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HEALTHY APPROACHES TO WEIGHT LOSS

 

Obesity is a chronic condition. Too often it is viewed as a temporary problem that can be treated for a few months with a strenuous diet. However, as most overweight people know, weight control must be considered a life-long effort. To be safe and effective, any weight-loss program must address the long-term approach or else the program is largely a waste of money and effort.

Who should lose weight? Health experts generally agree that adults can benefit from weight loss if they are moderately to severely overweight.  Health experts also agree that adults who are overweight and have weight-related medical problems or a family history of such problems can benefit from weight loss. Some weight-related health problems include diabetes, heart disease, high blood pressure, high cholesterol levels, or high blood sugar levels. Even a small weight loss of 10 to 20 pounds can improve your health, for example by lowering your blood pressure and cholesterol levels. You do not need to lose weight if your weight is within the healthy range on the weight-for-height chart, you have gained less than 10 pounds since you reached your adult height, and you are otherwise healthy.

(from NIH dietary guidelines)

Many health issues are related to weight loss.  The following are often cited as good reasons to shed those unwanted pounds.

Heart Disease and Stroke

Heart disease and stroke are the leading causes of death and disability for both men and women in the United States. Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, than people who are not overweight. Very high blood levels of cholesterol and triglycerides (blood fats) can also lead to heart disease and often are linked to being overweight. Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms.

The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. Reducing your weight by 10 percent can decrease your chance of developing heart disease by improving how your heart works, blood pressure, and levels of blood cholesterol and triglycerides.

Diabetes

Noninsulin-dependent diabetes mellitus (type 2 diabetes) is the most common type of diabetes in the United States. Type 2 diabetes reduces your body's ability to control your blood sugar. It is a major cause of early death, heart disease, kidney disease, stroke, and blindness. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. You can reduce your risk of developing this type of diabetes by losing weight and by increasing your physical activity.

If you have type 2 diabetes, losing weight and becoming more physically active can help control your blood sugar levels. If you use medicine to control your blood sugar, weight loss and physical activity may make it possible for your doctor to decrease the amount of medication you need.

Cancer

Several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast, and colon. Overweight men are at greater risk for developing cancer of the colon, rectum, and prostate. For some types of cancer, such as colon or breast, it is not clear whether the increased risk is due to the extra weight or to a high-fat and high-calorie diet.

Sleep Apnea

Sleep apnea is a serious condition that is closely associated with being overweight. Sleep apnea can cause a person to stop breathing for short periods during sleep and to snore heavily. Sleep apnea may cause daytime sleepiness and even heart failure. The risk for sleep apnea increases with higher body weights. Weight loss usually improves sleep apnea.

Osteoarthritis

Osteoarthritis is a common joint disorder that most often affects the joints in your knees, hips, and lower back. Extra weight appears to increase the risk of osteoarthritis by placing extra pressure on these joints and wearing away the cartilage (tissue that cushions the joints) that normally protects them. Weight loss can decrease stress on the knees, hips, and lower back and may improve the symptoms of osteoarthritis.

If you are a woman and your waist measures more than 35 inches, or if you are a man and your waist measures more than 40 inches, you are more likely to develop heart disease, high blood pressure, diabetes, and certain cancers. You may want to talk to your doctor or other health professional about the health risks of your weight.

Obesity affects about one in four adult Americans, and during any one year, over half of Americans go on a weight-loss diet or are trying to maintain their weight. For many people who try to lose weight, it is difficult to lose more than a few pound, and few succeed in remaining at the reduced weight.  The difficulty in losing weight and keeping it off leads many people to turn to a professional or commercial weight-loss program for help. These programs are quite popular and are widely advertised in newspapers and on television. What is the evidence that any of these programs is worthwhile, that they will help you lose weight and keep it off and that they will do it safely?

Almost any of the commercial weight-loss programs can work, but only if they motivate you sufficiently to decrease the amount of calories you eat or increase the amount of calories you burn each day (or both). What elements of a weight-loss program should an intelligent consumer look for in judging its potential for safe and successful weight loss?

A responsible and safe weight-loss program should be able to document for you the five following features:
  1. The diet should be safe. It should include all of the Recommended Daily Allowances (RDAs) for vitamins, minerals, and protein. The weight-loss diet should be low in calories (energy) only, not in essential foodstuffs.
  2. The weight-loss program should be directed towards a slow, steady weight loss unless your doctor feels your health condition would benefit from more rapid weight loss. Expect to lose only about a pound a week after the first week or two. With many calorie-restricted diets there is an initial rapid weight loss during the first 1 to 2 weeks, but this loss is largely fluid. The initial rapid loss of fluid also is regained rapidly when you return to a normal-calorie diet. Thus, a reasonable goal of weight loss must be expected.
  3. In most every instance where significant weight loss is expected, if there is a history of any medical problems, or if a change of activity level is being contemplated,  you should be evaluated by your doctor before beginning your weight-loss program. A doctor can assess your general health and medical conditions that might be affected by dieting and weight loss. Also, a physician should be able to advise you on the need for weight loss, the appropriateness of the weight-loss program, and a sensible goal of weight loss for you. Anyone who plans to use a very-low-calorie diet (a special liquid formula diet that replaces all food intake for 1 to 4 months), needs to have such a program administered by a doctor.
  4. Your program should include plans for weight maintenance after the weight loss phase is over. It is of little benefit to lose a large amount of weight only to regain it. Weight maintenance is the most difficult part of controlling weight and is not consistently implemented in weight-loss programs. The program you select should include help in permanently changing your dietary habits and level of physical activity, to alter a lifestyle that may have contributed to weight gain in the past. Your program should provide behavior modification help, including education in healthy eating habits and long-term plans to deal with weight problems. One of the most important factors in maintaining weight loss appears to be increasing daily physical activity, often by sensible increases in daily activity, as well as incorporating an individually tailored exercise program.                                                                                      
  5. A commercial weight-loss program should provide a detailed statement of fees and costs of additional items such as dietary supplements.

Your body weight is controlled by the number of calories you eat and the number of calories you use each day. So, to lose weight you need to take in fewer calories than you use. You can do this by becoming more physically active or by eating less. Following a weight-loss program that helps you to become more physically active and decrease the amount of calories that you eat is most likely to lead to successful weight loss. The weight-loss program should also help you keep the weight off by making changes in your physical activity and eating habits that you will be able to follow for the rest of your life.

Diet

The word "diet" probably brings to mind meals of lettuce and cottage cheese. By definition, "diet" refers to what a person eats or drinks during the course of a day. A diet that limits portions to a very small size or that excludes certain foods entirely to promote weight loss may not be effective over the long term. Rather, you are likely to miss certain foods and find it difficult to follow this type of diet for a long time. Instead, it is often helpful to gradually change the types and amounts of food you eat and maintain these changes for the rest of your life. The ideal diet is one that takes into account your likes and dislikes and includes a wide variety of foods with enough calories and nutrients for good health.

How much you eat and what you eat play a major role in how much you weigh. So, when planning your diet, you should consider: What calorie level is appropriate? Is the diet you are considering nutritionally balanced? Will the diet be practical and easy to follow? Will you be able to maintain this eating plan for the rest of your life? The following information will help you answer these questions.


Calorie Level

Low-calorie Diets. Most weight-loss diets provide 1,000 to 1,500 calories per day. However, the number of calories that is right for you depends on your weight and activity level. At these calorie levels, diets are referred to as low-calorie diets. Self-help diet books and clinical and non-clinical weight-loss programs often include low-calorie diet plans.

The calorie level of your diet should allow for a weight loss of no more than 1 pound per week (after the first week or two when weight loss may be more rapid because of initial water loss). If you can estimate how many calories you eat in a day, you can design a diet plan that will help you lose no more than 1 pound per week. You may need to work with a trained health professional, such as a registered dietitian. Or, you can use a standardized low-calorie diet plan with a fixed calorie level.

The selected calorie level, however, may not produce the recommended rate of weight loss, and you may need to eat more or less.


Good Nutrition


Make sure that your diet contains all the essential nutrients for good health. Using the above Food Pyramid provided by the USDA, as well as the Nutrition Facts Label that is found on most processed food products can help you choose a healthful diet. The Nutrition Facts Label will help you select foods that meet your daily nutritional needs. A healthful diet should include:

    Adequate vitamins and minerals. Eating a wide variety of foods from all the food groups on the Food Guide Pyramid will help you get the vitamins and minerals you need. If you eat less than 1,200 calories per day, you may benefit from taking a daily vitamin and mineral supplement.

    Adequate protein. The average woman 25 years of age and older should get 50 grams of protein each day, and the average man 25 years of age and older should get 63 grams of protein each day. Adequate protein is important because it prevents muscle tissue from breaking down and repairs all body tissues such as skin and teeth. To get adequate protein in your diet, make sure you eat 2-3 servings from the Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group every day. These foods are all good sources of protein.

    Adequate carbohydrates. At least 100 grams of carbohydrates per day are needed to prevent fatigue and dangerous fluid imbalances. To make sure you get enough carbohydrates, eat 6-11 servings from the Bread, Cereal, Rice, and Pasta Group every day.

    A daily fiber intake of 20 to 30 grams. Adequate fiber helps with proper bowel function. If you were to eat 1 cup of bran cereal, 1/2 cup of carrots, 1/2 cup of kidney beans, a medium-sized pear, and a medium-sized apple together in 1 day, you would get about 30 grams of fiber.


    No more than 30 percent of calories, on average, from fat per day, with less than 10 percent of calories from saturated fat (such as fat from meat, butter, and eggs). Limiting fat to these levels reduces your risk for heart disease and may help you lose weight. In addition, you should limit the amount of cholesterol in your diet. Cholesterol is a fat-like substance found in animal products such as meat and eggs. Your diet should include no more than 300 milligrams of cholesterol per day (one egg contains about 215 milligrams of cholesterol, and 3.5 ounces of cooked hamburger contain 100 milligrams of cholesterol).

    At least 8 to 10 glasses, 8 ounces each, of water or water-based beverages, per day. You need more water if you exercise a lot.

These nutrients should come from a variety of low-calorie, nutrient-rich foods. One way to get variety -- and with it, an enjoyable and nutritious diet -- is to choose foods each day from the each of the major food groups.  Note: This list represents approximate single servings in the food groups and should be used as a guide only in conjunction with your health care professional.

 

Milk, Yogurt, and Cheese
1 cup of milk or yogurt 1 1/2 ounces of natural cheese 2 ounces of process cheese

 
Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts
2-3 ounces of cooked lean meat, poultry, or fish 1/2 cup of cooked dry beans, 1 egg, or 2 tablespoons of peanut butter count as 1 ounce of lean meat

 
Vegetable
1 cup of raw leafy vegetables 1/2 cup of other vegetables, cooked or chopped raw 3/4 cup of vegetable juice

 
Fruit
1 medium apple, banana, orange 1/2 cup of chopped, cooked, or canned fruit 3/4 cup of fruit juice

 
Bread, Cereal, rice, and Pasta
1 slice of bread 1 ounce of ready-to-eat cereal 1/2 cup of cooked cereal, rice, or pasta
Milk, Yogurt, and Cheese
1 cup of milk or yogurt 1 1/2 ounces of natural cheese 2 ounces of process cheese

 
Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts
2-3 ounces of cooked lean meat, poultry, or fish 1/2 cup of cooked dry beans, 1 egg, or 2 tablespoons of peanut butter count as 1 ounce of lean meat

 
Vegetable
1 cup of raw leafy vegetables 1/2 cup of other vegetables, cooked or chopped raw 3/4 cup of vegetable juice

 
Fruit
1 medium apple, banana, orange 1/2 cup of chopped, cooked, or canned fruit 3/4 cup of fruit juice

 
Bread, Cereal, rice, and Pasta
1 slice of bread 1 ounce of ready-to-eat cereal 1/2 cup of cooked cereal, rice, or pasta

Types of Diets

    Fixed-menu diet. A fixed-menu diet provides a list of all the foods you will eat. This kind of diet can be easy to follow because the foods are selected for you. But, you get very few different food choices which may make the diet boring and hard to follow away from home. In addition, fixed-menu diets do not teach the food selection skills necessary for keeping weight off. If you start with a fixed-menu diet, you should switch eventually to a plan that helps you learn to make meal choices on your own, such as an exchange-type diet.

    Exchange-type diet. An exchange-type diet is a meal plan with a set number of servings from each of several food groups. Within each group, foods are about equal in calories and can be interchanged as you wish. For example, the "starch" category could include one slice of bread or 1/2 cup of oatmeal; each is about equal in nutritional value and calories. If your meal plan calls for two starch choices at breakfast, you could choose to eat two slices of bread, or one slice of bread and 1/2 cup of oatmeal. With the exchange-type diet plans, you have more day-to-day variety and you can easily follow the diet away from home. The most important advantage is that exchange-type diet plans teach the food selection skills you need to keep your weight off.

    Prepackaged-meal diet. These diets require you to buy prepackaged meals. Such meals may help you learn appropriate portion sizes. However, they can be costly. Before beginning this type of program, find out whether you will need to buy the meals and how much the meals cost. You should also find out whether the program will teach you how to select and prepare food, skills that are needed to sustain weight loss.

    Formula diet. Formula diets are weight-loss plans that replace one or more meals with a liquid formula. Most formula diets are balanced diets containing a mix of protein, carbohydrate, and usually a small amount of fat. Formula diets are usually sold as liquid or a powder to be mixed with liquid. Although formula diets are easy to use and do promote short-term weight loss, most people regain the weight as soon as they stop using the formula. In addition, formula diets do not teach you how to make healthy food choices, a necessary skill for keeping your weight off. These should only be considered after consultation with a health care professional, and should probably be avoided by those with multiple medical problems.

    Questionable diets. You should avoid any diet that suggests you eat a certain nutrient, food, or combination of foods to promote easy weight loss. Some of these diets may work in the short term because they are low in calories. However, they are often not well balanced and may cause nutrient deficiencies. In addition, they do not teach eating habits that are important for long-term weight management.  The Atkins-type (protein-sparing carbohydrate-free) diet in my opinion falls into this category.

    Flexible diets. Some programs or books suggest monitoring fat only, calories only, or a combination of the two, with the individual making the choice of both the type and amount of food eaten. This flexible type of approach works well for many people, and teaches them how to control what they eat. One drawback of flexible diets is that some don't consider the total diet. For example, programs that monitor fat only often allow people to take in unlimited amounts of excess calories from sugars, and therefore don't lead to weight loss.

It is important to choose an eating plan that you can live with. The plan should also teach you how to select and prepare healthy foods, as well as how to maintain your new weight. Remember that many people tend to regain lost weight. Eating a healthful and nutritious diet to maintain your new weight, combined with regular physical activity, helps to prevent weight regain.



Physical Activity

Regular physical activity is important to help you lose weight and build an overall healthy lifestyle. Physical activity increases the number of calories your body uses and promotes the loss of body fat instead of muscle and other nonfat tissue. Research shows that people who include physical activity in their weight-loss programs are more likely to keep their weight off than people who only change their diet. In addition to promoting weight control, physical activity improves your strength and flexibility, lowers your risk of heart disease, helps control blood pressure and diabetes, can promote a sense of well-being, and can decrease stress.

Any type of physical activity you choose to do -- vigorous activities such as running or aerobic dancing or moderate-intensity activities such as walking or household work -- will increase the number of calories your body uses. The key to successful weight control and improved overall health is making physical activity a part of your daily life.

For the greatest overall health benefits, experts recommend that you do 20 to 30 minutes of vigorous physical activity three or more times a week and some type of muscle strengthening activity, such as weight resistance, and stretching at least twice a week. However, if you are unable to do this level of activity, you can improve your health by performing 30 minutes or more of moderate-intensity physical activity over the course of a day, at least five times a week. When including physical activity in your weight-loss program, you should choose a variety of activities that can be done regularly and are enjoyable for you. Also, you should see your doctor before you start, especially if you are older than 40 years of age, very overweight, or have medical problems.


Behavior Change

Behavior change focuses on learning eating and physical activity behaviors that will help you lose weight and keep it off. The first step is to look at your eating and physical activity habits, thus uncovering behaviors (such as television watching) that lead you to overeat or be inactive. Next you'll need to learn how to change those behaviors.

Getting support from others is a good way to help you maintain your new eating and physical activity habits. Changing your eating and physical activity behaviors increases your chances of losing weight and keeping it off. For additional information on behavior change, you may wish to ask a weight-loss counselor or refer to books on this topic, which are available in local libraries.

RISKS OF TOO-RAPID DIETING

Gout

Gout is a joint disease caused by high levels of uric acid in the blood. Uric acid sometimes forms into solid stone or crystal masses that become deposited in the joints. Gout is more common in overweight people and the risk of developing the disorder increases with higher body weights.

Note: Over the short term, some diets may lead to an attack of gout in people who have high levels of uric acid or who have had gout before. If you have a history of gout, check with your doctor or other health professional before trying to lose weight.

Gallbladder Disease

Gallbladder disease and gallstones are more common if you are overweight. Your risk of disease increases as your weight increases. It is not clear how being overweight may cause gallbladder disease.

Weight loss itself, particularly rapid weight loss or loss of a large amount of weight, can actually increase your chances of developing gallstones. Modest, slow weight loss of about 1 pound a week is less likely to cause gallstones.


What's Best for You?

A variety of options exist to help you lose weight and keep it off. The key to successful weight loss is making changes in your eating and physical activity habits that you will be able to maintain for the rest of your life.