Weight Loss Tips
- Cognitive-Behavioral Therapy
- Reducing Television and Video Activities
- Drugs and Other Measures Used to Treat Excess Weight
- Experimental Therapies
- Spot Reduction
Calorie restriction has been the cornerstone of obesity treatment. The standard dietary recommendations for losing weight include decreasing calorie intake by 500 to 1000 calories a day and having a fat intake of no more than 30% of total calories. To maintain a health weight, the daily calorie needs are usually 10-12 calories for each pound of ideal body weight. In general one pound of fat equals about 3,500 calories so one could lose a pound a week by reducing daily calories by about 500 calories. Extreme diets with less than 1,100 calories per day have significant health risks and are often followed by bingeing or overeating. Such low calorie diets usually have insufficient vitamins and minerals, which must then be taken as supplements. Severe dieting has unpleasant side effects such as fatigue, intolerance to cold, hair loss, gallstone formation, and menstrual irregularities. Most of the initial weight loss is in fluids and minerals. Fat is lost later but so is muscle which can account for more that 30% of the weight loss. It is dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days.
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Recent studies have indicated that it is high fat intake, rather than high consumption of sugar, that is the primary culprit in dietary weight gain. Some studies suggest that replacing foods high in fats with low-fat complex carbohydrates (fruits, vegetables and whole grains) may even be more effective than calorie counting in maintaining weight loss. Counting only grams of fat, in fact, may be more effective than keeping a record of daily food intake. One gram of fat contains 9 calories while one gram of carbohydrates or protein has only 4 calories and dietary fat converts more readily to fat in the body than carbohydrates or proteins. In a one-year study, those on low-fat diets lost three times as much weight as those on standard low-calorie diets. No one should use a low-fat diet as an excuse for over consuming carbohydrates, particularly starchy foods and sugar. A high calorie diet from any source will add pounds. People on low fat diets should eat a wide variety of foods and take a multiple vitamin. Simply switching to low-fat or skimmed milk may help people achieve the recommended dietary goal of 30% or fewer calories from fat and also help provide calcium. Fat in this the diet should come from plant oils and fish and not from saturated fat from animal products or trans-fatty acids from hydrogenated (hardened) oils.
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Fat substitutes are added to commercial foods or used in baking to deliver some of the same qualities of fat with fewer calories.
- Avicel (cellulose gel), Carrageenan (made from seaweed), guar gum and gum arabic have been used for decades.
- Olestra is a synthetic fat that passes from the body without leaving behind any calories from fat. Some people experience abdominal cramps and mild to severe diarrhea after eating food s with Olestra. It depletes the body of vitamins A,K,D, and E and carotenoids.
All healthy diets should be high in fiber, which is an important weight loss factor.
- Fiber may reduce the risk for heart disease, diabetes, digestive disorders, and certain cancers.
- Fiber is found only in plants.
- Insoluble fiber found in wheat bran, whole grains, seeds and fruit and vegetable peels is most effective for weight loss.
- Soluble fiber found in dried beans, oat bra, barley, apples, citrus fruits, and potatoes has benefits for the heart.
- Pectin, a fiber found in apples, citrus fruits, and other fruits and vegetables, has been found to increase and prolong the feeling of fullness after eating in people of normal weight.
A number of artificial sweeteners are available such as saccharin, aspartame, Nutra-Sweet, acesulfame K, Sweet One, sucralose, and Splenda. Although contrary to previous concerns, there appear to be no health hazards involved with artificial sugar. Using these substances may give false comfort to some dieters who then increase their fat intake.
Large amounts of aspartame or Nutra-Sweet type of substitutes often seen in diet soda pop can cause significant diarrhea.
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High-protein low-carbohydrate diets are again popular. These diets lead to quick weight loss but the health benefits are questionable. Such diets trigger the release of ketones that can cause nausea, lightheadedness, and bad breath. Many high-protein diets are also high in fat and low in fiber from grains, fresh fruit and vegetables and may trigger carbohydrate binges. However, one 1999 study found that participants on a fat-reduction diet who chose protein-rich foods over carbohydrates reduced weight significantly. Another study found that a "ketone" diet high in protein and very low in fats and carbohydrates can be a safe and effective weight loss regimen for dangerously obese adolescents if they are carefully monitored by a health professional. In the study the diet not only improved weight loss but also decreased cholesterol levels and even restored normal sleep patterns in those who had previously suffered from sleep apnea.
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Most of the programs that offer packaged meals and planning guides tend to be expensive and have not publicized their results. One encouraging study, however, reported that most subjects who had undergone a 12 week weight loss program and then used Ultra Slim Fast supplements as directed for maintenance kept off more than half their weight loss after more than three years. A quarter of the subjects continued to lose weight.
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Exercise, which replaces fat with muscle, is the critical companion for any weight control program but it is as hard to sustain as dieting. Because obesity is often related to heart and other diseases, anyone who is overweight must discuss their exercise program with a physician or nurse practitioner before starting. Most experts recommend building up to 45-60 minutes a day of mostly aerobic exercise such as hiking, brisk walking, or energetic dancing. The treadmill burns the most calories though some studies suggest that frequent exercise sessions as short as 10 minutes in duration may be the most successful program for obese people. Metabolism remains elevated after exercise, and the more strenuous the exercise, the longer the metabolism continues to burn calories before returning to its resting level. Included in any exercise plan should be resistance or strength training performed two or three times a week to replace fat with muscle.
Moderate, regular exercise of any type helps improve insulin sensitivity and reduces the risk of heart disease and diabetes. Exercise must be done regularly as the benefits on heart disease and insulin sensitivity end when exercise is stopped. Exercise also:
- Improves psychological well-being and replaces the sedentary habits that usually lead to snacking.
- May be a mild appetite suppressant.
- Becomes easier as weight decreases.
- Needs to increase as weight decreases
- Needs to increase as people age to keep off the same amount of weight.
People who must sit for hours at work may increase their metabolic rate by frequently shifting positions.
The goal of cognitive-behavioral therapy is to change the daily patterns associated with eating; it is very useful for preventing regaining weight after initial weight loss.
- Record in a diary all activity related to eating patterns including the times of day, length of meal, emotional states, companions as well as the type and amount of food eaten.
- Review the diary to set realistic goals for changing identified patterns.
- Change daily routines to avoid activities that trigger eating.
- Reward success with non-food pleasurable activity.
- Work with others who have similar goals.
An important 1999 study on elementary school children reported that children whose television viewing time was restricted over a school year and who did not eat in from of the television had healthier weights compared to those who watched more television regardless of diet and physical activity. This is a small but significant study pointing to a major factor in the current obesity epidemic and a possible simple method for managing weight in children and possibly in adults.
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People must be cautious when using any weight-loss medications, including diet pills and herbal or natural remedies that do not require a prescription.
- Pills that contain phenylpropanolamine (Acutrim, Dexatrim) effectively suppress the appetite but have been known to cause severe high blood pressure and stroke if taken in doses of 75 mg or higher in the immediate-release form.
- A number of diet remedies (Herbal Phen-fen, Phen Trim, Phen-Cal Xenadrine) contain ephedrine which is derived from ephedra (also known as Ma Huang) herb. Ephedrine is actually a component in adrenaline and can cause rapid heartbeat, high blood pressure, psychosis, and seizures. Pseudoephedrine, an ingredient commonly found in antihistamines, has similar effects.
- Some people have used benzocaine, a local anesthetic available as a gum that alters taste and numbs the mouth.
- One study compared phenylpropanolamine, pseudoephedrine, and a combination of phenylpropanolamine and benzocaine gum. None resulted in any significant weight loss and the combination had more side effects.
- Chitosan, a dietary fiber from shellfish does prevent a little fat from being absorbed in the intestine, but studies have not found that it contributes to weight loss
- Garcinia or mangosteen is a tropical fruit containing hydroxycitric acid that claims to burn fat. Currently there are no studies showing significant weight loss with the chemical.
- Dietary herbal teas contain laxatives when can cause gastrointestinal distress and if overused may lead to chronic pain, constipation and dependency. In rare cases dehydration and death have occurred. Some laxative substances found in the teas include senna, aloe, buckthorn, rhubarb root, cascara, and castor oil.
This drug keeps neurotransmitters such as serotonin in balance and increases metabolism. It causes a feeling of fullness and increases energy levels. Studies indicate that sibutramine assists with weight loss and helps maintain it, however when the drug is stopped there is significant weight gain. Combining this drug with a behavioral modification program may be more effective than taking it alone. Common side effects include dry mouth, constipation, and insomnia. No increased risk of pulmonary hypertension or heart valve abnormalities has been identified. People who have high blood pressure, a history of stroke, heart arrhythmias, or are taking decongestants, asthma inhalers, MAO inhibitors or antidepressants such as Zoloft, Paxil or Prozac should avoid sibutramine (Merdia).
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The body's absorption of fats is reduced with this drug thereby lowering weight and cholesterol. This medication can help about 30% of obese patients with modest weight loss and can assist in long-term maintenance of weight loss. Orlistat blocks the action of an intestinal enzyme that breaks down fats. It does not increase serotonin but makes it work effectively and it is a stimulant. Studies have found that at the end of the first year orlistat users achieve an average of 5-10% drop in body weight. The drug can cause gastrointestinal problems and may interfere with absorption of the fat-soluble vitamins A, D, and E and other important nutrients.
Serotonin is a chemical in the brain that prevents depression and reduces calorie consumption. Unfortunately, the most popular of these drugs used for weight loss have very serious side effects including development of abnormalities in the valves of the heart and uncommonly, a potentially life-threatening condition called pulmonary hypertension. As a result of these problems, dexfenfluramine (Redux) is no longer available. Phentermine (Ionamin, Adipx, Fastin) is still available and is used to decrease appetite and prevent continued weight gain. Phentermine should not be taken with Prozac or similar drugs known as serotonin reuptake inhibitors or MAO inhibitors as they can produce cardiac and lung effects similar to those seen with Phen-fen treatment.
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The amphetamines dextroamphetamine (Dexedrine) , methamphetamine (Desoxyn) and phenmetrazine (Pleudin) were used most often in the past but are not longer prescribed for weight loss. These drugs elevate mood and produce some modest weight loss over the sort term but present serious risks of addiction, agitation and insomnia. Less addictive and possibly safer derivatives of these drugs include benzphetamine (didrex), diethylpropion, and phendimetrazine (Adipost, Botril, Melfiat, Plegine, Prelu-2, Statobex and mazindol (Mazanor, Sanorex).
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Early results from studies on the use of daily injections of genetically engineered leptin are reporting weight loss among some obese people. Higher doses may be needed for higher weights. The most common side effects are pain at the injection site and headache. There appear to be no significant effects on major organs, including the heart, liver, kidneys, central nervous system or gastrointestinal tract. It also does not appear to affect insulin levels.
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In one study, treatment with a combination of growth hormone and an insulin-like substance was shown to improve fat loss when added to diet and exercise in obese post-menopausal women. The drug is administered with self-injection and can cause water retention and swelling. An oral form is being studied but has not shown much effect.
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Phototherapy uses intense bright light (1,500 lux) that has an effect on the release of melatonin and serotonin in the body. Melatonin is a body hormone that regulates sleep and other functions. Phototherapy is often beneficial for depression affected by seasonal changes. One small study using phototherapy each morning reported that three out of four women who were sensitive to the effects of light lost between three and five pounds after ten days.
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Training particular areas of the body is ineffective in reducing fat in specific locations because exercise draws on fat stores throughout the body. Devices such as bust developers, vacuum pants, and exercise belts do absolutely nothing to reduce fat in specific locations or add bulk in the case of the bust developer. Electrical pads designed to wrap around the waist, arms, or thighs have caused burns and fires.
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Creams containing aminophylline (Cellution, Skinny Dip, Thermojetics Body Toning Cream, Smooth Contours) have not been found to reduce either thighs or stomach areas after 8 weeks of use. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could be dangerous for people with circulation problems.
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This procedure, done while under anesthesia, does get rid of fat cells in specific areas such as the thighs, buttocks, or knees. Any weight gain after the procedure is usually deposited in other locations. The pain after the operation can be severe and often the skin does not contract resulting in a flabby look. Ultrasound liposuction is being tested which uses a thin wand that vibrates fatty tissue at high speed until it breaks down and liquefies. Fat is then removed with suction. The procedure may be able to remove large volumes of fat, including fat in areas ordinarily hard to reach using standard liposuction techniques.
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OHSUis the premier bariatric surgery center for the treatment of obesity in Portland, Oregon. We look forward to serving you. Please contact us at 503-494-1983.
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