Obesity (Weight Loss) (cont.)
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Obesity facts
- What is obesity?
- How common is obesity?
- What are the health risks associated with obesity?
- What causes obesity?
- What are other factors associated with obesity?
- How is body fat measured?
- What about weight-for-height tables?
- What is the body mass index (BMI)?
- Does it matter where body fat is located?
- What can be done about obesity?
- What is the role of physical activity and exercise in obesity?
- What is the role of diet in the treatment of obesity?
- What is the role of medication in the treatment of obesity?
- What about herbal fen/phen?
- What about meal substitutes, artificial sweeteners, and OTC products?
- What is the role of surgery in the treatment of obesity?
- How can patients choose a safe and successful weight-loss program?
- Find a local Internist in your town
How can patients choose a safe and successful weight-loss program?
Scientists have made tremendous strides in understanding obesity and in improving the medication treatment of this important disease. In time, better, safer, and more effective obesity medications will be available. But currently there is still no "magic cure" for obesity. The best and safest way to lose fat and keep it off is through a commitment to a lifelong process of proper diet and regular exercise. Medications should be considered helpful adjuncts to diet and exercise for patients whose health risk from obesity clearly outweigh the potential side effects of the medications. Medications should be prescribed by doctors familiar with the patients' conditions and with the use of the medications. Medication(s) and other "herbal" preparations with unproven effectiveness and safety should be avoided.
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 a 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:
- 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.
- The weight-loss program should be directed toward 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 one to two weeks, but this loss is largely fluid.
- If you plan to lose more than 15 to 20 pounds, have any health problems, or take medication on a regular basis, you should be evaluated by your doctor before beginning your weight-loss program. A doctor can assess your general health and any 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. If you plan to use a very low-calorie diet (a special liquid formula diet that replaces all food intake for one to four months), you should do so under the close supervision of a health care professional.
- 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, and 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. Try to be more active throughout the day and incorporate some simple calorie burners into your everyday routine. Even the most basic activities (such as taking an after-dinner walk, using the stairs at the mall or office instead of taking an escalator or elevator, park your car farther away so you have a longer walk) can get you prepared for more regular exercise like walking or jogging. You may choose to incorporate an individually tailored exercise program into your schedule.
- A commercial weight-loss program should provide a detailed statement of fees and costs of additional items such as dietary supplements.
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 lifelong 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 time, money, and energy.
Maintaining your ideal body weight is a balancing act between food consumption and calories needed by the body for energy. You are what you eat. The kinds and amounts of food you eat affect your ability to maintain your ideal weight and to lose weight.
Medical science has established that eating proper foods can influence health for all age groups. The U.S. Department of Agriculture's current dietary guidelines state the following:
- Eat a variety of foods.
- Balance the food you eat with physical activity -- maintain or improve your weight.
- Choose a diet with plenty of grain products, vegetables, and fruits.
- Choose a diet low in fat, saturated fat, and cholesterol.
- Choose a diet moderate in sugars.
- Choose a diet moderate in salt and sodium.
- If you drink alcoholic beverages, do so in moderation.
National Institutes of Health (NIH); "Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks." "Body Mass Index Table."
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W. B. Droyvold, T. I. Lund Nilsen, S. Lydersen, K. Midthjel, P. M. Nilsson, J.-Å. Nilsson, J. Holmen; "Weight change and mortality: the Nord-Trondelag Health Study." Journal of Internal Medicine. Volume 257 Issue 4, Pages 338 - 345
National Center for Health Statistics; "National Health and Nutrition Examination Survey." http://www.cdc.gov/nchs/nhanes.htm.
World Health Organization; "Global Database on Body Mass Index."
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Lars Sjöström, M.D., Ph.D., Anna-Karin Lindroos, Ph.D., Markku Peltonen, Ph.D., Jarl Torgerson, M.D., Ph.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Kristina Narbro, Ph.D., Carl David Sjöström, M.D., Ph.D., Marianne Sullivan, Ph.D., Hans Wedel, Ph.D.. "Lifestyle, Diabetes, and Cardiovascular Risk FActors 10 Years after Bariatric Surgery." New England Journal of Medicine. Volume 351:2683-2693, December 23, 2004.
U.S. Department of Health and Human Services, U.S. Department of Agriculture; "Dietary Guidelines for Americans."
Previous contributing author: Dennis Lee, MD
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