weight reduction; intentional weight loss; excess weight reduction
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Introduction
The result of a conscious effort to lose weight or attenuate a tendency gain weight.
Epidemiology
- low-income overweight or obese adults are less likely to be counseled to lose weight than adults with higher incomes[32]
Physiology
- hormonal adaptations to weight loss may resist attempts to lose weight[15]
Complications
- weight cycling (fluctuations) among middle-aged or older women is not associated with elevated all-cause mortality or cardiovascular mortality[7]
Management
- goals of weight reduction
- diet
- see weight loss diet
- reducing calories 500 kcal/day results in 1 pound weight loss/week
- weight reduction associated with vegetables, whole grains, fruits, nuts, yogurt[20]
- olive oil-rich Mediterranean diet better than low fat diet for weight reduction & reduction in waist circumference[34][35]
- weight gain associated with potatoes, sugar-sweetened beverages & meat[20]
- consistent reduction in daily calories is the most effective & safest weight reduction strategy in to lose weight[9]
- lower intake of dietary sugars is associated with lower weight & measures of body fat in people who do not intend to lose weight[22]
- fast-Food restaurant patrons underestimate calorie contents of meals, especially for larger meals & especially at Subway[23]
- calorie restriction in obese elderly results in loss of muscle mass thus is less preferable to exercise alone for weight reduction in obese elderly[25]
- outcomes not considered
- gradual weight reduction no more effective than rapid weight reduction & rapid weight reduction is not associated with rapid regaining of weight[26]
- allowing choice of a diet, rather than prescribing one, does not improve weight loss[28]
- a low-fat plant-based diet reduces body weight & increases insulin sensitivity & postprandial metabolism in overweight patients[39]
- exercise (see aerobic exercise)
- behavioral therapy[9]
- drug therapy
- indications for drug therapy
- GLP-1 receptor agonists
- liraglutide[9] (preferred agent)
- semaglutide 2.4 mg/week subcutaneous
- serotonergic agents
- selective serotonin reuptake inhibitor (SSRI)
- serotonin agonist (triptan)
- lorcaserin (do not use with SSRI)
- short-term weight loss may occur
- chronic use may lead to weight gain
- orlistat (Xenical)
- sibutramine (Meridia)
- analeptics can suppress appetite for short-term
- bupropion (Wellbutrin)
- short-term weight loss
- no evidence it works long-term[2]
- naltrexone-bupropion[9]
- zonisamide (Zonegran) {anticonvulsant}
- topiramate (Topamax)
- may decrease appetite & reduce weight 6-10%
- adverse effects may outweigh benefits[2]
- phentermine/topiramate[13]
- comparison of different drug treatments[29]
- patients with at least 5% weight loss at 1 year
- placebo: 23%
- phentermine/topiramate: 75%
- injectable semaglutide best among glutides[40]
- liraglutide: 63%
- naltrexone-bupropion: 55%
- lorcaserin: 49%
- orlistat: 44%
- excess weight loss over placebo at 1 year
- phentermine/topiramate: 8.8 kg
- liraglutide: 5.3 kg
- naltrexone-bupropion: 5.0 kg
- lorcaserin: 3.2 kg
- orlistat: 2.6 kg
- likelihood of discontinuing because of adverse events compared with placebo
- highest with liraglutide (odds ratio, 2.95)
- lowest with lorcaserin (OR, 1.34)[29]
- patients with at least 5% weight loss at 1 year
- dietary supplements generally NOT proven safe or effective[2]
- Metabolife
- Xanadrine
- Dexatrim Results
- products with ephedra or ephedrine-related compounds
- bitter orange
- country mallow
- heart leaf
- ma huang
- ephedra-free products often substitute a similar stimulant with a different name
- even small weight reductions can reduce risk of:
- diabetes mellitus type 2
- hypertension
- 10 kg (22 lb) weight reduction can lower systolic blood pressure 5-20 mm Hg[9]
- heart disease
- no evidence that weight reduction will improve mortality[25][42]
- bariatric surgery may be indicated for morbidly obese
- commercial weight reduction programs
- little evidence to suggest benefit[4]
- more effective than advice from primary care doctor[14]
- wearable device that tracks exercise & energy expenditure of little or no benefit[30]
- weight management programs effective in patients taking antidepressants &/or antipsychotics[37]
- home-case component + monthly group meetings most effective strategy[5]
- professional sports-linked programs may motivate men to lose weight[24]
- adequate sleep is an important component of any weight reduction program[6][10][12]
- without pharmaceutical aids, the best success comes when patients use computer or other technology-based tools to motivate themselves[16][21]
- follow-up focuses on relapse prevention, self-monitoring, & social support may be of benefit
- 3 group visits with a dietitian within 10 weeks
- 8 phone calls within 40 weeks[33]
- lower carbohydrate, higher fat intake, with stable protein & energy intake, results in higher energy expenditure during weight-loss maintenance[36]
- intermittent fasting
- of no benefit over standard meals[38]
- may be of benefit at least in short term[41]
- intermittent fasting (8-10 hours/day) as effective as calorie-restriction for weight reduction[45]
Notes
- among commercial weight reduction programs including Weight Watchers, Jenny Craig, Nutrisystem, Health Management Resources (HMR), Medifast, OPTIFAST, Atkins, The Biggest Loser Club, eDiets, Lose It!, & SlimFast, only Jenny Craig & Weight Atchers able to achieve modest weight loss at 1 year (4.9% with Jenny Craig, 2.6% with Weight Watchers) relative to control group[27]
More general terms
Additional terms
References
- ↑ Journal Watch 22(17):131, 2002
Westman EC et al, Am J Med 113:30, 2002 - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Prescriber's Letter 10(6):32 2003
- ↑ Prescriber's Letter 11(1):4 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200110&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Journal Watch 25(4):36, 2005 Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005 Jan 4;142(1):56-66. Review. Summary for patients in: Ann Intern Med. 2005 Jan 4;142(1):I42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15630109
- ↑ 5.0 5.1 Wing RR, A self-regulation program for maintenance of weight loss. N Engl J Med 2006, 355:1563 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17035649
- ↑ 6.0 6.1 Patel SR et al, Association between reduced sleep and weight gain in women. Am J Epidemiol 2006, 164:947 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16914506
- ↑ 7.0 7.1 Field AE et al Weight cycling and mortality among middle-aged or older women. Arch Intern Med 2009 May 11; 169:881. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19433700
- ↑ Prescriber's Letter 17(1): 2010 Drugs for Weight Loss CHART: Drugs for Weight Loss CONTINUING EDUCATION: Natural Medicines in the Clinical Management of Obesity Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260111&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 10.0 10.1 Nedeltcheva AV et al Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity. Annals of Internal Medicine Oct 5, 2010, 153:435-441 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921542 <Internet> http://www.annals.org/content/153/7/435.abstract
Taheri S and Mignot E Sleep Well and Stay Slim: Dream or Reality? Annals of Internal Medicine Oct 5, 2010, 153:475-476 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921547 <Internet> http://www.annals.org/content/153/7/475.extract - ↑ Rock CL et al. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: A randomized controlled trial. JAMA 2010 Oct 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20935338 <Internet> http://dx.doi.org/10.1001/jama.2010.1503
Goodpaster BH et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: A randomized trial. JAMA 2010 Oct 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20935337 <Internet> http://dx.doi.org/10.1001/jama.2010.1505
Wing RR. Treatment options for obesity: Do commercial weight loss programs have a role? JAMA 2010 Oct 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20935335 <Internet> http://dx.doi.org/10.1001/jama.2010.1529) - ↑ 12.0 12.1 Nedeltcheva AV et al. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med 2010 Oct 5; 153:435 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921542 <Internet> http://www.annals.org/content/153/7/435.long
- ↑ 13.0 13.1 Gadde KM et al Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial The Lancet, Early Online Publication, 11 April 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21481449 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960205-5/abstract
- ↑ 14.0 14.1 Jebb SA et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: A randomised controlled trial. Lancet 2011 Sep 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21906798
Jolly K and Aveyard P. Provision of commercial weight management programmes. Lancet 2011 Sep 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21906799 - ↑ 15.0 15.1 Sumithran P et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011 Oct 27; 365:1597 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22029981 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
- ↑ 16.0 16.1 Appel LJ et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011 Nov 24; 365:1959 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22085317
Wadden TA et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 2011 Nov 24; 365:1969 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22082239
Yanovski SZ. Obesity treatment in primary care - Are we there yet? N Engl J Med 2011 Nov 24; 365:2030 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22085319 - ↑ Prescriber's Letter 19(4): 2012 Drugs for Weight Loss Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280403&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jakicic JM et al. Effect of a stepped-care intervention approach on weight loss in adults: A randomized clinical trial. JAMA 2012 Jun 27; 307:2617 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22735431
- ↑ 19.0 19.1 Gadde KM et al. Zonisamide for weight reduction in obese adults: A 1-year randomized controlled trial. Arch Intern Med 2012 Oct 15 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23070267 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1379168
- ↑ 20.0 20.1 20.2 Mozaffarian D et al Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men N Engl J Med 2011; 364:2392-2404 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21696306 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1014296
- ↑ 21.0 21.1 Spring B et al Integrating Technology Into Standard Weight Loss Treatment. A Randomized Controlled Trial. Arch Intern Med. 2012. Dec <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23229890 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1485082
Ma J et al Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care. A Randomized Trial. Arch Intern Med. 2012. Dec <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23229846 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1485081
Rao G and Kirley K The Future of Obesity Treatment: Accessible, Inexpensive, and Technology Based? Comment on "Integrating Technology Into Standard Weight Loss Treatment: A Randomized Controlled Trial" Arch Intern Med. 2012. Dec <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23229914 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1485083 - ↑ 22.0 22.1 Te Morenga L et al. Dietary sugars and body weight: Systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2013 Jan 15; 346:e7492 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23321486
- ↑ 23.0 23.1 Block JP et al. Consumers' estimation of calorie content at fast food restaurants: Cross sectional observational study. BMJ 2013 May 23; 346:f2907 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23704170
- ↑ 24.0 24.1 Hunt K et al. A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): A pragmatic randomised controlled trial. Lancet 2014 Jan 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24457205
- ↑ 25.0 25.1 25.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 26.0 26.1 Purcell K et al The effect of rate of weight loss on long-term weight management: a randomised controlled trial. The Lancet Diabetes & Endocrinology, 16 October 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25459211 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2814%2970200-1/abstract
- ↑ 27.0 27.1 Gudzune KA et al Efficacy of Commercial Weight-Loss Programs: An Updated Systematic Review. Ann Intern Med. 2015;162(7):501-512. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25844997 <Internet> http://annals.org/article.aspx?articleid=2214178
Wee CC The Role of Commercial Weight-Loss Programs. Ann Intern Med. 2015;162(7):522-523 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25845000 <Internet> http://annals.org/article.aspx?articleid=2214183 - ↑ 28.0 28.1 Yancy WS et al Effect of Allowing Choice of Diet on Weight Loss: A Randomized Trial. Ann Intern Med. 2015;162(12):805-814 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26075751 <Internet> http://annals.org/article.aspx?articleid=2322797
- ↑ 29.0 29.1 29.2 Khera R, Murad MH, Chandar AK et al. Association of pharmacological treatments for obesity with weight loss and adverse events: A systematic review and meta-analysis. JAMA 2016 Jun 14; 315:2424 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27299618
- ↑ 30.0 30.1 Jakicic JM, Davis KK, Rogers RJ Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss. The IDEA Randomized Clinical Trial. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27654602 JAMA. 2016;316(11):1161-1171. http://jama.jamanetwork.com/article.aspx?articleid=2553448
- ↑ Yeh JS, Kushner RF, Schiff GD. Obesity and Management of Weight Loss. N Engl J Med 2016; 375:1187-1189. September 22, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27653571 Free full text <Internet> http://www.nejm.org/doi/full/10.1056/NEJMclde1515935
- ↑ 32.0 32.1 Lorts C, Ohri-Vachaspati P. Disparities in Who Receives Weight-Loss Advice From a Health Care Provider: Does Income Make a Difference? Prev Chronic Dis 2016;13:160183. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27710763 Free Article https://www.cdc.gov/pcd/issues/2016/16_0183.htm
- ↑ 33.0 33.1 Voils CI, Olsen MK, Gierisch JM et al Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial. Ann Intern Med. Feb 21, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28241185 <Internet> http://annals.org/aim/article/2605026/maintenance-weight-loss-after-initiation-nutrition-training-randomized-trial
- ↑ 34.0 34.1 Shai I et al. for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008 Jul 17; 359:229. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/18635428 <Internet> http://content.nejm.org/cgi/content/full/359/3/229
- ↑ 35.0 35.1 Estruch R, Martinez-Gonzalez MA, Corella D et al Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes & Endocrinology. June 6, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27283479 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2930085-7/abstract
Mozaffarian D. Food and weight gain: time to end our fear of fat. Lancet Diabetes & Endocrinology. June 6, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27283481 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2930106-1/abstract - ↑ 36.0 36.1 Ebbeling CB, Feldman HA, Klein GL et al. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: Randomized trial. BMJ 2018 Nov 14; 363:k4583 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30429127 Free PMC Article
- ↑ 37.0 37.1 Wharton S, Kuk JL, Petrova L et al. Effectiveness of a community-based weight management program for patients taking antidepressants and/or antipsychotics. Obesity (Silver Spring) 2019 Sep; 27:1539. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31441235 https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22567
- ↑ 38.0 38.1 Lowe DA, Wu N, Rohdin-Bibby L et al Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity. The TREAT Randomized Clinical Trial JAMA Intern Med. Published online September 28, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32986097 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2771095
- ↑ 39.0 39.1 Kahleova H, Petersen KF, Shulman GI et al Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults. A Randomized Clinical Trial. JAMA Netw Open. 2020;3(11):e2025454, Nov 30 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33252690 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773291
- ↑ 40.0 40.1 Shi Q, Wang Y, Hao Q et al. Pharmacotherapy for adults with overweight and obesity: A systematic review and network meta-analysis of randomised controlled trials. Lancet 2021 Dec 8; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34895470 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01640-8/fulltext
- ↑ 41.0 41.1 Busko M Intermittent Fasting Good for Weight Loss, at Least Short Term. Medscape. March 18, 2022 https://www.medscape.com/viewarticle/970545
Varady KA, Cienfuegos S, Ezpeleta M, Gabel K. Clinical application of intermittent fasting for weight loss: progress and future directions. Nat Rev Endocrinol. 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35194176 Review. https://www.nature.com/articles/s41574-022-00638-x.epdf - ↑ 42.0 42.1 LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity- Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Sep 18;320(11):1172-1191. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30326501 Review.
- ↑ 43.0 43.1 43.2 NEJM Knowledge+ Endocrinology
- ↑ Jensen MD, Ryan DH, Apovian CM et al 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129(25 Suppl 2):S102-38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24222017 PMCID: PMC5819889 Free PMC article.
- ↑ 45.0 45.1 Lin S et al. Time-restricted eating without calorie counting for weight loss in a racially diverse population: A randomized controlled trial. Ann Intern Med 2023 Jul; 176:885. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37364268 https://www.acpjournals.org/doi/10.7326/M23-0052
- ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Choosing a Safe and Successful Weight-loss Program https://www.niddk.nih.gov/health-information/weight-management/choosing-a-safe-successful-weight-loss-program