Weight Loss Home:Position Statement:Top 4 Reasons for Weight Loss FailureMark KimathiTaking the major know factors that have implications on weight loss and grouping them, the author finds they fit into four internally related groups. They further find that, the lack of inclusion of any one of these four in their effective form for an individual is a major contributing factor to long term failure in losing weight. In effect this makes them the top reasons why one fails in losing weight. Herein the author makes a case for the Top 4 Reasons for Weight Loss Failure.Context: There is contradictory as well as seemingly contradictory information from different sources including adverts, news reports, science journals, diet books etc that makes it difficult and confusing to make decisions on how best to lose weight for the lay person. The purpose of this paper is to relay the more agreed on facts about losing weight. This will provide a basis for further search for information to make better decisions about losing weight.
IntroductionObesity though not agreed on, as being a disease 1,2 is a chronic disorder of excess body fat. According to World Health Organization (WHO) one is considered overweight if they have a BMI equal or above 25. At this stage, weight loss for health reasons is recommended3.Obesity has progressively become a world epidemic4 with the U.S leading with over 60% of its population as overweight5. And just to show the problem is entrenched, the epidemic is catching up with children6,7. There is further bad news to this; excess weight in the young is a predictor for overweight in adults8, meaning unless the problem is dealt with decisively and permanently, it can only get worse. There is no question as to whether an overweight person should lose weight or at least avoid any more weight gain. This is because obesity carries with it other chronic health conditions like Type II Diabetes, Hypertension, Asthma, Sleep Apnea, Gall Bladder problems, orthopedic conditions and even psycho-social effects and stigma8,9. Infact the risk of some accompanying disease like Type II diabetes directly increase with the increase of BMI9,10. Already these co-morbidities are present in children8. And though there is an endevour to lose weight a significant number are doing it for cosmetic reasons and have no reason to lose weight based on their BMI11. For the overweight though, even modest weight loss of between 5-10% has been found to improve health status12-14. Indeed successful weight loss has been defined as losing at least 10% at initial body weight and maintaining it for at least one year15. However, this definition only addresses short-term weight loss. A study shows that 97% of dieters regain all their weight in 5 years16 On the other hand overweight/obese patients show high expectation when going into a weight loss program and a 10% loss is considered disappointing. Weight loss targets are as high as 30% initial body weight17. Such high expectations are viewed as counter weight loss and recommendations are pointing to educating patients to lower their expectations. Though losing weight has its inherent disadvantages like increased risk of developing gallstones, hair loss, cholecystis etc., most are short term and are rarely severe enough to contradict the weight loss and health benefits accrued18.
Top 4 Reasons for Weight Loss FailureWeight gain results from simply a positive calorie balance. This excess energy or calories is stored as body fat in humans. Naturally to lose weight one needs to introduce a negative calorie balance. This introduces a deficit that is compensated for by the bodys fat, resulting to weight loss. Once desired weight is achieved the patient should hold in neutral calorie balance to maintain their weight.Consequently weight loss should be in two successive phases; weight loss and weight maintenance. In introducing a negative calories balance in a dieting program, there will have to be include a weight loss diet. This is the first of the Top 4 Reasons for Weight Loss Failure.
Weight Loss DietA weight loss diet is key in inducing a negative calories balance19, however there doesnt seem to be a meeting of minds as to which is the best weight loss diet. Different studies show different diets to be effective for weight loss with slightly differing results.Nearly all-popular diet forms have registered weight loss. They include the contentious low carb diets20-25, low energy low fat diets26 reduced energy Glycemic Index diet25-27 low calorie diets25 as well as Very Low Calorie Diets (VLCD)25. Even commercially formulated diets like Zone, Ornish and Weight Watchers have shown weight loss. And this includes Atkins that has attracted a lot of hue and cry28. What is common of all these diets is they manage somehow to introduce a calorie deficit needed for weight loss. They all have comparative advantage over each other like better adherence and improve level of health indicators like triglyceride level and insulin resistance. But in one year they tend to have nearly similar weight loss. Evidently it is unlikely one diet is optimal for all overweight individuals. Therefore recommending a weight loss diet that fit a patients preference, conditions and adherence levels would be most appropriate. Unfortunately though, however much we tinker with diets, they do not provide a lasting solution to obesity by themselves. They have inherent disadvantages like loss of lean body mass29. No definite diet is known to sustain long-term weight loss25. Actually weight loss through diets is known to be regained 65% in one year29. Hence the already common inclusion of weight loss exercises in dieting programs the second of the Top 4 Reasons for Weight Loss Failure.
Weigh loss Exercises (Physical Activities)Persistent weight regain from weight loss diets have result to the inclusion of the flip side of the negative calorie balance increased calorie expenditure.With little evidence of increased energy intake, cases of youth obesity are attributed to physical inactivity30. Infact todays youth are considered the most inactive in history8. As physical activities require energy it would follow that they result to weight loss. Indeed studies show they do result to weight loss albeit modest31-33. Though there are studies to the contrary,34,35 that physical activities do lead to weight reduction is generally agreed on. This apparent contradiction is probably indicates that there is a particular type of exercise that leads to weight loss, such as aerobics. Aerobic exercises can be designed to target mainly body fat and result to effective weight loss41. By themselves physical activities lead to little but better maintained weight loss than that by diets29,31. Of even greater interest is the increased weight loss and improved maintenance achieved by combining a weight loss diet and weight loss exercise29,31,36. This superiority has increased amount of weight loss achievable in the short term and length of maintenance. There is infact a dose response relationship between amount of exercises and length of maintenance37. This means the more exercises one is involved in the longer they can maintain the weight. This is not the only benefit weight loss exercises add to a weight loss plan. Exercises effectively prevent Non-insulin Dependant Diabetes Mellitus (NIDDM) and provide protection to persons of high risk like the obese38. Other risk indicators of cormbid factors like improved plasma lipoproteins are directly attributed to exercises39. Not to mention exercises help in retaining lean mass40,41 that can be lost with diets-only programs. To expressly avoid weight gain you need more exercises than those recommended to improve health. You will need 45-60 minutes/day and as high as 60-90 minutes/day of exercise of moderate intensity42. Fewer long-bout exercises or many short-bout exercises do not matter, provided you get to expend equal amounts of calories in a week41. What counts is the cumulative calorie expenditure. For previously sedentary persons, lifestyle physical activities like walking to the mall or taking the stairs are just as effective as a structured exercise program in the gym43,44. Evidence shows that patients lose weight in a program then, regain it when out of the program. There seems to be lack of transfer of behaviors consistent with weight loss from the program to real-life conditions45. This is a responsibility of the third of the Top 4 Reasons for Weight Loss Failure.
Weight Loss Behaviours / Motivation.Long-term weight loss maintainers have shown particular behavior as concerns diets and exercises. This is attributed to their successful maintenance46. Such behaviors include reaching a self determined goal, regular meal rhythms, eating breakfast, healthy eating, self monitoring regular exercise etc46,48.Similarly regainers show particular behaviors like failure to achieve weight loss, dissatisfaction with the weight achieved, lack of vigilance as concerns what they eat, emotional eating, evaluating self-worth in terms of shape and weight, history of yo-yo dieting, poor stress management among others47,49. Means of creating motivation to ensure acquisition application and persistence of long-term weight loss maintenance behaviour is necessary. Motivation is defined as an internal state or condition that arouses, energizes and/or directs intensity and persistence of a behavior50. Weight loss motivation would involve creating an internal state that directs and ultimately drives an individual to acquire and persist with long-term maintenance behaviour. For the majority long-term weight loss management is still a challenge51, probably because behavioral changes are not easily achieved52. Behavioral treatments that look into modifying weight loss goals, exercise, self-monitoring51, to achieve long term maintenance dont seem to result to acquisition and/or persistence of these skills long-term. However use of these motivation techniques do increase adherence to a weight loss plan53. Often motivation techniques are lumped together as behavioral treatment (BT). They include skills on self monitoring, healthy food choices, lifestyle physical activities, stimulus control, eating patterns quality of diets, problem solving, eating in a social situation, restaurant eating, assertive training, recipe modification, stress management, relapse management and motivation enhancement among others-. Some of these techniques that have documented results include motivational interviewing53, psycho education54, self-efficiency55 and confidence estimates56 among others. The problem has been in the persistence of these positive weight loss behaviours, which brings us to the fourth of the Top 4 Reason for Weight Loss Failure.
Weight Loss Support StructuresAs opposed to motivation which is internal, support structures, the author suggests, are physical means that assist in introducing calories deficit and/or in developing and acquiring coping skills that result to behavioral change, and hopefully lifestyle change consistent with a healthy weight.Until the recent past, use of products like diet supplements, pre-packaged meals, and online weight loss programs have been considered somewhat exploitive and even bogus58. And this was not without good reason; from toilet products that extract fat to shoe insoles that guarantee weight loss by reflexology59, the commercial sector has shown irresponsible enthusiasm. But with responsible use, support structure can act as adjuncts to weight loss. Support structure include meal plans, grocery list, recipes, logs for counting calories, diet supplements, diet drugs, meal replacements all the way to gastric surgery. Though some support structures like diet drugs20,61-62 and weight loss surgery have proven ability to result to weight loss by themselves, they should be used with the intention of lifestyle change and eliminate dependence. The combination of these structures with diet, exercises and/or behavioral changes has shown additive effect. This has been documented in the use of drugs62,64,65 and food provision63. Support structures that have shown results include structured meal plans that help in self monitoring and calorie estimation; food provision that improves adherence self monitoring quality of diet and nutrition knowledge- exercise equipment that increase adherence and improve long term maintenance69 as well as drugs20,65-66. Support structures should be use to make diets, exercises and behavioral changes more effective both in the short term and long term.
SummaryA problem caused by different yet loosely related factors would require a solution consisting of individual solutions to each factor working in tandem and hopefully in synergy. Obesity is such a problem.It results from a "toxic environment", poor emotional management, bad eating habits, poor food choices, a sedentary lifestyle, genetic just to mention a few. The author suggests that most of these factors can be mitigated from the perspective of diets and exercise to introduce calories deficit followed by an iso-caloric state for maintenance. The acquisition and continued practice of behaviors consistent with the iso-caloric state; and finally support structure that act as an adjunct to the calories deficit and maintenance of the iso-caloric state. This makes diets, exercises, behavioral changes and support structures as the Top 4 Reasons for Weight Loss Failure.
Special recommendation1. So far the only feasible way for long term weight loss maintenance is by lifestyle change. Approach weight loss based on the Top 4 Reasons for Weight Loss Failure with an intention to modify relevant behaviour for life.2. Efforts should be put to individualize weight loss plans or at least group together closely related cases into a similar program keeping in mind there is no one plan that fits all ---
CITATION: Mark Kimathi - Position Statement: Top 4 Reasons for Weight Loss Failure
http://www.health-emark.com/top-4-reasons-for-weight-loss-failure.html [Date Retrived]
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