Diet, Fitness and Weight Management – Find Healthy Diet plans
The avoidance of excessive weight gain from excess body fat must be the most crucial component of a successful weight-management program. From the first day of a person’s military service, the military is unique to discuss prevention. The military population is drawn from a pool of people who meet specific body mass index (BMI) and percent body fat requirements.
The primary aim should be to create an atmosphere that encourages people to maintain a healthy weight and body composition during their service. Losing excess body fat is difficult for most people, according to research, and the likelihood of regaining lost weight is high. What must convey an awareness of the fundamental causes of excessive weight gain to each person from the first day of initial entry training and a plan for maintaining healthy body weight as a way of life?
Weight benefit follows a straightforward formula: energy consumption exceeds energy expenditure. Overweight and obesity, on the other hand, are the product of a complex collection of interactions among genetic, behavioral, and environmental factors, as described in Chapter 3. Simultaneously, the overweight population has been given hundreds, if not thousands, of weight-loss techniques, diets, potions, and gadgets; the multi-factorial etiology of overweight challenges clinicians, researchers, and the overweight themselves to recognize lasting, successful weight-loss and maintenance strategies. The number of people who successfully lose weight and keep it off has been reported to be as low as 1 to 3%. (Andersen et al., 1988; Wadden et al., 1989).
Genetics tends to play a part in the etiology of obesity and overweight. On the other hand, genetics cannot explain the rise of overweight people in the United States over the last two decades. Instead, the behavioral and environmental factors that cause people to participate in too little physical activity and consume too much food compared to their energy expenditure must bear the brunt of the blame. These are the variables that weight-loss programs aim to address. This chapter examines the effectiveness and protection of weight-loss techniques and the variations of strategies to good weight loss. The components of good weight maintenance will also be discussed, as maintaining weight loss may contribute to the overweight issue. There is also a brief discussion of public policy interventions that can help reduce obesity and assist those attempting to lose or sustain weight loss.
ACTIVITY IN THE Real WORLD:
For overweight adults who are otherwise healthy, increased physical activity is an integral part of a comprehensive weight-loss plan. The ability to build and maintain an exercise routine is one of the best predictors of long-term success in treating overweight and obesity (Jakicic et al., 1995, 1999; Klem et al., 1997; McGuire et al., 1998, 1999; Schoeller et al., 1997). Exercise and wellness activities needed to meet the services’ physical readiness needs in general, and for weight control in particular, can be bolstered by the availability of exercise facilities on military bases. The intensity, length, frequency, and form of physical activity for a given individual will be determined by pre-existing medical conditions, previous activity levels, physical disabilities, and personal preferences. Referral for further professional evaluation may be necessary, particularly for those who have more than one of the extenuating factors listed above. Physical exercise has several advantages (see Table 4-1), even though weight loss is not achieved (Blair, 1993; Kesaniemi et al., 2001). One of the advantages, an improvement in high-density lipoproteins, has been demonstrated to be achievable with a monthly aerobic exercise threshold of 10 to 11 hours.
A steady progression of physical activity has been recommended for previously sedentary individuals, with the goal of 30 minutes of exercise per day after several weeks of incremental build-up. These may also extend to some military personnel, especially recruits or reservists called back to active duty who may have previously led relatively sedentary lives. Although this amount may be inadequate to prevent weight regain, the activity target has been expressed as an improvement in 1,000 kcal/wk (Jakicic et al., 1999; Pate et al., 1995). A weekly target of 2,000 to 3,000 kcal of additional operation may be required for this reason (Klem et al., 1997; Schoeller et al., 1997). Consequently, when losing weight, mental preparation for the amount of exercise needed to sustain weight loss must begin (Brownell, 1999).
Changing exercise levels is seen as more uncomfortable than changing eating patterns by many people. It’s been shown that breaking up a 30-minute daily workout “prescription” into 10-minute bouts improves enforcement over more prolonged bouts (Jakicic et al., 1995, Pate et al., 1995). Individuals who did brief bursts of physical activity, on the other hand, did not experience changes in long-term weight loss, cardiorespiratory health, or physical activity attendance as compared to those who did more prolonged bouts of exercise over 18 months. According to some research, home fitness equipment (such as a treadmill) increases daily practice probability and is linked to longer-term weight loss (Jakicic et al., 1999). Individual expectations are also essential factors to consider when choosing an operation.
Long-term outcomes can be better with weight training or resistance exercise paired with aerobic activity than aerobics alone (Poirier and Despres, 2001; Sothern et al., 1999). Since strength training helps build muscle, it can reduce lean body mass loss while increasing relative body fat loss. The reduction in resting metabolic rate associated with weight loss, likely as a result of maintaining or enhancing lean body mass, is an added advantage.
While exercise is helpful, current research on overweight people shows that exercise programs alone do not result in substantial weight loss in the populations studied. However, it should be noted that the majority of this research has been performed on middle-aged Caucasian women who live sedentary lifestyles. The inability of exercise alone to achieve substantial weight loss may be due to the neurochemical processes that control eating behavior, which allow people to compensate for the calories they burn during exercise by eating more food (calories). Although exercise programs may result in a short-term weight loss of 2 to 3 kg (Blair, 1993; Pavlou et al., 1989a; Skender et al., 1996; Wadden and Sarwer, 1999), when physical activity is paired with dietary intervention, the outcome improves significantly. After six months to 3 years of follow-up, a weight loss of 7.2 kg was achieved when physical exercise was paired with a reduced-calorie diet and lifestyle improvement (Blair, 1993). Physical activity combined with a healthy diet yields better outcomes than either diet or exercise alone (Blair, 1993; Dyer, 1994; Pavlou et al., 1989a, 1989b; Perri et al., 1993). Furthermore, Now physical exercise is paired with some other weight-loss program, weight regain is significantly reduced (Blair, 1993; Klem et al., 1997). If the exercise schedule is tracked and adjusted as part of the follow-up, there is a correlation between continued follow-up after weight loss and a better outcome (Kayman et al., 1990).
Although studies have shown that military recruits can lose significant amounts of weight through exercise alone during initial entry training, the limited time available to eat meals during training is likely to have contributed to this weight loss (Lee et al., 1994).
MODIFICATION OF BEHAVIOR AND LIFESTYLE:
The use of behavior and lifestyle change in weight control is based on a body of evidence that people become or stay overweight due to modifiable habits or behaviors (see Chapter 3) and that weight loss and maintenance can be accomplished by modifying those behaviors. The main goals of behavioral weight-control interventions are increasing physical activity and decreasing calorie consumption by changing eating habits (Brownell and Kramer, 1994; Wilson, 1995). The next segment addresses environmental management, which is a subcategory of behavior change. Behavioral therapy, which goes back to the 1960s, may be given to a single person or a group of individuals. Individuals typically engage in 12 to 20 weekly sessions lasting 1 to 2 hours each (Brownell and Kramer, 1994), with a weight loss target of 1 to 2 pounds per week (Brownell and Kramer, 1994). (Brownell and Kramer, 1994). Behavioral interventions were often used as stand-alone therapies to simply change dietary habits and lower calorie intake. However, these therapies have recently been used to encourage weight loss and maintenance services in conjunction with low-calorie diets, medical nutrition counseling, nutrition education, fitness programs, supervision, pharmacological agents, and social support.
Feedback and Self-Monitoring:
One of the cornerstones of behavioral therapy is self-monitoring of food intake and physical activity, which helps the person establish a sense of responsibility. Patients may also be required to maintain a regular log of their biological activities. Self-monitoring of food intake is often linked to a rapid reduction in food intake and, as a result, weight loss (Blundell, 2000; Goris et al., 2000). This decrease in food consumption is thought to result from increased food awareness and/or fear of what the dietitian or nutrition therapist will think about the patient’s eating habits. Food diaries are also used to identify personal and environmental factors that lead to overeating and pick and incorporate effective weight-loss strategies for the individual (Wilson, 1995). Although little research has been done in this field, the same could be said for physical activity tracking. Self-monitoring also allows clinicians and patients to assess which approaches are practical and how improvements in eating behavior or exercise affect weight loss. Recent research suggests that daily bodyweight self-monitoring may be a helpful supplement to behavior change services (Jeffery and French, 1999).
Such Psychological Techniques:
Eating only regularly scheduled meals; doing nothing else while eating; consuming meals only in one location (usually the dining room) and leaving the table after eating; shopping only from a list; and shopping on an empty stomach are some of the additional interventions used in behavioral therapy services (Brownell and Kramer, 1994).
Reinforcement methods are also used in the behavioral treatment of obese and overweight people. Subjects can choose a positively reinforcing experience, such as engaging in an incredibly pleasurable activity or buying a particular object after achieving a target (Brownell and Kramer, 1994).
Cognitive restructuring of erroneous or unhealthy weight-control beliefs may be another essential behavioral therapy services component (Wing, 1998). Cognitive behavior therapists’ techniques may be used to help a person recognize potential causes for overeating, cope with negative societal perceptions about obesity, and understand that a minor dietary infraction does not equal failure. Behavioral services also provide nutrition education and social care, which will be addressed later in this chapter.
Obesity behavioral therapies are often effective in the short term. The long-term efficacy of these therapies, on the other hand, is more debatable, with evidence showing that many people recover their original body weight within 3 to 5 years of completing treatment (Brownell and Kramer, 1994; Klem et al., 1997). (1) establishing requirements to match patients to therapies, (2) increasing initial weight loss, (3) increasing the duration of care, (4) stressing the role of exercise, and (5) integrating therapeutic programs with other treatments such as pharmacotherapy, surgery, or strict diets are all strategies for maximizing the long-term benefits of behavioral therapies (Brownell and Kramer, 1994).
Recent studies of people who have lost weight for a long time can provide new insights into developing behavioral treatment strategies. Klem and coworkers (1997) found that weight loss achieved by exercise, sensible dieting, decreased fat intake, and individual behavior improvements could be sustained for long periods after examining data from the National Weight Control Registry. However, since this population was self-selected, it does not represent the experiences of the average civilian. There is reason to believe that the Registry people are exceptionally disciplined because they have lost and retained a considerable amount of weight (at least 30 lb over 2 or more years). Consequently, the Registry’s experience could provide insight into the military population, but there is no evidence to back this up with authority. In either case, most Registry participants claim to have made substantial long-term behavioral improvements, such as portion control, low-fat food collection, 60 minutes or more of physical exercise, self-monitoring, and well-honed problem-solving skills.
Environments in which People Eat:
Restructuring the climate that causes overeating and inactivity may be an essential part of weight loss and management. The home, the office, and the community are all part of the atmosphere (e.g., places of worship, eating places, stores, movie theaters). Environmental considerations include the abundance of low-energy-density foods with high nutritional value, such as fruits, vegetables, nonfat dairy products, and other low-energy-density foods. Rather than grabbing a candy bar or bag of chips and a drink from a vending machine, environmental restructuring emphasizes frequenting dining facilities that generate attractive fares with lower energy density and enough time to consume a wholesome meal. Busy lifestyles and hectic work schedules can lead to eating habits that contribute to a less-than-ideal eating atmosphere, but small changes can break these habits.
Military base commanders should inspect their facilities to recognize and eradicate conditions that facilitate one or more unhealthy eating habits that contribute to obesity. Good eating choices have been expanded at several nonmilitary workplace dining facilities and vending machines. While several studies have shown that worksite weight-loss strategies are ineffective in reducing body weight (Cohen et al., 1987; Forster et al., 1988; Frankle et al., 1986; Kneip et al., 1985; Loper and Barrows, 1985), this might not be the case for the military due to the more significant influence it has over its “employees.”
Obesity-promoting eating habits include:
1.At home, eating little or no meals.
2.Choosing calorie-dense, high-fat foods
3.Choosing high-fat snack foods from conveniently located vending machines or snack shops, combined with a lack of time to prepare less costly, healthier alternatives.
4.Getting meals at sit-down restaurants with broad portion sizes or buffets with “all-you-can-eat” options
Easy improvements to the eating environment include:
1.Prepare meals at home and pack lunches in a bag.
2.In restaurants, learn to estimate or calculate portion sizes.
3.Recognize the fat content of menu items and buffet table dishes.
4.Smoking should be prohibited, and alcohol intake should be restricted.
5.Low-calorie foods can be substituted for high-calorie foods.
6.Change your commute to work to avoid passing by a favorite eatery.
Environment for Physical Activity:
Even in highly motivated individuals, significant barriers to exercise include the time it takes to complete the mission and the lack of facilities or appropriate places to exercise. Environmental interventions highlight the various ways that physical activity can be incorporated into a busy lifestyle and aim to take advantage of all available opportunities (HHS, 1996). Workplace facilities that are more “user friendly,” such as measured indoor walking routes and lunchtime low-level aerobics classes, may be needed to promote female participation in exercise activities, such as accommodating the need for more after-exercise “repair time” by women and accommodating the need for more after-exercise “repair time” by women (Wasserman et al., 2000). Healthy sidewalks and parks and alternative modes of transportation to work, such as walking or bicycling, all contribute to a more active community. Creating “car-free” zones is an example of a city shift that might encourage more physical activity.
Individual involvement is needed in the management of overweight and obesity through nutrition education. Nutritionists should provide individuals with a basis of information that will help them to make informed food choices.
Nutrition education is distinct from nutrition therapy, even though the two share a lot in common. The motivational, mental, and psychological problems associated with the current challenge of weight loss and weight control are more discussed explicitly in nutrition therapy and dietary management. It explores the how and why of dietary, behavioral changes. On the other hand, health education offers fundamental knowledge about the scientific foundations of nutrition, allowing people to make educated decisions about food, cooking methods, dining out, and portion sizes. Nutrition education programs can also address the importance of nutrition in disease prevention, sports nutrition, and nutrition for pregnant and lactating women. Successful health education imparts nutrition awareness and its application to healthy living. It describes the principle of energy balance in weight control, for example, in an open, realistic manner relevant to the individual’s lifestyle, including that of military personnel.
Nutrition education can be efficiently delivered using written materials prepared by different government departments or nonprofit health organizations. On the other hand, written materials are most valuable when used to supplement informal classroom or therapy sessions and offer exact details, such as a table of food calorie content. Education services can take many forms, including formal classes, informal community meetings, and teleconferencing. It’s beneficial if everyone in the community has a similar history (but seldom possible).
The most popular instructional formats are those that provide program participants with realistic and appropriate nutrition knowledge. Land trips to post exchanges, restaurants (fast food and others), movies, and other locations where food is bought or eaten, for example, are part of certain military weight-management services (Vorachek, 1999).
When spouses and other family members participate in an education program, it increases the probability that other members of the household will make permanent improvements, increasing the likelihood that program participants will continue to lose weight or sustain their weight loss (Hart et al., 1990; Hertzler and Schulman, 1983; Sperry, 1985). Those in the household who are most likely to shop for and prepare food need special attention. Nutrition control is rarely successful without the participation of family members unless the program participant lives alone.
There are two steps of weight-management programs: weight loss and weight maintenance. Although exercise is obviously the most crucial component of a weight-loss plan that influences the rate of weight loss, it is clear that dietary restriction is the most critical component of a weight-loss program that controls the rate of weight loss. Food intake accounts for 100% of daily energy intake, while exercise accounts for 15 to 30% of daily energy expenditure. As a consequence, decreasing energy consumption could have the most significant effect on the energy balance equation. The number of diets suggested is nearly infinite, but all diets include reductions in protein, carbohydrate (CHO), and fat proportions regardless of the term. The parts that follow look at various combinations of these three energy-containing macronutrients’ proportions.
Hypocaloric, nutritionally balanced diets:
Many dietitians who treat patients who want to lose weight advise them to eat a nutritionally balanced, hypocaloric diet. This diet consists of the same foods that a patient typically consumes but in smaller amounts. There are several reasons why such diets are appealing, but the main reason is that the advice is straightforward—individuals simply need to follow the Food Guide Pyramid of the United States Department of Agriculture. Individuals should consume a variety of foods, with the majority being grain products (e.g., bread, pasta, cereal, rice), eat at least five servings of fruits and vegetables each day, eat only small quantities of dairy and meat products, and reduce their intake of foods that are high in fat or sugar or contain little nutrients, according to the Pyramid. However, it is essential to emphasize the portion sizes used to calculate the recommended number of servings while using the Pyramid. A majority of customers, for example, are unaware that a slice of bread is one slice and that a serving of meat is just three ounces.
Since all that is required is to consume smaller servings, a pyramid-based diet can easily be adapted from foods eaten in group environments, including military bases. Also, with smaller servings, getting sufficient amounts of the other essential nutrients is not tricky. Much research in the medical literature is focused on a healthy hypocaloric diet with a 500 to 1,000 kcal reduction in energy intake from the patient’s average caloric intake. Diets like these are recommended by the US Food and Drug Administration (FDA) as the “ordinary protocol” in clinical trials of new weight-loss medications to be used by both the active agent community and the placebo group (FDA, 1996).
Consumers can buy meal replacement programs for a fair price from commercial sources. The meal replacement industry recommends using their items to supplement one or two of the three regular meals, while the third meal should be well-balanced. Furthermore, two snacks a day consisting of fruits, vegetables, or diet snack bars are recommended. Individuals on this plan consume approximately 1,200 to 1,500 kcal per day.
In contrast to conventional calorie-restricted diet plans, various studies have tested long-term weight management using meal replacement, either self-managed (Flechtner-Mors et al., 2000; Heber et al., 1994; Rothacker, 2000), with intensive nutritional therapy.
Or with behavior modification services (Ashley et al., 2001; Ditschuneit and Flechtner-Mors, 2001; Ditschuneit e Early in the studies (roughly the first three months of the plan), the most weight loss occurred (Ditschuneit et al., 1999; Heber et al., 1994). According to one report, women lost more weight by the third and sixth months of the plan, but men lost the majority of their weight by the third month (Heber et al., 1994). After 2 to 5 years of follow-up, all research found that substantial weight loss was sustained. According to Hill’s (2000) study of Rothacker (2000), the meal replacement group suffered a slight but notable weight loss throughout the 5-year program, while the control group gained significant weight. When meal substitutes were used in the diet, active intervention, which included nutritional therapy and behavior modification, was more successful in weight management (Ashley et al., 2001). Meal substitutes have also been found to increase dietary habits, such as nutrient delivery, micronutrient intake, and fruit and vegetable consumption.
Long-term weight loss with meal replacements increases biomarkers of disease risk, such as blood glucose, insulin, and triacylglycerol levels; systolic blood pressure (Ditschuneit and Fletchner-Mors, 2001; Ditschuneit et al., 1999); and plasma cholesterol reductions (Ditschuneit and Fletchner-Mors, 2001; Ditschuneit et al., 1999). (Heber et al., 1994).
Employees in high-stress positions (e.g., police, firefighters, hospital, and aviation personnel) who engaged in worksite weight-loss and maintenance programs that used meal substitutes were assessed by Winick and colleagues (2002). At a one-year follow-up, the meal replacements were successful in reducing weight and sustaining weight loss. In comparison, Bendix and coworkers (2002) found that meal replacements were linked to harmful weight loss and weight maintenance outcomes in Denmark. However, this was not an intervention study; instead, participants were tracked for six years via phone interviews, and data was self-reported.
Diets that are unbalanced and Hypocaloric:
Hypo caloric diets that are unbalanced limit one or more of the calorie-containing macronutrients (protein, fat, and CHO). The argument offered by proponents of these diets is that restricting one macronutrient promotes weight loss while limiting others. Many of these diets are included in layman’s books, and they are often not written by health practitioners and are not based on solid scientific nutrition principles. There are few to no research publications for any of these dietary regimens, and almost none have been researched long term. As a result, few conclusions can be made about the diets’ safety, if not their efficacy. Below are the most common types of unbalanced, hypo caloric diets.
Low-Carbohydrate, High-Protein Diets:
The optimum macronutrient ratio for adults has been a source of heated discussion. Typically, this research compares the amount of fat and carbohydrates in the diet; however, there has been a growing interest in the role of protein in the diet (Hu et al., 1999; Wolfe and Giovannetti, 1991). The results of a higher protein diet (CHO/protein ratio 1.0) versus a higher CHO diet (CHO/protein ratio 3.0) have been studied. Even though the high-protein diet does not result in substantially more significant weight loss than the high-CHO diet (Layman et al., 2003a, 2003b; Piatti et al., 1994), the high-protein diet has been shown to promote more significant changes in body composition through sparing lean body mass (Layman et al., 2003a; Piatti et al., 1994).
Stillman and Baker (1978) and Atkins (Atkins, 1988; Atkins and Linde, 1978), as well as Sears and Lawren, introduced high-protein, low-CHO diets to the American public in the 1970s and 1980s (1998). Some of these diets have a high-fat content (> 35 percent of calories), while others have a moderate fat content (25–35 percent of calories). Although most of these diets have been advocated by nonscientists who have performed little to no significant scientific study, others have been subjected to rigorous research (Skov et al., 1999a, 1999b). However, there is a dearth of 2-year or longer randomized clinical trials to determine the potential beneficial effect of weight loss (achieved by nearly any dietary regimen, no matter how unbalanced) on blood lipids. More extended studies are also required to differentiate the positive effects of weight loss from the long-term implications of eating an unbalanced diet.
Writers of layman’s books have suggested benefits of high protein diets, such as consuming a high-protein, low-CHO diet creates a “near-euphoric” state of optimum physical and mental efficiency (Sears and Lawren, 1998). These arguments are not backed up by empirical evidence.
Even though these diets are designed to be consumed ad libitum, overall daily energy consumption decreases due to the monotony of the food options, other diet restrictions, and the enhanced satiety effect of protein. Furthermore, reducing CHO intake causes glycogen loss and severe diuresis (Coulston and Rock, 1994; Miller and Lindeman, 1997; Pi-Sunyer, 1988). As a result, the relatively rapid initial weight loss on these diets is primarily due to the loss of body water rather than fat retained in the body. Mild dehydration can hurt physical and cognitive health, which is a primary concern for military personnel. Small changes in hydration status, for example, can impair an army pilot’s ability to detect changes in equilibrium.
Several recent studies have shown that eating a high-protein, low-carbohydrate diet can be beneficial. In addition to sparing fat-free mass (Piatti et al., 1994) and causing greater weight and fat loss than high-CHO diets (Skov et al., 1999b), high-protein diets have been linked to lower fasting triglycerides and free fatty acids in healthy people and the normalization of fasting insulin levels in hyperinsulinemic, normoglycemic obese people (Baba et al., 1999; Skov et al., 1999b). Furthermore, a 45-percent protein diet substantially decreased resting energy consumption than a 12-percent protein diet (Baba et al., 1999). The research that looked at high-protein diets lasted just a year or less, so these diets’ long-term protection is uncertain.
Diets that are low in fat:
For several years, low-fat diets have been one of the most frequently used therapies for obesity (Astrup, 1999; Astrup et al., 1997; Blundell, 2000; Castellanos and Rolls, 1997; Flatt, 1997; Kendall et al., 1991; Pritikin, 1982). Fat intakes of no more than 10% of total caloric intake are recommended by the most stringent versions of these diets, such as those suggested by Ornish (1993) and Pritikin (1982). While these restrictive diets can help people lose weight, the restricted food options make them difficult to sustain over long periods by people who want to live a regular life.
Smaller reductions in fat consumption, which make a food plan easier to adopt and consider for many people, can also help people lose weight (Astrup, 1999; Astrup et al., 1997, 2000; Blundell, 2000; Castellanos and Rolls, 1997; Flatt, 1997; Kendall et al., 1991; Shah and Garg, 1996). Sheppard and colleagues (1991) found that obese women who reduced their fat intake from approximately 39 percent to 22 percent of total calories lost 3.1 kg of body weight after one year, while obese women who reduced their fat intake from 38 percent to 36 percent of total calories lost just 0.4 kg.
Recent research suggests that those who have lost weight will benefit from fat restriction for weight maintenance (Flatt 1997; Miller and Lindeman, 1997). Dietary fat reduction can be accomplished by counting and limiting the number of grams (or calories) consumed as fat, limiting the intake of certain foods (for example, fattier cuts of meat), and substituting reduced-fat or nonfat versions of nutrition for their higher fat counterparts (for example, skim milk for whole milk, nonfat frozen yogurt for full-fat ice cream, baked potato chips for fried chips) (Dywer, 1995; Miller and Lindeman, 1997). The burgeoning availability of low-fat or fat-free goods, which have been promoted in response to evidence that decreasing fat intake can help in weight reduction, has made pursuing this latter strategy easier over the last decade.
The mechanisms underlying weight loss on a low-fat diet aren’t well understood. Weight loss could result from a decrease in overall energy consumption alone, but a low-fat diet could also affect metabolism (Astrup, 1999; Astrup et al., 2000; Castellanos and Rolls, 1997; Shah and Garg, 1996). According to reports, short-term adherence to a diet containing 20 or 30 percent of calories from fat improved 24-hour energy consumption in formerly obese women compared to an isocaloric diet containing 40 percent of calories from fat, according to reports (Astrup et al., 1994).
Fat consumption as a percentage of total caloric intake has decreased in the United States over the last two decades (Anand and Basiotis, 1998), while average body weight and the proportion of the population suffering from obesity have risen dramatically (Mokdad et al., 1999). This apparent inconsistency may be due to a variety of factors. First, when asked to report their dietary fat intake, both participants tend to selectively underestimate it while decreasing average fat intake (Goris et al., 2000; Macdiarmid et al., 1998). If these findings reflect people’s general tendencies who fill out dietary surveys, the amount of fat eaten by obese and likely nonobese people is higher than is generally stated. Second, although the percentage of total calories consumed as fat has decreased over the last 20 years, daily fat intake has remained constant or increased (Anand and Basiotis, 1998), implying that total energy intake has increased faster than fat intake. These results are bolstered by the fact that the availability of low-fat and nonfat, yet calorie-dense snack foods (e.g., crackers, candy, cookies, cake, frozen desserts) has increased significantly since the early 1990s. However, overall energy intake is still significant, and consuming too many of these low-fat snacks could contribute to weight gain as quickly as eating too many of their high-fat equivalents (Allred, 1995).
The overall effect of low-fat diets has been stated in two recent systematic studies. Astrup and colleagues (2002) looked at four meta-analyses of weight loss in ad libitum low-fat diet intervention studies. They discovered that low-fat diets resulted in substantial weight loss in both normal-weight and overweight people. There was also dose-response interaction, with a 10% reduction in dietary fat expected to result in a 4- to 5-kg weight loss in someone with a BMI of 30. Kris-Etherton and colleagues (2002) discovered that a moderate-fat diet (20 to 30% of energy from fat) was more likely to encourage weight loss because patients were more likely to stick to it than a diet that was highly limited in fat (less than 20% of energy).
Diets rich in fiber:
Most low-fat diets are also high in dietary fiber, and some researchers attribute low-fat diets’ beneficial effects to their high content of dietary fiber-rich vegetables and fruits. High-fiber diets are recommended because they can minimize energy intake and alter metabolism (Raben et al., 1994). Dietary fiber’s beneficial effects can be achieved by the following mechanisms: (1) caloric dilution (most high-fiber foods are low in calories and fat); (2) increased chewing and swallowing time reduces total intake; (3) improved gastric and intestinal motility and emptying with less absorption (French and Read, 1994; Leeds, 1987; McIntyre et al., 1997; RI gaud et al., 1998; Schonfeld et al., 1997; Vincent et al., 1997; Vincent et al., 1997 (Pasman et al., 1997a, 1997b, 1997c). Dietary fiber isn’t a magic bullet; in fact, the vast majority of controlled research on dietary fiber’s impact on weight loss shows little to no weight loss (LSRO, 1987; Pasman et al., 1997b, 1997c).
Many people and businesses advocate for dietary fiber supplements to help people lose weight and reduce their risk of heart disease and cancer. Numerous short-term experiments using purified or partially purified dietary fiber have demonstrated decreases in serum lipids, glucose, and insulin levels (Jenkins et al., 2000). Long-term research haven’t always backed up these claims (LSRO, 1987; Pasman et al., 1997b). Current guidelines indicate that a diet rich in whole fruits and vegetables, rather than dietary fiber supplements, may benefit cardiovascular and cancer risk factors (Bruce et al., 2000). These diets are usually lower in fat and higher in carbohydrates.
Diets with a Very Low-Calorie Count:
In the 1970s and 1980s, very-low-calorie diets (VLCDs) were commonly used for weight loss, but they have fallen out of favor in recent years (Atkinson, 1989; Bray, 1992a; Fisler and Drenick, 1987). A VLCD is described by the FDA and the National Institutes of Health as a diet with less than 800 calories per day. A more scientific concept is a diet that provides 10 to 12 kcal/kg of “desirable” body weight/day, which considers body size (Atkinson, 1989). Powdered formulas or limited-calorie servings of foods with a high-quality protein source, CHO, a small percentage of calories as fat, and the daily vitamin and mineral requirements are the most commonly used VLCDs (Kanders and Blackburn, 1994; Wadden, 1995). Three to five times a day, the portions are consumed. The primary aim of a VLCD is to achieve rapid weight loss without sacrificing significant lean body mass. VLCDs typically include 1.2 to 1.5 g of protein/kg of desired body weight in the formula or as fish, lean meat, or fowl to achieve this aim. Fisler and Drenick (1987) conducted a literature review and concluded that about 70 g of protein per day is needed to achieve nitrogen balance on a VLCD in a short period.
VLCDs aren’t right for anyone who’s overweight, and they’re typically reserved for people who have a BMI of more than 25 (some recommendations recommend a BMI of 27 or even 30), have medical problems from their weight, and have already sought more conservative treatment options. Furthermore, due to the potential for harmful side effects of these diets (e.g., gallstone development, dietary deficiencies, and cardiac arrhythmias), medical and nutritional monitoring is required when people are on them.
VLCDs are relatively successful in the short term, with weight losses of about 15 to 30 kg recorded in a variety of studies over 12 to 20 weeks (Anderson et al., 1992, 1999; Apfelbaum et al., 1987; Atkinson, 1989; Fisler and Drenick, 1987; Kanders and Blackburn, 1994). However, the long-term efficacy of these diets is questionable. About 40 to 50 percent of patients leave the program before meeting their weight-loss targets. Furthermore, only a small number of people who lose a considerable amount of weight using VLCDs can maintain their weight loss once they resume regular eating. Just 30% of patients who met their weight loss targets could hold it off for at least 18 months in two trials. Within a year, most patients had recovered about two-thirds of the weight they had lost (Apfelbaum et al., 1987; Kanders and Blackburn, 1994). The average recovery within the first three years of follow-up was 73 percent in a more recent longer follow-up study. However, by the fourth year, the weight had largely stabilized. The dieters had retained an average of 23% of their initial weight loss after 5 years. At the end of seven years, 25% of dieters had maintained a weight loss of 10% of their initial body weight (Anderson et al., 1999, 2001).
VLCDs tend to be more beneficial than hypo caloric-balanced diets for long-term weight loss. Anderson and colleagues (2001) contrasted the long-term weight-loss control of people on a VLCD diet with behavioral adjustment to people on a hypo caloric-balanced diet in a meta-analysis of 29 studies. They discovered that people who followed a VLCD lost considerably more weight at first and kept it off longer than those who followed a hypo caloric-balanced diet (see Table 4-2).
SYSTEMS OF SUPPORT:
Help programs can include almost any type of assistance offered to participants in a weight-loss program. Emotional support, food support, and physical activity support are examples of these programs. The majority of support programs are arranged in a standardized manner. Other programs are tailored to the needs of a particular location, program, or person. Almost any weight-loss program would be more effective if supported by support services, with a few exceptions (Heshka et al., 2000). However, not all services will help all patients, and not all services will be available in all environments. Furthermore, some participants in weight-loss programs will be hesitant to use any support services.
Services for Counselling and Psychotherapy:
Weight control is affected by psychological and emotional factors. Counseling programs take into account psychological problems related to binge eating. They are designed to educate the patient about the essence of these issues, their consequences, and long-term management opportunities. This intervention is less complex, intensive, and long-lasting than psychotherapy. Without continuing psychotherapy, it should be possible to help patients understand the existence and essence of a sabotaging household or stress-related feeding pattern. This service may be given by a counselor or therapist in person or group sessions. On the other hand, these counselors should be well-versed in the problems that occur with weight-loss plans, such as binge eating and purging. Specific case management and group meetings can be beneficial in the short term so patients can hear the perspectives of those with similar weight-management issues when discussing their concerns (Hughes et al., 1999; Perri et al., 2001; Wadden and Sarwer, 1999).
Person and group psychotherapy programs may also be beneficial. However, the costs of this form of service discourage many patients from using it. Nonetheless, individual patients’ benefits may be significant, and the choice should not be discounted solely based on cost. Concerns about childhood abuse, emotional ties to obesity (fat-dependent personality), and the treatment of coexisting mental health conditions are some of the problems that this form of support program could answer. The therapy format may be structured by the individual therapist, but, as with counseling, the therapist should be familiar with weight-management issues.
Nonprofessional patient-led groups and counseling, such as those offered by Taking Off Pounds Sensibly and Overeaters Anonymous, may be beneficial supplements to weight-loss attempts. Low cost, ongoing support and motivation, and a semi-structured approach to the problems among weight-management patients are all benefits of these services. Their downside is that, since the therapy is informal, the services are just as successful as those who participate. When used as a complement to a program with trained therapists and counselors, peer-support services are more likely to succeed. A sponsor-system program, which pairs people who can support one another, is used in Overeaters Anonymous, a variation of these groups.
Weight Watchers and Jenny Craig are two advertising services that can be useful. Commercial groups have their agendas, who must prevent inconsistencies between licensed counselors’ guidance and the commercial program’s help. Since commercial programs’ counselors are unlikely to be experts, these programs’ level of therapy differs depending on the counselors’ training.
Other Resources in the Community:
Supplemental weight-management programs are available in many communities. Community adult education can provide educational resources, especially in nutrition, using teaching materials from nonprofit organizations like the American Heart Association and the American Diabetes Association, and government agencies (FDA, National Institutes of Health, and U.S. Department of Agriculture). Dietitians on staff at several community hospitals are available for out-patient person therapy (Pavlou et al., 1989a). However, since the military’s TRICARE health-care contracts do not provide medical nutrition therapy, they will need to be changed to deliver dietitian services from community hospitals or other community services (and therefore dietitian counseling).
Support from family:
A person in a weight-loss program may benefit significantly from the support of his or her family. If a participant’s partner is also participating in the program, program dropout rates are lower (Jeffery et al., 1984). The spouse’s presence as a source of motivation (rather than as a source of discipline and monitoring) can become a resource to assist in assisting the individual with essential guidance and direction. However, individual family members (or the entire family) may become an impediment if they show a reluctance to change the household’s diet and eating habits. When children or teenagers are involved, or when partners are unable to relinquish status quo positions of power, family conflict becomes more complicated.
Services on the Internet:
Individuals attempting to lose weight can use a range of Internet and web-related resources (Davison, 1997; Gray and Raab, 1999; Riva et al., 2000). Like any other Internet service, the standard of these pages varies greatly (Miles et al., 2000). Reviewing specific sites to suggest the most useful ones is a vital task for weight-management practitioners. One facility has explored the use of e-mail therapy services for military personnel who travel regularly or are deployed in remote locations; preliminary findings are positive (James et al., 1999a). Using web-based modalities by trained counselors or facilitators stationed at large military installations will make those programs more available to personnel stationed at small bases or in remote areas.
Support Services for Physical Activity:
Military personnel who need to develop their physical health and activity levels may also require assistance. All military branches provide remedial physical fitness rehabilitation services for personnel who fail their fitness tests. Personnel, services, and equipment should all be available to provide practical guidance on how to begin and advance through physical exercise activities (including proper equipment usage and musculoskeletal injury prevention) and when and how to eat under physical activity demands.
DRUGS AND SUPPLEMENTS ON PRESCRIPTION AND OVER-THE-COUNTER:
The use of drugs to promote weight loss may often be effective. Almost all currently prescribed medications induce weight loss by reducing appetite or increasing satiety. One medicine, on the other hand, aids weight loss by preventing fat digestion. These medications must be taken daily to maintain weight loss; when they are stopped, some or all of the weight lost is usually regained. As a result, it is assumed that when medications are successful, they will be used forever. Weight-loss medications can only be used as part of a comprehensive weight-loss program for optimum gain and protection. In general, these drugs can cause a 5- to 10-percent drop in body weight within six months of starting treatment, but the effect varies depending on the person. The presence of side effects, as with any medication, can preclude its use in some occupational settings. Weight-loss medications are currently prescribed for otherwise safe people with a BMI of less than 30 or people with a BMI of 27 to 30 who have a comorbid disorder (e.g., hypertension, diabetes, heart disease). Given that weight-related diseases such as diabetes and hypertension are more prevalent in people with BMIs below 25. That weight loss improves these people’s conditions, weight-loss drug indications should be personalized to the individual patient.
Obese people differ from lean people in various hormonal and metabolic ways (Leibel et al., 1995; Pi-Sunyer, 1993), meaning that genetic factors play a role in weight. Obese people’s metabolisms change as they lose weight, limiting energy consumption and reducing protein synthesis. This change means that the body is attempting to maintain a higher weight.
The fact that genetics can play a role in hormonal and metabolic variations between individuals and the fact that weight loss changes metabolism suggests that obesity is more than a psychological issue or a lack of self-control. Instead, it is a chronic metabolic disorder that, like other chronic diseases, causes biochemical changes in the body. Obesity control and relapse prevention, like most chronic diseases that need ongoing pharmacotherapy to prevent recurrence of symptoms, can one day be achieved through this method of treatment. The parts that follow include a quick overview of the mechanisms of action, effectiveness, and protection of prescription weight-loss drugs and over-the-counter weight-loss supplements.
While it is unlikely that many active-duty military personnel will be candidates for obesity surgery, a discussion of weight-management services would be incomplete without a mention of this choice.
The moderate weight loss from lifestyle therapies and/or medications does not improve the obese status of massively obese people (those with a BMI of 35 or 40). Obesity surgery can result in significant, long-term weight loss for these people. Recent studies have shown substantial changes in the morbidity and mortality of those who are morbidly obese, and surgery is being prescribed to these people more frequently (Hubbard and Hall, 1991).
Surgical Procedures for Obesity Treatment in Humans:
Obesity surgery is appropriate for people who (1) have any of the complications of obesity, such as diabetes, hypertension, dyslipidemia, sleep disorders, pulmonary dysfunction, or elevated intracranial pressure, and have a BMI of 35 or higher, or (2) have a BMI of 40 or higher.
The gastric bypass procedure is currently the most used obesity surgery procedure. Patients lose 62 to 70 percent of their body weight after this treatment and hold it off for more than 5 years (Kral, 1998; MacDonald et al., 1997; Pories et al., 1992, 1995; Sugerman et al., 1989). Another form of obesity surgery, biliopancreatic bypass, and its variations result in weight loss equal to or better than gastric bypass (Kral, 1998). Obesity surgery improves health status in terms of hypertension, dyslipidemia, sleep apnea, pulmonary function (oxygen saturation and oxyhemoglobin levels and decreased carbon dioxide saturation) (Sugerman, 1987; Sugerman et al., 1986, 1988), obesity hypoventilation syndrome, and pseudotumor cerebri, urinary incontinence) (Sugerman, 1987; Sugerman et al., 1986, 1988 (Sugerman et al., 1995, 1999).
Obesity surgery, on the other hand, is considered a last resort operation due to the surgery’s short- and long-term complications. Perioperative mortality is low but critical (about 0.3 to 2%), and it tends to be inversely proportional to the surgeon’s experience (Kral, 1998). Vomiting, diarrhea, electrolyte defects, liver failure, renal stones, pseudo-obstruction syndrome, arthritis syndrome, and bacterial overgrowth syndromes are also possible side effects.
STRUCTURED MAINTENANCE PROGRAMS ARE USED:
When Do You Use a Maintenance Plan?
The individual’s participation in a clear and intentional follow-up program tends to be critical to long-term weight loss performance. Programs to help employees maintain their weight or avoid gaining weight are necessary when:
- A person has successfully met his or her weight-loss target and now wishes to sustain it.
- An overweight person has completed a weight-loss readiness assessment and concluded that he or she is not ready to lose weight at this time, or
- An overweight person is temporarily exempted from a weight-loss program before a medical, physical, or psychological problem is addressed.
A Repair Program’s Components:
Five essential components make up a systematic weight-maintenance strategy:
- It assists the patient in assessing a weight range that they can realistically maintain while mitigating health risks.
2. It helps you to keep track of your weight, food consumption, and physical activity over time.
3. It helps the patient comprehend and put into effect the idea of combining the energy consumed from food with daily physical activity.
4. It supports the patient in developing and sustaining lifestyle improvement techniques for a long enough period for the new behaviors to become lifelong habits (a minimum of 6 months has been suggested [Wing, 1998]).
- It takes into account the long-term effects of medications.
Assisting patients in learning how to harness their energy:
Individuals who have reached their weight-loss target fall into one of two categories: those who see no point in engaging in a maintenance program because they feel they already know how to keep the weight off, and those who are open to improvement and enhancing their weight-management skills.
The health care provider’s primary responsibility is to encourage the former community to learn the requisite weight-management skills. The abilities needed to:
- Maintain a daily exercise routine of at least 60 minutes per day, or an average weekly calorie expenditure of 2,000 to 3,000 kcal (8,368 kJ) (Klem et al., 1997; Schoeller et al., 1997).
- Reduce the number of high-energy foods you consume (especially those that are low in nutrients).
- Include fruits, vegetables, and whole grains in your diet for a balanced diet.
- Recognize the value of portion management.
- Use the services of nutritionists or other types of guidance.
Assisting patients in developing long-term lifestyle change strategies:
Individuals who have lost weight, as previously stated, must make permanent lifestyle changes to sustain their weight loss. Effective maintenance services will provide education and assistance with the following considerations (Foreyt and Goodrick, 1993, 1994; Kayman et al., 1990) to assist patients in making these changes:
Self-monitoring is a technique for keeping track of one’s own behavior. For the first month or two of the maintenance cycle and during times of elevated food exposure, regular weighing and documentation of daily food intake and physical activity is recommended (e.g., during the holidays). If weight gain occurs, resuming this practice can help you regain control of your weight. It’s also essential to stay in touch with counselors regularly (Petri et al., 1993). A schedule of daily, weekly to monthly contacts by mail, phone, or in-person is needed for effective follow-up. Help groups will assist with some of the follow-ups with a healthcare professional, but they should not entirely take their place.
Physical activity. is Maintaining essential weight requires an average of 80 minutes of moderate exercise per day or 35 minutes of vigorous activity per day (Schoeller et al., 1997).
Solving problems is a skill. It is essential to learn to recognize and predict issues that might jeopardize performance. Individuals with problem-solving capabilities will formulate solutions to solve problems as they occur.
Stress reduction. Stress can be reduced by exercise, relaxation, and social support. Some people who overeat in response to stress can benefit from stress-reduction techniques.
Prevention of relapse. It’s normal to experience relapse, a temporary loss of control, and a return to old habits. Learning to predict high-risk scenarios and devising solutions to mitigate the consequences is crucial to avoiding relapse. Patients must learn to forgive themselves and see lapses as “learning opportunities.” It’s vital to regain control.
Influence and support from others. Family or friend sabotage is prevalent, and it can be frustrating for someone trying to lose weight. It is possible to learn how to identify deliberate and accidental sabotage. In severe cases, choosing between a weight-loss program and a relationship may be necessary. Finding a new network of supporters or forming a support group may be beneficial.
MEASURES OF PUBLIC POLICY:
To the degree that the obesity epidemic can be traced back to changes in our living and working environments (e.g., increased availability of calorie-dense foods and reduced opportunities to burn calories), public policy interventions can help prevent obesity and aid those who are trying to lose or maintain weight loss (Koplan and Dietz, 1999). The following are some of the steps that have been proposed and/or tried:
- Increasing the number of low-calorie (and low-fat) items (e.g., fruits and vegetables) available at worksite eating establishments and vending machines, as well as lowering their costs (French et al., 1997; Hoerr and Louden, 1993)
- Putting in place workplace and community services that provide daily supervision, nutrition and wellness promotion, obesity prevention education, and exercise classes or groups.
- Providing more and better places for physical activity by renovating community spaces
- Changing work conditions or routines to promote more physical activity at work and at home
- Requiring employees to engage in routine physical exercise during the workday (IOM, 1998).
Aside from the apparent need to maximize energy consumption compared to intake, none of the weight-loss or weight-maintenance methods suggested have been widely accepted as having any value in weight control. Individual approaches have low effectiveness, and evidence for the efficacy of combinations of processes is limited, with findings varying from one study to the next and from person to person. Some popular strategies have been established in recent studies that have concentrated on identifying and researching individuals that have been effective at weight control. Self-monitoring, communication with and help from others, daily physical activity, problem-solving skills (to cope with challenging conditions and situations), and relapse prevention/limitation skills are some of these. Individual preparation, or high personal encouragement to excel in weight control, is another aspect found by effective weight managers and is not widely addressed when addressing weight-management strategies.