Dieting; Obesity; Weight loss
Even modest weight loss can reduce the risk factors for heart disease and diabetes. The simplest (but still difficult) approach to weight loss is reducing calories and exercising at least 150 minutes a week. Behavioral and mental changes in eating habits, physical activity, and attitudes about food and weight are also essential to weight management. Studies show that people who lost at least 10% of their body weight and kept the weight off for more than 1 year share several characteristics, including:
Some Tips for Losing Weight. The following are some general suggestions for dieters:
Key Components of a Lifestyle Change Program
Reduce rate of eating.
Keep food records.
Eliminate environmental triggers to eating.
Identify high-risk situations for overeating.
Separate eating from other activities.
Face up to emotional barriers to exercise.
Understand the link between exercise and weight control.
Establish reasonable exercise goals.
Develop a plan for regular activity.
Add increased activity into daily lifestyle.
Develop reasonable weight-loss goals.
Avoid "all or none" thinking.
Focus attention away from the scale and toward behavior.
Uncouple weight from self-esteem.
If you "fall off the wagon," take steps to ensure you do not repeat the situation (recover from lapses with constructive action).
Understand the key role of social support to health.
Identify supportive others.
Match personal style to support-seeking activities.
Be specific in making support requests.
Be assertive but reinforcing in drawing help from others.
Resist the temptation of popular fad diets.
Eat with your health in mind; do not concentrate on what should be "off-limits."
Eat with moderation in mind.
Develop a tailored plan.
From Brownell KD. The LEARN Program for Weight Control. 7th ed. Dallas, Tex: American Health Publishing Company; 1998.
Childhood obesity is best treated by a non-drug, multidisciplinary approach, including diet, behavior modification, and exercise. Evidence suggests that reducing calories by only 200 - 260 per day would prevent weight gain in most overweight children. Here are some tips for children who are overweight:
We Can! (Ways to Enhance Children's Activity & Nutrition) is a new national program designed to help children live healthier lives. This program "focuses on three important behaviors: improved food choices, increased physical activity and reduced screen time." We can! Is a collaboration of the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Child Health and Human Development; and the National Cancer Institute.
Commercial and Nonprofit Support Programs for Weight Loss. There are many different types of weight-loss program. (This report cannot address all of the many commercial and nonprofit weight-loss programs currently available, nor can it assess their claims.)
Taking off Pounds Sensibly (TOPS), a nonprofit support organization with many local chapters, is one of the least expensive programs, costing $26 a year.
Most of the commercial programs, such as Weight Watchers, Jenny Craig, and NutriSystem, offer individual or group support, lifestyle changes, and packaged meals. These programs tend to be expensive. There are few well-conducted studies on these programs.
Many regard the inability to follow a diet and lose weight as reflecting a lack of willpower. Unfortunately, these feelings simply reinforce a sense of failure. Some suggest attempting to shift the approach to one of managing where one focuses their attention. Evidence exists that exercise and adequate sleep will enhance the ability to manage and self-regulate behavior.
Short-term specific goals regarding exercise and eating should be approached as something to be learned rather than performed. Also, planning ahead when invited to eat out or going to another home for food is recommended.
Cognitive Behavioral Approaches. Most support programs use some form of cognitive-behavioral methods to change the daily patterns associated with eating. They are very useful for preventing relapse after initial weight loss. The following is a typical approach:
Behavioral modification has been shown to be helpful particularly for people who have an overly strong response to the taste, smell, and appearance of food. It also may be useful for binge eaters.
Stress-Reduction Techniques. Stress reduction and relaxation techniques may be helpful for some people with obesity, such as those whose weight is related to night-eating syndrome. [For more information, see In-Depth Report #31: Stress.]
Changing Sedentary Habits. Making even small changes in physical activity can expend energy. For example, simply getting up to turn the TV on and off instead of using the remote, and standing (instead of sitting) while talking on the phone may help a person lose up to five pounds a year. Other suggestions include cooking one's own food (instead of eating take-out or fast food), walking to as many places as possible, using stairs instead of escalators or elevators, and gardening. Even fidgeting may be helpful in keeping pounds off, and, in one study, chewing gum increased energy expenditure.
No one should rely on such mild activities, however, for serious weight loss. Only high levels of physical activity -- not just using up energy -- help prevent obesity.
Interventions to help children and adolescents lose weight and maintain weight loss have yet to show consistent benefit
Approach to Exercise. Exercise, which replaces fat with muscle, is the critical companion for any weight control program. In a one-year study, women who regularly averaged 3.5 days (176 minutes) of exercise each week lost significantly more weight than women who did not exercise regularly. Women who exercised more than 195 minutes a week lost nearly 7% of their abdominal fat.
It should be noted that increasing activity level in daily work and home life helps a great deal. For example, walking down the hall to speak with a coworker, rather than spending the same time sending an e-mail, may result in a loss of 5 kg over a 10-year period.
People who exercise are more apt to stay on a diet plan. Exercise improves psychological well-being and replaces sedentary habits that usually lead to snacking. Exercise may even act as a mild appetite suppressant. Moreover, exercise improves overall health even with modest weight loss.
Be aware, however, that the pounds won't melt off magically. Losing significant weight requires both intensive exercise and calorie restriction. In addition, if a person exercises but doesn't diet, any actual pounds lost may be minimal, because denser and heavier muscle mass replaces fat. Nonetheless, regardless of weight loss, a fit body will look more toned and be healthier. In addition, exercise benefits the heart even with modest weight loss.
The following are some suggestions and observations on exercise and weight loss:
Spot Exercising. Anyone seeking to lose weight must expect that the results may not be as cosmetically satisfying as one would wish. Spot exercising (training particular areas of the body) is ineffective in reducing fat in specific locations because exercise draws on fat stores throughout the body. Gimmicky devices such as bust developers, vacuum pants, and exercise belts do absolutely nothing to reduce fat or add bulk in specific locations. Electrical pads wrapped around the waist, arms, or thighs were reported to cause burns and fires.
Warning Note. Because obesity is one of the risk factors for heart disease and diabetes, anyone who is overweight must discuss their exercise program with a doctor before starting. Sudden demanding exercise, in such cases, can be very dangerous. [For more information, see In-Depth Report #29: Exercise.]
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