Title: Tackling Weight Loss and Obesity

Subtitle: Weight Loss and its causes and remedies for Body Weight Issues or Obesity
Author: Sarah Astarii
Release Date: une !" #$%& '(Book )*##+#,
Language: (nglish
Contents
%- Social conditions . /auses of Weight Difficulty
#- Intentional Weight Loss
+- Thera0eutic 1eight loss techni2ues
&- loss industry
!- Anti3obesity medication
*- Anti3obesity Drugs . 4echanisms of Action
5- 6istory of Weight Loss Techni2ues
7- /ontem0orary anti3obesity drugs
8- Limitations of current kno1ledge 3 Weight Loss Drugs
%$- 9uture de:elo0ments
%%- Dieting
%#- 6istory of Dieting
%+- 9at loss :ersus muscle loss
%&- (nergy obtained from food
%!- ;ro0er nutrition
%*- 6o1 the body eliminates fat
%5- Weight loss grou0s
%7- 9ood diary
%8- 4edications
#$- Diuretics
#%- Stimulants
##- 9asting
#+- Lo1 carbohydrate :ersus lo1 fat
#&- Lo1 glycemic inde<
#!- Weight Loss (ffects of Water
#*- ;ossible a00etite reduction effect
#5- /oncomitant dietary changes
Weight Loss and Obesity
Subtitle: Weight Loss and its causes for Sufferers of Obesity or (ating
Distress
Weight loss, often known as slimming, in the context of medicine, health, or physical fitness is a
reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean
mass, namely bone mineral deposits, muscle, tendon, and other connective tissue. It can occur
unintentionally due to an underlying disease or can arise from a conscious effort to improve an actual
or perceived overweight or obese state.
Social conditions Causes Weight Difficulty
Social conditions such as 0o:erty" social isolation and inability to get or 0re0are 0referred foods can
cause unintentional 1eight loss" and this may be 0articularly common in older 0eo0le- =utrient intake
can also be affected by culture" family and belief systems- Ill3fitting dentures and other dental or oral
health 0roblems can also affect ade2uacy of nutrition-
Loss of ho0e" status or social contact and s0iritual distress can cause de0ression" 1hich may be
associated 1ith reduced nutrition" as can fatigue-
Intentional Weight Loss
Intentional 1eight loss refers to the loss of total body mass as a result of efforts to im0ro:e fitness and
health" and>or to change a00earance-
Weight loss in indi:iduals 1ho are o:er1eight or obese can reduce health risks" increase fitness" and
may delay the onset of diabetes- It could reduce 0ain and increase mo:ement in 0eo0le 1ith
osteoarthritis of the knee- Weight loss can lead to a reduction in hy0ertension ?high blood 0ressure@"
ho1e:er 1hether this reduces hy0ertension3related harm is unclear-
Weight loss occurs 1hen an indi:idual is in a state of negati:e thermodynamic flu<: 1hen the body is
e<0ending more energy ?i-e- in 1ork and metabolism@ than it is absorbing ?i-e-" from food or other
nutritional su00lements@" it 1ill use stored reser:es from fat or muscle" gradually leading to 1eight loss-
It is not uncommon for some 0eo0le 1ho are at their ideal body 1eight to seek additional 1eight loss in
order to im0ro:e athletic 0erformance or meet re2uired 1eight classification for 0artici0ation in a s0ort-
Others may be dri:en to lose 1eight to achie:e an a00earance they consider more attracti:e- Being
under1eight is associated 1ith health risks such as difficulty fighting off infection" osteo0orosis"
decreased muscle strength" trouble regulating body tem0erature and e:en increased risk of death-
According to the A-S- 9ood and Drug Administration ?9DA@" healthy indi:iduals seeking to maintain their
1eight should consume #"$$$ calories 0er day-
According to the Dietary Buidelines for Americans those 1ho achie:e and manage a healthy 1eight do
so most successfully by being careful to consume Cust enough calories to meet their needs" and being
0hysically acti:e-
Lo13calorie regimen diets are also referred to as balanced 0ercentage diets- Due to their minimal
detrimental effects" these ty0es of diets are most commonly recommended by nutritionists- In addition
to restricting calorie intake" a balanced diet also regulates macronutrient consum0tion- 9rom the total
number of allotted daily calories" it is recommended that !!D should come from carbohydrates" %!D
from 0rotein" and +$D from fats 1ith no more than %$D of total fat coming from saturated forms- 9or
instance" a recommended %"#$$ calorie diet 1ould su00ly about **$ calories from carbohydrates" %7$
from 0rotein" and +*$ from fat- Some studies suggest that increased consum0tion of 0rotein can hel0
ease hunger 0angs associated 1ith reduced caloric intake by increasing the feeling of satiety- /alorie
restriction in this 1ay has many long3term benefits- After reaching the desired body 1eight" the calories
consumed 0er day may be increased gradually" 1ithout e<ceeding #"$$$ net ?i-e- deri:ed by subtracting
calories burned by 0hysical acti:ity from calories consumed@- /ombined 1ith increased 0hysical acti:ity"
long3term lo13calorie diets are thought to be most effecti:e long term" unlike crash diets 1hich can
achie:e short term results" at best- ;hysical acti:ity could greatly enhance the efficiency of a diet- The
healthiest 1eight loss regimen" therefore" is one that consists of a balanced diet and moderate 0hysical
acti:ity-
Weight gain has been associated 1ith e<cessi:e consum0tion of fats" sugars" carbohydrates in general"
and alcohol- De0ression" stress or boredom may also contribute to 1eight increase" and in these cases"
indi:iduals are ad:ised to seek medical hel0- A #$%$ study found that dieters 1ho got a full nightEs slee0
lost more than t1ice as much fat as slee03de0ri:ed dieters- The maCority of dieters regain 1eight o:er
the long term-
Therapeutic weight loss techniques
The least intrusi:e 1eight loss methods" and those most often recommended" are adCustments to eating
0atterns and increased 0hysical acti:ity" generally in the form of e<ercise- The World 6ealth
OrganiFation recommended that 0eo0le combine a reduction of 0rocessed foods high in saturated fats"
sugar and salt and caloric content of the diet 1ith an increase in 0hysical acti:ity-
An increase in fiber intake is also recommended for regulating bo1el mo:ements-
Other methods of 1eight loss include use of drugs and su00lements that decrease a00etite" block fat
absor0tion" or reduce stomach :olume-
Bariatric surgery may be indicated in cases of se:ere obesity- T1o common bariatric surgical
0rocedures are gastric by0ass and gastric banding- Both can be effecti:e at limiting the intake of food
energy by reducing the siFe of the stomach" but as 1ith any surgical 0rocedure both come 1ith their
o1n risks that should be considered in consultation 1ith a 0hysician-
Dietary su00lements" though 1idely used" are not considered a healthy o0tion for 1eight loss- 4any are
a:ailable" but :ery fe1 are effecti:e in the long term-
Girtual gastric band uses hy0nosis to make the brain think the stomach is smaller than it really is and
hence lo1er the amount of food ingested- This brings as a conse2uence 1eight reduction- This method
is com0lemented 1ith 0sychological treatment for an<iety management and 1ith hy0no0edia- Research
has been conducted into the use of hy0nosis as a 1eight management alternati:e- In %88* a study
found that cogniti:e3beha:ioral thera0y ?/BT@ 1as more effecti:e for 1eight reduction if reinforced 1ith
hy0nosis- Acce0tance and /ommitment Thera0y A/T" a mindfulness a00roach to 1eight loss" has also
in the last fe1 years been demonstrating its usefulness-
Weight loss industry
There is a substantial market for 0roducts 1hich 0romise to make 1eight loss easier" 2uicker" chea0er"
more reliable" or less 0ainful- These include books" DGDs" /Ds" cremes" lotions" 0ills" rings and
earrings" body 1ra0s" body belts and other materials" fitness centres" 0ersonal coaches" 1eight loss
grou0s" and food 0roducts and su00lements-
In #$$7 bet1een ASH++ billion and H!! billion 1as s0ent annually in the AS on 1eight3loss 0roducts
and ser:ices" including medical 0rocedures and 0harmaceuticals" 1ith 1eight3loss centres taking
bet1een * and %# 0ercent of total annual e<0enditure- O:er H%-* billion a year 1as s0ent on 1eight3
loss su00lements- About 5$ 0ercent of AmericansE dieting attem0ts are of a self3hel0 nature- Although
often short3li:ed" these diet fads are a 0ositi:e trend for this sector as Americans ultimately turn to
0rofessionals to hel0 them meet their 1eight loss goals-
In Western (uro0e" sales of 1eight3loss 0roducts" e<cluding 0rescri0tion medications" to00ed I8$$
million ?H%-& billion@ in #$$8-
Anti-obesity edication or 1eight loss drugs are all 0harmacological agents that reduce or control
1eight- These drugs alter one of the fundamental 0rocesses of the human body" 1eight regulation" by
either altering a00etite" or absor0tion of calories- The main treatment modalities for o:er1eight and
obese indi:iduals remain dieting and 0hysical e<ercise-
Only one anti3obesity medications orlistat ?Jenical@ is currently a00ro:ed by the 9DA for long term use-
It reduces intestinal fat absor0tion by inhibiting 0ancreatic li0ase- Rimonabant ?Acom0lia@" a second
drug" 1orks :ia a s0ecific blockade of the endocannabinoidsystem- It has been de:elo0ed from the
kno1ledge that cannabis smokers often e<0erience hunger" 1hich is often referred to as Kthe
munchiesK- It had been a00ro:ed in (uro0e for the treatment of obesity but has not recei:ed a00ro:al in
the Anited States or /anada due to safety concerns- The (uro0ean 4edicines Agency in October #$$7
recommended the sus0ension of the sale of rimonabant as the risks seem to be greater than the
benefits- Sibutramine ?4eridia@" 1hich acts in the brain to inhibit deacti:ation of the neurotransmitters"
thereby decreasing a00etite 1as 1ithdra1n from the Anited States and /anadian markets in October
#$%$ due to cardio:ascular concerns-
Because of 0otential side effects" it is recommended that anti3obesity drugs only be 0rescribed for
obesity 1here it is ho0ed that the benefits of the treatment out1eigh its risks-
Anti-obesity edication
Anti3obesity medication or 1eight loss drugs are all 0harmacological agents that reduce or control
1eight- These drugs alter one of the fundamental 0rocesses of the human body" 1eight regulation" by
either altering a00etite" or absor0tion of calories- The main treatment modalities for o:er1eight and
obese indi:iduals remain dieting and 0hysical e<ercise-
Only one anti3obesity medications orlistat ?Jenical@ is currently a00ro:ed by the 9DA for long term use-
It reduces intestinal fat absor0tion by inhibiting 0ancreatic li0ase- Rimonabant ?Acom0lia@" a second
drug" 1orks :ia a s0ecific blockade of the endocannabinoidsystem- It has been de:elo0ed from the
kno1ledge that cannabis smokers often e<0erience hunger" 1hich is often referred to as Kthe
munchiesK- It had been a00ro:ed in (uro0e for the treatment of obesity but has not recei:ed a00ro:al in
the Anited States or /anada due to safety concerns- The (uro0ean 4edicines Agency in October #$$7
recommended the sus0ension of the sale of rimonabant as the risks seem to be greater than the
benefits- Sibutramine ?4eridia@" 1hich acts in the brain to inhibit deacti:ation of the neurotransmitters"
thereby decreasing a00etite 1as 1ithdra1n from the Anited States and /anadian markets in October
#$%$ due to cardio:ascular concerns-
Because of 0otential side effects" it is recommended that anti3obesity drugs only be 0rescribed for
obesity 1here it is ho0ed that the benefits of the treatment out1eigh its risks-
Anti-obesity drugs !echaniss of Action
/urrent and 0otential anti3obesity drugs may o0erate through one or more of the follo1ing mechanisms:
Su00ression of the a00etite- /atecholamines and their deri:ati:es ?such as 0hentermine and other
am0hetamine3based drugs@ are the main tools used for this" although other classes of drugs such as
anti3de0ressants and mood stabiliFers ha:e been anecdotally used for a00etite su00ression ?see:
bu0ro0ion and to0iramate@- Drugs blocking thecannabinoid rece0tors may be a future strategy for
a00etite su00ression-
Increase of the bodyEs metabolism-
Interference 1ith the bodyEs ability to absorb s0ecific nutrients in food- 9or e<am0le" Orlistat ?also
kno1n as Jenical and Alli@ blocks fat breakdo1n and thereby 0re:ents fat absor0tion- The OT/ fiber
su00lements glucomannan and guar gum ha:e been used for the 0ur0ose of inhibiting digestion and
lo1ering caloric absor0tion
Anorectics are 0rimarily intended to su00ress the a00etite" but most of the drugs in this class also act
as stimulants ?de<edrine" e-g-@" and 0atients ha:e abused drugs Koff labelK to su00ress a00etite ?e-g-
digo<in@-
"istory of Weight Loss Techniques
The first described attem0ts at 0roducing 1eight loss are those of Soranus of (0hesus" a Breek
0hysician" in the second century AD- 6e 0rescribed eli<irs of la<ati:es and 0urgati:es" as 1ell as heat"
massage" and e<ercise- This remained the mainstay of treatment for 1ell o:er a thousand years- It 1as
not until the %8#$s and %8+$s that ne1 treatments began to a00ear- Based on its effecti:eness for
hy0othyroidism" thyroid hormone became a 0o0ular treatment for obesity in euthyroid 0eo0le- It had a
modest effect but 0roduced the sym0toms of hy0erthyroidism as a side effect" such as 0al0itations and
difficulty slee0ing- #"&3Dinitro0henol ?D=;@ 1as introduced in %8++L this 1orked by uncou0ling the
biological 0rocess of o<idati:e 0hos0horylation in mitochondria" causing them to 0roduce heat instead
of AT;- The most significant side effect 1as a sensation of 1armth" fre2uently 1ith s1eating- O:erdose"
although rare" lead to a rise in body tem0erature and" ultimately" fatal hy0erthermia- By the end of %8+7
D=; had fallen out of use because the 9DA had become em0o1ered to 0ut 0ressure on
manufacturers" 1ho :oluntarily 1ithdre1 it from the market-
Am0hetamines ?marketed as BenFedrine@ became 0o0ular for 1eight loss during the late %8+$s- They
1orked 0rimarily by su00ressing a00etite" and had other beneficial effects such as increased alertness-
Ase of am0hetamines increased o:er the subse2uent decades" including Obetrol and culminating in the
Krainbo1 0illK regime- This 1as a combination of multi0le 0ills" all thought to hel0 1ith 1eight loss" taken
throughout the day- Ty0ical regimens included stimulants" such as am0hetamines" as 1ell as thyroid
hormone" diuretics"digitalis" la<ati:es" and often a barbiturate to su00ress the side effects of the
stimulants- In %8*5>%8*7 a number of deaths attributed to diet 0ills triggered a Senate in:estigation and
the gradual im0lementation of greater restrictions on the market- This culminating in %858 1ith the 9DA
banning the use of am0hetamines" then the most effecti:e of the diet drugs" in diet 0ills-
4ean1hile" 0hentermine had been 9DA a00ro:ed in %8!8 and fenfluramine in %85+- The t1o 1ere no
more 0o0ular than other drugs until in %88# a researcher re0orted that 1hen combined the t1o caused
a %$D 1eight loss 1hich 1as maintained for more than t1o years- Fen-phen 1as born and ra0idly
became the most commonly 0rescribed diet medication- De<fenfluramine ?Redu<@ 1as de:elo0ed in the
mid3%88$s as an alternati:e to fenfluramine 1ith less side3effects" and recei:ed regulatory a00ro:al in
%88*- 6o1e:er" this coincided 1ith mounting e:idence that the combination could cause :al:ular heart
disease in u0 to +$D of those 1ho had taken it" leading to 1ithdra1al of 9en30hen and de<fenfluramine
from the market in Se0tember %885-
(0hedra 1as remo:ed from the AS market in #$$& o:er concerns that it raises blood 0ressure and
could lead to strokes and death-
Conteporary anti-obesity drugs
Some 0atients find that diet and e<ercise is not a :iable o0tionL for these 0atients" anti3obesity drugs
can be a last resort- Some 0rescri0tion 1eight loss drugs are stimulants" 1hich are recommended only
for short3term use" and thus are of limited usefulness for e<tremely obese 0atients" 1ho may need to
reduce 1eight o:er months or years-
#rlistat
Orlistat ?Jenical@ reduces intestinal fat absor0tion by inhibiting 0ancreatic li0ase- Some side3effects of
using Orlistat include fre2uent" oily bo1el mo:ements ?steatorrhea@- But if fat in the diet is reduced"
sym0toms often im0ro:e- Originally a:ailable only by 0rescri0tion" it 1as a00ro:ed by the 9DA for o:er3
the3counter sale in 9ebruary #$$5- On #* 4ay #$%$" the A-S- 9ood and Drug Administration ?9DA@ has
a00ro:ed a re:ised label for Jenical to include ne1 safety information about cases of se:ere li:er inCury
that ha:e been re0orted rarely 1ith the use of this medication- Of the &$ million users of Orlistat
1orld1ide" %+ cases of se:ere li:er damage ha:e been re0orted-
Lorcaserin
Lorcaserin ?Bel:i2@ 1as a00ro:ed une #7" #$%# for obesity 1ith other co3morbidities- The a:erage
1eight loss by study 0artici0ants 1as modest" but the most common side effects of the drug are
considered benign-
An e<cer0t from the Bloom % Study conducted by Arena ;harmaceuticals and later submitted for 9DA
a00ro:al:
At the end of Mear % of the BLOO4 trial" using Intent3to3Treat 1ith Last Obser:ation /arried
9or1ard analysis ?ITT3LO/9@" the 0ro0ortion of 0atients achie:ing at least !D body 1eight
loss in the lorcaserin grou0 ?&5-!D@ 1as more than t1ice that achie:ed by the 0lacebo
grou0 ?#$-+D@- =early three times as many 0atients achie:ed at least %$D 1eight loss in
the lorcaserin grou0 ?##-*D@ than in the 0lacebo grou0 ?5-5D@- Lorcaserin 0atients 1ho
com0leted the first year of the trial according to the 0rotocol lost an a:erage of 7-#D of their
baseline 1eight" or a00ro<imately %7 0ounds" at the end of Mear % as com0ared to
a00ro<imately 5 0ounds in the 0lacebo grou0- In Mear #" 0atients 1ho continued to take
lorcaserin 1ere significantly better able to maintain their Mear % 1eight loss than those 1ho
1ere s1itched to 0lacebo-
In Mear %" lorcaserin caused significant decreases in 1aist circumference" B4I" glycemic
0arameters" high3sensiti:ity /3reacti:e 0rotein" and fibrinogen le:els com0ared to 0lacebo-
Total cholesterol" LDL cholesterol and triglyceride le:els at Mear % 1ere significantly lo1er in
the lorcaserin grou0 than in the 0lacebo grou0- Lorcaserin did not increase heart rate or
blood 0ressureL rather" heart rate" systolic blood 0ressure and diastolic blood 0ressure
decreased slightly but significantly 1ith lorcaserin treatment com0ared to 0lacebo- Nuality
of life" measured by the Im0act of Weight on Nuality of Life3Lite 2uestionnaire" im0ro:ed in
both treatment grou0s" 1ith a greater im0ro:ement in the lorcaserin grou0 than in the
0lacebo grou0-
At the end of Mear %" !!-&D of 0atients in the lorcaserin grou0 and &!-%D of 0atients in the
0lacebo grou0 remained enrolled in the study" and 5-%D and *-5D of 0atients" res0ecti:ely"
discontinued the study due to an ad:erse e:ent- Among the most fre2uent ad:erse e:ents
re0orted 1ith lorcaserin 1ere headache ?%7-$D :s- %%-$D" lorcaserin :s- 0lacebo@L
diFFiness ?7-#D :s- +-7D@L and nausea ?5-!D :s- !-&D@- The rates of serious ad:erse
e:ents 1ere similar in both treatment grou0s- The rates of de0ression and the incidence of
an<iety and suicidal thoughts 1ere lo1 in both treatment grou0s- Lorcaserin caused no
significant increase com0ared to 0lacebo in the incidence of ne1 cardiac :al:ulo0athy-
Sibutraine
Sibutramine ?Reductil or 4eridia@ is an anorectic or a00etite su00ressant" reducing the desire to eat-
Sibutramine may increase blood 0ressure and may cause dry mouth" consti0ation" headache" and
insomnia-
In the 0ast" it 1as noted by the AS that 4eridia 1as a harmless drug for fighting obesity- The AS District
/ourt of the =orthern District of Ohio reCected %%+ cases com0laining about the negati:e effects of the
drug" stating that the clients lacked su00orting facts and that the re0resentati:es in:ol:ed 1ere not
2ualified enough-
Sibutramine has been 1ithdra1n from the market in the Anited States" the AO" the (A" Australia"
/anada" 6ong Oong and /olombia- Its risks ?non3life3threatening myocardial infarction and stroke@ ha:e
been sho1n to out1eigh the benefits-
$ionabant
Rimonabant ?Acom0lia@ is a recently de:elo0ed anti3obesity medication- It is cannabinoid ?/B%@
rece0tor antagonist that acts centrally on the brain thus decreasing a00etite- It may also act 0eri0herally
by increasing thermogenesis and therefore increasing energy e<0enditure-
Weight loss 1ith Rimonabant ho1e:er has not been sho1n to be greater than other a:ailable 1eight3
loss medication- Due to safety concerns" 0rimarily 0sychiatric in nature" the drug has not recei:ed
a00ro:al in the Anited States or /anada" either as an anti3obesity treatment or as a smoking3cessation
drug-
Sanofi3A:entis has recei:ed a00ro:al to market Rimonabant as a 0rescri0tion anti3obesity drug in the
(uro0ean Anion" subCect to some restrictions- 6o1e:er" in October #$$7" the (uro0ean 4edicines
Agency ?(4(A@ recommended that Acom0lia no longer be a:ailable in AO- One month later" Sanofi3
A:entis decided it 1ould no longer study rimonabant for any indication-
!etforin
In 0eo0le 1ith Diabetes mellitus ty0e #" the drug metformin ?Bluco0hage@ can reduce 1eight- 4etformin
limits the amount of glucose that is 0roduced by the li:er as 1ell as increases muscle consum0tion of
glucose-
%&enatide
(<enatide ?Byetta@ is a long3acting analogue of the hormone BL;3%" 1hich the intestines secrete in
res0onse to the 0resence of food- Among other effects" BL;3% delays gastric em0tying and 0romotes a
feeling of satiety- Some obese 0eo0le are deficient in BL;3%" and dieting reduces BL;3% further- Byetta
is currently a:ailable as a treatment for Diabetes mellitus ty0e #- Some" but not all" 0atients find that
they lose substantial 1eight 1hen taking Byetta- Dra1backs of Byetta include that it must be inCected
subcutaneously t1ice daily" and that it causes se:ere nausea in some 0atients" es0ecially 1hen thera0y
is initiated- Byetta is recommended only for 0atients 1ith Ty0e # Diabetes- A some1hat similar drug"
Symlin" is currently a:ailable for treating diabetes and is in testing for treating obesity in non3diabetics-
'ralintide
;ramlintide ?Symlin@ is a synthetic analogue of the hormone Amylin" 1hich in normal 0eo0le is secreted
by the 0ancreas in res0onse to eating- Among other effects" Amylin delays gastric em0tying and
0romotes a feeling of satiety- 4any diabetics are deficient in Amylin- /urrently" Symlin is only a00ro:ed
to be used along 1ith insulin by Ty0e % and Ty0e # diabetics- 6o1e:er" Symlin is currently being tested
in non3diabetics as a treatment for obesity- A dra1back is that Symlin must be inCected at mealtimes-
#ther drugs
Other 1eight loss drugs ha:e also been associated 1ith medical com0lications" such as fatal 0ulmonary
hy0ertension and heart :al:e damage due to Redu< and 9en30hen" and hemorrhagic stroke due
0henyl0ro0anolamine- 4any of these substances are related to am0hetamine-
Anresearched non0rescri0tion 0roducts or 0rograms for 1eight loss are hea:ily 0romoted by mail and
0rint ad:ertising and on the internet- The AS 9ood and Drug Administrationrecommends caution 1ith
use of these 0roducts" since many of the claims of safety and effecti:eness are unsubstantiated-
Indi:iduals 1ith anore<ia ner:osa and some athletes try to control body 1eight 1ith la<ati:es" diet 0ills
or diuretic drugs" although these generally ha:e no im0act on body fat- ;roducts that 1ork as a la<ati:e
can cause the bloodEs 0otassium le:el to dro0" 1hich may cause heart and>or muscle 0roblems-
;yru:ate is a 0o0ular 0roduct that may result in a small amount of 1eight loss- 6o1e:er" 0yru:ate"
1hich is found in red a00les" cheese" and red 1ine" has not been thoroughly studied and its 1eight loss
0otential has not been scientifically established-
'henterine(topiraate
The combination of 0hentermine and to0iramate" brand name Nsymia ?formerly Nne<a@ 1as a00ro:ed
by the A-S- 9DA on uly %5" #$%#" as an obestity treatment com0lementary to a diet and e<ercise
regimen-
Alternati:e medicine
Some su00lements and alternati:e medicine ha:e insufficient e:idence to su00ort or o00ose their use-
Side effects
Some anti3obesity drugs can ha:e se:ere" e:en" lethal side effects" fen30hen being a famous e<am0le-
9en30hen 1as re0orted through the 9DA to cause abnormal echocardiograms" heart :al:e 0roblems"
and rare :al:ular diseases- One of" if not the first" to sound alarms 1as Sir Arthur 4ac=alty" /hief
4edical Officer ?Anited Oingdom@- As early as the %8+$s" he 1arned against the use of dinitro0henol as
an anti3obesity medication and the inCudicious and>or medically unsu0er:ised use of thyroid hormone to
achie:e 1eight reduction- The side effects are often associated 1ith the medicationEs mechanism of
action- In general" stimulants carry a risk of high blood 0ressure" faster heart rate" 0al0itations" closed3
angle glaucoma" drug addiction" restlessness" agitation" and insomnia-
Another drug" orlistat" blocks absor0tion of dietary fats" and as a result may cause oily s0otting bo1el
mo:ements ?steatorrhea@" oily stools" stomach 0ain" and flatulence- A similar medication designed for
0atients 1ith Ty0e # diabetes is AcarboseL 1hich 0artially blocks absor0tion of carbohydrates in the
small intestine" and 0roduces similar side effects including stomach 0ain and flatulence-
Liitations of current )nowledge - Weight Loss Drugs
The limitation of drugs for obesity is that 1e do not fully understand the neural basis of a00etite and
ho1 to modulate it- A00etite is clearly a :ery im0ortant instinct to 0romote sur:i:al- Arguably any drug
that 1ould abolish a00etite may carry a high mortality risk and may be unsuitable for clinical use-
Because the human body uses :arious chemicals and hormones to 0rotect its stores of fat ?a reaction
0robably useful to our ancestors 1hen food 1as scarce in the 0ast"@ there has not yet been found a
Esil:er bulletE" or a 1ay to com0letely circum:ent this natural habit of 0rotecting e<cess food stores-
Because of this" anti3obesity drugs are not a 0ractical long3term solution for 0eo0le 1ho are o:er1eight-
In order to circum:ent the number of feedback mechanisms that 0re:ent most monothera0ies from
0roducing sustained large amounts of 1eight loss" it has been hy0othesiFed that combinations of drugs
may be more effecti:e by targeting multi0le 0ath1ays and 0ossibly inhibiting feedback 0ath1ays that
1ork to cause a 0lateau in 1eight loss- This 1as e:idenced by the success of the combination of
0hentermine and fenfluramine or de<fenfluramine" 0o0ularly referred to 0hen3fen" in 0roducing
significant 1eight loss but fenfluramine and de<fenfluramine 1ere 0ulled from the market due to safety
fears regarding a 0otential link to heart :al:e damage- The damage 1as found to be a result of acti:ity
of fenfluramine and de<fenfluramine at the !36T#B serotonin rece0tor in heart :al:es- =e1er
combinations of SSRIs and 0hentermine" kno1n as 0hen0ro" ha:e been used 1ith e2ual efficiency as
fen0hen 1ith no kno1n heart :al:e damage due to lack of acti:ity at this 0articular serotonin rece0tor
due to SSRIs- There has been a recent resurgence in combination thera0y clinical de:elo0ment 1ith
the de:elo0ment of + combinations: Nsymia ?to0iramate P 0hentermine@" (m0atic ?bu0ro0ion P
Fonisamide@ and /ontra:e?bu0ro0ion P naltre<one@-
*uture de+elopents
Other classes of drugs in de:elo0ment include li0ase inhibitors" similar to orlistat- Another li0ase
inhibitor" called BT +783#!!" is being de:elo0ed by ;e0timmune ?licensed from BenFyme@- This is a
no:el combination of an inhibitor and a 0olymer designed to bind the undigested triglycerides therefore
allo1ing increased fat e<0ulsion 1ithout side effects such as oily stools that occur 1ith orlistat- The
de:elo0ment seems to be stalled as ;hase % trials 1ere conducted in #$$& and there has been no
further human clinical de:elo0ment since then- In #$%%" ;e0timmune filed for /ha0ter 5 Li2uidation-
Another 0otential long3term a00roach to anti3obesity medication is through the de:elo0ment of
ribonucleic acid interference ?R=Ai@- Animal studies ha:e illustrated that the deletion of the RI;%&$
gene in mice by genetic knockdo1n results in the lack of fat accumulation" e:en 1hen mice are fed a
high fat diet- (<0eriments conducted by ;rofessor 4alcolm ;arker of Im0erial /ollege sho1 that by
silencing RI; %&$" a nuclear hormone co3re0ressor 1hich regulates fat accumulation" animal models
e<hibit a lean 0rofile throughout their life" are resistant to diet3induced obesity" and sho1 an enhanced
metabolic rate- /ytR< /or0oration is de:elo0ing R=Ai thera0eutics against this drug target for the
treatment of obesity and ty0e # diabetes- Similarly" another nuclear hormone rece0tor co3re0ressor"
S4RT" has demonstrated an o00osing effect in genetically engineered mice- Dr- Russell =ofsinger and
Dr- Ronald (:ans of the Salk Institute sho1ed that disru0tion of the molecular interaction bet1een
S4RT and their nuclear hormone rece0tor 0artners leads to increased adi0osity and a decreased
metabolic rate- These studies suggest that ne1 drugs targeting the molecular interaction bet1een
nuclear hormone rece0tors and their regulatory cofactors could 0ro:ide a useful ne1 category of
thera0eutic targets to be de:elo0ed in an effort to control obesity-
Another a00roach is to induce a sense of satiety by occu0ying s0ace in the gastric and intestinal
ca:ities- One clinical trial in:ol:es a hydrogel made of indigestible" food3grade materials- Another 0ilot
study uses 0seudobeFoars- Other drugs in clinical trials as of October #$$8 include /etilistat and
T4+77+5-
Dieting
Dieting is the 0ractice of eating food in a regulated fashion to decrease" maintain" or increase body
1eight- Dieting is often used in combination 1ith 0hysical e<ercise to lose 1eight in those 1ho are
o:er1eight or obese- Some 0eo0le" ho1e:er" follo1 a diet to gain 1eight ?usually in the form of
muscle@- Diets can also be used to maintain a stable body 1eight-
Diets to 0romote 1eight loss are generally di:ided into four categories: lo13fat" lo13carbohydrate" lo13
calorie" and :ery lo1 calorie- A meta3analysis of si< randomiFed controlled trials found no difference
bet1een the main diet ty0es ?lo1 calorie" lo1 carbohydrate" and lo1 fat@" 1ith a #.& kilogram 1eight
loss in all studies- At t1o years" all calorie3reduced diet ty0es cause e2ual 1eight loss irres0ecti:e of
the macronutrients em0hasiFed-
Some long3term studies of dieting indicate the maCority of indi:iduals 1ho ha:e dieted regain :irtually all
of the 1eight that 1as lost after dieting" regardless of 1hether they maintain their diet or e<ercise
0rogram and that after t1o years of dieting" u0 to t1o3thirds of dieters 1ere e:en hea:ier than they are
0rior to beginning their regimen- A study 0ublished in the A;AEs Cournal American ;sychologist found
diets Edo not lead to sustained 1eight loss or health benefits for the maCority of 0eo0le-E 6o1e:er" other
studies ha:e found that the a:erage indi:idual maintains some 1eight loss after dieting- Weight loss by
dieting" 1hile of benefit to those classified as unhealthy" may slightly increase the mortality rate for
indi:iduals 1ho are other1ise healthy-
The first 0o0ular diet 1as KBantingK" named after William Banting- In his %7*+ 0am0hlet" Letter on
orpulence, !ddressed to the "ublic" he outlined the details of a 0articular lo13carbohydrate" lo13
calorie diet that had led to his o1n dramatic 1eight loss-
"istory of Dieting
One of the first dietitians 1as the (nglish doctor Beorge /heyne- 6e himself 1as tremendously
o:er1eight and 1ould constantly eat large 2uantities of rich food and drink- 6e began a meatless diet"
taking only milk and :egetables" and soon regained his health- 6e began 0ublicly recommending his
diet for e:eryone suffering from obesity- In %5#&" he 1rote !n #ssay of $ealth and Long Life" in 1hich
he ad:ises e<ercise and fresh air and a:oiding lu<ury foods-
The Scottish military surgeon" ohn Rollo" 0ublished %otes of a &iabetic ase in %585- It described the
benefits of a meat diet for those suffering from diabetes" basing this recommendation on 4atthe1
DobsonEs disco:ery of glycosuria in diabetes mellitus- By means of DobsonEs testing 0rocedure ?for
glucose in the urine@ Rollo 1orked out a diet that had success for 1hat is no1 called ty0e # diabetes-
The first 0o0ular diet 1as KBantingK" named after the (nglish undertaker William Banting- In %7*+" he
1rote a booklet called Letter on orpulence, !ddressed to the "ublic" 1hich contained the 0articular
0lan for the diet he had successfully follo1ed- 6is o1n diet 1as four meals 0er day" consisting of meat"
greens" fruits" and dry 1ine- The em0hasis 1as on a:oiding sugar" saccharine matter" starch" beer" milk
and butter- BantingQs 0am0hlet 1as 0o0ular for years to come" and 1ould be used as a model for
modern diets- The 0am0hletEs 0o0ularity 1as such that the 2uestion KDo you bantRK referred to his
method" and e:entually to dieting in general- 6is booklet remains in 0rint as of #$$5-
The Atkins Diet 1as suggested by the American nutritionist Robert Atkins in %8!7" in a research 0a0er
titled KWeight ReductionK- Atkins used the study to resol:e his o1n o:er1eight condition and 1ent on to
0o0ulariFe the method in a series of books" starting 1ith &r. !tkins' &iet (evolution in %85#- In his
second book" &r. !tkins' %ew &iet (evolution ?#$$#@" he modified 0arts of the diet but did not alter the
original conce0ts-
Ty0es of diets
Low-fat diets
Lo13fat diets in:ol:e the reduction of the 0ercentage of fat in oneEs diet- /alorie consum0tion is reduced
because less fat is consumed- Diets of this ty0e include =/(; Ste0 I and II- A meta3analysis of %* trials
of #.%# monthsE duration found that lo13fat diets ?1ithout intentional restriction of caloric intake@
resulted in a:erage 1eight loss of +-# kg ?5-% lb@ o:er habitual eating-
Low-carbohydrate diets
Lo1 carbohydrate diets such as Atkins and ;rotein ;o1er are relati:ely high in 0rotein and fats- Lo13
carbohydrate diets are sometimes ketogenic ?i-e- they restrict carbohydrate intake sufficiently to cause
ketosis@-
Low-calorie diets
Lo13calorie diets usually 0roduce an energy deficit of !$$.%"$$$ calories 0er day" 1hich can result in a
$-! kilogram ?%-% lb@ to % kilogram ?#-# lb@ 1eight loss 0er 1eek- Some of the most commonly used lo13
calorie diets include DAS6 diet and Weight Watchers- The =ational Institutes of 6ealth re:ie1ed +&
randomiFed controlled trials to determine the effecti:eness of lo13calorie diets- They found that these
diets lo1ered total body mass by 7D in the short term" o:er +.%# months-
,ery low-calorie diets
Gery lo1 calorie diets 0ro:ide #$$.7$$ calories 0er day" maintaining 0rotein intake but limiting calories
from both fat and carbohydrates- They subCect the body to star:ation and 0roduce an a:erage 1eekly
1eight loss of %-!.#-! kilograms ?+-+.!-! lb@- K#3&3*37K" a 0o0ular diet of this :ariety" follo1s a four3day
cycle in 1hich only #$$ calories are consumed the first day" &$$ the second day" *$$ the third day" 7$$
the fourth day" and then totally fasting" after 1hich the cycle re0eats- These diets are not recommended
for general use as they are associated 1ith ad:erse side effects such as loss of lean muscle mass"
increased risks of gout" and electrolyte imbalances- ;eo0le attem0ting these diets must be monitored
closely by a 0hysician to 0re:ent com0lications-
Deto& diets
Deto< diets claim to eliminate undesirable Kto<insK from the human body rather than claiming to cause
1eight loss- 4any of these use herbs" homeo0athic remedies" or celery and other Cuicy lo13calorie
:egetables-
$eligious diets
Religious scri0ture may be a factor in moti:ating 0eo0le to a ado0t a s0ecific diet- 9or e<am0le" the
Biblical Book of Daniel ?%:#3#$" and %$:#3+@ refers to a %$ or #% day a:oidance of foods ?Daniel 9ast@
declared unclean by Bod in the la1s of 4oses- In modern :ersions of the Daniel 9ast" food choices
may be limited to 1hole grains" fruits" :egetables" 0ulses" nuts" seeds and oil- The Daniel 9ast
resembles the :egan diet in that it e<cludes ?fasts from@ the consum0tion of foods of animal origin- The
0assages strongly suggest that the Daniel 9ast 1ill 0romote good health and mental 0erformance-
*at loss +ersus uscle loss
Weight loss ty0ically in:ol:es the loss of fat" 1ater and muscle- O:er1eight 0eo0le" or 0eo0le suffering
from obesity" ty0ically aim to reduce the 0ercentage of body fat- Additionally" as muscle tissue is denser
than fat" fat loss results in increased loss of body :olume com0ared 1ith muscle loss- Reducing e:en
%$D body fat can therefore ha:e a dramatic effect on a 0ersonEs body sha0e- To determine the
0ro0ortion of 1eight loss that is due to decreased fat tissue" :arious methods of measuring body fat
0ercentage ha:e been de:elo0ed-
4uscle loss during 1eight loss can be restricted by regularly lifting 1eights ?or doing 0ush3u0s and
other strength3oriented calisthenics@ and by maintaining sufficient 0rotein intake- Those on lo13
carbohydrate diets" and those doing 0articularly strenuous e<ercise" may 1ish to increase their 0rotein
intake- According to the =ational Academy of Sciences" the Dietary Reference Intake for 0rotein is $-7
grams 0er kilogram of body 1eight for adults- (ndurance athletes" such as those 1ho com0ete in
distance running or cycling re2uire many more calories in order to maintain 1eight- Due to the large
caloric intake these athletes must consume it can be 0articularly tricky to ensure they obtain thenutrition
re2uired to maintain muscle mass-
(<cessi:e 0rotein intake" though not connected to declined kidney functioning in healthy indi:iduals"
may be harmful to those 1ith certain kidney diseases- There is no conclusi:e e:idence that moderately
high 0rotein diets in healthy indi:iduals are dangerousL it has only been sho1n that these diets are
dangerous in indi:iduals already suffering from kidney and li:er 0roblems-
The Basal 4etabolic Rate" 1hich is the amount of calories the body e<0ends at rest" meaning 1ithout
0erforming any 0hysical acti:ity" is influenced by the 0ersonEs total 1eightand total amount of muscle-
The more muscle" the more calories a 0erson can burn naturally- When the amount of muscle is
increased" then more calories can be ingested 1ithout gaining 1eight- /on:ersely" if the amount of fat
is increased" increasing the number of calories ingested 1ill only add 1eight-
=ormally" 1hen 0eo0le lose 1eight" they lose a combination of fat and muscle- If the diet 0lan includes
a daily caloric intake greater than the basal metabolic rate ?B4R@" the 0erson 1ill most likely lose fat- In
contrast" if the 0erson follo1s a diet that includes a lo1er caloric intake than the B4R" this 0erson 1ill
lose fat but also a higher 0ercentage of muscle- Se:ere diets may make 0eo0le lose !$D fat and !$D
muscle 1eight thus affecting their metabolism because by losing muscle the B4R is affected-
4aintaining muscle mass 1hile losing fat is therefore a key factor to reach both the ideal 1eight and
body com0osition-
%nergy obtained fro food
The energy intake from food is limited by the efficiency of digestion and the efficiency of utiliFation- The
efficiency of digestion is largely de0endent on the ty0e of food being eaten" 1hile efficiency of utiliFation
is affected by a :ariety of factors" including age" gender" body 1eight" hormone le:els" and many more-
/he1ing" es0ecially in the elderly" has been sho1n to increase the intake of micronutrients- 6o1e:er"
the effect of che1ing on the intake of macronutrients" such as sugars" fats" and 0roteins has not been
obser:ed-
'roper nutrition
9ood 0ro:ides nutrients from si< broad classes: 0roteins" fats" carbohydrates" :itamins" dietary
minerals" and 1ater- /arbohydrates are metaboliFed to 0ro:ide energy- ;roteins 0ro:ide amino acids"
1hich are re2uired for cell construction" es0ecially for the construction of muscle cells- (ssential fatty
acids are re2uired for brain and cell membrane construction- Gitamins and trace minerals hel0s to kee0
good electrolyte balance and are used for metabolic 0rocesses- Dietary fiber also affects oneEs health"
although itEs not digested into the body-
The =ational Academy of Sciences and the World 6ealth OrganiFation 0ublish guidelines for dietary
intakes of all kno1n essential nutrients-
Sometimes dieters 1ill ingest e<cessi:e amounts of :itamin and mineral su00lements- While this is
usually harmless" some nutrients are dangerous- 4en ?and 1omen 1ho donEt menstruate@ need to be
1ary of iron 0oisoning- Retinol ?oil3soluble :itamin A@ is to<ic in large doses- Gitamin ( su00lements
ha:e been found in some studies to increase mortality" congenital heart defects in offs0ring and an
increased risk of stroke ?see the corres0onding article@- 4ost 0eo0le can obtain their nutritional needs
from their diet- In any e:ent" a multi:itamin taken once a day 1ill suffice for the maCority of the
0o0ulation-
Weight loss diets that mani0ulate the 0ro0ortion of macronutrients ?lo13fat" lo13carbohydrate" etc-@ ha:e
not been sho1n to be any more effecti:e than diets that maintain a ty0ical mi< of foods 1ith smaller
0ortions and 0erha0s some substitutions ?e-g- lo13fat milk" or less salad dressing@- (<treme diets may"
in some cases" lead to malnutrition-
Besides the im0ortance of eating a balanced diet that includes all the necessary nutrients" other factors
also contribute to healthy nutrition- As 1ell" drinking sufficient amounts of 1ater is often claimed to hel0
eliminate to<ins and fat- 6ea:ily 0rocessed and fried foods as 1ell as s1eets" Cunk foods" and alcohol
should also be a:oided in a healthy diet-
Also a to0ic of great im0ortance discussed among nutritionists as 1ell as 0sychologists is the attitude to
1eight3loss and the consum0tion of food in general- Goicing ideas such as KitEs Cust one burgerK during
and after 1eight loss regimes is discouraged" and often is said on the 0art of an insecure indi:idual 1ho
has reached the unfortunate conclusion that nothing can be done any longer and that any effort to do
so is futile- The ad:ice gi:en is" a:oid reaching such a conclusion" as not only does it change oneEs
0erce0tion of the effect of e<cessi:e amounts of food on the body" but also encourages a ElacklustreE
lifestyle and a00roach to life as a 1hole-
=utritionists also agree on the im0ortance of a:oiding fats" es0ecially saturated fats" to reduce 1eight
and to be healthier- They also agree on the im0ortance of reducing salt intake because commercial
foods such as snacks" biscuits" and bread" among others" already contain salt" thus contributing to an
e<cess of salt daily intake-
4y;yramid 9ood Buidance System is the result of e<tensi:e research 0erformed by the Anited States
De0artment of Agriculture to re:ise the original 9ood Buide ;yramid- It offers a 1ide array of
0ersonaliFed o0tions to hel0 indi:iduals make healthy food choices- It also 0ro:ides ad:ice on 0hysical
acti:ity-
"ow the body eliinates fat
All body 0rocesses re2uire energy in order to function 0ro0erly- When the body is e<0ending more
energy than it is consuming ?e-g- 1hen e<ercising@" the bodyEs cells rely on internally stored energy
sources" such as com0le< carbohydrates and fats" for energy- The first source to 1hich the body turns
is glycogen ?by glycogenolysis@- Blycogen is a com0le< carbohydrate" *!D of 1hich is stored in skeletal
muscles and the remainderL in the li:er ?totaling about #"$$$ kcal in the 1hole body@- It is created from
the e<cess of ingested macronutrients" mainly carbohydrates- When glycogen is nearly de0leted" the
body begins li0olysis" the mobiliFation and catabolism of fat stores for energy- In this 0rocess" fatsL
obtained from adi0ose tissue" or fat cells" are broken do1n into glycerol and fatty acids" 1hich can be
used to generate energy- The 0rimary by30roducts of metabolism are carbon dio<ide and 1aterL carbon
dio<ide is e<0elled through the res0iratory system-
9ats are also secreted by the sebaceous glands ?in the skin@-
Weight loss groups
Some 1eight loss grou0s aim to make money" others 1ork as charities- The former include Weight
Watchers and ;eertrainer- The latter include" O:ereaters Anonymous" as 1ell as se:eral grou0s run by
local churches" hos0itals" and like3minded indi:iduals-
These organiFationsE customs and 0ractices differ 1idely- Some grou0s are modelled on t1el:e3ste0
0rograms" 1hile others are 2uite informal- Some grou0s ad:ocate certain 0re0ared foods or s0ecial
menus" 1hile others train dieters to make healthy choices from restaurant menus and 1hile grocery3
sho00ing and cooking-
*ood diary
A #$$7 study 0ublished in the American ournal of ;re:enti:e 4edicine sho1ed that dieters 1ho ke0t a
daily food diary ?or diet Cournal@" lost t1ice as much 1eight as those 1ho did not kee0 a food log"
suggesting that if you 1rite your food do1n" you 1ouldnEt eat as many calories- Accordingly" diet Cournal
soft1are and 1ebsites ha:e gained significant 0o0ularity" and hel0 0eo0le track calorie consum0tion"
calorie burning" 1eight loss goals" and nutritional balance-
!edications
/ertain medications can be 0rescribed to assist in 1eight loss- The most recent 0rescri0tion 1eight loss
medication released is Acom0lia ?generic name Rimonabant@" manufactured by Sanofi A:entis- Ased to
treat obesity in 0ersons 1ith a B4I ?body mass inde<@ of +$ or abo:e" as 1ell as for smoking cessation
treatments" Acom0lia is still 0ending 9DA a00ro:al for use in the Anited States- Other 1eight loss
medications" like am0hetamine" are addicti:e and conse2uently are no1 banned in the AS for casual
1eight loss- Some su00lements" including those containing :itamins and minerals" may not be effecti:e
for 1eight loss-
Diuretics
Diuretics induce 1eight loss through the e<cretion of 1ater- Diuretics" 1hich can be used in the forms of
medications" su00lements" or herbs" reduce o:erall body 1eight" but ha:e no effect on an indi:idualEs
total body fat content- Diuretics can thicken the blood" cause cram0ing" kidney and li:er damage- In a
single re0ort" the death of ac2ueline 6enson 1as found to be related to s1elling in her brain" 1hich
1as associated 1ith e<cessi:e 1ater consum0tion o:er a short 0eriod of time" 1hile she 1as on a
s0ecial 1ater diet-
Stiulants
Stimulants such as e0hedrine" green tea" caffeine or syne0hrine 1ork to increase the basal metabolic
rate-
;ossible 1eight loss effects of drinking 1ater 0rior to meals
A #$$8 re:ie1 found that e<isting limited e:idence suggests that encouraging 1ater consum0tion and
substituting energy3free be:erages for energy3containing be:erages may facilitate 1eight management-
A #$$8 article found that drinking !$$ ml of 1ater 0rior to meals for a %# 1eek 0eriod resulted in
increased long3term 1eight reduction- ?References gi:en in main article-@
*asting
Lengthy fasting can be dangerous due to the risk of malnutrition and should be carried out under
medical su0er:ision- During 0rolonged fasting or :ery lo1 calorie diets" the reduction of blood glucose"
the 0referred energy source of the brain" causes the body to de0lete its glycogen stores- Once
glycogen is de0leted the body begins to fuel the brain using ketones" 1hile also metaboliFing body
0rotein ?including but not limited to skeletal muscle@ to be used to synthesiFe sugars for use as energy
by the rest of the body- 4ost e<0erts belie:e that a 0rolonged fast can lead to muscle 1asting although
some dis0ute this- The use of short3term fasting" or :arious forms of intermittent fasting ha:e been used
as a form of dieting to circum:ent this issue-
9asting may refer to the a:oidance of s0ecific foods- 9or e<am0le" the modern Daniel 9ast resembles
the :egan diet because it fasts from foods of animal origin- 4eat" dairy" eggs" and fish are re0laced by
1hole grains" fruits" :egetables" 0ulses" nuts" seeds and oil-
While there are studies that sho1ed the health and medical benefits of 1eight loss" a study in #$$! of
around +$$$ 9inns o:er an %73year 0eriod sho1ed that 1eight loss from dieting can result in increased
mortality" 1hile those 1ho maintained their 1eight fared the best- Similar conclusion is dra1n by other
studies" and although other studies suggest that intentional 1eight loss has a small benefit for
indi:iduals classified as unhealthy" it is associated 1ith slightly increased mortality for healthy
indi:iduals and the slightly o:er1eight but not obese- This may reflect the loss of subcutaneous fat and
beneficial mass from organs and muscle in addition to :isceral fat 1hen there is a sudden and dramatic
1eight loss-
Low carbohydrate +ersus low fat
4any studies ha:e focused on diets that reduce calories :ia a lo13carbohydrate ?Atkins diet" Scarsdale
diet" Sone diet@ diet :ersus a lo13fat diet ?L(AR= diet" Ornish diet@- The=ursesE 6ealth Study" an
obser:ational cohort study" found that lo1 carbohydrate diets based on :egetable sources of fat and
0rotein are associated 1ith less coronary heart disease- The same study also found no correlation ?1ith
multi:ariate adCustment@ bet1een animal fat intake and coronary heart disease ?table &@- A long term
study that monitored &+"+8* S1edish 1omen ho1e:er suggests that a lo1 carbohydrate3high 0rotein
diet" used on a regular basis and 1ithout consideration of the nature of carbohydrates or the source of
0roteins" are associated 1ith increased risk of cardio:ascular disease-
A meta3analysis of randomiFed controlled trials by the international /ochrane /ollaboration in #$$#
concluded that fat3restricted diets are no better than calorie restricted diets in achie:ing long term
1eight loss in o:er1eight or obese 0eo0le- A more recent meta3analysis that included randomiFed
controlled trials 0ublished after the /ochrane re:ie1 found that Klo13carbohydrate" non3energy3
restricted diets a00ear to be at least as effecti:e as lo13fat" energy3restricted diets in inducing 1eight
loss for u0 to % year- 6o1e:er" 0otential fa:orable changes in triglyceride and high3density li0o0rotein
cholesterol :alues should be 1eighed against 0otential unfa:orable changes in lo13density li0o0rotein
cholesterol :alues 1hen lo13carbohydrate diets to induce 1eight loss are considered-K
The WomenEs 6ealth Initiati:e RandomiFed /ontrolled Dietary 4odification Trial found that a diet of
total fat to #$D of energy and increasing consum0tion of :egetables and fruit to at least ! ser:ings daily
and grains to at least * ser:ings daily resulted in:
no reduction in cardio:ascular disease
no statistically significant reduction in in:asi:e breast cancer
no reductions in colorectal cancer
Additional recent randomiFed controlled trials ha:e found that:
A com0arison of Atkins" Sone diet" Ornish diet" and L(AR= diet in premenopausal women found the
greatest benefit from the Atkins diet-
The choice of diet for a s0ecific 0erson may be influenced by measuring the indi:idualEs insulin
secretion:
In young adults KReducing glycemic 'carbohydrate, load may be es0ecially im0ortant to achie:e 1eight
loss among indi:iduals 1ith high insulin secretion-K This is consistent 1ith 0rior studies of diabetic
0atients in 1hich lo1 carbohydrate diets 1ere more beneficial-
The American Diabetes Association released for the first time a recommendation ?in its anuary #$$7
/linical ;ractice Recommendations@ for a lo1 carbohydrate diet to reduce 1eight for those 1ith or at
risk of Ty0e # diabetes-
Low glyceic inde&
KThe glycemic inde< ?BI@ factor is a ranking of foods based on their o:erall effect on blood sugar le:els-
The diet based around this research is called the Lo1 BI diet- Lo1 glycemic inde< foods" such as
lentils" 0ro:ide a slo1er" more consistent source of glucose to the bloodstream" thereby stimulating less
insulin release than high glycemic inde< foods" such as 1hite bread-K
The glycemic load is Kthe mathematical 0roduct of the glycemic inde< and the carbohydrate amountK-
In a randomiFed controlled trial that com0ared four diets that :aried in carbohydrate amount and
glycemic inde< found com0licated results:
Diet % and # 1ere high carbohydrate ?!!D of total energy intake@
Diet % 1as high3glycemic inde<
Diet # 1as lo13glycemic inde<
Diet + and & 1ere high 0rotein ?#!D of total energy intake@
Diet + 1as high3glycemic inde<
Diet & 1as lo13glycemic inde<
Diets # and + lost the most 1eight and fat massL ho1e:er" lo1 density li0o0rotein fell in Diet # and rose
in Diet +- Thus the authors concluded that the high3carbohydrate" lo13glycemic inde< diet 1as the most
fa:orable-
A meta3analysis by the /ochrane /ollaboration concluded that lo1 glycemic inde< or lo1 glycemic load
diets led to more 1eight loss and better li0id 0rofiles- $owever" the /ochrane /ollaboration grou0ed
lo1 glycemic inde< and lo1 glycemic load diets together and did not try to se0arate the effects of the
load :ersus the inde<-
Weight Loss %ffects of Water
The a00arent 1eight loss effects of 1ater ha:e been subCect to some scientific research-
There is some e:idence that suggests that drinking 1ater can be associated 1ith consuming fe1er
calories" burning slightly more calories" and eating more fruits and :egetables- Increased 1ater
consum0tion" or re0lacement of energy3containing be:erages 1ith energy3free be:erages" or
consum0tion of 1ater3rich foods such as fruits and :egetables 1ith a lo1er energy density" may hel0 in
1eight management- ;o0ular ad:ice to children regarding 1ater consum0tion is often inaccurate-
This e:idence has been used by some of the scientists 1ho 1orked on this research" and by others" to
bolster suggestions that 0eo0le 1ho are trying to lose 1eight can benefit from augmenting . but not
re0lacing . their dietary 0rograms by drinking 1ater" either before meals or at any time- Such ad:ice
had 0re:iously been gi:en by dieticians e:en before the most recent research 1as 0ublished-
'ossible appetite reduction effect
There is some e:idence drinking 1ater before or during a meal may hel0 aid 1eight loss 1hen used in
conCunction 1ith a calorie3controlled diet-
Drinking 1ater 0rior to each meal may hel0 in a00etite su00ression- A 0romising a00roach to reducing
a00etite 1hich does not in:ol:e taking any drugs" and is :ery safe" is to drink a moderate amount of
1ater before a meal- Though this had been a folk remedy for o:ereating for many years" and is
recommended by some dieticians and sti0ulated in some scientific studies" it 1as only recently that the
a00roach 1as subCected to a scientific randomised controlled trial to see ho1 much effect it had-
Researchers had found that 1ater drinkers ate 5! to 8$ fe1er calories 0er meal-
Concoitant dietary changes
Research by Barry ;o0kin et al. has sho1n that 0eo0le 1ho drink lots of 1ater eat more :egetables and
fruits" drink fe1er sugary be:erages" and consume fe1er total calories- The reason for drinking less
sugary be:erages 1ould likely be that the increased 1ater substitutes for them in the diet" 2uenching
the thirst so that the 0erson does not feel as much need to drink sugary be:erages-
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