Weight management is a key part of a healthy life, especially for individuals who are overweight or who live with obesity. Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss in individuals who are overweight or obese can reduce health risks, increase fitness, and may delay the onset of diabetes. It could reduce pain and increase movement in people with osteoarthritis of the knee. Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear.
However, weight loss - particularly extreme weight loss - is more complicated than consuming fewer calories than you burn. As many as 90 percent of people who have lost a considerable amount of weight will gain it back.
The Complexities of Weight Loss
Weight loss is not as simple as just eating less and exercising more. The body has several mechanisms that can prevent weight loss or encourage weight gain.
- Metabolic Compensation: The more you work out or manage your calorie intake to lose weight, the more your metabolism wants to compensate by slowing down to maintain your current weight; this is called metabolic compensation. It kicks in to preserve and store fat for future energy. Research shows that this happens because the human body has evolved to value storing fat and energy and to interpret a shortage of calories as a sign of distress.
- Hormonal Changes: Fat cells produce leptin, which tells your brain when you’re full. Fat cells shrink when you lose weight, producing less leptin, which means that you don’t feel as full. Your stomach produces ghrelin, which tells your brain when it’s time to refuel. When you lose weight, your ghrelin levels rise, making you want to eat more often.
- Brain Activity: When you lose weight, the part of your brain that regulates food restraint becomes less active - meaning that while you’re eating more to feel full (courtesy of leptin), you’re also less aware of how much you’re eating.
- Genetic Predisposition: More than 400 genes have been linked to obesity and weight gain, and they can affect appetite, metabolism, cravings, and body-fat distribution. If you have a genetic predisposition for obesity, it is easier to take a proactive stance to weight management. A preventive approach is more effective because you are preventing obesity from occurring in the first place.
- Set Point Weight: Some scientists think that your body has a set point weight and your metabolism, hormones, and brain will adjust to maintain that weight. People may have naturally higher or lower set weights than others; their set points can be impacted by genetics, aging, history of weight loss, and hormonal shifts. The theory suggests that your set point weight can rise but rarely lower. It is easier to maintain your set point weight because your body wants to remain at that point - not lose weight.
- Emotional Health: People often tie happiness and emotional health to weight loss. When they have successfully lost weight but remain dissatisfied with other parts of their life, they can fall into a cycle of dissatisfaction. Guilt at not feeling happy after weight loss can be a factor, as well as the temptation to eat to cope with these feelings.
After successful weight loss, your body may look different than you were expecting.
Strategies for Supporting Weight Loss Goals
Some simple strategies, such as making protein a staple of meals and snacks or starting a weight loss routine with cardio before switching to weight training and resistance later on, can help support your weight loss goals. It’s helpful to focus on small, achievable lifestyle goals for your emotional health during your weight loss journey. For example, instead of looking for a low number on the scale, you may focus on reaching a point where you feel comfortable playing sports or attending a group fitness class. Aiming for moderate goals that can build to bigger change can help you avoid the pitfalls of rapid, short-term solutions.
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"Both medical and surgical-assisted weight loss programs have proven to be very successful, but the key element is you," says Matthew R. Pittman, MD director of Bariatric Surgery, Northwestern Medicine Regional Medical Group. "Committing fully to the behavioral and lifestyle changes required is essential for long-term weight loss success. Working with a lifestyle medicine professional can also help you manage expectations, set reasonable goals and respond to your body’s changes if weight loss is a goal of yours. You may also want to consider whether a nutritionist is right for you.
Medical Terminology Related to Weight Loss
Here's a glossary of medical terms related to weight loss, providing a comprehensive understanding of the concepts and procedures involved:
5-hydroxytryptophan (5-HTP): Found in some over-the-counter weight loss products, this extract from a West African plant seed contains a contaminant linked to a rare and potentially deadly blood disorder. It has not been proven to effectively promote weight loss.
Adjustable Gastric Banding: A surgical procedure in which a band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. It can be tightened or loosened over time to change the size of the passage. This is a restriction operation.
Aerobic Exercise: Any activity involving large muscles, done for an extended period of time. Aerobic exercise can be done for weight loss, but it also provides cardiovascular benefits. Examples of aerobic exercise include walking, biking, jogging, swimming, aerobic classes, and cross-country skiing.
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Aloe: Herbal product derived from the aloe plant, it is often added to herbal weight loss products. However, it has not been shown to effectively promote permanent weight loss. Different parts of the aloe plant may be used. Aloe gel may lower blood sugar and keep other drugs from being properly absorbed. Aloe leaf lining has more side effects, including nausea, diarrhea, lowering of potassium in the blood, and laxative effects that could be dangerous to individuals in poor health.
Anaerobic Exercise: This is higher intensity exercise of shorter duration. Examples include weight lifting and body weight exercises like pushups, pullups, situps, squats, etc. Anaerobic exercise promotes lean muscle tissue. Muscle burns more calories, creating a higher metabolic rate and assists with weight loss.
Appetite Suppressants: Weight loss drugs that act upon the brain, "tricking" it into believing that it is not hungry or that it's full.
Bioelectrical Impedance Analysis: A body composition test that works by sending a small electrical signal through the body, enabling the amount of fat, muscle, and other lean tissue to be measured.
Body Composition Test: A test used to determine a person's current percentage of body fat. Hydrostatic Body Fat Testing, performed by submerging the person in water and then measuring their underwater weight, is the most reliable means of body fat testing.
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Body Mass Index (BMI): A popular method used to gauge whether or not a person is overweight or obese. BMI is calculated by dividing a person's weight (in kilograms or pounds) by their height (in meters or inches).
Calorie: A unit of measure for the amount of energy released when the body breaks down food.
Carbohydrate: Any of a large group of sugars, starches, cellulose, and gums that the body uses by converting into glucose, a simple sugar, for fuel.
Catecholamine: A chemical in the brain that affects mood and appetite.
Chitosan: A dietary supplement made from chitin, a starch found in the skeleton of shrimp, crab, and other shellfish. It has not been shown to contribute to permanent weight loss.
Cholesterol: A type of fat that circulates in your blood. It comes from two sources: the body, which makes its own regardless of what is eaten, and from foods containing animal products.
Chromium: This is thought to affect the breakdown of carbohydrates. Several studies have failed to show any benefit in weight loss after taking this nutritional supplement.
Dietician or Dietitian: A person who specializes in the study of nutrition.
Diuresis: Water loss.
Diuretic: A drug that promotes the formation and excretion of urine.
Duodenum: The beginning portion of the small intestine.
Ephedrine (ma huang): A common ingredient in herbal dietary supplements used for weight loss. Ephedrine can slightly suppress your appetite, but no studies have shown it to be effective in weight loss. Ephedrine is the main active ingredient of ephedra. Ephedra is also known as ma huang, not ephedrine. High doses of ephedra can cause a very fast heartbeat, high blood pressure, irregular heartbeats, stroke, vomiting, psychoses, and even death.
Extensive Gastric Bypass: A gastric bypass operation in which the lower portion of the stomach is removed. The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum portions of the small intestine.
Fat: Organic compounds that are made up of carbon, hydrogen, and oxygen; it is the body's most concentrated source of energy. Like protein and carbohydrates, fat is a principal and essential component of the diet.
Fat Absorption Inhibitor: Weight loss drug that works by preventing the body from breaking down and absorbing fat eaten with meals.
Food and Drug Administration (FDA): Government agency whose mission is "to promote and protect the public health by helping safe and effective products reach the market in a timely way, and monitoring products for continued safety after they are in use."
Food Triggers: A situation, such as a holiday party, or emotion, like anger, that causes a person to overeat.
Gastric Bypass: A type of operation that combines the creation of a small stomach pouch to restrict food intake and the construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption (decreased absorption of nutrients). Roux-en-Y Gastric Bypass (RGB) is a common type.
Glucomannan: Made from the root of Amorphophallus Konjac, an herbal supplement that is said to contribute to weight loss by delaying the absorption of glucose from the intestines.
Guarana: A nervous system stimulant derived from the seeds of a Brazilian plant of the same name; it is often found in herbal weight loss supplements.
Guar Gum: Also known as guar, guar flour, and jaguar gum, it is a dietary fiber obtained from the Indian cluster bean. Used extensively as a thickening agent for foods and pharmaceuticals, it is commonly sold as an herbal weight loss supplement.
High Protein Diet: Diets that recommend receiving up to 30% of calories (or more) from protein as opposed to the classic diet recommendation of 10%-15%. These diets also recommend receiving 40%-50% of calories from carbohydrates and 20%-30% from fat.
Hydrostatic Body Fat Testing: A body composition test performed by submerging the person in water and then measuring their underwater weight. This is the most reliable means of body fat testing.
Jejunum: The middle section of the small intestine.
Ketone: Waste products in the body that are a result of fat burning.
Ketosis: A secondary metabolic pathway for energy, resulting in an increase of ketones in the blood that are used as energy when carbohydrates or insulin are inadequate. This is dangerous for insulin dependent diabetics. It can also increase the risk of developing kidney stones. Ketosis is prevented by eating at least 100 grams of carbohydrates a day.
Ma Huang: See Ephedrine.
Meridia: See Sibutramine.
Metabolism: The amount of energy (calories) your body burns to maintain itself. Metabolism is the process in which nutrients are acquired, transported, used, and disposed of by the body.
Monounsaturated Fat: A type of fat found in large amounts in foods from plants, including olive, peanut, and canola oil.
Mortality: The rate of death.
Obesity: An excess proportion of total body fat. The most common measure of obesity is the body mass index (BMI). A BMI over 30 is considered obese. However, in people with large muscle mass, this could be an overestimate.
Orlistat: A commonly prescribed fat absorption medication; it is sold under the brand name Xenical.
Phen-fen: A weight loss drug made up of fenfluramine and phentermine. Fenfluramine use has been linked to heart valve problems and has been banned by the FDA.
Phenylpropanolamine (PPA): Once a common weight loss ingredient in appetite suppressants, recent studies have linked PPA to an increased risk of stroke. The FDA warns consumers to avoid use of products containing PPA and requested that manufacturers voluntarily discontinue marketing these products.
Polyunsaturated Fat: A type of fat that is found in large amounts in foods from plants, including safflower, sunflower, and corn oil.
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