July Spotlight: Dual Epidemics: Diabetes and Obesity
Diabetes and obesity have become an alarmingly prevalent combination. Diabetes affects nearly 26 million Americans, which is more than 8% of the population. Moreover, nearly 2 million people aged 20 years and older were newly diagnosed with diabetes in 2010.1 One of the main risk factors for type 2 diabetes is obesity, and during the past 20 years there has been a dramatic increase in obesity in the U.S.. More than one-third of adults (36%) and 17% of children and adolescents aged 2-19 years are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer.2
Type 2 diabetes also affects nearly 20% of Veterans who use the VA healthcare system, or more than one million Veterans at any given time.3 VA is working to decrease the incidence of both diabetes and obesity among Veterans, as well as improving care for Veterans with diabetes who are overweight or obese. VA/HSR&D's Diabetes Quality Enhancement Research Initiative (Diabetes-QUERI) has several studies targeting weight loss in this population, including the following study.
Weight Loss Pilot Study Targets VA's OEF/OIF Veterans
In May 2011, Diabetes-QUERI researchers began enrolling subjects in the "OEF/OIF Veteran Preferences for and Feasibility of Automated Physical Activity Interventions: A Pilot Study" at the VA Ann Arbor Healthcare System. This study assessed three home-based diet and exercise programs that use low-cost, commercially available devices or web-based products to encourage physical activity and promote weight loss. To address the needs and preferences of younger and fitter Veterans who are comfortable using technology, this study examined the value of:
- Enhancing social support with access to online communities;
- Improving self-monitoring with remote, objective physical activity assessment and feedback and;
- Emphasizing high-intensity resistance exercise, as opposed to more traditional moderate intensity aerobic exercise.
Enrolled Veterans were randomized to two of the three interventions for six weeks each, for a total of 12 weeks of participation. Preliminary results suggest that participants were most satisfied with–and lost the most weight (4.4 pounds on average) with the intervention that focused on online social support. The high-intensity resistance exercise had a mixed response; some participants enjoyed the challenge and felt like they were "doing something," while others were intimidated by the intensive regimen. Additionally, the high-intensity caused some minor injuries.
Future Studies: Results from the weight loss pilot are being used to support a proposal for a larger study of a lifestyle change program for OEF/OIF Veterans, and an additional study testing strategies to link Veterans to existing free web-based resources for weight loss, is in the planning stages.