What is the best approach for achieving weight loss?

From the Guidelines

The most effective approach for achieving weight loss is creating a sustainable calorie deficit through a combination of dietary changes and increased physical activity, as recommended by the most recent and highest quality study 1.

Key Recommendations

• Aim to consume 500-1000 fewer calories than you burn daily, which typically leads to 1-2 pounds of weight loss per week.
• Focus on eating nutrient-dense whole foods including plenty of vegetables, lean proteins, whole grains, and healthy fats while limiting processed foods, added sugars, and excessive alcohol.
• For exercise, incorporate both cardio (150+ minutes of moderate activity weekly) and strength training (at least twice weekly) to preserve muscle mass while losing fat.
• Track your food intake using an app or journal to maintain accountability.
• Ensure adequate sleep (7-9 hours nightly) and manage stress, as both affect hunger hormones and can sabotage weight loss efforts.
• Consider interventions including high frequency of counseling (≥16 sessions in 6 months) with focus on nutrition changes, physical activity, and behavioral strategies to achieve a 500–750 kcal/day energy deficit, as shown to be beneficial for weight loss 1.
• Nutrition recommendations should be individualized to the person’s preferences and nutritional needs, using nutritional plans that create an energy deficit, regardless of macronutrient composition, to achieve weight loss 1.

Additional Considerations

• For those with significant obesity or weight-related health conditions, medications like semaglutide (Wegovy), liraglutide (Saxenda), or tirzepatide (Zepbound) may be appropriate adjuncts when prescribed by a healthcare provider.
• Long-term weight maintenance programs are recommended for those who achieve weight loss goals, providing monthly contact and support, recommending ongoing monitoring of body weight and other self-monitoring strategies, and encouraging regular physical activity (200–300 min/week) 1.
• Consider systemic, structural, and socioeconomic factors that may impact nutrition patterns and food choices, such as food insecurity and hunger, access to healthful food options, cultural circumstances, and other social determinants of health 1.

From the FDA Drug Label

diet and exercise are the starting points for any weight loss program. Try these first before adding orlistat. use with a reduced-calorie, low-fat diet and exercise program until you reach your weight loss goal Use for weight loss in overweight adults, 18 years and older, when used along with a reduced-calorie and low-fat diet

The best approach for achieving weight loss is to start with diet and exercise before considering any medication like orlistat. It is recommended to use orlistat along with a reduced-calorie, low-fat diet and exercise program until the weight loss goal is reached.

• Diet: reduced-calorie, low-fat
• Exercise: check with your doctor before starting any exercise program
• Medication: consider orlistat if diet and exercise are not enough, for overweight adults 18 years and older 2, 2

From the Research

Effective Approaches to Weight Loss

• A whole food, plant-based diet has been shown to be effective for weight loss, as it helps to reduce calorie intake and improve overall health 3.
• Low-calorie diets can also be effective for weight loss, with an average reduction of 8% in total body weight in the short term 4.
• Very-low-calorie diets can produce more rapid weight loss, but should only be used for a short period due to potential clinical adverse effects 4, 5.
• Diets that are low in energy density and glycemic index may be beneficial for weight loss, as they can help to reduce overall calorie intake and improve metabolic health 5, 6.

Key Components of a Weight Loss Diet

• An energy deficit is the most important factor in weight loss, and can be achieved through a combination of reducing calorie intake and increasing physical activity 6.
• A low-calorie diet with a low fat or carbohydrate content may be recommended, but the optimal percentage of fat and carbohydrate has yet to be determined 4, 5.
• Meal timing is also an important factor in weight management, with higher-calorie breakfasts and overnight fasting potentially helping to prevent obesity 6.

Additional Strategies for Weight Loss Maintenance

• Exercise, particularly moderate-to-vigorous-intensity exercise, can be an effective strategy for weight loss maintenance, either alone or in combination with other treatments 7.
• Liraglutide therapy, a medication that helps to reduce appetite and increase feelings of fullness, can also be effective for weight loss maintenance, either alone or in combination with exercise 7.
• A combination of exercise and liraglutide therapy may be the most effective strategy for healthy weight loss maintenance, as it can help to improve metabolic health and reduce body fat percentage 7.