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Stephanie Rost
MS, RD, Corporate Program Development Director, Weight
Watchers, Int’l, New York, NY
George Askew
MD, FAAP, Senior Policy Advisor for Early Childhood Health
and Development, Administration for Children and Families,
Washington, DC
Susan Swider
PhD, APHN-BC, Professor, Rush University College of Nursing,
Chicago, IL
Weight Watchers International, Inc.
-A science-based lifestyle modification approach
focused on health promotion
Stephanie Rost, MS, RD,
Director of Corporate Program Development
Friday, October 14, 2011
4
About Us
• Who We Are
– Leading global provider of weight management services
for nearly 50 years
– Available in 25 countries
• Our Reach – U.S.
– Annually more than 1.7 million enrollments in Weight
Watchers meetings and 1 million signups for
WeightWatchers.com
– 25,000 meetings each week held in convenient times and
locations (~ 5000 in workplace)
• 75% of our members live with a 12 minute drive to a meeting
Weight Watchers Method
•
Developed by healthcare
professionals
–
•
Delivered by role models in a
supportive environment
–
•
A lifestyle modification program based
on science that includes education,
behavior change and group support
All meeting staff have consistently lost
and maintained their weight on the
Weight Watchers program
This method enables science to be
translated and applied in a way
that real people can understand
and follow in a sustainable way.
How to Follow Weight Watchers
•Monthly Pass:
•Unlimited meetings
•Etools
•$39.95/month
•Most popular option
Monthly Pass:
More Engagement, More Weight Loss
• People who attended
meetings + eTools lost
50% more weight than
those who attended
meetings alone*
14
Weight loss (lbs)
• Strong correlation
between meeting
attendance and weightloss success
16
12
10
8
6
4
2
0
24 weeks
*Nguyen V et al. Obesity 15(9) suppl. A221, 2007.
Mtgs
Mtgs + Web
Weight Watchers Meetings
• Weight Watchers staff give a private and
confidential weigh-in prior to the meeting start
• Each meeting is a discussion led by a Leader,
with new topics each week (topics are
consistent in every location)
• Topics cover everything from holiday
eating and struggles to family meal ideas,
with lots of tips and suggestions
• Leaders are trained in the program and to pass
on their expertise and unique personal
experiences as Lifetime Members of Weight
Watchers
Online
• Tracking tools, robust content on
weight/lifestyle topics, recipe builder,
community
• ~1 million subscribers
• Mobile options (iPhone/iPad/Android)
• > 1.5MM downloads of iPhone App
• WW Kitchen Confidential Ipad App
• Support for other mobile platforms
The Four Pillars of the
Weight Watchers Approach
Diet
Activity
Cognitive Skills
Social Support
Uses formula based on macronutrients, net calories and satiety
to calculate PointsPlus value of a food
Fruit and most vegetables assigned 0 PointPlus value
“Power Food” designation rates foods based on health and
satiety
Scientific Heritage
• Strong
commitment to evaluating
efficacy of the Weight Watchers
methodology
•Established body of evidence
• 65 original scientific publication todate and growing
•Located in the Weight Watchers Scientific
Compendium Online
• Scientific Advisory Board
composed of world-renowned
obesity experts
Primary Care Referral to a Commercial Provider for Weight Loss
Treatment, relative to standard care: An international
randomized controlled trial.
Susan A Jebb, Amy L Ahern, Ashley D Olson, Louise A Aston, Christina Holzapfel, Julia
Stoll, Ulrike Amann-Gassner, Annie E Simpson, Nicholas R Fuller, Suzanne Pearson,
Namson S Lau, Adrian P Mander, Hans Hauner, Ian D Caterson
MRC Human Nutrition Research, Cambridge, UK
(published in The Lancet, September 7th, 2011)
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Study objectives
Primary objective
• To examine the differences in weight loss at 12
months between general practitioner referral
(GP) to Weight Watchers (WW) program and
standard management in primary care (as
informed by national guidelines) across 3
countries.
• N = 772 participants (n = 377 WW, n = 395 SC)
Secondary objectives
• To investigate the number of subjects losing 5%
or 10% of baseline weight in each group.
• To investigate changes in indicators of
metabolic risk – including waist circumference,
body composition, blood pressure, blood
glucose, lipids, etc.
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Results
• In all analyses, participants referred to WW lost more than twice as much
weight as people receiving standard care over 12 months
• Weight loss over 1 year with WW was an average of 7 kg (15.4 lbs)
– This is considerably less than the 3 kg (6.6 lbs) loss among standard
care
• Among WW completers, 60% of participants
lost >5% and 32% lost >10% of baseline
weight
– Among Standard Care completers,
25% lost >5% and about 9%
lost >10% of baseline weight
• Odds ratios of WW group achieving
at least 5% or 10% weight loss at
12 months:
– All subjects: 3.0; 3.2
– Completers: 2.9; 3.5
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Weight Watchers on
prescription: An
observational study of
weight change among adults
referred to Weight Watchers
by the NHS
Amy L Ahern, Ashley D Olson, Louise A
Aston, Susan A Jebb.
BMC Public Health 2011, 11:434.
Identify and prescribe a set of solutions that reverse
or prevent the progression of weight of gain
Progression of Weight Gain
Requires a Portfolio of Solutions
Variety of options needed to match the
diverse needs of individuals with effective
solutions
Morbid
Obese
Obese
Surgeries (e.g., banding, gastric
sleeve)
Medical Devices (e.g., VBLOC)
Medications (e.g., sibutramine,
phentermine)
Overweight
Lifestyle Modification
• Structured eating plan
Healthy Weight
• Regular physical activity
• Cognitive skills
• Support
Research in Early Head Start
GEORGE L. ASKEW, MD, FAAP
OFFICE OF THE ASSISTANT SECRETARY
ADMINISTRATION FOR CHILDREN AND FAMILIES
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
AMERICAN ASSOCIATION OF NURSING
3 8 TH A N N U A L M E E T I N G A N D C O N F E R E N C E
OCTOBER 14, 2011
What I Will Cover Today
 Brief Overview of Administration for Children and
Families
 Brief Overview of Early Head Start
 Review of Research in Early Head Start (BABY
FACES)
 Questions and Answers
Administration for Children and Families
What is Early Head Start?
 Head Start
 Early Head Start
 Established 1995
 Serves children birth to three: 1008 programs; over 133,000
children
 Promotes healthy prenatal outcomes, enhances the
development of infants and toddlers, and promotes healthy
family functioning.
 4 Cornerstones: Child Development, Family Development,
Community Building and Staff Development
 3 other areas of importance: Administrative Management,
Continuous Improvement and Children with Disabilities
Service Delivery: PIR & Baby FACES
Staff Characteristics
Teachers
HV
6
22
39
33
2
20
27
51
64
55
8
59
4
6
Highest level of education:
High school or less
Some college
Associate’s
Bachelor’s or higher
Field of study early
childhood or child development
CDA
Elevated depressive symptoms
Linguistic and Ethnic Diversity
What Do We Know About Health of EHS Children?
Children Are Healthy at Birth and Age 1
 Low rates of premature birth and low birth weight




(about 10 percent)
63 percent were breastfed (average 4 months)
96 percent have insurance coverage
92 percent up-to-date immunizations
74 percent had well-child checkups
Poor Feeding Practices Start Early
Percentage
Parent Reported Feeding Practices at Age 1
Some Incidence of Positive Feeding Practices
Percentage
Parent Reported Feeding Practices at Age 1
Children’s BMI Similar to Other Low Income Samples
 About 1/3 are overweight or obese at age 2
– 16 percent are overweight (85-94th percentile)
– 17 percent are obese (95th percentile or higher)
 Just 6 percent of parents report a medical
professional said child is overweight
 Rates of overweight and obesity not predicted by
feeding practices or other characteristics (including
race/ethnicity)
Programmatic Initiatives
 Office of Head Start is piloting obesity prevention
programs:
–
Head Start: I Am Moving I Am Learning
–
Early Head Start: Little Voices for Healthy Choices
Overall Impacts for Children: Age 3
 Higher immunization rate
 Fewer emergency room visits for accidents and




injuries
Cognitive development (higher Bayley scores &
fewer in low-functioning group*)
Larger receptive vocabularies
Lower levels of aggressive behavior
Greater sustained attention with objects,
engagement of parent, and less negativity
Overall Impacts for Parents: Age 3
 More positive (and less negative) parenting
observed in parent-child play: both mothers and
fathers
 Higher HOME scores, more stimulating home
environments, support for learning
 More daily reading
 Less spanking: both mother and father report
 More hours in education and job training
Impact on Breastfeeding
For those women who enrolled during pregnancy:
 44% of EHS moms
 33% of the control group
Questions
?s
Promoting happy, healthy and successful
children, strong families and supportive
communities
The National Prevention Strategy
Disease Prevention and Health Promotion
for Populations
Susan M. Swider, PhD, APHN-BC, Rush University
[email protected]
Health Promotion Initiatives Panel,
Health Promotion Across the Lifespan: Focus on Evidence
October 14, 2011
National Prevention Strategy
41
The Affordable Care Act
In Addition to Coverage, Quality, and Cost…
Unique Opportunities for
Prevention
Global Health Indicators
(OECD, 2008)
% GDP Spent on Health
18
16
14
12
10
8
6
4
2
0
US
Germany
Japan
% GDP
UK
Canada
Global Health Indicators
(WHO, 2006)
Life Expectancy
84
82
80
78
Years
76
74
72
US
Germany
Japan
UK
Canada
Global Health Indicators
(CIA World Factbook, 2009)
Infant mortality (# deaths before age 1/1,000 live
births)
10
8
6
# deaths
4
2
0
US
Germany
Japan
UK
Canada
US Health Outcomes
• United States is a global leader in medical
technology, treatment, and research, BUT
• 47 million Americans lack health insurance
• Health care costs at 14-16% GDP
• Significant disparities in health access and
outcomes across race and SES
Social determinants of health
Economic and social conditions under which
people live which determine their health.
•
•
•
•
•
Race/ethnicity
Income
Education
Housing
Civil unrest
Proportion of Early Deaths
Preventable by Treatment Type
20%
10%
Medical Treatment
Public
Health/Prevention
Genetic (not
preventable)
70%
Contributions of Prevention and Medical
Treatment to the 30 years of Increased Life
Expectancy Achieved Since 1900
17%
Medical care
Prevention
83%
Focus of U. S. Health
Expenditures
4%
Medical Treatment
Public Health
96%
National Prevention Council
Bureau of Indian Affairs
Department of Labor
Corporation for National and
Community Service
Department of Transportation
Department of Agriculture
Department of Veterans Affairs
Department of Defense
Environmental Protection Agency
Department of Education
Federal Trade Commission
Department of Health and Human
Services
Office of Management and Budget
Department of Homeland Security
Office of National Drug Control Policy
Department of Housing and Urban
Development
White House Domestic Policy Council
Department of Justice
51
Advisory Group
• 17 non-federal members
• Statutory Role:
– Develop policy and program recommendations
– Advise National Prevention Council on prevention
and health promotion practices
52
National Prevention Strategy
• Extensive stakeholder
and public input
• Aligns and focuses
prevention and health
promotion efforts
with existing evidence
base
• Supports national
plans
53
Vision
Working together to improve the health and
quality of life for individuals, families, and
communities by moving the nation from a focus
on sickness and disease to one based on
prevention and wellness.
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National Prevention Strategy
55
Healthy and Safe Community
Environments
• Clean air and water
• Affordable and secure
housing
• Sustainable and
economically vital
neighborhoods
• Make healthy choices
easy and affordable
56
Clinical and Community Preventive
Services
• Evidence-based preventive
services are effective
• Preventive services can be
delivered in communities
• Preventive services can be
reinforced by community-based
prevention, policies, and programs
• Community programs can promote
the use of clinical preventive
service (e.g., transportation, child
care, patient navigation issues)
57
Empowered People
• People are empowered when they
have the knowledge, resources
ability, and motivation to identify
and make healthy choices
• When people are empowered, they
are able to take an active role in
improving their health, supporting
their families and friends in making
healthy choices, and leading
community change
58
Elimination of Health Disparities
• Health outcomes vary widely
based on race, ethnicity,
socio-economic status, and
other social factors
• Disparities are often linked to
social, economic or
environmental disadvantage
• Health disparities are not
intractable and can be
reduced or eliminated with
focused commitment and
effort
59
Priorities
• Tobacco Free Living
• Preventing Drug Abuse
and Excessive Alcohol Use
• Healthy Eating
• Active Living
• Mental and Emotional
Well-being
• Reproductive and Sexual
Health
• Injury and Violence Free
Living
Five Causes Account For
66% of All Deaths
Heart Disease
All Other
Causes
34%
5%
5%
Cancer
27%
Chronic Lower
Respiratory Disease
23%
Stroke
6%
Unintentional Injuries
Source: National Vital Statistics
Report, CDC, 2008
60
Recommendations (Example)
Active Living
• Encourage community design and development that
supports physical activity.
• Promote and strengthen school and early learning
policies and programs that increase physical activity.
• Facilitate access to safe, accessible, and affordable
places for physical activity.
• Support workplace policies and programs that
increase physical activity.
• Assess physical activity levels and provide education,
counseling, and referrals.
61
Actions (Example)
Federal Government will….
• Promote the development of transportation options
and systems that encourage active transportation
and accommodate diverse needs.
• Support adoption of active living principles in
community design, such as mixed land use, compact
design, and inclusion of safe and accessible parks
and green space.
• Support coordinated, comprehensive, and
multicomponent programs and policies to encourage
physical activity and physical education, especially in
schools and early learning centers.
62
Partners Can…. (Example)
States, Tribal, Local, and Territorial Governments
• Support schools and early learning centers in meeting
physical activity guidelines.
Businesses and Employers
• Adopt policies and programs that promote walking, bicycling,
and use of public transportation.
Health Care Systems, Insurers, and Clinicians
• Conduct physical activity assessments, provide counseling,
and refer patients to allied health care or health and fitness
professionals.
Individuals and Families
• Engage in at least 150 minutes of moderate-intensity activity
each week (adults) or at least one hour of activity each day
(children).
63
NPS Implementation Resources:
Indicators/Key Documents
64
NPS Implementation Resources:
Evidence by Recommendation
65
NPS Implementation Resources:
Key Indicators
66
Optimal Implementation
Communication
Alignment
Network & Capacity Building
Partner Engagement
Analysis and Research
Evaluation and Accountability
67
What’s Next
• Execute and coordinate NPS actions across
Council agencies
• Encourage partners to create and execute
their own NPS action plans
• Monitor and track progress
• Share successes!
68
Implications for Nursing
• Research into effective disease prevention and
health promotion strategies
– individual and population level
• Educate students and nurses on effective health
promotion and disease prevention strategies
• Practice disease prevention and health
promotion
– New partnerships
• Civic and policy activism in reforming health care
For more information go to:
www.healthcare.gov/nationalpreventioncouncil
Contact the National Prevention Council at:
[email protected]
70
Academy Open Forum