Lifestyle Changes for Obesity and Weight Loss

• Introduction to lifestyle changes for obesity and weight loss
• Weight loss aims and benefits
• Overview of lifestyle treatments
• Dietary approaches for weight loss
• Physical activity for weight loss
• Behavioural therapy for weight loss
• Other

Introduction to lifestyle changes for obesity and weightloss

Obesity is a chronic health problem which now affects many Australians. Some say the rates are so high that we have reached an obesity epidemic. Overweight and obesity are dangerous conditions as they can contribute to a number of different health problems (eg, heart disease and diabetes). It is therefore extremely important that obesity is treated aggressively. Lifestyle changes remain the mainstay of treatment and are important for the long term maintenance of weight loss.

The increased rates of overweight and obesity in Australia is part of a worldwide trend. Today, over 50% of women, up to 75% of males and approximately 25% of children and adolescents are classified as overweight or obese. The reasons for this increase are complex, but environment and changing lifestyles certainly play significant roles. High energy foods have become readily available, and it is no longer essential to engage in physical activity. As a result, obesity and its health problems have become all too common in Australian individuals.

Unfortunately obesity is a chronic condition and there is no ‘quick fix’ solution or treatment that is effective for all overweight or obese individuals. Furthermore, after following weight loss programs, relapses of weight gain are extremely common. This emphasises the importance of a lifetime commitment to healthy eating and exercise practices. A range of different treatment options are available for obesity. Lifestyle modification (with a reduction of energy intake and an increase in physical activity) is essential in all treatment strategies. There are currently no long-term treatment programs that do not require at least some lifestyle changes. Positive changes in your eating and exercise behaviour are essential for sustained reductions in weight. However, if you are extremely overweight it may be recommended that you also take weight loss medications or undergo bariatric surgery.

Weight loss aims and benefits

As you may be aware, obesity is associated with a range of health consequences including metabolic diseases (like diabetes), heart disease, some cancers and arthritis. Lifestyle modifications aim to reduce the burden of obesity and reduce the associated conditions. In general, the greater the degree of weight loss achieved, the greater the health benefits. However, even a small amount of weight loss (5-10% of body weight) can lead to significant benefits. Some people consider this small amount of weight loss unsatisfactory, but the health benefits are much more important than physical appearance. You should discuss with your doctor what weight loss aims are suitable for you.

The overall success of a weight loss program really depends on whether the weight loss is sustained in the long term. For this to be achieved you must be well educated about obesity and be extremely dedicated to your lifestyle changes. It may be useful to elicit the help of your friends and family to keep you motivated. Lifestyle changes for the whole family are extremely important to achieve healthy weight in children.

Overview of lifestyle treatments for weight loss

Lifestyle treatments for weight loss focus on reducing energy intake and increasing physical activity through diet, exercise and behavioural measures. You should try to alter your bad eating and activity habits. (Please refer to eating habits of women and eating habits of men for more information). In general, a combination of treatments is the most effective way to achieve weight loss.

A program is now available online that helps you to determine which of your lifestyle behaviours are unhealthy. This is called the Diet, Activity and Behaviour Questionnaire (DAB-Q). It consists of a series of simple questions about your eating and activity behaviours and helps you grade how easy it would be for you to make appropriate changes. At the end of the questionnaire you will be given a graded score of the most important factors contributing to your excess weight, which you can hopefully address in the future.

You can complete this program at home and bring it to your next doctor’s appointment. This will provide your doctor with extremely valuable information which can be used to devise weight loss targets specifically for you. This is very important as it is often difficult for your doctor to get a good understanding of the lifestyle factors contributing to your weight. You can access this program for free by visiting http://www.professortrim.com/DAB-Q/. All questionnaire answers remain confidential.

Lifestyle treatments for obesity and weight loss can be challenging and time consuming. To re-emphasise, much of the success of your treatment will rely on your own dedication and effort.

Dietary approaches for weight loss

Dietary control has probably been the main treatment used for weight loss in the past. Diets are based on the principles of metabolism and work by reducing the intake of calories (energy) to create a negative energy balance (i.e. more energy is used than is consumed). There are countless commercial diets available and you should try to choose one that is suitable for you. The crash or fad diets published in magazines should generally be avoided, as they can be dangerous to your health and tend not to produce good long term results. You should try to choose diets that are medically proven or diets developed by dedicated weight loss services such as Weight Watchers or Jenny Craig. Your doctor can help you choose a diet which is safe, effective and suited to your needs. Below are some of the different mechanisms used in diets for weight loss:

• Reducing fat, carbohydrate (especially those with a high glycaemic index), protein or alcohol intake. Reducing alcohol intake is a very good way to lose weight, as each gram of alcohol contains a large amount of energy on top of your normal daily intake.
• Smaller portion sizes. You can try using a smaller plate size at each meal.
• Food restrictions at various times of the day. It can be helpful to have a big breakfast and reduce the intake of energy rich foods later in the day. This can help your metabolism and ensure that most of the energy that you consume is burnt throughout the day.
• Combining different foods to reduce total energy intake. Some diets have set food regimes for weight loss.
• Diets centered on a single low-energy food.

Most diets produce some weight loss and are successful in the short-term. However, less than 10% of patients will maintain the weight loss in the long term. Once again it must be emphasised that permanent changes to eating habits are required. You must be careful whilst dieting to ensure that you still receive all the essential proteins, vitamins and trace elements. The best way to achieve this is by eating a well balanced diet with a wide variety of nutritious foods. A successful weight loss program may include cutting fats and sugars from your diet while ensuring you eat lots of healthy foods such as wholegrain, fruits and vegetables. Some diet programs may also require you to take vitamin or mineral supplements.

Be careful when shopping for low fat foods or brands labeled as ‘diet’ in the supermarket. Many low fat foods can be high in sugar and still contribute a lot to your daily energy or caloric intake. You should learn how to read food labels carefully and aim to consume foods that are low in saturated fat, sugars and, if appropriate, glycaemic index.

Diets that teach you how to select and prepare healthy foods may be more successful in the long term than restrictive diets with strict daily eating regimes or pre-prepared meals.

Reduced energy diets encourage you to choose healthy meal options, aiming to reduce your energy intake by a small amount every day. They teach you healthy eating behaviours which you can maintain in the long term.

Low energy diets are more restrictive and limit your energy intake to a greater degree. Set meal programs need to be followed. This type of diet can lead to a weight loss between 7-13 kilograms and may be used if you have significant health problems related to obesity.

Very low energy diets cut daily energy intake significantly and tend to be reserved for people who have failed other treatments or who have significant co-morbidities. These types of diets are generally followed for 8-16 weeks and often consist of liquid meal replacements (discussed below) from pharmacies. Unfortunately much of the weight lost is regained after the diet is stopped, but behavioural or drug therapies following treatment can help maintain some of the weight loss.

Meal Replacement Programs

Recently weight loss programs have been developed that replace normal meals with prepared meal plans or meal supplements (such as vitamin-rich shakes, soups and bars). These supplements act as complete meals, as they contain all the required vitamins and minerals. Meal Replacement Programs operate on the principles of a low calorie diet and induce a mild state of ketosis. The diets limit your intake of carbohydrates so that the body starts to break down fat stores for energy. The meal replacement programs are specially formulated so that they contain adequate energy and do not cause malnutrition.

Physical activity for weight loss

In addition to reducing your energy intake, increased physical activity is essential for the maintenance of weight loss and should form part of any weight loss program. However, to achieve significant weight loss from exercise alone, a very high level of activity is required, which can be challenging.

You should gradually build up your exercise as your personal fitness allows. You can start with simple measures such as walking to nearby places rather than driving, or climbing the stairs rather than using an elevator or escalator. Thirty minutes of walking 3-5 times per week is a good starting point.

If you are very overweight, some exercises (especially those that require weight bearing) can be physically difficult. In this case you could try activities such as swimming, walking in water or cycling. Once your fitness levels improve you could change to other exercises in the long term.

You should try to choose activities that you enjoy, as you will be more likely to continue them in the long term. Participating in team sports or exercising with a friend or family member can help you to remain motivated. It may be useful to see a physiotherapist or exercise physiologist to help you develop an appropriate exercise program. Try to focus on overall lifestyle measures as they tend to produce greater long term adherence.

Exercise has benefits beyond modest reductions in weight. Increasing your physical activity can improve your cardio-respiratory fitness, metabolic health, quality of life and general wellbeing. However, strenuous exercise can be risky in some patients such as those with cardiovascular problems. You should consult your doctor to discuss what level of physical activity will be safe for you.

Behavioural therapy for weight loss

Behavioural techniques may be useful in conjunction with diet and exercise programs to improve long-term weight loss. Behavioural treatment is usually performed by a psychologist who analyses your eating, physical activity and thinking habits. Cognitive behavioural therapy (CBT) is a classic example which encourages you to change these behaviours and take responsibility for your lifestyle changes. Other strategies may include stress management, relapse prevention, counselling, and techniques such as hypnosis and psychotherapy. However, some of these behavioural techniques can be very time consuming and expensive.

Some basic steps may include:

• Self monitoring: Identifying and recording any adverse patterns of behaviour.
• Stimulus control: This involves removing factors that encourage you to eat badly. For example, you should shop carefully and remove trouble foods (such as chocolates and chips) from the house so you cannot be tempted.
• Problem solving: Identifying and addressing problems associated with eating and physical activity. You should consider which factors have led to your excess weight and address them appropriately.
• Reward systems: You could reward yourself for positive behaviours such as exercise by treating yourself to new clothes.
• Social support: Strong social support from your friends and family can improve weight loss. It may be beneficial for you to enrol in a commercial program which offers a social support network.

Other

Beyond the specific measures highlighted above, it is also important that you maintain an overall balanced and healthy lifestyle. You should avoid stress, depression, boredom and frustration as these can be triggers to unhealthy eating behaviours. Keeping yourself occupied with enjoyable activities such as sports or socializing with friends and family can help you achieve a healthy lifestyle. If you eat excessively due to stress you could consider enrolling in relaxation programs.

More information

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.

References

1. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book]
2. Clinical practice guidelines for the management of overweight and obesity in adults [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 18 September 2003 [cited 9 August 2007]. Available from: URL link
3. Proietto J, Baur L. Management of obesity. Med J Aust. 2004;180(9):474-80. [Abstract | Full text]
4. Summary report – Acting on Australia’s weight: a strategic plan for the prevention of overweight and obesity [online]. Canberra, ACT: Australian Government National Health and Medical Research Council (NHMRC); 2007 [cited 9 August 2007].  Available from: URL link