WEIGHT MANAGEMENT TECHNIQUES

Weight loss occurs when the calories consumed are less than the energy the body needs for physiological maintenance and activity.  This may sound overly simplified and certainly the $50 billion-a-year weight loss industry would like us to think it is much more complicated than this.

Weight loss followed by weight gain may be less healthy and certainly more frustrating than maintaining body weight, even at weight above the desirable levels.  When a diet or weight loss strategy fails, the person, not the diet, is blamed.  This causes people to jump to another weight loss method and then another, and a vicious cycle has begun.

 However, a commitment to lifestyle change of eating in healthy ways and engaging in regular exercise seems to be the most effective strategy for weight loss and weight maintenance.  It is also important to set a goal to lose not more than 2 pounds a week because the body tends to lose muscle rather than fat if the weight loss occurs too rapidly.  Many people also complain of “hanging skin” after a rapid, drastic weight loss, which can then require cosmetic surgery to rectify.

A number of approaches to weight loss can be pursued.  How do dieters know when they have succeeded?

Dietary Alterations

A diet that reduces caloric intake is the most common approach to weight loss.  The choice of food and the amount of food are the two factors that distinguish the wide range of diets currently available.  It’s important to note, however, that dieting alone usually does not result in long-term weight loss.  Effective and lasting weight loss requires a lifestyle change, not just going on a diet for a specific time period only to return to your old patterns of eating.  This is the problem many people face, as they go on strict diets and overly restrict their calories.  Because the diet is so restrictive and demanding, it is impossible to continue to follow it for very long and so people return to their previous eating patterns.  In addition, people tend to overeat the foods they denied themselves while dieting because they feel deprived and the forbidden food seems even more alluring this can also lead to binge eating.  Thus diets tend not to work in the long run.

Balanced Diets Supported by Portion Control

For nutritional health, a logical approach to weight loss and subsequent weight maintenance is to establish a nutritionally sound balanced diet (moderately-low in fat, low in saturated fat, and high in complex carbohydrates) that controls portions.  Many people are confused about the difference between a portion size and a serving size.  Diet scales or food models can assist in gaining an understanding of portion sizes.  However, a simple way of measuring one serving size is to think of a serving as equal to the size of the palm of your hand or your fist.  This is not to say that this is all you need to eat for a meal, as the food pyramid recommends that we eat six to eleven servings of grains, three to five servings of vegetables, two to four servings of fruit, two to three servings of milk, and two to three servings of meat each day.

Fad Diets

Many people use fad diets in an attempt to lose weight quickly.  Currently there are over 150 popular diets, often promoted by people who claim to be nutrition experts.  With few exceptions, these approaches are both ineffective and potentially dangerous.  In addition, some involve significant expense.

High-Protein/Low-Carbohydrate Diets

Currently, the most popular diets are those that reduce carbohydrate intake to an extremely low level, while permitting an almost unlimited consumption of animal protein (meat), with its accompanying high fat content.  These diets, such as Dr. Atkins’ New Diet Revolution, Mastering the Zone, and sugar busters, involve potential problems, particularly if followed for long periods.

The restriction of calories is the basis of all diets.  Some suggest limiting the consumption of fat, others sugar, or the caloric intake is dangerously low for all food groups.  Many diet plans, such as the Atkins’ Diet, advocate the restriction of carbohydrates which can cause ketosis.  When the carbohydrate calories are limited, intake of fat usually increases.  This high fat diet can cause an increase in blood ketosis can cause the blood to become too acidic and dehydration can occur.  The body requires a minimum of 50-100 grams of carbohydrate per day to avoid ketosis.  Low-carbohydrate diets are characterized by initial rapid weight loss which is appealing to most people, but this loss is primarily due to water and not fat loss.  Complications associated with low-carbohydrate, high protein diets include dehydration, electrolyte loss, calcium depletion, weakness due to inadequate dietary carbohydrate, nausea due to ketosis, vitamin and mineral deficiencies, and possible kidney problems.  The risk of coronary heart disease may be higher in those who stay on the diet a long time, due to the increased consumption of foods high in saturated fat and cholesterol.

Controlled Fasting

In cases of extreme obesity, some patients are placed on a complete fast in a hospital setting.  The patient consumes only water, electrolytes, and vitamins.  Weight loss is substantial because the body is quickly forced to begin catabolism of its fat and muscle tissues.  Sodium loss, a negative nitrogen balance, and potassium loss are particular concerns.

Today, some people regularly practice unsupervised modified fasting for short periods.  Solid foods are removed from the diet for a number of days.  Fruit juice, water, protein supplements, and vitamins are used to minimize the risks associated with total fasting.  However, unsupervised short-term fasting that is done too frequently can be dangerous and is not generally recommended.

Weight-Reduction Programs

In virtually every area of the country, at least one version of the popular weight-reduction programs, such as TOPS (Take Off Pounds Sensibly), Jenny Craig, Nutri Sure Loser, and Weight Watchers, can be found.  These programs generally feature a format consisting of (1) a well- balanced diet emphasizing portion control and moderate fat, low-saturated fat, and high-complex carbohydrate foods, (2) specific weight loss goals to be attained over a set of period of time, (3) encouragement from supportive leaders and fellow group members, (4) emphasis on regular physical activity, and (5) a maintenance program (follow-up program).

In theory, these programs offer an opportunity to lose weight for people who cannot or will not participate in a physical activity program.  But their effectiveness is very limited.  In fact, the limited success of these programs and the difficulty that working people have in attending meetings have resulted in falling enrollment and the development of home-based programs, such as hospital-based wellness programs, YMCA and YWCA programs, and Weight Watchers.  All these programs are costly when compared with self-directed approaches, especially when the program markers its own food products.

Diet and Physical Activity

Most Americans attempting to lose weight fail to include physical activity component in their dietary approach.  How much exercise is enough? New studies suggest that Americans should engage in at least 45 minutes a day, 5 times a week of moderately intense aerobic exercise.  Also weight training has become a more important factor in weight management.  As with most things, too much or too little exercise is not beneficial.  Some people with eating disorders tend to over-exercise which result in diminishing returns.

Physical Intervention

A second approach to weight loss involves techniques and products designed to change basic eating patterns.  Some are self-selected and self-applied, and others must be administered in an institutional setting by highly trained professionals.

Hunger-and Satiety-Influencing Products

Many overweight people want to lessen their desire to eat or develop a stronger sense of when they have eaten enough.  Today, many dieters are confused about the safety of pharmaceutical approaches to weight loss, including both over-the-counter (OTC) and prescription drugs.

Until recently, phenylpropanolamine (PPA) was incorporated into many OTC weight-loss products.  Discontinuation if its use is based on its adverse effects on conditions such as hypertension, diabetes, glaucoma, and thyroid disease.  PPA can also be found in some OTC and prescription cold and cough medications.  The FDA recommends that consumers not any products containing PPA due to its association with higher risk for stroke.

The FDA also continues to advise against using OTC weight loss products containing the recently banned ephedrine (ma huang and Chinese ephedra).  Because they are categorized as dietary supplements, the FDA can’t regulate these products to ensure that they meet certain standards or are safe and effective.  Many people see these supplements as safe because they are “natural,” and yet they can be more dangerous and deadly than prescription medications because they are not inspected as to the purity and accuracy of the contents or the potency of the ingredients.  A recent review showed that the use herbal supplements increased by 370% between 1990 and 1997.  Ephedrine, found in most herbal diet pills, has been linked to heart attacks, strokes, hepatitis, headache, tremors, anxiety, extreme irritability, and insomnia in consumers of all ages.  Metabolife, an herbal diet supplement that contains ephedra which was recently banned by the FDA has sold 50 million bottles in the last five years, about 101,000 pills an hour.  In 2003 the death of 23 – years-old Baltimore Orioles pitcher Steve Bechler was linked to an Ephedra supplement, prompting the FDA to re-examine the supplement.  Ephedra was banned by the FDA in late 2003.

Some prescription medications have been shown to produce serious side effects.  Two such medications, phentermine and fenfluramine, have been prescribed for patients who wanted to lose weight.  Both drugs affect levels of serotonin, the neurotransmitter associated with satiety.  This popular combination is referred to as phenfen, gradually raise concern among health experts because of the side effects it produced in people with angina, glaucoma, and high blood pressure.  In addition, reports began to surface that some patients had developed a rare but potentially lethal condition called pulmonary hypertension.

During the mid-1990s, a new serotonin-specific weight loss drug, dexfenfluramine (Redux), was approved for use in United States.  Results among patients who used the drug, in combination with dietary modification and exercise, seemed impressive during the initial months of its widespread use.  However, some patients began to take dexfenfluramine with fenfluramine in an attempt to find a new combination that would be more effective than phen-fen or Redux used alone, and death resulted in some cases.

Thus, two combinations of three serotonin-specific drugs were in vogue in early 1997.  However, by May of 1997, there were reports of weight loss patients with newly diagnosed heart valve damage who had been using these drug combinations.  In some cases, damage was only correctable by valve-replacement surgery.  Accordingly, in September 1997 the FDA requested voluntary withdrawal of fenfluramine and dexfenfluramine from the market.  Manufacturers responded by ceasing all distribution of drugs.  Phentermine remains on the market and is used in combination with various antidepressants, such as Prozac, Zoloft, and Paxil.

Soon after reports of initial concern over the use of phentermine and fenfluramine, the FDA approved another serotonin-specific obesity drug, sibutramine (Meridia) even though an advisory committee within the FDA recommended against approving it.  Meridia acts on serotonin in the body similarly to how phenfen and redux functioned and, like its predecessors, has been linked to heart attacks, high blood pressure, strokes, and death; however, it still remains on the market in the United States.  Italy recently pulled Meridia from the market following reports of deaths linked to this drug.

A non-serotonin influencing drug, orlistat (Xenical), has recently been approved.  Unlike the serotonin drugs, orlistat reduces fat absorption in the small intestine by about 30%.  The drug is intended for use among people who are 20% or more above ideal weight.  It could cause a 10% loss of body weight without significant dietary restriction.  Some concern exists about the lack of absorption of fat soluble vitamins among people taking the drug.  Additionally, anal leakage may accompany the drug’s use, particularly following meals with high fat content.

Surgical Measures

When a person is morbidly obese and weight loss is critical, surgical intervention may be considered.  A gastrointestinal or bariatric surgery is a major operation in which a portion of the small intestine is bypassed by in an attempt to decrease the body’s ability to absorb nutrients.  Candidates for these surgery include those with a BMI above 40 or about 100 pounds overweight for men and 80 pounds overweight for women.  People with a BMI between 35-40 who suffer from type 2 diabetes or life threatening cardiopulmonary problems may also be candidates for surgery.  Although this procedure can produce a major weight loss, it is associated with many unpleasant side effects (including diarrhea and liver damage) and various nutritional deficiencies.

Gastric Band Surgery

This is a surgical procedure in which a gastric band implanted around the stomach, dividing the stomach into upper and lower parts.  The band can be tightened or loosened by inflating or deflating the hollow connection tubing which is filled with liquid.  After implantation, a small amount of food fills the top of the stomach and keeps the individual feeling full for longer periods of time, dramatically reducing food intake.  The surgery takes around 2 hours and involves the risks associated with major surgery.  The band is permanent and some potential side effects are vomiting and nausea, and excess food may back up into the esophagus.  Typically, weight is somewhat slower with this type of surgery as compared to bypass surgery.

Gastroplasty, or stomach stapling, is a surgical procedure that involve sealing off a sizable portion of the stomach with surgical staples or recently approved adjustable implanted stomach bands.  The resulting reduced capacity of the stomach decreases the amount of food it can hold.  Patients feel full more quickly after eating a small meal.  This procedure carries the general risks associated with surgery, involves the expense of a major surgical procedure, and is sometimes reversible.  It is also possible to loosen the staples through overeating, negating the effects of the surgery.

Liposuction

Another form of surgical weight loss management is liposuction, or lipoplasty.  In this procedure, a physician inserts a small tube through the skin and vacuum aspirates away fat cells.

Liposuction is basically a cosmetic procedure.  Possible infection, pain and discomfort, bruising, swelling, discoloration, abscesses and unattractive changes in body contours are possible outcomes of liposuction.  Therefore people considering this procedure should carefully investigate all its aspects, including the training and experience of the surgeon, to determine whether it is appropriate for them.

Body Wraps

Although not a surgical procedure or a weight loss technique, body wrapping is another form of body contouring.  In this procedure, various areas of the body are tightly wrapped with 6-inch strips of materials soaked in a solution of amino acids, which is claimed to draw toxins out of the underlying tissue, shrink fatty deposits, diminish cellulite, lighten stretch marks, and eliminate inches of fat.  Once the wrapping is removed, the newly-contoured body area may remain this way for 4 to 10 weeks.  Although the secret to the success of a particular spa’s body wrapping approach is supposed to lie in its uniquely formulated soaking solution, the contouring effect probably results from dehydration of underlying tissue and redistribution of extracellular fluids through pressure from the wrapping.