuals intentionally lose at least 10 percent of their body weight and keep it off for at least one year.<\/li>\r\n \t<li>Although there is a great variety of approaches to achieve successful weight loss most report that it involves adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day).<\/li>\r\n \t<li>The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0recommendations are based upon scientific evidence.<\/li>\r\n \t<li>The other part of the energy balance equation is physical activity. The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines<\/em>\u00a0were complemented by the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>\u00a0issued by the HHS in an effort to provide evidence-based guidelines for appropriate physical activity levels.<\/li>\r\n \t<li>On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the recent past (2007\u20132011) several newly created initiatives and organizations are actively reinforcing strategies that aim to meet the challenge of improving the health of all Americans.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<div id=\"zimmerman_1.0-ch11_s04_s02_s03_n02\" class=\"exercises block\">\r\n<div id=\"section_7\" class=\"mt-section\">\r\n<h3 id=\"Discussion_Starters-598\">Discussion Starters<\/h3>\r\n<ol id=\"zimmerman_1.0-ch11_s05_s05_l02\" class=\"orderedlist\">\r\n \t<li>Discuss ways to address the childhood obesity problem in your own community.<\/li>\r\n \t<li>Calculate your EER by using the formula in this chapter and determine whether your average daily intake of calories falls below, meets, or exceeds your EER.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/div>","rendered":"<div id=\"skills\">\n<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Explain the complementary actions of dietary changes and increased physical activity level on health.<\/li>\n<li>Formulate an exercise plan that fits your lifestyle and that follows the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p>We have just considered the gravity of the obesity problem in America and worldwide. How is America combating its weight problem on a national level and have the approaches been successful?<br \/>\nSuccessful weight loss is defined as individuals intentionally losing at least 10 percent of their body weight and keeping it off for at least one year.<span id=\"zimmerman_1.0-fn11_016\" class=\"footnote\">Wing, R. R. and J. O. Hill. \u201cSuccessful Weight Loss Maintenance.\u201d\u00a0<em class=\"emphasis\">Annu Rev Nutr<\/em>\u00a021 (2001): 323\u201341. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11375440?dopt=Abstract\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11375440?dopt=Abstract<\/a>.<\/span>\u00a0Results from lifestyle intervention studies suggest fewer than 20 percent of participants are successful at weight loss. An evaluation of successful weight loss, involving more than fourteen thousand participants published in the November 2011 issue of the\u00a0<em class=\"emphasis\">International Journal of Obesity<\/em>\u00a0estimates that more than one in six Americans who were overweight or obese were successful in achieving long-term weight loss.<span id=\"zimmerman_1.0-fn11_017\" class=\"footnote\">Kraschnewski, J. L. et al. \u201cLong-Term Weight Loss Maintenance in the United States.\u201d\u00a0<em class=\"emphasis\">Int J Obes<\/em>\u00a034, no. 11 (2010): 1644\u201354.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20479763\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20479763<\/a>.<\/span>\u00a0However, these numbers are on the high end because many similar studies report fewer than 10 percent of participants as successful in weight loss.<\/p>\n<p id=\"zimmerman_1.0-ch11_s05_p03\">The National Weight Control Registry (NWCR) tracks over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year. Their research findings are that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking.)<span id=\"zimmerman_1.0-fn11_018\" class=\"footnote\">The National Weight Control Registry. \u201cResearch Findings.\u201d Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.nwcr.ws\/Research\/default.htm\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.nwcr.ws\/Research\/default.htm<\/a>.<\/span>\u00a0Although there are a great variety of approaches taken by NWCR members to achieve successful weight loss, most report that their approach involved adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day). Moreover, most members eat breakfast every day, watch fewer than ten hours of television per week, and weigh themselves at least once per week. About half of them lost weight on their own and the other half used some type of weight-loss program. In most scientific studies successful weight loss is accomplished only by changing the diet\u00a0<em class=\"emphasis\">and<\/em>\u00a0by increasing physical activity. Doing one without the other limits the amount of weight lost and the length of time that weight loss is sustained. On an individual level it is quite possible to achieve successful weight loss, as over ten thousand Americans can attest. Moreover, losing as little as 10 percent of your body weight can significantly improve health and reduce disease risk.<span id=\"zimmerman_1.0-fn11_019\" class=\"footnote\">National Heart, Lung, and Blood Institute. \u201cClinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.\u201d\u00a0<em class=\"emphasis\">Obes Res<\/em>\u00a06 supplement (1998): 51S\u2013210S.\u00a0<a class=\"link external\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2003\/\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2003\/<\/a>.<\/span>\u00a0You do not have to be overweight or obese to reap benefits from eating a healthier diet and increasing physical activity as both provide numerous benefits beyond weight loss and maintenance.<\/p>\n<div id=\"zimmerman_1.0-ch11_s05_s01\" class=\"section\">\n<div id=\"section_1\" class=\"mt-section\">\n<h3 id=\"Evidence-Based_Dietary_Recommendations-599\">Evidence-Based Dietary Recommendations<\/h3>\n<p id=\"zimmerman_1.0-ch11_s05_s01_p01\">The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0offers specific, evidence-based recommendations for dietary changes aimed at keeping calorie intake in balance with physical activity, which is key for weight management. These recommendations include:<span id=\"zimmerman_1.0-fn11_020\" class=\"footnote\">US Department of Agriculture.\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>. 2010. Accessed October 7, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines2010.pdf\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines 2010.pdf<\/a>.<\/span><\/p>\n<ul id=\"zimmerman_1.0-ch11_s05_s01_l01\" class=\"itemizedlist\">\n<li><strong class=\"emphasis bold\">Increase intake of whole grains, vegetables, and fruits.<\/strong>\u00a0Scientific evidence demonstrates that adults who have a higher intake of whole grains, mainly those high in dietary fiber, have lower body weights compared to adults who eat a smaller amount of whole grains. Moreover diets incorporating more whole grains reduce chronic disease risk . A higher intake of fruits and vegetables is scientifically shown to protect against weight gain in adults and there is some evidence that this is also true for children and adolescents.<\/li>\n<li><strong class=\"emphasis bold\">Reduce intake of sugar-sweetened beverages.<\/strong>\u00a0There is good evidence that reducing consumption of sugar-sweetened beverages, especially in children and adolescents, decreases body weight and reduces chronic disease risk.<\/li>\n<li><strong class=\"emphasis bold\">Monitor intake of 100 percent fruit juice for children and adolescents, especially those who are overweight or obese.<\/strong>\u00a0There is some evidence that increased intake of 100 percent juice exacerbates weight problems in children and adolescents who are already overweight or obese.<\/li>\n<li><strong class=\"emphasis bold\">Monitor calorie intake from alcoholic beverages for adults.<\/strong>\u00a0Drinking in moderation is not linked to weight gain; however, excessive intake of alcohol over time is associated with weight gain.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"zimmerman_1.0-ch11_s05_s02\" class=\"section\">\n<div id=\"section_2\" class=\"mt-section\">\n<h3 id=\"Evidence-Based_Behavioral_Recommendations-599\">Evidence-Based Behavioral Recommendations<\/h3>\n<p id=\"zimmerman_1.0-ch11_s05_s02_p01\">In addition to the dietary recommendations, the\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0offers specific evidence-based recommendations that address behavioral changes aimed to keep calorie intake in balance with physical activity. The recommendations include:<\/p>\n<ul id=\"zimmerman_1.0-ch11_s05_s02_l01\" class=\"itemizedlist\">\n<li><strong class=\"emphasis bold\">Focus on the total number of calories consumed.<\/strong>\u00a0Reducing calorie intake improves health and aids in weight management.<\/li>\n<li><strong class=\"emphasis bold\">Monitoring food and caloric intake.<\/strong>\u00a0Being more aware of the calories in foods and beverages by reading the Nutrition Facts panel is helpful for consumers to monitor intake. Vigilant monitoring of food and caloric intake assists in weight management.<\/li>\n<li><strong class=\"emphasis bold\">When eating out, choose smaller portions or lower-calorie options.<\/strong>\u00a0As mentioned in an earlier section of this chapter, eating out more often, especially at fast food restaurants, contributes to weight gain. The\u00a0<em class=\"emphasis\">Dietary Guidelines<\/em>\u00a0advise people that when they are eating out to order smaller portions, share meals when possible, or take home part of the meal.<\/li>\n<li><strong class=\"emphasis bold\">Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories.<\/strong>\u00a0Having less on your plate helps you eat less.<\/li>\n<li><strong class=\"emphasis bold\">Eat a nutrient-dense breakfast.<\/strong>\u00a0The old adage that \u201cbreakfast is the most important meal of the day\u201d holds true when you consider that not eating breakfast is associated with higher body weights, especially among children and adolescents. Moreover, eating a nutrient-dense breakfast has in some scientific studies been shown to stimulate weight loss.<\/li>\n<li><strong class=\"emphasis bold\">Limit screen time.<\/strong>\u00a0In children, adolescents, and adults, the sedentary activities of watching television and spending time on the computer are linked to increased overweight and obesity. The\u00a0<em class=\"emphasis\">Dietary Guidelines<\/em>\u00a0recommend children and adolescents spend no more than one to two hours daily watching television, playing electronic games, or using the computer (other than for homework).<span id=\"zimmerman_1.0-fn11_021\" class=\"footnote\">US Department of Agriculture.\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>. 2010. Accessed October 7, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines2010.pdf\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines 2010.pdf<\/a>.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"zimmerman_1.0-ch11_s05_s03\" class=\"section\">\n<div id=\"section_3\" class=\"mt-section\">\n<h3 id=\"Evidence-Based_Physical_Activity_Recommendations-599\">Evidence-Based Physical Activity Recommendations<\/h3>\n<p id=\"zimmerman_1.0-ch11_s05_s03_p01\">The other part of the energy balance equation is physical activity. The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines<\/em>\u00a0are complemented by the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>\u00a0issued by the Department of Health and Human Services in an effort to provide evidence-based guidelines for appropriate physical activity levels. The\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines<\/em>\u00a0provide guidance to Americans aged six and older about how to improve health and reduce chronic disease risk through physical activity. Increased physical activity has been found in scientific studies to lower the risk of heart disease, stroke, high blood pressure, Type 2 diabetes, colon, breast, and lung cancer, falls and fractures, depression, and dying early. Increased physical activity not only reduces disease risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance. The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in\u00a0<a title=\"12: From Pregnancy to the Toddler Years\" href=\"https:\/\/med.libretexts.org\/Bookshelves\/Nutrition\/Book%3A_An_Introduction_to_Nutrition_(Zimmerman)\/12%3A_From_Pregnancy_to_the_Toddler_Years\" rel=\"internal\">elsewhere<\/a>):<span id=\"zimmerman_1.0-fn11_022\" class=\"footnote\">US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>. 2008. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx<\/a>.<\/span><\/p>\n<ul id=\"zimmerman_1.0-ch11_s05_s03_l01\" class=\"itemizedlist\">\n<li>Even small amounts of activity are beneficial to your health.<\/li>\n<li>More substantial health benefits are obtained by doing at least two hours and thirty minutes per week of moderate-intensity, or one hour and fifteen minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof. Aerobic activity has better benefits if performed for at least ten minutes at a time, spread throughout the week.<\/li>\n<li>More extensive health benefits occur when moderate aerobic physical activity is increased to five hours per week of moderate-intensity, or to two hours and thirty minutes of vigorous-intensity aerobic physical activity, or a combination thereof. Additional health benefits are gained by going beyond these recommended amounts of physical activity.<\/li>\n<li>Muscle-strengthening activities at moderate or high intensity involving all major muscle groups two or more days per week provides additional health benefits to aerobic exercise.<\/li>\n<\/ul>\n<p id=\"zimmerman_1.0-ch11_s05_s03_p02\">The\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines<\/em>\u00a0broadly classify moderate physical activities as those when \u201cyou can talk while you do them, but can\u2019t sing\u201d and vigorous activities as those when \u201cyou can only say a few words without stopping to catch your breath.\u201d<span id=\"zimmerman_1.0-fn11_023\" class=\"footnote\">US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>. 2008. Accessed October 8, 2011.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/guidelines\/chapter2.aspx<\/a>.<\/span><\/p>\n<div id=\"zimmerman_1.0-ch11_s05_s03_t01\" class=\"table block\">\n<table cellpadding=\"0\" style=\"border-spacing: 0px;\">\n<caption><em><em><strong>Table\u00a0<span class=\"MJX_Assistive_MathML\" role=\"presentation\">9.5.1<\/span><\/strong><\/em><\/em><em><strong>:<\/strong>\u00a0Moderate and Vigorous Physical Activities<\/em><\/caption>\n<thead>\n<tr>\n<th><strong>Moderate Activities<\/strong><\/th>\n<th><strong>Vigorous Activities<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Ballroom\/line dancing<\/td>\n<td>Aerobic dance<\/td>\n<\/tr>\n<tr>\n<td>Biking on level ground<\/td>\n<td>Biking (more than 10 miles per hour)<\/td>\n<\/tr>\n<tr>\n<td>Canoeing<\/td>\n<td>Heavy gardening (digging, hoeing)<\/td>\n<\/tr>\n<tr>\n<td>Gardening<\/td>\n<td>Hiking uphill<\/td>\n<\/tr>\n<tr>\n<td>Baseball, softball, volleyball<\/td>\n<td>Fast dancing<\/td>\n<\/tr>\n<tr>\n<td>Tennis (doubles)<\/td>\n<td>Jumping rope<\/td>\n<\/tr>\n<tr>\n<td>Walking briskly<\/td>\n<td>Martial arts (karate)<\/td>\n<\/tr>\n<tr>\n<td>Water aerobics<\/td>\n<td>Race walking<\/td>\n<\/tr>\n<tr>\n<td>Using hand cyclers<\/td>\n<td>Jogging or running<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Sports with running (basketball, hockey, soccer)<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Swimming laps<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Tennis (singles)<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Ice hockey<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"copyright\">\n<h5 class=\"para\">Source: US Department of Health and Human Services.\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans.<\/em>\u00a02008.\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/<\/a>.<\/h5>\n<\/div>\n<\/div>\n<div id=\"zimmerman_1.0-ch11_s05_s03_n01\" class=\"callout\">\n<div class=\"note1\">\n<div class=\"textbox\">\n<p class=\"boxtitle\"><strong>INTERACTIVE 9.5.1<\/strong><\/p>\n<hr \/>\n<p id=\"zimmerman_1.0-ch11_s05_s03_p03\" class=\"para\">To get started on ramping up your physical activity or following a new exercise program use the toolkit, \u201cBe Active Your Way\u201d available from HHS:\u00a0<a class=\"link external\" href=\"http:\/\/www.health.gov\/paguidelines\/adultguide\/activeguide.aspx\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.health.gov\/paguidelines\/adultguide\/activeguide.aspx<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"zimmerman_1.0-ch11_s05_s04\" class=\"section\">\n<div id=\"section_4\" class=\"mt-section\">\n<h3 id=\"Campaigns_for_a_Healthy-Weight_America-599\">Campaigns for a Healthy-Weight America<\/h3>\n<p id=\"zimmerman_1.0-ch11_s05_s04_p01\">On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the recent past (2007\u20132011) several newly created initiatives and organizations are actively reinforcing strategies aimed to meet the challenge of improving the health of all Americans.<\/p>\n<p id=\"zimmerman_1.0-ch11_s05_s04_p02\">In 2010 the national campaign to reduce obesity was reinforced when First Lady Michelle Obama launched the \u201cLet\u2019s Move\u201d initiative, which has the goal of \u201csolving the challenge of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight.\u201d<span id=\"zimmerman_1.0-fn11_024\" class=\"footnote\">The White House, Office of the First Lady. \u201cFirst Lady Michelle Obama Launches Let\u2019s Move: America\u2019s Move to Raise a Healthier Generation of Kids.\u201d February 9, 2010.\u00a0<a class=\"link external\" href=\"http:\/\/www.whitehouse.gov\/the-press-office\/first-lady-michelle-obama-launches-lets-move-americas-move-raise-a-healthier-genera\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.whitehouse.gov\/the-press-office\/first-lady-michelle-obama-launches -lets-move-americas-move-raise-a-healthier-genera<\/a>.<\/span>\u00a0Another campaign, \u201cCampaign to End Obesity,\u201d was recently established to try to enable more Americans to eat healthy and be active by bringing together leaders from academia and industry, as well as public-health policy-makers in order to create policies that will reverse the obesity trend and its associated diseases. It remains to be seen whether these new initiatives will finally help improve American health.<\/p>\n<div class=\"mt-video-widget mt-video-width-50\">\n<div>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"CampaignToEndObesity.mov\" width=\"500\" height=\"375\" src=\"https:\/\/www.youtube.com\/embed\/R4yfFpKTbmU?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<\/div>\n<h4 id=\"zimmerman_1.0-ch11_s05_s04_n01\" class=\"callout block\"><em><strong>Video\u00a0<\/strong><\/em>9.5.1: View this brief video on the Campaign to End Obesity.<\/h4>\n<\/div>\n<\/div>\n<div id=\"section_5\" class=\"mt-section\">\n<h3 id=\"The_.E2.80.9CSmall-Change.E2.80.9D_Approach-599\">The \u201cSmall-Change\u201d Approach<\/h3>\n<p id=\"zimmerman_1.0-ch11_s05_s05_p01\">Currently, most people are not obese in this country. The gradual rise in overweight is happening because, on average, people consume slightly more calories daily than they expend, resulting in a gradual weight gain of one to two pounds a year. In 2003 the idea was first published that promoting small lifestyle changes to reduce weight gain occurring over time in all age groups may better reduce obesity rates in the American population.<span id=\"zimmerman_1.0-fn11_025\" class=\"footnote\">Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d\u00a0<em class=\"emphasis\">Am J Clin Nutr<\/em>\u00a089, no. 2 (2009): 477\u201384.\u00a0<a class=\"link external\" href=\"http:\/\/www.ajcn.org\/content\/89\/2\/477.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span>\u00a0Scientific studies have demonstrated that asking people to increase the number of steps they take each day while providing them with pedometers that count the steps they take each day successfully prevented weight gain. A \u201csmall-changes\u201d study published in the October 2007 issue of\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0evaluated whether families that made two small lifestyle changes, which were to walk an additional two thousand steps per day and to eliminate 100 kilocalories per day from their typical diet by replacing dietary sugar with a noncaloric sweetener, would prevent weight gain in overweight children.<span id=\"zimmerman_1.0-fn11_026\" class=\"footnote\">Rodearmel, S. J. et al. \u201cSmall Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.\u201d\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0120, no. 4 (2007): e869\u201379.\u00a0<a class=\"link external\" href=\"http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long<\/a>.<\/span>\u00a0The results of this study were that a higher percentage of children who made the small changes maintained or reduced their BMI in comparison to children of families given a pedometer but not asked to also make physical activity or dietary changes.<span id=\"zimmerman_1.0-fn11_027\" class=\"footnote\">Rodearmel, S. J. et al. \u201cSmall Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.\u201d\u00a0<em class=\"emphasis\">Pediatrics<\/em>\u00a0120, no. 4 (2007): e869\u201379.\u00a0<a class=\"link external\" href=\"http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long<\/a>.<\/span>\u00a0Several more studies funded by the National Institutes of Health and USDA are ongoing and are evaluating the effectiveness of the \u201csmall-changes\u201d approach in reducing weight gain.<\/p>\n<p id=\"zimmerman_1.0-ch11_s05_s05_p02\">In 2009, a report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council proposed that the \u201csmall-changes\u201d approach when supported at the community, industry, and governmental levels will be more effective than current strategies in gradually reducing the obesity rate in America.<span id=\"zimmerman_1.0-fn11_028\" class=\"footnote\">Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d\u00a0<em class=\"emphasis\">Am J Clin Nutr<\/em>\u00a089, no. 2 (2009): 477\u201384.\u00a0<a class=\"link external\" href=\"http:\/\/www.ajcn.org\/content\/89\/2\/477.long\" target=\"_blank\" rel=\"external nofollow noopener\">http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span>\u00a0The HHS encouraged the approach and launched a \u201cSmall Step\u201d website in 2008.<\/p>\n<\/div>\n<div id=\"section_6\" class=\"mt-section\">\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways<\/h3>\n<ul id=\"zimmerman_1.0-ch11_s05_s05_l01\" class=\"itemizedlist\">\n<li>Successful weight loss is defined as when individuals intentionally lose at least 10 percent of their body weight and keep it off for at least one year.<\/li>\n<li>Although there is a great variety of approaches to achieve successful weight loss most report that it involves adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day).<\/li>\n<li>The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines for Americans<\/em>\u00a0recommendations are based upon scientific evidence.<\/li>\n<li>The other part of the energy balance equation is physical activity. The\u00a0<em class=\"emphasis\">2010 Dietary Guidelines<\/em>\u00a0were complemented by the\u00a0<em class=\"emphasis\">2008 Physical Activity Guidelines for Americans<\/em>\u00a0issued by the HHS in an effort to provide evidence-based guidelines for appropriate physical activity levels.<\/li>\n<li>On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the recent past (2007\u20132011) several newly created initiatives and organizations are actively reinforcing strategies that aim to meet the challenge of improving the health of all Americans.<\/li>\n<\/ul>\n<\/div>\n<div id=\"zimmerman_1.0-ch11_s04_s02_s03_n02\" class=\"exercises block\">\n<div id=\"section_7\" class=\"mt-section\">\n<h3 id=\"Discussion_Starters-598\">Discussion Starters<\/h3>\n<ol id=\"zimmerman_1.0-ch11_s05_s05_l02\" class=\"orderedlist\">\n<li>Discuss ways to address the childhood obesity problem in your own community.<\/li>\n<li>Calculate your EER by using the formula in this chapter and determine whether your average daily intake of calories falls below, meets, or exceeds your EER.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-423\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Dietary, Behavioral, and Physical Activity Recommendations for Weight Management. <strong>Authored by<\/strong>: Maureen Zimmerman and Beth Snow. <strong>Provided by<\/strong>: Lardbucket. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/2012books.lardbucket.org\/books\/an-introduction-to-nutrition\/s15-04-dietary-behavioral-and-physica.html\">https:\/\/2012books.lardbucket.org\/books\/an-introduction-to-nutrition\/s15-04-dietary-behavioral-and-physica.html<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA: Attribution-NonCommercial-ShareAlike<\/a><\/em><\/li><li>Dietary, Behavioral, and Physical Activity Recommendations for Weight Management. <strong>Authored by<\/strong>: Medical LibreTexts Contributors. <strong>Provided by<\/strong>: LibreTexts. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/09%3A_Energy_Balance_and_Healthy_Weight\/9.5%3A_Dietary%2C_Behavioral%2C_and_Physical_Activity_Recommendations_for_Weight_Management\">https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/09%3A_Energy_Balance_and_Healthy_Weight\/9.5%3A_Dietary%2C_Behavioral%2C_and_Physical_Activity_Recommendations_for_Weight_Management<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA: Attribution-NonCommercial-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":44985,"menu_order":7,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Dietary, Behavioral, and Physical Activity 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