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Weight Loss Information for Adults

Introduction

No matter how many new weight loss methods and products are developed, basic concepts about weight and calories do not change. The "calories in - calories out" concept summarizes the basic message, which is: if you eat more calories than you need, you will gain weight. If you eat fewer calories than you need, you will lose weight. And if you eat exactly as much as you need, you will maintain your weight.

There are no magic pills for weight loss. FDA-approved weight loss medications can be valuable tools for weight loss, but individuals taking these medications must still make diet and lifestyle changes or they won't lose weight. Over-the-counter medications continue to be unsafe, ineffective or both.

Fad diets help some people lose weight, but the weight is often re-gained when the diets are discontinued.  Many fad diets are based on the fact that water weight is lost first when calories are reduced. Once the diets are discontinued, water weight is quickly regained. These diets are ineffective for long term weight loss (which involves fat loss), and they do not teach people how to make the long term changes that are necessary to keep the weight off after it has been lost.

Bariatric surgery is one of the newest weight loss methods. It has received positive media attention; nonetheless, all types of bariatric surgeries have risks and require very stringent post-operative diets. Individuals who do not follow the post-operative diets run the risk of serious health consequences and the likelihood of regaining weight.

For most people, weight loss is best achieved through gradual changes in diet and lifestyle. The good news is that these changes can be made in many different ways, allowing individuals to choose the specific steps that work best for them. 

Determining Overweight Status
(for adults & adults with special needs

Determining overweight status is not always easy. Some adults carry extra weight well, and because so many people are heavier now than people in the past, being heavier appears "normal".

Body mass index is the main measure used to determine healthy body weight. Body mass index (BMI) is a ratio of weight to height. The higher the BMI, the heavier the individual is for his particular height. For adults, the range of BMIs that is considered healthy is: 18.5 - 24.9

There are important limitations to BMI. BMI is an indirect measure of body fatness based on population averages. Some individuals are heavier than average not because they have more fat, but because they have more bone and muscle mass than average. These individuals may have healthy body weights, but because of the extra bone and muscle mass, their BMIs may be above 24.9. Unusally tall and large adults, adults with large frame sizes or extra muscle mass can fall into this category

Adult With Special Needs

It can be challenging to determine weight status in adults who have unusual body shapes, missing limbs, or atrophied limbs. BMI may be of limited usefulness in these cases. In general, if the face and torso appear to be fat, particularly if the face has a double chin, weight loss may be needed. If scoliosis or kyphosis are present, the face may be a more reliable indicator than the torso.

For amputees, there is a clinical method for adjusting body weight based on the missing limb(s). Therefore, desirable body weight ranges can be determined in these cases.

BMI Summary

BMI equals weight (kg) divided by height (meters) squared.

  • A BMI between 18.5 - 24.9 is within normal range.

  • It is possible to have a BMI within normal range and still be overweight. This can happen if an individual has a BMI at the upper end of the range when he or she should have a BMI at the lower end.

  • A BMI between 24.9 - 29.9 indicates overweight status for people with small, medium, (most) large builds, and some extra large builds. While some people are able to maintain BMIs in this range for years before health problems develop, it is considered stage I obesity. Health problems can develop over time, so it is usually a good idea for people in this weight category to lose weight.

  • Individuals with extra large builds or extra muscle mass who have BMIs between 24.9 - 29.9 require individual evaluations to determine whether their BMIs correspond to healthy or unhealthy body weights.

  • A BMI between 30.0 - 39.9 indicates stage II obesity. Health Rrisks are significantly increased, and some health related diagnoses are likely to affect everyone with BMIs in this range.

  • A BMI of 40 and above indicates extreme obesity (stage III) and extreme risk for health problems.

  • Any adult who has difficulty determining whether he or she is overweight should consult a dietitian or physician.

Steps to Weight Loss

Most people think only about losing weight. But preventing further weight gain is an extremely important step in minimizing the degree of overweight. And keeping the weight off after losing it might be considered the most important step of all, because there is no point in going to the trouble of losing weight if it is just going to be re-gained all over again.

Step 1: Prevent Further Weight Gain

Many adults gain a few pounds each year, often during the winter holidays. Over a few decades, these pounds can add up to quite a bit of extra weight. Therefore, preventing further weight gain at any point along the way is an important step in getting back toward a healthy body weight.

Preventing further weight gain is also a good goal for adults who do not yet have the time and energy for a serious weight loss effort. Individuals can explore and experiment with small changes in diet and lifestyle with little or no pressure. The changes made during this time, however large or small, can be carried over later into more serious weight loss efforts. Preventing further weight gain may give many adults the encouragement they need to take further steps toward weight loss.

Preventing Further Weight Gain

  • Eat breakfast most days of the week. Numerous studies have shown that people who eat breakfast, and who eat earlier in the day are less likely to overeat.
  • Bring a bag lunch to work on some or all days of the work week.
  • Eat fewer fast food and restaurant meals.
  • Eat less food for dinner. Reduce portions by small amounts (take away 1 - 2 tablespoons), eliminate "seconds", increase portions of low calorie vegetables.
  • Avoid eating after dinner.
  • Switch to some low calorie foods, such as: low fat mayonnaise, light salad dressings, lower fat dairy products. See Low Calorie Substitutes handout.
  • Limit intake of regular soft drinks. Switch to some calories free products, or drink water.
  • Limit cream and sugar in coffee and tea.
  • Reduce number of snacks eaten or choose more low-calorie snacks. See Low Calorie Snacks handout.
  • Avoid buying foods that are easy to overeat, such as: chips, candy, ice cream, etc.
  • Get rid of open bowls of snack foods in the workplace and at home.
  • Increase your daily activity in small ways. See Physical Activity & Exercise section.
  • Watch out for the holidays! Eat a snack before holiday parties so you will be less likely to overeat during them. Do not eliminate but do limit the number of sweets and desserts you eat during the holidays.

Step 2: Lose Weight Safely

The good news is that weight can be lost by reducing calories and not doing anything else. The bad news is that once the weight has been lost, exercise is the single most important factor in keeping it off. People who do not become more physically active after they lose weight are highly likely to gain the weight back.  Although weight can be lost through dieting alone, it is lost more quickly when dieting and exercise are combined. Because exercise is so important in keeping the weight of after weight loss, most experts advise people to start exercising while they are in the process of losing weight. This is so they will be more likely to keep exercising after the weight has been lost.

Interestingly, exercise by itself has not been found to be a good weight loss method. Individuals who exercise but do not cut back on calories lose weight much more slowly than individuals who reduce calories or who reduce calories and exercise.

So, the message is: if you can do only one thing to lose weight, reduce your calorie intake. But be prepared to be more phyiscally active after you have lost weight.

Essential Tips for Weight Loss

  • Weight should be lost at a safe rate. Losing weight too quickly can cause gallstones, electrolyte imbalances, loss of heart muscle, heart attack, and even death.
    • A reasonable rate of weight loss for adults is ½ - 4 pounds per week or 2 - 15 pounds per month.
    • The exception to this rule is the first 4 - 6 weeks of weight loss when water weight is lost. Many people lose more than ½ - 4 pounds per week during this first phase. After the first 6 weeks, weight loss should slow down to 2 - 15 pounds per month.
       
  • Break large weight loss goals into smaller ones. Research indicates that people are more successful at losing weight when they focus on losing small amounts rather than large amounts of weight at a time.    
           
    • The initial goal should be to lose 5 - 10 pounds. Once this goal has been reached, the next 5 - 10 pounds can be targeted, and so on. Each successful step builds confidence and momentum for the next step. This approach also builds moderation into weight loss efforts. No one should try to lose 50 pounds in a month, but it can be lost in a year, 5 - 10 pounds at a time.
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  • Find the weight loss approach(es) that work best for each individual. In general, weight loss is achieved by:
    • Changing eating habits (eating more home prepared meals, eating more slowly, etc.)
    • Changing kinds of foods eaten (eating more low-calorie foods and fewer high calorie foods).
    • Changing the amount of foods eaten (reducing portion sizes or number of meals, snacks, or beverages).
       
  • Some people need to make only a few changes in one or two categories in order to lose weight. Others may need to make changes across the board. (See "Action Steps for Weight Loss" for more information.
  • Get Support. While some adults can successfully lose weight on their own, many people find that the support of friends and family is very important.  Individuals who need extra structure and support for weight loss, and those who need guidance in how to make major lifestyle changes for weight loss should consult reputable weight loss counselors and weight loss programs for assistance.
  • Write things down. According to all the weight loss experts, keeping track of what is being eaten, when it is eaten, and why it is eaten are key steps in helping individuals understand their eating habits and gain control over them.
  • Take setbacks in stride. Weight loss is a process, not a test that one passes or fails. Learning to identify and cope with situations that promote overeating is an essential part of learning how to lose weight and how to keep it off.
  • Identify Emotional Eaters. Individuals who chronically binge on food due to stress or depression may benefit from consulting a counselor or seeking psychiatric help before trying to lose weight.

Step 3: Keep the Weight Off

Based on data from the national Weight Control Registry, which has tracked over 5,000 individuals who have maintained significant amounts of weight loss over time should do the following things to keep the weight off after weight loss:

  • Eat at home for almost all of their meals.
  • Eat breakfast.
  • Eat diets moderately low in fat. See Help! Is This a High Fat Food? handout.
  • Be physically active almost every day of the week. See Physical Activity & Exercise section.
  • Check weight frequently. If weight gain is noticed, take steps right away to lose it and prevent it from becoming larger.

Health Risks of Being Overweight

         
  • Heart disease - heart attacks, stroke, blood clots, high blood pressure
       
  • Diabetes
  • Reproductive Problems
  • Cancer
  • Arthritis, disk problems, hip, knee, and foot pain
  • Shortness of breath, fatigue
  • Sleep apnea
  • Reflux (heartburn)
  • Gallstones 

Adults With Special Needs

Down syndrome

Individuals with Down syndrome are among the very few who can legitimately claim that they have a genetic tendency toward being overweight.  Basal metabolic rates are lower for people with Down syndrome, causing them to require significantly fewer calories than are required by other adults. As a result, reduced calorie diets are likely to be the norm for many individuals with this syndrome, and weight gain prevention is a key strategy.

Exercise should be encouraged whenever possible.  Aerobic activities can help keep weight down. Activities that require coordination, balance and agility are also good choices. Adults with Down syndrome are usually sociable and may be motivated to exercise if they can do so with friends, family or in exercise classes.

For individuals who need to lose weight, calories may have to be reduced significantly. To insure that the weight loss strategies are appropriate, individuals with this syndrome should ideally consult health care providers who have expertise in weight management and familiarity with Down syndrome.

Prader-Willi syndrome

In individuals with Prader-Willi syndrome, the satiety center of the brain is not working properly.  Consequently, individuals with this syndrome are always hungry and always trying to eat. Strict diets and exercise are likely to be necessary. Locking the kitchen cabinets and refrigerator may also be necessary.  Behavioral therapy may help individuals learn appropriate eating patterns, but unfortunately, they will still have a lifelong struggle with food.

Prader-Willi syndrome predisposes individuals to have low muscle tone. Activities that build strength and endurance are good ideas, and aerobic exercise is essential for weight control.

Beckwith-Wiedeman syndrome and other gigantism syndromes

Adults with any of these syndromes my be unusually large and heavy.  Being larger does not necessarily make all individuals with these syndromes overweight.  In cases where individuals are overweight, weight loss goals and strategies are likely to be similar to those for other adults.

Other Genetic Syndromes

Turner's syndrome, Alstrom syndrome, Proteus syndrome, Cohen syndrome, and others predispose adults to obesity.  The best approach in these cases is to limit weight gain by using reduced calorie diets and encouraging physical activity when possible.

Corticosteroids

Any adult on corticosteriods for more than a few weeks is likely to gain weight.  Steriods cause extra fluid and fat retention in the body, making weight gain extremely likely.  It is difficult if not impossible to lose weight while steriod use continues. However, weight loss can be accomplished after steriod use is discontinued.

Because corticosteriods cause bone thinning overtime, extra calcium and vitamin D may be needed, and weight bearing exercise (which stimulates and strengthens the bones) is important.  Adults taking steriods should be medically cleared for exercise by their physicians.  Many common activities provide weight bearing exercise.  A few examples are: walking, jogging, dancing, swimming, yoga, martial arts, gymnastics, weight lifting, bowling and team sports. One important exception is bicycling, which is a good aerobic exercise but is not a weight bearing exercise. Therefore, biking should not be a frequent for of exercise for this population.

Other Medications

Other medications besides corticosteriods can cause weight gain, increased appetite, or both in some individuals. These include Zyprexa, Risperdal, Depakote (valproic acid), Paxil and others.  Unwanted weight gain is a very common side effect of Zyprexa and Risperdal in particular. A few individuals manage to maintain normal body weights while taking these medications, but many others gain excess weight and find weight loss difficult.  Adults being prescribed any of these medications for the first time should be informed of the risk for weight gain, so they can try to prevent this side effect to whatever extent possible.

Dysphagia

Adults who have dysphagia (difficulty swallowing) may require thickened liquids and/or thickened solids in some cases.  All thickeners, whether homemade or commercially made, contain calories and add extra calories to the diet.  Weight gain is likely to result unless other parts of the diet are reduced.  Sometimes overall diet quality suffers when reductions are made, and vitamin supplements may be needed to compensate.  Adults who can exercise should do so, to keep undesirable weight gain to a minimum.

Adults with Newly Acquired Disabilities

New amputees and new wheelchair users often require fewer calories than they required previously. Because their stomachs are used to a certain volume of food, they may continue to eat more than necessary and gain weight. To avoid this, these individuals should be made aware of their reduced calorie needs so that they can take steps to prevent undesirable weight gain.

References

Information about adult weight loss was adapted from:

      

  • The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults; NIH Publication NO. 00-4084, October, 2000; published by National Institutes of Health; National Heart, Lung and Blood Institute; NHLBI Obesity Education Initiative; North American Association for the Study of Obesity.
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  • Adult Weight Management Evidence-Based Nutrition Practice Guideline, May 2006; American Dietetic Association Evidence Library; www.adaevidencelibrary.com
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  • Certificate of Training in Adult Weight Management; American Dietetic Association and Commission on Dietetic Registration, 2002.
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  • "Beyond the Diet - For the Professional: Issues in Getting Weight Under Control", Janalee Heineman, The Gathered View, Nov - Dec 2000, Prader-Willi Syndrome Association.
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  • Physical Activity and Public Health: Updated Recommendation for Adults; Haskell, W., I-MIn Lee, Pate, R. et al, Medicine and Science in Sports and Exercise, 2007, published by the American College of Sports Medicine and the American Heart Association
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  • Tips for Meeting Physical Activity and Public Health Guidelines; American College of Sports Medicine website:www.acsm.org.
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