February 2010 // Volume 48 // Number 1 // Tools of the Trade // 1TOT1
Eat Smart, Move More, Weigh Less: A Weight Management Program for Adults
Eat Smart, Move More, Weigh Less (ESMMWL) is a 19-week weight-management program that is delivered by local educators. Published research data were used to identify strategies that would lead to weight loss and/or weight maintenance. The program uses the Theory of Planned Behavior, informing, empowering, and motivating participants to live mindfully as they make choices about eating and physical activity. The program provides opportunities for participants to keep a journal of healthy eating and physical activity behaviors. ESMMWL is offered at worksites and at other sites for people interested in eating smart, moving more, and achieving a healthy weight.
The issue of overweight and obesity continues to be the most pressing public health problem of our time (Ogden, Carroll, McDowell, Tabak, & Flegal, 2006; Flegal, Graubard, Williamson, & Gail, 2005). An estimated 50% of adults attempt to lose weight or not gain weight each year. However, most people do not follow recommendations for calorie restriction and adequate levels of physical activity (Weiss, Galuska, Khan, & Serdula, 2006).
North Carolina, like many other states, has a plan to prevent overweight, obesity and related chronic diseases (Caldwell et al., 2006). To achieve the goals of the state plan, accessible and affordable, family-based, culturally relevant, interdisciplinary weight management services for adults are needed. Local educators need educational materials that address weight management that are built on accurate content (Lohse & Stotts, 2006). The Eat Smart Move More Weigh Less (ESMMWL) curriculum was created in response to this call for action. The objective of this project was to develop a comprehensive, low-cost weight loss/weight maintenance curriculum for adults that could be widely implemented across the state by trained professionals.
The Eat Smart, Move More, Weigh Less (ESMMWL) weight-management curriculum was created by a team of interagency professionals with expertise in nutrition, physical activity, and behavior change. Published research data were used to identify strategies that would lead to weight loss and/or weight maintenance. These included eating fewer calories; including more fruits, vegetables, and whole grains in meals; eating breakfast regularly; controlling/decreasing portion sizes; eating more meals at home; drinking fewer calorie-containing beverages; keeping a food/physical activity record; increasing physical activity; and watching less television.
The above strategies were used to create 19 ESMMWL lessons (Figure 1). The curriculum is presented in electronic and hard-copy format and includes speaker notes, PowerPoint presentations, evaluation instruments, and marketing materials. ESMMWL uses the Theory of Planned Behavior (Ajzen, 2002). Each lesson 1) discusses a behavior and its importance to the participant's goal of weight loss or weight maintenance; 2) shows how others, including family members, can support the participant in doing the behavior; and 3) provides strategies for adopting the behavior, empowering the participant to attempt the identified behavior.
Additionally, each lesson includes a "family spotlight" describing ways the entire family can adopt the behavior, opportunities for sharing and celebrating success and tips for a guided discussion about the behavior. The curriculum also includes information and strategies to live mindfully, paying attention to the events, activities, and thoughts that make up participants' lives. Participants are asked to eat with awareness, be attentive to how they move, and to do things consciously rather than out of out of habit. Participants are asked to track their mindfulness, physical activity, weight, and the food and beverages consumed in a journal that is provided.
Participants also receive a full-color, 35-page magazine that contains key points from each lesson, recipes, sample physical activity routines and their personal record keeping instrument for each week of the program (Figure 2). The state Cooperative Extension Service produces the ESMMWL magazines and journals to ensure quality and to keep cost low ($3.50 per magazine, $1.00 per journal).
Eat Smart, Move More, Weigh Less Magazine
ESMMWL is delivered in group settings such as faith communities, worksites, civic clubs, or other groups organized specifically for this purpose (e.g., weight loss class at a physician's office). The local provider determines the number of weeks that best fits the group's interests and needs. ESMMWL groups usually meet once a week for 15 to 19 weeks for a 45- to 60-minute educational/motivational program and personal goal assessment. Some include physical activity time. Each participant sets a healthy-weight goal, which may be a steady loss of weight or maintenance of current weight. Weight-loss goals must be in the range of a recommended safe weight loss of 1/2 to 2 pounds per week in keeping with the North Carolina Administrative Code Title 21, Chapter 17, Section .0200, which regulates weight management programs for safety.
A physician-quality, beam-balance scale or high-quality digital scale is placed in an accessible place for the group, with reasonable privacy for weigh-ins. Participant weighs weekly and records their weight in their Personal Record. Blood pressure and waist circumference are measured and recorded at the beginning and end of the program by trained personnel. A program fee is determined locally and is kept to a minimum to encourage participation by a broad population. Costs usually range from $0-$50 for the entire series. Incentives such as receiving a portion of their registration fee back for successful completion, employer approved time off from work, water bottles, t-shirts, or other small give-a-ways have been used to encourage weekly attendance, completion of the program, and working towards weight loss/weight maintenance goals.
Potential program instructors include agents with North Carolina Cooperative Extension (agents) and Health Promotion Coordinators with local health departments (HPC) who attended a required training. The daylong training included in-depth information about weight loss strategies, the Theory of Planned Behavior, and how the ESMMWL program could be implemented in their county. Agents and HPC from the same or nearby communities were encouraged to work together to develop a delivery strategy for ESMMWL for their area.
Experts in the areas of nutrition, physical activity, and weight loss developed ESMMWL. All materials were peer reviewed by a broad group of health and nutrition education professionals at the national, state, and local level. Suggestions from their review were incorporated into the final version of the materials.
The need for a low-cost comprehensive weight management curriculum is evident based on the response to the program thus far. In the first 9 months of the program, local educators offered the program to more than 1,000 participants across North Carolina. Early correspondences with local educators delivering the program indicate that there is a high level of interest in participating in the program and that participants are responding favorably to the content and delivery method. The early interest in the program across the state has prompted additional agencies requesting training in the curriculum for dissemination to an even larger audience. Formal evaluation of the program is ongoing.
Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the Theory of Planned Behavior. Journal of Applied Sociology and Psychology. 32, 665-683.
Caldwell, D., Dunn, C., Keene, A., Kolasa, K., Hardison, A., Lenihan, A., Nelson, S., Reeve, R., Ritzman, R., Sauer, M., Schneider, L., Thomas, C., & Vodicka, S. (2006). Eat Smart, Move More: North Carolina's plan to prevent overweight, obesity, and related chronic disease. Eat Smart Move More Leadership Team.
Flegal, K. M., Graubard, J. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association. 293(15), 1861-1867.
Lohse, B., Stotts, J. L. (2006). Extension education about healthy weight: A case study emphasizes need to find the target audience. Journal of Extension [On-line], 44(5) Article 5COM1. Available at: http://www.joe.org/joe/2006october/comm1.php.
Ogden, C. L., Carroll, M. D., McDowell, M. A., Tabak, C. J., Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association. 295(13), 1549-1555.
Weiss, E. C., Galuska, D. A., Khan, L. K., & Serdula, M. K. (2006). Weight —control practices among U.S. adults, 2001-2002. American Journal of Preventative Medicine. 31(1), 18-24.2.