Saturday, October 28, 2006

 

Weight Loss Strategies

There are many obesity treatment strategies. What works for you may not be the best method for someone else. In this section, we will help you learn more about obesity treatment so that you can better discuss the issue with a healthcare professional

Weight Loss Strategies

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.
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:
The National Heart, Lung and Blood Institute's:
Daily Food and Activity Diary
Shopping Guide
Recipes
Sample Reduced-Calorie Menus
Menu Planner
International Food Information Council's, Avoid Tipping the Scales - How to Determine Portion and Serving Sizes
The U.S. Department of Agriculture’s (USDA) Interactive Healthy Eating Index
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:
The USDA's Recipes and Tips for Healthy, Thrifty Meals has sample menus and nutritional information for each recipe.
c) Food Composition:
The FDA's Consumer's Guide to Fats
Fat Replacers: The FDA's Taking the Fat Out of Food
Fiber Information: The FDA's Bulking Up Fiber's Healthful Reputation
Fruits and Vegetable Information: The FDA's Eating Your Way to 5 A Day
d) Restaurants and Eating Out:
FDA article on eating out, Today's Special: Nutrition Information
Fast Food Nutritional Information from Wake Forest University Baptist Medical Center
e) Fad Diets
International Food Information Council's Fad Diets: Look Before You Leap.

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.

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.

source- American Obesity Association

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