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Losing Weight
 

Basic Facts

  • Gaining weight is the result of consuming too many calories and not expending enough energy.
  • By losing just 10 percent of body weight, people can greatly reduce their risk of developing serious conditions or improve existing conditions.
  • The most successful method for losing weight is a combination of a low-calorie diet, increased physical activity, and behavior therapies.
  • Research evidence is pointing to a clear role for obesity in the development of many illnesses as well as their continuation or worsening.
Being overweight or obese is defined as carrying too much total body weight. In general, people gain weight by consuming too many calories and not expending enough energy to burn them away. To determine whether a patient is overweight or obese, a physician uses body mass index (BMI) and waist circumference measurements. To determine BMI, the physician multiplies the patient's weight (in pounds) by 704.5. This number is divided by the patient's height (in inches) squared.

The BMI classifications are:
  • Less than 18.5 (underweight);
  • 18.5 to 24.9 (normal weight);
  • 25 to 29.9 (overweight);
  • 30 to 34.9 (obesity, class 1);
  • 35 to 39.9 (obesity, class 2); and
  • More than 40 (extreme obesity, class 3).
Waist circumference measurement helps physicians determine a person's amount of abdominal fat.

Being overweight or obese is preventable. People can lose weight, and by losing weight they can greatly reduce their risks of developing other conditions or improve existing conditions. Physicians may recommend one or more of the following weight loss therapies:
  • Low-calorie diet;
  • Physical activity;
  • Behavior therapy;
  • Combination therapy;
  • Medications; or
  • Bariatric (weight-reduction) surgery.
WHAT CONDITIONS WILL LOSING WEIGHT HELP?

Losing weight can help a patient improve or prevent many of the following conditions:
  • High blood pressure;
  • High cholesterol;
  • Type 2 diabetes;
  • Coronary artery disease;
  • Cardiomyopathy;
  • Atherosclerosis;
  • Pulmonary hypertension;
  • Stroke;
  • Gallbladder disease;
  • Osteoarthritis;
  • Sleep apnea;
  • Varicose veins;
  • Cancers, such as endometrial, breast, prostate, and colon cancer;
  • Psychological problems, such as depression;
  • Incontinence; and
  • Reproductive problems, such as infertility, early puberty, or absence of ovulation.
Waist circumference measurement helps physicians determine a person's amount of abdominal fat.
Waist circumference measurement helps physicians determine a person's amount of abdominal fat.
GETTING STARTED

Physicians use BMI and waist circumference to assess the severity of overweight and obesity. Losing weight requires careful planning and monitoring. In some cases, a physician may recommend a meeting with a certified dietitian, nutritionist, or fitness trainer.

WHAT TO EXPECT ON A WEIGHT LOSS PROGRAM

The goal of a treatment program is to reduce a person's weight by at least 10 percent. In some cases, when a patient has lost at least 10 percent of his or her total body weight, the physician may create a plan to maintain this weight for 6 months to see if the patient can prevent regaining the weight. If, after 6 months, a patient has not regained a significant amount of weight and wants to lose more weight, the physician may recommend starting a weight-loss plan again.

To lose weight, a patient must create an energy deficit, which means to use more energy than a person takes in. A physician may recommend one or a combination of the following: Diet therapy. The most successful diet that physicians recommend is low in calories, saturated and total fat, cholesterol, and salt and high in calcium and fiber. For patients with a BMI of 27 to 35, guidelines recommend reducing calories by 300 to 500 per day. For patients with a BMI higher than 35, the guidelines recommend reducing calories by 500 to 1,000 per day. Besides reducing calories, patients should lower their fat intake to 30 percent or less of their total calories. A low-calorie diet should include healthy amounts of protein and carbohydrates. A healthy low-calorie diet should also include the required vitamins and minerals.

Increasing physical activity. By increasing physical activities, patients can burn more calories and speed weight loss. Overweight and obese patients should consult a physician before starting any exercise program. Exercise should start slowly and increase gradually. Patients should begin with a slow-paced aerobic exercise, such as walking or swimming.

Behavior therapy. The goals of behavior therapy are to permanently change the eating and exercising habits of a patient and to help the patient learn to avoid situations where he or she is likely to overeat. Physicians will counsel patients on how to develop new healthy behavior patterns that will help them lose weight. Some recommendations of behavior therapy that a physician may suggest include:
  • Monitoring food intake;
  • Recording physical activity;
  • Managing stress;
  • Controlling impulsive behaviors; and
  • Seeking social support networks.
Combination of techniques. A combined program of low-calorie diet, physical activity, and behavior therapy is the most successful way for people to lose weight and maintain a healthy weight.

Medications. Prescribed medications help those who have a difficult time losing weight or maintaining the healthier weight. Medications should only be considered an adjunct to a combination weight-loss plan.

The Food and Drug Administration currently approves two medications for long-term weight loss therapy. These are sibutramine (Meridia) and orlistat (Xenical). Other medications that may be used for weight loss but are not approved for long-term use include appetite suppressants such as diethylpropion (Tenuate), mazindol (Mazanor), phendimetrazine (Bontril), and pentermine (Adipex-P).

Liquid diets. Liquid diets are only recommended for severely obese patients. The physician will prescribe and closely supervise the diet. On a liquid diet, the physician instructs the patient to drink a nutrient supplement, usually a drink similar to a shake in place of meals. In some cases, the patient may be required to replace all three meals; in other cases, the physician will instruct the patient to replace only two meals, and eat a nutritionally balanced third meal.

Bariatric surgery. In previous years, surgery was only recommended for use in extreme obesity (BMI more than 40) or obese people with other risk factors (BMI more than 35), but that is changing as more data emerges on the moderately obese. Two of the most common types of weight-reduction surgery are gastroplasty and gastric bypass. Both are designed to reduce the amount the stomach holds by creating a smaller stomach. Patients should adopt healthier habits in conjunction with bariatric surgery to keep the weight off.

Weight maintenance. Once the weight goal has been reached, a physician will instruct the patient on a weight maintenance program. In many cases, the physician will recommend that the patient continue diet, exercise, and behavior therapy, possibly for the rest of the patient's life.

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