Maintaining a healthy weight is crucial for overall well-being, influencing everything from mood and energy levels to the prevention of serious illnesses. Proper nutrition, regular exercise, and informed food choices are all vital components of a successful weight loss plan. This article explores effective weight loss strategies, drawing upon research and practical approaches to provide a comprehensive guide for individuals seeking to achieve and maintain a healthy weight.
The Importance of Proper Diet and Nutrition
A well-nourished body is better equipped to function optimally. Proper diet is essential to maintaining good health. Keeping the body well-nourished and at a healthy weight has been proven to improve mood, quality of life and longevity. It may also go a long way in preventing or controlling many serious illnesses. Not only do people feel more energetic and happier when they eat well, they also keep their bodies in the best possible condition. The benefits of good nutrition include developing and maintaining physical strength as well as preventing or controlling disease processes. A healthy diet is a varied one, containing the balanced nutrition needed for cell growth, cell regeneration and the maintenance of healthy organs and tissues. It includes an appropriate balance of protein, fiber, carbohydrates and unsaturated fats in reasonable portions. Calorie intake should be determined by age, activity level and weight goal. While our culture tends to focus on avoiding obesity, being underweight or malnourished is also a serious and often life-threatening problem. In some cases, depending on age and physical condition, certain individuals may require vitamin or mineral supplements in order to maintain proper nutrition and an appropriate weight. Obesity, which affects approximately a third of all adults and a fifth of all children in the United States, is avoidable with proper diet and nutrition and a program of regular exercise. Through refraining from overeating and from ingesting foods high in calories and low in nutritional values, individuals can improve their health immeasurably. Since avoiding obesity requires making wise food choices, the more informed individuals are about what they eat, the better. Reading labels, eating fresh foods whenever possible and keeping informed about nutritional research -- may all contribute to leading a healthier, and often a longer, life. Nutritional counseling is invaluable in pursuing this goal. Nutritional counseling services include initially taking a medical, and sometimes psychological, history and establishing a customized dietary plan for each individual patient. A specific diet takes into account each patient's weight goals, personal food preferences, overall health and particular medical conditions. Anyone can benefit from nutritional counseling, especially patients with food allergies or eating disorders.
The Challenge of Weight Loss Maintenance
Maintenance of weight loss remains a challenge for most individuals, thus practical and effective weight loss maintenance (WTLM) strategies are needed. Few people recover from even minor weight gains of 1-2 kg (2) and most regain all weight lost within three years (1, 3). These poor long-term outcomes highlight the need for practical and effective intervention strategies to maintain weight loss (4, 5).
Self-Regulatory Strategies for Weight Loss Maintenance
Self-regulatory strategies, such as daily self-monitoring of body weight, physical activity, and fruit/vegetable consumption, facilitate weight loss maintenance (WTLM) (3, 6-10). Daily self-weighing is associated with less weight regain and healthier lifestyle behaviors (2, 3, 7-11) and the importance of daily physical activity in weight gain prevention is well known (2, 9, 12-18).
The Role of Water Consumption in Weight Loss
Water consumers ingest ~200 fewer calories per day and consume more fruits, vegetables and dietary fiber; fewer sugar-sweetened beverages and added sugars; and a less energy-dense diet (kcal/gram weight of food) than non-consumers of water (24-26). Among middle-aged and older adults (55+), consuming 16 fl oz of water 30 minutes before an ad libitum meal reduced meal energy intake compared to a no-water condition (27, 28). When combined with a hypocaloric diet, consuming 16 fl oz of water prior to each meal led to ~ 2 kg greater weight loss over 12 weeks in older adults compared to a hypocaloric diet alone (29). The above mentioned weight loss approach for middle-aged and older adults (aged 55-75) may be attractive for several reasons. First, the number of obese older adults has increased in the past decade (30), making this a population which warrants additional attention (31). Second, water is widely available and inexpensive, and it has been shown to decrease energy intake and increase weight loss in this population (27-29). Increasing water consumption may also reduce risk of dehydration in a population with reduced thirst sensations (32-34).
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A Study on Weight Loss Maintenance in Older Adults
The aim of this study was to determine the feasibility and effectiveness of a WTLM intervention for older adults using daily self-monitoring of body weight, step count, fruit/vegetable intake, and water consumption. Participants were invited to participate in a 12-month single-blinded WTLM intervention (June 2007-February 2010) following completion of a 12-week randomized controlled weight loss (WL) intervention trial (July 2006-July 2008). The WL participants were overweight and obese (BMI 25-40 kg/m2) adults aged 55-75 years who were recruited through local newspaper advertisements (29).
Inclusion and Exclusion Criteria
To be included in the WL study, individuals were required to be weight stable (± 2kg, > one year), and non-smokers. Exclusion criteria were as follows: history of depression, eating disorders, diabetes, uncontrolled hypertension, heart/lung/kidney disease, cancer, or use of medications known to alter food intake or body weight (i.e.
Study Design and Procedures
Participants in the WL intervention trial were randomly assigned to one of two groups: 1) intervention group (1200-1500 kcal hypocaloric diet + 16 floz water prior to each daily main meal) or 2) control group (1200-1500 kcal hypocaloric diet alone), as previously described (29). The WL intervention did not include self-regulation, or self-monitoring strategies (29). The pre-meal water level was based upon prior research (27, 28). For the WTLM intervention, participants continued in their assigned treatment group (increased water consumption, “WEV+”; versus no increased water consumption, “WEV”); program characteristics are described below. This study protocol was approved by Virginia Tech Institutional Review Board.
During the “WEV Changed” program, participants were instructed to record their body weight (W), daily physical activity (E) assessed by pedometer step count, and fruit/vegetable intake (V) using the self-monitoring tracking sheets. In addition, WEV+ was instructed to record daily water consumption. WEV+ participants were provided with a 16 fl oz Nalgene water bottle with fl oz markings, and were instructed to continue consuming water as they did in the WL phase (16 fl oz, three times per day, 30 minutes prior to breakfast, lunch, and dinner). Targeted health behaviors included program and individual goals; individual goals were determined by the participant and discussed with the study coordinator. Program goals were as follows: ≥ 10,000 steps per day, ≥ five fruit and vegetable servings per day, remain at or below baseline “reduced” body weight (within 3 lbs.; 1.36kg), and consume at least 16 fl oz water three times per day (≥ 48 fl oz), prior to each main meal (WEV+ only). Although there is no standard definition of WTLM, changes in fluid balance can yield a daily weight change of ± 3 lbs (35).
Participants were instructed to return tracking sheets weekly to the study coordinator for the duration of the 12-month study. For individuals who sent tracking sheets by postal service, pre-stamped and addressed envelopes were provided. Monthly laboratory-based assessments included body weight, four-day food intake records, resting blood pressure (BP), and an individualized counseling session with an RD. Counseling sessions varied with each participant and were based on the participant’s personal need each month (e.g., holiday eating, eating while traveling, physical activity routines). Height (m) was measured without shoes using a wall mounted stadiometer, and weight (kg) was measured without shoes wearing light street clothes, to the nearest 0.1 kg on a digital scale (Scale-tronix 5002, White Plains, NY). BMI was calculated as weight (kg)/height (m)2. Waist circumference was measured to the nearest 0.5 cm at the umbilicus, using a tape measure (Gulick, Country Technology, Gays Mill, WI). Seated resting BP was measured using an automated blood pressure monitor (Colin Pressmate, Omron Co., San Antonio, TX). After a five-minute rest, measurements were taken every three minutes until two measurements were within six mmHg for systolic and diastolic BP. The average of two measurements is reported.
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To assess possible changes in metabolic rate over the 12-month WTLM intervention (36, 37), resting metabolic rate (RMR) was measured by indirect calorimetry using a ventilated hood and a metabolic system (Parvo Medics TrueOne 2400, Sandy, UT) (38, 39). Participants were tested 30 minutes upon awakening and after a 12-hour fast. After a 10-minute rest period on a hospital bed, inspired (O2) and expired (CO2) gases were collected and analyzed while participants rested quietly for a 45-minute testing period. Participants completed a questionnaire to measure the Social Cognitive Theory constructs of self-efficacy, social support, outcome expectations and self-regulation for diet and physical activity variables (40).
To assess habitual dietary intake, participants were instructed in proper methods to record four-day food intake records by an RD. Records were kept for three consecutive weekdays and one weekend day. Two-dimensional food diagrams were provided to assist participants in portion size determination. Records were reviewed for completeness and analyzed using the Nutrition Data System for Research nutrition analysis software (NDS-R 4.05, 2007, University of Minnesota, Minneapolis, MN). A second trained technician reviewed all diet analyses for data entry errors. To assess habitual beverage consumption, baseline, months six and 12 food intake records were manually reviewed to determine mean daily amounts (kcal, g) of water and other beverages consumed.
Statistical Analysis
The sample size for the WL intervention (20 subjects/group) was determined based upon expected group differences in daily energy intake (180 kcals/day) and body weight reduction (2.0 kg) and associated standard deviations (energy intake: 200 kcal; body weight: 2.5 kg) with an alpha of 0.05 and 80% power (beta) (29). Independent samples t-tests were used to compare baseline demographic characteristics between groups using the Statistical Package for the Social Sciences software (SPSS version 12.0 for Windows, 2003, SPSS Inc, Chicago, IL). When baseline group differences were present (i.e. pre-study average weight loss), those variables were used as covariates in subsequent analyses. A random coefficients (multi-level) model (i.e. growth curve analysis) was used to determine the effects of the intervention on both self-reported (daily for 365 days) and laboratory-based measures of body weight (monthly for 12 months) among the WEV+ and the WEV groups. The growth curve model was fitted using STATA 9.1 xtmixed function. Growth curve analysis, as opposed to repeated-measures analysis of variance, is able to correct for measurement unreliability, uses all of an individual’s data, and utilizes individual trajectories as opposed to average value (41, 42). Two levels were used, with the first being an estimation of the individual regression for weight change over time. The second level included the predictors of the regression parameters of individual trajectories (assignment to the WEV+ or WEV condition). This model could also determine if there was a quadratic effect of time on weight change and whether there was an interaction between treatment condition and the quadratic effect of time. Because of the small sample size with the monthly measured data, bootstrapping using 1,000 samples was used to estimate bias-corrected confidence intervals by repeated re-estimation of the parameter estimates. To do this, a random samples with replacement from the original data was used (43). When data were analyzed by random coefficients model, full information maximum likelihood estimation was computed for the observed portion of each participant’s data, accumulated, and then maximized to address missing data (44).
Analysis of the daily self-reported body weight data over the 365-day study period provided more statistical power to test for possible group differences in weight change; daily weight change was calculated as the difference from Day 1, and a quadratic growth curve model was fitted to the weight data for participants in two groups. Differences between groups and over time (i.e., baseline, months six and 12) in other variables were assessed using repeated measures ANOVA; when significant differences were detected, paired t-tests were used for time measures and independent samples t-tests were used as post-hoc analyses for group differences. Program compliance was determined by number of tracking days completed divided by 365. Self-reported adherence to program goals (body weight, step count, water, and fruit and vegetable consumption) was determined by number of days reported adherent to each goal divided by the number of days recorded. Group differences in criteria for successful WTLM were assessed using a Pearson’s X2.
Study Results
Forty two individuals completed the WL intervention (29) and were invited to participate in the WTLM intervention. Of these, 40 individuals aged 62.7 ± 0.9 years enrolled, and 39 individuals completed the 12-month intervention (i.e., 98% retention; Figure 1). The sample was 95% Caucasian and 55% female. There was a group baseline difference in previous weight loss (−7.7 ± 1.0kg WEV+ versus −5.7 ± 0.6kg WEV), but no significant group differences in height, body weight, BMI, and waist circumference. Using the definition of successful WTLM of 3% weight regain from baseline (35), 80% of all participants were categorized as successful. There was a significant linear decline in weight (β = −0.32, P < 0.001), indicating that participants in both groups lost weight over time. There was also a significant quadratic trend in weight change (β = 0.02, P < 0.01), indicating that weight change leveled off in the final months. There was no group difference in overall weight change using the laboratory-based weights (β = −0.23, P = 0.08). Monthly laboratory weights were closely associated with self-reported weights (r = 0.99, P < 0.001). Results utilizing the daily self-reported body weight data over the 365-day study period indicated that WEV+ exhibited greater weight loss over the 365 days than WEV, representing an 87% greater decline in weight (β = −0.01, P < 0.01) and mean weight changes of −0.67 kg and 1.00 kg, respectively (online supplemental Figure 2). Thus daily self-monitoring of pre-meal water consumption may be an effective WTLM self-regulation approach, beyond that achieved by daily monitoring of body weight, step count, and fruit/vegetable consumption. Previous investigations have shown that as part of a WL intervention, increasing water consumption can lead to greater weight loss (29, 45) and a reduction in meal and total daily energy intake (27, 28, 46). Yet, a recent cross-sectional survey of self-reported weight loss and WTLM maintenance practices did not identify water consumption (i.e., “drink plenty of water”) as a dietary strategy used more often among successful weight loss maintainers as compared to those unsuccessful at weight loss maintenance (47).
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