4.6: Weight Loss Strategies

We know that a majority of our population should implement strategies to lose weight and we know over 50% of Americans have indicated they would like to lose weight. The Dietary Guidelines for Americans and the Physical Activity Guidelines for Americans provide numerous tips for adjusting diet and exercise to support a health weight, these were explained in Chapters 2 and 3 of this textbook.

Here are additional strategies for weight loss:

Commit to a Weight Loss Plan

As you learned in chapter 1, setting goals is important for behavior change.

• Make a commitment to lose weight.
  • Explain your “why” for wanting to lose weight
• Take stock of where you are
  • Take time to assess your current health and lifestyle.
  • Record a food and exercise diary for one week and review the diary to help you recognize the changes you could make to help you lose weight.
  • The Body Weight Planner is a helpful tool for assisting you in making a personalized calorie and physical activity plans to reach your goal weight within a specific time period and to maintain it afterwards.
• Make SMART goals
• Find resources, tools, information, or support that can help you successfully reach your goals.
• Record your progress and acknowledge or reward your hardwork.

How to assess safe and effective weight loss programs

Would you like additional help and support that may be provided by a structured weight loss program? With so many different weight loss programs, it may be difficult to choose which program is right for you.

Begin by talking with your healthcare provider. Share your concern regarding your weight and ask if they can refer you to a weight loss program or specialist.

When reviewing weight loss programs, look for ones that are not just focused on eating a specific food, but rather take more of a holistic view of your overall health and lifestyle habits.

According to the National Institute of Diabetes and Digestive and Kidney Disease, a safe and successful weight-loss programs should include:

• behavioral treatment, also called lifestyle counseling, that can teach you how to develop and stick with healthier eating and physical activity habits—for example, keeping food and activity records or journals.
• information about getting enough sleep, managing stress, and the benefits and drawbacks of weight-loss medicines.
• ongoing feedback, monitoring, and support throughout the program, either in person, by phone, online, or through a combination of these approaches.
• slow and steady weight-loss goals—usually 1 to 2 pounds per week (though weight loss may be faster at the start of a program).
• a plan for keeping the weight off, including goal setting, self-checks such as keeping a food journal, and counseling support.

If you would prefer an online program, it should include:

• organized, weekly lessons, offered online or by podcast, and tailored to your personal goals.
• support from a qualified staff person to meet your goals.
• a plan to track your progress on changing your lifestyle habits, such as healthy eating and physical activity, using tools such as cellphones, activity counters, and online journals.
• regular feedback on your goals, progress, and results provided by a counselor through email, phone, or text messages.
• the option of social support from a group through bulletin boards, chat rooms, or online meetings.

Avoid weight-loss programs that make any of the following promises:

• Lose weight without diet or exercise!
• Lose weight while eating as much as you want of all your favorite foods!
• Lose 30 pounds in 30 days!
• Lose weight in specific problem areas of your body!
• Other warning signs to look out for include
  • very small print, asterisks, and footnotes, which may make it easy to miss important information.
  • before-and-after photos that seem too good to be true.
  • personal endorsements that may be made up.

Dietary Approaches to Weight loss

Tips for healthy eating include:

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include a variety of protein foods such as seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds.
• Reduce saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
• Stay within your daily calorie needs
  • Replace some higher calorie foods with foods that are lower in calories and fill you up.
  • Choose smaller portion sizes. Research shows that people unintentionally consume more calories when faced with larger portions.
    • If eating out where there are large portion sizes, take half of your meal home.
  • When eating a salad, dip your fork into dressing instead of pouring lots of dressing on the salad.
  • When eating out, substitute a broth-based soup or a green lettuce salad for French fries or chips as a side dish.
  • Add more vegetables such as cucumbers, lettuce, tomato, and onions to a sandwich instead of extra meat or cheese.
• Rethink your drink and drink more water
  • Carry a water bottle with you and refill it throughout the day.
  • Freeze some freezer safe water bottles. Take one with you for ice-cold water all day long.
  • Choose water over sugary drinks.
  • Opt for water when eating out. You’ll save money and reduce calories.
  • Serve water during meals.
  • Add a wedge of lime or lemon to your water. This can help improve the taste and help you drink more water than you usually do.
• Plan your meals
  • Since high-calorie foods are everywhere, it’s important to take the time to plan ahead to make sure you have healthy options available.
  • Check the restaurant menu and plan your meal ahead of time.
  • Write down everything you eat and drink. It keeps you accountable to yourself!
• Have healthy snacks ready
  • “Grab-and-go” fruits: apples, oranges, bananas, canned fruit without added sugars, and raisins
  • Washed and chopped fresh vegetables: celery, carrots, and cucumbers
  • Low-fat and fat-free milk products: yogurt without added sugars, milk, and low-fat cheeses
  • Whole-grain crackers and breads
  • Protein choices such as low-fat deli turkey slices or almonds and other nuts and seeds

When eating your favorite comfort foods:

• Eat them less often. If you normally eat these foods every day, cut back to once a week or once a month.
• Eat smaller amounts. If your favorite higher-calorie food is a chocolate bar, have a smaller size or only half a bar.
• Try a lower-calorie version. Use lower-calorie ingredients or prepare food differently. For example, if your macaroni and cheese recipe includes whole milk, butter, and full-fat cheese, try remaking it with non-fat milk, less butter, low-fat cheese, fresh spinach and tomatoes. Just remember to not increase your portion size.

Diets

The Dietary Guidelines for Americans stresses the importance of developing a healthy eating pattern. For some people, it can be helpful to follow a specific diet. If you are interested in following a diet it is important to recognize that even if a particular diet may be successful for one person, it may not be effective for another due to individual differences in genes and lifestyle. Harvard School of Public Health provides detailed reviews of the following diets for your consideration:

• Anti-Inflammatory Diet
• DASH Diet
• Gluten-Free for Weight Loss
• Intermittent Fasting for Weight Loss
• Ketogenic Diet for Weight Loss
• Mediterranean Diet
• Mindful Eating
• Paleo Diet for Weight Loss

Bariatric Surgery

Weight-loss surgery, also known as bariatric surgery, is an operation that makes changes to the digestive system. In the United States, surgeons most often perform three types of operations: gastric sleeve, gastric bypass, and adjustable gastric band. Bariatric surgery may be an option if you have extreme obesity (over 40 BMI) or are at lower levels of obesity (over 30 BMI) but you have serious health problems, such as type 2 diabetes or sleep apnea, related to obesity. Bariatric surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes. Side effects of the surgery may include bleeding, infection, leaking from the surgery site, diarrhea, and blood clots.

A longitudinal study of bariatric surgery (gastic bypass and gastric band) was conducted to understand immediate and long term effects^[10]. The study included people who had bariatric surgery between 2005-2009. Researchers met with the participants before surgery, 30 days after, 6 months after, and then annually until 2015.

Thirty days after bariatric surgery, researchers found that

• Death rates were low. Only 2.1 percent of participants who had open gastric bypass and 0.2 percent of participants who had laparoscopic gastric bypass died. No participants who had gastric band surgery died.
• Only 4.1 percent of participants had at least one major bad outcome, such as death, development of blood clots, repeat surgeries, or failure to be released from the hospital.
• No significant differences in complication risk were found based on the type of gastric bypass procedure.
• Participants with the highest BMI values had the greatest risk of complications.
• Participants with a history of deep vein blood clots or sleep apnea had a higher risk of complications.

At the 7-year follow-up, LABS researchers found that

• Participants lost an average of 28.4 percent of their body weight after gastric bypass surgery and 14.9 percent of their body weight after laparoscopic gastric band surgery.
• Most participants maintained their weight loss. Three to 7 years after surgery, participants who had gastric bypass surgery regained an average of 3.9 percent of their body weight, and participants who had gastric band surgery regained on average of 1.4 percent of their body weight.
• High cholesterol was less common after gastric bypass and gastric band surgery.
• Diabetes and high blood pressure were less common after gastric bypass surgery. Over time, diabetes reoccurred in some patients, but numbers of new cases were low.
• Alcohol use disorders increased after gastric bypass surgery but not after gastric band surgery.
• Pain and physical function improved after bariatric surgery.