The November issue of the Journal of the American Dietetic Association features a commentary by James O. Hill, an honorary ADA member, professor of pediatrics and medicine and director of the Center for Human Nutrition at the University of Colorado-Denver. He is also co-founder of America on the Move, a national weight gain prevention initiative that aims to inspire Americans to make small changes in how much they eat and how much they move to prevent weight gain.

This special commentary, providing health-care professionals with insights into obesity and ways to effectively treat and prevent it, is available to subscribers and non-subscribers of the Journal.

The term "energy gap" was developed to estimate the degree of change in the energy balance point required for success in achieving weight loss, gain or management. The energy gap concept is especially relevant when addressing prevention of excessive weight gain and maintenance of weight loss.

"With the exception of bariatric surgery, there has not been a great deal of success in helping people maintain substantial weight losses," Hill writes. "Many people can achieve significant weight losses with our current interventions, but very little of this weight loss seems be maintained by most people over the long term. The energy gap can help estimate the degree of behavior change that must be maintained to maintain a given amount of weight loss for any individual."

The commentary also points out the effectiveness of small behavior changes in preventing further weight gain in those who are already overweight or obese or preventing people from becoming overweight or obese. Evidence suggests that small changes, such as eating 100 less calories per day, are easy to achieve and sustain for most people.

"[While] restoring normal body weights among those already obese would likely require more dramatic intervention, including pharmacological and surgical treatment," Hill writes, "a small-changes approach must be included in public health strategies and public policies to address obesity."