What is the appropriate approach to initiate a weight loss program?

From the Guidelines

To initiate a weight loss program, a comprehensive lifestyle intervention that includes diet modification, increased physical activity, and behavior modification is fundamental, as recommended by the most recent and highest quality study 1. When starting a weight loss program, it is essential to set realistic goals, such as losing 1-2 pounds per week, which is considered healthy and sustainable.

• Calculate daily calorie needs and create a deficit of 500-1000 calories through a combination of diet changes and exercise.
• Focus on consuming whole foods, including lean proteins, plenty of vegetables, fruits, whole grains, and healthy fats, while limiting processed foods, added sugars, and excessive alcohol.
• Portion control is essential, and incorporating regular physical activity, aiming for at least 150 minutes of moderate exercise weekly, is crucial.
• Combining cardio with strength training 2-3 times per week can help preserve muscle mass.
• Staying hydrated by drinking plenty of water can also help control hunger, and tracking food intake and physical activity using a journal or app can maintain accountability.
• Getting adequate sleep (7-9 hours nightly) is also vital, as sleep deprivation can increase hunger hormones. Some key points to consider when initiating a weight loss program include:
• Assessing a person's motivation level, life circumstances, cultural considerations, socioeconomic factors, and ability to implement behavioral changes to achieve weight loss 1.
• Offering long-term comprehensive weight loss maintenance programs to people who have lost weight, which should be delivered by an interprofessional team with appropriate training and experience 1.
• Including at least monthly contact with trained individuals, ongoing monitoring of body weight, and continued focus on nutrition and behavioral changes in weight maintenance programs 1. Weight loss medications like semaglutide (Wegovy) or orlistat may be considered for those with BMI over 30 or over 27 with weight-related conditions, but should only be used under medical supervision, as recommended by 1 and 1. Remember that sustainable weight loss comes from lifestyle changes rather than temporary diets, so focus on building habits you can maintain long-term, as emphasized by 1, 1, and 1.

From the FDA Drug Label

diet and exercise are the starting points for any weight loss program. Try these first before adding orlistat. The appropriate approach to initiate a weight loss program is to start with diet and exercise before considering the addition of orlistat. It is also recommended to check with your doctor before starting any exercise program. Additionally, orlistat should be used with a reduced-calorie, low-fat diet and exercise program. Key points to consider when initiating a weight loss program with orlistat include:

• Starting with diet and exercise
• Checking with your doctor before starting any exercise program
• Using orlistat with a reduced-calorie, low-fat diet and exercise program 2

From the Research

Initiating a Weight Loss Program

To initiate a weight loss program, the following approaches are recommended:

• A moderately reduced-calorie diet, increased physical activity, and the use of behavior strategies to facilitate adherence 3
• A comprehensive lifestyle intervention, consisting of a reduced-calorie diet, increased physical activity, and behavior therapy, with a minimum of 6 months of high-intensity intervention 4
• A combination of energy and fat restriction, regular physical activity, and behavioral strategies, such as self-monitoring 5

Key Components of a Weight Loss Program

The key components of a weight loss program include:

• Dietary modifications, such as reduced fat intake and increased dietary fiber 3, 5
• Increased physical activity, with a goal of at least 150 to 300 min/week of moderate-intensity or 75 to 150 min/week of vigorous-intensity aerobic physical activity 3
• Behavior strategies, such as motivational interviewing, cognitive behavior therapy, and self-monitoring 3, 5

Effective Weight Loss Interventions

Effective weight loss interventions typically result in 8-10% weight loss within 6-12 months after initiating treatment 6

• Physical activity is a key component of these interventions, with weight loss achieved with physical activity averaging approximately 1-3 kg 6
• Clinically managed weight loss programs, with a team including a dietitian, exercise professional, psychologist, and/or physician or nurse practitioner oversight, may be effective, but more research is needed to confirm this 7