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August 5, 2010 Volume VII, No. 5

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Nutritional labeling and point-of-purchase signs can influence an individual's choice in healthy food selection, according to a study highlighted in this week's issue. Also this week, discover how a patient's weight can be affected after knee and hip replacement surgery and whether a Web site can help a person maintain their weight loss.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Influencing Healthy Food Choices
  2. Knee, Hip Replacement & Weight Decrease
  3. Becoming a Health Coach
  4. Role of Dieting Messages
  5. Telehealth-Targeted Conditions
  6. 2010 Obesity Benchmarks
  7. Maintain Weight Loss Online
  8. Health Coaching 2010

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Nutritional Labeling and Point-of-Purchase Signs Influence Healthy Food Choices

Poor diet and physical inactivity leading to obesity are poised to overtake tobacco use as the leading cause of preventable death in the U.S. With over 30 percent of U.S. adults obese, the significant adverse health effects of obesity (including heart disease and diabetes) are widespread throughout the country. Two studies published in the Journal of the American Dietetic Association shed light on behaviors regarding food choices and good nutrition, and report on how nutritional labeling and point-of-purchase signs are influencing healthy food choices. Researchers examined to what extent people used the nutritional label on food products and whether that use affected their nutrient intake.

Using a nationally representative sample of U.S. adults who participated in the 2005-2006 National Health and Nutrition Examination Survey (NHANES), the researchers found that 61.6 percent of participants reported using the nutrition facts panel, 51.6 percent used the list of ingredients, 47.2 percent read the serving size, and 43.8 percent reviewed health claims at least sometimes when deciding to purchase a food product. Significant differences in mean nutrient intake of total calories, total fat, saturated fat, cholesterol, sodium, dietary fiber and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total calories and fat and for use of specific nutrient information on the food label.

According to researchers, “If the food label is to have a greater public health impact, rates of use will likely need to be increased among U.S. adults. Low rates of label use also suggest that national campaigns or modification of the food label may be needed to reduce the proportion of the population not using this information. Possible changes to the current label that have been suggested include bolding calorie information, reporting the total nutrient intake for foods likely to be consumed in a single sitting, and using more intuitive labeling that requires less cognitive processing such as a red, yellow and green ‘traffic light’ signs on the front of the label. The food label alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes, but may be used by individuals and nutrition professionals as a valuable and motivating tool in our efforts to combat obesity and diet-related chronic disease.”

A pilot study of a point-of-purchase (POP) program was shown to influence the purchasing behaviors of a multi-ethnic college population shopping at an on-campus convenience store. This 11-week study collected baseline sales data for six weeks during the middle of the Fall 2008 semester. After students returned from winter break, “Eat Smart” program materials featuring the “Fuel Your Life” logo were placed in the on-campus convenience store. Sales data were collected during the middle of the spring 2009 semester for five weeks, ending just before students left for spring break. Healthful items in seven food categories (cereal, bread, soup, cracker, canned vegetable, granola/energy bar and salad dressing) were tagged throughout the market. There was no difference in price between the tagged and untagged items. While no significant difference in sales of any particular food item was observed between baseline and intervention, overall sales of tagged items, as a percentage of total sales in the cereal, soup, and cracker categories, increased as a result of the intervention, while sales of tagged bread items decreased. Though not statistically significant, the intervention resulted in a 3.6 percent increase in the percentage of sales from tagged items.

The researchers state that “This pilot project was the first to use computerized sales data to examine the effect of a POP nutrition information program on the food-buying habits of multi-ethnic college students. Promising results imply that students were influenced by “Fuel Your Life” shelf tags and related materials. Despite several study limitations, the program was successful in increasing the percentage of tagged food items sold relative to other non-tagged items in the same category. Keeping all items in the same category at the same price meant that consumer choice was based on perceived nutritional benefit, not economics. This research indicates that a simple logo helped students identify healthful food choices, and positively influenced food choice. It would be interesting to determine if a combination of POP nutrition information, coupled with economic incentives (e.g. lower prices for healthier foods) would further drive consumers to choose these healthier food items."

To learn more about this research, please visit:

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Knee, Hip Replacement Patients Experience Weight Decrease After Surgery

A Mount Sinai School of Medicine study has found that patients often exhibit a significant decrease in weight and BMI after undergoing knee or hip replacement surgery (arthroplasty). The study is the first of its type to correct for the annual increase in BMI typically found in North Americans between the ages of 29 to 73 years.

A total of 196 Mount Sinai patients who had knee or hip replacement from 2005–2007 to treat osteoarthritis were randomly selected for the study. Mean patient age at surgery was 67.56 years, with about 65 percent female and 35 percent male. Of this group, 19.9 percent demonstrated a clinically significant decrease in weight (defined as the loss of five percent or more of body weight) and BMI following knee or hip replacement. In addition, the mean weight of the group dropped from 79.59 kg (175.47 lbs) to 78.13 kg (172.24 lbs) after surgery. Significant BMI decrease was found to be greater in knee replacement patients (21.5 percent) than hip replacement patients (16.9 percent). Patients who were obese prior to surgery, with BMI greater than 30, were the most likely to experience significant post-surgery weight reductions.

"Total joint arthroplasties are performed with the intent of relieving a patient’s pain and disability," said a study author. "Both total knee patients and total hip patients experienced a statistically significant and clinically significant corrected weight loss following surgery, which indicates a healthier overall lifestyle." The incidence of overweight and obese adults has been steadily increasing over the past five decades in the U.S. Lifestyle modification, consisting of changes in patterns of dietary intake, exercise and other behaviors, is considered the cornerstone of overweight and obesity management. Overweight patients often argue that their osteoarthritis limits their mobility and ability to exercise. Thus, patients may feel frustrated that they are unable to lose weight, and are often hopeful that losing weight would be easier postoperatively.

To learn more about this research, please visit:

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Becoming a Health Coach

With so many companies focusing on wellness and prevention, it's a great time to be a health coach, explains Darcy Hurlbert, health and wellness product specialist for Ceridian Lifeworks. She describes the criteria for pairing a health coach with a client and reviews the importance of a veteran Ceridian health coach in the 100 hours of training delivered to the company's health coaches each year.

To listen to this complimentary HIN podcast, please visit:

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How Dieting Messages Influence Weight Management

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Peggy Crum, registered dietician and nutrition consultant in Michigan State University’s Health4U program.

Question: What is the role of dieting messages and interventions in the obesity population?

Response: I write a publication called Recipe for Health featuring a food and recipe of the month. Rather than focusing on calorie and fat content, the purpose is to teach readers how to find, store and prepare the food and when it is in season. It’s all about how to get food on the table. In another publication, Nutrition Matters E-Message, written for How To Eat program graduates, I report and interpret a current study on a diet-related trend. One recent topic addressed the oft-touted suggestion to use a smaller dish as a strategy to eat smaller portions. The message to use a smaller plate is not helpful. We don’t need to use gimmicks to trick ourselves into eating less. These messages distract you from what your body is telling you. Your body can tell you what and how much to eat.

Schools’ well-intentioned attempts at restricting unhealthy foods are setting children up for disordered eating. It is ill-advised for schools to tell parents what kids can and cannot take to school. I have no problem with taking soda machines out of schools; they never belonged there in the first place. But to set arbitrary rules — telling a child that they cannot have a cookie — is contributing to the good food-bad food dilemma. Rather than criticize the family, school officials need to recognize and support the power of the family in influencing nutrition. There are many benefits to having family meals, including increased nutrient intake.

Treatments for obesity have become more drastic and expensive, yet the population is getting heavier and heavier. At some point, we must recognize that current treatments are not working, and recognize that many accepted dieting interventions and messages are in fact leading to people becoming fatter. The beauty of the eating competence intervention is that it does not make a judgment about weight. The objective is to achieve positive, rewarding, sustainable eating — each person moves along toward the goal at his or her own pace.

For more obesity and weight management benchmarks, please visit:

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Which Conditions Are Targeted by Telehealth?

With many healthcare organizations hotwired for telehealth and telemedicine, we wanted to find out which health conditions or concerns were being targeted by telehealth. See the responses we received from 139 healthcare organizations.

Click here to view the chart.

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2010 Benchmarks in Obesity and Weight Management

This white paper captures the top strategies organizations are implementing to prevent and reduce obesity and related conditions and costs, based on responses from 131 healthcare organizations to the April 2010 Healthcare Intelligence Network Obesity and Weight Management e-survey.

To download this complimentary white paper, please visit:

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Interactive, Personalized Web site Helps People Maintain Weight Loss

The more people used an interactive weight management Web site, the more weight loss they maintained, according to a Kaiser Permanente Center for Health Research study. The National Institutes of Health-funded study evaluated an Internet-based weight maintenance intervention involving 348 participants. Consistent Web site users who logged on and recorded their weight at least once a month for two-and-a-half years maintained the most weight loss, the study found.

This weight maintenance intervention was part of the Weight Loss Maintenance Trial, one of the largest and longest-running weight maintenance trials ever conducted — lasting three years and including more than 1,600 people at four study sites across the U.S. To enroll in the trial, participants had to be overweight or obese based on their BMI and taking medication for high blood pressure or high cholesterol. For the first six months, participants attempted to lose weight by attending weekly group meetings at which they were weighed, encouraged to keep food diaries, and given extensive information about exercise and healthy eating. Participants had to lose at least nine pounds to remain in the trial for the weight loss maintenance phase, which lasted an additional two-and-a-half years and included three groups of randomized participants: those with no intervention, those who had monthly contact with a personal health coach, and those given unlimited access to a weight-maintenance Web site created specifically for the trial.

The Internet group included 348 participants who were encouraged to log in at least once a week. If they didn’t, they received e-mail reminders and follow-up automated phone messages. Once on the Web site, participants were prompted to record their weight, their minutes of exercise and the number of days they kept food diaries. If they went longer than seven days without recording their weight, other parts of the Web site were disabled until the weight was recorded. The Web site included an interactive bulletin board on which participants could talk with others involved in the study and pose questions to nutrition and exercise experts.

During the first six months of the trial, while they were attending group sessions and before they had access to the Web site, participants who ended up in the Internet group had lost an average of 19 pounds. Once they were given Web site access, their objective was to keep off as much of that weight as possible. Consistent users who logged in and recorded their weight at least once a month for 24 months maintained the greatest weight loss — keeping off an average of nine of the 19 pounds they’d lost during the initial phase of the trial. Those who logged on less consistently — at least once a month for 14 months — kept off an average of five pounds. Those who logged on even less kept off an average of only three pounds of their original weight loss. At the end of the study, 65 percent of the participants were still logging on to the Web site. The study authors were encouraged by this level of participation, noting that it is rare to see that kind of commitment — even in shorter-term weight maintenance studies involving the Internet.

While the study Web site is no longer available, there are many useful weight management Web sites that people can access. The study authors advise consumers to look for sites that:

  • Encourage accountability by asking users to consistently record weight, exercise and calories consumed;
  • Offer tailored or personalized information;
  • Have interactive features that allow users to communicate with each other and with nutrition and exercise experts; and
  • Provide accurate health information.
To learn more about this research, please visit:

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Health Coaching in 2010

Health coaching's domain has moved beyond traditional disease management to encompass care transitions coaching, medication adherence, and more. Take HIN's third annual Health Coaching survey to find out how healthcare organizations are implementing health coaching as well as the financial and clinical outcomes that result. Complete the survey by August 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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