Prescription Thyroid Replacement Does Not Affect Outcomes in an Intensive Weight Reduction Program With the complex role of the thyroid in metabolism and conflicting evidence of weight gain or loss as a result of prescription thyroid hormone replacement (THR), it is important to understand how THR affects weight loss beyond the standard measures of body weight % and body mass index (BMI). We examined differences in body composition improvement in individuals taking and not taking THR over 60 d of an intensive weight loss program. The 20Lighter Program (T20LP), a doctor-supervised weight loss and metabolic health program, included 6 wk of patent-pending very low calorie meal plans and a 3-wk customized transition back to a normal dietary intake. Of 2200 participants completing T20LP by December 31, 2017, ~10% reported taking prescription THR. From initial baseline to 60 d, T20LP participants from both groups showed statistically significant and clinically meaningful reductions in body weight, BMI, % body fat, visceral fat, metabolic age, and increases in % body water. To our knowledge, our study is the first large-scale analysis comparing weight loss outcomes in participants who take THR and participants who do not. Our data show both groups do equally well with respect to % body weight lost, BMI reduction, body fat and visceral fat reduction, and improvement in tissue hydration, and we found no disadvantage in any physiologic or metabolic outcome in weight loss participants on THR. Weight loss participants requiring prescription THR are capable of achieving body composition and metabolic improvements on par with those who do not require prescription THR.

Time to Elevate the Education of Clinical Exercise Physiologists: A Professional Doctorate Model The increasing prevalence of noncommunicable diseases and multimorbidity negatively affects an individual’s quality of life and health trajectory; this trend and resultant personal and clinical outcomes are of significant concern. Healthy living (HL) behaviors (physical activity, dietary modification, smoking cessation, and medication compliance) are known to provide substantial health benefits that slow the progression or in some cases reverse the deleterious effects associated with inactivity and consumption of a diet high in sodium, fat content, added sugars, and energy-dense foods. However, it is becoming increasingly clear that a one-size-fits-all approach to HL interventions in populations at risk for or diagnosed with noncommunicable diseases is inadequate to promote optimization of health outcomes. Practitioners implementing HL interventions, such as clinical exercise physiologists (CEP), must instead understand the complexity or multimorbidity phenotypes and be able to effectively tailor programs for each condition. Although CEP may receive master’s level training in this area, the rise in patients with complex multimorbidity warrants consideration of elevating the professional expectations to better prepare CEP in training to deliver highly effective primary and secondary prevention HL interventions. Many licensed allied health professions (i.e., physical therapy, pharmacy, occupational therapy, nursing, nutrition, etc.) have recognized the call to move toward professional doctoral degree programs to better prepare practitioners within their field. This article proposes a professional doctorate degree program aimed at enhancing the training of CEP to become highly effective practitioners.

Letter to the Editor: Enhancing the Utility and Reporting of Real-World Exercise Programs in Cancer Care No abstract available

Response to Letter to the Editor: Enhancing the Utility and Reporting of Real-World Exercise Programs in Cancer Care No abstract available