Weight Loss Programs and Insurance

Another set of two articles to ponder.

The first comes from the Consumer Reports Health Blog: Commercial Weight-Loss Programs: The Evidence

The second comes from Dr. Judith Wurtman on the Huffington Post: Weight Loss: Should Commercial Programs be Covered by Health Insurance?

It's one of those never-ending battles: do weight-loss programs actually work? Some say they do, some say they don't, others say they only work short-term or never allow the participants to have a "normal" food life without gaining all the weight back. And what is the scientific evidence for them? Strangely, there have been very few studies. The blog post from Consumer Reports looks at two recent studies in the Journal of the American Medical Association (JAMA) that looked at lifestyle interventions and prepared meals to help with weight-loss.

The first study lasted one year and split the participants into two groups. The first group had diet and physical activity interventions for the full year, the second group started with just a diet intervention and started physical activity six months later. The results? The group that did both diet and exercise initially had a greater weight-loss at the six-month mark, but after adding exercise, both groups had similar weight loss at the twelve-month mark.

I'm not sold on the study design. I think delaying the exercise in one group, but still having both groups do it, confounds the results. The initial intention wasn't to determine if delaying exercise had any effect on weight loss; it was looking at the efficacy of diet and exercise interventions. If I were planning this study I would have one group with only a diet intervention, one group with only a physical activity intervention, and one group with both interventions. This would (hopefully) allow the researchers to determine which type of intervention, or combination of interventions, was most effective.

So a structured diet and exercise plan works, and helps the participants keep the weight off for at least a year. What about the other study? This study was looking at the effect of pre-packaged meals as part of a structured weight-loss program (this study was funded by Jenny Craig). It compared two groups: one that received ongoing support in addition to prepackaged meals during the initial weight loss, the other group received standard obesity counseling and monthly "contact." The group that received meals and structured support had greater, sustained weight loss.

I like a couple things about this study. First, I like that the two groups were clearly defined; there wasn't any crossing-over with their interventions. Second, a two year follow-up gives a better picture of whether the intervention worked in the long-term. I'm not necessarily a fan of prepackaged meals. I question whether people would actually follow the program if they had to pay the inflated price for all of these meals (the study participants received them for free). And I don't like the idea that people aren't taught the principles of feeding themselves with real, fresh food. I'll be honest, I'm not familiar with the Jenny Craig plans and their prepackaged meals. Perhaps participants are taught the basics of good nutrition, maybe they do learn what to prepare for themselves after the packaged phase. But I'm hesitant. Will these people become reliant on a company to tell them what to eat to stay "healthy" (read: thin). Will they trust their own instincts on feeding themselves? What lessons are they passing on to their children with this? And there are a few bigger issues: the disparity created by those who can't afford these programs and concerns related  to packaged foods. I worry about added salt, sugar, preservatives, and the loss of the concept of real food. (I would love to go on about my views of nutrition, health, weight, and food, but that is best left for another post...or series of posts)

And what to do with this information? This is where the second article I linked to heads: should insurance companies cover weight-loss programs? Insurers are willing to shell out big bucks for obesity drugs and surgeries. Why? Because obesity costs them. And why won't these same companies pay for commercial programs? I'm at a loss there. It appears that it is a cheaper, effective alternative (probably not as effective as surgery, but one could argue that it is more cost-effective). I wonder if the companies see less weight loss as less healthy. I personally think fitness is preferable to thinness and I would presume that diet/exercise programs would achieve that better than surgery. It's an argument that could go around and around.

Thoughts?

~L

The End of the Beginning

It's hard to believe that my first semester of graduate school is almost over. It's gone quickly; I've enjoyed it more than I thought I would, I've learned a lot, and met a lot people.



In some ways I feel a little different than my fellow students. I only took six credits this semester. I worked full-time (40 hours/week) for the first half of the semester and even now that I've cut back to 60% (24 hrs/week), it's still very different work from the graduate assistantships and research assistantships that many of my classmates have. But then I realize that maybe I'm not really that different: we all come from different backgrounds, from different stages of life, some have come directly from undergrad, some have come from careers, and we all do school and the path to a degree just a little differently.



And I'm not sure I'm entirely used to the fact that graduate school is different from undergrad. I went "across the river" for the first time a couple weeks ago. I had forgotten what the between class migrations were like. It seemed so natural to come out of a huge lecture with one or two friends and merge seamlessly into the mass of bodies moving across campus. I haven't had to deal with that all semester. Being on the health side of campus there isn't the same density of classrooms. We all filter in to the building from different places on campus. All the classes are small so we get to know each other to a certain extent. Class ends and we trickle out, some alone, some in small groups, each headed a different direction. And then there's the frenzied ten minutes at the top of the hour. The classes I have this semester and next semester don't fall into that rigid hourly class schedule. There is no rushing insanity when we get out of class.



I'm sure I have more comments on grad school, but I should probably wrap this up and study for the Healthcare Organization and Policy final I have tomorrow afternoon.



~L

Productive Procrastination

I am usually amazed at how incredibly productive I can be while trying to avoid homework.

Today I have not been productively procrastinating. So I'll leave you with a couple videos from my senior flute recital at Iowa State.










~L

Interview with Dr. Paik

What is your educational background?
I have a BA in Public Policy, and an MA and PHD in Sociology.  All of my
degrees are from the University of Chicago, but I did spend four years
working in Washington, DC after college.


How did you get into sociology?
While working in DC, I became fascinated with cooperative relationships
and conflict in organizations.  Indeed, I was living through my share of
both.


How and when did you get started in network research?
Network analysis was a natural way to understand the organization of
work, so I immediately started taking classes in the area.  I took classes
on networks from Ron Burt, John Padgett, Roger Gould, and my advisor Edward
Laumann.  Ed was the person who introduced me to the concept of "sexual
networks." 


What do you think are the biggest benefits of network research? The biggest drawbacks?
The biggest benefit of network analysis is that it emphasizes how social
relationships take concrete forms (i.e., social structure).  This allows
researchers to specify pathways of influence and diffusion.  The biggest
drawback, however, is that network analysis is incredibly data intensive.
As such, we are often limited by the amount of data that we can collect and
by significant amounts of missing data.


What is the most challenging part of researching networks?
The most challenging part of this field is keeping up with it.  Since it
is interdisciplinary in nature, it is extremely fast moving and technical.


You have done some network research into health issues, do you think network research hold promise for public health?
 I do think that combining network analysis with the study of public
health is an excellent opportunity.  There have been several high profiles
articles and texts (e.g., Tom Valente's new textbook) that have highlighted
the natural fit between public health and network analysis.


What do you think sociology can offer to the field of public health?
I would say that network analysis is not just a sociological venture.
Its origins are in sociology and anthropology, but today's researchers come
from many fields, including business, public health, economics, and computer
science.  Sociology, however, can offer ways to think about network
structures.


Thank you Dr. Paik for answering my questions!


~L