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Management by diet and exercise
Strategies of Weight Management
  • Diet Therapy
  • Physical exercise
  • Stress Management
  • Pharmaco Therapy
  • Weight Loss Surgery
Common Problems in Obesity

Plateau Effect

A common experience in weight reduction programs when the weight remains static for a while and eventually comes to a halt. One theory states these interim plateaus reflect reduction of lipids in the adipocytes and signal the demands of metabolic adjustment and weight maintenance.

Weight Cycling

Many obese lose and gain weight several times over their lifetime called the Yo – Yo effect. With each turn of the cycle it takes longer to lose the same amount of weight and conversely less time to regain the weight.
Aim initially at slow reduction of 7% to 10% from baseline weight. Even small amounts of weight loss are associated with significant health benefits. Reduce body weight by 7% to 10% during 1st year of therapy. Continue weight loss thereafter to extent possible with goal to ultimately achieve desirable weight.
  • A diet that is individually planned and takes into account the patient's overweight status in order to help create a deficit of 500 to 1,000 kcal/day should be an integral part of any weight loss program.
  • For overweight patients a decrease of 300 to 500 kcal/day will result in weight losses of about 1/2 to 1 lb/week and a 10 percent loss in 6 months.
  • For more severely obese patients, deficits of up to 500 to 1,000 kcal/day will lead to weight losses of about 1 to 2 lb/week and a 10 percent weight loss in 6 months.
  • It is essential that the prescribed diet be a balanced diet.
  • There should be ample intakes of fruits, vegetables, and whole grains; Fruits and vegetables are recommended to provide fiber, vitamins, and minerals and to increase the volume of food ingested to help avoid feelings of deprivation and restriction.
  • Effective weight loss requires a combination of caloric restriction, physical activity & motivation.
  • Effective lifelong maintenance of weight loss requires a balance between caloric intake and physical activity.
  • After 6 months, the rate of weight loss usually declines and weight plateaus because of a lesser energy expenditure at the lower weight and the lifestyle prescription needs to be revised.
  • Experience reveals that lost weight usually will be regained unless a weight maintenance program consisting of dietary therapy, physical activity, and behavior therapy is continued indefinitely.
Nutritional Guidelines
Carbohydrates:
  • The widespread misconception that carbohydrates (in any form) should not be eaten by people with obesity should be removed.
  • Carbohydrates in the form of simple sugars need restriction. The carbohydrates should be in the form of complex polysaccharides (starch) and contain adequate amount of fibers.
  • Carbohydrates should constitute around 60-70% of the total calories which is usually found in traditional diets eaten in various parts of India.
  • It should be low in simple sugars and refined carbohydrates, to reduce calorie intake further, but sufficient in protein to preserve muscle mass. 
  • Very high carbohydrate intakes can exacerbate the dyslipidemia of the metabolic syndrome.
Protein:
  • Protein intake should be approx. 0.8 - 1gms/kg ideal body weight; this usually comprises around 12-18% of the calorie intake.
  • The requirements for proteins may be increased in catabolic states, pregnancy, lactation and in some elderly patients.
  • This should be preferably taken from natural sources rather than commercially available protein supplements as far as is convenient.
Fat:
  • High fat diets increase post prandial lipemia and chylomicron remnants.
  • Fat when replaced with carbohydrate in the diet causes changes in the triglyceride and HDL levels. Low fat diets raise triglyceride levels and HDL-C levels can decline; thus, very-low-fat diets may exacerbate atherogenic dyslipidemia.
  • Low fat diets high in SFA will not help reduce LDL. Thus it is of great importance that one preferably take equal amounts of saturated, mono-unsaturated and polyunsaturated fats (1:1:1).
It is a misconception to feel that polyunsaturated fats are safe and can be taken freely, it is essential it be taken in moderation.

It is recommended that the saturated fat intake should be <7% of total calories; reduce trans fat; dietary cholesterol <200 mg/dL; total fat 20- 25 % of total calories. Most dietary fat should be unsaturated; simple sugars should be limited.

These goals can be achieved by (1) choosing lean meats and vegetable alternatives; (2) selecting fat-free (skim), 1%-fat, and low-fat dairy products; and (3) minimizing intake of partially hydrogenated fats.

AHA recommends total fat intake be less that 30% of calories; ATP III Has broadened the intake to 25-35% of energy with less that 7% coming from saturated fat.

Many foods contain fats; this “invisible fat” should be taken into account when estimating the total fat intake.

It is advisable to restrict the total intake of cooking fats to less than 6% of the total energy intake Food should be cooked in the least amount of oil or ghee; preferably grilled, steamed, stewed, broiled or pan broiled, roasted, microwaved, rather than fried. The total intake of cholesterol should be restricted to around <200 mg per day. Egg yolks, organ meats, sea foods such as crabs, shrimps and lobster have a high cholesterol content, thus should consumed rarely. The fat intake may need to be further modified if associated dyslipidemia is present.
Essential fatty Acids:

Recent evidence suggests that attention must be paid to the intake of essential fatty acids (EFAs) such as omega-6 and omega-3 fatty acids. These EFAs make to be derived from food as they cannot be synthesized in the body.
 Type of Oil Omega - 6 Omega - 3 W6 / W3
Sunflower 49 0.3 163
Safflower 73 0.5 146
Sesame 40 0.5 80
Corn 57 0.8 71
Groundnut 28 0.8 35
Ricebran 33 1.6 34.6
Palmolein 9 0.3 30
Soyabean 52 5 10.4
Ghee (Cow) 1.6 0.5 3.2
Ghee Buffalo 2 0.9 2.2
Mustard/ Rape 13 8.6 1.5
Coconut 1.8 -- --
Salt Intake

Salt restriction is necessary in patients with associated hypertension, cardiac failure and fluid overload. Reduce sodium intake to no more than 100 meq/day (2.4 g of sodium or 6 g of salt)

Fibre

Fibre both dietary and complex carbohydrate are extremely beneficial in tackling excess calorie intake. High fibre diets promote weight loss. They increase satiety, delay gastric emptying by releasing certain gut hormones.
Soluble fibres such as pectins, gums, hemicellulose (in fruits)
  • Increase intestinal transit time
  • Delay gastric emptying slow glucose absorption
  • Lower serum cholesterol.
Insoluble fibres such as cellulose and lignin (vegetables, grains)
  • Decrease intestinal transit time
  • Increase fecal bulk
  • Delay glucose absorption and slow starch hydrolysis.
 
 
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