Obesity Patient Education
Lifestyle Modification
Advantages of Weight Loss
- Reduction in blood pressure (BP), lipid levels (eg total cholesterol, TG, and LDL) and all-cause mortality
- Decrease in BP (<130/80 mmHg), LDL <3.4 mmol/L, fasting blood glucose <5.5 mmol/L
- Risks of developing diabetes mellitus (DM) and osteoarthritis are reduced
Dietary Therapy
- Energy expenditure should be more than total energy intake (caloric deficit)
- Patients are generally advised to decrease portion size of food, choose low energy-dense foods and drinks, avoid between-meal snacks, not skip breakfast and avoid nighttime eating, and reduce binge eating
- Consumption of low-fat, low-calorie diets are important for successful weight loss for 12 months
- Calories
- 500-1000 kcal/day reduction from usual intake to achieve weight loss of 1-2 lb/week
- Every 24 kcal/day reduction will result in approximately 1 kg loss in body weight, half of which occurs in 1 year and 95% in 3 years
- Intake of 1200-1500 kcal/day for most women and 1500-1800 kcal/day for most men
- Calorie reduction may also be simplified by using a 9-inch plate with half of the plate composed of vegetables and fruits and the other half divided between carbohydrates and protein
- Fats
- Amount reduced will depend on each specific country’s national standard
- Total fat should be ≤30% of total calories (trans fat <1%, saturated fat 7-10%, monosaturated fat up to 15% of total calories); with most fats coming from fish, nuts and vegetable oils
- Carbohydrates
- Should comprise 55% of total calories
- Complex carbohydrate from fruits, vegetables and whole grains are preferred
- Protein
- Should be ≤15% of total calories
- Derived from plant source or lean animal sources
- Fiber
- Should get ≥25-35 g/day
- Delays gastric emptying causing a feeling of fullness and decreased appetite/hunger
- Also helps decrease absorption of fat and cholesterol
- May be obtained from oatmeal, whole wheat bread, rice, beans, citrus fruits, carrots, cauliflower, strawberries, peaches and apple with skin
- Vitamins and minerals
- Calcium: 1000 mg/day depending on local guidelines (especially for women at risk of osteoporosis)
- Vitamin D: 10-20 mcg/day
Modified Diets
- Low-Calorie Diet (LCD)
- Food-based approach intended to lower caloric intake by 500 kcal/day from maintenance requirement regardless of macronutrient composition
- Contains approximately 40 g fat, 200 g carbohydrate, and 70 g protein
- An average of 8-10% reduction in total body weight was noted over a 6-month period
- Very Low-Calorie Diet (VLCD)
- Caloric intake of 800 kcal/day regardless of macronutrient composition
- Uses calorie-controlled, vitamin/mineral fortified liquid meals utilized as the only nutrient source, substituting all meals
- Used for maximum of 12 weeks; requires use of supplements and monitoring under experienced practitioners
- Indicated in moderately to severely obese patients who are motivated but have failed with conservative methods, or in patients with BMI of 27-30 who have medical conditions that might respond to rapid weight loss
- Weight loss of approximately 20 kg is noted within the first 6 months; fast regain between 6-12 months
- Best done by a certified nutritionist or dietitian
- Physicians should also consult with nutrition professionals when prescribing a particular weight loss diet, including individualized medical nutrition therapy, that will address the patient’s needs
Physical Activity
- There is very strong evidence supporting the role of regular physical activity in the prevention and management of cardiovascular disease and DM
- Moderate- to vigorous-intensity aerobic exercises (eg swimming, table tennis, 3-4 mph brisk walking, 10 mph cycling) are recommended for 30-60 minutes, 5 days/week (>150 minutes a week)
- 30 minutes/day for cardiovascular fitness
- 60 minutes/day or >250 minutes/week to control body weight after weight loss
- Resistance training using major muscle groups in single-set exercises may also be advised 2-3 times/week to maintain weight or modestly increase mobility and muscular or fat-free mass
- Appetite is suppressed during and immediately after exercise, but increases after an hour
- Activity should be tailored to patient’s age, ability and cardiovascular risk
- Increase in daily activity should be encouraged (eg walking, climbing stairs)