Weight loss is a multifaceted journey influenced by various factors, ranging from individual lifestyle choices to medical interventions. This article explores a spectrum of weight loss tips and strategies, drawing from personal anecdotes, dietary approaches, and medical advancements.
The Power of Lifestyle Adjustments
Weight loss often begins with simple yet effective lifestyle adjustments. These adjustments can significantly impact one's weight and overall well-being.
The "Sex Diet" and the Role of Intimacy
Thirty-year-old Kerry McCloskey, once overweight, not working out, and eating poorly, discovered a unique approach to weight loss that also revitalized her marriage: incorporating more intimacy into her life. Kerry explains, "A half hour of sex burns about 200 calories. My husband and I have sex about eight times per week. You do the math!" By increasing their passion and intimacy, Kerry says she lost 23 pounds in six months! Along with the weight loss came a renewed confidence and a healthier eating style. According to Kerry, there are certain foods you can eat to get in the mood, such as bananas and chocolate. And here's their biggest secret: Ben, Kerry's husband, eats a lot of celery. Kerry says when men eat celery they emit a scent that's a turn-on. Who knew?! By turning basic exercises into foreplay, Kerry has even found a sexy way to firm up her problem areas. She and her husband get up-close-and-personal for moves like the "love squat." Sometimes, she says they just turn on some music and dance. Kerry shares all in her book The Ultimate Sex Diet. "I'm healthier and happier than ever before," says Kerry.
The Power of Motivation and Fun
Like many moms, Jennifer found herself battling baby weight after giving birth to her second child. Tipping the scale at 200 pounds, Jennifer says she was "sick of wearing big, black baggy clothes, a lot of makeup and big hair to try to change the way I looked." That's when she became determined to get fit-for herself and her children. To get motivated, Jennifer set a goal to compete in a bikini contest-even though winning was a long shot at 70 pounds overweight. But after months of hard work, Jennifer reached her goal. "I was like an animal that had been unlocked out of the cage," Jennifer recalls. "My confidence went over the roof!" Jenny went on to become Miss Bikini America and was also named Miss Muscle and Fitness. So how did a mother of two get a rock hard bikini body? By using a unique way to exercise and spend time with her children. For example, she keeps her legs in shape doing squats while using her toddler as a weight. Or, she sneaks kisses from her baby between push-ups. "I want mothers and mothers-to-be to know it won't be easy, but you can make it fun and it will happen," says Jennifer. "Just work hard, enjoy being a mother.
The Importance of Mindful Eating
A self-described emotional eater, 34-year-old Timarie says she'd been battling her weight for years. After putting on 100 pounds in her 20s, Timarie says she started becoming quiet and introverted-and started to feel undeserving of certain opportunities. But Timarie still wanted to be social and so she was set up on a blind date. Timarie and her date spoke on the phone for over a month before meeting. But when the two finally met face to face, she says he claimed to have a conference call and bailed out on their date. "I kind of stood there dumbfounded…I didn't even know how to react." Timarie says that was her turning point: "It was really at that point when I realized that I needed to take control of my life." Timarie found success with a weight loss trick that helped her beat emotional overeating. When she feels hungry and craves something fattening, she'll have a glass of water and wait 15 minutes until the craving goes away. This trick has helped her lose over 114 pounds! Today, Timarie says she feels confident and fabulous.
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Dietary Strategies for Weight Management
Dietary interventions play a crucial role in achieving desired weight loss. Many approaches involve reducing caloric intake, with some diets excluding macronutrients or specific food groups altogether.
Ketogenic Diet
The ketogenic diet, popularized in the 1920s, involves restricting carbohydrate intake to <50 g daily (the recommended daily value of carbohydrates is 130 g).[16][17][18] This diet is often used by individuals wishing to lose weight rapidly in the short term, with some reports of people losing up to 9.9 pounds (4.5 kg) in 2 weeks and up to 57.3 pounds (26 kg) if maintained over 2 years.[19][20] Risks include vitamin and mineral deficiencies.[19] For individuals undergoing a 12-week ketogenic diet, magnesium, calcium, iron, phosphorus, and potassium levels were found to be less than the recommended values.
Atkins Diet
The Atkins diet, created in the 1960s, is similar to the ketogenic diet, restricting carbohydrates and promoting increased fats and proteins.[24] However, it differs in that it slowly increases carbohydrates through different program phases. The first 2 weeks of the diet constitute an induction phase, with <20 g of carbohydrates consumed daily (even less than the ketogenic diet).
Paleolithic Diet
The paleolithic diet, introduced in the 1980s, focuses on eliminating processed foods and only consuming lean meats, fruits, nonstarchy vegetables, nuts, and seeds while restricting dairy products.[30] Individuals adhering to this diet over 12 weeks were found to have weight loss as high as 4% to 6% of their starting body weight.[31] There is limited research regarding long-term adherence and sustainability.
Intermittent Fasting
Intermittent fasting, thought to improve metabolic and glycemic control, is defined as abstinence from food for a given amount of time followed by a meal.
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The Risks of Rapid Weight Loss
Rapid weight loss, induced by intense dieting, extreme exercise, fluid restriction, medication use, or fasting without electrolyte supplementation, can lead to a series of adverse effects with electrolyte derangements, decreased athletic performance, hormone imbalance, and potential organ damage.[12][41] Intermittent and long-term fasting can result in sodium, potassium, and uric acid imbalances due to fluid shifts, reduced electrolytes, and reduced water uptake.[42][43][44] These shifts are typically transient, and electrolyte levels tend to normalize once the body reestablishes fluid balance.[45] Athletes often employ fluid or calorie restrictions over short periods to induce rapid weight loss.
Understanding Metabolic Adaptation
Homeostasis occurs in each human body at a different level of weight. Each person has a resting metabolic rate, defined as the rate of energy production and expenditure needed to function while at rest.[54] After weight loss, the resting metabolic rate slows, likely to counter weight loss and return to homeostasis.[55] It is hypothesized that due to this phenomenon of "metabolic adaptation," weight regain is likely even after weight is lost.[56][57]
Hormonal Influences on Weight
Alterations in body mass can cause a shift in homeostasis, influencing the delicate balance of anorexogenic and orexigenic hormones that regulate satiety and hunger.[58] This can lead to changes in the body's ability to sense satiety.[59]Anorexogenic hormones, such as leptin, peptide YY, and cholecystokinin, play a crucial role in signaling satiety, communicating to the brain that the body does not require additional calories. Orexigenic hormones, like ghrelin, stimulate hunger. During dieting and caloric restriction periods, orexigenic hormones increase, and anorexogenic hormone levels decrease.[60] Even after weight loss, the drive to eat remains heightened, potentially indicating the risk of weight regain.[61] Hormone levels may never revert to their pre-dieting states. These ongoing hormonal imbalances increase individuals' challenges in maintaining long-term weight loss.[59][58]
Thyroid Hormones and Weight Loss
Thyroid hormones, T3 and T4, have been identified as contributors to weight loss, with medications and supplements targeting thyroid hormones becoming another method utilized. Desiccated thyroid extract can be used to treat hypothyroidism in individuals, but it has also been shown to aid in weight loss compared to individuals taking levothyroxine.[62] Some thyroid hormones, such as T3, promote energy expenditure in their active state. For thyroid hormones to become active, they must convert from their inactive form, T4, to their active form, T3.With weight loss, there is a reduction in the peripheral conversion of the prohormone to T3.
Medical Interventions for Weight Loss
When lifestyle adjustments and dietary changes are insufficient, medical interventions may be considered.
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Weight Loss Medications
Medications, including orlistat, phentermine and topiramate, naltrexone and bupropion, liraglutide, and semaglutide, have obtained FDA approval for weight loss in the United States, and all are effective for weight loss.[8] FDA guidelines recommend that consideration for these medications include a body mass index (BMI) >30 or ranging from 27 to 30 with an obesity-related comorbidity (type 2 diabetes, hypertension, or any other disease secondary to obesity).[64] There are both over-the-counter and prescription anti-obesity medications. One over-the-counter weight loss option in the United States is orlistat, which was FDA-approved in 2007.[65] Although not approved for weight loss, other medications have demonstrated weight reduction effectiveness. Desiccated thyroid extract, used in treating hypothyroidism, has been shown to reduce weight by at least 4 lb (1.8 kg) over 6 months compared with individuals taking levothyroxine.[62] Medications, such as diuretics and laxatives, are often used in sports for rapid weight loss but are ineffective long-term and are not FDA-approved for this use.[66] When weight loss medications are considered, individuals should be educated that they will likely be on anti-obesity medicines for life, as obesity is a chronic disease, often relapsing if pharmacotherapy is ceased.[64] Sustained results are demonstrated when individuals actively engage in lifestyle modifications such as dieting and exercise concurrently with medication.[67] Despite weight loss medications effectively causing >5% body weight loss in most individuals, undesirable adverse effects are common.
Specific Weight Loss Medications
- Phentermine and topiramate: A prescription appetite suppressant combining the weight loss medication phentermine and the anti-epileptic medication topiramate.[64]
- Naltrexone and bupropion: A prescription weight loss medication that decreases appetite and cravings.
- Liraglutide: A prescription medication glucagon-like peptide-1 analog, delaying gastric emptying and increasing satiety.[72]
- Semaglutide: A prescription glucagon-like peptide-1 analog, demonstrating a total weight loss of 14.9% over a 68-week study.[74]
- Orlistat: An over-the-counter medication in the United States, it reduces fat absorption by up to 30%.
Bariatric Surgery
Bariatric surgery, coming into existence in the 1950s, has become a method for rapid weight reduction exceeding 20% of total body mass in some cases.[10][79] Surgery may be appropriate for individuals who have a BMI >40 or >35 with an underlying health condition, such as diabetes mellitus.[80] The 2 most common bariatric surgeries performed worldwide are the sleeve gastrectomy and the gastric bypass.[81]
Types of Bariatric Surgery
- Sleeve gastrectomy: The sleeve gastrectomy removes a portion of the stomach, including the fundus.
- Gastric bypass: Gastric bypass involves restricting the size of the gastric pouch and rerouting that pouch to the jejunum, bypassing the duodenum and most of the stomach.
Post-Surgery Considerations
Aside from immediate postoperative complications, chronic long-term complications include nutrient deficiencies secondary to anatomical changes that can be present for life. Dumping syndrome (accelerated gastric emptying after meals) has also been reported amongst bariatric patients, especially those with gastric bypass, with resolution usually by 2 years postsurgery.[89][90]
The Importance of a Multidisciplinary Approach
Often, bariatric surgeries are completed with a multidisciplinary approach to the patient, involving multiple specialties. Some of these specialists include nutritionists and dieticians who provide assistance with supplementation as needed, primary care clinicians who manage underlying comorbidities, weight-loss coaches, and exercise trainers.
The Impact of Weight Loss on Body Composition
Regardless of how weight is lost, it is not limited to only the loss of adipose tissue. It can also affect fat-free mass, such as muscle and bone. Moderate exercise and strength training have been suggested to combat muscle reduction.