Current Guidelines for Weight Loss
The cornerstone of obesity management is helping people transition from a pro-obesogenic to a healthy lifestyle through a comprehensive approach that includes reduced calorie intake, increased physical activity, and behavioral strategies. 1
Initial Assessment
- Calculate BMI to identify adults who may be at elevated risk of cardiovascular disease (BMI 25.0-29.9 kg/m²) or mortality from all causes (BMI ≥30 kg/m²) 1
- Measure waist circumference at annual visits in overweight and obese adults to identify those at higher cardiometabolic risk 1
- Advise patients that greater BMI and waist circumference correlate with greater risk of cardiovascular disease, type 2 diabetes, and all-cause mortality 1
Weight Loss Goals
- Even modest weight loss of 3-5% can produce clinically meaningful health benefits, including reductions in triglycerides, blood glucose, and hemoglobin A1c 1
- Greater weight loss (5-10%) provides additional benefits, including improvements in blood pressure, LDL-C, HDL-C, and reduced need for medications 1, 2
- Most weight loss occurs in the first 6 months of treatment 3
Dietary Interventions
Prescribe a diet to achieve reduced calorie intake using one of these evidence-based approaches: 1
- 1200-1500 kcal/day for women and 1500-1800 kcal/day for men (adjusted for individual body weight)
- 500-750 kcal/day energy deficit from baseline
- Evidence-based diet that restricts certain food types (high-carbohydrate, low-fiber, or high-fat foods)
Any diet program that creates the required energy deficit is appropriate, as comparative trials have shown no long-term superiority between different macronutrient composition diets 1
Limit or avoid liquid calories (sodas, juices, alcohol) 1
Meal replacements can be effective when used once or twice daily but must be continued indefinitely for weight maintenance 2
Physical Activity Recommendations
- Initially aim for moderate-intensity activity for 30-40 minutes per day, 3-5 days per week 2
- For weight loss maintenance, increase to 200-300 minutes per week of moderate-intensity physical activity 1, 4
- Include resistance exercises 2-3 times per week to enhance muscular strength and physical function 2
- Exercise alone has modest effects on weight loss but improves insulin sensitivity, lowers blood glucose, and is crucial for long-term weight maintenance 2
Behavioral Therapy
- Advise overweight and obese individuals to participate for ≥6 months in a comprehensive lifestyle program that uses behavioral strategies to support diet and physical activity changes 1
- High-intensity interventions (≥14 sessions in 6 months) provided by a trained interventionist are recommended 1
- Key behavioral strategies include self-monitoring of eating habits, physical activity, and weight 2, 4
- Regular weight monitoring (at least weekly) is essential for maintenance 4
- For weight loss maintenance, prescribe face-to-face or telephone-delivered programs with regular contact (monthly or more frequently) 1
Adjunctive Therapies
- Pharmacotherapy may be considered for adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one obesity-related complication 2
- FDA-approved medications like orlistat should be used along with a reduced-calorie and low-fat diet 3
- Consider bariatric surgery for patients with BMI ≥40 kg/m² or BMI ≥35 kg/m² with obesity-related comorbidities who have not responded adequately to behavioral treatment 1
- Very-low-calorie diets (<800 kcal/day) should only be used in limited circumstances under medical supervision due to potential health complications 1
Common Pitfalls to Avoid
- Expecting rapid weight loss or setting unrealistic goals can lead to disappointment and abandonment of weight loss efforts 2
- Without continued support and follow-up, most people regain lost weight 2
- Standard weight reduction diets alone are unlikely to produce long-term weight loss; structured intensive lifestyle programs are necessary 2
- Using very-low-calorie diets without proper medical supervision can lead to health complications 1
- Focusing solely on diet without addressing physical activity and behavioral changes reduces long-term success 5, 6