Additionally, because of the potential detrimental side effects of these diets e. On a short-term basis, VLCDs are relatively effective, with weight losses of approximately 15 to 30 kg over 12 to 20 weeks being reported in a number of studies Anderson et al.
However, the long-term effectiveness of these diets is somewhat limited. Approximately 40 to 50 percent of patients drop out of the program before achieving their weight-loss goals. In addition, relatively few people who lose large amounts of weight using VLCDs are able to sustain the weight loss when they resume normal eating. In two studies, only 30 percent of patients who reached their goal were able to maintain their weight loss for at least 18 months. Within 1 year, the majority of patients regained approximately two-thirds of the lost weight Apfelbaum et al.
In a more recent study with longer followup, the average regain over the first 3 years of follow-up was 73 percent. However, weight tended to stabilize over the fourth year. At 5 years, the dieters had maintained an average of 23 percent of their initial weight loss.
At 7 years, 25 percent of the dieters were maintaining a weight loss of 10 percent of their initial body weight Anderson et al. It appears that VLCDs are more effective for long-term weight loss than hypocaloric-balanced diets. In a meta-analysis of 29 studies, Anderson and colleagues examined the long-term weight-loss maintenance of individuals put on a VLCD diet with behavioral modification as compared with individuals put on a hypocaloric-balanced diet.
They found that VLCD participants lost significantly more weight initially and maintained significantly more weight loss than participants on the hypocaloric-balanced diet see Table Almost any kind of assistance provided to participants in a weight-management program can be characterized as support services.
These can include emotional support, dietary support, and support services for physical activity. The support services used most often are structured in a standard way. Other services are developed to meet the specific needs of a site, program, or the individual involved. With few exceptions, almost any weight-management program is likely to be more successful if it is accompanied by support services Heshka et al.
However, not all services will be productively applicable to all patients, and not all can be made available in all settings. Furthermore, some weight-loss program participants will be reluctant to use any support services.
Psychological and emotional factors play a significant role in weight management. Counseling services are those that consider psychological issues associated with inappropriate eating and that are structured to inform the patient about the nature of these issues, their implications, and the possibilities available for their ongoing management. This intervention is less elaborate, intense, and sustaining than psychotherapy services.
For example, it should be useful to help patients understand the existence and nature of a sabotaging household or the phenomenon of stress-related eating without undertaking continuing psychotherapy. A counselor or therapist can provide this service either in individual or group sessions. These counselors should, however, be sufficiently familiar with the issues that arise with weight-management programs, such as binge eating and purging.
Short-term, individual case management can be helpful, as can group sessions because patients can hear the perspective of other individuals with similar weight-management concerns while addressing their individual concerns Hughes et al. Psychotherapy services, both individual and group, can also be useful. However, the costs of this type of service limits its applicability to many patients.
Nevertheless, the value for individual patients can be substantial, and the option should not be dismissed simply because of cost. Concerns about childhood abuse, emotional linkages to sustaining obesity fat-dependent personality , and the management of coexisting mental health problems are the kinds of issues that might be addressed with this type of support service. The individual therapist can structure the format of the therapy but, as with counseling services, the therapist should be familiar with weight-management issues.
Nonprofessional patient-led groups and counseling, such as those available with organized programs like Take Off Pounds Sensibly and Overeaters Anonymous, can be useful adjuncts to weight-loss efforts.
These programs have the advantages of low cost, continuing support and encouragement, and a semi-structured approach to the issues that arise among weight-management patients. Their disadvantage is that, since the counseling is nonprofessional in nature, the programs are only as good as the people who are involved. These peer-support programs are more likely to be productive when they are used as a supplement to a program with professional therapists and counselors. In Overeaters Anonymous, a variant of these groups is a sponsor-system program that pairs individuals who can help one another.
Certain commercial programs like Weight Watchers and Jenny Craig can also be helpful. Since commercial groups have their own agenda, caution must be exercised to avoid contradictions between the advice of professional counselors and that of the supportive commercial program. Since the counselors in commercial programs are not likely to be professionals, the quality of counseling offered by these programs varies with the training of the counselors.
Many communities offer supplemental weight-management services. Educational services, particularly in nutrition, may be provided through community adult education using teaching materials from nonprofit organizations such as the American Heart Association, the American Diabetes Association, and government agencies FDA, National Institutes of Health, and U. Department of Agriculture. Many community hospitals have staff dietitians who are available for out-patient individual counseling Pavlou et al.
However, the military's TRICARE health services contracts would need to be modified to include dietitian services from community hospitals or other community services since these contracts do not currently include medical nutrition therapy and therefore dietitian counseling. The family unit can be a source of significant assistance to an individual in a weight-management program.
For example, program dropout rates tend to be lower when a participant's spouse is involved in the program Jeffery et al. With simple guidance and direction, the involvement of the spouse as a form of reinforcement rather than as a source of discipline and monitoring can become a resource to assist in supporting the participant.
However, individual family members or the family as a group can become an obstacle when they express reluctance to make changes in food and eating patterns within the household. Issues of family conflict become more complex when the participants are children or adolescents or when spouses are reluctant to relinquish status quo positions of control.
A variety of Internet- and web-related services are available to individuals who are trying to manage their weight Davison, ; Gray and Raab, ; Riva et al.
As with any other Internet service, the quality of these sites varies substantially Miles et al. An important role for weight-management professionals is to review such sites so they can recommend those that are the most useful.
The use of e-mail counseling services by military personnel who travel frequently or who are stationed in remote locations has been tested at one facility; initial results are promising James et al. The use of web-based modalities by qualified counselors or facilitators located at large military installations would extend the accessibility of such services to personnel located at small bases or stationed in remote locations.
Support is also required for military personnel who need to enhance their levels of physical fitness and physical activity.
All branches of the services have remedial physical fitness training programs for personnel who fail their fitness test, but support is also needed for those who need to lose weight and for all personnel to aid in maintaining proper weight. Support services should include personnel, facilities, and equipment, and should provide practical advice on how to begin and progress through physical training routines including proper use of training equipment and how to prevent musculoskeletal injuries , as well as advice on when and how to eat in conjunction with physical activity demands.
Success in the promotion of weight loss can sometimes be achieved with the use of drugs. Almost all prescription drugs in current use cause weight loss by suppressing appetite or enhancing satiety. One drug, however, promotes weight loss by inhibiting fat digestion. To sustain weight loss, these drugs must be taken on a continuing basis; when their use is discontinued, some or all of the lost weight is typically regained. Therefore, when drugs are effective, it is expected that their use will continue indefinitely.
For maximum benefit and safety, the use of weight-loss drugs should occur only in the context of a comprehensive weight-loss program. In general, these drugs can induce a 5- to percent mean drop in body weight within 6 months of treatment initiation, but the effect can be larger or smaller depending on the individual. As with any drug, the occurrence of side effects may exclude their use in certain occupational contexts. Recognition that weight-related diseases, such as diabetes and hypertension, occur in individuals with BMI levels below 25, and that weight loss improves these conditions in these individuals, suggests that indications for weight-loss drugs need to be individualized to the specific patient.
A number of hormonal and metabolic differences distinguish obese people from lean people Leibel et al. Weight loss alters metabolism in obese individuals, limiting energy expenditure and reducing protein synthesis. This alteration suggests that the body may attempt to maintain an elevated body weight.
The facts that genetics might play a role in hormonal and metabolic differences between people and that weight loss alters metabolism imply that obesity is not a simple psychological problem or a failure of self-discipline. Instead, it is a chronic metabolic disease similar to other chronic diseases and it involves alterations of the body's biochemistry. Like most other chronic diseases that require ongoing pharmacotherapy to prevent the recurrence of symptoms, obesity management and relapse prevention may someday be accomplished through this form of treatment.
The following sections provide a brief review of the mechanisms of action, efficacy, and safety of prescription agents that have been approved for weight loss and the various over-the-counter substances that are promoted for weight loss.
Energy intake may be curbed by reducing hunger or appetite or by enhancing satiety. Some obesity drugs may reduce the preference for dietary fat or refined CHOs Blundell et al. For example, the drug orlistat reduces the absorption of fat, which results in energy loss in the feces; other drugs not approved for obesity treatment reduce CHO absorption Heal et al.
These drugs may produce sufficiently adverse effects, such as oily stools or increased flatus, so that patients reduce consumption of high-fat foods in favor of less energy-dense foods McNeely and Benfield, ; Sjostrom et al. Obesity drugs also may increase activity levels or stimulate metabolic rate. Drugs such as fenfluramine or sibutramine were reported to increase energy expenditure in some studies Arch, ; Astrup et al. Fluoxetine, although not approved for obesity treatment, has been shown to increase resting metabolic rate Bross and Hoffer, Ephedrine and caffeine, which act on adenosine receptors, may increase metabolic rate, reduce body-fat storage, and increase lean mass Liu et al.
With one exception orlistat , all currently available prescription obesity drugs act on either the adrenergic or serotonergic systems in the central nervous system to regulate energy intake or expenditure Bray, b. Table summarizes the mechanism of action of pharmacological agents used for treating obesity, which are discussed in detail below.
Phentermine, an adrenergic agent, is the most commonly used prescription drug for obesity and has one of the lowest costs of all prescription agents.
Weight loss is comparable with that of other single agents Silverstone, Diethylpropion, phendimetrazine, and benzphetamine are other adrenergic agents that stimulate central norepinephrine secretion and produce weight loss similar to that of phentermine Griffiths et al.
The categorization of phendimetrazine and benzphetamine as Drug Enforcement Agency Schedule III drugs may have limited their use, although little evidence exists to suggest that they have a higher abuse potential than does phentermine. Diethylpropion was reported to have a higher reinforcement potential in nonhuman primates than that of the other Schedule III and IV adrenergic drugs Griffiths et al.
No currently available agents for treating obesity are exclusively serotonergic. Fluoxetine and sertraline are selective serotonin reuptake inhibitors that produce weight loss Bross and Hoffer, ; Goldstein et al. Fluoxetine produced good weight loss after 6 months, but 1-year results were not different from those of placebo treatment Goldstein et al. Sertraline also produced short-term weight loss Ricca et al. Sibutramine inhibits reuptake of both norepinephrine and serotonin in central nervous system neurons.
Blood pressure rose slightly in normotensive subjects, but fell in hypertensive subjects Heal et al. Decreases in fasting blood glucose, insulin, waist circumference, waist-hip ratio, and computerized tomography-estimated abdominal fat were greater with sibutramine than with placebo Heal et al.
The greater weight losses observed in the sibutramine group compared with the placebo group may be responsible for the greater improvements in other parameters. Common complaints with the use of centrally active adrenergic and serotonergic obesity drugs include dry mouth, fatigue, hair loss, constipation, sweating, sleep disturbances, and sexual dysfunction Atkinson et al. Sibutramine can increase blood pressure and pulse rate in occasional patients and may cause dizziness and increased food intake Cole et al.
Mazindol may cause penile discharge van Puijenbroek and Meyboom, Orlistat binds to lipase in the gastrointestinal tract and inhibits absorption of about one-third of dietary fat Hollander et al.
Average weight loss on orlistat is about 8 to 11 percent of initial body weight at 1 year James WP et al. Although weight loss may be responsible for some of the observed improvements, orlistat lowered LDL independently of its effect on weight loss.
Acarbose is an alpha glucosidase inhibitor that inhibits or delays absorption of complex CHOs Wolever et al. This drug is approved by FDA for the treatment of diabetes mellitus, but not for weight loss. Although it produces modest weight loss in animals, it has minimal or no effect on humans. Adverse side effects of orlistat include abdominal cramping, increased flatus formation, diarrhea, oily spotting, and fecal incontinence Hollander et al. These adverse effects may serve as a behavior modification tool to reduce the level of fat in the diet and presumably to reduce energy intake.
Orlistat has been shown to produce small reductions in serum levels of fat-soluble vitamins. The manufacturer recommends that a vitamin supplement containing vitamins A, D, E, and K be prescribed for patients taking orlistat. A variety of drugs currently on the market for other conditions, but not approved by FDA for obesity treatment, have been evaluated for their ability to induce weight loss.
Metformin Lee and Morley, , cimetidine Rasmussen et al. A single copy of these materials may be reprinted for noncommercial personal use only. This site complies with the HONcode standard for trustworthy health information: verify here. This content does not have an English version.
This content does not have an Arabic version. See more conditions. Healthy Lifestyle Weight loss. Products and services. Weight loss: 6 strategies for success Follow these proven strategies to reduce your weight and boost your health. By Mayo Clinic Staff. Thank you for subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information.
Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Hensrud DD, et al. Ready, set, go. In: The Mayo Clinic Diet. Mayo Clinic; Duyff RL.
Reach and maintain your healthy weight. Losing weight: Getting started. Centers for Disease Control and Prevention. Accessed Nov. Do you know some of the health risks of being overweight? Journal of the American College of Cardiology. Department of Health and Human Services and U. Department of Agriculture. Beverages like juice, soda, sweet teas, energy drinks, and flavored coffees can put a big dent in your daily calorie budget.
Make a habit of increasing your water intake. Count your cocktails too. Alcohol is dense in calories, even before it makes its way into a mixer. Rethink your drink! While nutrition plays the starring role in weight loss, physical activity is more than just an understudy. Fit in ways to get FFIT! Try a new dance or martial arts class, take a hike or sign up for a local 5K fun run or walk. F requency - The most current physical activity guidelines recommend a minimum of minutes of moderate-intensity aerobic activity a week.
LiveStrong sports a large community with many subgroups catering to different needs and goals. FitDay has one of the more spartan interfaces among the web-based selections in today's Hive, but that isn't necessarily a bad thing. Using FitDay you can track common stats like weight and calorie consumption, but you can also track interesting tangential metrics, like your level of hunger, level of energy, happiness , and so on.
When generating reports, you can compare this data, which may provide interesting insights into changes you make in your diet and habits. FitDay is available as a webapp and a Windows application, also free. Now that you've had a chance to look over the top contenders for best weight-loss tool, it's time to log a vote for your favorite:.
Which Weight-Management Tool is Best? This week we've got an honorary mention, the Nintendo Wii Fit.
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