PUTTING IT ALL TOGETHER
Combining the weight-loss strategies discussed herein is more likely to produce success than use of any single strategy alone. The LEARN program, a self-help system designed for use in health care settings, combines many of the modalities discussed in this article and can get patients started in the right direction. Table 2 provides a similarly helpful summary of behavioral techniques for weight loss, and readers are encouraged to give a photocopy of this table to their patients. Behavioral research indicates several predictors for weight maintenance: consistent physical activity, development of strategies to prevent relapse, frequent follow-up with health care professionals, and social support, all of which overlap with strategies for weight loss. As noted previously, physical activity is the single best predictor of weight maintenance. Patients should have a planned structured exercise regimen and adopt strategies to increase NEAT. Identifying triggers for relapse and developing strategies for dealing with those triggers are important skills (“if-then” scenarios). One such trigger for relapse is when dieters believe they have exceeded their energy intake for the day. Studies show that this often leads to disinhibited eating with marked increases in energy intake. Patients should be advised not to let one mistake trigger a cascade of mistakes. Excessive alcohol consumption reduces the ability to resist temptation and is often a factor in failure to maintain behavior. Patients should be advised to use the strategy of avoiding alcohol in high-risk eating situations.
People who have lost weight and maintained that loss for years have found that it gets easier with time. They succeed by consuming less fat and exercising 60 minutes or more daily. The strategies outlined in this review cannot be implemented in a single office visit. Both patients and physicians should view the treatment of obesity as a long-term process requiring the implementation of strategies and solutions over time. The primary care clinician has no more daunting challenge than helping a patient lose and maintain weight. However, few aspects of medical practice are more rewarding than seeing a patient succeed at losing weight, maintain that weight loss, and thus enjoy greater quality of life.
1. Warren G. Thompson, MD,
2. David A. Cook, MD,
3. Matthew M. Clark, PhD,
4. Aditya Bardia, MD, MPH and
5. James A. Levine, MD, PhD
doi: 10.4065/82.1.93 Mayo Clinic Proceedings January 2007 vol. 82 no. 1 93-102
Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530-1538.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861-1867.
Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999;31(11, suppl):S663-S667.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549-1555.
Stafford RS, Radley DC. National trends in antiobesity medication use. Arch Intern Med. 2003;163:1046-1050.
Ruser CB, Sanders L, Brescia GR et al. Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med. 2005;20:1139-1141.
Yusuf S, Hawken S, Ounpuu S, et al.,INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640-1649.
McArtor RE, Iverson DC, Benken D, Dennis LK. Family practice residents’ identification and management of obesity. Int J Obes Relat Metab Disord. 1992;16:335-340.
Wadden TA, Foster GD. Behavioral treatment of obesity. Med Clin North Am. 2000;84:441-461.