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journals\t(\nNHLBI,\t2014\n).\tThe\tfive\n\tareas\taddressed\tin\t2013\twere\tas\tfollows:\t(1)\twhat\tare\tthe\texpected\nhealth\tbenefits\tof\tweight\tloss\tas\ta\tfunction\tof\tthe\tamount\tand\tduration\tof\tweight\tloss,\t(2)\tare\tcurrent\nWC\tand\tBMI\tcut\tpoints\tappropriate\t(defined\tobesity)\tfor\tcertain\tpopulation\tsubgroups,\t(3)\twhich
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diets—among\ta\thandful\tof\tpopular\tdiets—are\teffective\tfor\tweight\tloss,\t(4)\twhat\tis\tthe\tefficacy\tand\neffectiveness\tof\tcomprehensive\tlifestyle\n\tapproaches\tto\tweight\tloss\tand\tweight\tloss\tmaintenance,\tand\n(5)\twhat\tis\tthe\tefficacy\tand\tsafety\tof\tbariatric\tsurgical\tprocedures.
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(5)\twhat\tis\tthe\tefficacy\tand\tsafety\tof\tbariatric\tsurgical\tprocedures.\nBefore\tthe\tNHLBI\tevidence\treport\tclinicians\tfocused\talmost\tentirely\ton\tweight\tloss\tvia\tcaloric\nrestriction,\texercise\twas\tnot\troutinely\trecommended,\tand\tweight\tloss\tmaintenance\twas\tgenerally\noverlooked.\tThe\tstrategies\tfor\tweight\tloss\t(and\tweight\tloss\tmaintenance)\tanalyzed,
|
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] |
reviewed,\tand\noutlined\tin\tthe\tNHLBI\treport\twere\tdietary\ttherapy\t(CR),\tphysical\tactivity,\tbehavior\ttherapy\t(self-\nmonitoring,\tstress\tmanagement,\tstimulus\tcontrol,\tproblem-solving,\tcontingency\tmanagement,\ncognitive\trestructuring,\tand\tsocial\tsupport),\tcombined\ttherapy\t(dietary,\tphysical\tactivity,\tand
|
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behavioral\ttherapies),\tpharmacotherapy,\tand\tsurgery.\tToday,\ta\tchronic\tdisease-prevention\tmodel\nincorporates\tthese\tinterdisciplinary\ttherapies\tand\tlifestyle\tinterventions\tfrom\tphysicians,\tdietitians,\nexercise\tspecialists,\tand\tbehavior\ttherapists.\nGoals\tof\ttreatment
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] |
exercise\tspecialists,\tand\tbehavior\ttherapists.\nGoals\tof\ttreatment\nThe\tgoal\tof\tobesity\ttreatment\tis\tto\tachieve\tenough\tweight\tloss\tto\tsignificantly\timprove\toverall\nhealth.\tAchieving\ta\tmoderate\tloss\tis\tbeneficial.\tObese\tpersons\twho\tlose\t5%\tto\t10%\tof\tinitial\tbody\nweight\tare\tlikely\tto\timprove
|
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] |
weight\tare\tlikely\tto\timprove\n\ttheir\tblood\tglucose,\tblood\tpressure,\tand\tcholesterol\tlevels\tand\treduce\nvarious\tmarkers\tof\tsystemic\tinflammation.\tSince\tcontinual,\tgradual\tweight\tgain\tis\tthe\tnorm,\nchoosing\tto\tmaintain\tpresent\tbody\tweight\tis\talso\tbeneficial\t(but\talso\trequires\tvigilance\tand\teffort).
|
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Despite\tthe\trecognition\tthat\tmoderate\tweight\tloss\tis\tbeneficial\tand\tmay\tbe\tmore\teasily\tachievable,\npatients\tusually\thave\tself-defined\n\tgoal\tweights\tthat\tare\tconsiderably\thigher.\tTherefore\thealth\nprofessionals\tneed\tto\tencourage\ttheir\tpatients\tto\ttarget\tmore\trealistic\tinitial\tweight\tloss\tgoals.
|
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In\tgeneral,\tweight\tloss\tafter\tage\t65\tis\tnot\tadvised;\tactuarial\ttables\tshow\tno\tbenefit\tand\tpossible\nharm\tdue\tto\tloss\tof\tLBM.\tIn\tfact,\tin\tthe\tobese\tolder\tadult,\tsarcopenia\t(loss\tof\tmuscle\tmass)\tis\tthe
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strongest\tpredictor\tof\tdisability\tand\n\tinability\tto\tperform\tdaily\tactivities.\tA\tBMI\tbelow\t23\tis\nconsidered\tbelow\tdesirable\tin\tolder\tadults\t(see\t\nChapter\t19\n).\nRate\tand\textent\tof\tweight\tloss\nReduction\tof\tbody\tweight\tinvolves\tthe\tloss\tof\tboth\tprotein\tand\tfat.\tThe\trelative\tproportions\tof\teach
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depend\ton\tinitial\tbody\tcomposition\tand\tto\tsome\tdegree\tby\tthe\trate\tof\tweight\treduction.\tStrength\ntraining\tcan\thelp\tminimize\tloss\tof\tlean\ttissue\n\tin\tsome\tsubjects.\tSteady\tweight\tloss\tover\ta\tlonger\nperiod\tfavors\treduction\tof\tfat\tstores,\tlimits\tthe\tloss\tof\tvital\tprotein\ttissues,\tand\tminimizes\tthe\tdecline
|
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] |
for\tthose\twith\tBMIs\tgreater\tthan\t35.\tThese\tenergy\ndeficits\tneed\tto\tbe\tindividually\tcalculated,\tand\tcontinually\tadjusted\twith\tweight\tloss\tin\torder\tto\nmaintain\tthe\ttargeted\tcalorie\tdeficits\tand\ttherefore\tweekly\trates\tof\tweight\tloss\t(\nByrne\tet\tal,\t2012\n).
|
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] |
Byrne\tet\tal,\t2012\n).\nWhen\tthese\tdeficits\tare\tmaintained,\tthey\twill\tlead\tto\tan\tapproximately\t10%\tweight\tloss\tin\t6\tmonths\n(\nAcademy\tof\tNutrition\tand\tDietetics\t[AND],\t2016\n).\tFor\tthe\tnext\t6\tmonths\tthe\tfocus\tchanges\tfrom\nweight\tloss\tto\tweight\tmaintenance.\tAfter\tthis\tphase,\tfurther\tweight\tloss\tmay\tbe\tconsidered.
|
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] |
Even\twith\tthe\tsame\tcaloric\tintake,\trates\tof\tweight\treduction\tvary.\tMen\treduce\tweight\tfaster\tthan\nwomen\tof\tsimilar\tsize\tbecause\tof\ttheir\thigher\tLBM\tand\tRMR.\tThe\theavier\tperson\texpends\tmore\nenergy\tthan\tone\twho\tis\tless\tobese\tand\tloses\tfaster\ton\ta\tgiven\tcalorie\n\tintake\tthan\ta\tlighter\tperson.
|
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intake\tthan\ta\tlighter\tperson.\nMany\tpeople\twho\tdo\tnot\tlose\tweight\twhen\tfollowing\ta\tprescribed\tenergy\trestriction\tmay\tbe\nconsuming\tmore\tenergy\tthan\tthey\treport\tand\tmay\talso\toverestimate\ttheir\tphysical\tactivity\tlevels.\nUnderreporting\tof\tenergy\tintake\tis\tthe\tnorm\tand\tis\tshown\tto\tincrease\twith\tBMI.\tUnderreporting\tof
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0.11919233947992325,
0.09797453880310059,
0.005097588058561087,
-0.007095070090144873
] |
estimated\tintake\thas\tbeen\textensively\tstudied;\tit\timpacts\tthe\treliability\tof\tepidemiologic\n\tstudies\tand\ncreates\tthe\tillusion\tof\tresistance\tto\tweight\tloss\tduring\tenergy\trestriction\t(\nDhurandhar\tet\tal,\t2015\n).\nLifestyle\tmodification\nBehavior\tmodification\tis\tthe\tcornerstone\tof\tlifestyle\tintervention.\tIt\tfocuses\ton\trestructuring\ta
|
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] |
person’s\tenvironment,\tdietary\tintake,\tand\tphysical\tactivity\tby\tusing\tgoal\tsetting,\tstimulus\tcontrol,\ncognitive\trestructuring,\tand\trelapse\tprevention.\tIt\talso\n\tprovides\tfeedback\ton\tprogress\tand\tplaces\tthe\nresponsibility\tfor\tchange\tand\taccomplishment\ton\tthe\tpatient.\nStimulus\tcontrol
|
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] |
Stimulus\tcontrol\n\tinvolves\tidentifying\tstimuli\tthat\tmay\tencourage\tincidental\teating\tand\tidentifying\nand\tlimiting\texposure\tto\thigh-risk\tsituations.\tExamples\tof\tstimulus\tcontrol\tstrategies\tinclude\nlearning\tto\tshop\tcarefully\tfor\thealthy\tfoods,\tshopping\twhen\tnot\thungry,\tkeeping\thigh-calorie\tfoods
|
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] |
out\tof\tthe\thouse,\tlimiting\tthe\ttimes\tand\tplaces\tof\teating,\tand\tconsciously\tavoiding\tsituations\tin\twhich\novereating\toccurs.\nProblem\tsolving\n\tis\tthe\tprocess\tof\tdefining\ta\tproblem,\tgenerating\tpossible\tsolutions,\tevaluating\tand\nchoosing\tthe\tbest\tsolution,\timplementing\tthe\tnew\tbehavior,\tevaluating\toutcomes,\tand\treevaluating
|
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] |
connection\tsuccessfully\tusing\tpositive\tlong-term\tmental\tstrategies,\thas\tbeen\tdeveloped\tand\tfound\nuseful\t(\nBeck,\t2011\n).\nSelf-monitoring\twith\tdaily\n\tfood\tand\tactivity\trecords\tis\tpositively\tassociated\twith\tgreater\tweight\nloss.\tAdding\tthe\tplace\tand\ttime\tof\tfood\tintake,\tas\twell\tas\taccompanying\tthoughts\tand\tfeelings,\tadds
|
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] |
complexity\t(which\treduces\tcompliance)\tbut\tmay\thelp\tidentify\tthe\tphysical\tand\temotional\tsettings\tin\nwhich\teating\toccurs.\tPhysical\tactivity\tcan\tbe\ttracked\tin\tminutes,\tmiles,\tor\tcalories\texpended.\tSelf-\nmonitoring\tcan\talso\tprovide\n\tinsight\tinto\tthe\toccurrence\tof\trelapses\tand\thow\tthey\tcan\tbe\tprevented.
|
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] |
A\tcomprehensive\tprogram\tof\tlifestyle\tmodification\tproduced\ta\tloss\tof\tapproximately\t10%\tof\tinitial\nweight\tin\t16\tto\t26\tweeks\tin\ta\treview\tof\trandomized\tcontrolled\ttrials,\tincluding\tthe\tDiabe-tes\nPrevention\tProgram.\tLong-term\tcontinued\tpatient-therapist\tcontact\tsignificantly\timproves\tweight-\nloss\tmaintenance\t(\nAND,\t2016\n).\nEmail
|
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0.0033450035843998194
] |
loss\tmaintenance\t(\nAND,\t2016\n).\nEmail\n\tand\tphone\tconsults\tappear\tto\tbe\tuseful\tmethods\tfor\tcontact\tand\tsupport\tas\tpart\tof\nstructured\tbehavioral\tweight\tloss\tand\tweight\tloss\tmaintenance\tprograms.\tMultiple\tstrategies\tfor\nbehavior\ttherapy\toften\tare\tneeded.\tSelf-monitoring\twith\tmobile\tdevice\tapps\t(see\t\nBox\t4.5\n\tin\t\nChapter\n4
|
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] |
Box\t4.5\n\tin\t\nChapter\n4\n),\tpharmacotherapy,\ttargeted\teducational\tinterventions\tfrom\tthe\tweb,\tmeal\treplacements,\tand\ntelephone\tinterventions\thave\n\ttaken\tover\tthe\tweight\tloss\tindustry.\tBody\tmonitoring—a\tnew\nmonitoring\tmethod\tto\tmeasure\tweight\tchange—involves\twearing\ta\tdevice\tthat\ttracks\tbody\tprocesses
|
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like\ttemperature,\tmovement,\tacceleration,\theating\tfluctuations,\tand\tso\ton—and\trecords\tcalorie\tburn.\nCombined\twith\ta\tfood\tlog\tentered\tinto\tthe\tsystem,\ta\tperson\tcan\tadjust\tfood\tintake\tbased\tupon\tdata\nprovided\tby\tthe\tsystem.\nTelehealth\n\tprograms,\n\twhich\tprovide\tinteraction\twith\thealth\tcare\tprofessionals\tthrough\tvisual\tand
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verbal\tcommunication\tvia\tphone\tand\tcomputer\tscreens,\tare\texploding\tin\thealth\tcare,\twhile\tsaving\ntremendous\tcosts\tand\ttime.\tTelehealth\tis\tnow\tbeing\tused\tas\tan\teffective\tvehicle\twith\tdietitians\tfor\none-on-one\tand\tgroup\tconsults\tand\tfor\tproviding\tnutrition\teducation\tprograms.\nDietary\tmodification\trecommendations\nWeight
|
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Dietary\tmodification\trecommendations\nWeight\n\tloss\tprograms\tshould\tcombine\ta\tnutritionally\tbalanced\tdietary\tregimen\twith\texercise\tand\nlifestyle\tmodification.\tSelecting\tthe\tappropriate\ttreatment\tstrategy\tdepends\ton\tthe\tgoals\tand\thealth\nrisks\tof\tthe\tpatient.\tWhen\tthese\tapproaches\tfail\tto\tbring\tabout\tthe\tdesired\treduction\tin\tbody\tfat,
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] |
sometimes\tmedication\tmay\tbe\tadded.\tFor\t\nmorbid\tobesity\n\t(BMI\t≥40)\tsurgical\tintervention\tmay\tbe\nnecessary.\nTreatment\n\toptions\tinclude\tthe\tfollowing:
|
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] |
•\t\nA\tbalanced\treduced-calorie\tmacronutrient\tadjusted\teating\tplan,\tincreased\tphysical\tactivity,\nand\tlifestyle\tmodification\n•\t\nA\tbalanced\treduced-calorie\tmacronutrient\tadjusted\teating\tplan,\tincreased\tphysical\tactivity,\nlifestyle\tmodification,\tand\tpharmacotherapy\n•
|
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lifestyle\tmodification,\tand\tpharmacotherapy\n•\t\nSurgery\tplus\tan\tindividually\tprescribed\teating\tregimen,\tphysical\tactivity,\tand\tlifestyle\nmodification\n\tprogram\n•\t\nPrevention\tof\tweight\tregain\tvia\tactively\tbalancing\tenergy\tintake\tand\toutput\n•\t\nMindset\tinterventions\tvia\tcognitive\trestructuring\nRestricted-energy\teating\tplan
|
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Restricted-energy\teating\tplan\nA\tbalanced,\trestricted-energy\teating\tplan\tis\tthe\tmost\twidely\tprescribed\tmethod\tof\tweight\treduction.\nThe\tdiet\tshould\tbe\tnutritionally\tadequate\tand\tmeet\tbut\tnot\texceed\tenergy\tneeds\tfor\tweight\nreduction.\tA\tcaloric\tdeficit\tof\n\t500\tto\t1000\tkcal\tdaily\tusually\tmeets\tthis\tgoal\tfor\tsubjects\t≥30\tBMI.
|
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500\tto\t1000\tkcal\tdaily\tusually\tmeets\tthis\tgoal\tfor\tsubjects\t≥30\tBMI.\nThe\tprescribed\tenergy\tlevel\tvaries\twith\tthe\tindividual’s\tbody\tsize\tand\tactivities.\tFor\texample,\tfor\ta\n500-calorie\tdeficit\tthe\tinitial\tdaily\tenergy\tprescription\tfor\ta\t5′5″,\tage\t35,\t30-BMI\tfemale\twould\tbe
|
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] |
approximately\t1400\tcalories,\tor\tapproximately\t1700\tcalories\tfor\ta\t40-BMI\tfemale\tof\tthe\tsame\theight\nand\tage.\tRegardless\tof\tthe\tlevel\n\tof\tCR,\thealthful\teating\tand\tregular\tphysical\tactivity\tshould\tbe\tdaily\ngoals.\tAll\tmeans\tpossible\t(coaching,\tmotivational\tinterviewing,\tcognitive\trestructuring,\tetc.)\tshould
|
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] |
be\tutilized\tby\tthe\thealth\tcare\tteam\tto\tsupport\thealthy\tlifestyle\tchanges.\nAll\treduced\tcalorie\tdiets\t(low-fat,\tlow-carbohydrate,\tbalanced)\tproduce\tsimilar\t(long-term)\tweight\nloss\twhich\tmeans\trecommendations\tcan\tbe\ttailored\tto\n\tindividual\tpreferences\t(\nHall,\t2017\n;\t\nJohnston,\n2014
|
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] |
individual\tpreferences\t(\nHall,\t2017\n;\t\nJohnston,\n2014\n).\tIn\tall\tcases\tsubjects\tshould\tbe\tencouraged\tto\tconsume\tpredominantly\twhole\tfoods\toptions\n(fresh,\tunprocessed\tvegetables,\tfruits,\tbeans\t[legumes],\tand\twhole\tgrains\tplus\ta\tvariety\tof\tseafood,\npoultry,\tand\tlean\tmeats).
|
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] |
poultry,\tand\tlean\tmeats).\nThe\trecommended\tdietary\tallowance\t(RDA)\tfor\tprotein\tis\tbased\ton\tmaintenance\tlevel\tenergy\nrequirements\tand\tis\tnot\tapplicable\tto\n\tthe\tsituation\tof\tenergy\trestriction.\tToo\tlittle\tattention\tto\nprotein\tintake\tduring\tenergy\trestriction\tresults\tin\tundesirable\teffects\ton\tLBM\tand\tunderlying\tREE.
|
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] |
Protein\tprescription\tof\t1.2\tg\tper\tkg\tappears\tto\tbe\tnecessary\tto\tminimize\tthe\tloss\tof\tLBM,\tprevent\nreduced\tREE,\tand\tpreserve\tbone\tmineral\tdensity\tin\tsituations\tof\tenergy\trestriction\t(\nDrummen\tet\tal,\n2018\n;\t\nLeidy,\t2015\n;\t\nWesterterp-Plantenga\tet\tal,\t2012\n).\tHowever,\thigher\tlevels\tof\tprotein\talso\ttend\tto
|
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).\tHowever,\thigher\tlevels\tof\tprotein\talso\ttend\tto\nblunt\timprovements\tin\tinsulin\tresistance\tin\tindividuals\twith\tinsulin\tresistance.\nAlcohol\tand\tfoods\thigh\tin\tsugar,\tespecially\tbeverages,\tshould\tbe\tlimited\tto\tsmall\tamounts.\tAlcohol\nmakes\tup\t10%\tof\tthe\tdiet\tfor\tmany\tregular\tdrinkers\tand\tcontributes\t7\tkcal/g.\tHeavy\tdrinkers\twho
|
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] |
consume\t50%\tor\tmore\tof\tdaily\tcalories\tfrom\talcohol\tmay\thave\ta\tdepressed\n\tappetite,\twhereas\nmoderate\tusers\ttend\tto\tgain\tweight\twith\tthe\tadded\talcohol\tcalories.\tHabitual\tuse\tof\talcohol\tmay\nresult\tin\tlipid\tstorage,\tweight\tgain,\tor\tobesity.\nThere\tis\tno\tevidence\tthat\tusing\tnonnutritive\tsweeteners\treduces\tfood\tintake\tor\tenhances\tan
|
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nonnutritive\tsweeteners\tmay\tbe\tassociated\twith\tincreased\tBMI\tand\tcardiometabolic\trisk.\tFurther\nresearch\tis\tneeded\tto\tfully\tcharacterize\tthe\tlong-term\trisks\tand\tbenefits\tof\tnonnutritive\tsweeteners\n(\nAzad\tet\tal,\t2017\n).\nVitamin\tand\tmineral\tsupplements\tthat\n\tmeet\tage-related\trequirements\tusually\tare\trecommended
|
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] |
meet\tage-related\trequirements\tusually\tare\trecommended\nwhen\tthere\tis\ta\tdaily\tintake\tof\tless\tthan\t1200\tkcal\tfor\twomen\tand\t1800\tkcal\tfor\tmen,\tor\twhen\tit\tis\ndifficult\tto\tchoose\tfoods\tthat\twill\tmeet\tall\tnutrient\tneeds\tat\tthe\trestricted\tenergy\tintake.\nWeight\tloss\tprograms\nCommercial\tand\tself-help\tprograms\nMillions\tof\tAmericans\tturn\tto
|
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] |
Commercial\tand\tself-help\tprograms\nMillions\tof\tAmericans\tturn\tto\t\ncommercial\tweight\tloss\tcenters\n\t(NutriSystems,\tJenny\tCraig,\n\tetc.)\n(\nTable\t20.4\n)\tor\t\nself-help\tprograms\n\t(diet\tbook\tor\tInternet-based)\tin\tsearch\tof\tpermanent\tweight\tloss\neach\tyear.\tCommercial\tweight\tloss\tcenters\tusually\trequire\tthe\tuse\tof\tproprietary\tprepackaged
|
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] |
meals.\tPrepackaged\tdiets\tallow\tsubjects\tto\tavoid\tfood\tpreparation\tand\treduce\tthe\tnumber\tof\tchoices\nabout\tfood\t(and\twhat\tto\teat)\tthroughout\tthe\tday.\tSome\tprovide\tclasses\ton\tbehavior\tmodification\tand\nhealthy\teating.
|
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] |
TABLE\t20.4\nPopular\tWeight\tLoss\tDiets\n*\nAtkins\tDiet\nBlood\tType\tDiet\nCaveman\tDiet\nDetox\tDiet\nFlat\tBelly\tDiet\nFlexitarian\nGlycemic\tIndex\tDiet\nHCG\tDiet\nIntermittant\tfasting\nJenny\tCraig\nLA\tWeight\tLoss\nMayo\tClinic\tDiet\nMedifast\tDiet\nNutriSystem\tDiet\nNutritarian\tDiet\nRaw\tFood\tDiet\nSouth\tBeach\tDiet\nThe\t17-Day\tDiet\nThe\t5:2\tDiet\nThe\t8-Hour\tDiet\nThe\tFast\tDiet
|
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The\t17-Day\tDiet\nThe\t5:2\tDiet\nThe\t8-Hour\tDiet\nThe\tFast\tDiet\nThe\tKetogenic\tDiet\nThe\tMediterranean\tDiet\nThe\tPaleo\tDiet\nVegan\tDiet\n*\nThe\tAcademy\tof\tNutrition\tand\tDietetics\thas\ta\tpage\ton\ttheir\twebsite\tdevoted\tto\tevaluating\tweight\tloss\tand\tfad\tdiets\nhttps://www.eatright.org/health/weight-loss/fad-diets\nSome\tbrands\tof\t\nmeal\treplacements
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] |
Some\tbrands\tof\t\nmeal\treplacements\n\tare\tavailable\tover\tthe\tcounter\t(OTC)\tin\tdrug\tstores,\nsupermarkets,\tor\tvia\thome\tdelivery\t(e.g.,\tWeight\tWatchers,\tSlimFast,\n\tHMR,\tetc.).\tThe\tgoal\tof\tusing\nthese\tfoods\tis\tto\tprovide\tstructure\tand\treplace\tother\thigher\tcalorie\tfoods.\tPer\tserving,\tmost\tmeal
|
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] |
replacements\tinclude\t10\tto\t20\tg\tof\tprotein,\tvarious\tamounts\tof\tcarbohydrate,\t0\tto\t10\tg\tof\tfat,\tup\tto\t5\ng\tof\tfiber,\tand\t25%\tto\t30%\tof\tRDAs\tfor\tvitamins\tand\tminerals.\tUsually\tdrinks\tor\tshakes\tare\tmilk\n(casein\tor\twhey),\tpea\tprotein,\trice\tprotein,\tor\tsoy\tbased;\tare\thigh\n\tin\tcalcium;\tand\thave\t150\tto\t250
|
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in\tcalcium;\tand\thave\t150\tto\t250\nkcal\tper\tserving.\tThey\tare\tfrequently\tready\tto\tuse,\tportion\tcontrolled,\tor\tmade\twith\ta\tpurchased\npowder.\tPeople\twho\thave\tdifficulty\twith\tself-selection\tor\tportion\tcontrol\tmay\tuse\tmeal\treplacements\nas\tpart\tof\ta\tcomprehensive\tweight\tmanagement\tprogram.\tSubstituting\tone\tor\ttwo\tdaily\tmeals\tor
|
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snacks\twith\tmeal\treplacements\tis\ta\tsuccessful\tweight\tloss\tand\tweight\tmaintenance\n\tstrategy\t(\nAND,\n2016\n).\tMeal\treplacements\tare\talso\tutilized\tin\t\nmedically\tsupervised\tweight\tloss\tprograms\n\t(see\nVery-Low-Calorie\tDiets\n).\nThe\tInternet\thas\tspawned\ta\tnew\tgeneration\tof\tweb-based\tweight\tloss\toptions\tincluding\t\nDiet.com\n,\nNutriSystem.com\n,
|
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] |
Diet.com\n,\nNutriSystem.com\n,\t\nSparkPeople.com\n,\t\nSouthBeach.com\n,\tMyFitnessPal,\tand\t\nWeightWatchers.com\n.\tA\nhandful\tof\trandomized\tcontrolled\tclinical\ttrials\thave\tattempted\tto\taddress\twhether\n\tpersonalization\nimproves\toutcomes\tfrom\tthese\tprograms.\tHowever,\tresults\thave\tbeen\tmixed\tand\tit\tremains\tto\tbe\ndetermined\t(\nCollins\tet\tal,\t2012
|
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0.007886088453233242
] |
determined\t(\nCollins\tet\tal,\t2012\n).\tApart\tfrom\tWeight\tWatchers,\tthere\tis\tnot\ta\tstrong\tbase\tof\tevidence\nbehind\tthe\tmajor\tcommercial\tand\tself-help\tweight\tloss\tprograms.\tThe\tFederal\tTrade\tCommission\n(FTC)\trequires\tprogram\tadvertisements\tto\tvoluntarily\tinclude\tthe\tphrase\t“results\tnot\ttypical,”\n\tbut
|
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] |
but\nhas\tinsufficient\tresources\tto\tfurther\tprotect\tconsumers\tfrom\tmisleading\tadvertising.\tMore\tcontrolled\ntrials\tare\tneeded\tto\tassess\tthe\tefficacy\tof\tcommercial\tprograms,\ttherefore\tit\tis\timportant\tto\tevaluate\nall\tweight\tloss\tprograms\tfor\tsound\tnutritional\tand\tbehavioral\tpractices.\nVery-low-calorie\tdiets\nDiets\tproviding\t≤800\tkcal\tare\tclassified\tas
|
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carefully,\tis\tless\tthan\t65\tyears\told,\tand\thas\ta\tcondition\tsuch\tas\tcongestive\theart\tfailure\tsecondary\tto\nobesity.\tIn\tsuch\ta\tcase,\timmediate\tand\trapid\tweight\tloss\tis\tconsidered\tlife\tsaving.\nVLCDs\tare\thypocaloric\n\tbut\trelatively\trich\tin\tprotein\t(0.8\tto\t1.5\tg\tper\tkg\tper\tday).\tThey\tare
|
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] |
designed\tto\tinclude\ta\tfull\tcomplement\tof\tvitamins,\tminerals,\telectrolytes,\tand\tessential\tfatty\tacids,\nbut\tnot\tcalories,\tand\tthey\tare\tusually\tgiven\tfor\ta\tperiod\tof\t12\tto\t16\tweeks\tas\tpart\tof\ta\tmedically\nsupervised\tcomprehensive\tlifestyle-modification\tprogram\trequiring\tregular\tmedical\tmonitoring\tand\nattendance\tof\tweekly
|
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] |
attendance\tof\tweekly\n\tgroup\tclasses.\tTheir\tmajor\tadvantage\t(with\tpatient\tcompliance)\tis\trapid\tweight\nloss.\nPhysicians\toften\trefer\tpatients\tthat\twould\tbenefit\tmedically\t(\nFig.\t20.6\n)\tfrom\trapid\tweight\tloss\t(e.g.,\nsevere\tobstructive\tsleep\tapnea,\tcongestive\theart\tfailure,\tand\tsevere\tobesity\twith\tmultiple
|
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] |
comorbidities)\tto\tVLCD\tprograms.\tBecause\tof\tpotential\tside\teffects,\tprescription\tof\tthese\tdiets\tis\nreserved\tfor\tpersons\n\twith\ta\tBMI\tof\t≥30\t(or\t≥27\twith\tat\tleast\tone\tcomorbidity)\tfor\twhom\tother\tdiet\nprograms\thave\tbeen\tunsuccessful.
|
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] |
FIG.\t20.6\nBMI\tContinuum\t&\tTreatment\tRecommendations\t(NIH).\t1998\tNational\tHeart,\tLung,\tand\tBlood\nInstitute\t-\tNational\tInstitute\tof\tDiabetes\tand\tDigestive\tand\tKidney\tDiseases:\tClinical\tGuidelines\ton\tthe\nIdentification,\tEvaluation,\tand\tTreatment\tof\tOverweight\tand\tObesity\tin\tAdults:\tEvidence\tReport.
|
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] |
An\tOTC\tVLCD\tthat\tfirst\tbecame\tpopular\tin\tthe\tearly\t1970s\tresulted\tin\tseveral\tdeaths\trelated\tto\n\tits\nlow-quality,\tincomplete\tprotein\tprofile.\tThe\thigh-quality\tprotein\tformulations\tused\tin\tmedically\nsupervised\tprograms\tprovide\tefficacy\tand\tsafety\tfor\tthose\twith\tmorbid\tobesity.\tAdverse\tside\teffects
|
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] |
to\tVLCDs\tinclude\thigher\trisk\tfor\tgallstones,\tcold\tintolerance,\tfatigue,\tweakness,\tlightheadedness,\nconstipation\tor\tdiarrhea,\thair\tloss,\tdry\tskin,\tmenstrual\tchanges,\tand\tgout;\tsome\tof\tthese\tmay\tbe\nrelated\n\tto\ttriiodothyronine\t(thyroid)\tdeficiency\t(see\t\nChapter\t30\n).\tEmerging\tdata\tseem\tto\tindicate
|
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] |
Chapter\t30\n).\tEmerging\tdata\tseem\tto\tindicate\nthat\tas\tfat\tstores\tdiminish,\tmolecules\tare\treleased\tthat\tcan\taffect\tfurther\tweight\tloss\t(see\t\nClinical\nInsight:\n\tWhat’s\tin\tThat\tFat\tWhen\tYou\tLose\tIt?\n).\nThe\tcurrent\tliterature\tindicates\tthat\teven\tthough\tthere\tis\tsignificantly\tgreater\tweight\tloss\twith
|
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0.1279040277004242,
0.04978588968515396,
0.09174485504627228,
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] |
VLCDs\tin\tthe\tshort\tterm\t(up\tto\t13%\tgreater\tthan\tlow\tcalorie\n\tdiets,\tor\tLCDs,\twith\tbehavioral\ncounseling),\tthere\tare\ton\taverage\tno\tsignificant\tdifferences\tin\tthe\tlong\tterm\t(\nGudzune\tet\tal,\t2015\n).\nWeight\tloss\tmaintenance\trequires\tongoing\tvigilance\tand\tpermanent\tlifestyle\tchanges—that\ttarget\ta
|
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] |
reduced\tweight\tnet-energy-balance—regardless\tof\tthe\tmethods\temployed\tto\tlose\tweight\t(\nHall\tet\tal,\n2011\n).\nPopular\tdiets\tand\tpractices\nEach\tyear,\tnew\tbooks\t(or\twebsites)\n\tpromising\tweight\tloss\tfind\ttheir\tway\tto\tthe\tconsumer\tthrough\nthe\tpopular\tpress\tand\tmedia.\tSome\tof\tthe\tprograms\tare\tsensible\tand\tappropriate,\twhereas\tothers
|
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approach,\tfor\tpeople\ton\tthe\trun\twho\tcarry\ttheir\tphones\tand\tcomputers,\twith\ta\tproduct\tline\n\toffered\nand\taccessibility\tto\tcounselors\tand\thealth\tprofessionals,\thas\tmade\tthe\tbusiness\tof\tdiets\ta\nmultibillion-dollar\tindustry.\tOne\ton\tone\tand\tgroup\tonline\tcounseling,\tphone\taccess\tto\tdiscuss\tweight
|
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0.04935675486922264,
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0.05081627517938614,
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0.054523177444934845,
0.016236562281847,
0.07117529213428497,
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] |
loss\tprogress\tand\tsetbacks,\tand\tdelivery\tof\t“to-your-door”\tfoods\tand\tmeals\tare\tsome\tof\tthe\tenticing\naspects\tof\tjoining\tthese\tprograms.\tConsumers\tcontinue\tto\tneed\tproper\tguidance\tto\tseparate\tthe\ngood,\n\tsound\tdiet\tprograms\tfrom\tthe\tbad.\tPopular\tdiets\tcome\tand\tgo;\tsome\tare\treviewed\tor\tdescribed\nby\tvarious\twebsites\t(see\t\nTable\t20.4\n).
|
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0.06374823302030563,
0.021127624437212944,
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0.05413359776139259,
0.03753207251429558,
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0.045205820351839066,
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] |
by\tvarious\twebsites\t(see\t\nTable\t20.4\n).\nIntermittent\tfasting\nTraditionally,\tfasting\thas\tbeen\tconsidered\tprimarily\tthe\tact\tof\twillingly\tabstaining\tfrom\tfood,\tdrink,\nor\tboth,\tfor\ta\tset\tperiod\tof\ttime\tand\thas\tbeen\tused\tat\tdifferent\ttimes\tof\tthe\tyear\tin\treligious\nobservances\tfor\tcenturies.\tApplying\t\nintermittent\tfasting\t(IF)
|
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observances\tfor\tcenturies.\tApplying\t\nintermittent\tfasting\t(IF)\n\ttype\tregimes\tas\tan\tapproach\tto\nweight\tloss\thas\trecently\tbeen\tpopularized\tby\tvarious\tdiet\tbooks\twhich\tclaim\tthere\tare\tmetabolic\nadvantages\tto\tIF\tleading\tto\tfaster,\tor\tmore,\tweight\tloss.\nIn\tthe\tpopular\tliterature\tIF\tencompasses\ta\tvariety\tof\tapproaches\tincluding\t(1)\tlimiting\teating\tto
|
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the\tsame\t8\thours\tdaily,\t(2)\tan\talternating\tpattern\tof\tunder-\tand\tovereating\tdays,\t(3)\tfasting\t2\tdays\nper\tweek\tand\n\teating\tnormally\tthe\tother\t5\tdays,\tand\t(4)\thaving\tregular\tsplurge\tdays\t(in\tthe\tmiddle\tof\nstretches\tof\tfasting).\nWhile\tthere\tare\tmultiple\tstudies\tpertaining\tto\tIF\tin\tthe\tscientific\tliterature,\tmost\tare\tstudying
|
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biomarkers\tof\tcardiovascular\tdisease\tor\tlongevity\tand\thave\tnot\tlooked\tat\tweight\tloss\tas\tan\toutcome.\nAdditionally,\tmany\thave\tno\tcontrol\tor\tcomparison\tgroups.\tReviews\tof\tstudies\tthat\thave\n\tcompared\tIF\nwith\ta\tconstant-calorie-restriction\tgroup\t(\nDavis\tet\tal,\t2016\n;\t\nHarris\tet\tal,\t2018\n;\t\nHeadland\tet\tal,\t2016\n)
|
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] |
Davis\tet\tal,\t2016\n;\t\nHarris\tet\tal,\t2018\n;\t\nHeadland\tet\tal,\t2016\n)\nfind\tno\tdifferences\tin\tweight\tloss,\tbody\tcomposition,\tor\tinsulin\tsensitivity.\nSome\tpopular\tIF\tregimes\thave\tbeen\tcriticized\tfor\tpromoting\tan\tunhealthy\t“anything\tgoes”\tdiet\ton\nnonfasting\tdays,\twhich\tseems\tto\tborder\ton\tencouragement\tfor\tbinging\tand/or\tdisordered\teating.\nDiet\tquality,
|
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] |
Diet\tquality,\n\thowever,\tbecomes\tmore—not\tless—important\tduring\tany\tongoing\tperiod\tof\tenergy\nrestriction.\nIn\tsummary,\tIF\tis\tno\tmore\teffective\tthan\tother\tapproaches\tto\tcalorie\trestriction\tand\tthe\teffects\tof\nusing\tIF\tfor\tweight\tloss\tmaintenance\thave\tyet\tto\tbe\tstudied.\nLow-carbohydrate\tand\tketogenic\tdiets
|
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Low-carbohydrate\tand\tketogenic\tdiets\nWhen\tcarbohydrate\tintake\tis\tless\tthan\t50\tg\tper\tday,\t\nketosis\n\tprovides\tthe\tbrain\tand\tskeletal\tmuscles\nwith\n\tan\talternate\tenergy\tsource\tin\tthe\tform\tof\t\nketones\n\tderived\tfrom\tlipolysis\t(the\tbreakdown\tof\tfat).\nKetones\tare\tbelieved\tto\timprove\tsatiety\t(suppress\tappetite),\tat\tleast\tinitially.
|
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800-calorie\tmixed\tdiet,\tsubjects\tdid\tlose\tweight\tmore\trapidly\tat\tthe\tbeginning\tof\tthe\tketogenic\tdiet\nperiod,\thowever\tthe\textra\tweight\tloss\twas\tdue\tsolely\tto\texcess\twater\tlosses.\tBoth\tdiets\tled\tto\tthe\nsame\tamount\tof\tbody\tfat\tand\n\tprotein\t(LBM)\tlosses\t(\nYang\tand\tVan\tItallie,\t1976\n).\tA\trecent\tmuch
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] |
protein\t(LBM)\tlosses\t(\nYang\tand\tVan\tItallie,\t1976\n).\tA\trecent\tmuch\nshorter\tversion\tof\tthis\ttype\tof\tstudy\tby\tthe\tNIH\talso\tfound\tno\tadvantage\tto\tthe\tketogenic\tdiet\t(\nHall\net\tal,\t2015\n).\nThe\timpact\tof\ta\tketogenic\tdiet\ton\tthe\tmicrobiome\tand\toverall\tnutrient\tintake\tare\ttwo\tareas\tof
|
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] |
concern.\tA\trecent\tstudy\ton\tthe\teffect\tof\ta\tketogenic\tdiet\ton\tthe\tgut\tmicrobiota\tfound\ta\tbacterial\ngroup\tsupposed\tto\tbe\tinvolved\n\tin\tthe\texacerbation\tof\tthe\tinflammatory\tcondition\tof\tthe\tgut\tmucosa\nassociated\twith\tthe\tketogenic\tdiet\tpattern\t(\nTagliabue\tet\tal,\t2017\n).\tThe\trecommended\tupper\tlimit\tfor
|
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] |
Tagliabue\tet\tal,\t2017\n).\tThe\trecommended\tupper\tlimit\tfor\ndietary\tfat\tis\t35%\tof\tcalorie\tintake\tper\tthe\tdietary\treference\tintakes,\twhich\tare\tintended\tto\tensure\nadequate\tmicronutrients\tand\tshield\tagainst\tpreventable\tdiseases\t(see\t\nAppendix\t19\n\ton\tthe\tketogenic\ndiet).\nHigh-protein\t(rather
|
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] |
Appendix\t19\n\ton\tthe\tketogenic\ndiet).\nHigh-protein\t(rather\n\tthan\thigh-fat)\tvariants\tof\tlow-carbohydrate\tand\tketogenic\tdiets\tinclude\tthe\nZone\tand\tSouth\tBeach\tDiets,\twhich\trestrict\tcarbohydrates\tto\tno\tmore\tthan\t40%\tof\ttotal\tcalories,\nwith\tfat\tand\tprotein\teach\tproviding\t30%\tof\ttotal\tcalories.\tThese\tdiets\tare\tconsidered\tmoderate
|
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] |
choices\twithin\tthe\tlow-carbohydrate\tcategory\tand\tinclude\tgenerous\tamounts\tof\tfiber\tand\tfresh\tfruits\nand\tvegetables,\tand\tthey\tstress\tthe\n\tkind\tof\tfat,\twith\temphasis\ton\tmonounsaturated\tand\npolyunsaturated\tfat\tand\tlimitation\tof\tsaturated\tfat.\tFor\tmore\tinformation\tabout\ta\tketogenic\tdiet\tand\nthe\tconditions\tfor\twhich\tit\thas\tbeen\tstudied,\tsee
|
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] |
the\tconditions\tfor\twhich\tit\thas\tbeen\tstudied,\tsee\t\nAppendix\t19\n.\nUnanswered\tquestions\tabout\tthe\tketogenic\tdiet\tinclude:\n•\t\nWhat\tare\tthe\tlong-term\t(1\tyear\tor\tlonger)\teffects,\tis\tit\tsafe?\n•\t\nDo\tthe\tdiet’s\thealth\tbenefits\textend\tto\thigher\trisk\tindividuals\n\twith\tmultiple\thealth\tconditions
|
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] |
with\tmultiple\thealth\tconditions\nand\tthe\telderly?\tFor\twhich\tdisease\tconditions\tdo\tthe\tbenefits\tof\tthe\tdiet\toutweigh\tthe\trisks?\n•\t\nAs\tfat\tis\tthe\tprimary\tenergy\tsource,\twhat\tis\tthe\teffect\tof\tsuch\ta\thigh-fat\tdiet\tthat\tincludes\tso\nmuch\tsaturated\tfat?\n•\t\nIs\tthe\thigh\tfat,\tmoderate\tprotein\tintake\ton\ta\tketogenic\tdiet\tsafe\tfor\tdisease\tconditions\tthat
|
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] |
interfere\twith\tnormal\tprotein\tand\tfat\tmetabolism,\tsuch\n\tas\theart,\tkidney,\tand\tliver\tdiseases?\n•\t\nIs\ta\tketogenic\tdiet\ttoo\trestrictive\tfor\tperiods\tof\trapid\tgrowth?\n•\t\nIs\tthe\tketogenic\tdiet\tsafe\tand\tis\tit\teffective\tfor\tathletes?\nThe\t\ncarbohydrate-insulin\ttheory\tof\tobesity\n\tis\tthe\tfoundation\tof\tlow-carbohydrate\tand\tketogenic
|
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] |
is\tthe\tfoundation\tof\tlow-carbohydrate\tand\tketogenic\ndiets.\tThe\tbasic\ttheory\tis\tthat\tcarbohydrates\tstimulate\tinsulin\tsecretion\tcausing\tincreased\tfat\nstorage,\twhich\tincreases\tappetite\n\tand\tsuppresses\tmetabolism\tresulting\tin\tweight\tgain.\tLow\ncarbohydrate\tintake\tdoes\tdecrease\tinsulin\tsecretion\t(\nAbassi,\t2018\n).\tThe\tinsulin\ttheory\thowever,\tonly
|
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] |
Abassi,\t2018\n).\tThe\tinsulin\ttheory\thowever,\tonly\ndescribes\tpostprandial\tenergy\tmetabolism\twhile\tignoring\tthe\trest\tof\tthe\t24-hour\tenergy\tmetabolism\npicture.\tInsulin\tlevels\tdon’t\tremain\televated,\tand\tovernight—in\tthe\tfasting\tstate—fat\toxidation\nincreases,\treducing\tfat\tstores.\tA\tnet\tgain\tin\n\tfat\tstores\tonly\toccurs\twith\tpositive\tenergy\tbalance.
|
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fat\tstores\tonly\toccurs\twith\tpositive\tenergy\tbalance.\nRecent\tcarefully\tcontrolled\tmetabolic\tlaboratory\tstudies\tappear\tto\thave\tinvalidated\tthe\tinsulin\ntheory\tof\tobesity\t(\nHall\tet\tal,\t2015\n;\t\nHall\tand\tGuo,\t2017\n).\tA\trecent\tsystematic\treview\tof\thigh\tquality
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;\t\nHall\tand\tGuo,\t2017\n).\tA\trecent\tsystematic\treview\tof\thigh\tquality\nrandomized\tcontrolled\ttrials\t(RCTs)\tcomparing\tlow-carbohydrate\twith\tisoenergetic\t(having\tthe\tsame\ntotal\tcalories)\tbalanced\tdiets\tfound\tessentially\n\tno\tdifference\tin\tweight\tloss,\tmeasures\tof\tglycemic\ncontrol,\tblood\tpressure,\tor\tblood\tlipid\tbetween\tthe\ttwo\tdiets\t(\nNaude\tet\tal,\t2014
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Naude\tet\tal,\t2014\n).\nVery-low-fat\t(high-carbohydrate)\tdiets\nVery-low-fat\t(high-carbohydrate)\tdiets\tcontain\tless\tthan\t10%\tof\tcalories\tfrom\tfat,\tsuch\tas\tthe\toriginal\nDr.\tDean\tOrnish’s\tProgram\tfor\tReversing\tHeart\tDisease\tand\tthe\tPritikin\tProgram.\tTen\tpercent\tof\nenergy\tfrom\tfat\thowever
|
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0.04404464736580849,
0.13239853084087372,
0.07027160376310349,
0.08323293179273605,
-0.012113802134990692
] |
energy\tfrom\tfat\thowever\n\tis\twell\tbelow\tthe\tcurrent\tacceptable\tmacronutrient\tdistribution\trange\n(AMDR)\tfor\tfat\twhich\tis\t20%\tto\t35%\tof\ttotal\tcalorie\tintake\t(\nNational\tAcademy\tof\tSciences\tInstitute\tof\nMedicine,\t2005\n).\tLess\tthan\t20%\tfat\tmay\tnegatively\timpact\tessential\tfatty\tacid\tintake\tand\tfat-soluble\nnutrient\tabsorption\t(\nTable\t20.5
|
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0.042756736278533936,
0.09934020787477493,
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] |
nutrient\tabsorption\t(\nTable\t20.5\n).\tLess\trestrictive\tand\tmore\tpopular\tvariations\tof\tthese\tdiets\tdo\tallow\nfat\tas\t20%\tof\ttotal\n\tenergy\tintake.\tWeight\tloss\ton\tthese\tdiets\tis\tdue\tsolely\tto\tenergy\trestriction.\nBecause\tfat\tprovides\tmore\tthan\ttwo\ttimes\tthe\tenergy\tper\tgram\tas\tprotein\tor\tcarbohydrate\t(9\tkcal
|
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] |
versus\t4\tkcal),\tlimiting\tfat\tis\ttheoretically\tthe\tmost\tefficient\tway\tto\tdecrease\tcalories.\tThe\nunforeseen\tconsequence\tof\tsevere\tfat\trestriction\thowever\tis\tcompensatory\tintake\tof\tsugar\tand/or\nprocessed\tcarbohydrates\twhich\tcan\n\ttrigger\tmetabolic\tsyndrome.\nTABLE\t20.5\nAcceptable\tMacronutrient\tDistribution\tRanges\t(AMDR)%\tof\tTotal\tCalorie\tIntake\n2005
|
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] |
2005\nPrevious\tGuidelines\nProtein\n10%\tto\t35%\n10%\tto\t35%\nCarbohydrate\n45%\tto\t65%\n50%\tor\tmore\nFat\n20%\tto\t35%\n30%\tor\tless\nNAS\tIOM:\tDietary\tReference\tIntakes\tfor\tEnergy,\tCarbohydrate,\tFiber,\tFat,\tFatty\tacids,\tCholesterol,\tProtein,\tand\tAmino\tAcids\t(Macronutrients),\t\nThe\nNational\tAcademies\tPress\n.\t2005.\nBalanced\tlower\tcalorie\tdiets
|
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] |
Balanced-nutrient\treduction\tdiets\tare\tless\tcommon\tamong\tso-called\t“popular”\tdiets.\tThe\tfull\ndocument\tof\tthe\t(2015–2020)\tDietary\tGuidelines\tfor\tAmericans\toutlines\tthe\tdetails\tof\tthree\teating\nplans\tin\tits\tappendices\tthat\tqualify:\tthe\tHealthy\tU.S.-Style\tEating\tPattern,\tHealthy\tMediterranean-\nStyle\tEating\tPattern,\tand\tHealthy\tVegetarian
|
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Style\tEating\tPattern,\tand\tHealthy\tVegetarian\n\tEating\tPattern.\nReduced-energy\tdiets\tfor\tweight\tmanagement\tshould\tbe\tnutritionally\tsound,\tnot\tharmful,\tand\nfeasible\tto\tmaintain\tover\ttime.\tThis\trequires\tsustainability\tin\tterms\tof\tease\tof\tadherence,\tusing\nreadily\tavailable\tand\taffordable\tfoods,\tand\tsocial\tand\tcultural\tacceptability\t(\nNaude\tet\tal,\t2014
|
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] |
Naude\tet\tal,\t2014\n).\tThe\nU.S.\tDepartment\tof\tAgriculture\t(USDA)\tsupported\ta\tscientific\treview\tof\tpopular\tdiets\tto\n\tassess\ttheir\nefficacy\tfor\tweight\tloss\tand\tweight\tmaintenance,\tas\twell\tas\ttheir\teffect\ton\tmetabolic\tparameters,\nmental\twell-being,\tand\treduction\tof\tchronic\tdisease.\tA\tsummary\tis\tshown\tin\t\nTable\t20.6\n.\nTABLE\t20.6
|
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] |
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