What are the options for weight loss?

Weight Loss Options

For adults seeking weight loss, begin with lifestyle modification combining a 500-1000 kcal/day calorie deficit, 30-40 minutes of moderate-intensity exercise 3-5 days per week initially (progressing to 200-300 minutes weekly), and behavioral therapy with regular self-monitoring—targeting 5-10% weight loss within 6 months. 1

Initial Weight Loss Goals

• Target 5-10% of initial body weight as your primary goal, which yields significant health benefits 1
• Even 3-5% weight loss improves obesity-related health outcomes 1
• Most weight loss occurs within the first 6 months of intervention 2

Dietary Interventions

• Create a calorie deficit of 500-1000 kcal/day to achieve 0.45-0.9 kg (1-2 pounds) weekly weight loss 1
• Women should consume 1200-1500 kcal/day; men should consume 1500-1800 kcal/day 3
• Reduce both dietary fat and carbohydrates to facilitate calorie reduction 1
• Avoid very low-carbohydrate diets (<130g/day) for long-term treatment due to unknown effects and elimination of important food sources 1
• Consider meal replacements (liquid or solid prepackaged) once or twice daily, but continue indefinitely for weight maintenance 1

Physical Activity Requirements

• Start with 30-40 minutes of moderate-intensity activity, 3-5 days per week 1
• Progress to 200-300 minutes per week of moderate-intensity activity for long-term weight maintenance 1
• Alternative: 150-300 minutes/week moderate-intensity OR 75-150 minutes/week vigorous-intensity activity 3
• Add resistance exercises 2-3 times weekly to enhance muscular strength and physical function 1
• Exercise alone produces modest weight loss but critically improves insulin sensitivity, lowers blood glucose, and is essential for long-term maintenance 1

Behavioral Modification (Essential Component)

• Implement behavioral therapy for all individuals at any stage of overweight or obesity 1
• Self-monitor eating habits, physical activity levels, and weight regularly 1
• Weigh yourself at least weekly for maintenance 1, 3
• Attend high-intensity lifestyle interventions: 14 visits during 6 months (weekly for month 1, biweekly for months 2-6), then monthly thereafter 1

Pharmacotherapy (When Lifestyle Modification Insufficient)

• Consider medications for BMI ≥30 kg/m² OR BMI ≥27 kg/m² with at least one obesity-related complication 1
• Use medications only as adjunct to lifestyle modification, never as monotherapy 1
• FDA-approved options include orlistat, naltrexone/bupropion, and liraglutide 4
• Orlistat: Take 1 capsule with each fat-containing meal (maximum 3 capsules daily) combined with reduced-calorie, low-fat diet 2
• Take a multivitamin at bedtime when using orlistat 2
• Assess drug efficacy and safety continually; discontinue if ineffective or serious adverse effects occur 1

Bariatric Surgery

• Consider for BMI ≥40 kg/m² OR BMI ≥35 kg/m² with comorbidities when less invasive methods have failed 1
• Options include gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass 4

Monitoring and Follow-Up Strategy

• Evaluate effectiveness within 3 months; intensify therapy if minimal weight loss achieved 1
• Maintain at least monthly follow-up appointments with healthcare professionals 3
• Without continued support and follow-up, most people regain lost weight 1
• If weight regain occurs after stopping treatment, restart the comprehensive program including potential medication 2

Special Population Considerations

• Older adults: Supplement with calcium 1000-1500 mg daily to reduce osteoporosis risk during weight loss 1
• Children/adolescents: Work with parents or caregivers to support healthy eating habits and regular physical activity 1

Critical Pitfalls to Avoid

• Unrealistic expectations: Rapid weight loss goals lead to disappointment and program abandonment 1
• Standard diets alone: Weight reduction diets without structured intensive lifestyle programs are unlikely to produce long-term weight loss 1
• Lack of continued support: This is the primary reason for weight regain 1
• Skipping behavioral therapy: Diet and exercise alone without behavioral modification have significantly lower success rates 1