Weight loss is recommended for anyone with a BMI of 30 or higher or those who are overweight and have two or more risk factors, or have a large waist circumference. Examples of risk factors include cardiovascular disease or a family history of it, smoking, hypertension, age (men: 45 years or older; women: 55 years or older, or postmenopausal), diabetes, and physical inactivity.

Dietary modifications and increased physical activity are generally recommended to help people achieve and maintain a healthier body weight. But for very obese individuals, additional treatment options or interventions may be warranted. There are a few FDA approved antiobesity drugs that can be prescribed as an adjunct to diet, exercise, and behavior therapy for these individuals. For those with extreme obesity (BMI of 40 or above or a BMI of 35 or above with additional risk factors), weight loss surgery may be recommended. At present, in the case of extreme obesity, weight loss surgery (also known as bariatric surgery) is the most effective treatment to yield significant weight loss and reduction of weight-related disorders. Although not without significant risk, these procedures dramatically reduce stomach capacity, limit food intake, and increase satiety. Losses of 50% of excess body weight are not unusual. (INFOGRAPHIC 15.13)

Question 15.12

Question 15.13

A modest reduction in body weight can result in significant improvements in health for people who are overweight or obese. Losing 5% to 10% of body weight (and maintaining that lower weight) can reduce the risk of chronic diseases (cardiovascular disease and diabetes, for example) and premature all-cause mortality by about 50%.

For those with less severe weight problems, dietary and lifestyle approaches to weight loss may be enough. There are numerous dietary approaches to weight loss, as shown by the number of “diet” books published each year, magazine articles promising an end to the battle of the bulge, and advertisements for commercial weight-loss programs and products. Low-fat diets, low-carbohydrate diets, meal-replacement plans, and others vie for the attention of Americans who are considering or actively pursuing weight loss. Studies demonstrate that most “diets” result in a reduction in calorie intake and that ultimately they vary little in terms of weight loss. Of course, some approaches are more nutritionally sound and conducive to sustaining changes and keeping weight off.

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Healthy weight loss plans maximize nutrient density while reducing calorie intake; increase physical activity; incorporate behavioral strategies to enhance compliance; address individual health concerns; and consider not only dropping pounds, but the maintenance of a lower body weight. One effective and healthful dietary approach seems to be a moderately low-fat diet (less than 30% of total calories from fat), coupled with a moderately high protein intake (25% to 30% of total calories). Including significant amounts of nonstarchy vegetables, fruit, minimally processed whole grains that are high in fiber, and lean sources of protein will decrease the energy density of the diet. This will allow for the consumption of greater quantities of food while keeping energy intake low, which may increase the perception of satiation while adhering to a reduced-calorie diet.

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A common misconception about weight loss is that a person can simply reduce his or her food intake by a certain amount of calories and expect to lose a proportional amount of weight (assuming that a pound of fat contains approximately 3,500 kcal). For example, if a 700 kcal per day decrease in energy intake is made today, and that new lower-calorie intake is maintained for 100 days, many would predict a body weight loss of 20 pounds (70,000 kcal/3,500 kcal/lb of fat). In reality, only about half that weight would be lost in that time because a lighter body expends fewer calories while resting and while moving. As weight loss continues, the magnitude of the calorie deficit will be consistently shrinking (along with the shrinking body), and the rate of weight loss will continually slow. (INFOGRAPHIC 15.14)

Question 15.14

The likelihood of regaining weight lost through any diet or program is well-known and discouraging. However, the National Weight Control Registry (NWCR) provides hope and strategies through the findings from data collected from more than 10,000 people who have successfully maintained long-term weight loss. According to the NWCR, most “successful losers” share common strategies that include maintaining a lower-fat, reduced-calorie eating plan; eating breakfast; weighing themselves at least once a week; watching fewer than 10 hours of television per week; and exercising on average about one hour per day.