Weight-loss ideas that work

GREENVILLE -- Last of five parts

There is no shortage of solutions to solve obesity.

Asked by The News & Observer to share their weight-loss success stories, people across North Carolina swore by Weight Watchers or Jenny Craig diet programs, $162-a-month fat-busting elixirs, gym memberships, inexpensive walking regimens, $10,000 gastric bypass surgeries, "The Biggest Loser" television show, avoidance of sweets and snacks, weeks at a residential weight-loss clinic, workplace health challenges.

All have worked.

Yet 65.2 percent of North Carolinians remain obese or overweight, a percentage that has only worsened since the 1970s.

More troubling, people are growing fatter at an earlier age. Researchers at UNC-Chapel Hill reported this past fall that obese teens not only stay obese, but also pack on an average 80 more pounds to become severely obese adults, foretelling an onslaught of diabetes, heart disease, arthritis, cancer and other ailments in younger adults instead of seniors.

Barry Popkin, an author of that study and a national leader of a push to tax sugared drinks, said the issue goes beyond personal responsibility and must be tackled with major public policy changes.

The United States, he said, "talks the most and does the least" toward making changes.

For example, a broad consensus exists among health leaders that sugar consumption should be scaled back, said Popkin, a professor of nutrition at UNC Gillings School of Global Public Health. But powerful beverage manufacturers and sugar producers have worked to kill efforts to tax sugary drinks. He contends higher prices for sodas and fruit drinks would make them less appealing, much like tax hikes on cigarettes can prompt people to quit smoking.

And it's not just that high-calorie foods are cheap and abundant. Other subtle influences have diminished physical activity. Over the decades, schools quit offering daily physical education, towns built neighborhoods without sidewalks and desk jobs increasingly replaced manufacturing and physical labor.

Our culture is "obesogenic," meaning it's as good at creating obesity as Angelina Jolie is at making pretty photographs. Big changes are needed, health leaders say.

"We have had diets for years - I think the Romans had diet books," joked Mark Dessauer, communications director with Active Living by Design in Chapel Hill. The program, affiliated with the UNC Gillings School of Global Public Health, last year funded $33 million in grants for sidewalks, garden projects, greenways and other infrastructure changes throughout the United States aimed at encouraging physical activity and health.

"When people say we need to eat right and exercise more, this is not a lightning bolt - 'Oh my gosh! What were we thinking?'" Dessauer said. "But we've created systems where the unhealthy choice is the easy choice, and solving the problem is not going to be done with one standard solution, nor overnight. We have to see change on the community level."

Where people live

When it comes to fighting obesity, the interventions that work best tend to arise from an intimate understanding of the people they're targeting.

That's how Tim Hardison, a middle school science teacher in Eastern North Carolina, became a leading warrior in the obesity battle.

Hardison, whose easy drawl announces his Martin County roots, was appalled that obesity rates in his community were among the state's highest. So five years ago he quietly began teaching his seventh-graders about the body mass index and how to read food labels, while encouraging them to exercise.

A funny thing happened.

"I lost 12 pounds!" exclaimed former student Kabrina Woolard, who is now in 11th grade and helps manage her high school football team.

She wasn't alone. Lots of kids lost weight - 42 percent went from overweight to normal during the school year. Many saw their blood pressure and other health measures improve long term. Some actually posted higher math scores on end-of-year exams, a finding that has been noted in other studies as health leaders have argued for more school-based physical education.

The assertion is simple: As bodies improve, minds improve.

"But I couldn't get anyone to listen to me," Hardison said.

He became frustrated that the federal government invested millions of dollars in a multistate intervention in middle schools that has produced mixed results, while his effort had great effect using $50 donations from area civic clubs and whatever he could spare from his own paycheck.

Now backed by scientists at East Carolina University, his MATCH program has won grants from the Blue Cross and Blue Shield of North Carolina Foundation. Last fall, the program received a $100,000 check as part of the foundation's anniversary.

"They're showing so much promise with the outcomes they're achieving," said Kathy Higgins, president of the BCBSNC Foundation. "We hope they can elevate their work in a way that can be a model for all of North Carolina and at the national level."

Hardison's initial success has been repeated as his program spreads to more of the state's eastern counties, where obesity and the illnesses it causes are more prevalent than in most other places in North Carolina.

He theorizes that his intervention works because of his intrinsic knowledge of the communities he serves - his kids, his school, his county, his region.

"We've got too many programs developed by people on the outside who don't understand our priorities," Hardison said.

Targeting teens

Tailoring programs to unique populations or individuals speaks to the complexity of solving the obesity problem.

Efforts aimed at young people are among the most urgently needed, offering hope along with a hint of desperation.

That's because once the weight is on, it's hard to take off and harder still to keep off - as anyone who has tried can attest.

"There are huge environmental pressures that make it difficult to keep the weight off," said Dr. Laura Svetkey, director of clinical research at the Sarah W. Stedman Nutrition and Metabolism Center at Duke. "We've done a bunch of research on how to help people make lifestyle changes to achieve and sustain weight loss in a healthy way, and there's really excellent data that weight loss can prevent the development of further disease."

Svetkey said intervening early, before bad habits become ingrained, has become a state and national priority. The National Institutes of Health, the government's primary source of medical research dollars, will dedicate an estimated $784 million to obesity studies this year, much of it aimed at young people.

Two projects in the Triangle are getting under way: one at Duke and one at UNC-CH, both seeking ways to incorporate cell phones and other new media into diet and exercise interventions for young adults.

"It's challenging to think how to approach prevention in this age group," Svetkey said, noting that people gain the most weight between the ages of 18 and 34, when their lifestyles change with new jobs, families and priorities.

Finding the right tools and the right way to communicate with people is key.

Svetkey's team will try using cell phones, enlisting 300 young people in the Triangle.

Participants will be given Android phones specially equipped with a highly interactive application, developed at Massachusetts Institute of Technology. The phones will connect the participants with one another and with researchers, transmit data such as weight or food consumption and send reminders, pep talks and other messages. If someone is going to a party and doesn't want to stray off a diet, for example, the phone might send a text message offering words of encouragement.

"Kooky, corny stuff might be helpful," Svetkey said. "We're getting input from people in this age group - do they want this? Would that be annoying or helpful? We're in the process of building this programming to be fun and engaging, and have it not be irritating."

Social media motivation

Similar efforts are under way at UNC-Chapel Hill. Deborah Tate, an associate professor of nutrition at UNC Gillings School of Global Public Health, specializes in using technology and media in weight-loss programs. She has employed podcasts, Twitter messages, Internet tutorials, chat groups, video games. All help keep people motivated.

Shane Hudson, a participant in Tate's current study - called PODS-II, an acronym for Pounds Off Digitally II - said the social media applications, especially Twitter, have been helpful in his efforts to lose weight. If, for example, he's having lunch at a Mexican restaurant, he can Tweet his fellow dieters for advice on menu selections that fall within his caloric range.

"It's immediate and real and gives you moral support," said Hudson, who lost 70 pounds last year.

A 35-year-old professional fundraiser from Durham, Hudson said the ongoing exchanges on his iPhone demand he be accountable to his dieting friends at all times.

"Regardless of what kind of hand you've been dealt, we're trying to set up in your own social environment and support the changes you're trying to make," Tate said, adding that keeping young people from gaining weight in the first place could keep them on a healthy track for the remainder of their lives.

"It's a toxic environment we live in," Tate said. "If we don't pay close attention to what's happening every day, these small gains are going to occur."