Obesity has become one of the most important public health problems worldwide, which suggests the need for evidence-based dietary strategies for weight loss and its maintenance. If you’re like millions of other Americans - 1 in 3 adults are overweight and 2 in 5 have obesity - you’re carrying more pounds than is healthy for you. And you’re feeling it.
Weight management depends upon complex factors such as amount of food eaten, type of food eaten, and timing of meals. Weight loss, even as little as 5% to 10% of your body weight, can have huge health benefits. This article explores the numerous benefits of weight loss, from improved cardiovascular health to enhanced mental well-being, and examines various strategies and tools available to achieve and maintain a healthy weight.
The Science of Weight Loss: Energy Balance and Dietary Strategies
An energy deficit is the most important factor in weight loss. Under the “calories-in, calories-out” model, dietary management has focused on the concept of “eat less, move more,” and patients have been advised to consider and calculate their calorie balance whenever they eat. A low-calorie diet with a low fat or carbohydrate content has been recommended; however, in some cases, a very-low-calorie diet is required for a short period. Some macronutrient composition-based diets, such as the ketogenic diet or high-protein diet, could be considered in some cases, although the potential risks and long-term effectiveness remain unknown.
Optimal diets for weight management have been a topic of debate not only among researchers, nutrition experts, and healthcare professionals, but also among the general public. According to a meta-analysis of several diet programs, calorie restriction was the primary driver of weight loss, followed by macronutrient composition. Meal timing is also an important factor in weight management, and higher-calorie breakfasts in combination with overnight fasting may help to prevent obesity. Our review indicated that there is no single best strategy for weight management.
Complex factors shape and influence diets, especially for weight management. However, amount of food eaten, type of food consumed (macronutrient composition), and meal timing of meals are the key components of weight-management strategies.
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Low-Calorie Diet vs. Macronutrient Composition
The key component of diets for weight loss and weight-loss maintenance is an energy deficit. A low-calorie diet involves consumption of 1,000-1,500 calories per day; deficits of 500-750 calories per day have been used for weight loss and are recommended by many obesity societies and guidelines. Low-calorie diets typically restrict fats or carbohydrates, neither of which has been determined to be more important for weight loss if only a calorie deficit occurs.
Very-Low-Calorie Diets (VLCD)
Traditionally, a very-low-calorie diet (VLCD), which provides <800 kcal a day, is not recommended for routine weight management and should only be used in limited circumstances along with medical monitoring according to obesity guidelines. However, a recent review suggested that a VLCD used in combination with behavioral programs can provide greater long-term weight loss than behavioral programs alone, and that it is tolerable and has few adverse effects. Another form of the VLCD-the very-low-calorie ketogenic diet (VLCKD)-has been proposed as a promising option for significant weight loss in a short duration of time and stability for 2 years. The VLCKD consists of very-low-calorie (<700-800 kcal/day) and low-carbohydrate (<30-50 g/day) intake along with adequate protein consumption (equivalent to 0.8-1.2 g/day/kg of ideal body weight) for a short period, followed by a gradual switch to a low-calorie diet.
Macronutrient-Focused Diets
The strategy of reducing total fat intake is widely used for weight loss because a single gram of fat contains more calories than a gram of carbohydrates or protein. Although an energy deficit is the most important way to lose weight, weight regain after successful weight loss is very common and may seem inevitable.
Low-carbohydrate (low-carb) diets have been widely used not only for weight reduction, but also to manage T2DM; many randomized controlled trials have been conducted. A low-carb diet is defined as a carbohydrate intake below the lower boundary of the macronutrient distribution range for healthy adults (45%-65% of total daily energy) and encompasses a range of carbohydrate intake from 50-130 g/day or 10%-45% total energy from carbohydrates. With carbohydrate intake <10% (or <20-50 g/day), nutritional ketosis can occur; this type of diet is called a ketogenic diet. Ketogenic diet can suppress hunger during calorie restriction and may have some therapeutic effects on T2DM, polycystic ovary syndrome, and cardiovascular and neurological diseases.
High-protein diet has been popularized as a promising tool for weight loss because it improves satiety and decreases fat mass. Dietary guidelines for adults recommend protein intake of 46-56 g or 0.8 g/kg of ideal body weight per day. Thus, if dietary protein consumption exceeds 0.8 g/kg/day, it is considered a high-protein diet. Usually, a high-protein diet refers to an increased protein intake to 30% of the total daily calories or 1-1.2 g/kg of the ideal body weight per day.
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Other Dietary Approaches
The Mediterranean diet involves high intake of fruits and vegetables, poultry, and fish and dairy products, and little to no consumption of red meat. The effectiveness of the Mediterranean diet for weight loss and preventing cardiovascular disease is supported by sufficient evidence. Its benefits may extend to the reduction in cancer risk and significant reduction in digestive cancer risk.
The Paleolithic (Paleo) diet is also known as the hunter-gatherer diet, caveman diet, primal diet, or Stone Age diet; all these diets suggest that our bodies have not evolved to handle highly processed foods. This diet follows the nutritional patterns of early humans who lived in the Paleolithic era, which began more than 2 million years ago and continued until about 10,000 years ago, when humans started to cultivate plants and domesticate animals. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts while avoiding grains, dairy products, processed foods, and added sugar and salt.
A low-GI diet emphasizes exchanging high-GI foods for low-GI alternatives. Nothing is strictly forbidden with the low-GI diet, but high-GI foods such as white bread, bagels, cereals, mashed potatoes, pasta, and noodles should be replaced by low-GI foods.
The new Nordic diet is based on unprocessed whole grains, high-fiber vegetables, fish, low-fat dairy foods, lean meat of all types (beef, pork, lamb), beans and lentils, fruit, dense breads, tofu, and skinless poultry. This diet recommends more calories from plant foods and fewer from meat and more foods from the sea, lakes, and the wild countryside. It is based on whole and minimally processed foods and is high in both fiber and omega-3 fats.
There are many reasons to adopt a vegetarian diet for health. These diets can lower the risk of ischemic heart disease, T2DM, and cancer. Vegetarian diets can reduce blood pressure, lipid profiles, and inflammatory biomarkers and improve glycemic control and other cardiometabolic risk factors. This diet excludes meat, fish, and poultry, but there are many variations of the diet, including lactovegetarians and lacto-ovo-vegetarians.
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The Dietary Approaches to Stop Hypertension (DASH) diet was originally developed to lower blood pressure without medication, but it is now considered one of the healthiest eating patterns. The DASH plan includes many vegetables, fruits, and grains with an emphasis on whole grains. Low-fat or non-fat dairy foods, pulses, nuts, seeds, lean meats, poultry, and seafood are also allowed.
The Portfolio diet is a vegan plan that emphasizes a “portfolio” of foods or food components that lower cholesterol. To include a portfolio of cholesterol-lowering foods, the diet recommends daily consumption of 2 g of plant sterols, 50 g of nuts, 10-25 g of soluble fibers from plant foods, and 50 g of soy protein; meat, poultry, seafood, dairy, and eggs are not allowed.
The Role of Meal Timing
Recently, fasting has received interest not only from medical experts, but also from members of the general public with an interest in health. Intermittent fasting involves regular periods with no or very limited calorie intake. Intermittent fasting focuses on the time window of eating instead of calorie calculations or macronutrient composition, helping people to restrict food intake without having to count calories and to avoid late-night snacking. Meal timing and the circadian rhythm have raised a novel issue in weight management.
Alterations in circadian rhythms produce biochemical, physiological, and behavioral circadian rhythm disruptions, which can be caused by the lack of change between day/night synchronization (such as being exposed to artificial light at night), eating at night, or a shift in time due to jet lag or shift work. Eating late can cause circadian disruption, resulting in production of free cortisol, changes in daily rhythms of body temperature, decreased resting energy expenditure, and decreased glucose tolerance. Thus, timing of meals could have serious implications not only for weight management, but also for development of cardiovascular disease.
Key Takeaways for Dietary Strategies
There is no single best strategy for weight management, although some evidence-based methods have been suggested. Reducing daily calorie intake is the most important factor for weight loss. Low-calorie recipes, especially those for low-fat or low-carbohydrate diets, have been suggested as the first dietary strategy, although in some cases, a VLCD is required for a short period. Except for energy deficit, there seems to be no significant difference between macronutrient composition-based diets. Improvement in cardiometabolic factors strongly depends on degree of weight loss. However, as in the Mediterranean diet, increasing consumption of fruits and vegetables and intake of healthy fats (including monounsaturated as well as polyunsaturated fats) can be a healthy strategy for weight loss and maintenance. Eating breakfast and avoiding late-night eating should be considered important dietary strategies not only for weight loss, but also for metabolic health and are based on the physiologic clock. Time-restricted eating or intermittent fasting can be considered other options for weight loss and its maintenance. Maintenance of a low-calorie intake should be continued throughout an individual’s lifespan. Thus, the best diet for weight management is one that can be maintained in the long term.
Improved Cardiovascular Health
When you’re overweight or obese, the extra pounds can have a dangerous effect on your cardiovascular system. From high blood pressure and high cholesterol to blockages in your blood vessels and irregular heart rhythms, there are very few cardiovascular conditions that don’t include excess weight as a risk factor. If you lose just 5% to 10% of your body weight, you can:
- Raise your high-density lipoproteins by 5 points
- Lower your low-density lipoproteins
- Decrease triglycerides by 40 mg/dL
- Lower your blood pressure by 5 mmHg
- Lower your A1C (blood sugar) by a half a point
These are all significant changes that can greatly improve your heart and blood vessel health and even reverse the course of your life.
Enhanced Sleep Quality
Being overweight or having obesity is a primary driver of obstructive sleep apnea (OSA), a sleep disorder that affects at least 30 million Americans. With OSA, soft tissues at the back of your throat collapse while you sleep and block your airways. To help you breathe, your brain wakes you, just enough to clear your throat. This can happen over and over throughout the night, which means you’re not getting anything remotely resembling restorative sleep. When you lose weight, you lose it everywhere, including in the tissues around your throat. As a result, these tissues are less likely to collapse while you sleep, so you can finally rest and wake up refreshed.
Improved Musculoskeletal Health
Your musculoskeletal structure is designed to carry a certain amount of weight. When you exceed that ideal number, your bones and soft tissues pay the price. From early onset arthritis to a greater risk of strains and sprains, extra weight can wreak havoc on your body. When you lose weight, you’ll likely find a new spring to your step as you, literally, lighten the load and take the added pressure off of your joints, back, and other important structures.
The Role of Probiotics, Caffeine, and Green Tea
Probiotics are beneficial bacteria that live in your gut and help break down and digest food. One 2018 review of 15 well-designed trials found that probiotics, either in foods or in supplements, helped overweight and obese people reduce their body weight and body fat. Some manufacturers are combining probiotics with prebiotics, a type of fiber that feeds gut bacteria. Although few studies have examined the safety of probiotics, they have a long history of safety, particularly in healthy people, according to the NIH. If you have a weakened immune system, rare side effects may occur from taking probiotics.
Caffeine is a stimulant found in tea, guarana, yerba mate and other herbs that is often added to weight loss supplements. It helps liberate fatty acids from our fatty tissues, especially for cardiovascular exercise. Studies have shown only a moderate weight loss effect, however. Caffeine and other fat-burning supplements need to be accompanied by changes to diet and lifestyle. People with high blood pressure or heart problems should check with their health care provider before taking a supplement with caffeine.
Green tea contains a class of phytochemicals that are known as antioxidants. A few studies do seem to indicate that green tea extracts could make you burn more calories, even when you’re at rest. Green tea may have other benefits, potentially protecting against heart disease and cancer. Experts warn that large doses could cause liver damage.
Noom: A Behavioral Change Approach to Weight Loss
Noom has been around for over 15 years and boasts one of the most trending weight loss platforms. It combines a diet and exercise community, expert support, and psychology to round out the trifecta of long-term successful weight management. According to Noom, people who use the program and adopt a healthy lifestyle can expect to lose 1 to 2 pounds (lb) (0.5 to 1 kilogram [kg]) per week.
Noom is a mobile app you download to a smartphone or tablet. Noom focuses on behavioral changes, so it calls itself a lifestyle rather than a diet. Noom relies on a color-coded system for tracking your consumption throughout the day. It encourages you to eat more “green” foods, which are typically vegetables and whole grains. These are the least calorie-dense and most nutrient-dense options. “Yellow” foods are foods Noom encourages in moderation. These include lean meats and starches. “Orange” foods, like desserts and red meat, are the most calorie-dense. Noom encourages you to eat these in smaller portions and less frequently. Noom will deconstruct and group together green, yellow, and orange foods from your breakfast, lunch, and dinner each day.
To support behavior change, the app provides access to the following: tools to track your progress, a virtual coaching team, biometric tracking, and weekly challenges and educational information. Noom offers a 7-day trial if you’d like to test it out before paying the monthly fee.
How Noom Works
Noom aims to help you lose weight the same way as most other commercial diet plans and programs by creating a calorie deficit. Noom uses an algorithm to estimate your daily calorie needs based on your sex, age, height, weight, and answers to a series of lifestyle questions. Noom encourages food logging and weekly weigh-ins. These two self-monitoring behaviors are associated with weight loss and long-term weight loss maintenance. Noom encourages regular exercise by setting daily step goals and providing a generic workout guide.
Noom Med: Integrating Weight Loss Medications
Startup Noom says it helps members lose weight by tracking their diet and promoting healthy habits. Now, it's going a step further by launching a program that can prescribe a new generation of weight-loss drugs that have gained in popularity. The company recently announced the launch of Noom Med, a new program meant to help certain members lose weight with the help of anti-obesity medications like Wegovy.
Noom Med users first undergo lab work and a health evaluation by a physician or nurse practitioner. The results allow a clinician to create a care plan specific to their health goals. Medically-qualified users will be eligible to receive a prescription for GLP-1 agonists - a class of drugs including Mounjaro, Wegovy and Ozempic that amplify the natural signal between the stomach and the brain indicating fullness - and other anti-obesity medications through the program.
The membership fee for Noom Med is $49 per month and is only available to Noom Weight members. Noom Weight members must start with a four-month subscription billed upfront as an auto-renewing plan at $169, or about $42 per month. Subsequent subscription plans can range from a $70 monthly auto-renewing plan to a $209 annual auto-renewing plan. Noom's membership fees do not cover the GLP-1 drugs, which can cost upward of $1,000 per month.
Eligibility for Noom Med
Noom Med is available to Noom Weight members with a body mass index of at least 30, or those with a BMI of at least 27 if they have a weight-related medical condition like Type 2 diabetes.
Medications Prescribed by Noom
Noom Med offers a variety of weight-loss medications, including GLP-1 drugs. The GLP-1 drug class includes Ozempic and Mounjaro, which are prescribed to treat diabetes, and Wegovy made by Novo Nordisk, which has been approved to treat weight loss. The drug is given through weekly self-injections.
Considerations for Noom
While any reduced-calorie diet plan or program can help you lose weight if you follow it, sticking with a diet can be difficult for many people. In fact, most diets are unsuccessful because they’re difficult to maintain. Noom may be a good option for people who are trying to lose weight but are unsure how to get started, need extra motivation from coaches or peers to stay on track, or are looking to build healthy habits and seeking a more sustainable alternative to fad diets and other short-term solutions. However, Noom might not be suitable for people who regularly cook homemade meals, enjoy cuisines from a variety of cultures, or are very active or have increased calorie needs.
The Rise of GLP-1 Medications: A New Era in Weight Loss?
Whether you view the latest weight loss drugs as a miracle or a menace, the hype around them is impossible to ignore. Ozempic seized the spotlight first; a weekly injection intended to treat diabetes, it was quickly repurposed by people trying to trim down. Then came Wegovy, a high-dose version officially marketed as an obesity treatment. In November, Eli Lilly’s Zepbound joined their ranks.
The drugs work by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which curbs hunger. GLP-1 also slows down the movement of food from the stomach to the small intestine - hence a feeling of fullness - and increases insulin production, lowering blood sugar. The gist? GLP-1 drugs make you eat less. Over time, obese patients lose roughly 12% of their body weight on Wegovy (semaglutide) and about 18% on Zepbound (tirzepatide, which targets GLP-1 and another gut hormone, GIP.)
Potential Benefits of GLP-1 Medications
Recent studies have shown that semaglutide also helps people with obesity lower their high blood pressure and reduce their odds of heart attacks or strokes. Early evidence suggests the drugs might also improve depression and substance abuse disorders.
Potential Side Effects and Risks
The potential side effects of GLP-1 drugs are no fun: nausea, vomiting, fatigue, diarrhea, constipation. Patients have sued the drugmakers after developing dangerous conditions, such as stomach paralysis and bowel obstructions. "The stomach contents are retained sometimes for days on GLP-1s,” Koliwad says. “People facing surgery have fasted for 24 hours so they can safely get anesthesia. They’re not meant for everyone.
Access and Affordability
The soaring demand for GLP-1s has created shortages across the country. The shortages have made it difficult for some people to get GLP-1 agonists - even those with health insurance coverage for the drugs. Shortages aside, many insurers still won’t pay for GLP-1 agonists unless the patient has been diagnosed with diabetes or cardiovascular disease. A 2003 law currently prohibits Medicare from covering drugs for weight loss alone. Meanwhile, states get to decide whether to cover the drugs under Medicaid. A lot of people struggling with obesity can’t afford the most effective treatment.
The Importance of Lifestyle Factors
The injection alone is not a solution. Exercise is still important - for your heart, bones, brain, and more. And the nutritional quality of your food matters, not just the quantity. Talya Kurzion, MS, RD, a clinical dietitian with UCSF Health, says patients taking GLP-1s should prioritize fruits and vegetables; whole grains; lean protein; and the healthy fats found in olive oil, nuts, and seeds.
Long-Term Considerations
The existing studies are clear: People who go off the drugs eventually regain much of their lost weight.