Weight Management Health Article

Aspects of weight management

Since the late 1980s, nutritionists and health care professionals had come to recognize that successful weight management programs have three characteristics, as follows:

• They present weight management as a lifetime commitment to healthful patterns of eating and exercise, rather than emphasize strict dieting alternating with carelessness about eating habits.
• They are tailored to each person's age, general health, living situation, and other individual characteristics.
• They recognize that the emotional, psychological, and spiritual facet of human life are as important to maintaining a healthy lifestyle as the medical and nutritional facets.

Nutrition

The nutritional aspect of weight management programs includes education about healthful eating, as well as modifying the person's food intake.

DIETARY REGULATION. Most weight-management programs are based on a diet that supplies enough vitamins and minerals; 50–63 grams of protein each day; an adequate intake of carbohydrates (100 g) and dietary fiber (20–30 g); and no more than 30% of each day's calories from fat. Good weight-management diets are intended to teach people how to make wise food choices and to encourage gradual weight loss. Some diets are based on fixed menus, while others are based on food exchanges. In a food-exchange diet, a person can choose among several items within a particular food group when following a menu plan. For example, if a person's menu plan allows for two items from the vegetable group at lunch, they can have one raw and one cooked vegetable, or one serving of vegetable juice along with another vegetable. More detailed information about these and other weight-management diets is available in a booklet from the Weight Information Network of the National Institutes of Health, called Weight Loss for Life, listed under "Resources" below.

NUTRITIONAL EDUCATION. Nutritional counseling is important to successful weight management because many people, particularly those with eating disorders, do not understand how the body uses food. They may also be trying to manage their weight in unhealthy ways. One recent study of adolescents found that 32% of the females and 17% of the males were using such potentially dangerous methods of weight control as smoking, fasting, over-the-counter diet pills, or laxatives.

Exercise

Regular physical exercise is a major part of weight management because it increases the number of calories used by the body and because it helps the body to replace fat with lean muscle tissue. Exercise also serves to lower emotional stress levels and to promote a general sense of well-being. People should consult a doctor before beginning an exercise program, however, to make sure that the activity that interests them is safe relative to any other health problems they may have. For example, people with osteoarthritis should avoid high-impact sports that are hard on the knee and ankle joints. Good choices for most people include swimming, walking, cycling, and stretching exercises.

Psychological/psychiatric

Both obesity and eating disorders are associated with a variety of psychiatric disorders, most commonly major depression and substance abuse. Almost all obese people feel harshly judged and criticized by others, and fear of obesity is a major factor in the development of both anorexia and bulimia. Many people find medications and/or psychotherapy to be a helpful part of a weight management program.

MEDICATIONS. In recent years, doctors have been cautious about prescribing appetite suppressants, which are drugs given to reduce the desire for food. In 1997, the Food and Drug Administration (FDA) banned the sale of two drugs: fenfluramine (known as "fen-phen") and phentermine when they were discovered to cause damage to heart valves. A newer appetite suppressant, known as sibutramine, has been approved as safe. Another new drug that is sometimes prescribed for weight management is called orlistat. It works by lowering the amount of dietary fat that is absorbed by the body. However, it can cause significant diarrhea.

People with eating disorders are sometimes given antidepressant medications, most often fluoxetine (Prozac) or venlafaxine, to relieve the symptoms of depression or anxiety that often accompany eating disorders.

COGNITIVE-BEHAVIORAL THERAPY. Cognitive-behavioral therapy (CBT) is a form of psychotherapy that has been shown to be effective in reinforcing the changes in food selection and eating patterns that are necessary to successful weight management. In this form of therapy, patients learn to modify their eating habits by keeping diaries and records of what they eat, what events or feelings trigger overeating, and any other patterns that they notice about their choice of foods or eating habits. They also examine their attitudes toward food and weight management, and work to change any attitudes that are self-defeating or interfere with a healthy lifestyle. Most CBT programs also include nutritional education and counseling.

WEIGHT-MANAGEMENT GROUPS. Many doctors and nutritional counselors suggest that patients attend a weight-management group for social support. Social support is essential in weight management, because many who suffer from obesity or an eating disorder struggle with intense feelings of shame. Many isolate themselves from others because they are afraid of being teased or criticized for their appearance. Such groups as Overeaters Anonymous (OA) or Take Off Pounds Sensibly (TOPS) help members in several ways: They help to reduce the levels of shame and anxiety that most members feel; they teach strategies for coping with setbacks in weight management; they provide settings for making new friends; and they help people learn to handle problems in their workplace or in relationships with family members.