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Weight Management
Reprinted from Food Insight
July/August 1992

It all seems so simple: eat less, exercise, and lose weight. Yet approximately 44 million Americans are overweight, and dieters are spending an average of $30 billion a year on commercial weight loss programs to take it off.

Yet no matter what approach most people use to diet, their weight loss is temporary. The weight they lose almost always returns in the long run.

That's the conclusion of a 13-member panel of obesity, metabolic and other experts convened by the National Institutes of Health (NIH) last spring. The panel examined the nature and effectiveness of approaches to voluntary weight loss and control.

Studies show as much as two thirds of the weight lost through dieting is regained within one year, and almost all the weight is regained within five years. Other weight loss techniques such as behavior modification, exercise and drugs--even in controlled settings--usually produce only short-term results.

Given this discouraging dieting outlook, many experts are beginning to shift their focus to the concept of weight management. Adopting a healthy lifestyle with a reasonable approach to caloric consumption and exercise may ultimately offer more promise in managing overweight than traditional dieting strategies.

Overweight: What and Why

Although precise definitions vary among experts, overweight has been traditionally defined as 10 to 20 percent above an optimal weight for height derived from statistics.

Some scientists argue, however, that the amount and distribution of an individual's body fat is a significant indicator of health risk and therefore should be considered in defining overweight. Abdominal fat has been linked to more adverse health consequences than fat in the hips or thighs. Thus, calculations of waist-to-hip ratio are preferred by some health experts to help determine if an individual is overweight.

Regardless of the definition, the prevalence of overweight among Americans has increased during the last 20 years, adversely affecting public health. Overweight is associated with elevated serum cholesterol, high blood pressure, diabetes, gallbladder disease, gout and certain types of cancer. Because of its serious impact on cardiovascular health and lung function, the National Heart, Lung and Blood Institute is launching a special obesity education initiative, targeted both at high-risk individuals and the general population.

Although the basic mechanism of overweight involves an imbalance between caloric intake and energy expenditure, it's unclear why this imbalance occurs in certain individuals. However, it is clear that overweight is more than simply a matter of willpower. A complex combination of genetic, environmental, cultural, socioeconomic and physiological factors are beved to contribute to this condition.

Surveys indicate that 33 to 40 percent of adult women and 20 to 24 percent of adult men are trying to lose weight, whether they need to or not. Another 28 percent each of males and females are trying to maintain their weight.

In women, the percentage trying to lose weight does not differ significantly among various ethnic groups, even though black and Hispanic women have a higher prevalence of overweight than white women do. Among men, Hispanics report the highest rates of attempted weight loss.

While it's human nature to want "quick results," it appears most people take weight loss more seriously. The average reported time on a weight loss regimen is five or six months.

Decisions to lose weight are motivated by a variety of factors: the desire to improve self-image reduces disease risk, improve overall health, or avoid societal "discrimination" against overweight people.

In one survey, women cited appearance as a more important reason for losing weight than fitness, while the reverse was true for men. But, according to Judith Rodin, Ph.D., professor of medicine and psychiatry at Yale University, more and more women are beginning to embrace the fitness mentality. "The look for the '90s woman is still lean, but now there is the added pressure to be fit. The emphasis on health and fitness is a new social force pushing increased body awareness," she said.

Beating The Odds

When it comes to losing weight and keeping it off, many Americans are called but few are successful. Yet, individuals who have "beaten the odds" in weight management share some commonalties in how they've achieved success.

Based on more than 20 years of working with overweight cnts, John Foreyt, Ph.D., director of the Nutrition Research Clinic at Houston's Baylor College of Medicine, offers the following recommendations for successful weight management:

Regular physical activity: Exercise not only increases caloric expenditure, it increases feelings of well being and perceived energy level. Studies also suggest exercise can be effective in regulating appetite. However, the challenge is to incorporate exercise into other life-long habits. Social support: Long-term weight regulation is easier when individuals are supported in their goals by family, friends, colleagues and treatment support groups. Internal motivation: Those who demonstrate internal motivation such as "I'm doing this to be in charge of my life," are more successful in weight management than those who focus on external reasons like "fitting into a new pair of jeans." Positive health benefits. Focusing on positive health benefits such as an ability to walk further without being winded increases the chances of successful long-term weight management. Smaller, more frequent meals: Eating smaller, more frequent meals throughout the day helps maintain blood sugar levels and avoids feelings of starvation, which can lead to bingeing. Gradual changes. Those who make gradual changes in diet and exercise are more likely to successfully manage their weight in the long run, than those who make dramatic changes at once are.

Weight Management Approaches

Managing caloric intake is the most popular way people attempt to lose or maintain healthy weight. Results of the Food and Drug Administration's recent Weight Loss Practices Survey indicate that many people are using reduced-calorie foods as part of their weight management strategies, including low-calorie dressings, low-calorie sweeteners, low-fat frozen desserts, low-fat cheeses, diet breads and light alcohol beverages.

Vitamins, meal replacements: over-the-counter products, weight loss programs and diet supplements are also being used by men and women in decreasing order from 28 to 3 percent. While certain diets alter the proportion of calories from fat, carbohydrate and protein, the NIH panel concluded the effectiveness of such changes appear to be more variable than cutting back on total calories alone.

Some studies show, however, that overweight individuals do consume more fat in the diet than their slender counterparts. Gram-for-gram, dietary fat provides more than twice the number of calories as carbohydrate or protein.

Pound-for-pound, how does that effect of caloric restriction compare to exercise? Evidence suggests that greater amounts of weight are lost more quickly with caloric restriction than with increased caloric expenditure. But, when exercise is added to dietary change, even greater weight losses are possible.

Steven Blair, P.E.D., an exercise physiologist at the Institute for Aerobics Research in Dallas, conducted a one-year study comparing volunteers who dieted with those who dieted and exercised. The diet plus exercise group lost more weight and fat and had a greater improvement in the waist-to-hip ratio than the diet-only groups.

According to Blair, exercise builds and preserves the body's muscles. "When you diet, your body loses both muscle and fat. The goal is to maximize fat loss and minimize muscle loss.

"Exercise builds muscle tissue, and muscle cells burn more calories while you are resting than do fat cells. The more muscle you have, the more energy you burn while at rest," he said.

Blair also cited exercise's beneficial role in the prevention of overweight as well as in long-term weight maintenance. Overweight men and women appear to benefit from exercise even if they remain overweight, with more active individuals having lower rates of morbidity and mortality.

Weight Cycling

Although the health consequences suffered by those who repeatedly lose and gain weight need further exploration, at least one study has found serious adverse effects of such weight cycling.

American and Swedish researchers analyzed weight fluctuations and later health problems over a period of 32 years in more than 3,000 participants in the ongoing Framingham Health Study.

The researchers found that people who repeatedly lose and regain weight have an overall higher death rate. They also may be at greater risk of heart disease and some cancers than those may whose weight remains stable or steadily increases, even if they are overweight.

In addition, programs that claim rapid weight loss, which rarely are successful over the long-term can cause depression, anger and bingeing. Those who attempt such programs may ultimately regain weight faster and weight more than when they initially started.

The NIH panel underscored the importance of being realistic when selecting any personal weight management strategy. It takes time to gain weight, so losing it will take time as well. Modest goals and a slow, steady course of weight loss will maximize the probability of both losing weight and keeping it off.

In the end, the panel advised that individuals should view their weight loss goals as part of an overall long-term strategy to achieve a healthier life.

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