Weight loss maintenance: keeping off pounds.

Introduction

The world is in the grip of an obesity epidemic. In my post, Is obesity a disease or risk factor for other conditions? I had discussed the magnitude of obesity and had also highlighted that today most of the major international and national health organisations, including the World Health Organization (WHO), World Obesity Federation, and American Medical Association recognise obesity as a disease. However, rather than considering obesity in a conventional way, one aspect that needs serious consideration is that normal weight doesn’t always equal healthy weight. In my post ‘What is obesity – is it merely about BMI?‘ obesity had been defined as “excessive body fat accumulation (not weighing too much), which is associated with clear risks to health.” In my post ‘Normal Weight Obesity – a myth or a reality? I had described individuals who have weight within normal limits according to the BMI but have a high body fat percentage and are predisposed to the same health risks as in obesity. Lifestyle modifications encompassing dieting, physical activity and behavioural modifications often lead to weight loss. However, over the long term, the vast majority of individuals regain the weight they have lost. Thus, long-term weight loss maintenance remains the main challenge of obesity treatment. Various studies have shown that this relapse has a strong physiological basis and is not simply the result of the voluntary resumption of old habits.

Long-term weight loss maintenance remains the main challenge of obesity treatment. The image depicts an obese women on a weighing scale.
An obese women on a weighing scale

What is the successful maintenance of weight loss?

To assess the population of individuals who successfully maintain weight loss, it is pertinent to lay down objective criteria to define ‘successful maintenance of weight loss’. The most commonly followed definition of successful maintenance of weight loss was proposed by Wing and Hill; they define successful maintenance of weight loss as “intentionally losing at least 10 per cent of the initial body weight and keeping it off for at least one year.” Rossner proposed that sustained weight loss of about 5% to 10% of baseline body weight represents a definite degree of success. This goal for weight loss is in accordance with the recommendation of various health and nutrition organisations for reducing the risk of various disease conditions associated with obesity.

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Say NO to Fad diets

Introduction  

The world is in the grip of an obesity epidemic; additionally, a “fad diet” industry has arisen. Worldwide obesity has tripled since 1975. It is a chronic and multifactorial disease and one of the most important causes of morbidity and premature mortality worldwide. In my post, Is obesity a disease or risk factor for other conditions? I had discussed the magnitude of obesity and had also highlighted that today most of the major international and national health organisations, including the World Health Organization (WHO), World Obesity Federation, and American Medical Association recognise obesity as a disease. In my post, Childhood obesity: a serious public health challenge and Complications of obesity: the mother of all diseases, I had discussed the health implications of obesity.

The image depicts fronts covers of various diet books with a caption 'Say No to Fad Diets'.
Some popular fad diets.

In my post Diet Plan for Weight Loss – It is going to be a journey, I had discussed in detail, the dietary interventions for the management of obesity. However, in general, our beliefs about food are highly irrational and when we are struggling with weight, we want a magic pill, or in the least, a diet plan for weight loss that’s a functional equivalent of a pill. In my post Diet Plan for Weight Loss, referred to above, I had discussed the issue of weight loss and regain and had highlighted that due to the strong physiological tendency to regain weight, long-term weight loss maintenance remains the main challenge of obesity treatment. Another important aspect that I had discussed in this post was the dramatic disparity between the patient’s expectations from a weight loss regimen and the professional recommendations or reasonable weight loss that can be accomplished and maintained in most cases. The patient’s frustration and anxiety arising as a result of the gulf between the patient’s unrealistic expectations and professional recommendations have been exploited up to the hilt by the dieting industry.

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Keto Diet – Debunking the Myth

Introduction

Obesity continues to be a major worldwide health problem, despite the efforts of the medical community. Intensive lifestyle interventions can achieve weight loss that is sustained over the long-term. Diet is an important component of any lifestyle intervention programme. The dietary plan that restricts energy and fat is the most common strategy and based on it, several other dietary strategies have been proposed. However, the very-low-carbohydrate, high-fat keto diet differs from these approaches. 

In my post Diet Plan for Weight Loss – It’s going to be a journey, I had described various options for the treatment of obesity. As highlighted there, the core principle of any obesity treatment is that it must shift the balance between energy intake and energy expenditure – treating obesity requires creating a state of negative energy balance, therefore a reduction in energy intake is the primary factor that needs to be addressed in a dietary intervention designed to promote weight loss. In the above post, under dietary interventions for the management of obesity, I had briefly discussed the various calorie reduction strategies including reduced-calorie diets, low-calorie diets (LCD), very-low-calorie diets (VLCD) and #keto diets. In the above referred to post, I had discussed reduced-calorie diets in details; in my post, Very-Low-Calorie Diet – All you Need to Know, I had discussed the LCDs and VLCDs. Here, in this post, I shall be discussing the keto diets.

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Very Low Calorie Diet – All You Need to Know!

Introduction

In my post Diet Plan for Weight Loss – It’s going to be a journey, I had described various options for treatment of obesity. As highlighted there, the core principle of any obesity treatment is that it must shift the balance between energy intake and energy expenditure – treating obesity requires creating a state of negative energy balance, therefore a reduction in energy intake is the primary factor that needs to be addressed in a dietary intervention designed to promote weight loss. In the above post, under dietary interventions for the management of obesity, I had discussed various calorie reduction strategies including reduced-calorie diets, low-calorie diets (LCD) and very-low-calorie diets (VLCD). In the above referred to post, I had discussed reduced-calorie diets in details; here, in this post, I shall be discussing the other two diets plans viz. low-calorie diets and very-low-calorie diets. The use of very-low-calorie diets to induce rapid weight loss, in contrast to many other weight loss products in the market, is backed by decades of medical research, and very-low-calorie diets have been in clinical use for almost 40 years. 

A women shopping for vegetables in a food store. Consumption of fruits and vegetables are very useful in formulation of very low calorie diets.
Source: UConn Rudd Center for Food Policy & Obesity
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Diet Plan for Weight Loss – It’s going to be a journey.

Introduction

Before I discuss the diet plan for weight loss, the subject matter of this post, it would be worthwhile to discuss certain salient aspects of obesity. Obesity is a multifactorial disease and is the result of a complex interplay of genetic, environmental, metabolic, physiologic, behavioural and social factors; the underlying mechanism is a sustained positive energy imbalance (i.e. the energy intake is more than the expenditure). Therefore, irrespective of the cause(s) of obesity in an individual, the basic concept of weight loss for the management of obesity revolves around energy balance between the number of calories you consume and the number of calories your body uses. To lose weight, it is necessary to create a sustained negative energy imbalance, i.e. reduce energy intake below the energy expenditure and sustain it in the long-term. Though there are many strategies available, however in the present post, my focus will be primarily on formulating a diet plan for weight loss.

Diet plan for weight loss must include healthy foods such as fruits and vegetables.
Source: UConn Rudd Center for Food Policy and Obesity
A woman shopping in the produce department of a grocery store.
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Weight Bias: pervasive yet hidden harm of obesity

Introduction

Worldwide prevalence of obesity has been increasing at a menacing pace. As per WHO data, the incidence of obesity worldwide has tripled since 1975. As discussed in my post ‘Is obesity a disease or a risk factor for other conditions?’ in 2016 more than 1.9 billion adults, 18 years and older, were overweight; of these 650 million were obese. It has assumed epidemic proportions in children too. As discussed in my post ‘Childhood obesity: a serious public health challenge’, as per a study led by Imperial College of London and WHO, in a span of just 40 years, the number of school-age children and adolescents (5-19 years of age) with obesity has risen more than 10-fold from 11 million in 1975 to 124 million in 2016. Unfortunately, the obesity epidemic has been accompanied by a parallel epidemic of weight bias.

Rally for end to 'shaming and blaming' people for weight.
Rally for end to ‘shaming and blaming’ people for weight.

In my post ‘Complications of obesity: the mother of all diseases’, I had highlighted that obesity affects almost every aspect of health, from reproductive and respiratory function to memory and mood. Among the various psycho-social complications of obesity, I had discussed weight bias, which negatively affects not only psychological well-being but physical health as well. Although weight bias is pervasive in society and undermines people’s health extensively, awareness about it is very limited. In order to raise awareness about the prevalence, severity and diversity of weight stigma, the World Obesity Federation chose ‘End Weight Stigma’ as the theme for the World Obesity day 2018. To begin with, to help understand the topic better, the term weight bias and other related terms will be explained here briefly.

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Complications of Obesity: the mother of all diseases

Introduction

In my post ‘What is Obesity – is it merely about BMI? I had discussed the definition of obesity, as laid down by the WHO, as “A condition of abnormal or excessive body fat accumulation, to the extent that health may be impaired.” People who are obese are at increased risk for many serious diseases and health conditions, compared to those with a normal or healthy weight. However, in my post “Normal weight obesity – a myth or a reality?” I had discounted a widely prevalent myth amongst the general populace that ‘normal body weight always equals healthy weight’. There I had discussed a subset of individuals, among individuals with normal body weight, who develop and suffer from complications of obesity similar to individuals with a more ‘overt’ obesity.

Obesity affects almost every aspect of health, from reproductive and respiratory function to memory and mood. It decreases both the lifespan and the quality of life and increases costs of health care, both at the individual as well as at the national level. It does this through a variety of pathways; some as straightforward as the mechanical stress of carrying extra weight and some as a result of excessive secretion of certain products by enlarged fat cells and ectopic fat depots. The mechanisms by which obesity gives rise to its various ill-effects on health were discussed in my post “Is obesity a disease or a risk factor for other complications?”

However, the good news is that weight loss can reduce some of the risks associated with obesity. Loss of as little as 5 to 10 per cent of body weight provides substantial health benefits to people, and even if they begin to lose weight later in life.

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Childhood obesity: a serious public health challenge.

Introduction

Childhood obesity has reached epidemic proportions and is today one of the most serious public health challenges of the 21st century. The problem is global; even though, more recently the childhood obesity rates appear to be plateauing in high-income countries, albeit at unacceptably high levels, they continue to soar in low- and middle-income countries. A study led by Imperial College, London and WHO, which analysed weight and height measurements from nearly 130 million people, including 31.5 million children aged 5-19 years of age, was published in ‘The Lancet’, a prestigious medical journal, on the eve of the World Obesity Day on 11th Oct 2017. According to the study, the areas of the world with some of the largest increase in the number of obese children and adolescents were East Asia and the Middle East and North Africa.

The rise in childhood obesity rates has recently accelerated, especially in Asia. According to the study, the world will have more obese children and adolescents than underweight by 2022. Unfortunately, in spite of the rapid rise in child and adolescent obesity rates globally, few countries are taking action against this damaging health issue. To focus world attention on this burning issue, World Obesity federation chose the theme ‘Childhood Obesity’ for the World Obesity day 2017, celebrated on 11th Oct each year.

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Waist Size: Measure your waist, measure your risk.

Introduction

In 1997 the World Health Organisation (WHO) Expert Consultation on Obesity recognised the importance of abdominal fat mass (referred to as abdominal, central or visceral obesity), which can vary considerably within a narrow range of total body fat and body mass index (BMI). It also highlighted the need for other indicators to complement the measurement of BMI, to identify individuals at increased risk of obesity-related diseases. Two such proxy measures of abdominal obesity, which can complement the measure of BMI are waist size (circumference) and waist-to-hip ratio (WHR).

In my post ‘What is obesity – is it merely about BMI? What is obesity? I had highlighted that over the years, starting from the early 1980s, many research studies had confirmed the notion that rather than the excess body fat per se, regional distribution of body fat at different anatomic sites was much more important in driving the risk of cardiovascular diseases and other health hazards linked to obesity. In the same post I had described ‘abdominal obesity’ (individuals with excess intra-abdominal fat) and a characteristic obesity phenotype – ‘Asian Indian Phenotype or Paradox’ (Asians, particularly people in South-East Asia and China, displaying a greater amount of intra-abdominal fat for a given waist size [circumference] or BMI).

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Body Mass Index (BMI) – is it the best measure of obesity?

Introduction

          In my post “What is Obesity – is it merely about BMI? What is obesity? I had defined obesity as an abnormal accumulation of fat such that health is impaired. Body Mass Index is the most widely used measure of identifying obesity. However, in my post, I had cautioned that contrary to the general perception, obesity is not about BMI. In this post, I will be discussing what is Body Mass Index, its advantages and limitations. In addition to describing the method for calculation of BMI, for the ease of readers, I will be briefly discussing ‘BMI calculator tool’ and ‘BMI charts’.

What is Body Mass Index

Body Mass Index is a simple index of weight-for-height that is commonly used to assess ‘normalcy’ for body weight. It is defined as the body mass divided by the square of the body height. It is universally expressed in units of kg/m2, resulting from body mass in kilograms and height in meters. If pounds and inches are used as a measure of body mass and height respectively, a conversion factor of 703 is used. The formula for calculation of Body Mass Index  is as under:

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