Mark S. Nash, Jochen Kressler

Problems posed by obesity-related endocrine diseases embody a national health crisis. Caloric excess and sedentary lifestyle from which they develop also pose significant challenges for rehabilitation providers. Almost 2/3 Americans are currently overweight or obese, a number that has increased by more than 10% within the past decade and is expected to grow. An overweight body habitus is strongly associated with clinical hazards including cardiometabolic syndrome, diabetes hypertension, and coronary artery disease. The component health risks of the cardiometabolic syndrome include coalescing of risk factors that predict a health calamity unless effective interventions can be developed and widely adopted. Obesity by itself is now considered an ADA-qualified disability, but is also disturbingly prevalent in other physical disability groupings of adults and children. This monograph describes successes of the Diabetes Prevention Program (DPP), an NIH multi-site randomized clinical trial that reported significant weight reduction and a 58% decreased incidence of type-2 diabetes accompanying one year of structured lifestyle intervention (LI). This treatment benefit: i) exceeded that of Metformin pharmacotherapy, ii) was so powerful that the trial was closed before reaching endpoints, and iii) was judged cost-effective for the patient and society. The DPP roadmap incorporating physical activity, diet, and behavioral approaches has been widely adapted to specific community, faith, racial, ethnic, school, and national populations with excellent outcomes success. The lockstep physical activity approach, activity prescription, and long-term success of the program are described and compared with other approaches programs to illustrate effective countermeasures for the pandemics of obesity and obesity-related cardioendocrine disease. We will illustrate adaptation of the DPP for a cohort of persons with disability from spinal cord injuries, and the benefits observed.