In 1995, the National Obesity Education Initiative of the National Heart, Lung, and
Blood Institute (NHLBI), in cooperation with the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), convened the first Expert Panel on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults to develop clinical practice
guidelines for primary care practitioners. The impetus for these guidelines was the recognition
that the prevalence of overweight and obesity in the United States is increasing, and
that practitioners need to be alerted to the|
accompanying health risks.
The panel reviewed relevant treatment strategies designed for weight loss that can also be used to
foster long-term weight control and prevention
of weight gain. The consequent recommendations emphasize the potential effectiveness of
weight control using multiple interventions and strategies, including dietary therapy, physical
activity, behavior therapy, pharmacotherapy, and surgery, as well as combinations of these
1. Dietary Therapy
- Low-calorie diets (LCDs) are recommended for weight loss in overweight and obese persons.
- Reducing dietary fat alone without reducing calories is not sufficient for weight loss.
However, reducing dietary fat, along with
reducing dietary carbohydrates, can facilitate caloric reduction.
- A diet that is individually planned to help create a deficit of 500 to 1,000 kcal/day
should be an integral part of any program
aimed at achieving a weight loss of 1 to 2 lb/week.
2. Physical Activity
- Physical activity is recommended as part of a comprehensive weight loss therapy and
weight control program because it:
- modestly contributes to weight loss in overweight and obese adults;
- may decrease abdominal fat;
- increases cardiorespiratory fitness;
- may help with maintenance of weight loss.
- Physical activity should be an integral part of weight loss therapy and weight maintenance.
Initially, moderate levels of physical
activity for 30 to 45 minutes, 3 to 5 days a week, should be encouraged. All adults
should set a long-term goal to accumulate
at least 30 minutes or more of moderate intensity physical activity on most, and
preferably all, days of the week.
Effects of Physical Activity and Diet on Weight Loss (Combined Therapy)
- The combination of a reduced calorie diet and increased physical activity is recommended
since it produces weight loss that may also result in decreases in abdominal
fat and increases in cardiorespiratory fitness.
3. Behavior Therapy
- Behavior therapy is a useful adjunct when incorporated into treatment for weight loss
and weight maintenance.
- Practitioners need to assess the patient’s motivation to enter weight loss therapy;
assess the readiness of the patient to implement the plan and then take appropriate
steps to motivate the patient for treatment.
4. Summary of Lifestyle Therapy
Weight loss and weight maintenance therapy should employ the combination of
LCDs, increased physical activity, and behavior therapy.
- Weight loss drugs approved by the FDA may be used as part of a comprehensive
weight loss program, including dietary therapy and physical activity for patients
with a BMI of ?30 with no concomitant obesity-related risk factors or diseases, and
for patients with a BMI of ?27 with concomitant obesity-related risk factors or
diseases. Weight loss drugs should never be used without concomitant lifestyle modifications.
Continual assessment of drug therapy for efficacy and safety is necessary. If
the drug is efficacious in helping the patient to lose and/or maintain weight loss
xxviii and there are no serious adverse effects, it can be continued. If not, it should be discontinued.
6. Weight Loss Surgery
Weight loss surgery is an option for carefully selected patients with clinically severe
obesity (BMI ?40 or ?35 with comorbid conditions) when less invasive methods of
weight loss have failed and the patient is at high risk for obesity-associated morbidity
For heavy duty bariatric equipment go to: uCan
Health Bariatric Equipment Site