Losing weight can be a significant challenge for many women, often leading to cycles of weight loss followed by regain. This article provides a comprehensive guide to weight loss, emphasizing sustainable lifestyle changes and the role of obstetrician-gynecologists (OB/GYNs) in supporting women's health and weight management.
Introduction: The Importance of Sustainable Lifestyle Changes
There is no quick fix for losing weight. The key is to focus on small, healthy changes that you can stick with for the rest of your life. Losing weight is part of loving a healthier lifestyle.
Setting the Stage for Success
Timing is Key
Some periods in life are more conducive to change than others. Big life events, such as moving, getting married or divorced, graduating, or starting a new job, can create stress that makes weight loss more difficult. It may be wise to postpone weight loss efforts until a more stable time.
Realistic and Measurable Goals
Avoid setting unrealistic expectations, such as aiming to lose 30 pounds in a month. Instead, set a goal of losing one pound per week and track your progress. Consult with your doctor or nurse to determine a safe and appropriate weight loss rate for you. Celebrate your achievements with a fun activity (but not an unhealthy treat) when you meet each goal!
Addressing Underlying Health Issues
Prioritize addressing any existing health problems before focusing on weight loss. For instance, if you are severely depressed, seek treatment for depression first. If you have sleep apnea, discuss weight loss as a potential treatment option or consider treating the sleep apnea initially. Insufficient or poor-quality sleep can contribute to weight gain. Consult your doctor or nurse to determine the optimal time to work on weight loss, considering any other health concerns you may have.
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Practical Strategies for Weight Loss
Meal Planning
Most people who eat healthy plan most of their meals ahead of time so that they don’t binge as much on unhealthy food. Plan your meals for the week ahead, identifying the meals you will eat at home. Create a grocery store list for those meals and snacks.
Tracking Food and Fitness
Utilize free tools to monitor your progress and learn effective strategies. The MyPlate Plan tool can help you find a personalized healthy eating plan. You can also track your weight over time and receive weight-loss advice. Studies have shown that women who use a food journal lose more weight than those who don't.
Gradual Changes
Avoid attempting to overhaul your entire diet at once. Instead, choose one small healthy eating goal and work on it until you can consistently achieve it, or until you realize it's not suitable for you. Then, select another healthy eating goal.
Moderation, Not Deprivation
It's tempting to eliminate all unhealthy foods (like cookies, cake, chips, soda, and French fries) to lose weight. This strategy may be easy at first, but it can be difficult to continue over time. You might end up binging on unhealthy foods because you feel deprived.
Mindful Eating
Pay attention to your eating habits and triggers. Notice how you feel each time you eat something. Do you find yourself eating to relieve stress, boredom, or anxiety? Is there a healthier option that you can substitute?
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Smart Eating Out
Restaurant foods are often high in salt, fat, and calories. Choose smaller portions when eating out: Order the small or lower-calorie option, share a meal, or take home part of the meal. Calorie information may be available on menus, in a pamphlet, on food wrappers, or online.
Hydration First
Sometimes what we think is hunger is actually thirst. Try drinking water before snacking to see if that helps you put off eating until it’s time for a meal. Or maybe you will eat less if you’ve filled up on some water first.
Occasional Treats
It can be difficult to stick with a healthy eating plan if you feel deprived all of the time. Eat healthy 90% of the time, but have a less healthy treat sometimes so you don’t feel like you’re missing out.
Rethinking Your Drink
Don’t forget to add in the calories you drink each day. Juices, coffees with syrup or creamer, and flavored water all add calories. Even some diet sodas can have a small number of calories that are not listed on the Nutrition Facts label. If you drink alcohol and want to lose weight, cutting down on the number of drinks you have each week is one of the easiest ways to lose weight, since you don’t get any essential vitamins, minerals, or other nutrients from alcohol.
Cooking Skills
You don’t have to be a top chef like on TV, but usually people who eat healthy know how to cook a few simple meals for themselves or their families. If you know how to cook a few easy dishes, you’ll be less likely to order unhealthy takeout or eat unhealthy snacks.
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Portion Control
Prepare and serve smaller portions when you eat at home: It is natural to eat everything on your plate. Solve this problem by putting less on the plate to start. You can also try using a smaller plate.
Distraction Strategies
Is there something else you can do if you are not truly hungry? Try something that will keep your hands busy and your mind off food, like knitting, reading a book, playing with your kids, or doing chores that are not in the kitchen.
Limiting Screen Time
Time spent in front of the screen, especially the TV, is linked to weight gain. Make an effort to eat at the table, and turn off the TV, tablet, or phone. When you’re distracted, you may eat more than you realize, making it tough to lose weight.
Strength Training
Muscle burns more calories than fat. Aim for two or three strength-training sessions a week. Allow a day or so in between workouts for your body to rest.
Walking and Physical Activity
Most women need about 30 minutes of moderate physical activity, like cycling or brisk walking, most days in order to be healthy. Getting enough physical activity not only helps you maintain or lose weight, it lowers your risk for many diseases and boosts your mood.
Stress Management
Stress can make weight gain more likely. Find ways to unplug and lower stress that work for you. Some options include meditation, yoga, reading, religious worship, spending quality time with friends and family, learning a new healthy recipe, trying out a new physical activity like bicycling or an exercise class, or volunteering in your community.
Self-Acceptance
Weight, for women, is often a sensitive issue that many have been dealing with for their entire lives. Weight is important, but it is just one indicator of your health. It helps to be comfortable with who you are regardless of your weight. Having overweight or obesity does not make you a bad or weak person.
Persistence
Successfully losing weight is often a matter of trying different strategies until you find out what works for you. One of the keys to weight loss is to keep trying. If a certain strategy doesn’t work for you, that doesn’t mean you are a failure. As long as you learn something from that particular experience, it can give you valuable insight into what might work better for you in the future.
Embrace Discomfort
Losing weight is not always fun or easy. Sometimes it can be emotionally difficult to face issues that contribute to unhealthy eating. Sometimes you might feel hungry, or left out if friends or family are indulging. Know that feeling uncomfortable will pass and does not last forever.
Find Inspiration
Sometimes women find it easier to make healthy changes for someone else - to benefit their unborn child or to get ready for a family milestone like a wedding or reunion. Whether your inspiration is the image of yourself wearing a smaller dress size or lowering your blood pressure so that you don’t need medicine anymore, keep your inspiration in mind when you’re tempted to eat unhealthy foods or skip your exercise routine.
New Rewards
We all enjoy eating and have rewarded ourselves with ice cream or cake in the past. If you’re trying to lose weight, it can be difficult to substitute other rewards. Figure out ahead of time what makes you feel good - taking a long bath, spending time with loved ones, enjoying a hobby. Then, when you have something to celebrate or want to indulge, you’ll be prepared with healthy and rewarding activities.
Prioritize Sleep
Sleep plays an important role in weight management. Studies show that not getting quality sleep or getting fewer than seven hours of sleep at night can lead to weight gain. If you find that you struggle with sleep, you may need to talk to your doctor or nurse. Try not to use sleep medicines often. Most sleep medicines can lead to weight gain.
Medication Review
Talk to your doctor or nurse about the medicines you take: Many prescription medicines women take can lead to weight gain. Medicines that are prescribed for depression, sleep problems, high blood pressure, and diabetes can cause weight gain. Your doctor or nurse might be able to prescribe a different medicine that does not lead to extra weight.
Seek Support and Try New Approaches
If you tried losing weight on your own in the past and it didn’t work, try joining a weight-loss group. If your partner isn’t willing to eat healthy along with you, talk about how they might support you in the future. Figure out some of the reasons why you weren’t able to lose weight before and do it differently next time.
Personal Motivation
The motivation needs to come from you, not anyone else. Do it for yourself. Define why you want to lose weight or what is motivating you to lose weight. Be sure to document your motivation. If you choose to keep your weight-loss plans private, be accountable to yourself. Make sure you are doing regular weigh-ins, and track your food and exercise progress in a journal. Regular physical activities combined with calorie restrictions will help give you the weight-loss edge. Plus, there are numerous health benefits that include improving your mood, strengthening your cardiovascular system along with reducing blood pressure. If you feel as though you have an unhealthy relationship with food, discuss this with your doctor.
Hormone Therapy
Hormone therapy (HT) will not help you lose weight, nor is it indicated for weight loss. It also won’t prevent hair loss, stop wrinkles or halt the aging process. HT may actually contribute to a little bloating in the midsection for some patients. Although HT will not cause weight loss, there is some evidence that it can help redistribute fat from the midsection to the peripheral sites, thighs and gluteal region.
Weight Loss Medication
Weight loss drugs may be appropriate if body mass index (BMI) is greater than 30kg/m2 or 27KG/m2 with other medical comorbidities like diabetes or hypertension. Moreover, these drugs can be associated with troublesome side effects, including nausea and diarrhea. Plus, for most people, they’re not affordable. Even though you may experience weight loss while taking the medication, once it’s stopped, it’s likely you’ll gain the weight back.
The Role of OB/GYNs in Weight Management
Unique Position
OB/GYNs are uniquely positioned for diagnosing and treating women with obesity, as they are often the only doctors a woman sees in her childbearing years. They are seeing progressively more patients with obesity, and hence are increasingly seeing associated complications (e.g., infertility, high-risk pregnancies, and gynecological cancers).
Addressing Obesity in the OB/GYN Setting
The potential to treat obesity in the obstetrics and gynecology setting is not fully realized. While a high percentage of OB/GYNs counsel patients for obesity, a smaller percentage prescribe antiobesity medications (AOMs) or routinely refer patients to other health professionals for weight management. This may be due to pessimism about their ability to help, perceived lack of time, inadequate reimbursement, and challenges in accessing AOMs.
Treatment Tiers
Obesity treatment recommended by international and national guidelines comprises three tiers, starting with lifestyle intervention composed of dietary modification and increased physical activity, advancing to pharmacotherapy, and escalating to metabolic and bariatric surgery.
Benefits of Weight Loss
International guidelines for obesity treatment recommend at least 5%-10% loss of initial weight, ideally reached within 6 months to achieve clinically meaningful benefits. In women with overweight/obesity and PCOS, it is recommended to lose at least 5%-15% of bodyweight to improve hyperandrogenism, infrequent periods, anovulation, insulin resistance, and hyperlipidemia, and at least 10% weight loss to increase the chances of conception and live birth. The long-term benefits of weight loss include prevention or improvement of other obesity-related complications, lower health care cost, and increase in quality of life.
Antiobesity Medications (AOMs)
There are currently four AOMs approved and marketed in the United States for chronic weight management: Orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide 3.0 mg. Liraglutide 3.0 mg is the first AOM to mimic the action of a naturally occurring incretin hormone secreted by the gut. Semaglutide is another GLP-1 RA, further modified to achieve a prolonged action allowing once-weekly dosing. It is currently approved for treatment of T2D only; however, trials investigating its efficacy and safety as an AOM are ongoing.
Liraglutide 3.0 mg
Liraglutide 3.0 mg, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is superior to placebo in achieving weight loss and improving cardiometabolic profile, in both clinical trial and real-world settings. In addition, women with fertility complications receiving liraglutide 1.8-3.0 mg can benefit from improved ovarian function and fertility. Liraglutide 3.0 mg is generally well tolerated, but associated with transient gastrointestinal side effects, which can be mitigated.
Discussing Weight with Patients
It is important to recognize women who have overweight/obesity before pregnancy to allow time for counseling about bodyweight. OBGYNs should be encouraged to routinely discuss bodyweight with patients and play an active role in identifying weight-management solutions. Given the persisting stigma around obesity, physicians are encouraged to be mindful of their own implicit biases and choose a respectful and compassionate way to open the discussion about bodyweight with patients' permission. Open-ended questions about their physical abilities in everyday life, such as climbing stairs or getting up off the floor, can be asked.
Prescribing Liraglutide 3.0 mg
Liraglutide 3.0 mg is prescribed in addition to dietary modification and increased physical activity in adults with BMI ≥30 kg/m2 with or without comorbidities, or ≥27 kg/m2 with one or more weight-related comorbidities (e.g., hypertension, dyslipidemia, and T2D). It has recently been approved for use in patients with concomitant insulin treatment, with recommended dose reduction of antidiabetic drugs to reduce the risk of hypoglycemia. Contraindications include pregnancy, personal or family history of multiple endocrine neoplasia syndrome type 2 or medullary thyroid carcinoma (but not the more common and unrelated papillary thyroid cancer), and hypersensitivity to liraglutide or other product components.
Considerations for Women
Prescription of liraglutide 3.0 mg can be given to young women over 18 years of age with overweight/obesity to prevent development of obesity-related complications, including infertility; women with overweight/obesity and infertility to increase chances of getting pregnant later and carrying pregnancy to term with fewer complications; women with overweight/obesity who have had children and are no longer nursing; or women with overweight/obesity who have not had children. If adolescent women with obesity present with suspected diabetes, OBGYNs should refer them to pediatric endocrinologists.
Important Counseling Points
Women of childbearing age should use effective contraception while on weight-loss therapy to prevent overlap between treatment and potential pregnancy, although there is no known teratogenicity. The injections should be administered subcutaneously in the abdomen, thigh, or upper arm once a day, at any time of day (preferably at a similar time), and independent of meal times. It is recommended to start with a low dose of 0.6 mg, followed by weekly increments of 0.6 mg, until 3.0 mg is reached. All staff (e.g., medical assistants and nurses) within a practice should be familiar with the pen technique explained in the product instructions to ensure patients are trained and comfortable with liraglutide administration.
Insurance and Support
The PA request form required by many insurance companies contains a few simple clinical questions that staff can answer from the patient's chart. However, many insurance companies do not cover AOMs, even with PA. Successfully treating obesity requires time, education, and accountability for patients. There are many programs available, both in the community and with the use of technology.
Managing Side Effects
Gastrointestinal side effects are common, but usually mild to moderate and transient, mostly occurring in the first few weeks during dose escalation. Patients should be assured that the weight-loss effect is not related to the gastrointestinal side effects. It is recommended that the daily dose is escalated slowly. If a dose increase is not well tolerated, the patient may temporarily de-escalate to previously tolerated dose and attempt the dose increase again in several days to 1 week, depending on the severity of the response. Dose timing can be changed according to patients' response to the treatment, for example, before bedtime. In more severe cases of nausea and vomiting, prescribing antiemetics may be considered.
Long-Term Success
Persisting with AOMs is crucial for achieving and maintaining weight loss while the patient continues with dietary modification and increased physical activity. Patients should be reminded of the many health benefits of losing weight, including prevention, improvement, or even remission of chronic diseases, increased fertility, and better pregnancy outcomes. Patients should be encouraged to achieve and maintain ≥5% to 10% weight loss. It is strongly recommended that patients set their nutrition and exercise goals and self-monitor their progress, including weighing regularly, at least once a week. Any goal-setting should follow the SMART method (Specific, Measurable, Attainable, Realistic, and Time-bound) to facilitate progress.
Additional Services Offered by OB/GYNs
In addition to reproductive health services, OB/GYNs can also provide:
- Immunizations: Keeping you up to date with your vaccinations.
- Birth control counseling: Providing advice on the best birth control methods for you.
- Joint and bone health: Monitoring and addressing concerns about joint and bone health.
- Weight management: Discussing concerns about your weight and healthy ways to manage it.
- Skin issues: Addressing skin issues that may be linked to hormonal conditions.
- Thyroid problems: Identifying and addressing thyroid problems that can affect weight management.
- Mental health: Providing support and guidance for mood issues, depression, or anxiety.
- Puberty advice: Offering guidance and support for daughters approaching puberty.
- Emotional support: Helping you cope with the emotional transitions you go through during your life.
12 Steps to Optimal Nutrition
For those who prefer a gradual approach, here are 12 simple, easily manageable steps to adopt a healthy, real food-based diet:
- Eat More Protein: Boost your metabolism and reduce your appetite.
- Start Eating a Healthy Breakfast: Preferably with eggs.
- Replace Crappy Fats and Oils: With good fats and oils.
- Remove Sugar-Sweetened Beverages and Fruit Juices: From your diet.
- Start Exercising: Find something that you enjoy and can stick to.
- Replace Sugar, Refined Carbs and Modern Wheat: With other healthier foods.
- Start Eating Meat or Fish and Plenty of Vegetables For Dinner
- Match Carb Intake: To Your Metabolic Health and Activity Levels.
- Take Care of Your Lifestyle: Emphasizing Adequate Sleep and Reduced Stress Levels.