Weight
Loss
Options
The FDA
is
calling
the
nation’s
obesity
problem
an
“epidemic”
and
released
a report
in 2004
with
goals
and
actions
focusing
on a
campaign
entitled,
“Calories
Count.”
Recommended
actions
include:
enhancing
the food
label to
display
calorie
count
more
prominently
and to
use
meaningful
serving
sizes
initiating
a
consumer
education
campaign
focusing
on the
"Calories
Count"
message
encouraging
restaurants
to
provide
nutritional
information
to
consumers
stepping
up
enforcement
actions
concerning
accuracy
of food
labels
revising
FDA
guidance
for
developing
drugs to
treat
obesity
working
cooperatively
with
other
government
agencies,
non-profits,
industry,
and
academia
on
obesity
research
Obesity
is
associated
with
increased
morbidity
and
mortality.
Weight
loss
reduces
risk
factors
for
complications
associated
with the
excess
weight,
including
diabetes
and
cardiovascular
diseases.
There
are
several
treatment
options
for the
management
of
overweight
and
obese
individuals,
including
diet
therapy,
changes
in
physical
activity,
behavioral
therapy,
drug
therapy,
surgery
and a
combination
of
these.
The
initial
goal of
weight
loss
therapy
is to
decrease
body
weight
by about
10%.
Once
this
goal is
met,
then
further
weight
loss can
be
attempted.
This
weight
loss
will not
occur
overnight,
but you
can see
a
difference
over
mere
weeks if
you stay
with
your
program.
Once the
weight
is lost,
maintenance
of the
loss
needs to
be
implemented
to
ensure
that the
weight
stays
off.
Treatment for Morbid Obesity
A statistic frequently used
about obesity treatment is that 95 percent of
people who lose weight gain it all back. That
statistic, based on a small study from 1959, is
no longer valid. Much has changed in the way of
obesity treatment since then. Thousands of
people have succeeded in losing weight and
keeping it off -- an encouraging fact for many
that are discouraged by outdated information.
There are several different types of effective
treatment options to manage weight including:
dietary therapy, physical activity, behavior
therapy, drug therapy, combined therapy and
surgery.
Weight loss of about 10 percent
of excess body weight is proven to benefit
health by reducing many obesity-related risk
factors. Recommendations for treatment are now
focusing on 10 percent weight loss to help
patients with long-term maintenance of weight
loss. Health professionals including physicians,
nutritionists, exercise physiologists,
psychologists and bariatric surgeons help
persons with overweight and obesity to determine
the most appropriate treatment.
Dietary Therapy
Lifestyle
modifications
such as
increasing
physical
activity
and
decreasing
calorie
intake
are
recommended
instead
of
"dieting."
Crash
diets
should
definitely
be
avoided.
The best
approach
to
changing
your
diet is
to talk
to your
doctor
to find
out what
is best
for you.
Your
doctor
can
provide
you with
dietary
guidelines
or refer
you to a
dietician
for
further
help.
Dietary
guidelines
will
differ
for each
person
depending
on
height,
weight,
concurrent
health
conditions,
and
desired
amount
of
weight
loss. A
diet
must be
established
that
will
allow
for
weight
loss and
be easy
to
comply
with.
Maintenance
of your
program
is the
key to
keeping
the
pounds
off.
Exercising
is
important
to any
good
weight
loss
program.
An
aerobic
exercise
program
reduces
weight
regardless
of any
changes
you make
in your
diet.
Adding
45
minutes
of
aerobic
exercise
a day is
the
equivalent
of
losing
400-800
Calories
depending
on your
intensity.
Minimally,
that
would
result
in
losing
one
pound
per
week.
Even if
you can
only
exercise
three
times
per
week,
that
would
still
help you
lose
almost 2
pounds
per
month or
20
pounds
over a
year!
Remember
that
this is
without
any
changes
in your
diet.
Dropping
500
Calories
a day
from
your
diet
(the
equivalent
of one
large
French
fries)
will
double
your
results.
Weight
training
and
calisthenics
also
help you
to
reduce
weight
not by
direct
loss but
by
decreasing
fatty
tissue
and
increasing
lean
body
mass.
This
will
increase
your
metabolism
and burn
more
calories
while at
rest.
Obese
patients
should
start
slowly
with
low-intensity
walking
or
swimming
and
advance
intensity
as
tolerated.
If you
have
cardiovascular
disease
or other
conditions
that may
make
exercise
very
difficult,
talk to
your
physician
before
you
begin.
-
Dietary therapy involves
instruction on how to adjust a diet to
reduce the number of calories eaten.
-
Reducing calories
moderately is essential to achieve a slow
but steady weight loss, which is also
important for maintenance of weight loss.
-
Strategies of dietary
therapy include teaching about calorie
content of different foods, food
composition (fats, carbohydrates, and
proteins), reading nutrition labels, types
of foods to buy, and how to prepare foods.
-
Some diets for weight loss
include low-calorie, very-low calorie, and
low-fat.
Physical Activity
-
A decrease in the amount of
daily activity related to work,
transportation and personal chores is
believed to contribute to the high
percentage of overweight and obesity today.
-
Moderate physical activity,
progressing to 30 minutes or more on most
or preferably all days of the week is
recommended for weight loss.
-
Physical activity is
reported to be a key part of maintaining
weight loss.
-
Abdominal fat, and in some
cases waist circumference can be modestly
reduced through physical activity.
-
Strategies of physical
activity include: the use of aerobic
exercise (such as aerobic dancing, brisk
walking, jogging, cycling, and swimming),
beginning slowly and gradually increasing
intensity, and selecting enjoyable
activities that can be scheduled into a
regular routine.
Behavior Therapy
Behavior
modification
is
common
to all
weight
loss
programs.
Modification
includes
strategies
that aid
individuals
to
overcome
barriers
to
comply
with
dietary
changes
and
physical
activity.
Most
behavioral
modification
programs
encourage
self-monitoring
of both
diet and
exercise
to
increase
one's
own
awareness
of the
activities.
Modification
strategies
may also
include
stress
management,
social
support,
and
stimulus
control.
Combining
behavioral
therapy,
diet
therapy,
and
increased
physical
activity
should
be
considered
as
initial
"therapy"
for
weight
loss.
This
combination
should
be
continued
for at
least 6
months
before
proceeding
to drug
therapy.
-
Behavior therapy involves
changing diet and physical activity
patterns and habits to new behaviors that
promote weight loss.
-
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
After
all
other
modes of
losing
weight
have
failed,
you
should
talk to
your
physician
about
your
options
with
drug
therapy.
Drug
therapy
may be
considered
for some
individuals
as a
supplement
to a
comprehensive
weight
loss
program
that
also
includes
diet,
exercise,
and
behavioral
therapy.
Medications
can be
used to
stimulate
weight
loss by
either
decreasing
the
appetite
or
inhibiting
the
absorption
of fat
from the
intestines.
Also,
certain
antidepressants
such as
fluoxetine
(Prozac)
and
sertraline
(Zoloft)
may
suppress
the
appetite
by
regulating
levels
of
serotonin,
a
neurotransmitter
in the
brain.
Serotonin
is
thought
to
induce a
feeling
of
hunger
and
fullness.
Click on
the
links
below to
learn
more
about
available
prescription
medications
that can
aid in
weight
loss.
Many
health
food and
supplement
stores
promote
various
"natural"
or
herbal
products
for
weight
loss.
Even
though
they
claim to
be
effective
and
"natural,"
these
products
can be
associated
with
certain
harmful
side
effects.
The U.S.
Food and
Drug
Administration
(FDA)
has
stringent
rules
pertaining
to the
safety,
efficacy,
and
quality
that
pharmaceutical
manufacturers
must
follow
in order
to
market
drugs in
the U.S.
Manufacturers
of
herbal
supplements
do not
have to
follow
these
same
rules to
sell
their
products.
For this
reason,
there is
limited
research
evaluating
supplements'
safety
and
efficacy
in the
human
body. As
a
result,
anyone
who
chooses
to take
these
substances
does so
at their
own
risk.
The most
important
thing to
remember
is that
weight
loss
takes
time and
effort,
and is a
lifelong
process.
Also, it
is
important
to set
reasonable
goals.
Sensible
weight
loss
does not
occur
overnight
and it
takes
major
changes
in your
lifestyle
before
significant
changes
in
weight
may be
observed.
Permanent
weight
loss can
be
reached
by
continued
lifestyle
changes.
-
Drug therapy is recommended
as a treatment option for persons with: 1)
a Body Mass Index (BMI) > 30 with no
obesity-related conditions or 2) a BMI of
> 27 with two or more
obesity-related conditions.
-
Drug treatment should be
used with appropriate lifestyle
modifications.
-
Drug therapy may be used
for weight loss and weight maintenance.
-
Patients should be
regularly assessed to determine the effect
and continuing safety of a drug.
-
Three weight loss drugs,
approved by the US Food and Drug
Administration (FDA) for treating obesity,
are Orlistat (Xenical), Phentermine, and
Sibutramine (Meridia).
-
Orlistat works by
blocking about 30 percent of dietary
fat from being absorbed, and is the
most recently approved weight loss
drug.
-
Phentermine, an
appetite suppressant, 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 is an
appetite suppressant approved for
long-term use.
Combined Therapy
-
A combination of a diet
(with lower calories) and increased
physical activity is reported to produce
more weight loss than diet alone or
physical activity alone.
-
A combination of behavior
therapy and drug therapy could prove to be
an effective treatment for obesity.
-
Drug therapy appears to
assist in the adherence to dietary therapy
(low-fat, low-calorie diet and may
improve maintenance of weight loss.
Bariatric 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.
-
Obesity surgery is used to
modify the stomach and or intestines to
reduce the amount of food that can be
eaten.
-
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.
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