A good strategy
is important to help you lose weight and keep it off. A healthcare
professional can help you plan out an appropriate strategy for
you to determine how much weight to lose and how to lose it.
A recently concluded clinical trial, the Diabetes
Prevention Program, revealed how powerful lifestyle interventions
can be in delaying the onset of type 2 diabetes.
Achieving Weight Loss
The National Weight
Control Registry (NWCR) is a database of people who have
self-reported a weight loss of 30 pounds or more and kept
it off for at least a year. NWCR participants have chosen
to share information about their weight loss and weight maintenance
efforts. NWCR data is not a comparison study of populations
that have successfully and unsuccessfully lost weight and
kept it off, rather a report of successful attempts.
Participants were asked questions about how they achieved
their weight loss, and the researchers who maintain the NWCR
found that:
- 89 percent changed their diets and increased physical
activity (10 percent used diet modification only and one
percent used activity only).
- 55 percent used a formal program (like Weight Watchers)
or professional assistance (dietitian, psychologist, etc.).
- 87.6 percent limited some type or class of food (especially
high-fat and high-calorie foods).
- 44.2 percent limited the quantities of food they ate.
- 43.7 percent counted calories.
- 92 percent exercised at home, 40.3 percent exercised regularly
with a friend, and 31.3 percent exercised regularly with
a group.
- Walking was the most common activity reported.
- 77 percent said a medical or emotional event triggered
weight loss.
- 42.7 percent described losing weight as hard, 31.4 percent
as moderately hard, and 25.7 percent as easy.
- Two-thirds were overweight as children (about 46 percent
indicated that they became overweight at age 11 years or
younger and 25.3 percent at 12 to 18 years).
- 46 percent had one biological parent who was overweight,
and 26.8 percent indicated that both biological parents
overweight.
- 91 percent had tried to lose weight before.
Comparing successful weight loss attempts to previous ones,
NWCR researchers found that:
- 81.3 percent used more exercise.
- 63 percent used a stricter dietary approach.
- As a result of weight loss, 85 percent reported improvements
in physical health, quality of life, energy level, physical
mobility, general mood and self-confidence.
How Much Weight Should You Lose?
Assess Your Risk
You can do a self-assessment like the AOA's Weight
Wellness Profile. The profile takes into account your
weight (Body Mass Index (BMI) and waist size), lifestyle pattern
(exercise, diet and smoking habits), and medical history.
If you find yourself at risk for obesity and its related medical
conditions, bring the results to a healthcare professional
who can help you plan a treatment strategy.
Before beginning any kind of weight loss program, you should
meet with your doctor who can assess your condition and determine
what kind of weight loss program is appropriate for you. If
you don't have a doctor, check the AOA Provider Directory. The American Society of Bariatric
Physicians can also help you Locate
a Physician.
Reachable Goals
Leading experts in obesity now recommend that individuals
try to lose five to 10 percent of body weight. If you are
overweight, losing five to 10 percent of body weight and keeping
it off is a realistic goal. It helps to reduce your risk for
disease and improves high blood pressure and high blood cholesterol.
Once you reach this goal, you can determine if you need to
lose more weight and set new goals.
Read The Partnership for Healthy Weight Management's brochure,
Setting
Goals for Weight Loss.
Gradually reducing weight by losing one to two pounds per
week is a safe and healthy strategy and may help you keep
the weight off for the long-term. A combination of cutting
back on the number of calories you eat and increasing exercise
can help you achieve a one to two pound per week goal. In
general, reducing 500 calories per day results in a 1 pound
per week weight loss, and 1000 calories per day, a 2 pound
per week reduction.
If you are obese or have serious health problems associated
with obesity, you may need a more aggressive approach. In
such cases, a doctor's supervision is necessary for safety
and effectiveness.
What Treatments are Available?
There are several different types of effective treatment
options including: dietary therapy, physical activity, behavior
therapy, drug therapy, combined therapy and surgery. Health
professionals that can assist in determining the most appropriate
treatment for you include: physicians, nutritionists, exercise
physiologists, psychologists and bariatric surgeons.
Dietary Therapy
Dietary therapy involves reducing the number of calories
you eat and learning strategies like how to read nutrition
labels and select portion sizes, which types of foods to buy,
and how to prepare them.
1) How Much Should You Eat?
Knowing how many calories you eat will help you determine
the amount to reduce from your current intake.
Keeping a food diary is a good starting point to determine
what you eat and drink, and to calculate the total calories
for an average day. Some resources on the Internet to help
you do this include:
a) Low and Very-Low Calorie Diets
These diets are designed for individuals whose health would
benefit from rapid weight loss. Supervision by a healthcare
professional is recommended when calorie intake is below 1000
calories per day. Some side effects such as nutritional deficiencies
may occur.
- Low-calorie diets are about 800 to 1,400 calories per
day. If you have a BMI of 27 or more, or a BMI of 25 or
more with co-morbid conditions, this diet may be appropriate
for you.
- Very-Low calorie diets are less than 800 calories per
day. If you have a BMI of 30 or more, or a BMI of 27 or
more with co-morbid conditions, this diet may be appropriate
for you.
- Read the National Institute for Diabetes and Digestive
and Kidney Diseases' Weight-control Information Network's
pamphlet on Very-Low
Calorie Diets.
b) Consult your doctor, dietitian or join a reputable program
for help on determining how many calories to reduce. They
can follow your progress, and help you make changes as needed.
- To find a dietitian or program in your area, the American
Dietetic Association can help you Find
a Dietitian.
2) What Should You Eat?
Reducing calories involves making sure to balance your
diet with a variety of foods. The USDA's Dietary
Guidelines for Americans recommends at least five
servings a day of fruits and vegetables, choosing whole
grains, lean meat and low-fat or non-fat dairy products.
Use the following resources to find out more about planing
a healthy diet:
a) Understanding the Food Guide Pyramid and Reading Nutrition
Labels:
- The USDA Food
Guide Pyramid serves as a guide on daily nutrition,
and is based on the Dietary Guidelines for Americans.
- The Nutrition
Facts Panel, developed by the Food and Drug Administration
(FDA), provides information about calories, portions (servings)
and nutrients of packaged food and beverage products.
b) Recipes and Menus:
c) Food Composition:
d) Restaurants and Eating Out:
e) Fad Diets
Physical Activity
Americans are less active today than ever before, which contributes
to the high rate of overweight and obesity. One reason for
the increase of inactivity is that our environment offers
many more conveniences than ever before, such as elevators
and escalators and remote controls. There are also more people
driving cars instead of walking, and a decrease of manual
labor in the workforce.
Daily activity (exercise or lifestyle) is important for weight
loss, maintenance of weight loss and general good health.
The U.S. Surgeon General recommends moderate physical activity
on most days of the week of at least 30 minutes per day for
adults and 60 minutes per day for children. However, this
level is not necessarily sufficient for weight loss.
- Read the Surgeon General's Report
on Physical Activity and Health.
- If you are obese or severely obese, you may find it difficult
to begin an exercise program. You may find it intimidating
or too strenuous. The Weight-control Information Network's
pamphlet, Active
at Any Size offers tips to help you get started.
Tips to making physical activity a daily routine:
- Let your doctor know if you are starting a new or strenuous
exercise routine to make sure that it's safe for you.
- Begin your routine slowly. Gradually increase intensity.
- Select exercise activities that you enjoy and that can
be scheduled into a regular routine.
- Add lifestyle activity every chance you get, like taking
stairs instead of using elevators or parking farther away
from a store entrance than you normally do.
1) Calories In / Calories Out: What is Basal Metabolic Rate?
Basal Metabolic Rate (BMR) is the amount of energy (calories)
that you need to live in a state of rest (completely without
any type of activity). Getting an estimate of your BMR and
adding it to the calories you use from exercise and daily
activities can give you an idea of the total number of calories
you expend in a day. This is sometimes known as "Calories
Out." Knowing this can help you determine if you are keeping
a balance with your "Calories In," which is the amount of
calories you eat and drink.
- Find out more about BMR and find a BMR
calculator at Cornell University's Sports Nutrition
website. Note: There are several formulas for calculating
BMR. Results should be taken as a range of plus (+) or minus
(-) 10 percent.
- Use the physical
activity calculator on the National Association for
Health and Fitness website to find out how many calories
you would expend for various activities.
- Use the National Heart, Lung and Blood Institute's Daily
Food and Activity Diary to estimate your "calories in"
and to log your "calories out" from exercise.
Behavior Therapy
Behavior therapy involves changing diet and physical activity
patterns to new behaviors that promote weight control.
Behavioral therapy strategies for weight loss and maintenance
include:
- Recording diet and exercise patterns in a diary.
- Identifying high-risk situations (such as having high-calorie
foods in the house), and consciously avoiding them.
- Rewarding specific actions, such as exercising for a longer
time or eating less of a certain type of food.
- Changing unrealistic goals and false beliefs about weight
loss and body image to realistic and positive ones.
- Developing a social support network (family, friends or
colleagues) or joining a support group that can encourage
weight loss in a positive and motivating manner.
For more information, read the National Heart, Lung and
Blood Institute's Guide
to Behavior Change.
Drug Therapy
If you have a Body Mass Index (BMI) of 30 or more with no
obesity-related conditions or a BMI of 27 to 29.9 and two
or more obesity-related conditions, ask your doctor about
drug treatment for weight loss and weight maintenance. Drugs
for treating obesity have had a bad track record. Amphetamines
and the fen-phen combination produced serious side effects
and were discontinued. However, the products on the market
now have good safety records, and studies have shown them
to be effective. But no products are 'magic bullets." Patients
taking drugs still need to work on their diets and physical
activity.
Drug treatment should be used in combination with a healthy
diet and physical activity. Your doctor may also suggest a
combination of behavior therapy and drug therapy, which may
improve your treatment outcome. Regularly follow-up visits
to your doctor are recommended to monitor progress and to
maintain safety of the drug's use.
Weight loss drugs approved by the U.S. Food and Drug Administration
(FDA) for treating obesity include: Orlistat (Xenical), Phentermine,
and Sibutramine (Meridia).
- Orlistat (known as Xenical)
works by blocking about 30% of dietary fat from being absorbed,
and is the most recently approved weight loss drug.
- Phentermine (a generic drug) is an appetite suppressant
that has been available for many years. It is half of the
"fen-phen" combination that remains available for use. The
use of phentermine alone has not been associated with the
adverse health effects of the fenfluramine-phentermine combination.
- Sibutramine (known as Meridia)
is an appetite suppressant approved for long-term use.
For more information, read the Weight-control Information
Network's, Prescription
Medications for the Treatment of Obesity.
Surgery
Obesity surgery is recommended as a treatment option for
persons with obesity that have: 1) a BMI > 40 or 2) a BMI
of 35 to 39.9 with serious medical conditions. In 1991, the
National Institutes of Health published a consensus statement
on Gastrointestinal
Surgery for Severe Obesity. It cited studies showing
that following bariatric surgery, most patients lost weight
rapidly and continued to do so for 18 to 24 months. Patients
may lose up to 50 percent of their excess weight in the first
six months and 77 percent of excess weight in one year. Patient
were able to maintain 50 to 60 percent of their weight loss
10 to 14 years after surgery.
Surgery is a well-established method for long-term weight
control for persons with severe obesity. Much progress has
been made to develop safer and more effective procedures used
in obesity surgery today.
- Before surgery, patients should be informed about the
risks and benefits.
- Patients should be motivated and committed to making
a lifestyle change after surgery.
- A medical team, including behavioral and nutritional
professionals, should be part of a life-long follow-up plan.
Dietary Supplements and Liposuction
Anyone who has been to a drug store recently or who has picked
up a newspaper has seen dozens of advertisements for weight
loss products. Many good products have gotten lumped in with
worthless products. Items like Slim-Fast and other pre-packaged
meals that are nutritionally balanced do help with letting
you know exactly how many calories one is consuming. Other
products that promise quick, pain-less weight loss are of
dubious help. None have sufficient clinical data to be included
in the treatment guidelines established by the National Institutes
of Health (NIH), the AOA / Shape Up America! guidelines or
other reputable statements.
Liposuction involves the removal of fat in one location and
the amount of fat is usually too little for serious weight
loss. Therefore, liposuction is not recommended for weight
loss.
Read more about dietary supplements from the NIH's Office
of Dietary Supplements.
