The cornerstone of any successful weight management strategy is preventing unwanted weight gain from excess body fat. Given that the military population is initially selected based on specific body mass index (BMI) and body fat percentage criteria, the primary objective should be to cultivate an environment that encourages the maintenance of healthy body weight and composition throughout an individual's military career. Evidence suggests that losing excess body fat is challenging for many, and the risk of regaining lost weight is significant. Therefore, from the outset of initial entry training, individuals should be educated on the fundamental causes of excess weight gain and provided with strategies for maintaining a healthy body weight as a way of life.
Understanding Weight Gain
The basic principle of weight gain is that energy intake surpasses energy expenditure. However, overweight and obesity result from complex interactions among genetic, behavioral, and environmental factors. The challenge for practitioners, researchers, and individuals is to identify permanent, effective strategies for weight loss and maintenance, given the multifaceted nature of overweight. It's estimated that only a small percentage of individuals, around 1 to 3 percent, successfully maintain weight loss.
While genetics plays a role in overweight and obesity, behavioral and environmental factors are primarily responsible for inducing individuals to engage in too little physical activity and consume too much relative to their energy expenditure. Weight-management strategies target these factors. This article reviews the efficacy and safety of various weight loss strategies, as well as the combinations of strategies that appear to be associated with successful loss. It also discusses the elements of successful weight maintenance and public policy measures that may help prevent overweight and assist those trying to lose weight or maintain weight loss.
The Role of Physical Activity
Increased physical activity is crucial for a comprehensive weight-reduction strategy for overweight adults who are otherwise healthy. The ability to develop and sustain an exercise program is one of the best predictors of long-term success in managing overweight and obesity. The availability of exercise facilities can reinforce exercise and fitness programs for weight management. The intensity, duration, frequency, and type of physical activity depend on medical conditions, previous activity levels, physical limitations, and individual preferences. Professional evaluation may be necessary, especially for individuals with multiple extenuating factors.
The benefits of physical activity are significant, even without weight loss, including an increase in high-density lipoproteins, which can be achieved with a threshold level of aerobic exercise of 10 to 11 hours per month.
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For previously sedentary individuals, a gradual increase in physical activity is recommended to achieve 30 minutes of daily exercise after several weeks. This may also apply to some military personnel entering service from sedentary lifestyles. The activity goal has been expressed as an increase in energy expenditure of 1,000 kcal/wk, although a weekly goal of 2,000 to 3,000 kcal of added activity may be necessary to prevent weight regain. Mental preparation for the amount of activity necessary to maintain weight loss must begin while losing weight.
Changing activity levels can be perceived as more unpleasant than changing dietary habits for many individuals. Breaking up a 30-minute daily exercise into 10-minute bouts has been shown to increase compliance compared to longer bouts. Some evidence suggests that home exercise equipment increases the likelihood of regular exercise and is associated with greater long-term weight loss. Individual preferences are paramount in choosing activities.
Combining strength training or resistance exercise with aerobic activity may yield better long-term results than aerobics alone. Strength training builds muscle, minimizing the loss of lean body mass and increasing the relative loss of body fat. It also attenuates the decrease in resting metabolic rate associated with weight loss, possibly due to preserving or enhancing lean body mass.
While exercise is valuable, research indicates that exercise programs alone may not produce significant weight loss in overweight individuals. However, these studies have often been conducted with middle-aged Caucasian women leading sedentary lifestyles. The failure of exercise alone to produce significant weight loss may be because neurochemical mechanisms regulate eating behavior, causing individuals to compensate for the calories expended in exercise by increasing food intake. Exercise programs can result in an average weight loss of 2 to 3 kg in the short-term, but outcomes improve significantly when physical activity is combined with dietary intervention. Physical activity plus diet produces better results than either diet or physical activity alone. Weight regain is significantly less likely when physical activity is combined with any other weight-reduction regimen. Continued follow-up after weight loss improves outcomes if the activity plan is monitored and modified.
Military recruits were able to lose significant weight during initial entry training through exercise alone, but the restricted time available to consume meals during training likely contributed to this weight loss.
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Behavior and Lifestyle Modification
Behavior and lifestyle modification in weight management is based on evidence that people become or remain overweight due to modifiable habits or behaviors. Changing these behaviors can lead to weight loss and maintenance. The primary goals of behavioral strategies for weight control are to increase physical activity and reduce caloric intake by altering eating habits. Environmental management is a subcategory of behavior modification. Behavioral treatment, introduced in the 1960s, can be provided to individuals or groups. Typically, individuals participate in 12 to 20 weekly sessions that last from 1 to 2 hours each, with a goal of losing 1 to 2 lb/wk. Behavioral approaches have evolved from stand-alone treatments to modify eating habits and reduce caloric intake to being used in combination with low-calorie diets, medical nutrition therapy, nutrition education, exercise programs, monitoring, pharmacological agents, and social support to promote weight loss, and as a component of maintenance programs.
Self-Monitoring and Feedback
Self-monitoring of dietary intake and physical activity is a cornerstone of behavioral treatment, enabling individuals to develop a sense of accountability. Patients keep a daily food diary, recording what and how much they have eaten, when and where the food was consumed, and the context in which the food was consumed. They may also keep a record of their daily physical activities. Self-monitoring of food intake is often associated with a relatively immediate reduction in food intake and consequent weight loss, resulting from increased awareness of food intake or concern about what the dietitian or nutrition therapist will think about the patient's eating behavior. The information obtained from food diaries is used to identify personal and environmental factors that contribute to overeating and to select and implement appropriate weight-loss strategies for the individual. The same may be true of physical activity monitoring, although little research has been conducted in this area. Self-monitoring also provides a way for therapists and patients to evaluate which techniques are working and how changes in eating behavior or activity are contributing to weight loss. Regular self-monitoring of body weight is a useful adjunct to behavior modification programs.
Other Behavioral Techniques
Additional techniques in behavioral treatment programs include eating only regularly scheduled meals; doing nothing else while eating; consuming meals only in one place (usually the dining room) and leaving the table after eating; shopping only from a list; and shopping on a full stomach.
Reinforcement techniques are an integral part of the behavioral treatment of overweight and obesity. Subjects may select a positively reinforcing event, such as participating in an enjoyable activity or purchasing a special item when a goal is met.
Cognitive restructuring of erroneous or dysfunctional beliefs about weight regulation is another important component of behavioral treatment programs. Techniques developed by cognitive behavior therapists can help individuals identify specific triggers for overeating, deal with negative attitudes towards obesity in society, and realize that a minor dietary infraction does not mean failure. Nutrition education and social support are also components of behavioral programs.
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Behavioral treatments of obesity are frequently successful in the short-term. However, the long-term effectiveness of these treatments is more controversial, with data suggesting that many individuals return to their initial body weight within 3 to 5 years after treatment has ended. Techniques for improving the long-term benefits of behavioral treatments include: (1) developing criteria to match patients to treatments, (2) increasing initial weight loss, (3) increasing the length of treatment, (4) emphasizing the role of exercise, and (5) combining behavioral programs with other treatments such as pharmacotherapy, surgery, or stringent diets.
Recent studies of individuals who have achieved success at long-term weight loss may offer other insights into ways to improve behavioral treatment strategies. Analysis of data from the National Weight Control Registry found that weight loss achieved through exercise, sensible dieting, reduced fat consumption, and individual behavior changes could be maintained for long periods of time. The majority of participants in the Registry report they have made significant permanent changes in their behavior, including portion control, low-fat food selection, 60 or more minutes of daily exercise, self-monitoring, and well-honed problem-solving skills.
Restructuring Eating Environments
A significant part of weight loss and management involves restructuring the environment that promotes overeating and underactivity. The environment includes the home, the workplace, and the community. Environmental factors include the availability of foods such as fruits, vegetables, nonfat dairy products, and other foods of low energy density and high nutritional value. Environmental restructuring emphasizes frequenting dining facilities that produce appealing foods of lower energy density and providing ample time for eating a wholesome meal rather than grabbing a candy bar or bag of chips and a soda from a vending machine. Busy lifestyles and hectic work schedules create eating habits that may contribute to a less than desirable eating environment, but simple changes can help.
Natural Methods for Weight Loss
Incorporating natural methods can also contribute to effective weight management. Eating fewer processed foods, drinking more green tea, and taking probiotics are natural methods that can promote weight loss. The speed at which weight loss occurs may vary by method.
Dietary Adjustments for Weight Loss
Several dietary adjustments can naturally promote weight loss:
- Prioritize Whole, Single-Ingredient Foods: Base your diet on whole, single-ingredient foods to eliminate added sugar, added fat, and processed food. Whole foods are naturally filling and provide essential nutrients.
- Limit Processed Foods: Processed foods are high in added sugars, added fats, and calories and are engineered to encourage overeating.
- Stock Up on Nutritious Foods and Snacks: Having nutrient-dense food available reduces the chances of eating less nutritious items. Nutritious snacks include yogurt, whole fruit, nuts, carrots, and hard-boiled eggs.
- Limit Intake of Added Sugar: High consumption of added sugar is linked to heart disease, type 2 diabetes, and cancer.
- Drink Water: Water can help with weight loss, especially when it replaces other beverages that are high in calories and sugar.
- Drink Unsweetened Coffee: Black coffee is weight loss friendly, making you feel full with almost no calories.
- Supplement with Glucomannan: Glucomannan is a natural dietary fiber that absorbs water, promoting fullness and aiding weight loss.
- Limit Intake of Refined Carbs: Refined carbs have had most of their beneficial nutrients and fiber removed, increasing the risk of overeating and disease.
- Drink Unsweetened Green Tea: Green tea is linked with increased fat burning and weight management.
- Eat More Fruits and Vegetables: Fruits and vegetables are nutritious, weight-loss-friendly foods with low energy density.
Lifestyle Practices for Weight Management
Adopting certain lifestyle practices can also support weight loss efforts:
- Fast Intermittently: Intermittent fasting can make you eat fewer calories overall, without having to consciously restrict calories during the eating periods, potentially leading to weight loss.
- Count Calories Occasionally: Being aware of what youâre eating is helpful when trying to lose weight.
- Use Smaller Plates: Using smaller plates may help you eat less by changing how you perceive portion sizes.
- Eat More Slowly: Eating slowly may help you eat fewer calories and increase the production of hormones that are linked to weight loss.
- Add Eggs to Your Diet: Eggs are low in calories, high in protein, and loaded with nutrients, potentially decreasing appetite and reducing caloric intake.
- Spice Up Your Meals: Capsaicin may reduce appetite and calorie intake.
- Get Enough Sleep: Sleep deprivation is linked to increased food intake, particularly in foods that are high in carbohydrates and fats.
- Eat More Fiber: Fiber-rich foods may help with weight loss by delaying stomach emptying and promoting the release of satiety hormones.
- Brush Your Teeth After Meals: Dental hygiene products can temporarily affect the taste of food and beverages, which may help limit the desire to snack or eat between meals.
- Work to Overcome Food Addiction: Food addiction involves overpowering cravings and changes in your brain chemistry that make it harder to resist eating certain foods.
- Do Some Sort of Cardio: Cardio is a great way to burn calories and improve both mental and physical health.
- Add Resistance Exercises: Resistance exercises can help build muscle and burn calories.
- Practice Mindful Eating: Mindful eating helps you make conscious food choices and develop awareness of your hunger and satiety cues.
- Focus on Changing Your Lifestyle: Instead of focusing only on losing weight, make it a primary goal to nourish your body with nutritious food and daily movement.
Exploring Scientific Advancements in Weight Loss
Researchers continue to explore innovative approaches to weight loss, including targeting fat cell conversion and inhibiting fat absorption.
Converting White Fat to Beige Fat
Recent research has focused on converting calorie-storing white fat cells into energy-burning beige fat cells. Studies have shown that mice lacking the KLF-15 protein in white fat cells converted them to beige fat cells. Stimulating the Adrb3 receptor also caused mice to lose weight, suggesting a potential target for weight loss medication with limited side effects.
Inhibiting Fat Absorption with Plant-Based Microbeads
Scientists have developed plant-based microbeads that bind to fat droplets, preventing their absorption in the body. These microbeads, made from green tea polyphenols and vitamin E, are coated in a natural polymer derived from seaweed to protect them from the acidic environment of the stomach. Studies in rats have shown that these microbeads can lead to significant weight loss, reduced adipose tissue, less liver damage, and increased fat excretion in feces. Human clinical trials are underway to assess the efficacy of these microbeads in weight loss.
Understanding Weight Loss in Context
Weight loss refers to a reduction of total body mass, including fluid, body fat, or lean mass. It can be intentional, resulting from efforts to improve fitness and health, or unintentional, due to malnourishment or an underlying disease. Intentional weight loss can reduce health risks, increase fitness, and delay the onset of diabetes. It can also reduce pain and increase movement in people with osteoarthritis of the knee.
Weight loss is achieved by consuming fewer calories than are expended. Depression, stress, or boredom may contribute to unwanted weight gain or loss, and individuals are advised to seek medical help in these cases. Bariatric surgery may be indicated in cases of severe obesity.
The Weight Loss Market
There is a substantial market for products claiming to make weight loss easier, quicker, cheaper, more reliable, or less painful. Billions of dollars are spent annually on weight-loss products and services, including medical procedures, pharmaceuticals, and weight-loss supplements.
Unintentional Weight Loss
Unintentional weight loss can occur due to an inadequately nutritious diet relative to a person's energy needs, generally called malnutrition. Continuing weight loss may deteriorate into wasting, a condition called cachexia, which involves a systemic inflammatory response. Common causes of unexplained weight loss include cancer, infection, renal disease, and cardiac disease.
Popular Beliefs and Misconceptions
Some popular beliefs attached to weight loss have been shown to either have less effect on weight loss than commonly believed or are actively unhealthy.
Health Risks of Obesity and Benefits of Weight Loss
Obesity is a risk factor for certain conditions, including diabetes, cancer, cardiovascular disease, high blood pressure, and non-alcoholic fatty liver disease. Reduction of obesity lowers those risks.
Guidelines and Recommendations
The US Department of Health and Human Services provides dietary guidelines for Americans, emphasizing the importance of a balanced diet and regular physical activity.
Long-Term Weight Maintenance
Maintaining weight loss requires developing lifestyle habits that can be sustained over the long term. Key habits of people who have lost weight and kept it off include regular exercise, sensible dieting, reduced fat consumption, and individual behavior changes, such as portion control, low-fat food selection, 60 or more minutes of daily exercise, self-monitoring, and well-honed problem-solving skills.
Seeking Professional Guidance
Consult with a doctor to discuss weight loss goals and determine if a referral to a Registered Dietitian Nutritionist (RDN) is appropriate. Setting realistic goals and tracking progress are key to success.