II. Management: Select appropriate target weight loss
- Body Mass Index (BMI) > 30: Current BMI - 2
- Body Mass Index (BMI) <= 30: Lose 10% of current weight
III. Management: Establish basic weight loss program
- Establish regular follow-up visits
- Schedule at least one session per month for 3 months (AAFP recommendations)
- Focus on intensive counseling and behavioral intervention
- Celebrate benefits beyond weight loss (e.g. increased energy, better fitting clothes, improved sleep)
- Simple interventions are effective with better compliance
- Higher fiber and more vegetables
- Stand more each day
- Practice Motivational Interviewing
- See Health Risk Motivational Counseling (e.g. Five Rs Technique)
- Express empathy
- Assess for patient motivation and confidence to achieve weight loss
- Juxtapose the risks and benefits of change
- Reinforce a patient's ideas and solutions to achieve weight loss
- Emphasize the positive aspects of weight loss (rather than the negative aspects of Obesity)
- Healthy eating and reduced Caloric Intake
- See Nutrition Guidelines
- Reduce Caloric Intake
- See Energy Deficit Calculation
- Typical deficit: 500 kcal/day
- Avoid very low calorie diets (>800 kcal/day) except under close observation
- Women: 1200-1500 kcal/day
- Men: 1500-1800 kcal/day
- Eat a minimum of 3 times daily (esp. eat breakfast daily)
- Stop Binge Eating at bedtime
- Limit high sugar foods and highly processed foods
- Drink non-sugar, non-Caffeine fluid >64 ounces/day
- Observe serving size and ingredients closely
- Super-sized meals dramatically increase calories
- One 8 ounce soda contains 15 teaspoons of sugar
- Write down everything you eat (one approach)
- Weight watchers
- Handheld log
- Balance Log
- Vivonic
- Calorie Chart
- Lose It!
- Use high bulk, low density foods
- Choose dietary management for the longterm
- Diets are equally effective in weight loss
- Dansinger (2005) JAMA 293:43-53 [PubMed]
- Increase Physical Activity
- See Exercise in Obesity
- Start with 10 minutes everyday and build
- Goals
- Overall activity (HHS) of 150-300 min/week moderate activity (or 75-150 min/week vigorous activity)
- Prevent Obesity (NIH) with 45-60 min/day moderate activity
- Prevent regaining weight (NIH) with 90 min/day moderate activity
- Stand more each day
- Exercise is key in a weight loss
- However Exercise without dietary change does not result in weight loss
- Wing (1999) Med Sci Sports Exerc 31:S547 [PubMed]
- Incorporate Lifestyle change strategies
- Consider changing from Medications Associated with Weight Gain
- Consider organized weight loss program
- Weight Watchers
- TOPS (Take Off Pounds Sensibly)
IV. Management: Modify weight loss program based on Obesity Risk
- Moderate Risk
- Basic weight loss program
- Consider low calorie diet
- High and very high risk
- Basic weight loss program
- Consider very low calorie diet
- Consider Obesity Medication
- Extremely high risk
- Basic weight loss program
- Consider very low calorie diet
- Consider Obesity Medication
- Consider Obesity Surgery (Bariatric Surgery)