Pennington Nutrition Series

Healthier lives through education in nutrition and preventive medicine 2009 No. 26

Weight Loss Methods

Body Mass Index (BMI) is a way to define

overweight and obesity. The index is a mathematical
formula in which a person's body weight in kilograms
is divided by the square of his or her height in meters
[kg/m2]. The BMI is more highly correlated with body
fat than any other mathematical ratio of height and
weight; however, athletes and individuals with high
percentage of muscle in their bodies may have a BMI
in the overweight range because of the heavier weight
of muscle tissue (fat floats and muscle sinks
in water).

BMI Defined as:

Overweight is defined as
18-25 Normal weight increased weight in relation to
height. Obesity is
25-29.9 Overweight
defined as an excessively high
>30 Obese amount of body fat or adipose
tissue in relation to lean
body mass.

Waist Circumference:
The distribution of body fat is important from a
chronic disease perspective. Those who have more
body fat inside the abdomen have an increased
risk for elevated triglycerides, high blood
pressure and glucose intolerance. There is less
risk for chronic diseases with fat accumulating
in the lower body. Waist circumference correlates
with chronic disease risk. Men with a waist larger
than 40 inches (102 cm) or women with a waist
larger than 35 inches (88cm) have increased
intra-abdominal fat with a greater risk of
chronic disease.

When someone is a few pounds overweight and is motivated to

lose weight, there are safe and effective methods to lose a few
pounds and to maintain a weight loss. Exercise is a safe way to
reduce excess body fat.
1. Dieting with the Exchange Diet
How to use the exchange plan:
The American Diabetes Association breaks food down into six
The number of exchanges per day is
categories called exchanges:
determined by the number of calories needed
each day. It is different for each person and
Starch/bread
depends on height, weight and the amount of
Meat
energy expended. The most accurate way
Vegetables
to determine the number of exchanges you
Fruit
need is with the help of a registered
Milk
dietitian, health professional or a trained
Fat
fitness professional. For more
information about the exchange
diet, contact:
http://www.diabetes.org/home.jsp

This Exchange diet is used to treat diabetes and other chronic diseases. The exchange system also
works well for use in weight management. It is a balanced system, with foods from each group, and can be
followed indefinitely. The diet is an easy way to monitor intake of carbohydrates, fat and protein, as
well as portion sizes.

Dieting using calorie control portions

Meal Replacement Plan. Using a product with a fixed number of calories in each portion
to replace a meal is the rationale behind this plan, whether the product is a liquid formula
or a packaged item. This takes the guesswork out of meal planning, and the person can
be assured of not consuming too many calories. By controlling portion sizes, fat and
carbohydrate intake, a person can control calories.

The replacement items are balanced and contain a mix of protein, carbohydrates and fat, as well as other
nutrients. Four different types of meal replacements are available:

Powder mixes
Shakes
Bars The usual plan is to use a meal replacement for one
Prepackaged meals or two meals a day while having sensible meals that
combine lean meat, starch, vegetables and fruit for
the other meals during the day. An intake of five
fruits and vegetables is recommended. A meal
replacement program is more effective for losing
weight than a conventionally structured weight loss
diet. Meal replacements offer a convenient and
nutritionally beneficial weight loss alternative to
conventionally structured weight loss diets.
2. Exercise
Maintaining, gaining and losing weight are tied to energy balance. Positive energy
balance leads to weight gain, negative energy balance leads to weight loss and
maintaining weight means an energy balance has been reached. Physical activity and
caloric intake balance each other. Exercise is excellent in helping to maintain a zero
energy balance. Exercise can build lean body mass, which burns more calories than
fat. Walking, running and doing physical activity can burn two to three times more
calories than a similar amount of time sitting. Weight loss is easier to achieve by
dieting, and exercise adds little to the weight loss of diet alone.

The strength of exercise is in maintaining a weight loss attained through diet.

There is an improvement in overall physical fitness with an exercise program
that may reduce blood pressure and improve insulin sensitivity. An exercise
program with 150 to 200 minutes of moderate physical activity each week
combined with a diet for weight loss can result in the maintenance of reduced
body fat, particularly intra-abdominal fat.

3. Behavior Change
Eating right and losing weight can be difficult. To lose weight and keep it off, changes in lifestyle and daily
habits are necessary. Long-term lifestyle changes require more than simply watching what one eats and how
much one exercises. It requires changing one’s approach (thinking, feelings and actions) to eating and physical
activity. Behavior change is one of the most widely used strategies for helping people to lose weight and
maintain a healthy lifestyle. Studies have demonstrated several tools that are effective in helping people
make this change toward a healthy way of living. These behavior change tools focus on maladaptive eating and
exercise patterns that can lead to weight gain, and these tools are designed to reduce the cues in our
environment that predispose us to weight gain. These tools help to increase awareness of eating and activity
patterns, to normalize eating patterns, to reduce exposure to cues for unhealthy eating or activity patterns,
and to alter responses to difficult situations.

Some common behavior change tools include:

(1) Making lifestyle changes a priority
(2) Establishing a plan for success
(3) Setting goals for eating and exercise
(4) Keeping a record of eating and physical activity every day
(5) Avoiding a food chain reaction
(learning the social and environmental cues around you that
encourage unhealthy eating or sedentary behavior and
avoiding/distracting yourself from these triggers)
(6) Rewarding yourself with nonfood “prizes” for each met goal.
 4. Medication and Surgical Treatment
Medication is indicated when BMI is higher than 30 kg/m2 or when it is
higher than 27 kg/m2 and cardiovascular risk factors are present and safer
methods have proven unsuccessful. The use of medication is always combined
with a diet and lifestyle instruction under continued medical supervision. The
medication and dosage are tailored individually to the patient. A person can
expect a 7 percent to 10 percent weight loss with the use of medication.

Medication

Phentermine
Phentermine first received approval from the Food and Drug
Administration (FDA) in 1959 as an appetite suppressant for the
short-term treatment of obesity. Phentermine affects certain
neurotransmitters in the brain that decrease appetite, causing
the person to eat less. When phentermine was approved, obesity
was thought to be caused by bad eating habits. Psychologists tell
us that habits can be learned or retrained over a few (up to 12)
weeks. Thus, phentermine was tested over this period. We now
understand obesity to be a chronic medical problem in which
weight is maintained at a higher than healthy level, much as blood
pressure control is dysregulated in a person with high blood
pressure. Phentermine can be just as effective for weight loss
when used every other month. In this way, phentermine can still
be used successfully to control weight chronically while
conforming to the instructions in the package insert.

Sibutramine
Sibutramine induces weight loss primarily through its effect on
food intake, but it also increases metabolic rate to a lesser degree.
Sibutramine enhances satiety. Studies indicate that maximum
weight loss is achieved by six months. Most individuals lose from 5
percent to 10 percent of their body weight. Weight regain occurs
after sibutramine is discontinued. Normally when individuals lose
weight, their metabolic rate goes down and energy expenditure
decreases. Sibutramine helps to prevent this decline. Sibutramine
use may increase heart rate and blood pressure. Regular blood
pressure checkups are encouraged. Sibutramine is not recommended
for someone with uncontrolled hypertension or tachycardia.
Orlistat
Orlistat prevents the absorption of dietary fat. It inactivates an enzyme that
is involved with fat digestion called lipase, and, in this way, about 30 percent
less fat is absorbed. The unabsorbed dietary fat is then eliminated in the stool.
This may change bowel habits, resulting in oily stools, fatty stools, increased
frequency of bowel movements and an inability to control bowel movements.
Orlistat intake, together with a 30 percent fat diet, can result in modest
weight loss of about 6 to 7 pounds a year while minimizing the gastrointestinal
side effects. Because less fat is absorbed, this also improves blood lipids. A
decrease in blood cholesterol levels and blood pressure can be anticipated.

Surgery

Malabsorptive:
Gastric bypass. This operation creates a very small stomach
pouch from which the rest of the stomach is separated. The
small intestine is attached to the newly created small stomach,
thereby bypassing the rest of the stomach and the first part of
the small intestine and a portion of the second. After surgery,
there is delayed absorption of food. The operation restricts
food intake and reduces the feeling of hunger by activation
hormones in the lower small intestine. The result is an early
Malabsorptive
sense of fullness followed by a sense of satisfaction. The portion
size is reduced to a small 2- to 6-ounce serving. Patients
continue to enjoy eating all types of food in smaller portions
after surgery.

Restrictive:
A restrictive silicone band is placed around the upper part of the
stomach, creating a smaller gastric pouch, limiting the amount of
food that the stomach will hold at any time. The inflatable ring
controls the flow of food from this smaller pouch to the rest of
the digestive tract. A small amount of food creates a sense of
fullness, and because of slow emptying, the feeling of fullness
lasts for several hours.

Restrictive
 The Pennington Biomedical Research Center is a world-renowned nutrition research
center.

Mission:
To promote healthier lives through research and education in nutrition and preventive
medicine.

The Pennington Center has several research areas, including:

Clinical Obesity Research

Experimental Obesity
Pennington Nutrition Series, Functional Foods
Number 26, 2005 Health and Performance Enhancement
Edited : Oct 2009 Nutrition and Chronic Diseases
Nutrition and the Brain
Authors: Dementia, Alzheimer’s and healthy aging
Heli Roy PhD, RD Diet, exercise, weight loss and weight loss maintenance
Shanna Lundy, BS
Beth Kalicki The research fostered in these areas can have a profound impact on healthy living and
on the prevention of common chronic diseases, such as heart disease, cancer, diabetes,
hypertension and osteoporosis.
Division of Education
Phillip Brantley PhD, Director The Division of Education provides education and information to the scientific com-
Pennington Biomedical Research munity and the public about research findings, training programs and research areas,
Center and coordinates educational events for the public on various health issues.
Claude Bouchard PhD, Executive
We invite people of all ages and backgrounds to participate in the exciting research
Director studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you
would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225)
763-3000.
10/09

References:
http://www.cdc.gov
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loss in overweight, sedentary women. JAMA 10: 1323-1330, 2003.
http://www.diabetes.org/home.jsp Website accessed September 16, 2004
Noakes M, Foster PR, Keogh JB, Clifton PM. Meal replacements are as effective as structured weight loss diets for
treating obesity in adults with features of a metabolic syndrome. J Nutr. 134: 1894-1899, 2004.
http://www.slim-fast.com/plan/index.asp?bhcp=1 Accessed September 16, 2004.
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Heal DJ, Aspley S, Prow MR, et al. Sibutramine: a novel anti-obesity drug. A review of the pharmacological evidence to
differentiate it from d-amphetamine and d-fenfluramine. Int J Obes Relat Metab Disord 1998 Aug; 22 Suppl 1: S18-S29.