Introduction to lifestyle changes for obesity and weightloss
Obesity is a
chronic health problem which now affects many Australians. Some say the rates are so high that we have reached an
obesity epidemic. Overweight and obesity are dangerous conditions as they can contribute to a number of different health problems (eg,
heart disease and
diabetes). It is therefore extremely important that obesity is treated aggressively.
Lifestyle changes remain the mainstay of treatment and are important for the long term maintenance of
weight loss.
The increased rates of
overweight and
obesity in
Australia is part of a worldwide trend. Today, over 50% of women, up to
75% of males and approximately 25% of children and adolescents are
classified as overweight or obese. The reasons for this increase are
complex, but environment and changing lifestyles certainly play
significant roles. High energy foods have become readily available, and
it is no longer essential to engage in physical activity. As a result,
obesity and its health problems have become all too
common in
Australian individuals.
Unfortunately obesity is a
chronic condition and
there is no ‘quick fix’ solution or treatment that is effective for all
overweight or obese individuals. Furthermore, after following weight
loss programs,
relapses of
weight gain are extremely common. This emphasises the importance of a
lifetime commitment to healthy eating and exercise practices. A range of different treatment options are available for obesity.
Lifestyle modification
(with a reduction of energy intake and an increase in physical
activity) is essential in all treatment strategies. There are currently
no long-term treatment programs that do not require at least some
lifestyle changes. Positive changes in your eating and exercise
behaviour are essential for sustained reductions in weight. However, if
you are extremely overweight it may be recommended that you also take
weight loss
medications or undergo
bariatric surgery.
Weight loss aims and benefits
As you may be aware, obesity is associated with a range of
health consequences including metabolic diseases (like
diabetes),
heart disease, some
cancers and
arthritis. Lifestyle modifications aim to reduce the
burden of obesity
and reduce the associated conditions. In general, the greater the
degree of weight loss achieved, the greater the health benefits.
However, even a small amount of weight loss (5-10% of body weight) can
lead to significant benefits. Some people consider this small amount of
weight loss unsatisfactory, but the health benefits are much more
important than physical appearance. You should discuss with your doctor
what weight loss aims are suitable for you.
The overall success of a weight loss program really depends on
whether the weight loss is sustained in the long term. For this to be
achieved you must be well educated about obesity and be extremely
dedicated to your lifestyle changes. It may be useful to elicit the help
of your friends and family to keep you motivated. Lifestyle changes for
the whole family are extremely important to achieve healthy weight in
children.
Overview of lifestyle treatments for weight loss
Lifestyle treatments for weight loss focus on
reducing energy intake and
increasing physical activity through
diet,
exercise and
behavioural measures. You should try to alter your bad eating and activity habits. (Please refer to
eating habits of women and
eating habits of men for more information). In general, a combination of treatments is the most effective way to achieve
weight loss.
A program is now available online that helps you to determine which
of your lifestyle behaviours are unhealthy. This is called the Diet,
Activity and Behaviour Questionnaire (DAB-Q). It consists of a series of
simple questions about your eating and activity behaviours and helps
you grade how easy it would be for you to make appropriate changes. At
the end of the questionnaire you will be given a graded score of the
most important factors contributing to your excess weight, which you can
hopefully address in the future.
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You can complete this program at home and bring it to your next
doctor’s appointment. This will provide your doctor with extremely
valuable information which can be used to devise
weight loss targets
specifically for you. This is very important as it is often difficult
for your doctor to get a good understanding of the lifestyle factors
contributing to your weight. You can access this program for free by
visiting
http://www.professortrim.com/DAB-Q/. All questionnaire answers remain confidential.
Lifestyle treatments for obesity and weight loss can be challenging
and time consuming. To re-emphasise, much of the success of your
treatment will rely on your own dedication and effort.
Dietary approaches for weight loss
Dietary control has probably been the main treatment used for weight loss in the past. Diets are based on the principles of
metabolism
and work by reducing the intake of calories (energy) to create a
negative energy balance (i.e. more energy is used than is consumed).
There are countless commercial diets available and you should try to
choose one that is suitable for you. The
crash or fad diets
published in magazines should generally be avoided, as they can be
dangerous to your health and tend not to produce good long term results.
You should try to choose diets that are
medically proven
or diets developed by dedicated weight loss services such as Weight
Watchers or Jenny Craig. Your doctor can help you choose a diet which is
safe, effective and suited to your needs. Below are some of the
different mechanisms used in diets for weight loss:
- Reducing fat, carbohydrate (especially those with a high glycaemic index),
protein or alcohol intake. Reducing alcohol intake is a very good way
to lose weight, as each gram of alcohol contains a large amount of
energy on top of your normal daily intake.
- Smaller portion sizes. You can try using a smaller plate size at each meal.
- Food restrictions at various times of the day. It can be helpful to
have a big breakfast and reduce the intake of energy rich foods later in
the day. This can help your metabolism and ensure that most of the
energy that you consume is burnt throughout the day.
- Combining different foods to reduce total energy intake. Some diets have set food regimes for weight loss.
- Diets centered on a single low-energy food.
Most diets produce some weight loss and are
successful in the
short-term. However, less than 10% of patients will maintain the weight loss in the long term. Once again it must be emphasised that
permanent changes
to eating habits are required. You must be careful whilst dieting to
ensure that you still receive all the essential proteins, vitamins and
trace elements. The best way to achieve this is by eating a well
balanced diet with a wide variety of nutritious foods. A successful
weight loss program may include cutting fats and sugars from your diet
while ensuring you eat lots of healthy foods such as wholegrain, fruits
and vegetables. Some diet programs may also require you to take vitamin
or mineral supplements.
Be careful when shopping for low fat foods or brands labeled as
‘diet’ in the supermarket. Many low fat foods can be high in sugar and
still contribute a lot to your daily energy or caloric intake. You
should learn how to read food labels carefully and aim to consume foods
that are low in saturated fat, sugars and, if appropriate, glycaemic
index.
Diets that teach you how to select and prepare healthy foods may be
more successful in the long term than restrictive diets with strict
daily eating regimes or pre-prepared meals.
Reduced energy diets encourage you to choose healthy meal
options, aiming to reduce your energy intake by a small amount every
day. They teach you healthy eating behaviours which you can maintain in
the long term.
Low energy diets are more restrictive and limit your energy
intake to a greater degree. Set meal programs need to be followed. This
type of diet can lead to a weight loss between 7-13 kilograms and may be
used if you have significant health problems related to obesity.
Very low energy diets cut daily energy intake significantly
and tend to be reserved for people who have failed other treatments or
who have significant
co-morbidities.
These types of diets are generally followed for 8-16 weeks and often
consist of liquid meal replacements (discussed below) from pharmacies.
Unfortunately much of the weight lost is regained after the diet is
stopped, but behavioural or drug therapies following treatment can help
maintain some of the weight loss.
Meal Replacement Programs
Recently weight loss programs have been developed that replace normal
meals with prepared meal plans or meal supplements (such as
vitamin-rich shakes, soups and bars). These supplements act as complete
meals, as they contain all the required vitamins and minerals.
Meal Replacement Programs operate on the principles of a low calorie diet and induce a mild state of
ketosis.
The diets limit your intake of carbohydrates so that the body starts to
break down fat stores for energy. The meal replacement programs are
specially formulated so that they contain adequate energy and do not
cause
malnutrition.
Physical activity for weight loss
In addition to reducing your energy intake,
increased physical activity
is essential for the maintenance of weight loss and should form part of
any weight loss program. However, to achieve significant weight loss
from exercise alone, a very high level of activity is required, which
can be challenging.
You should
gradually build up your exercise as your
personal fitness allows. You can start with simple measures such as
walking to nearby places rather than driving, or climbing the stairs
rather than using an elevator or escalator. Thirty minutes of walking
3-5 times per week is a good starting point.
If you are very overweight, some exercises (especially those that
require weight bearing) can be physically difficult. In this case you
could try activities such as swimming, walking in water or cycling. Once
your fitness levels improve you could change to other exercises in the
long term.
You should try to choose activities that you enjoy, as you will be
more likely to continue them in the long term. Participating in team
sports or exercising with a friend or family member can help you to
remain motivated. It may be useful to see a physiotherapist or exercise
physiologist to help you develop an appropriate
exercise program. Try to focus on overall lifestyle measures as they tend to produce greater
long term adherence.
Exercise has benefits beyond modest reductions in weight. Increasing
your physical activity can improve your cardio-respiratory fitness,
metabolic health, quality of life and general wellbeing. However,
strenuous exercise can be risky in some patients such as those with
cardiovascular problems. You should consult your doctor to discuss what level of physical activity will be safe for you.
Behavioural therapy for weight loss
Behavioural techniques may be useful in conjunction
with diet and exercise programs to improve long-term weight loss.
Behavioural treatment is usually performed by a psychologist who
analyses your eating, physical activity and thinking habits.
Cognitive behavioural therapy (CBT) is a classic example which encourages you to
change these
behaviours and
take responsibility
for your lifestyle changes. Other strategies may include stress
management, relapse prevention, counselling, and techniques such as
hypnosis and psychotherapy. However, some of these behavioural
techniques can be very time consuming and expensive.
Some basic steps may include:
- Self monitoring: Identifying and recording any adverse patterns of behaviour.
- Stimulus control: This involves removing factors
that encourage you to eat badly. For example, you should shop carefully
and remove trouble foods (such as chocolates and chips) from the house
so you cannot be tempted.
- Problem solving: Identifying and addressing
problems associated with eating and physical activity. You should
consider which factors have led to your excess weight and address them
appropriately.
- Reward systems: You could reward yourself for positive behaviours such as exercise by treating yourself to new clothes.
- Social support: Strong social support from your
friends and family can improve weight loss. It may be beneficial for you
to enrol in a commercial program which offers a social support network.
Other
Beyond the specific measures highlighted above, it is also important that you maintain an overall
balanced and
healthy lifestyle. You should avoid
stress,
depression, boredom and frustration as these can be triggers to unhealthy eating behaviours. Keeping yourself occupied with
enjoyable activities
such as sports or socializing with friends and family can help you
achieve a healthy lifestyle. If you eat excessively due to stress you
could consider enrolling in relaxation programs.
Source
References
1. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book]
2. Clinical practice guidelines for the management of overweight and
obesity in adults [online]. Canberra, ACT: Australian Government
Department of Health and Ageing; 18 September 2003 [cited 9 August
2007]. Available from: URL link
3. Proietto J, Baur L. Management of obesity.
Med J Aust. 2004;180(9):474-80. [
Abstract |
Full text]
4. Summary report – Acting on Australia’s weight: a strategic plan for
the prevention of overweight and obesity [online]. Canberra, ACT:
Australian Government National Health and Medical Research Council
(NHMRC); 2007 [cited 9 August 2007]. Available from:
URL link http://www.myvmc.com/treatments/lifestyle-changes-for-obesity-and-weight-loss/
