It is essential, if you wish to demonstrate a response to changing the caloric content of food, that studies are carried out blind: It proved difficult to find studies that had covertly reduced energy consumption and monitored subsequent calorie intake as the majority of studies either had added calories or were not blind Table 1. That is, reducing the calorie content of particular foods resulted in no overall reduction in energy consumption. Understanding these differential responses may be the key to learning to benefit from a reduced calorie intake. In addition energy compensation may be aided by changes in metabolic rate.
Body weight decreased significantly after fasting or restricting the diet, although when allowed to eat normally the lost body weight was regained within 4 days. There had, however, been no increase in the amount of food eaten, and it appeared that reducing food intake had decreased the metabolic rate and thus ensured the recovery of body weight. This study suggested that the failure to maintain a reduced body weight does not necessarily reflect an increased appetite or a raised food intake; rather physiological mechanisms have important roles.
In the context of attempting to reduce body weight, this is the worst possible scenario. For example, when a larger portion supplies more calories, if it is part of a general and prolonged increase in energy intake it will tend to be stored as fat.
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The body does not try to reduce subsequent food intake to return to the preexisting body weight but rather anticipates starvation by storing energy. In contrast, if calorie intake is reduced, the body compensates by decreasing its metabolic rate or stimulating food intake. Rather than assuming that decreasing calorie intake will inevitably influence body weight, a more sophisticated conception is that there are regulatory mechanisms that influence future food intake.
When food intake was measured over days, de Castro found evidence of feedback mechanisms. A study of military trainees during basic training found that on a day-to-day basis there was no relationship between energy intake and expenditure. Again when cyclists taking part in the Tour de France were monitored, the association between energy expenditure and subsequent intake was closer after 3 to 5, rather than 1 to 2 days Saris, Both of these studies examined those who were physically active; however, a similar finding has been reported in those displaying more normal levels of activity.
The findings are consistent. Food consumption is influenced by previous energy intake, often after as much as 4 days. Thus short-term studies, of the type that typifies much of the psychological work in this area, will be unable to examine the mechanisms that regulate food-intake. The existence of mechanisms that smooth out the day-to-day energy intake suggests that the minor changes in caloric intake associated with the modification of food items are unlikely to have a significant impact.
What happens when, over a longer period, energy intake is reduced? Although a diet may produce a short-term gain, it is at a long-term cost. Even one year after dieting, the levels of leptin, peptide YY, cholecystokinin, insulin, ghrelin, gastric inhibitory polypeptide, and pancreatic polypeptide have been found to differ from baseline values Sumithran et al.
There are other physiological changes. Given these responses to dieting, it is not surprising that it has been proposed that in the long term it does not work; any lost weight tends not to be maintained. In fact an examination of the long-term consequences of low-calorie diets found that between one third and two thirds of dieters regained more weight than they lost initially Mann et al. Weight cycling, or more colloquially yo-yo dieting, refers to a cycle of weight loss followed by regaining the lost weight, followed by again dieting, and so on. The Summermatter Cycle describes how, initially during dieting, the energy expenditure of muscle reduces.
Such a mechanism illustrates that directing attention to the reduction of food intake, without realizing that it is the maintenance of weight loss that is important, is unlikely to be successful. Thus the body has as short-term goals the smoothing out of energy intake and maintaining the existing body weight. However, in the long term other mechanisms come into play that discourage large fluctuations in weight. Although over a period of months large amounts of energy are consumed, over time there are often relatively small variations in body weight.
The mechanisms are not perfect, but over long periods the ability of the body to balance energy intake and expenditure is staggering. It has been estimated that the average year-old male in Western Europe consumes 1. Similarly the United Nations Food and Agriculture Organization calculated that the average American consumes 3, calories Based on food consumption data, the U. Department of Agriculture found that over a year the average American consumes nearly one ton of food. However, although a large energy intake might be expected to be associated with putting on large amounts of weight, the figures do not add up.
This level of energy intake needs to be placed in the context of the U. The organization calculates that a sedentary adult male requires 2, calories 9. The comparable figure is 2, Without the intervention of compensatory mechanisms, this great excess of energy intake over expenditure would result in a massive annual increase of weight. Although these ballpark figures cannot be expected to produce anything other than crude estimates, it is obvious that the weight of the average American is not increasing by anything in the range suggested by the difference between the actual and recommended levels of energy intake.
Without compensatory mechanisms every year, this difference would result in an increase in weight approaching pounds. Therefore, someone who was initially pounds 68 kg would 20 years later be pounds 75 kg ; that is, the person would have put on 0. When 15, Swedish women were monitored over 10 years, the annual weight gain was 0. In a Scottish population, over 9 years the average annual weight increase, in those initially aged 39 years, was 1.
Females aged initially 59 years, increased by 0.
Similarly over 10 years a German study found an annual weight gain of 0. In the context of the observed annual weight increase, it has been calculated that over a year 3, kcals These figures translate to a daily excess of energy intake over expenditure of only 9 kcal 38 kJ , a figure put in context by a teaspoon of sugar providing 16 kcal 67 kJ.
Given the large number of calories often consumed, it is clear that factors other than calorie intake need to be considered. There is, however, evidence that the analysis of weight change over long periods may be misleading. Weight may not increase gradually, but rather stay stable for long periods Speakman et al. This observation of periods of weight stability again suggests an ability to balance energy intake and expenditure.
If for much of the time the body is able to generate energy balance, this would again argue against the expectation that reducing the caloric content of food will decrease body weight. Average changes in weight, however, hide individual differences. Trying to understand why some manage to maintain their existing weight while others gain weight may be profitable.
A consistent picture has emerged. Even though excessive amounts of energy are consumed, over a year it is, on average, associated with only small increases in body weight. Clearly to understand the development of obesity we need to look beyond the number of calories that pass our lips. The impression gained is of finely tuned control mechanisms that monitor and respond to energy intake and expenditure. Examining these control mechanisms may well be more productive than reducing the caloric content of particular food items that are responsible for a small percentage of a million calories.
A soundly based approach to dealing with body weight needs to reflect the mechanisms by which body weight is determined and maintained. Two main approaches have been suggested: The set point theory suggests that the level of body fat is monitored and compared with a target value Kennedy, As necessary, intake or expenditure is then modified to maintain the desired level of body fat. One problem with this approach is that it does not explain why the incidence of obesity has increased so markedly.
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A second issue is that it does not account for people with different lifestyles having a different risk of becoming obese. The biological mechanisms that control energy balance are programed by environmental factors, such that the point at which body weight is defended may change over time. The settled point is defended by metabolic and behavioral adaptations.
Rosenbaum and Leibel , p. In addition, de Castro and Plunkett suggested that the defended point reflects both the internal and external milieu. With the settling point approach there is a need to distinguish the initial development of obesity from subsequent attempts to reduce it. There can be no doubt that changes in the availability of food, and its increased caloric content, have played a major role in the obesity epidemic. It follows that public health advice has been to reduce food intake, although there has been limited success. Unfortunately, although the high level of calorie intake was a large part of the initial problem, it does not follow that its reduction will be a major part of the solution.
When a reduction in calorie intake has decreased body weight, there are powerful physiological adaptations that favor regaining that weight Greenway, When the initial attention associated with attempting to lose weight dissipates, body weight increases and returns to, or even exceeds, the starting level Mann et al. The present argument that there are mechanisms that over time defend the existing body weight raises a question: If this is the case, why is there an obesity epidemic?
There are various contributory factors. First, obesity often reflects putting on one or two pounds 0. Second, the nature of the entire diet is important. To prevent energy compensation, low-energy dense foods should be consumed see below. However, many Western diets have a high energy density that rapidly compensates for any reduction in energy intake. Poverty is associated with a low expenditure on food, a low intake of fruits and vegetables, and a high intake of fat.
The cheapest foods tend to have a high energy density. Another part of the answer is that to control weight it must be possible to both lose weight and maintain that loss. It may be that it is not the amount consumed at a meal that is important but rather the lack of opportunity to prevent subsequent compensatory adjustments. Having eaten a large meal, is there an opportunity to subsequently reduce calorie intake?
Often we do not eat because we are hungry but because it is meal time; we do not choose what to eat but rather eat what has been prepared by others; we consume a portion determined by those serving the meal, the food manufacturer, or the food outlet. As such, the opportunity to balance energy consumption and expenditure may be limited.
It is clear that obesity reflects many factors other than calorie intake and any coherent policy should address more than the caloric content of a meal. Although being aware of calorie intake is an approach often taken by those in control of their weight, the present question is the extent to which reducing calorie intake can help more generally to decrease obesity. More specifically, is covertly decreasing calorie levels, for example by decreasing a portion size, going to be influential in those not consciously engaged in reducing intake?
The weight conscious are actively engaged with trying to not put on weight. As often these people are close to energy balance, counting calories is potentially a successful approach. There remain the two thirds of the U. In this circumstance, is reducing the calorie content of particular meals helpful? Whereas those who are weight conscious are working at the margin of energy balance, and may even consume less energy than they expend, the obese tend to have an intake in excess of expenditure.
Why then should a small difference in calorie consumption greatly influence body weight? The settled point is defended, such that any decrease in energy intake will stimulate compensatory mechanisms. In those who are obese, calorie intake will reduce weight only if an energy deficit can be achieved. Although both the obese and those who successfully control their weight are faced with powerful pressures to regain any lost calories, there are critical differences. Those maintaining a low weight often use cognitive strategies to prevent compensatory increases in calorie consumption.
Those who put on weight may be unaware of psychological strategies or may choose not to use them. Unless the obese consciously engage with calorie control, requiring food manufacturers and food outlets to reduce portion size would be expected to be ineffective. If there is no conscious control of calorie intake, the body will simply replace the lost energy. In addition, it is unlikely that minor changes in diet will reduce the incidence of obesity, as controlling body weight will often require a complete dietary makeover. It does, however, seem likely that concentrating on the nature of the food consumed, rather than simply reducing calories, offers advantages.
An approach that considers macro-nutrients, energy density, and glycemic load may help to prevent energy compensation.
There are reports that appetite, the control of body weight, and energy compensation are influenced by the macronutrient composition of meals amount of fat, carbohydrate, and protein. When in the short term the energy content of the diet is reduced, if some of the available foods are energy dense, that is they provide more calories per gram of food, then the lost energy tends to be replaced. As we tend to eat a similar volume of food, the same volume of low density foods provides fewer calories. Thus a low-energy diet has two advantages: It decreases energy intake but also helps to maintain any weight loss.
Low-energy dense foods tend to have a high level of water and a low fat content; fruit and vegetables are good examples. A satiety index has been developed that found eating foods that contained more protein, fiber, and water resulted in feeling fuller after a meal, whereas the fat content had the opposite impact S. These findings were confirmed more recently when foods were rated for their perceived ability to induce satiety.
Eating protein stimulates energy expenditure associated with its absorption, digestion, and metabolism thermogenesis: After dieting, in a randomized trial for 6 months, either a high-protein or control diet was consumed. Similarly, a Cochrane review concluded that the overweight and obese lost more weight when on a low-glycemic-load diet; that is, they consumed a diet that produced smaller increases in the level of blood glucose.
The fall in resting energy expenditure was, however, largest after the low-fat diet: After a delay of 3 to 4 days a greater intake of carbohydrate or protein, but not fat, was part of a negative feedback loop that reduced subsequent energy intake. Hence, there is the potential to develop a diet based on the nature of the food items, rather than calorie content, that will help to maintain a lower weight. However, rather than concentrating specifically on the properties of individual foods, it should be remembered that it is the habitual pattern of eating that predisposes to obesity.
Thus the opportunity exists for psychology to encourage the consumption of diets that are less likely to be associated with the gaining or regaining of weight. This will, however, involve considerations other than simply reducing calorie intake. In summary, a short-term priority of the body is to balance the extremes of energy intake that occur from meal to meal. As such, minor changes in caloric intake are unlikely to have a long-term impact.
A second objective, following a loss of weight, is to ensure a return to the preexisting body weight. These mechanisms have implications for those recommending that we should try to reduce obesity by decreasing calorie intake: They suggest that the strategy, unless part of a wider intervention, will tend to fail. Before you jump to start a crazy cleanse, check if you have other symptoms of liver problems, such as fatigue, insomnia, brain fog, rashes or acne, digestive troubles constipation, acid reflux, indigestion, bloating , high cholesterol, and blood sugar and insulin imbalances, which can lead to low energy, cravings, and excessive thirst and urination.
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Once you have the results, you can make the following lifestyle changes to help remedy and even reverse the problem. Use medications only when necessary, as even taking a Tylenol can have severe consequences on the liver. Eat and drink clean. Skip foods and beverages that contain high-fructose corn syrup, hydrogenated oils, additives, hormones, preservatives, or artificial colors, and eat free-range or organic whenever possible. Your liver has to work harder to filter all this gunk.
Consume cruciferous vegetables such as Brussels sprouts, broccoli, cauliflower, kale, collards, and cabbage. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:. Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet.
To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time. Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. A behavior modification program can help you make lifestyle changes and lose weight and keep it off.
Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns.
Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work. Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria:.
Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions. Commonly prescribed weight-loss medications include orlistat Xenical , lorcaserin Belviq , phentermine and topiramate Qsymia , buproprion and naltrexone Contrave , and liraglutide Saxenda.
You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost. In some cases, weight-loss surgery, also called bariatric surgery, is an option.
Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks. Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and:.
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It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full.
This new technology received FDA approval in for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Unfortunately, it's common to regain weight no matter what obesity treatment methods you try.
If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile. One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.
You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Your effort to overcome obesity is more likely to be successful if you follow strategies at home in addition to your formal treatment plan.
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Numerous dietary supplements that promise to help you shed weight quickly are available. The effectiveness, particularly the long-term effectiveness, and safety of these products are often questionable. Herbal remedies, vitamins and minerals, all considered dietary supplements by the Food and Drug Administration, don't have the same rigorous testing and labeling process as over-the-counter and prescription medications do.