Weight loss

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Weight loss
Before and after comparison of weight loss 2015-06-25.png

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other connective tissue). Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.

Contents

Intentional

Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss is the main treatment for obesity, [1] [2] [3] and there is substantial evidence this can prevent progression from prediabetes to type 2 diabetes with a 7–10% weight loss and manage cardiometabolic health for diabetic people with a 5–15% weight loss. [4]

Weight loss in individuals who are overweight or obese can reduce health risks, [5] increase fitness, [6] and may delay the onset of diabetes. [5] It could reduce pain and increase movement in people with osteoarthritis of the knee. [6] Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear. [5] [ failed verification ] Weight loss is achieved by adopting a lifestyle in which fewer calories are consumed than are expended. [7] Depression, stress or boredom may contribute to unwanted weight gain or loss depending on the individual, [8] [9] and in these cases, individuals are advised to seek medical help. A 2010 study found that dieters who got a full night's sleep lost more than twice as much fat as sleep-deprived dieters. [10] [11] Though hypothesized that supplementation of vitamin D may help, studies do not support this. [12] The majority of dieters regain weight over the long term. [13] According to the UK National Health Service and the Dietary Guidelines for Americans, those who achieve and manage a healthy weight do so most successfully by being careful to consume just enough calories to meet their needs, and being physically active. [14] [7]

For weight loss to be permanent, changes in diet and lifestyle must be permanent as well. [15] [16] [17] There is evidence that counseling or exercise alone do not result in weight loss, whereas dieting alone results in meaningful long-term weight loss, and a combination of dieting and exercise provides the best results. [18] Meal replacements, orlistat, a very-low-calorie diet, and primary care intensive medical interventions can also support meaningful weight loss. [19] [20]

Techniques

Orlistat (Xenical), a commonly used anti-obesity medication, and sibutramine (Meridia), a withdrawn medication due to cardiovascular side effects Obesity Med2008.JPG
Orlistat (Xenical), a commonly used anti-obesity medication, and sibutramine (Meridia), a withdrawn medication due to cardiovascular side effects

Diet and exercise

The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. [21] The World Health Organization recommends that people combine a reduction of processed foods high in saturated fats, sugar and salt, [22] and reduced caloric intake with an increase in physical activity. [23] Both long-term exercise programs and anti-obesity medications reduce abdominal fat volume. [24] Self-monitoring of diet, exercise, and weight are beneficial strategies for weight loss, [21] [25] [26] particularly early in weight loss programs. [27] Research indicates that those who log their foods about three times per day and about 20 times per month are more likely to achieve clinically significant weight loss. [21] [28]

Permanent weight loss depends on maintaining a negative energy balance and not the type of macronutrients (such as carbohydrate) consumed. [29] High protein diets have shown greater efficacy in the short term (under 12 months) for people eating ad libitum due to increased thermogenesis and satiety, however this effect tends to dissipate over time. [30]

Hydration

Increasing water intake can reduce weight by increasing thermogenesis, by reducing food intake, and by increasing fat oxidation. [31] Persons dieting for weight loss have demonstrated the weight-reducing effects of increased water consumption. [32] Among adults in the U.S. there is a significant association between inadequate hydration and obesity. [33]

Medications

Other methods of weight loss include use of anti-obesity drugs that decrease appetite, block fat absorption, or reduce stomach volume.[ citation needed ] Obesity has been resistant to drug-based therapies, with a 2021 review stating that existing medications are "often delivering insufficient efficacy and dubious safety". [34] Semaglutide has also become popular recently as an aid in weight loss. [35] It’s particularly beneficial for those with type 2 diabetes and obesity.

Bariatric surgery

Bariatric surgery may be indicated in cases of severe obesity. Two common bariatric surgical procedures are gastric bypass and gastric banding. [36] Both can be effective at limiting the intake of food energy by reducing the size of the stomach, but as with any surgical procedure both come with their own risks [37] that should be considered in consultation with a physician.

Weight loss industry

There is a substantial market for products which claim to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, DVDs, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, fitness centers, clinics, personal coaches, weight loss groups, and food products and supplements. [38] Dietary supplements, though widely used, are not considered a healthy option for weight loss, and have no clinical evidence of efficacy. [39] Herbal products have not been shown to be effective. [40]

In 2008, between US$33 billion and $55 billion was spent annually in the US on weight-loss products and services, including medical procedures and pharmaceuticals, with weight-loss centers taking between 6 and 12 percent of total annual expenditure. Over $1.6 billion per year was spent on weight-loss supplements. About 70 percent of Americans' dieting attempts are of a self-help nature. [41] [42]

In Western Europe, sales of weight-loss products, excluding prescription medications, topped €1,25 billion (£900 million/$1.4 billion) in 2009. [42]

The scientific soundness of commercial diets by commercial weight management organizations varies widely, being previously non-evidence-based, so there is only limited evidence supporting their use, because of high attrition rates. [43] [44] [45] [46] [47] [48] Commercial diets result in modest weight loss in the long term, with similar results regardless of the brand, [45] [47] [49] [50] and similarly to non-commercial diets and standard care. [43] [3] Comprehensive diet programs, providing counseling and targets for calorie intake, are more efficient than dieting without guidance ("self-help"), [43] [51] [50] although the evidence is very limited. [48] The National Institute for Health and Care Excellence devised a set of essential criteria to be met by commercial weight management organizations to be approved. [46]

Unintentional

Characteristics

Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or a combination of these. [52] [53] It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months [52] [54] or 5% in the last month. [55] Another criterion used for assessing weight that is too low is the body mass index (BMI). [56] However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person. [57]

Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss. [52] [53] [58] [59] [60] Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy. [54]

Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia. [57] Cachexia differs from starvation in part because it involves a systemic inflammatory response. [57] It is associated with poorer outcomes. [52] [57] [58] In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help. [54] Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue. [54]

Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates. [52] [57] Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including: [56]

Malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores. [56] Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer [52] and type 1 diabetes. [61] In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery. [56] According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition. [56] A high proportion (10–60%) of hospital patients are also at risk, along with a similar proportion in care homes. [56]

Causes

Disease-related malnutrition can be considered in four categories: [56]

Overview of disease-related causes for weight loss
ProblemCause
Impaired intakePoor appetite can be a direct symptom of an illness, or an illness could make eating painful or induce nausea. Illness can also cause food aversion.

Inability to eat can result from: diminished consciousness or confusion, or physical problems affecting the arm or hands, swallowing or chewing. Eating restrictions may also be imposed as part of treatment or investigations. Lack of food can result from: poverty, difficulty in shopping or cooking, and poor quality meals.

Impaired digestion &/or absorptionThis can result from conditions that affect the digestive system.
Altered requirementsChanges to metabolic demands can be caused by illness, surgery and organ dysfunction.
Excess nutrient lossesLosses from the gastrointestinal can occur because of symptoms such as vomiting or diarrhea, as well as fistulae and stomas. There can also be losses from drains, including nasogastric tubes.

Other losses: Conditions such as burns can be associated with losses such as skin exudates.

Weight loss issues related to specific diseases include:

  • As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass. [58] Around 25% experience moderate to severe weight loss, and most others have some weight loss. [58] Greater weight loss is associated with poorer prognosis. [58] Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing). [58]
  • Cancer, a very common and sometimes fatal cause of unexplained (idiopathic) weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobiliary (hepatocellular carcinoma, pancreatic cancer), ovarian, hematologic or lung malignancies.
  • People with HIV often experience weight loss, and it is associated with poorer outcomes. [62] Wasting syndrome is an AIDS-defining condition. [62]
  • Gastrointestinal disorders are another common cause of unexplained weight loss – in fact they are the most common non-cancerous cause of idiopathic weight loss.[ citation needed ] Possible gastrointestinal etiologies of unexplained weight loss include: celiac disease, peptic ulcer disease, inflammatory bowel disease (crohn's disease and ulcerative colitis), pancreatitis, gastritis, diarrhea, chronic mesenteric ischemia [63] and many other GI conditions.
  • Infection. Some infectious diseases can cause weight loss. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, Whipple's disease and some other subacute or occult infections may cause weight loss.
  • Renal disease. Patients who have uremia often have poor or absent appetite, vomiting and nausea. This can cause weight loss.
  • Cardiac disease. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss.
  • Connective tissue disease
  • Oral, taste or dental problems (including infections) can reduce nutrient intake leading to weight loss. [54]

Medical treatment can directly or indirectly cause weight loss, impairing treatment effectiveness and recovery that can lead to further weight loss in a vicious cycle. [52] Many patients will be in pain and have a loss of appetite after surgery. [52] Part of the body's response to surgery is to direct energy to wound healing, which increases the body's overall energy requirements. [52] Surgery affects nutritional status indirectly, particularly during the recovery period, as it can interfere with wound healing and other aspects of recovery. [52] [56] Surgery directly affects nutritional status if a procedure permanently alters the digestive system. [52] Enteral nutrition (tube feeding) is often needed. [52] However a policy of 'nil by mouth' for all gastrointestinal surgery has not been shown to benefit, with some weak evidence suggesting it might hinder recovery. [64] Early post-operative nutrition is a part of Enhanced Recovery After Surgery protocols. [65] These protocols also include carbohydrate loading in the 24 hours before surgery, but earlier nutritional interventions have not been shown to have a significant impact. [65]

Social conditions

Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people. [66] Nutrient intake can also be affected by culture, family and belief systems. [54] Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition. [54]

Loss of hope, status or social contact and spiritual distress can cause depression, which may be associated with reduced nutrition, as can fatigue. [54]

Myths

Some popular beliefs attached to weight loss have been shown to either have less effect on weight loss than commonly believed or are actively unhealthy. According to Harvard Health, the idea of metabolic rate being the "key to weight" is "part truth and part myth" as while metabolism does affect weight loss, external forces such as diet and exercise have an equal effect. [67] They also commented that the idea of changing one's rate of metabolism is under debate. [67] Diet plans in fitness magazines are also often believed to be effective but may actually be harmful by limiting the daily intake of important calories and nutrients which can be detrimental depending on the person and are even capable of driving individuals away from weight loss. [68]

Health effects

Obesity increases health risks, including diabetes, cancer, cardiovascular disease, high blood pressure, and non-alcoholic fatty liver disease, to name a few. Reduction of obesity lowers those risks. A 1 kilogram (2.2 lb) loss of body weight has been associated with an approximate 1 millimetre of mercury (0.13 kPa) drop in blood pressure. [69] Intentional weight loss is associated with cognitive performance improvements in overweight and obese individuals. [70]

See also

Related Research Articles

Dieting is the practice of eating food in a regulated way to decrease, maintain, or increase body weight, or to prevent and treat diseases such as diabetes and obesity. As weight loss depends on calorie intake, different kinds of calorie-reduced diets, such as those emphasising particular macronutrients, have been shown to be no more effective than one another. As weight regain is common, diet success is best predicted by long-term adherence. Regardless, the outcome of a diet can vary widely depending on the individual.

<span class="mw-page-title-main">Obesity</span> Medical condition in which excess body fat harms health

Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

<span class="mw-page-title-main">Cachexia</span> Syndrome causing muscle loss not entirely reversible

Cachexia is a complex syndrome associated with an underlying illness, causing ongoing muscle loss that is not entirely reversed with nutritional supplementation. A range of diseases can cause cachexia, most commonly cancer, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and AIDS. Systemic inflammation from these conditions can cause detrimental changes to metabolism and body composition. In contrast to weight loss from inadequate caloric intake, cachexia causes mostly muscle loss instead of fat loss. Diagnosis of cachexia can be difficult due to the lack of well-established diagnostic criteria. Cachexia can improve with treatment of the underlying illness but other treatment approaches have limited benefit. Cachexia is associated with increased mortality and poor quality of life.

<span class="mw-page-title-main">Low-carbohydrate diet</span> Diets restricting carbohydrate consumption

Low-carbohydrate diets restrict carbohydrate consumption relative to the average diet. Foods high in carbohydrates are limited, and replaced with foods containing a higher percentage of fat and protein, as well as low carbohydrate foods.

<span class="mw-page-title-main">Mediterranean diet</span> Diet inspired by the Mediterranean region

The Mediterranean diet is a diet inspired by the eating habits and traditional food typical of southern Spain, southern Italy, and Crete, and formulated in the early 1960s. It is distinct from Mediterranean cuisine, which covers the actual cuisines of the Mediterranean countries, and from the Atlantic diet of northwestern Spain and Portugal. While inspired by a specific time and place, the "Mediterranean diet" was later refined based on the results of multiple scientific studies.

<span class="mw-page-title-main">Marasmus</span> Medical condition

Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein. This clear-cut separation of marasmus and kwashiorkor is however not always clinically evident as kwashiorkor is often seen in a context of insufficient caloric intake, and mixed clinical pictures, called marasmic kwashiorkor, are possible. Protein wasting in kwashiorkor generally leads to edema and ascites, while muscular wasting and loss of subcutaneous fat are the main clinical signs of marasmus, which makes the ribs and joints protrude.

<span class="mw-page-title-main">Anti-obesity medication</span> Class of pharmacological agents

Anti-obesity medication or weight loss medications are pharmacological agents that reduce or control excess body fat. These medications alter one of the fundamental processes of the human body, weight regulation, by: reducing appetite and consequently energy intake, increasing energy expenditure, redirecting nutrients from adipose to lean tissue, or interfering with the absorption of calories.

Calorie restriction is a dietary regimen that reduces the energy intake from foods and beverages without incurring malnutrition. The possible effect of calorie restriction on body weight management, longevity, and aging-associated diseases has been an active area of research.

<span class="mw-page-title-main">High-protein diet</span> A diet high in protein

A high-protein diet is a diet in which 20% or more of the total daily calories come from protein. Many high protein diets are high in saturated fat and restrict intake of carbohydrates.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

The duodenal switch (DS) procedure, gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.

<span class="mw-page-title-main">Very-low-calorie diet</span> Diet with very or extremely low daily food energy consumption

A very-low-calorie diet (VLCD), also known as semistarvation diet and crash diet, is a type of diet with very or extremely low daily food energy consumption. VLCDs are defined as a diet of 800 kilocalories (3,300 kJ) per day or less. Modern medically supervised VLCDs use total meal replacements, with regulated formulations in Europe and Canada which contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, protein and electrolyte balance. Carbohydrates may be entirely absent, or substituted for a portion of the protein; this choice has important metabolic effects. Medically supervised VLCDs have specific therapeutic applications for rapid weight loss, such as in morbid obesity or before a bariatric surgery, using formulated, nutritionally complete liquid meals containing 800 kilocalories or less per day for a maximum of 12 weeks.

A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long-term elevations in blood sugar.

Bariatric surgery is a medical term for surgical procedures used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

Intermittent fasting is any of various meal timing schedules that cycle between voluntary fasting and non-fasting over a given period. Methods of intermittent fasting include alternate-day fasting, periodic fasting, such as the 5:2 diet, and daily time-restricted eating.

<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify the ideal body weights for different individuals.

Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in health care. Clinical in this sense refers to the management of patients, including not only outpatients at clinics and in private practice, but also inpatients in hospitals. It incorporates primarily the scientific fields of nutrition and dietetics. Furthermore, clinical nutrition aims to maintain a healthy energy balance, while also providing sufficient amounts of nutrients such as protein, vitamins, and minerals to patients.

Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.

<span class="mw-page-title-main">Sweetened beverage</span> Type of beverage

Sugar-sweetened beverages (SSB) are any beverage with added sugar. They have been described as "liquid candy". Consumption of sugar-sweetened beverages have been linked to weight gain and an increased risk of cardiovascular disease mortality. According to the CDC, consumption of sweetened beverages is also associated with unhealthy behaviors like smoking, not getting enough sleep and exercise, and eating fast food often and not enough fruits regularly.

<span class="mw-page-title-main">Preventive nutrition</span> Branch of nutrition science

Preventive Nutrition is a branch of nutrition science with the goal of preventing, delaying, and/or reducing the impacts of disease and disease-related complications. It is concerned with a high level of personal well-being, disease prevention, and diagnosis of recurring health problems or symptoms of discomfort which are often precursors to health issues. The overweight and obese population numbers have increased over the last 40 years and numerous chronic diseases are associated with obesity. Preventive nutrition may assist in prolonging the onset of non-communicable diseases and may allow adults to experience more "healthy living years." There are various ways of educating the public about preventive nutrition. Information regarding preventive nutrition is often communicated through public health forums, government programs and policies, or nutritional education. For example, in the United States, preventive nutrition is taught to the public through the use of the food pyramid or MyPlate initiatives.

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