The rationale given for these diets by their advocates is that the restriction of one particular macronutrient facilitates weight loss, while restriction of the others does not. Many of these diets are published in books aimed at the lay public and are often not written by health professionals and often are not based on sound scientific nutrition principles. For some of the dietary regimens of this type, there are few or no research publications and virtually none have been studied long term. Therefore, few conclusions can be drawn about the safety, and even about the efficacy, of such diets.
The major types of unbalanced, hypocaloric diets are discussed below. There has been considerable debate on the optimal ratio of macronutrient intake for adults. This research usually compares the amount of fat and CHO; however, there has been increasing interest in the role of protein in the diet Hu et al. Although the high-protein diet does not produce significantly different weight loss compared with the high-CHO diet Layman et al. High-protein, low-CHO diets were introduced to the American public during the s and s by Stillman and Baker and by Atkins Atkins, ; Atkins and Linde, , and more recently, by Sears and Lawren While most of these diets have been promoted by nonscientists who have done little or no serious scientific research, some of the regimens have been subjected to rigorous studies Skov et al.
There remains, however, a lack of randomized clinical trials of 2 or more years' duration, which are needed to evaluate the potent beneficial effect of weight loss accomplished using virtually any dietary regimen, no matter how unbalanced on blood lipids. In addition, longer studies are needed to separate the beneficial effects of weight loss from the long-term effects of consuming an unbalanced diet.
These claims are unsupported by scientific data. Although these diets are prescribed to be eaten ad libitum, total daily energy intake tends to be reduced as a result of the monotony of the food choices, other prescripts of the diet, and an increased satiety effect of protein. Thus, the relatively rapid initial weight loss that occurs on these diets predominantly reflects the loss of body water rather than stored fat.
This can be a significant concern for military personnel, where even mild dehydration can have detrimental effects on physical and cognitive performance. For example, small changes in hydration status can affect a military pilot's ability to sense changes in equilibrium. Results of several recent studies suggest that high-protein, low-CHO diets may have their benefits. In addition to sparing fat-free mass Piatti et al. Furthermore, a percent protein diet reduced resting energy expenditure to a significantly lesser extent than did a percent protein diet Baba et al.
The length of these studies that examined high-protein diets only lasted 1 year or less; the long-term safety of these diets is not known. Low-fat diets have been one of the most commonly used treatments for obesity for many years Astrup, ; Astrup et al. The most extreme forms of these diets, such as those proposed by Ornish and Pritikin , recommend fat intakes of no more than 10 percent of total caloric intake.
Although these stringent diets can lead to weight loss, the limited array of food choices make them difficult to maintain for extended periods of time by individuals who wish to follow a normal lifestyle. More modest reductions in fat intake, which make a dietary regimen easier to follow and more acceptable to many individuals, can also promote weight loss Astrup, ; Astrup et al. For example, Sheppard and colleagues reported that after 1 year, obese women who reduced their fat intake from approximately 39 percent to 22 percent of total caloric intake lost 3.
Results of recent studies suggest that fat restriction is also valuable for weight maintenance in those who have lost weight Flatt ; Miller and Lindeman, Dietary fat reduction can be achieved by counting and limiting the number of grams or calories consumed as fat, by limiting the intake of certain foods for example, fattier cuts of meat , and by substituting reduced-fat or nonfat versions of foods for their higher fat counterparts e.
Over the past decade, pursuit of this latter strategy has been simplified by the burgeoning availability of low-fat or fat-free products, which have been marketed in response to evidence that decreasing fat intake can aid in weight control. The mechanisms for weight loss on a low-fat diet are not clear. Weight loss may be solely the result of a reduction in total energy intake, but another possibility is that a low-fat diet may alter metabolism Astrup, ; Astrup et al.
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Support for the latter possibility has come from studies showing that the short-term adherence to a diet containing 20 or 30 percent of calories from fat increased hour energy expenditure in formerly obese women, relative to an isocaloric diet with 40 percent of calories from fat Astrup et al. Over the past two decades, fat consumption as a percent of total caloric intake has declined in the United States Anand and Basiotis, , while average body weight and the proportion of the American population suffering from obesity have increased significantly Mokdad et al.
Several factors may contribute to this seeming contradiction. First, all individuals appear to selectively underestimate their intake of dietary fat and to decrease normal fat intake when asked to record it Goris et al.
Why Is Weight Maintenance More Difficult Than Weight Loss? | SparkPeople
If these results reflect the general tendencies of individuals completing dietary surveys, then the amount of fat being consumed by obese and, possibly, nonobese people, is greater than routinely reported. Second, although the proportion of total calories consumed as fat has decreased over the past 20 years, grams of fat intake per day have remained steady or increased Anand and Basiotis, , indicating that total energy intake increased at a faster rate than did fat intake. Coupled with these findings is the fact that since the early s, the availability of low-fat and nonfat, but calorie-rich snack foods e.
However, total energy intake still matters, and overconsumption of these low-fat snacks could as easily lead to weight gain as intake of their high-fat counterparts Allred, Two recent, comprehensive reviews have reported on the overall impact of low-fat diets. Astrup and coworkers examined four meta-analyses of weight change that occurred on intervention trials with ad libitum low-fat diets. They found that low-fat diets consistently demonstrated significant weight loss, both in normal-weight and overweight individuals.
A dose-response relationship was also observed in that a 10 percent reduction in dietary fat was predicted to produce a 4- to 5-kg weight loss in an individual with a BMI of Most low-fat diets are also high in dietary fiber, and some investigators attribute the beneficial effects of low-fat diets to the high content of vegetables and fruits that contain large amounts of dietary fiber.
The rationale for using high-fiber diets is that they may reduce energy intake and may alter metabolism Raben et al. The beneficial effects of dietary fiber might be accomplished by the following mechanisms: Dietary fiber is not a panacea, and the vast majority of controlled studies of the effects of dietary fiber on weight loss show minimal or no reduction in body weight LSRO, ; Pasman et al. Many individuals and companies promote the use of dietary fiber supplements for weight loss and reductions in cardiovascular and cancer risks.
Numerous studies, usually short-term and using purified or partially purified dietary fiber, have shown reductions in serum lipids, glucose, or insulin Jenkins et al. Current recommendations suggest that instead of eating dietary fiber supplements, a diet of foods high in whole fruits and vegetables may have favorable effects on cardiovascular and cancer risk factors Bruce et al. Such diets are often lower in fat and higher in CHOs. Very-low-calorie diets VLCDs were used extensively for weight loss in the s and s, but have fallen into disfavor in recent years Atkinson, ; Bray, a; Fisler and Drenick, The VLCDs used most frequently consist of powdered formulas or limited-calorie servings of foods that contain a high-quality protein source, CHO, a small percentage of calories as fat, and the daily recommendations of vitamins and minerals Kanders and Blackburn, ; Wadden, The servings are eaten three to five times per day.
The primary goal of VLCDs is to produce relatively rapid weight loss without substantial loss in lean body mass. To achieve this goal, VLCDs usually provide 1.
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VLCDs are not appropriate for all overweight individuals, and they are usually limited to patients with a BMI of greater than 25 some guidelines suggest a BMI of 27 or even 30 who have medical complications associated with being overweight and have already tried more conservative treatment programs.
Additionally, because of the potential detrimental side effects of these diets e. On a short-term basis, VLCDs are relatively effective, with weight losses of approximately 15 to 30 kg over 12 to 20 weeks being reported in a number of studies Anderson et al.
However, the long-term effectiveness of these diets is somewhat limited. Approximately 40 to 50 percent of patients drop out of the program before achieving their weight-loss goals. In addition, relatively few people who lose large amounts of weight using VLCDs are able to sustain the weight loss when they resume normal eating. In two studies, only 30 percent of patients who reached their goal were able to maintain their weight loss for at least 18 months. Within 1 year, the majority of patients regained approximately two-thirds of the lost weight Apfelbaum et al. In a more recent study with longer followup, the average regain over the first 3 years of follow-up was 73 percent.
However, weight tended to stabilize over the fourth year. At 5 years, the dieters had maintained an average of 23 percent of their initial weight loss. At 7 years, 25 percent of the dieters were maintaining a weight loss of 10 percent of their initial body weight Anderson et al. It appears that VLCDs are more effective for long-term weight loss than hypocaloric-balanced diets. In a meta-analysis of 29 studies, Anderson and colleagues examined the long-term weight-loss maintenance of individuals put on a VLCD diet with behavioral modification as compared with individuals put on a hypocaloric-balanced diet.
They found that VLCD participants lost significantly more weight initially and maintained significantly more weight loss than participants on the hypocaloric-balanced diet see Table Almost any kind of assistance provided to participants in a weight-management program can be characterized as support services. These can include emotional support, dietary support, and support services for physical activity.
The support services used most often are structured in a standard way. Other services are developed to meet the specific needs of a site, program, or the individual involved. With few exceptions, almost any weight-management program is likely to be more successful if it is accompanied by support services Heshka et al. However, not all services will be productively applicable to all patients, and not all can be made available in all settings. Furthermore, some weight-loss program participants will be reluctant to use any support services.
Psychological and emotional factors play a significant role in weight management. Counseling services are those that consider psychological issues associated with inappropriate eating and that are structured to inform the patient about the nature of these issues, their implications, and the possibilities available for their ongoing management. This intervention is less elaborate, intense, and sustaining than psychotherapy services.
For example, it should be useful to help patients understand the existence and nature of a sabotaging household or the phenomenon of stress-related eating without undertaking continuing psychotherapy. A counselor or therapist can provide this service either in individual or group sessions. These counselors should, however, be sufficiently familiar with the issues that arise with weight-management programs, such as binge eating and purging.
Short-term, individual case management can be helpful, as can group sessions because patients can hear the perspective of other individuals with similar weight-management concerns while addressing their individual concerns Hughes et al. Psychotherapy services, both individual and group, can also be useful. However, the costs of this type of service limits its applicability to many patients.
Nevertheless, the value for individual patients can be substantial, and the option should not be dismissed simply because of cost. Concerns about childhood abuse, emotional linkages to sustaining obesity fat-dependent personality , and the management of coexisting mental health problems are the kinds of issues that might be addressed with this type of support service. The individual therapist can structure the format of the therapy but, as with counseling services, the therapist should be familiar with weight-management issues. Nonprofessional patient-led groups and counseling, such as those available with organized programs like Take Off Pounds Sensibly and Overeaters Anonymous, can be useful adjuncts to weight-loss efforts.
These programs have the advantages of low cost, continuing support and encouragement, and a semi-structured approach to the issues that arise among weight-management patients. Their disadvantage is that, since the counseling is nonprofessional in nature, the programs are only as good as the people who are involved. These peer-support programs are more likely to be productive when they are used as a supplement to a program with professional therapists and counselors. In Overeaters Anonymous, a variant of these groups is a sponsor-system program that pairs individuals who can help one another.
Certain commercial programs like Weight Watchers and Jenny Craig can also be helpful. Since commercial groups have their own agenda, caution must be exercised to avoid contradictions between the advice of professional counselors and that of the supportive commercial program. Since the counselors in commercial programs are not likely to be professionals, the quality of counseling offered by these programs varies with the training of the counselors. Many communities offer supplemental weight-management services. Educational services, particularly in nutrition, may be provided through community adult education using teaching materials from nonprofit organizations such as the American Heart Association, the American Diabetes Association, and government agencies FDA, National Institutes of Health, and U.
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Many community hospitals have staff dietitians who are available for out-patient individual counseling Pavlou et al. However, the military's TRICARE health services contracts would need to be modified to include dietitian services from community hospitals or other community services since these contracts do not currently include medical nutrition therapy and therefore dietitian counseling. The family unit can be a source of significant assistance to an individual in a weight-management program. For example, program dropout rates tend to be lower when a participant's spouse is involved in the program Jeffery et al.
With simple guidance and direction, the involvement of the spouse as a form of reinforcement rather than as a source of discipline and monitoring can become a resource to assist in supporting the participant. However, individual family members or the family as a group can become an obstacle when they express reluctance to make changes in food and eating patterns within the household. Issues of family conflict become more complex when the participants are children or adolescents or when spouses are reluctant to relinquish status quo positions of control.
A variety of Internet- and web-related services are available to individuals who are trying to manage their weight Davison, ; Gray and Raab, ; Riva et al. As with any other Internet service, the quality of these sites varies substantially Miles et al. An important role for weight-management professionals is to review such sites so they can recommend those that are the most useful. The use of e-mail counseling services by military personnel who travel frequently or who are stationed in remote locations has been tested at one facility; initial results are promising James et al.
The use of web-based modalities by qualified counselors or facilitators located at large military installations would extend the accessibility of such services to personnel located at small bases or stationed in remote locations. Support is also required for military personnel who need to enhance their levels of physical fitness and physical activity. All branches of the services have remedial physical fitness training programs for personnel who fail their fitness test, but support is also needed for those who need to lose weight and for all personnel to aid in maintaining proper weight.
Support services should include personnel, facilities, and equipment, and should provide practical advice on how to begin and progress through physical training routines including proper use of training equipment and how to prevent musculoskeletal injuries , as well as advice on when and how to eat in conjunction with physical activity demands. Success in the promotion of weight loss can sometimes be achieved with the use of drugs. Almost all prescription drugs in current use cause weight loss by suppressing appetite or enhancing satiety.
One drug, however, promotes weight loss by inhibiting fat digestion. To sustain weight loss, these drugs must be taken on a continuing basis; when their use is discontinued, some or all of the lost weight is typically regained. Therefore, when drugs are effective, it is expected that their use will continue indefinitely. For maximum benefit and safety, the use of weight-loss drugs should occur only in the context of a comprehensive weight-loss program.
In general, these drugs can induce a 5- to percent mean drop in body weight within 6 months of treatment initiation, but the effect can be larger or smaller depending on the individual. As with any drug, the occurrence of side effects may exclude their use in certain occupational contexts. Recognition that weight-related diseases, such as diabetes and hypertension, occur in individuals with BMI levels below 25, and that weight loss improves these conditions in these individuals, suggests that indications for weight-loss drugs need to be individualized to the specific patient.
A number of hormonal and metabolic differences distinguish obese people from lean people Leibel et al. Weight loss alters metabolism in obese individuals, limiting energy expenditure and reducing protein synthesis. This alteration suggests that the body may attempt to maintain an elevated body weight. The facts that genetics might play a role in hormonal and metabolic differences between people and that weight loss alters metabolism imply that obesity is not a simple psychological problem or a failure of self-discipline.
Instead, it is a chronic metabolic disease similar to other chronic diseases and it involves alterations of the body's biochemistry. Like most other chronic diseases that require ongoing pharmacotherapy to prevent the recurrence of symptoms, obesity management and relapse prevention may someday be accomplished through this form of treatment. The following sections provide a brief review of the mechanisms of action, efficacy, and safety of prescription agents that have been approved for weight loss and the various over-the-counter substances that are promoted for weight loss.
Energy intake may be curbed by reducing hunger or appetite or by enhancing satiety. Some obesity drugs may reduce the preference for dietary fat or refined CHOs Blundell et al. For example, the drug orlistat reduces the absorption of fat, which results in energy loss in the feces; other drugs not approved for obesity treatment reduce CHO absorption Heal et al. These drugs may produce sufficiently adverse effects, such as oily stools or increased flatus, so that patients reduce consumption of high-fat foods in favor of less energy-dense foods McNeely and Benfield, ; Sjostrom et al. Obesity drugs also may increase activity levels or stimulate metabolic rate.
Drugs such as fenfluramine or sibutramine were reported to increase energy expenditure in some studies Arch, ; Astrup et al. Fluoxetine, although not approved for obesity treatment, has been shown to increase resting metabolic rate Bross and Hoffer, Ephedrine and caffeine, which act on adenosine receptors, may increase metabolic rate, reduce body-fat storage, and increase lean mass Liu et al.
With one exception orlistat , all currently available prescription obesity drugs act on either the adrenergic or serotonergic systems in the central nervous system to regulate energy intake or expenditure Bray, b. Table summarizes the mechanism of action of pharmacological agents used for treating obesity, which are discussed in detail below. Phentermine, an adrenergic agent, is the most commonly used prescription drug for obesity and has one of the lowest costs of all prescription agents.
Weight loss is comparable with that of other single agents Silverstone, Diethylpropion, phendimetrazine, and benzphetamine are other adrenergic agents that stimulate central norepinephrine secretion and produce weight loss similar to that of phentermine Griffiths et al. The categorization of phendimetrazine and benzphetamine as Drug Enforcement Agency Schedule III drugs may have limited their use, although little evidence exists to suggest that they have a higher abuse potential than does phentermine.
Diethylpropion was reported to have a higher reinforcement potential in nonhuman primates than that of the other Schedule III and IV adrenergic drugs Griffiths et al. No currently available agents for treating obesity are exclusively serotonergic. Fluoxetine and sertraline are selective serotonin reuptake inhibitors that produce weight loss Bross and Hoffer, ; Goldstein et al. Got a story idea? Give us a shout! Sometimes I wonder if I will ever make it to the maintenance stage.
I maintained for years. The I got sick. Weight has been growing since then. I have made this journey into a lifestyle. Keep moving and keep dieting. I have maintained a lb. I weigh every day and record it. Watch my calories and nutrition. Of course I exercise at least 6 days a week.
I would like to lose an additional 14 lbs.
If it happens good for me if not it's still a good for me! Can't wait to get there - again! Great tips, thank you! Thanks for sharing this information Report. This is an excellent article. I agree with every word written. I lost 50 pounds. Three years later I gained 35 back.
Three years later due to depression I lost the In the years that followed I have gained a lot of weight. I am in a wheelchair due to severe spinal damage. I no longer diet. I have made many changes to my lifestyle and have managed to lose 25 pounds over the last few years. For 2 years now I am stuck at up a pound and down a pound or two. This is a huge culprit in reducing calories burned and increasing calories intake. A major change in your work schedule will force you to rethink or adjust your plan for exercise and healthful meals. Do what it takes to insure that you have time for both.
Consider taking five extra minutes to stair climb before and after your work day, in addition to walking during lunch yes, take a break for lunch no matter how busy you are. As well, it is important to plan for healthful meals despite a busy schedule. Can you make time to bring healthful meals and snacks to work so you are not dependent on higher calorie vending, take-out or dining options? Do you know where you can find healthier fast food options near where you work?
Can you cook and freeze over the weekend for healthful fast dinner options during the weekdays? If you do not plan to handle a major work schedule change, then I can almost guarantee that you will regain weight. This is another change that results in a double whammy — increased food and beverage calories with a decrease in exercise. If you find yourself traveling more often now, then plan for how you can stay in energy balance.
Walk the airports to burn calories. Request that you stay in a hotel with a gym, pool, or at the very least, a stairwell. Search the restaurants in the area in which you will be staying so that you can eat at those with healthier food options.
Do I have to be in Perfect Calories Balance Everyday to Maintain My Weight?
Avoid or limit consumption of sweetened beverages and alcoholic drinks. Skip the bread, chips, and desserts. Avoid appetizers unless they include non-starchy vegetables or fresh fruit. If you find yourself unable to eat or exercise according to your typical pattern, and you expect this change to last for an extended time period, then you need a plan to maintain your weight. Physical therapists are highly skilled at helping patients remain active in almost any state of mobility — take advantage of their services if you can.
For newly diagnosed food and digestion related diseases, please consider seeking individualized care with a registered dietitian. If you have recently been put on a medication that you suspect is causing weight gain, then talk with your physician about your concerns rather than simply stopping the medication.
Your pharmacist is also a good resource for information about medication interactions. Whether it is taking care of your newborn or starting to care for an elderly parent, it is important to remember that to be a good caretaker, if you have to also take care of yourself. You will have to plan time for yourself, otherwise, you will not have it. Create a support system for yourself — which friends and family members can you count on to help you?
Also find out about community-based support for help in taking care of your elderly family member contact your local senior center or agency on aging. The more you plan for help and support, the more time you will create for yourself and maintaining your health. Managing stress so that you do not shift back into old coping strategies is critical to maintaining your weight. If you find yourself in a chronically stressful situation, be proactive and get help. I am a big supporter of counseling and therapy, especially during stressful periods divorce, death of a loved one, job change, moving a household, birth, etc.
Make the time and find the resources to get the help that you need before you feel like you are drowning.
Why Is Weight Maintenance More Difficult Than Weight Loss?
It is possible that after weight loss, your Daily Food Calorie Budget overestimates your calories needed for weight maintenance. Although MyNetDiary uses the evidence-based energy equations from the Dietary Reference Intakes, your total energy expenditure after weight loss might be lower than expected. If you suspect this is the case, then consider lowering your Daily Food Calorie Budget by about calories and see if that nudges you back into weight maintenance over the next few weeks.
As you continue to log during weight maintenance, you will discover an average calories intake that keeps you in weight maintenance. We all want to know how successful people tick. What do they do to be successful? If you are curious about how other people have successfully kept their weight off, visit the National Weight Control Registry: Anyone who has lost 30 lbs or more and has kept the weight off for at least one year is eligible to become a registered member of this site.
Members report how they lost weight as well as how they continue to keep the weight off. These are some of the things that the long term weight loss maintainers do:. This registry would benefit from your data! The majority of registry participants are female, middle-aged, and white. They need to hear from more men and women of different ages and ethnicities.