Weight reduction can help reduce the complications of obesity, including T2D and hypertension.
WEIGHT REDUCTION
Weight reduction can
help reduce the complications of obesity, including T2D and hypertension. To
achieve weight reduction, the obese patient must decrease energy intake or
increase energy expenditure, although decreasing energy intake is thought to
contribute more to inducing weight loss. Typically, a prescription for weight
reduction combines dietary change; increased physical activity; and behavioral
modification, which can include nutritional education and meal planning,
recording and monitoring food intake through food diaries, modifying factors
that lead to overeating, and relearning cues to satiety. Once weight loss is
achieved, weight maintenance is a separate process that requires vigilance
because the majority of patients regain weight after they stop their weight
loss efforts.
An increase in physical
activity can create an energy deficit. Although adding exercise to a
hypocaloric regimen may not produce a greater weight loss initially, exercise
is a key component of programs directed at maintaining weight loss. In
addition, physical activity increases cardiopulmonary fitness and reduces the
risk of cardiovascular disease, independent of weight loss. Persons who combine
caloric restriction and exercise with behavioral treatment may expect to lose
about 5%–10% of initial body weight over a period of 4–6 months. Studies show
that individuals who maintain their exercise program regain less weight after
their initial weight loss.
Dieting is the most
commonly practiced approach to weight control. Because 1 pound of adipose
tissue corresponds to approximately 3,500 kcal, one can estimate the effect
that caloric restriction will have on the amount of adipose tissue. Weight loss
on calorie-restricted diets is determined primarily by energy intake and not
nutrient composition. [Note: Compositional aspects can, however, affect
glycemic control and the blood lipid profile.] Caloric restriction is
ineffective over the long term for many individuals. More than 90% of people
who attempt to lose weight regain the lost weight when dietary intervention is
suspended. Nonetheless, it is important to recognize that, although few
individuals will reach their ideal weight with treatment, weight losses of 10%
of body weight over a 6-month period often reduce blood pressure and lipid
levels and enhance control of T2D. The health benefits of even relatively small
weight losses should, therefore, be emphasized to the patient.
Several weight-loss
medications are currently approved by the U.S. Food and Drug Administration for
use in adults with a BMI of 30 or higher. Three approved for long-term use are:
1) orlistat (decreases absorption of dietary fat), 2) lorcaserin (promotes
satiety), and 3) a combination of phentermine (suppresses appetite) and
extended-release topiramate (controls seizures). [Note: Phentermine monotherapy
is approved for short-term use only.] Their effects on weight reduction tend to
be modest, and weight regain upon termination of drug therapy is common.
Gastric bypass and restriction surgeries are effective in causing weight loss in severely obese individuals. Through mechanisms that remain poorly understood, these operations greatly improve poor blood sugar control in morbidly obese diabetic individuals.
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