Weight Management State of the Science and Opportunities for Military Programs (2003) / Chapter Skim
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4 Weight-Loss and Maintenance Strategies
4 Weight-Loss and Maintenance Strategies
Pages 79-112
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From page 79... ...
There is significant evidence that losing excess body fat is difficult for most individuals and the risk of regaining lost weight is high. From the first day of initial entry training, an understanding of the fundamental causes of excess weight gain must be communicated to each individual, along with a strategy for maintaining a healthy body weight as a way of life.
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From page 80... ...
A brief discussion of public policy measures that may help prevent overweight and assist those who are trying to lose weight or maintain weight loss is also included. PHYSICAL ACTIVITY Increased physical activity is an essential component of a comprehensive weight-reduction strategy for overweight adults who are otherwise healthy.
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From page 81... ...
An added benefit is the attenuation of the decrease in resting metabolic rate associated with weight loss, possibly as a consequence of preserving or enhancing lean body mass. As valuable as exercise is, the existing research literature on overweight individuals indicates that exercise programs alone do not produce significant weight loss in the populations studied.
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From page 82... ...
The primary goals of behavioral strategies for weight control are to increase physical activity and to reduce caloric intake by altering eating habits (Brownell and Kramer, 1994; Wilson, 1995~. A subcategory of behavior modification, environmental management, is discussed in the next section.
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From page 83... ...
The information obtained from the food diaries also is used to identify personal and environmental factors that contribute to overeating and to select and implement appropriate weight-loss strategies for the individual (Wilson, 1995~. The same may be true of physical activity monitoring, although little research has been conducted in this area.
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From page 84... ...
Although multiple publications suggest that worksite weight-loss programs are not very effective in reducing body weight (Cohen et al., 1987; Forster et al., 1988; Frankle et al., l 986; Kneip et al., 1985; Loper and Barrows, 1985) , this may not be the case for the military due to the greater controls the military has over its "employees" than do nonmilitary employers.
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From page 85... ...
Establishing "car-free" zones is an example of an environmental change that could promote increased physical activity. Nutrition Education Management of overweight and obesity requires the active participation of the individual.
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From page 86... ...
For example, it explains the concept of energy balance in weight management in an accessible, practical way that has meaning to the individual's lifestyle, including that in the military setting. Written materials prepared by various government agencies or by nonprofit health organizations can be used effectively to provide nutrition education.
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From page 87... ...
Many of the studies published in the medical literature are based on a balanced hypocaloric diet with a reduction of energy intake by 500 to 1,000 kcal Mom the patient's usual caloric intake.
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From page 88... ...
pointed out that the group receiving meal replacements maintained a small, yet significant, weight loss over the 5-year program, whereas the control group gained a significant amount of weight. Active intervention, which included dietary counseling and behavior modification, was more effective in weight maintenance when meal replacements were part of the diet (Ashley et al., 2001~.
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From page 89... ...
Although the high-protein diet does not produce significantly different weight loss compared with the high-CHO diet (Layman et al., 2003a, 2003b; Piatti et al., 1994) , the high-protein diet has been reported to stimulate greater improvements in body composition by sparing lean body mass (Layman et al., 2003a; Piatti et al., 1994~.
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From page 90... ...
reported that after 1 year, obese women who reduced their fat intake Dom approximately 39 percent to 22 percent of total caloric intake lost 3.1 kg of body weight, while women who reduced their fat intake from 38 percent to 36 percent of total calories lost only 0.4 kg. Results of recent studies suggest that fat restriction is also valuable for weight maintenance in those who have lost weight (Flats 1997; Miller and Lindeman, 1997~.
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From page 91... ...
Second, although the proportion of total calories consumed as fat has decreased over the past 20 years, grams of fat intake per day have remained steady or increased (Anand and Basiotis, 1998) , indicating that total energy intake increased at a faster rate than did fat intake.
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From page 92... ...
. Dietary fiber is not a panacea, and the vast majority of controlled studies of the effects of dietary fiber on weight loss show minimal or no reduction in body weight (LSRO, 1987; Pasman et al., 1997b, 1997c)
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From page 93... ...
SUPPORT SYSTEMS Almost any kind of assistance provided to participants in a weight-management program can be characterized as support services. These can include emotional support, dietary support, and support services for physical activity.
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From page 94... ...
Furthermore, some weight-loss program participants will be reluctant to use any support services. Counseling and Psychotherapy Services Psychological and emotional factors play a significant role in weight management.
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From page 95... ...
WEIGHT-LOSS AND MAINTENANCE STRATEGIES 95 programs are only as good as the people who are involved. These peer-support programs are more likely to be productive when they are used as a supplement to a program with professional therapists and counselors.
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From page 96... ...
Physical Activity Support Services Support is also required for military personnel who need to enhance their levels of physical fitness and physical activity. All branches of the services have remedial physical fitness training programs for personnel who fail their fitness test, but support is also needed for those who need to lose weight and for all personnel to aid in maintaining proper weight.
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From page 97... ...
Weight loss alters metabolism in obese individuals, limiting energy expenditure and reducing protein synthesis. This alteration suggests that the body may attempt to maintain an elevated body weight.
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From page 98... ...
Increased thermogenesis with food intake, cold, activity Altered nutrient partitioning: increased fat oxidation Obesity drugs also may increase activity levels or stimulate metabolic rate. Drugs such as fenfluramine or sibutramine were reported to increase energy expenditure in some studies (Arch, 1981; Astrup et al., 1998; Bross and Hoffer, 1995; Heal et al., 1998; Scalfi et al., 1993; Troiano et al., 1990)
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From page 99... ...
Sibutramine can increase blood pressure and pulse rate in occasional patients and may cause dizziness and increased food intake (Cole et al., 1998; Hanotin et al., 1998a, 1998b)
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From page 100... ...
Drugs affecting absorption Amphetamines Methamphetamine Benzphetamine Phedimetrazine Diethylpropionb MazindolC Phentermine PhenylpropanolamineC d, 1 -fenfluramineC d-norfenfluramineC SSRI anti-depressants Sibu~amine Orlistat Acarbose~ a DEA - Drug Enforcement Agency h High abuse potential - measured by the ratio of anorexiant dose to reinforcing dose. weight loss on orlistat is about 8 to 11 percent of initial body weight at 1 year (James WT et al., 1997; Sjos~om et al., 1998~.
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From page 101... ...
The manufacturer recommends that a vitamin supplement containing vitamins A, D, E, and K be prescribed for patients taking orlistat. Drugs Approvedfor Other Conditions A variety of drugs currently on the market for other conditions, but not approved by FDA for obesity treatment, have been evaluated for their ability to induce weight loss.
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From page 102... ...
The combination of ephedrine and caffeine to treat obesity has been reported to produce weight losses of 15 percent or more of initial body weight (Daly et al., 1993; Toubro et al., 1993~. Both drugs are the active ingredients in a number of herbal weight-loss preparations.
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From page 103... ...
Drug companies are devoting a large amount of resources to find new agents to treat obesity. Potential candidates include cholecystokinin, cortiocotropin-releasing hormone, glucagon-like peptide 1, growth hormone and other growth factors, enterostatin, neurotensin, vasopressin, anorectin, ciliary neurotrophic factor, and bombesin, all of which potentially either inhibit food intake or reduce body weight in humans or animals (Bray, 1992b, 1998; Ettinger et al., 2003; Okada et al., 1991; Rudman et al., 1990; Smith and Gibbs, 1984~.
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From page 104... ...
It may be possible in the future to develop gene therapy or products that correct these defects in order to treat obesity. Summary Although obesity drugs have been available for more than 50 years, the concept of long-term treatment of obesity with drugs has been seriously advanced only in the last 10 years.
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From page 105... ...
Insufficient data Yes Insufficient data Insufficient data No Insufficient data Insufficient data similar to other chronic diseases associated with alterations in the biochemistry of the body. Most other chronic diseases are treated with drugs, and it is likely that the primary treatment for obesity in the fixture will be the long-term administration of drugs.
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From page 106... ...
The frequency of known side effects of current weight-loss drugs is sufficiently low that the potential for adverse events would not seem to be a reason to avoid the use of these drugs by military personnel. The use of available dietary supplements and herbal preparations to control body weight is generally not recommended because of a lack of demonstrated efficacy of such preparations, the absence of control on their purity, and evidence that at least some of these agents have significant side effects and safety problems.
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From page 107... ...
2. It provides an opportunity for continued monitoring of weight, food intake, and physical activity.
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From page 108... ...
Liposuction (Kral 1998) , Small intestine malabsorption Small intestine malabsorption Small intestine malabsorption Partial gastric outlet obstruction, limited food intake Reduced food intake secondary to very small stomach size arid restricted flow rate into small intestine, reduced intestinal absorption Reduced food intake secondary to very small stomach size and restricted flow rate into small intestine, reduced intestinal absorption Reduced food intake secondary to very small stomach size and restricted flow rate into small intestine, reduced intestinal absorption Prevents solid food consumption Loss of motor function leads to stomach distension which causes a feeling of fullness that may signal the central nervous system Removal of subcutaneous fat " Humoral or neural effects of exposure of ileum to nutrients may lead to increased effects.
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From page 109... ...
. · Practice healthy eating by including fruits, vegetables, and whole grains in the diet.
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From page 110... ...
Daily physical activity is key to successful weight maintenance; it is the factor cited as the most important in maintaining weight loss by the majority of individuals in the National Weight Loss Registry (Klem et al., 1997~. An average of 80 min/day of moderate activity or 35 min/day of vigorous activity is needed to maintain weight (Schoeller et al., 1997~.
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From page 111... ...
Recent studies that have focused on identifying and studying individuals who have been successful at weight management have identified some common techniques. These include self-monitoring, contact with and support from others, regular physical activity, development of problem-solving skills (to deal with difficult environments and situations)
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From page 112... ...
an extremely sensitive area of research, the military could acicIress the question of whether genetic screening for obesity-prone indivicluals is appropriate for their mission. Role of Infectious Disease in Obesity A provocative hypothesis that has been proposer!
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