Weight Loss Interventions

1. The Importance of Having a Healthy Weight

Achieving and maintaining a healthy weight includes healthy eating, physical activity, optimal sleep, stress reduction, as well as several other factors. Physical activity and nutrition habits can be a good place to start. Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. How much physical activity you need depends partly on whether you are trying to maintain weight or lose weight. Walking is often a good way to add more physical activity to your lifestyle.

key concept

As people age, body composition shifts so that the proportion of muscle decreases and the proportion of fat increases. This shift slows their metabolism, making it easier to gain weight. In addition, some people become less physically active as they get older, increasing the risk of weight gain.

By avoiding weight gain, you avoid higher risks of many chronic diseases, such as heart disease, stroke, type 2 diabetes, high blood pressure, osteoarthritis, and some forms of cancer. Even losing 5-10% of total body weight is likely to produce health benefits.

EXAMPLE

If you weigh 200 pounds, a 5 percent weight loss equals 10 pounds. While this weight may still be in the “overweight” or “obese” range, this weight loss can decrease risk factors for chronic diseases related to obesity.

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2. Achieving a Healthy Weight

In addition to healthy eating, consistent physical activity can reduce risks for many chronic diseases and help maintain your weight. Physical activity is an integral part of weight management and a vital part of general health. Self-monitoring by weighing yourself on a regular basis as well as tracking food and activity in a journal make it more likely that you’ll lose weight or maintain a healthy weight.

think about it

Self-monitoring is a great way to stay on top of your health. What are some ways that you self-monitor?

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3. Working With Healthcare Professionals for Weight Loss

If you have questions about weight loss programs or your personal goals, talk to your healthcare provider or a registered dietitian. Below are some things to think about before your visit.

• How can I change my eating habits so I can be healthier and reach a healthy weight?
• How much and what type of physical activity do I think I need to be healthier and reach a healthy weight?
• Could I benefit from seeing a nutrition professional or weight-loss specialist, or joining a weight-loss program?

key concept

To be prepared to talk about weight loss with your registered dietitian or other healthcare provider, write down your questions ahead of time, make a list of all medications and supplements you take, document other weight loss programs or diets you have tried in the past.

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4. Weight Loss Programs

If a healthcare professional says you should lose weight, you may want to ask for a referral to a registered dietitian. A registered dietitian can help you find a program that works for you. A successful weight-loss program should promote healthy behaviors that help you lose weight safely, that fits with your daily goals, and that you can sustain indefinitely.

IN CONTEXT

Safe and successful weight-loss programs should include:

• behavioral treatment, also called lifestyle counseling, that can teach you how to develop healthier eating and physical activity habits like keeping food and activity records or journals
• information about getting enough sleep, managing stress, and the benefits and drawbacks of weight-loss medicines
• ongoing feedback, monitoring, and support throughout the program, either in person, by phone, online, or through a combination of these approaches
• slow and steady weight-loss goals that are usually 1 to 2 pounds per week
• a plan for keeping the weight off, including goal setting, self-checks such as keeping a food journal, and counseling support

Although some commercial weight-loss programs may have these components, they may not help people keep the weight off long term. Fast weight loss programs have related health risks.

IN CONTEXT

Many weight-loss programs are offered partly or completely online and through apps for mobile devices. Experts suggest that these weight-loss programs should provide the following:

• organized, weekly lessons, offered online or by podcast, and tailored to your personal goals
• support from a registered dietitian to meet your goals
• a plan to track your progress on changing your lifestyle habits, such as healthy eating and physical activity, using tools such as cellphones, activity counters, and online journals
• regular feedback on your goals, progress, and results provided by a counselor through email, phone, or text messages
• the option of social support from a group through bulletin boards, chat rooms, or online meetings

Whether a program is online or in person, you should get as much background as you can before you decide to join.

hint

Avoid weight-loss programs that make any of the following promises:

• Lose weight without diet or exercise!
• Lose weight while eating as much as you want of all your favorite foods!
• Lose 30 pounds in 30 days!
• Lose weight in specific problem areas of your body!

Other warning signs to look out for include:

• very small print, asterisks, and footnotes, which may make it easy to miss important information
• before-and-after photos that seem too good to be true
• personal endorsements that may be made up

Regardless of the format, weight-loss program staff should be able to answer questions about the program’s features, safety, costs, and results. Here are some other things to consider:

Nutrition:

• Am I expected to follow a specific meal plan?
• Am I encouraged to write down what I eat each day?
• Do I have to buy special meals or supplements? If so, what are the daily or weekly costs?
• Does the program offer healthy meal-plan suggestions that I could stick with?
• If the program requires special foods, can I make changes based on my likes, dislikes, and any food allergies I may have?

Physical Activity:

• Does the program include a physical activity plan?
• Does the program offer ways to help me be more physically active and stay motivated?

Counseling:

• Does the program offer one-on-one or group counseling to help me develop and stick with my healthier habits?
• Does the program include a trained coach or counselor to help me overcome roadblocks and stay on track?

Weight Maintenance:

• Does the program include a plan to help me keep off the weight I’ve lost?
• What does that program include? Will there be ongoing counseling support?

Other Features:

• How long is the actual weight-loss program? How long is the weight-loss maintenance program?
• Does the program require that I take any kind of medicine? Could the program cause health problems or be harmful to me in any way?
• Can I speak with a doctor or certified health professional if I need to?
• Can I change the program to meet my lifestyle, work schedule, and cultural needs?
• Will the program help me cope with such issues as stress or social eating, getting enough sleep, changes in work schedules, lack of motivation, and injury or illness?
• Is the program in person? Is there an online part to the program?
• Does a doctor or other certified health professional run or oversee the program?
• Does the program include specialists in nutrition, physical activity, behavior change, and weight loss? What type of certifications, education, experience, and training do staff members have?
• What is the total cost of the program, from beginning to end?
• Are there costs that are not included in that total, such as membership fees or fees for weekly visits?

If a weight-loss program is not enough to help you reach a healthy weight, ask a healthcare professional about other types of weight-loss treatments.

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5. Weight Loss Surgery

For some people who have extreme obesity, weight loss (bariatric) surgery may be an option. Weight-loss surgery encompasses a group of operations that help you lose weight by making changes to the digestive system.

key concept

People who have bariatric surgery lose on average 15 to 35 percent of their starting weight, depending on the type of surgery they have. No diet or surgery can help produce and maintain weight loss for everyone. Some people regain a portion of the weight they lost and factors that affect weight regain may include a person’s weight before surgery, the type of operation, and behavioral changes in activity and nutrition.

Bariatric surgery can cost between $15,000 and $25,000 or even more, depending on what type of surgery and if there are complications. Medicare and some Medicaid programs may cover the major types of weight-loss surgery if you have a healthcare professional’s recommendation and you meet certain criteria. Most insurers require proof you were unable to lose weight by completing a nonsurgical weight-loss program.

In the United States, surgeons most often perform three types of operations:

• gastric sleeve
• gastric bypass
• adjustable gastric band

Surgeons less commonly use a fourth operation, biliopancreatic diversion with duodenal switch.

term to know

Weight-Loss Surgery

An operation that helps you lose weight by making changes to the digestive system.

5a. Gastric Sleeve

With the gastric sleeve, a surgeon removes most of the stomach, leaving only a banana-shaped section that is closed with staples. The surgery reduces the amount of food that can fit in the stomach. Taking out part of the stomach affects hormones and bacteria in the gastrointestinal tract that impact appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.

5b. Gastric Bypass

Gastric bypass surgery, also called Roux-en-Y gastric bypass, is done in three steps.

step by step

1. The surgeon staples the stomach, creating a small pouch in the upper section. The staples make the stomach much smaller, so you eat less because you feel full sooner.
2. The surgeon divides the small intestine into two parts and attaches the lower part directly to the small stomach pouch. Food will bypass most of the stomach and the upper part of the small intestine, so your body absorbs fewer calories.
3. The surgeon then reconnects the upper part of the small intestine to a new location farther down on the lower part of the small intestine. This allows digestive juices in the stomach to flow from the bypassed part of the small intestine to the lower part of the small intestine, so that food can be fully digested.

The bypass changes hormones, bacteria, and other substances in the gastrointestinal tract that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.

5c. Adjustable Gastric Band

In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of the stomach to create a small pouch. Like gastric sleeve and gastric bypass surgery, the gastric band makes you feel full after eating a small amount of food. The inner band has a circular balloon inside that is filled with saline. The surgeon can adjust the inner band to resize the opening from the pouch to the rest of your stomach by injecting or removing the saline solution through a small device, called a port, that is placed under your skin. After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping, the surgeon may remove it.

5d. Biliopancreatic Diversion with Duodenal Switch

This complicated and risky surgery involves two separate procedures. The first procedure is similar to gastric sleeve surgery. A second surgical procedure divides the small intestine into two tracts. Food moves through one tract, bypassing most of the small intestine. This reduces the number of calories and amount of nutrients absorbed. Digestive juices flow from the stomach through the other intestinal tract and mix with food as it enters the colon.

key concept

Everyone will experience different weight loss, side effects, and long-term benefits. Reaching your health goal depends on committing to healthy lifestyle habits.

REFERENCES

U.S. Department of Health and Human Services. (n.d.). Types of weight-loss surgery. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved June 10, 2022, from www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types

U.S. Department of Health and Human Services. (n.d.). Weight-loss (bariatric) surgery. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved June 10, 2022, from www.niddk.nih.gov/health-information/weight-management/bariatric-surgery

Centers for Disease Control and Prevention. (2021, March 19). External Resources. Centers for Disease Control and Prevention. Retrieved June 10, 2022, from www.cdc.gov/healthyweight/tools/index.html