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Developing a new treatment paradigm for disease prevention and healthy aging

  • Practice and Public Health Policies
  • Published:
Translational Behavioral Medicine

ABSTRACT

An increasingly prevalent pattern of risk factors has emerged in middle-aged and older adults that includes the presence of type 2 diabetes or prediabetes, overweight or obese weight status with central obesity and very high body fat, low cardiorespiratory fitness (CRF), low strength, and a low lean-body-mass-to-body-fat ratio. Traditionally, these problems have been approached with a low-fat and low-calorie diet and with lower to moderate intensity activity such as walking. While the treatment has some clear benefits, this approach may no longer be optimal because it does not reflect more recent findings from nutrition and exercise sciences. Specifically, these fields have gained a greater understanding of the metabolic and functional importance of focusing on reducing body fat and central obesity while maintaining or even increasing lean body mass, a quality weight loss, and how to efficiently and effectively increase CRF and strength. Evidence is presented for shifting the treatment paradigm for disease prevention and healthy aging to include the DASH nutrition pattern but with additional protein, higher intensity, brief aerobic training, effort-based, brief resistance training, and structured physical activity. Recent interventions based on social cognitive theory for initiating and then maintaining health behavior changes show the feasibility and efficacy of the approach we are advocating especially within a multiple health behavior change format and the potential for translating the new treatment paradigm into practice.

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Acknowledgments

This paper’s development and recent work cited was supported by a grant from the National Institute of Diabetes, Digestive, and Kidney Diseases (R01DK082383-01A1, NCT01112709), a grant from the National Cancer Institute (R01 CA106250-01A1, NCT00128570), and previous funding from the National Cancer Institute (R01CA79469 ) and Virginia Tech’s ASPIRES program. We acknowledge the contributions of Sarah Kelleher, Kyle Flack, Mary Elizabeth Baugh, John Pownall, Nabal Boutagy, Adrienne Clark, David Williams, Soheir Boshra to the NIDDK project, Ashley Dorough to the DASH project, and Eileen Anderson-Bill to the NCI projects.

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Authors and Affiliations

  1. Psychology Department, Virginia Tech, Blacksburg, VA, 24061, USA

    Richard A Winett PhD

  2. Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA

    Brenda M Davy PhD & Elaina Marinik PhD

  3. Human Development, Virginia Tech, Blacksburg, VA, 24061, USA

    Jyoti Savla PhD

  4. Personal Computer Resources, Inc., Blacksburg, VA, 24060, USA

    Sheila G Winett MS

  5. Kinesiology Department, McMaster University, Hamilton, Ontario, L8S 4 K1, Canada

    Stuart M Phillips PhD

  6. Psychology Department, East Carolina University, Greenville, NC, 27858, USA

    Lesley D Lutes PhD

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  1. Richard A Winett PhD
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  2. Brenda M Davy PhD
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  3. Elaina Marinik PhD
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  4. Jyoti Savla PhD
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  5. Sheila G Winett MS
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  6. Stuart M Phillips PhD
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  7. Lesley D Lutes PhD
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Correspondence to Richard A Winett PhD.

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Implications

Practice: Treatment needs to reflect both the high prevalence of a multiple risk pattern and recent findings from nutrition and exercise sciences that point to a different set of intervention components delivered in different modalities and representing a new paradigm for disease prevention and healthy aging.

Policy: The high prevalence of a pattern of multiple risk factors foretells considerable individual and societal burden unless new approaches reflecting advances in psychological, nutrition, and exercise sciences and demonstrating long-term maintenance of behavior changes that can be attractive to health care insurers are translated into practice.

Research: Research within a new treatment paradigm needs to focus on improvement of components of multiple health behavior change interventions and especially on their overall feasibility and strategies for their translation into practice.

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Winett, R.A., Davy, B.M., Marinik, E. et al. Developing a new treatment paradigm for disease prevention and healthy aging. Behav. Med. Pract. Policy Res. 4, 117–123 (2014). https://doi.org/10.1007/s13142-013-0225-0

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