Weight Management Programs

The AHA recognizes that information on the benefits of weight loss in the elderly (people aged 75 years and older) is clearly lacking and consequently recommends that elderly people discuss their plans with their physicians before beginning a weight loss program. They should be encouraged to adopt a healthy lifestyle that includes a low-fat diet and regular physical activity.

These guidelines focus on the health benefits of weight loss associated with a healthy lifestyle that should lead to improved cardiovascular health (eg, a reduction in serum levels of total cholesterol, low density lipoprotein cholesterol, and blood pressure and an increase in high density lipoprotein cholesterol). The guidelines also emphasize the importance of weight management programs in which participants achieve and maintain realistic weight loss goals for a lifetime because the maintenance of even small weight losses may be associated with improvements in cardiovascular risk factors. In addition, the achievement and maintenance of realistic weight loss goals are critical to effective weight management programs. Some studies have suggested increased morbidity and mortality as a result of weight cycling; others have not. This issue will not be resolved without further study. Weight management programs are less likely to be effective if they are not adapted to the individual characteristics of each participant.

The question of who should lose weight has frequently been asked of health care professionals; however, comprehensive guidelines for the general public are not available. Clearly, people who might benefit medically from weight loss should be targeted because the reduction of risk factors for heart disease, hypertension, and diabetes improves quality of life as well as reduces future health care costs. People with a history of weight cycling should also be encouraged to enroll in professionally supervised weight management programs that are based on realistic weight loss goals. The use of weight management programs solely to achieve aesthetic changes should be discouraged because of the unnecessary exposure to the risks of weight cycling.

People who are within 20% of their ideal body weight might be more appropriately encouraged to increase their physical activity and reduce their dietary fat intake to levels associated with good health rather than to lose weight, because such improvements should result in a lower body fat level and favorable changes in blood lipids and blood pressure. Those who are more than 20% above their ideal body weight should be considered potential candidates for effective weight management programs, especially if they are at risk for coronary heart disease, hypertension, or diabetes. People with abdominal obesity should be screened for unfavorable lipid profiles, high blood pressure, or abnormal glucose tolerance because abdominal obesity has been associated with increased risk for these problems. More research is needed to develop methods of identifying abdominal obesity.

Background
Although the development of obesity has a genetic component, the mechanism is unknown, and for most people the imbalance between energy intake and energy expenditure is the key. Weight gain is usually due to an excess of energy intake, a lack of energy expenditure due to low levels of leisure-time physical activity, or both. A successful weight loss program therefore must (in addition to being nutritionally sound) be based on a reduction of energy intake, including reduced intake of total fat and saturated fat, and an increase in energy expenditure through physical activity.

For weight loss, the intensity of physical activity is not nearly as important as the amount and duration. For example, there is only a small difference between the amount of energy expended by briskly walking 10 blocks and by running 10 blocks. As people lose weight their energy needs decrease because of a decline in resting metabolic rate, and weight loss will be slowed (or there may even be some weight gain) if they continue to consume the same amount of energy in food without increasing energy expenditure. It is therefore extremely important to gradually increase physical activity to maintain weight control.

The proposed dietary changes, the most important of which is reduction of total fat and saturated fat intake, should be both pleasant and acceptable, and the increased physical activity should be enjoyable, practical, and safe. People who have difficulty maintaining a normal weight should be evaluated by a physician, especially if they are very overweight or have been unsuccessful in weight loss programs. Most people lose weight and maintain weight loss on their own by reducing their energy intake, frequently that from fat (because fat has more energy per gram than protein or carbohydrate), and by increasing their energy expenditure through physical activity. However, some people may prefer an organized weight loss program. Such programs should conform to the principles of the AHA guidelines for weight reduction by reducing intake of total fat and saturated fat. The program should be based on a balanced diet (ie, a nutrient intake sufficient to prevent deficiencies of vitamins and minerals), and provide a safe and pleasant program of physical activity.

Farnoush Gidanian
MS, RD, CLE

A registered dietitian and
owner of Sierra Nutrition.

eat4health@sierranutrition.com

(949) 533-3557