What are the recent guidelines for a weight loss program?

Recent Guidelines for Weight Loss Programs

The most effective weight loss program includes a calorie-restricted diet (1200-1500 kcal/day for women and 1500-1800 kcal/day for men), increased physical activity (150-300 minutes/week), and behavioral strategies to facilitate adherence, with a goal of 5-10% weight loss maintained long-term. 1

Dietary Recommendations

Caloric Restriction

• Prescribe a diet with reduced calorie intake using one of these methods:
  • 1200-1500 kcal/day for women and 1500-1800 kcal/day for men 1
  • 500-750 kcal/day energy deficit from baseline 1
  • Evidence-based diet restricting certain food types (high-carbohydrate, low-fiber, or high-fat foods) 1

Diet Types

Various dietary approaches can produce weight loss with similar effectiveness:

• Lower-fat diets (<30% of total calories from fat) 1
• Higher-protein diets (25% of total calories from protein) 1
• Low-carbohydrate diets (<30g/day carbohydrate initially) 1
• Mediterranean-style diet 1
• Low-glycemic-load diet 1

Time-Restricted Eating

• An 8-10 hour eating window with 14+ hours of fasting enhances fat loss and improves cardiovascular endpoints 2
• Early time-restricted eating (e.g., 8:00 AM to 4:00 PM) appears more beneficial for weight and glycemic control 2

Physical Activity Recommendations

• Advise 150-300 minutes/week of moderate-intensity physical activity for initial weight loss 1
• Recommend 200-300 minutes/week of physical activity for weight loss maintenance 1
• Include resistance training 2-3 times/week to preserve lean muscle mass 3
• Exercise alone has modest effects on weight loss but is crucial for long-term weight maintenance 1, 3

Comprehensive Lifestyle Intervention

• Recommend participation in a comprehensive lifestyle program for ≥6 months 1
• Prescribe high-intensity (≥14 sessions in 6 months) interventions provided by trained interventionists 1
• Include regular self-monitoring of food intake, physical activity, and weight 1
• Electronically delivered programs with personalized feedback can be prescribed but may result in smaller weight loss than face-to-face interventions 1
• Some commercial-based programs with evidence of safety and efficacy can be prescribed 1

Weight Loss Pattern and Expectations

• Weight loss is typically maximal at 6 months, with smaller losses maintained for up to 2 years 1
• Expect weight loss of 4-12 kg at 6 months with dietary interventions 1
• After initial weight loss, gradual weight regain of 1-2 kg/year is common 1
• Even modest sustained weight loss of 3-5% produces clinically meaningful health benefits 1
• Greater weight loss (>5%) provides additional benefits for blood pressure, lipids, and glycemic control 1

Special Considerations

Very-Low-Calorie Diets

• Very-low-calorie diets (<800 kcal/day) should only be used in limited circumstances 1
• Require medical supervision due to rapid weight loss and potential health complications 1
• Should be provided by trained practitioners in a medical care setting 1

Weight Loss Maintenance

• Advise participation in a long-term (≥1 year) weight loss maintenance program 1
• Prescribe face-to-face or telephone-delivered maintenance programs with regular contact (monthly or more frequent) 1
• Recommend monitoring body weight regularly (weekly or more frequently) 1
• Consider orlistat as an adjunct to lifestyle modification for eligible adults (BMI ≥27 with comorbidities or BMI ≥30) 4

Managing Weight Loss Plateau

• Verify patient is creating a true 500-750 kcal/day energy deficit 3
• Evaluate dietary composition beyond calories, increasing water-rich foods and limiting high-fat foods 3
• Address psychological factors that may impact weight loss (stress, depression, binge eating) 3
• Consider adjusting physical activity type, intensity, or duration 3

Common Pitfalls and Caveats

• Underestimation of caloric intake and overestimation of physical activity are common barriers 3
• Avoid dietary supplements marketed for weight loss as they lack clear evidence of effectiveness 3
• Weight regain is common and driven by complex biological and behavioral factors 3
• Take a multivitamin once daily at bedtime when using orlistat to prevent nutrient deficiencies 4