Weight Loss Options
A comprehensive weight loss program should include a combination of reduced-calorie diet, increased physical activity, and behavior modification therapy, with pharmacotherapy and bariatric surgery as additional options for selected patients. 1
Initial Assessment and Goals
- BMI and comorbidities should be assessed to determine the severity of obesity and guide treatment approach 2
- A weight loss goal of 5-10% of initial body weight is recommended, as this amount is sufficient to yield significant health benefits 1
- Even modest weight loss of 3-5% can improve health outcomes related to obesity 2
Dietary Interventions
- Create a calorie deficit of 500-1000 kcal/day to achieve weight loss of 0.45-0.9 kg (1-2 pounds) per week 1
- Recommended daily calorie intake: 1200-1500 kcal/day for women and 1500-1800 kcal/day for men 2
- Reducing dietary fat along with carbohydrates can facilitate calorie reduction 1
- Low-carbohydrate diets (<130g/day) are not recommended for long-term treatment due to unknown effects and elimination of important food sources 1
- Meal replacements (liquid or solid prepackaged) can be effective when used once or twice daily but must be continued indefinitely for weight maintenance 1
Physical Activity
- Initially aim for moderate-intensity activity for 30-40 minutes per day, 3-5 days per week 1
- Long-term goal: 200-300 minutes per week of moderate-intensity activity for weight loss maintenance 1
- Exercise alone has modest effects on weight loss but improves insulin sensitivity, lowers blood glucose, and is crucial for long-term weight maintenance 1
- Include resistance exercises 2-3 times per week to enhance muscular strength and physical function 1
Behavior Modification
- Behavioral therapy should be recommended for individuals at all stages of overweight or obesity 1
- Key behavioral strategies include:
- Regular weight monitoring (at least weekly) is essential for maintenance 2
- High-intensity lifestyle interventions should include 14 visits during a 6-month period (weekly for the first month, biweekly for months 2-6) and monthly thereafter 1
Pharmacotherapy
- Consider pharmacotherapy for adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one obesity-related complication 1
- FDA-approved medications include orlistat, naltrexone/bupropion, liraglutide, lorcaserin, and phentermine/topiramate 3
- Orlistat is available over-the-counter for adults 18 years and older, to be used with a reduced-calorie, low-fat diet and exercise program 4
- Medications should only be used as an adjunct to lifestyle modification 1
- Assess drug efficacy and safety continually; discontinue if ineffective or if serious adverse effects occur 1
Bariatric Surgery
- Consider for patients with BMI ≥40 kg/m² or BMI ≥35 kg/m² with comorbid conditions when less invasive methods have failed 1
- Options include gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass 3
- Can produce remarkable health improvements and reduce mortality for patients with severe obesity 3
Special Considerations
- For children and adolescents, work with parents or caregivers to support healthy eating habits and regular physical activity 1
- Older adults may require calcium supplementation (1000-1500 mg daily) to reduce osteoporosis risk during weight loss 1
- Evaluate effectiveness of lifestyle changes within 3 months; consider intensifying therapy if minimal weight loss is achieved 1
Common Pitfalls to Avoid
- Expecting rapid weight loss or setting unrealistic goals can lead to disappointment and abandonment of weight loss efforts 1
- Without continued support and follow-up, most people regain lost weight 1
- Standard weight reduction diets alone are unlikely to produce long-term weight loss; structured intensive lifestyle programs are necessary 1
- Neglecting the maintenance phase after initial weight loss is a common reason for weight regain 5, 6