File Name: principles of energy balance and weight control .zip
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Metrics details. Reducing dietary energy density has proven to be an effective strategy to reduce energy intakes and promote weight control. This effect appears most robust when a low energy dense preload is consumed before meals. Yet, much discussion continues regarding the optimal form of a preload. The purpose of the present study was to compare effects of a solid grapefruit , liquid grapefruit juice and water preload consumed prior to breakfast, lunch and dinner in the context of caloric restriction.
KYLE J. Patient Information Handout. Related Editorial. Obesity has reached epidemic proportions in the United States. More than 60 percent of U. Physical activity has a positive effect on weight loss, total body fat, and body fat distribution, as well as maintenance of favorable body weight and change in body composition.
Many of the protective aspects of exercise and activity appear to occur in overweight persons who gain fitness but remain overweight. Despite the well-known health and quality-of-life benefits of regular physical activity, few Americans are routinely active.
Results of research studies have shown that physician intervention to discuss physical activity including the wide array of health benefits and the potential barriers to being active need not take more than three to five minutes during an office visit but can play a critical role in patient implementation.
This article describes elements of effective counseling for physical activity and presents guidelines for developing physical activity programs for overweight and obese patients. An estimated 97 million adults in the United States, or more than six out of 10 men and women, are overweight or obese.
No longer is there any serious doubt about the strong impact of physical activity on promoting health and preventing disease, or achieving and maintaining a healthy body weight. Despite the well-known benefits of regular physical activity, only about 15 percent of American adults regularly engage in the modest amount of activity required to obtain health benefits, while more than one fourth of adults are sedentary. Results of a recent study, 5 however, indicate that only 42 percent of the 12, obese adults involved in the study had been advised by a health care professional to lose weight during the past year.
Another study suggests the figure may be even lower. This article focuses on one component of the interaction between physicians and overweight patients: the promotion of physical activity. The authors present a description of elements important in counseling patients about physical activity and guidelines for developing physical activity programs for patients who are overweight or obese.
The potential medical hazards of obesity have been documented extensively. The presence of cardiovascular risk factors is highly associated with the distribution of fat; abdominal or visceral fat is considered at least as important a health risk as the total amount of body fat. Although its etiology is not completely understood, it is generally agreed that obesity results from a chronic imbalance between energy intake and energy expenditure.
It has been suggested that societal or environmental factors such as large food portions and inexpensive, energy-dense foods, along with our increased reliance on technology, have resulted in a constant pressure toward positive energy balance by promoting energy intake and discouraging physical activity.
The issue of which side of the energy balance equation is more responsible for the growing prevalence of obesity is complicated by the lack of credible data about national trends in energy intake and energy expenditure. Nevertheless, a reduction in physical activity and, possibly, a greater energy intake appear to influence the growing prevalence of obesity. Each year, millions of persons in the United States claim they are dieting; meanwhile, a progressive increase in the prevalence of obesity continues.
This situation emphasizes the strong influence of sedentary behaviors on weight and the ineffectiveness of diet alone in sustaining weight loss. Physical activity, particularly endurance-type exercise of sufficient intensity, duration, and frequency, favorably affects weight loss, total fat content, and body fat distribution; however, data comparing diet, exercise, or a combination suggest that diet is more effective than exercise in causing initial weight loss.
Similarly, in persons who are overweight or obese, weight loss through physical activity alone produces only a modest reduction in weight and abdominal fat compared with dieting alone.
This finding may be primarily the result of a low initial level of cardiorespiratory fitness that limits the person's ability to create an energy deficit that can result in a substantial weight loss. On the other hand, a marked energy deficit can be achieved through dieting, particularly when the person's energy intake was previously very high.
In patients who are obese, physical activity without caloric reduction most often results in only a slow rate of weight loss e. This understanding will help them avoid unrealistic expectations and stress the importance of combining a balanced diet with routine physical activity. Regular physical activity helps persons achieve and maintain weight loss, particularly when exercise is combined with a reduction in energy intake, and regular physical activity plus the fitness that results confers a variety of health-related benefits in obese patients even if they lose no weight.
Examples of important patient education points are summarized below. Study results show significant reductions in cardiovascular morbidity and mortality in patients who are overweight but achieve even a moderate level of cardiorespiratory fitness versus those who are overweight and remain unfit.
Hypertension, insulin resistance, elevated blood glucose levels, and dyslipidemia have been shown to improve as a result of enhanced physical activity and increased fitness level in adults who are overweight or obese, even in the absence of weight loss.
As much as 50 percent or more of the weight loss achieved through dieting can occur at the expense of lean body mass, causing a loss of muscular strength that is amplified by feelings of fatigue and reduced basal metabolic rate—all of which can have a detrimental effect on long-term, successful weight management. Increased cardiorespiratory fitness and greater muscular strength to perform activities of everyday life may improve the mobility, functional abilities, and quality of life in obese persons.
Results of numerous studies support the conclusion that successful weight maintenance in persons who have lost weight is highly dependent on the level of physical activity they sustain. The largest of these studies 24 enrolled overweight women and overweight men who lost an average of 66 lb 30 kg and maintained a required minimum weight loss of In addition to consuming a low-fat diet, these patients were highly active and expended approximately 2, kcal per week during approximately one hour of moderate to vigorous physical activity performed an average of five times per week.
The calculation and classification of body mass index BMI is provided in the most current evidence-based guidelines on the identification, evaluation, and treatment of adults who are overweight or obese Table 1. Adapted from Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report.
Bethesda, Md. NIH publication no. According to the American College of Sports Medicine ACSM , 26 , 27 most patients who are obese or overweight can begin an exercise program with a gradual increase in physical activity e. In addition, the evaluation of coexisting cardiovascular risk factors or musculoskeletal conditions is recommended to provide safe exercise guidelines.
Predicting a patient's readiness to lose weight and identifying potential variables associated with successful weight loss are important steps in promoting a useful physical activity program.
This may be easier said than done. According to contemporary guidelines for the treatment of obese patients, physicians and other health care professionals should briefly consider the issues outlined in Table 2 28 when assessing a patient's readiness to change.
Before beginning treatment, professionals must determine if patient recognizes the need and benefits of weight loss and wants to lose weight. Patients who report higher-than-usual stress levels may be unable to focus on weight management. To increase the chances of weight-loss success, stress management may need to be initiated. Binge eaters are typically distressed by their chaotic eating patterns; the greater the person's distress or depression, the more likely the need for other forms of counseling psychologic or nutritional.
Does patient understand the treatment requirements and believe that they can be met? Health care professional and patient should select a course of treatment requirements together. Treatment activities should include those that are a high priority for the patient and those that the patient believes can be performed successfully.
Professionals must assist patients in understanding that slow, modest weight loss can improve health. In addition to weight loss, progress should be assessed by achievement of overall health improvement goals. Adapted from The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Although debate continues about the amount of weight loss required to achieve meaningful risk-factor reduction for CHD and other comorbidities associated with obesity, convincing evidence suggests that reducing initial body weight by 5 to 10 percent will result in significant CHD risk-factor reduction and health gains.
An initial weight loss of 10 percent of body weight over six months is a recommended target, and subsequent weight loss may then be attempted after establishing longer periods of weight maintenance. Physician understanding and discussion of potential social barriers e. Allow patients to select their own goals and provide guidance in setting flexible, short-term goals.
Use environmental cues or stimuli to remind patients of their exercise commitment. Encourage patients to practice self-reinforcement, including a focus on increasing self-esteem and realizing the health benefits of exercise. Prepare patients for situations that may create a relapse and a challenge to exercise.
Discuss coping strategies that can help in the prevention of a complete relapse. Adapted with permission from American College of Sports Medicine. ASCM's guidelines for exercise testing and prescription. A summary of the main components of the exercise prescription is provided in Table 4. Three to five days per week. More frequent exercise is desirable, but care should be taken to first establish a regular exercise habit before recommending levels that may not be sustainable in the long term.
Emphasis should be on increasing duration rather than intensity, with the goal of optimizing caloric expenditure. Multiple short bouts produce similar benefits as a single long bout of the same total duration. Low-impact activities e. Specific advice on the components of frequency, intensity, time, and type of exercise provides a framework of evidence-based recommendations for a safe and effective exercise program for overweight and obese adults.
Information from references 26 , 27 , and Resistance strength training is recommended as an adjunct to aerobic conditioning because it assists in the maintenance of basal metabolic rate and effectively improves strength and ability to perform a wide variety of physical activities associated with normal daily living e.
Daily lifestyle activities also should be emphasized as a way to increase overall physical activity levels and energy expenditure. Sharing with patients the Activity Pyramid Figure 1 , which was developed along the lines of the Food Guide Pyramid, may encourage them to understand and use the incremental or progressive nature of physical activity and personal conditioning.
Another approach to the promotion of physical activity when using the activity pyramid is to emphasize spending less time being physically inactive i. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
Already a member or subscriber? Log in. McInnis received a doctorate of science in applied anatomy and physiology from Boston University and a master's degree in cardiac rehabilitation from Springfield College, Springfield, Mass.
Franklin received a doctoral degree in physiology from Pennsylvania State University, University Park, and a master's degree in exercise physiology from the University of Michigan, Ann Arbor.
Rippe received his medical degree from Harvard Medical School, Boston, and completed postgraduate training in cardiology at Massachusetts General Hospital, Boston. Address correspondence to Kyle McInnis, Sc. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. The spread of the obesity epidemic in the United States, — Actual causes of death in the United States.
Prevalence of overweight among adolescents—United States, — Physical activity and health: a report of the Surgeon General. Atlanta, Ga. Are health care professionals advising obese patients to lose weight? National patterns of physician activities related to obesity management.
How to lose weight is one of the most pressing health questions for many people. People gain weight by consuming more energy than they burn, so consuming fewer calories , or energy, can help. However, other factors play a role, such as genetic factors, metabolism, hormones, the type of food you eat, your body type, and lifestyle. This article will look at the reasons to lose weight, the most effective methods and medical interventions. Health experts around the world now see obesity as an an epidemic. Some are evidence-based, safe and effective, but others are not. Most health professionals, dietitians, and nutritionists agree that the best results tend to come from combining a healthful, weight-reduction diet with physical activity, especially in the long term.
Weight management is the phrase used to describe both the techniques and underlying physiological processes that contribute to a person's ability to attain and maintain a certain weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Due to the rising obesity rates in many parts of the world, proper weight management strategies most often focus on achieving healthy weights through slow but steady weight loss, followed by maintenance of an ideal body weight over time. Rising obesity rates are a major concern around the world, especially in North America. There are many factors that contribute to a person's weight, including: diet, physical activity, genetics, environmental factors, medications, and illnesses.
Consume more than the body burns, weight goes up. Less, weight goes down. But what about the type of calories: Does it matter whether they come from specific nutrients-fat, protein, or carbohydrate?
Energy is another word for "calories. You burn a certain number of calories just by breathing air and digesting food. For example, children burn calories just being students—walking to their lockers, carrying books, etc. A chart of estimated calorie requirements for children and adults is available at the link below; this chart can help you maintain a healthy calorie balance.
A healthy lifestyle includes good nutrition and adequate physical activity. If your body weight has not changed for several months, the calories you consume from food and the calories you burn from physical activity are balanced. If you need to gain or lose weight, consider changing your dietary pattern and physical activity level to achieve your goal. Counting calories all the time is not necessary, but in the beginning, it may help to determine how many calories are in the foods and drinks you consume regularly. See MyPlate Plan external icon to determine how many calories a day you need to maintain your current weight based on your age, sex, height, weight, and physical activity level.
When it comes to losing weight, the details don't matter much.
KYLE J. Patient Information Handout. Related Editorial. Obesity has reached epidemic proportions in the United States. More than 60 percent of U. Physical activity has a positive effect on weight loss, total body fat, and body fat distribution, as well as maintenance of favorable body weight and change in body composition. Many of the protective aspects of exercise and activity appear to occur in overweight persons who gain fitness but remain overweight.
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