TITLE: A PHYSICIAN EXTENSION MODEL FORDIABETES/OBESITY TREATMENT (DOTM)

AUTHOR(S): G. Loredo, RD, CDE; S. St. Jeor, PhD, RD; R.Plodkowski, MD; Division of Medical Nutrition, Department of InternalMedicine, University of Nevada School of Medicine, Reno, NV

LEARNING OUTCOME: To develop and evaluate a teaching/training module that can be effectively implemented in physician-based practices.

TEXT: The prevalence of diabetes in the United States has increasedsignificantly and it has been estimated that nearly 90% of individualswith type 2 diabetes are overweight or obese. Therefore, strategiesare needed to encourage physicians to incorporate weightmanagement for their patients with diabetes into their generalpractice. Thus, a Diabetes/Obesity Treatment Module (DOTM) wasdeveloped to extend physician time and to support their primary careteams to comprehensively manage obese patients with diabetes. Themodule consists of a 4 hour CME program for physicians and alliedhealth professionals, a hands-on workshop, certification forassessment measures for their office staff and resource materials forimplementation of the counseling and weigh in sessions. The modulesalso include an optional assessment and treatment plan for “at risk”family members of the patient. This encourages the family to worktogether in developing healthy eating habits and promoting increasesin physical activity. The DOTM module encourages physician-basedoffices to integrate obesity treatment and prevention into theirdiabetes management practices. Improved patient outcomes can beanticipated by implementing practical methods to help physiciansextend their time through the training of their office personnel andinfluence their patients to become active participants in the careprocess.

FUNDING DISCLOSURE: Joint project with Nevada DiabetesPrevention and Control Program, funded by Centers for DiseaseControl and Prevention

TITLE: AN INNOVATIVE POPULATION APPROACH TO ADDRESSOVERWEIGHT AND OBESITY IN THE VETERANS HEALTHADMINISTRATION: A NATIONAL INITIATIVE

AUTHOR(S): V.E. Zele, MS, RD, LDN; R.T. Harvey, PhD; S.J. Yevich,MD, MPH; L. Kinsinger, MD, MPH; M.A. Burdick, PhD, RN; K.A.Straits-Troster, PhD; Veterans Administration National Center forHealth Promotion and Disease Prevention, NC

LEARNING OUTCOME: The participants will be able to describe aweight management initiative for the Veterans Health Administration,including treatment levels and rationale for the multidisciplinaryprimary care approach.

TEXT: The Veterans Administration National Center for HealthPromotion and Disease Prevention (NCP), in response to the obesityepidemic, developed a comprehensive, evidence-based, multidisciplinary,multi-level treatment plan addressing overweight (BMI 25-30) andobesity (BMI�30) in the veteran population. Annual estimated total costsof obesity in the United States are up to 100 million dollars, includingmedical costs and lost productivity. An estimated 68% of the female and73% of the male veteran population are overweight or obese, higher thanthe general US adult population rates of 62% for women and 67% formen. The MOVE! (Managing Overweight/Obesity for VeteransEverywhere!) initiative, designed for national implementation throughoutthe Veterans Health Administration, will be available in 162 hospitalsand more than 1000 community based outpatient clinics, affecting over 6million veterans. There are 5 levels of treatment. Level 1 includes acomputerized patient assessment and individualized personal reportdeveloped by NCP specifically for veterans, using tailored handouts, goalsetting, and frequent follow-up. Level 2 incorporates group sessions andindividual consultation for behavior modification, nutrition, and physicalactivity. Level 3 adds weight loss medications to Levels 1 or 2. Level 4involves brief residential treatment with intensive therapy and classes;and Level 5 is bariatric surgery. A six-month, 17-site feasibility trial isunderway to pilot implementation in the primary care clinic settingincorporating the first two MOVE! treatment levels with 1000 subjects.MOVE! has the potential to positively impact quality of life and healthoutcomes for millions of veterans.

FUNDING DISCLOSURE: The initiative was supported in part by anunrestricted grant from Roche Pharmaceuticals, Inc.

TITLE: BREAKFAST TYPE INFLUENCES WEIGHT AND BODYCOMPOSITION IN POSTMENOPAUSAL WOMEN

AUTHOR(S): L.J.H. Cerundolo, MS; R.A. Brownbill, MS, RD; J.Z.Ilich, PhD, RD; University of Connecticut, School of Allied Health,Storrs, CT

LEARNING OUTCOME: To identify the relationship of breakfasttype on body weight and composition in postmenopausal women.

TEXT: Some studies have shown eating breakfast influences weight andbody composition. Limited data exist regarding the relationship ofbreakfast type and the above parameters. This study investigated therelationship between breakfast type and body composition in over 60healthy, Caucasian, postmenopausal women (mean age 68 years atenrollment) in a 3-year study. Anthropometries (height, weight, BMI),body composition (fat, lean tissue by DEXA), total activity score, and 3-daydietary records were taken at baseline and every 6 months and thecumulative averages for each variable were calculated. The diet recordswere analyzed by Food Processor� for energy, alcohol and all othernutrients. Most of the subjects consumed either hot or cold cereals with/without fruits, and just a few consumed only fruits/vegetables/juices, eggs/bacon/dairy or muffins/danish/sweets. There were no skippers. Therefore,for further analyses, breakfast types were categorized in 2 groups: sugaryhot/cold cereals with/without fruits (n�18) and non-sugary hot/cold cerealswith/without fruits (n�42). ANCOVA, adjusted for age, height, activity,energy, and alcohol intake, was utilized to examine differences in weight,BMI, fat, and lean tissue with respect to 2 breakfast categories. ANCOVArevealed significantly higher weight (68.0 vs. 63.9kg), BMI (26.7 vs.25.0kg/m2), and fat (27.0 vs. 23.6kg), p�0.05 in subjects consuming sugarycompared to subjects consuming non-sugary cereals, and no difference inlean tissue. Based on our data, breakfast type was a significant predictorfor weight, BMI, and body fat, with non-sugary cereals having beneficialinfluence. However, our data are limited, since only 2 breakfast typeswere considered. More research with more varieties in breakfast choices iswarranted.

FUNDING DISCLOSURE: NRI/USDA 2001-00836, DonaghueMedical Research Foundation DF98-056, Mission Pharmacal�, andUniversity of Connecticut

TITLE: EVERY BODY’S DIFFERENT: A CONFERENCE ON NEWAPPROACHES TO HEALTH FOR CHILDREN AND ADOLESCENTSOF ALL SIZES

AUTHOR(S): J. Hill, MS, RD; E. D’Urso-Fischer, MS, RD; L.McDonald, LD; D. Weinstein, MNS, RD; J. Kaiser-Froehlke, MNS, RD;V. Burr, MS, RD; The University of Chicago, IL

LEARNING OUTCOME: To identify the rationale for a new paradigmHealth at Every Size and incorporate it into effective practice workingwith children and families on issues concerning weight and disorderedeating.

TEXT: According to a Community Health survey done in Chicago, fortyto fifty percent of children from communities of color are consideredoverweight and/or at risk for obesity. At the same time, few treatmentand medical interventions that target weight loss as an outcome havehad successful long-term results. Many practitioners have abandonedtreatment and turned their efforts only towards prevention,surrendering thousands of children to a lifetime risk of nutrition relateddiseases. A conference was convened in Chicago to take up a newparadigm of health at every size. This approach is characterized byintuitive eating, helping people identify and honor cues of hunger andfullness. An appreciation and understanding of natural body shape, theenjoyment of food and movement, rather than restrictive eating andpunitive exercise is emphasized. In addition to identifying majorcomponents of the approach, presenters identified research studies thatsupport this and other non-dieting interventions as a way to help peopleincrease physical activity and reach their natural body size. Personaland social attitudes were identified that contribute to fat-phobia andnegative body image. Participants experienced a variety of activitiesthat demonstrated how to introduce normalized eating, enjoyment ofmovement and size acceptance to children and families. There was anemphasis on helping clients recognize cultural influences affectingattitudes towards body size, food and activity, to address inappropriatedieting, body shape preoccupation and eating disorders, particularly inteens. An evaluation form rated each section of the program.Participants were particularly welcoming of applicable patient focusedmaterials.

FUNDING DISCLOSURE: Dominick’s Children’s Foundation

SUNDAY, OCTOBER 3

POSTER SESSION: NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY

Journal of THE AMERICAN DIETETIC ASSOCIATION / A-23