Methods of weight loss include dietary change, exercise, behavior modification, metabolic stimulants, appetite suppressants or a combination of these. Limitations on dietary intake, the most common method used for weight loss, can last several weeks to months, depending on individual need and motivation. Altering dietary proportions of fat, protein, carbohydrate, using macronutrient substitutes, and taking vitamins, diet supplements or meal replacements are all techniques used to modify food intake.
America has become a nation of chronically overweight people. Today well over 60% of American adults are either overweight or obese, according to the U.S. Centers of Disease Control and Prevention. Between 1991 and 2002, the percentage of Americans who meet the criteria for obesity more than doubled.
The good news is that by burning off more calories than you're taking in will cause you to lose weight. The bad news is, there's no magic formula – no silver bullet that leads to effective, permanent weight loss. If the silver bullet exists, obesity research has yet to find it. Indeed, the idea that some great weight loss secret exists is what fuels the less scrupulous members of the dieting market. People who've tried exercise, dieting, support groups and other options begin to get desperate, and are willing to try just about anything. An effective weight loss secret has become the Holy Grail of modern times, and it's about as elusive.
A 1999 study of 2,800 individuals who lost at least 30 pounds (14kg) and maintained the weight loss for more than a year reported the following:
Eating and chewing food slowly will send nervous system signals to the stomach that it is "full" and will assist in weight loss and deter weight gain after dieting, especially if a healthy diet is selected. When hungry, consider drinking a glass of cold water before eating. Aside from doing you good, it can provide a sense of 'fullness' as well as shrink the stomach somewhat. NOTE: The cooler the water, the more calories your body must expend in order to bring it up to body temperature. Because of water's high specific heat capacity, it takes a lot of energy to raise the temperature of water even a little.
Water is also necessary for the metabolism of your stored fat. Weight loss cannot occur without an active metabolism and that requires large quantities of water.
Exercising is another way to lose weight and although the average weight loss from exercise alone is 8.8-15.4lbs (4-7kgs), much greater weight loss is possible. Regular workouts are advantageous to increasing high-density lipoprotein cholesterol and lean body mass, and diminishing rapid weight gain. Exercise produces increased muscle mass, and muscles in turn burn calories at a much higher rate than other tissue – even when not exercising. Great weight loss can require at least an hour of aerobic-type exercise at least 5 days a week.
Research shows that you burn more stored fat for energy when you do aerobic exercises on an empty stomach. You burn more stored fat when you exercise late in the day rather than in the morning. The best time to exercise for weight loss is in the late afternoon/early evening before dinner. Doing this will not only burn off stored fat but increase your metabolism for 2 to 3 more hours just when it was starting to slow down. This produces a significant increase in fat burning, even after the exercise is over. The next best time to exercise for weight loss is in the morning before breakfast. The minimum time for this effect to take place is 20 to 30 continuous minutes.
Behavior modification produces gradual change. Four steps to behavior modification are:
Sometimes dieters resort to the use of metabolic stimulants such as caffeine and ephedra (often from the herb ma huang) which are central nervous system stimulants that, when combined, may help people lose weight. Some, but not all, studies examining the effect of a caffeine-ephedra combination suggest that it does promote weight loss in some individuals, especially when combined with exercise. These stimulants should be used only under a physician's supervision.
On the other hand, some people lose weight faster by reducing their intake of caffeine. Caffeine leads to an increase of insulin in your body which retards the burning of stored fat. This is a simple chemical reaction in your body that you can change. Reduce your caffeine intake by 50% and see what happens.
Ephedra has long been known for its stimulatory effects, which may assist weight loss, but involves risks, such as high blood pressure and over stimulation. As more people are taking products containing ephedrine, the evidence of these risks is growing. A review of FDA records showed that 42% of all "adverse event" reports for dietary supplements from January 1993 to February 2000 involved products containing Ephedra.
Synephrine has been shown to stimulate the receptors which selectively stimulate fat breakdown and increase the resting metabolic rate. Unlike ephedrine, synephrine has little effect on other receptors, which are responsible for elevating blood pressure, dry mouth, nervousness and other stimulant-like side-effects. Also, unlike Ephedra, Synephrine does not readily cross the blood-brain barrier. Synephrine is a compound prepared and standardized from an extract of Citrus aurantium and should become increasingly available.
Losing as little as a 5-10% of body weight and maintaining that loss can significantly improve the health of obese patients by increasing glucose tolerance and lowering blood pressure and cholesterol levels. Therefore, if you are obese, you should seek medical help to lose weight as well as to maintain it.
Low calorie diets (1000-1500 calories per day) and very low calorie diets (800 or fewer calories per day) help patients lose weight rapidly. A physician's supervision is recommended, however, to prevent adverse side-effects, such as excessive loss of lean body mass, particularly in individuals with chronic health problems such as hypertension.
To be successful at achieving weight loss goals to improve your health, experts recommend losing weight a rate of no more than one to two pounds per week, and then maintaining that loss for six months before losing more. Maintaining weight loss can be more difficult than losing the weight to begin with, so long-term lifestyle change is key.
On average, weight loss of 1-1.5 lbs per week (about 0.5-0.75kg) is a reasonable goal, which can be achieved by combining exercise, reduced dietary intake and behavioral changes. Successful weight loss involves a combination of these methods that are suited to the individual and applied in a manner which results in a slow and steady weight loss. It may be best to weigh yourself only once per week to monitor weight loss. Daily weighing may lead to misinterpretations and unnecessary concern or discouragement.
The safest way to lose weight is to eat a nutritionally complete diet that is moderate in calories and fat and add exercise to your daily routine. In some cases, for example, if your health is being immediately and severely compromised because of your weight, faster weight loss may be appropriate. In these cases, your health care professional may recommend drug therapy or surgery.
Losing weight takes a huge effort. If you're determined to lose weight, you must:
People who have more than 100 pounds (45kg) to lose must prepare to make lifetime changes. This kind of change takes a long time and the pervasive dominance of a weight loss program can be both overwhelming and lonely. Many people suffer from depression when they're overweight or dieting. For very heavy people, many months go by before anyone begins to notice the changes. In the meantime, the temptation to give up is great.
Hospital and clinic programs are the safest and the most realistic. A health care provider can determine which programs are most appropriate. Having a combination of resources, advice, medical supervision, regular weigh-ins, nutrition plans, psychological support and therapy, and regular encouragement, all combined into a planned clinical program, is more likely to produce success.
Changing Your Diet
The first element of treatment is changing your diet. Your health care professional should provide detailed guidance on the number and types of calories you should eat. As a rule of thumb, if you take in about 250 calories per day less than is needed to maintain your current weight, combined with an exercise regime that burns an additional 250 calories a day, you will lose about a pound per week.
To determine how many calories your body needs to maintain its basic functions known as your basal metabolic rate, multiply your current weight in pounds by 10. For example, a woman who weighs 200 pounds requires 2,000 calories per day to maintain bodily functions like breathing and digestion. You need additional calories (about 30-50% more) if you are moderately active, to provide energy for daily activities like walking, vacuuming, even sitting at the computer.
It is difficult to determine exactly how many calories you need to maintain your weight at your current level of physical activity. You may want to take your basal metabolic rate and add about 10% if you're relatively sedentary, 20% if you're lightly active, and 30% if you're moderately active, and then subtract the 250 calories to arrive at your new recommended daily total.
A slightly more accurate method is to keep a detailed food diary over the course of a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day several books and web sites provide calorie counts for thousands of different foods and use that figure as a starting place from which you would subtract 250 calories.
After you've determined how many calories per day you should eat, you need to plan daily menus. A dietician or nutritionist can help you plan menus that include the types and amounts of food you should eat, emphasizing balance, moderation and variety in food choices, with a special emphasis on whole grain products, vegetables and fruits.
To satisfy basic nutritional needs, eat a variety of foods every day and allow for an occasional treat. While you should try to cut back on fats and sugars, all foods and beverages can be consumed in moderation. As soon as you label a food as off limits, chances are you will crave and perhaps even binge on it.
Balanced food plans encourage making wise choices about everyday food choices you can make to stay at your proper weight for life. Many popular diet plans of the high protein/low carbohydrate variety (e.g. the Atkins Diet), for example, don't include balanced choices. While women can lose weight on these diets, they can be dangerously deficient in certain required nutrients or food groups and dangerously high in others. In most cases, women who go on these diets tend to regain any lost weight after they go off the diet. That's because these diets don't help you change your lifestyle and your way of handling food and temptation in the long run.
Most successful weight-loss plans call for a reduction in both calories and fat, although fat is probably not a critical component in obesity. Instead, overall calories and lack of physical activity, coupled with a sedentary lifestyle, are. Still, guidelines recommend that women moderate their fat consumption to 25-35% or less of their total calorie intake, with saturated fats accounting for only about 10% of intake and being comprised of equal amounts of monounsaturated fat and polyunsaturated fats – that is, more vegetable-source fats. Also, reduce cholesterol intake to about 300mg per day. Strategies for reducing saturated fat and cholesterol intake include:
Increasing Physical Activity
The second element of treatment is to add exercise to your daily routine. Exercise not only burns calories, it also tempers the appetite. Exercise boosts metabolism, which dieting can impair, improves sleep and provides psychological benefits, such as an increased feeling of control and self esteem, as well as stress reduction.
WARNING: If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or suffer from a chronic condition, you should consult a physician before you begin your effort to increase your physical activity. Be sure to notify your physician about any chest pain, faintness or dizziness, bone or joint pain and any medications you may be taking.
The best kinds of exercises for burning calories are aerobic activities, which involve using the large muscles of your body in a rhythmic, continuous activity. Aerobics not only help to reduce body fat but also improve cardiovascular conditioning. It is recommended by the U.S. Centers for Disease Control and Prevention and other professional groups that healthy women do some sort of moderate-to-vigorous aerobic exercise on most or all days of the week for 30 to 45 minutes. These minutes can be accumulated 15 minutes of an aerobics video in the morning and 15 minutes of brisk walking in the evening, for example. However, a single sustained exercise session may be more effective in helping you to lose weight.
If you have been inactive for a while, you will need to work up slowly to this amount so that you don't get injured or overly fatigued and then discouraged. Start with five or 10 minutes or whatever you're comfortable with every other day, and add one minute every other session. Low- to moderate-intensity aerobic exercise, like housework, gardening and walking the dog all provide a great deal of general health benefits, but for actual weight loss you need to exercise at a higher intensity with vigorous activities like brisk walking or jogging, singles tennis/racket sports, aerobics classes, ice or roller skating, swimming or cycling.
Because the goal of aerobic exercise is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and then sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds. Your heart rate should be about 70-85% percent of its maximum, which is your age subtracted from 220.
The following chart illustrates recommended 10-second heart rate counts; the number of beats your count should fall between the two numbers listed beside your age:
|Age||70% of maximum||85% of maximum|
If you are out of shape or older than 60, you should aim for an intensity at 50-70% of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.6 for the lower end of the range and 0.73 for the higher end. For example, if you're 70:
An easier way to judge intensity is the talk test. You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.
Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance such as in push ups not only improves muscular strength and endurance, it also raises metabolism, causing you to burn more calories even after you stop exercising.
Make sure you take a few minutes to stretch and warm up before doing any kind of exercise.
It is best to incorporate a combination of both types of exercise into your lifestyle aerobics to burn fat and strength training to build muscle, because neither type is as effective alone.
At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with obesity.
Here are a few other low-impact exercises you can do:
FDA-Approved Medications for Treating Obesity
Weight-loss medications may be recommended for patients who are at increased medical risk because of their obesity. Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight loss program that includes dietary therapy and physical activity. Currently available prescription medications include:
Most of these appetite-suppressants have been approved for short-term use, meaning a few weeks or months. Sibutramine and orlistat are the only weight-loss medications approved for longer-term use in significantly obese patients, although the safety and effectiveness have not been established for use beyond one year.
Most of these drugs decrease appetite by affecting levels of the brain neurotransmitters catecholamine, serotonin and/or noradrenaline – brain chemicals that affect mood and appetite. Orlistat (Xenical) does not act directly on the central nervous system but inhibits an enzyme essential to fat digestion. In general, these medications are modestly effective, leading to an average weight loss of 5 to 22 pounds above that expected with non-drug obesity treatments.
By far the most common types of prescription diet pills are the appetite suppressants, a family of drugs that includes Meridia® (Sibutramine) (withdrawn from the U.S. market in October 2010) and Adipex-P® (phentermine). Appetite suppressants increase the amount of serotonin and catecholamine in the brain. The two chemicals are responsible for both mood and appetite. At sufficient levels, they reduce hunger and give you a feeling of fullness.
Most appetite suppressants can only be used for short periods: weeks, or sometimes months. Meridia is an exception, and can be prescribed for up to a year. Meridia's safety for longer periods than a year has yet to be determined, and claims of serious side-effects, including possible heart disease, have been made.
Xenical® (Orlistat) is a lipase inhibitor. That is, rather then working on brain chemicals as appetite suppressants do, lipase inhibitors block the absorption of dietary fat in the intestines. Up to a third of all ingested fat may be blocked. Unlike most appetite suppressors, Xenical can be prescribed for up to a year. Most side-effects involve changes in bowel movements. You may have urgent bowel movements, or need to use the restroom more frequently. Gas, orange-colored stools and oily bowel movements are also common. Women may experience irregular menstrual periods. If you experience itching, swelling, breathing problems or fever while on Xenical, call your doctor immediately.
Dietary Supplements and Other Weight Loss Products
In the absence of effective prescription diet pills, a staggering range of non-prescription diet pills, herbal weight loss products and dietary supplements have flooded the market. The claims made by these products are only loosely based in scientific research, if at all. Very few have been subjected to clinical trials to determine either their effectiveness or their safety.
Many such products claim to burn fat by boosting the body's metabolism. In many cases, this apparent metabolism boost is due to high amounts of caffeine or other stimulants in the product. Long-term use of weight loss products high in stimulants may increase the risk of hypertension and heart disease.
Other common ingredients in weight loss dietary supplements include chromium picolinate, chitosan, pectin, and Siberian ginseng.
For clinically severe obesity, surgery may be an element of treatment. Many people, some physicians included, wrongly believe that obese people merely need to stop eating so much and they will lose weight. In reality, severe obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a physician who:
There are two types of obesity surgery, namely restrictive and combined restrictive/malabsorptive. Different ways of performing each surgery have been developed. Each type of surgery has its own risks and side-effects.
Restrictive surgery, also called a gastric bypass, uses surgically placed bands or staples to decrease the size of your stomach, creating a restriction in the amount of food you can eat. Possible complications include leaking of stomach juices into the abdomen, injury to the spleen, erosion of the band, breakdown of the staple line and the sectioned portion stretching from overeating.
Infection or death has been reported in under 1% of patients. After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly; if you don't adjust your eating habits, your weight loss will be inhibited. In addition, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins, often with the help of a nutritionist or other health care professional.
80% of restrictive surgery patients lose some weight; 30% reach normal weight. Equally important, the operation appears to resolve a variety of serious weight-related health problems. Diabetes, which is common in obese people and which can lead to blindness, nerve degeneration and death, is often much improved or even cured by the weight loss that occurs after a gastric bypass.
The procedure can also stop Idiopathic Intracranial Hypertension (IIH), or high pressure in the fluid surrounding the brain and spinal cord, a potentially fatal problem that may be related to obesity.
Combined restrictive and malabsorptive surgery is a combination of restrictive surgery as described above, along with bypass or malabsorptive surgery, in which the stomach is connected to the small intestine, bypassing the duodenum, which is the beginning portion of the small intestine. The longer the segment of small intestine bypassed, the greater the malabsorption, and the fewer the calories absorbed from the food you eat and the greater the weight loss.
There is a risk from this procedure for nutritional deficiencies including malabsorption of vitamin B12, leading to anemia and iron deficiency. The reduction in vitamin D and calcium absorption can cause osteoporosis and other bone disease. Other complications are similar to those of restrictive surgery and are due to creating the stomach pouch. After surgery, lifelong use of nutritional supplements such as multivitamins, vitamin B12, vitamin D and calcium is necessary, as is nutritional counseling. The dumping syndrome in which food moves too quickly through the small intestine can cause nausea, weakness, sweating, faintness and sometimes diarrhea after eating. There can also be an inability to eat sweets without severe weakness and sweating. Dairy intolerance, constipation, headache, hair loss and depression are other possible side-effects.
The average weight loss in patients undergoing this kind of surgery, depending on the specific operative procedure, is between 67 and 93 pounds in one year, and 66-75% of excess body weight over three years.
Another key to successful weight loss is incorporating into your new eating and exercise plan behavioral strategies designed to improve eating and physical activity habits. Learning about nutrition, planning what to eat, and making sure you eat regularly help put an end to impulsive and thoughtless eating.
Some specific and helpful behavioral strategies include:
Setting the right goals. Your goals should focus on specific dietary and exercise changes, such as "I will eat five servings of fruits and vegetables every day this week", or "I will work up to being able to walk briskly for 30 minutes at a time", rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once.
Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of the gaining the weight back.
Long-Term Weight Maintenance
A further benefit of a comprehensive clinical program is the likelihood of getting help establishing a maintenance plan once you reach your weight goal. One of the greatest barriers to successful weight loss is the return to old habits. Only a small minority of people who lose weight are able to keep if off for more than three years.
Research studies explain how successful people lose weight and maintain the loss beyond the critical three-year point.
One study showed that people who substitute diet shakes for meals seem to have some success at keeping weight off after they've reached their target weight. First, the use of nutritional diet shakes to substitute for one or two meals a day works well for people who tend to nibble when they're cooking a meal. Furthermore, the likelihood of overeating is eliminated when you carry a fixed portion with you.
Once the weight goal is reached, successful dieters continue to monitor their weight. As soon as they notice a slight gain, they return to a regimen of substituting a shake for one meal a day until the weight has stabilized at or slightly below their ideal weight.
Studies have found that if you lose the weight slowly, you'll be much more effective at keeping it off, especially if you incorporate exercise into your routine and reduce other sedentary behavior, such as watching TV.
Side-effects of anti-obesity drugs can range from mild to serious and should be discussed in detail with your health care professional before making a decision to use these medications.
If considering the use of weight-loss drugs then if you are, may be or could become pregnant or are nursing, be sure to tell your healthcare professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite-suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.
You also will need to tell your health care professional about any existing medical problems before taking these medications, especially thyroid problems, anxiety disorders, epilepsy or other seizure disorders, diabetes, heart disease, high blood pressure, arteriosclerosis, or glaucoma. Also, your healthcare professional needs to be aware of any other medications you are taking or have taken within the last 14 days, especially monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil). Mention any existing or previous problems with alcohol or drug abuse as well.
Weight loss is often recommended.
At least a half dozen controlled studies of patients with hypertension concluded that short-term weight loss is usually associated with a reduction of blood pressure. In patients who experienced a weight loss of 11.7 kg ( about 25.7 lbs), an average blood pressure reduction of -20.7/-12.7mm Hg was recorded. A similar study found that a decrease in blood pressure of -2.5/-1.5mm Hg per kilogram of reduction of weight, and further demonstrated a significant correlation between weight change and blood pressure change.
The sad thing, according to the director of nutrition for the Center for Science in the Public Interest, is that "people keep believing that the magic bullet is just around the corner... if they only eliminate food 'X' or combine foods 'A' and 'B', or twirl around three times before each meal." The reality is that most ordinary people lose weight without the gimmicks Americans spend $30 billion a year on. [Annals of Internal Medicine 119 (1993): p.661]
In the largest survey ever undertaken on the long-term maintenance of weight loss, Consumer Reports found that the vast majority of the most successful dieters said they lost weight entirely on their own, without enrolling in some expensive program, or buying special foods or supplements or following the regimen of some diet guru [Consumers Union news release, 6 May 2002]. The most popular fad diet right now may be Atkins, but it's not the most popular diet, and not the one that seems to work the best.
One of the first lines of approach is to lose excess weight. A good way to do this is to cut down on the amount of sugary snacks and drinks consumed and to eat three well balanced meals a day containing complex carbohydrates and "good" fats which are found in fish, olive oil and nut oils. If you are overweight, losing weight will make the body more insulin sensitive, i.e. less insulin will be required to move sugar from the bloodstream and into various tissues.
Overweight people can lessen the shock to their joints by losing weight. Knees, for example, sustain an impact three to five times the body weight when descending stairs. Therefore a loss of five pounds can eliminate at least 15 pounds of stressful impact on the joint. The greater the weight loss, the greater the benefit.
Achieve normal body weight but avoid rapid weight loss diets, which may result in increased uric acid levels in the blood.
Weight reduction can not only reverse testosterone and luteinizing hormone abnormalities and infertility seen with PCOS, but also improve glucose, insulin and lipid profiles. Obesity is an important feature with regard to hirsutism because it is associated with decreased sex hormone binding globulin (SHBG). This results in increased levels of unbound testosterone and contributes to the acne and hair growth seen in PCOS.
Snoring thought to be caused by excessive weight may be curtailed by a sensible weight loss and exercise program.
It is important to keep your weight at your ideal level as extra body fat places strain on your legs and veins.
During analysis of the data from a Yale study (see link between Increased Risk of Stomach Cancer and treatment Vegetarian/Vegan Diet) the research team found that obesity is strongly linked with risk of these cancers. "The increase in the prevalence of obesity in the United States certainly contributes to the time trends... Our results suggest that prevention strategies for these cancers should emphasize increased consumption of plant foods, decreased consumption of foods of animal origin with the possible exception of dairy products, and control of obesity."
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