Weight Loss Guide

What can I do to lose weight?

Diet and exercise are the first and best solutions for losing weight. Not only does being overweight increase heart disease risk in itself, it also increases your risk of developing many other heart disease risk factors (Obesity & Overweight). Losing weight and exercising helps reduce your risk of developing diabetes, high cholesterol, high blood pressure, and the metabolic syndrome. It also lowers levels of inflammatory chemicals including CRP and improves the heart’s ability to function. Even losing as little as 5% of your body weight can make a big difference.

Though studies have shown that losing weight is good for your body, there isn’t a lot of research showing that weight loss can directly reduce the risk of having a heart attack or dying of heart disease. This is mostly because researchers have trouble finding large numbers of people who have managed to keep the excess weight off for more than 5 years.

Weight Loss Options Based on BMI

Treatment
options

Your BMI

25.0-26.9

27.0-29.9

30.0-34.9

35.0-39.9

40.0 or more

Diet, exercise and behavior changes

Yes

Yes

Yes

Yes

Yes

Weight Loss Medication*

No

If you have obesity-related disease

Yes

Yes

Yes

Surgery†

No

No

No

If you have obesity-related health problems

Yes

*Drug therapy should be considered only for people who have tried and failed with diet and exercise.

†Weight loss surgery should be considered only for people who are unable to lose weight with any other method.

What kind of diet will help me lose weight?

There are many different kinds of diets available to you. The National Heart, Lung, and Blood Institute (NHLBI) recommends weight loss at a rate of 1 to 2 pounds per week based on cutting 500 to 1,000 calories out of your daily diet. The American Heart Association (AHA) recommends a low-calorie diet of 1,200 calories a day for most women. Women who weigh more than 165 pounds may have 1,200 to 1,500 calories per day. This diet should include:

  • eating a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats
  • limiting intake of foods that are high in saturated fat, trans-fatty acids, and cholesterol

Very low calorie diets (less than 800 calories a day) are not recommended because they don’t provide enough vitamins and minerals, and they don’t help you lose weight in the long-term.

When researchers compared low-carbohydrate, high-protein, high-fat diets (e.g., Atkins diet) with conventional low-fat diets, they found that people lost about twice as much weight with a low-carbohydrate diet at 3 and 6 months. But 1 year later, dieters on both plans had lost about the same amount of weight. The long-term heart health effects of a low-carbohydrate, high-protein, high-fat diet are not known. The AHA advises against these diets because eating large amounts of saturated fat and cholesterol may increase your risk of heart disease.

A recent study of 160 overweight or obese men and women (51% were women) found that the key to dieting success was not necessarily the diet you chose, but rather how long you could stick to it. People who chose more extreme changes to their eating habits (such as the Atkins diet) were less likely to stick with their plan than people who chose more moderate diets, including Weight Watchers or The Zone.

Do I need to exercise to lose weight?

Combining exercise and diet is more effective than dieting alone. Not only will this combination allow you to lose more weight, it will help you to keep the weight off.

In a national registry of about 3,000 people who lost more than 10% of their body weight and kept the weight off for at least 1 year, 81% of these successful dieters reported increasing their physical activity.

Exercise helps reduce the risk of heart disease and reduce the impact of other risk factors for heart disease including diabetes, high blood pressure, and high LDL (bad) cholesterol. Also, physical activity can help you trim your waistline, even if you do not lose weight. This is important because fat around the belly increases the risk of heart disease and other health problems regardless of weight. If you can reduce the amount of belly fat you have, you will see healthful benefits even if you don’t lose weight overall.

To stay healthy, adults should aim for about 30 minutes of moderate exercise on most days of the week. To actually shed extra pounds, you should get about 60 to 90 minutes of at least moderately-intense physical activity (such as brisk walking) on most days of the week. On average, US adults gain 0.4 to 1.8 pounds a year and women tend to gain more weight over time than men. Exercise helps prevent or stall age-related weight gain, especially if you are already overweight.

I have tried to lose weight before but couldn’t. What can I do to be more successful?

Losing weight is difficult. Many people struggle to lose a few pounds and then put the weight back on again. Since there is no quick fix for losing weight, the best treatments involve making changes to your behavior and lifestyle. There are things you can do to make this life-changing process less daunting:

  • Set realistic goals that can be measured. Don’t be unreasonable and expect to lose 30 pounds in the first month. Instead, strive to shave off just a few pounds or an inch from your belly at a time.
  • Make small, rather than large, changes. By taking baby steps to achieve your larger goals, you’re more likely to stick with your new habits. For example, you are more likely to stick with a plan to eat a few more servings of fresh fruits and vegetables each week than to go completely vegetarian.
  • Monitor yourself by keeping an exercise log and food diary, and weighing yourself. Food logs are an excellent way to see exactly what you put into your body every day. They can also help you see where your diet might be out of balance. By keeping track of how much you exercise and how much you weigh, you’ll be able to see the progress you’re making towards becoming healthier.

Weight Loss Drugs

Can I take a weight loss drug to help me lose weight?

If you have tried dieting and exercising without much success, you doctor may prescribe medication to help you lose weight. Only obese (BMI of 30 or more) people or those who are very overweight (BMI 27-29.9) and have obesity-related medical problems such as sleep apnea (breathing trouble in your sleep), high blood pressure, or heart failure should use drugs to try and lose weight. If you fall into one of these categories and have tried dieting and exercising without much success for 6 months or more, your doctor may prescribe medication to help you lose weight. You may be prescribed an appetite suppressant or a fat blocker (lipase inhibitor) that reduces the body’s ability to absorb fat. Some available drugs include:

  • orlistat (Xenical)
  • sibutramine hydrochloride (Meridia)
  • phentermine (Adipex-P, Ionamin)
  • phendimetrazine tartrate (Bontril)

Weight loss drugs are not a miracle cure. When researchers studied the effects of these drugs, they found that people lost only about 11 pounds over a year with these medications. All drugs have potential side effects and you should discuss these with your doctor before taking any medications to lose weight. Two medications, Xenical (orlistat) and Meridia (sibutramine), have been approved for long-term use (2 years or more). The other weight loss medications should only be taken for a few weeks because researchers still aren’t sure about the long-term side effects of using these drugs.

The drugs are not a substitute for diet and exercise, and medication doesn’t work for everyone.2 If the drug is working for you, you should have lost more than 4.4 pounds after four weeks. Usually, people who lose weight with these drugs gain it back when they stop taking the medication.

What about over-the-counter or herbal weight loss drugs?

Weight loss products make a lot of sensational claims, but very few have any evidence to back them up. The Federal Trade Commission warns consumers to stay away from any products that make the following claims:

  • “Lose weight without diet or exercise!”
  • “Lose weight no matter how much you eat of your favorite foods!”
  • “Lose weight permanently! Never diet again!”
  • “Block the absorption of fat, carbs, or calories!”
  • “Lose 30 pounds in 30 days!”
  • “Everybody will lose weight!”
  • “Lose weight with our miracle diet patch or cream!”

Many appetite suppressant drugs used to contain ephedra, a chemical that was banned by the Food and Drug Administration (FDA) in April of 2004. Ephedra can cause serious heart problems or even death and you should avoid taking any product that contains this chemical. Other names for ephedra include:

  • ma huang
  • sida cordifolia
  • pinellia

The FDA also warns consumers to avoid weight loss drugs containing phenylpropanolamine (it is also sold as a nasal decongestant). In November of 2000, drug companies were asked by the FDA to stop selling weight loss products with this ingredient because research showed that it may increase your risk of having a stroke.

Be aware that “herbal” or “natural” weight loss products are not necessarily safe. They may have unknown side effects and can interact with other medications you may be taking. Some products may contain ephedra like compounds that can be dangerous. You should speak with your doctor before taking any alternative or herbal supplement.

Weight Loss Surgery

What about weight loss surgery?

Weight loss surgery  also called bariatric surgery – has become more popular in recent years. More than 109,000 weight loss operations were performed in 2003. Bariatric surgery is not a “quick fix”; it is major operation that has risks, as with any other type of surgery. Common complications include bleeding, infections, respiratory problems, and even death. It is important to understand the risks and benefits before deciding to have this procedure.

Who should consider weight loss surgery?

Though it is the most effective weight loss therapy for very obese men and women, weight loss surgery is not for everyone. Only people with extreme obesity (class III, a BMI over 35) or people with class II obesity and a severe obesity-related medical complication such as high blood pressure, diabetes, heart failure, or sleep apnea should consider having this surgery. But even then, this is a treatment of last resort after both lifestyle changes and drug therapy have failed.

What is weight loss surgery?

There are 5 different types of weight loss surgery, each distinguished by the technique they use to physically shrinking the size of the stomach. The most popular type of weight loss surgery is gastric bypass surgery.

What happens during gastric bypass surgery?

In gastric bypass surgery, a small portion of the stomach is either stapled or strapped aside to create a pouch. The pouch is then attached to a middle portion of the small intestine so that the food bypasses much of the stomach and the intestines as it is being digested. The smaller stomach cavity means that you feel full more quickly and because the food travels though a smaller section of the intestines, fewer calories are absorbed. Generally, a 3 to 4 day hospital stay is required. After you go home, you’ll need to follow a strict diet, take nutritional supplements, and exercise for the rest of your life.

What other factors should I consider before having surgery?

The procedure may or may not be covered by your insurance (bariatric surgery generally costs between $20,000 and $35,000). If you and your doctor do decide that this surgery is right for you, choose a surgeon who has done many of these procedures before. The risk of death and complications is lower for a surgeon with more experience. A study of more than 60,000 Californians who underwent gastric bypass surgery between 1995 and 2004 found that they were twice as likely to be hospitalized in the year after their surgery than in the year prior. Most of these hospital stays were for complications related to the gastric bypass operation.

How well does this surgery work?

People who have had weight loss surgery lose an average of 44 to 66 pounds. Along with shedding the extra pounds, people who underwent weight loss surgery found that some risk factors for heart disease, such as diabetes and high blood pressure, improved. A few studies show that people who have this procedure keep the weight off for many years. However, some people do gain the weight back. In one study, after 14 years, 10% of people who had gastric bypass gained back much of the weight they had lost.

Will liposuction reduce my risk of heart disease?

Liposuction is a cosmetic procedure where a plastic surgeon uses a small vacuum to suction out areas of fat from under the skin. The jury is still out on whether or not liposuction can reduce your risk of heart disease. One small study of 15 women found that 3 months after the procedure, risk factors such as CRP, cholesterol, and blood pressure had not changed for these obese women. A second small study of 30 women found that 6 months after liposuction, formerly obese women had reduced some risk factors for heart disease. Other studies have also found that some, but not all, risk factors are reduced after liposuction, but the results are mixed and the studies have only been done on small groups of women.

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