Advantages of Weight Loss

• Reduction in blood pressure, lipid levels (eg total cholesterol, triglycerides, and LDL) and all-cause mortality
  
  • Decrease in blood pressure (<130/80 mmHg), LDL <3.4 mmol/L, fasting blood glucose <5.5 mmol/L

• Risks of developing diabetes mellitus and osteoarthritis are reduced

Dietary Therapy

• Energy expenditure should be more than total energy intake
• Consumption of low fat, low calorie diets are important for successful weight loss for 12 months
• Eating breakfast is important to control weight and increase metabolism for the day
• Calories
  
  • 500-1000 kcal/day reduction from usual intake to achieve weight loss of 1-2 lb/week
  • 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 max 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 that will address the patient’s needs 

Physical Activity

• There is very strong evidence supporting the role of physical activity in the prevention and management of cardiovascular disease and diabetes mellitus
• Studies have shown that losing weight is difficult with moderate-intensity physical activity only
• Moderate-intensity 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 cadiovascular 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
• Appetite is suppressed during and immediately after exercise, but increases after an hour
• Activity should be tailored to patient’s age, ability, cardiovascular risk
• Increase in daily activity should be encouraged (eg walking, climbing stairs)