Cities try to cut the fat with weight-loss programs

Ten pounds can seem like a hundred when you're trying to lose weight.

So just think how Oklahoma City residents must feel. They're looking to lose a million.

Across the country, mayors have been urging their citizens to downsize themselves. The goal in Philadelphia: Drop 76 tons of rotundity in 76 days. (Didn't happen.) In Louisville, Ky.: Pare off 100,000 pounds of pudge over a summer. (Didn't happen.) In Corpus Christi, Texas: Dispose of 50,000 pounds of avoirdupois in a year. (Could happen: This campaign is just getting started.)

Scientists who study obesity and weight loss generally agree that such challenges can work — can even work wonders — for particular individuals. But some are less convinced that they're the best way to achieve large-scale weight reduction.

The programs, they say, may need to be more focused, and participants may need more tools to succeed. And, as with any weight-loss effort, there's always the worry that people who do lose weight will gain it right back.

"I think these programs are well-intended," says James Hill, Anschutz professor of health and wellness at the University of Colorado in Denver, "but a little misguided."

Citywide weight-loss initiatives continue to proliferate. If the past is any clue, the challenges are likely to generate some real enthusiasm, some good publicity and some decidedly mixed results.

One thing diet challenges can do — and do well — is catch people's attention, says Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. "For some people, the contest will help motivate them to at least start thinking about losing weight."

Indeed, Oklahoma City Mayor Mick Cornett says he challenged his community to lose a million pounds in 2008 "as kind of a trick, to get people talking about it." And judging by his interactions with people on the street, he believes it has worked: "I'd say 80% to 90% are aware of the program." As it enters its fourth year, the running tally on the "This City Is Going on a Diet" website (http://www.thiscityisgoingonadiet.com) stands at nearly 45,000 participants.

About 26,000 people signed on for Philadelphia's "76 Tons of Fun" challenge in 2001, one of the earliest big-city weight loss efforts. On the other hand, last year's "Lose It, Louisville" aimed to attract 10,000 participants but did not come close.

Campaigns generally don't tell people to go on a diet and then abandon them to their own devices. They usually use advice-laden websites, newsletters, nutrition workshops, etc. to try to inspire the masses to become less massive.

So how well do these well-meaning efforts do?

The relatively small Tucson Challenge, which ran for a few months each year from 2003 through 2006, was centered on classes in dieting strategies that had proved successful in clinical trials: eating well, being active, understanding the mind/body connection and cultivating social support. Participants in that effort lost 3,500 pounds in the first three years of the program, for an average loss of 6 to 10 pounds per person.

In Oklahoma City, the general populace is not a million pounds lighter — not yet — but the running tally on the website suggests that they're nearly two-thirds of the way there.

But in general, it's slim pickings if you're looking for hard and fast statistics on the results of citywide diets. So it's difficult to say exactly how successful they are. (The mayors during the campaigns in Philadelphia and Louisville — John Street and Jerry Abramson, respectively — declined to say anything at all about the ones they ran.)

Some people, at least, do respond well to diet campaigns. One participant in the "Lose It, Louisville" campaign shed 53 pounds in the first three months. The "biggest loser" in Philadelphia scaled herself back by 81 pounds. Multiple Oklahoma Citians have recorded decreases of 100 pounds or more.

And there are ways to grow the number of people who manage to shrink themselves during such efforts, experts believe.

Brownell says it's crucial that cities make it easier for people to lose weight — perhaps by changing zoning laws to keep out fast-food restaurants, improving nutritional options for kids in school, levying a tax on sugared beverages or building more walking and biking paths. (Some cities have included such measures in their flab-fighting campaigns: Oklahoma City has built 400 miles of sidewalks and more than 100 miles of bike trails, for example.)

Every campaign should have a scientific advisory board, adds Susan Roberts, a senior scientist in the School of Medicine at Tufts University. "Programs will only be successful to the extent that the recommended strategies actually are proven to work. Otherwise, it is worse than useless because it makes people feel like they can't lose weight."

Community restaurants can also contribute to the project, Roberts believes. "Whatever else you do, restaurants providing reasonable amounts of food — and not two to three times what people need — has to be part of the fix."

In Oklahoma City, Cornett agreed to endorse Taco Bell's Fresco Menu, which offers items with reduced fat and calories. Brownell considers such endorsements risky. "Just putting a few healthy items on a menu doesn't excuse other things on the menu." And in any case — alack and alas — restaurants can't lose weight for you, and no one else can either.

But research suggests that you're more apt to shed heft if you get support and encouragement from others. In the Tucson Challenge, for example, participants who signed up as teams lost 7.5 pounds on average over a three-month session, while those who joined as individuals lost less than half that much.

And, of course, joining a weight-loss team has benefits that are hard to measure. "People often set out to lose weight only to discover that the real 'win' is the camaraderie," says Lauve Metcalfe, director of the Tucson Challenge and an associate director of the University of Arizona College of Medicine in Tucson.

"The idea that you're not alone is very, very important," adds Oklahoma City's Mayor Cornett, who admits to a rather extensive dieting history stemming from an irrepressible passion for desserts. "Our website serves as a sort of support group."

Amy Petty, who has lost 190 pounds while participating in the Oklahoma City diet, says she used to go to the website every day. After all her success, Petty doesn't need so much support herself these days but says, "I'm excited to try to inspire other people. The mayor put the city on a diet. Now I'm trying to put my workplace on a diet."

She may be on to something. Weight-loss campaigns are often conducted in offices (including Dunder Mifflin on the TV show "The Office"), as well as in gyms and clubs and on teams. Smaller groups like these may actually have an advantage over cities because they're more focused, Roberts says. Citywide campaigns should definitely be tried, she says, and she hopes they'll be successful. "But if not, it may mean we need to rethink what kinds of communities would be effective."

Weight loss is one thing. But what about keeping it off? "The hardest thing about losing weight is sticking with it," says Ron Duperroir, the executive director of Clarity Healthcare Alliance, which is organizing the new Journey to Health diet challenge for Corpus Christi. He's working on ideas to keep people interested over time — such as awarding monthly prizes to individuals and groups who have lost the most weight.

Knowing that weight can come back is one more factor making it hard to judge the success of citywide challenges. Hill has his doubts that most participants sustain their losses over time. If they do, "I'd be shocked," he says. "We can't do it in our programs, and we spend a lot of effort on it."

He would like to see a first-do-no-harm approach to citywide campaigns. Instead of trying to get people to lose weight, he'd prefer campaigns to try to get people to stop gaining. People's weight tends to creep up 1 or 2 pounds a year, but they can prevent that by making fairly small behavior changes.

For most people, walking 15 minutes and giving up one soda a day will do it, Hill says. And it's easier to keep doing those little things day in and day out than to keep doing the much bigger ones it takes to lose weight.

The Tucson Challenge encouraged weight loss, but only through the stick-to-it-able sort of lifestyle changes that Hill favors. The original plan was to weigh participants from year to year to see if they had maintained their weight loss. But even in this relatively small and focused campaign, not enough participants returned each year to make follow-up possible.

"We have to figure out how to sustain it," says Timothy Lohman, professor emeritus at the University of Arizona College of Medicine in Tucson and one of the challenge organizers. "We don't need to give up at all, but we do need some new ideas."

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