Weight Management

Generally, programs designed to assist individuals to lose weight or to maintain a desired body weight. Americans who diet to lose weight frequently participate in weight management programs for many reasons. Statistics show that meeting external expectations motivates most dieters. Current American images of attractiveness and success place a premium on being slender, especially for women. A second motivation to manage weight is an awareness of the ramifications of being excessively overweight. obesity, defined as having a body mass index of 25 or higher, carries increased risks for diabetes, hypertension, and CARDIOVASCULAR DISEASE. Certain people tend to gain excess fat on their upper body, and upper body fat increases the waist to hip ratio, which correlates with a greater risk of heart disease.

Strategies for Weight Loss

Short-term weight loss readily can be attained by extreme measures: a drastic reduction in caloric intake (semi-starvation); crash dieting; unbalanced diets emphasizing high fat and high protein with little or no CARBOHYDRATE. However, most of this lost weight represents WATER and muscle protein loss rather than fat loss. Without a commitment to changing long-term behavior, pounds lost will be rapidly regained; frequently lost muscle is replaced by fat at the termination of the weight loss program. Several popular, doctor-supervised, very low-calorie programs are available. There is little published data on the success rates of most weight management programs. The limited information available suggests that only 2 percent to 10 percent of people who have enrolled in such programs successfully keep off lost pounds for a year or more.

These strategies can lead to weight losses of several pounds per week and often employ liquid protein meal replacements. Current liquid formula diets are much improved over 1970s versions. Regular food allotments plus three meal replacements can bring the total calories up to 1,200 per day, and with supervision they are often safe for several weeks. A major disadvantage: They often reinforce the unhealthy pattern of eating lightly at breakfast and lunch, and eating heavily at dinner or later. Under starvation or semi-starvation conditions, usually less than 1,200 calories per day, the body’s metabolism compensates for decreased caloric intake by gearing down the rate at which calories are burned. In other words the basal metabolic rate declines as a protective adaptation. Furthermore, the body preferentially breaks down protein in the early stages of semi-starvation to meet energy requirements; paradoxically, the body can therefore become proportionately fatter during this period. Programs that incorporate medications to curb craving as well as increased exercise and restricted caloric intake have been recommended for obese people.

Recommendations for Weight Management

People who have lost weight permanently and have maintained a desired weight for a number of years share certain characteristics that permit several generalizations for managing weight successfully. Committing to Exercising for Life Daily exercises can temporarily increase the basal metabolic rate and thus increase the efficiency of burning calories, even when calories are restricted. Even a daily half hour of vigorous walking will help maintain weight. Regular exercise is often sufficient to lose a small amount of weight and to become leaner. Moderate exercise is more effective for weight management because it preferentially burns fat, and intense exercise burns carbohydrate (glycogen), which is easily replenished.

Committing to Changing Eating Habits Highcalorie, high-fat foods make up a large percentage of the American diet. Fat provides more than twice as many calories per gram as carbohydrate or protein, and fat calories are more readily converted to body fat. Eating less fat will help bring about weight loss. High dietary fat correlates with increased risk of disease; generally, dietary guidelines call for consuming less saturated fat while increasing fresh fruits and vegetables, whole grains, and legumes. Foods containing high levels of refined carbohydrate, like sugar, white flour, and fat, provide few other nutrients. People relying on such foods need to select extra nutrient-rich foods to make up for this deficiency, not a usual pattern in the United States. A combination of exercise and improved food selection is often adequate to lose 10 to 20 pounds a year without dieting.

Dieting and Exercising Combined To lose up to 50 pounds, dieting combined with exercise is recommended.
Patients should:

• Lose weight gradually, no more than a pound per week. Conditions that promote rapid weight loss cause the body’s metabolism to switch to favor loss of muscle protein and water and, less rapidly, fat. Severe caloric restriction reduces thyroid gland activity, slowing the metabolism and slowing fat loss.
• Consume at least 1,200 calories daily with adequate intake of high-quality protein, vitamins, and minerals to meet daily needs in order to accomplish gradual weight loss. Generally 45 to 60 g of FISH, POULTRY, lean MEAT, soy protein, or other complete protein will meet daily requirements of all essential amino acids. This step will assure an adequate supply of all essential amino acids and will help prevent loss of muscle. Diets supplying less than 1,500 calories per day require supplementation—for example, with calcium—to achieve adequate intake. vitamin C, the B complex, and trace minerals are known to help metabolize fat, and adequate intakes are important.

• Eat adequate FIBER: Both soluble fiber, as found in fresh FRUITS, VEGETABLES, LEGUMES, and certain grains, and insoluble fiber, as found in whole grains and bran. Fiber contributes to normal digestion, maintenance of the digestive tract, and a feeling of satiety.

• Drink plenty of water. The kidneys require water to excrete metabolic wastes and fat breakdown products. 

Seeking Out Emotional Support Overeating usually is symptomatic of deeper emotional issues. Until these are dealt with, long-term changes in eating behavior are difficult to achieve. When people substitute eating for self-acceptance or for avoiding emotional pain, weight management becomes increasingly difficult. Overeaters Anonymous and other support groups can help nurture self-esteem and self-forgiveness.