Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspective.
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Reviewed herein are the long-term weight loss outcomes of three fairly recent major modifications of standard dietary therapy for obesity. Appraised separately and in combination, these therapeutic approaches are very low calorie diets (VLCD), behavior modification, and exercise. The weight loss results from VLCD are impressive for only the first 6 to 10 months. Adding behavioral procedures to VLCD increases the weight loss for the first year or two, but not in 3 to 5 years. Adding exercise further increases the weight loss at 1 to 2 years, and those who continue regular exercise achieve the best weight loss results 1 to 6 years later.Keywords:
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In this study we aimed to determine whether very low calorie diets (VLCDs) can be an effective means of weight reduction in obese patients in general practice. Twenty-six patients showed a mean reduction in weight of 15 kg and in body mass index (BMI) of 6.1% within a 12-month period. VLCDs with regular monitoring and feedback were shown to be effective in reducing and maintaining weight loss for up to a year with no reported serious side effects.
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Background and Significance: Although known to effectively provoke large scaled weight-loss, less is known regarding age- and sex-related influences on treatment outcomes of bariatric patients treated with a very-low calorie diet (VLCD) program. Purpose: This study retrospectively examined body composition and metabolic changes induced by a 12-wk proprietary VLCD treatment in obese patients while assessing age and sex differences. Methods: Male (n=16) and female (n=16) patients underwent 12 weeks of VLCD under standard medical care. Results: Older patients exhibited a greater relative loss of FFM compared to younger patients (p=0.004). Older patients also lost a greater proportion of total weight-loss as FFM (p=0.003) and lower proportion as FM (p=0.003) compared to the young group. This age-specific difference in weight-loss composition was driven by the older males. Conclusion: The results demonstrate the need for special clinical considerations for VLCD treated patients, such as older adults and perhaps older males specifically, who demonstrate a reduced quality of weight-loss compared to their younger counterpart.
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To review of the literature on the topic of very-low-calorie diets (VLCDs) and the long-term weight-maintenance success in the treatment of obesity.A literature search of the following keywords: VLCD, long-term weight maintenance, and dietary treatment of obesity.VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from -7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance.VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success.
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For the treatment of obesity we have three diet programs, 1, 000, 900, and 700 calorie diets, containing 60 g protein, 13-18 per cent calorie fat and 53-58 per cent carbohydrate. Regardless of age, height, grade of obesity or daily activity, we prescribed the 1, 000-calorie diet for obese men and the 900-calorie diet for women. Observing the cessation of weight reduction, we reduced to 900-calorie diet for men and 700-calorie diet for women. Four hundred and sixty obese patients were treated with these dietary regimens. Of these, 400 were treated in out-patients clinic and 60 in hospitalization. Different from the general incidence of obesity, there were over four times more women who visit the obesity clinic than men, and there were slightly more young ones. Of 400 out-patients, 12.8 per cent did not return after the diet was prescribed and 5.3 per cent did not obtain a weight loss even though they came back. A weight loss was observed in 82 per cent, among whom 51.7 per cent obtained a weight loss of more than 4kg. The average number of weeks required for a weight loss of 4 kg were 5.0±0.3 weeks in 183 out-patients and 2.2±0.2 weeks in 44 inpatients. The fact that the speed of weight loss is slower in out-patients in spite of the possibility of having more activity is thought to be because it is difficult for them to adhere to the prescribed diet at home.
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In the majority of obese patients adjustment of the diet will be required to reduce calorie intake. In general, diets containing 1,000 to 1,800 kcal/day should be selected for obese patients. VLCD (very low calorie diet) is below 600 kcal/day. VLCD should not be used routinely for weight loss therapy because they require special monitoring and supplementation. A diet should be integral part of any program aimed an achieving a weight loss of 5%. Protein is approximately 15-20%, carbohydrate 60%, fat is 20-25% of total calories. Low carbohydrate-high protein diets, used on a regular basis and without consideration of the nature of carbohydrates the source of proteins, are associated with the increased risk of cardiovascular disease. Consumption of high-fructose corn syrup in beverages may play a role the epidemic of obesity.
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Very Low Calorie Diets (VLCD) have been demonstrated to achieve rapid and significant weight loss in obese people without kidney disease. However, there is no published evidence on the use of VLCD in end-stage kidney disease (ESKD) patients. Current manufacturers' guidelines state the meal replacement VLCD are contra-indicated in patients with impaired kidney function (eGFR <60ml/min). The aim of the study is to determine if the use of a VLCD with 3 meal replacements is safe and effective for weight loss in patients with ESKD treated with haemodialysis (HD).
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