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How to Achieve Weight Loss? Solutions for Bariatric Patients

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 strategies:

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: 
    1. modestly contributes to weight loss in overweight and obese adults;
    2. may decrease abdominal fat;
    3. increases cardiorespiratory fitness;
    4. 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 patients 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.

5. Pharmacotherapy

  • 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
or mortality.

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