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Combination Approaches to Weight Management Part 3

Oct 19, 2004
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Encouraging regular physical activity is an essential element in the weight loss plan.[28] In addition to enhancing weight loss, physical activity may be a requirement for long-term maintenance of weight loss.[28,29] Everyone can find ways to increase his or her level of physical activity. Although commitment to physical activity enhances other elements of the lifestyle change, exercise alone is not an effective tool for promoting weight loss.[29]

Combination Approaches to Weight Management

 

James W. Anderson, MD, Director, Metabolic Research Group; Professor of Medicine and Clinical Nutrition, University of Kentucky; Director, HMR Weight Management Program, University of Kentucky; President, Obesity Research Network, Lexington, Kentucky

Integrating Lifestyle Components

Physical Activity

Encouraging regular physical activity is an essential element in the weight loss plan.[28] In addition to enhancing weight loss, physical activity may be a requirement for long-term maintenance of weight loss.[28,29] Everyone can find ways to increase his or her level of physical activity. Although commitment to physical activity enhances other elements of the lifestyle change, exercise alone is not an effective tool for promoting weight loss.[29]

We find pedometers to be useful adjuncts to weight loss.[18] Usually we encourage patients to obtain baseline assessments of daily steps or miles and increase this by about 50% initially. For people who do not wish to use pedometers, we encourage walking a specific number of minutes daily. I usually list 3 goals on a prescription pad that the patient and I have mutually developed: (1) a specific physical activity goal such as walking 20 minutes daily (or increasing pedometer steps by 50%) or doing 4 sets of upper-body exercises with weights twice daily; (2) specific nutrition goals (eg, 2 MR daily or diet soda instead of regular soda); and (3) a specific quantity of fruits and vegetables daily.

Behavioral Education

Instructing patients in diets and physical activity regimens has little impact unless they are empowered to make these important lifestyle changes. Behavior therapy for weight management teaches individuals the process of changing their eating, physical activity, and thinking habits.[19] Eating patterns are often interrupted by the use of MR and the removal of usual favorite and comfort foods. As patients are deconditioned to the intake of their usual foods, they can incorporate healthier, lower-energy foods as substitutes. This process of environmental control first is "subtractive," in that usual foods are removed, and later is "additive," in that healthier choices are brought into the environment.[30] Patients increase their physical activity because this is expected by their healthcare team, they learn new strategies for "doable" physical activity under their specific circumstances, and they keep daily records of physical activity.[30] Individuals learn these new habits through practice and incorporate healthier food choices and physical activity into their daily routines. People who learn new habits and practice them for at least 6 months have an excellent chance to maintain these new behaviors in the long term.

Conclusions

More than two thirds of patients in physicians’ offices are overweight or obese. These individuals provide a significant challenge because most are slowly gaining weight and seem unable to reverse this trend. With encouragement, direction, and regular visits, most of these individuals can begin losing weight and reducing their risk factors. Use of MR is the centerpiece of management for most successful patients. Adjunctive pharmacotherapy contributes to success for a small percentage of these patients. For patients who have BMI > 30 kg/m2 and do not quickly respond to the use of MR and coaching by the physician, referral to an intensive behavioral program using LED is the treatment of choice. These programs enable patients to lose > 20% of their initial body weight and maintain this weight loss long-term. Bariatric surgery should be reserved for individuals who have morbid obesity and are unable to achieve and maintain substantial weight loss with intensive behavioral intervention.

References

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To read part one of this series please click here.

To read part two of this series please click here.

James W. Anderson, MD, Director, Metabolic Research Group; Professor of Medicine and Clinical Nutrition, University of Kentucky; Director, HMR Weight Management Program, University of Kentucky; President, Obesity Research Network, Lexington, Kentucky

     
     
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