By Robert Lee, ND, MS, MA
If you have weight loss resistance, it is vital that you have and are utilizing the most proven weight management recommendations that are available. Not sure what is available? Take a look at the most proven (a.k.a. evidence-based guidelines) for weight loss and maintenance, and incorporate these strategies into your lifestyle if you are not already doing so. As everyone has different health issues, please see your primary care physician and other healthcare provider to determine whether the following strategies are appropriate for you and also to refer you for nutritional, behavioral, psychological and exercise professionals, as indicated.
This article is part of a series on evidence-based guidelines on weight management. It will focus on the strong, imperative strategies for weight loss and management, which are the most proven and globally applicable strategies available. Subsequent parts will focus on additional globally applicable strategies for weight management (such as one emphasizing exercise/activity levels, additional counseling and micronutrient specific strategies). However, the strategies summarized in future reports have not been substantiated by research sciences to the extent to which the strategies summarized in this segment have been. All the strategies being presented may complement what you are currently doing.
I. Medical Nutrition Therapy with a Registered Dietician Nutritionist (RDN) or other healthcare professional for overweight and obese individuals. If you are not sure if you are overweight or obese, you may use the Body-Mass Index (BMI) calculator on the following link: BMI Calculator. To achieve most effective weight loss, medical nutrition therapy should consist of at least 14-visits with a qualified healthcare professional over a period of at least 6-months.. Following weight loss, weight maintenance through medical nutrition therapy should be utilized and consist of monthly visits for 1-year with a qualified healthcare professional. These interventions result in both weight loss and weight maintenance, respectively, as well as reduced risk for diabetes, disorders of lipid metabolism and hypertension.
- A reduced calorie diet
- Increasing physical activity, and
- Use of behavioral therapies.
This combination approach is more successful than using any one intervention alone andcan lead to weight loss as well as improved glucose tolerance and other physiological factors for the reduction of cardiovascular disease.
III. Utilize Multiple Behavioral Therapies within the Comprehensive Weight Management Program. These behavioral therapies should include:
- Self-monitoring: Adults who need or desire to lose or maintain weight benefit from using self-monitoring of food intake (such as food diaries, online or smart phone based food entry and calculator programs). These self-monitoring programs improve nutrition-related outcomes related to weight loss and maintenance.
- Motivational support significantly enhances weight loss, as well as, adherence to programs and improvement in glycemic control, percentage of energy intake from fat, fruit and vegetable intake. Motivational support should come from the healthcare practitioner working with you, yourself personally, as well as from family members, friends, co-workers and the rest of the environment surrounding you (nutrition and exercise classes, nature, the gym, etc.).
- Portion control, structured meal plans and meal replacements. Strong evidence suggests a positive relationship between portion size and bodyweight, and various types of meal replacements products and structured meal plans are helpful in achieving health and food behavior change.
- Goal-setting: Your active participation in selecting and setting goals helps to target important and personally appropriate goals.
- Problem-solving strategies can result in improvements in key outcome measures including weight loss management in people with diabetes and improvements in fat consumption, self-efficacy and physical activity. For example, substituting fruits for pastries, consuming green tea instead of soda, preparing healthy meals with friends on the weekend and/or walking daily in the morning and/or right after dinner can be helpful strategies that encourage you to overcome problems at hand.
IV. Setting Realistic Weight Loss Goals. Such as ONE of the following:
- Up to two pounds per week
- Up to 10% of baseline body weight
- A total of 3-5% of baseline body weight, if you have hypertension, hyperlipidemia or hyperglycemia
These strategies report successful weight loss of one to two pounds per week and up to 10% of body weight over one year. Sustained weight loss of 3-5% of baseline body weight also result in clinically meaningful reductions in triglycerides, blood glucose, glycosylated hemoglobin (HbA1C), and the risk of developing type 2 diabetes. Greater amounts of weight loss also reduce blood pressure, improve LDL (“bad”) and HDL (“good”) cholesterol, and reduce the need for medications.
V. Utilize Community Resources such as local food sources, food assistance programs, support systems and recreational facilities. A moderate strong link exists between food environment and dietary intake. Ask qualified healthcare professionals to direct you to community resources and also search for these resources online, at local hospitals, through town/city and county resources, community centers, and ask friends, family and co-workers of any resources they can provide you.
VI. Assess Energy Intake and Nutrient Content of the Diet
Qualified healthcare professionals can assess your energy intake and diet. You can also estimate the energy and nutrient intake of the diet using free, online and smart phone based programs. The two resources most frequently used for these purposes are MyFitnessPal and NutritionData, although suitable alternative to these may be available.
VII. Achieve Nutrient Adequacy During Weight Loss
During weight loss, a qualified healthcare professional should prescribe for you an individualized diet, including your preference and health status, to achieve and maintain adequate nutrient adequacy and reduce caloric intake based on one of the following strategies:
- 1,200 Cal to 1,500 Calories per day for women and 1,500 to 1,800 Calories per day for men.
- Energy deficit of approximately 500 to 750 Calories per day
- A diet emphasizing high consumption of fruits and vegetables as well as restriction in high-carbohydrate, low-fiber, high-fat and fast foods, which are all proven to promote weight loss. Examples of these diets include Harvard’s Healthy Eating Plate, the Mediterranean Diet, the Anti-inflammatory Diet, as well as condition specific diets including DASH Diet for blood pressure reduction, TLC Diet for cholesterol reduction, and MIND Diet for Alzheimer’s disease prevention and cognitive health. Note: Dietary patterns emphasizing glycemic index and glycemic load of the diet have not been shown to specifically affect weight loss although they may be helpful for diabetes related health outcomes.
VIII. Maintain Nutrient Adequacy during Weight Maintenance
Following weight loss, calories of food consumed should generally match (and not be greater than 500 calories below) the amount of calories burned per day. A qualified healthcare professional should assess this. You can also estimate the amount of calories burned per day by adding the calories burned by the body’s resting (or basal) metabolic rate and the calories burned by activities (including exercise and routine movement like walking, shopping and cleaning). See these links to calculate your resting (basal) metabolic rate and calories burned from typical activities.
IX. Assess, Monitor and Evaluate Data of the Comprehensive Weight Management Program.
The following data should be assessed by a qualified healthcare professional to individualize and improve effectiveness of the Comprehensive Weight Management Program:
- Food and nutrition related history including but not limited to beliefs and attitudes including food preference and motivation, food environment including access to fruits and vegetables, dietary behaviors such as eating out and screen time (TV, computer, etc.), dietary experiences including food allergies and past dieting history, medication and supplements, as well as, physical activity.
- Physical measurements including height, weight, BMI, waist circumference, weight history, and body composition (if available).
- Biochemical data and medical tests including but not limited to glucose and endocrine profile and lipid panel.
- Nutrition-focused physical findings including ability to communicate, emotional patterns, amputations, appetite, blood pressure, body language and heart rate.
- Past medical history and/or related family and social history such as: appropriateness of weight management in certain populations (such as eating disorders, pregnancy, receiving chemotherapy), living and housing situation and socio-economic status.
Potential Benefits Of These Strategies
- Improving a person’s ability to achieve optimal nutrition through healthful food choices and a physically active lifestyle.
- Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT is essential for improved outcomes.
- MNT education can be considered cost-effective when considering the benefits of nutrition interventions on the onset and progression of comorbidities versus the cost of the intervention.
Overall Risk/Harm Considerations
When using these recommendations, have your physician and other healthcare provider consider the following general risks and harms:
- Your age, socio-economic status, cultural issues, psychosocial and mental health status, health history and other health conditions.
Assess how these recommendations may work with or against any other therapies you are currently receiving and/or the conditions that you currently have.
- Academy of Nutrition and Dietetics. Adult weight management evidence-based nutrition practice guideline. Chicago (IL): Academy of Nutrition and Dietetics; 2014. Available at http://www.guideline.gov/content.aspx?f=rss&id=48761&osrc=12 (accessed Mar 24, 2015).
About Robert E. Lee, MA, ND, MS
Dr. Lee is an intern at Yale-Griffin Prevention Research Center as well the owner and a primary care general practitioner at The Awakening Center in Connecticut. He is a board-certified and state licensed naturopathic physician that graduated with top of class marks in clinical rotations from the oldest accredited naturopathic medical school, National College of Natural Medicine in Portland, OR. Dr. Lee also holds two masters degrees focused on both the research sciences and arts of integrative medicine, and has worked in research since 2006 at various departments of Yale University’s School of Medicine and its affiliates, as well as Helfgott Research Institute, with support from National Institutes of Health grants and a number of additional funding sources.
Dr. Lee’s career focuses on helping people and the world through implementation, investigation and validation of integrative and naturopathic medicines, particularly mind-body medicines, spirituality, nutrition, exercise, manual therapies, herbal medicine and other lifestyle approaches. In addition to his training in naturopathic and integrative medicines, Dr. Lee has been practicing meditation since childhood, studying nutrition and exercise since adolescence, is a student and teacher of advanced forgiveness, mindfulness and spirituality based on A Course In Miracles and other traditions, and is also trained in cognitive behavioral therapy, transcendental meditation, kriya yoga and vipassana. Furthermore, Dr. Lee was a collegiate ice hockey player and is currently a Crossfit athlete.