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Comprehensive Weight Management from AMITA Health Weight Loss SolutionsComprehensive weight optimization -
Weight vectors of the index system. Calculating the subjective weight of an index. Step 1: Create the weight judgment matrix. Calculating the objective weight of an index. Step 1: Generate the decision matrix. To eliminate the influences of each evaluation index on the evaluation of the route scheme due to the different dimensions of each evaluation index, normalization is required.
The normalized value is found as follows: 7 Step 3: Calculate the weight. If the feature weight of the i th evaluation object is P ij under the j th index, then 8 Step 4: Calculate the entropy e j of the j th index: 9 Step 5: Calculate the coefficient of difference d j for the j th index.
For a certain index d j , the smaller the difference v ij is, the larger d j will be. Comprehensive weight. TOPSIS evaluation model. Step 1: If there are n evaluation objects and m evaluation indexes, then we can obtain an m × n initial judgment matrix V : 17 Step 2: The dimension of each index may be different, so that decision matrix should be normalized: 18 Where 19 Step 3: Calculate the weight vector of each index from Eq 16 and generate a weighted judgment matrix.
Step 5: Calculate the Euclidean distance between each target value and the ideal value,. Results Highway route scheme optimization algorithm First, the indicator system of the highway route scheme can be constructed according to the characteristics of the project.
Second, the subjective weight and objective weight are calculated. Route scheme selection automation Highway route optimization algorithm involves a lot of calculation, especially when the number of experts and stakeholders is large. Discussion and empirical research The intelligent optimization method proposed in this paper establishes an index system based on the whole life cycle, which is comprehensive and avoids the adverse impact of incomplete index system on the results.
Table 6. Evaluation results of the relative degree of closeness. Fig 4. Sensitivity analysis chart of the preference coefficient. Table 7. Conclusions In this paper, we discussed the limitations of highway route selection. The following conclusions can be drawn: The construction of evaluation indexes directly influences the results of scheme evaluation.
Supporting information. S1 Appendix. s DOCX. S1 Table. Index system data, scored the weight of 23 evaluators. s XLSX. Acknowledgments The authors gratefully acknowledge Prof. References 1. Luiz F, Gomes L. Multicriteria ranking of urban transportation system alternatives.
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As with any drug, the occurrence of side effects may exclude their use in certain occupational contexts. Recognition that weight-related diseases, such as diabetes and hypertension, occur in individuals with BMI levels below 25, and that weight loss improves these conditions in these individuals, suggests that indications for weight-loss drugs need to be individualized to the specific patient.
A number of hormonal and metabolic differences distinguish obese people from lean people Leibel et al. Weight loss alters metabolism in obese individuals, limiting energy expenditure and reducing protein synthesis. This alteration suggests that the body may attempt to maintain an elevated body weight.
The facts that genetics might play a role in hormonal and metabolic differences between people and that weight loss alters metabolism imply that obesity is not a simple psychological problem or a failure of self-discipline.
Instead, it is a chronic metabolic disease similar to other chronic diseases and it involves alterations of the body's biochemistry. Like most other chronic diseases that require ongoing pharmacotherapy to prevent the recurrence of symptoms, obesity management and relapse prevention may someday be accomplished through this form of treatment.
The following sections provide a brief review of the mechanisms of action, efficacy, and safety of prescription agents that have been approved for weight loss and the various over-the-counter substances that are promoted for weight loss. Energy intake may be curbed by reducing hunger or appetite or by enhancing satiety.
Summary of Potential Mechanisms of Action of Obesity Drugs. Some obesity drugs may reduce the preference for dietary fat or refined CHOs Blundell et al.
For example, the drug orlistat reduces the absorption of fat, which results in energy loss in the feces; other drugs not approved for obesity treatment reduce CHO absorption Heal et al.
These drugs may produce sufficiently adverse effects, such as oily stools or increased flatus, so that patients reduce consumption of high-fat foods in favor of less energy-dense foods McNeely and Benfield, ; Sjostrom et al. Obesity drugs also may increase activity levels or stimulate metabolic rate.
Drugs such as fenfluramine or sibutramine were reported to increase energy expenditure in some studies Arch, ; Astrup et al. Fluoxetine, although not approved for obesity treatment, has been shown to increase resting metabolic rate Bross and Hoffer, Ephedrine and caffeine, which act on adenosine receptors, may increase metabolic rate, reduce body-fat storage, and increase lean mass Liu et al.
With one exception orlistat , all currently available prescription obesity drugs act on either the adrenergic or serotonergic systems in the central nervous system to regulate energy intake or expenditure Bray, b.
Table summarizes the mechanism of action of pharmacological agents used for treating obesity, which are discussed in detail below. Prescription Pharmacological Agents for Weight-Loss Treatment and Mechanisms of Action.
Phentermine, an adrenergic agent, is the most commonly used prescription drug for obesity and has one of the lowest costs of all prescription agents. Weight loss is comparable with that of other single agents Silverstone, Diethylpropion, phendimetrazine, and benzphetamine are other adrenergic agents that stimulate central norepinephrine secretion and produce weight loss similar to that of phentermine Griffiths et al.
The categorization of phendimetrazine and benzphetamine as Drug Enforcement Agency Schedule III drugs may have limited their use, although little evidence exists to suggest that they have a higher abuse potential than does phentermine.
Diethylpropion was reported to have a higher reinforcement potential in nonhuman primates than that of the other Schedule III and IV adrenergic drugs Griffiths et al.
No currently available agents for treating obesity are exclusively serotonergic. Fluoxetine and sertraline are selective serotonin reuptake inhibitors that produce weight loss Bross and Hoffer, ; Goldstein et al.
Fluoxetine produced good weight loss after 6 months, but 1-year results were not different from those of placebo treatment Goldstein et al. Sertraline also produced short-term weight loss Ricca et al. Sibutramine inhibits reuptake of both norepinephrine and serotonin in central nervous system neurons.
Blood pressure rose slightly in normotensive subjects, but fell in hypertensive subjects Heal et al. Decreases in fasting blood glucose, insulin, waist circumference, waist-hip ratio, and computerized tomography-estimated abdominal fat were greater with sibutramine than with placebo Heal et al.
The greater weight losses observed in the sibutramine group compared with the placebo group may be responsible for the greater improvements in other parameters.
Common complaints with the use of centrally active adrenergic and serotonergic obesity drugs include dry mouth, fatigue, hair loss, constipation, sweating, sleep disturbances, and sexual dysfunction Atkinson et al. Sibutramine can increase blood pressure and pulse rate in occasional patients and may cause dizziness and increased food intake Cole et al.
Mazindol may cause penile discharge van Puijenbroek and Meyboom, Orlistat binds to lipase in the gastrointestinal tract and inhibits absorption of about one-third of dietary fat Hollander et al.
Average weight loss on orlistat is about 8 to 11 percent of initial body weight at 1 year James WP et al. Although weight loss may be responsible for some of the observed improvements, orlistat lowered LDL independently of its effect on weight loss.
Acarbose is an alpha glucosidase inhibitor that inhibits or delays absorption of complex CHOs Wolever et al. This drug is approved by FDA for the treatment of diabetes mellitus, but not for weight loss. Although it produces modest weight loss in animals, it has minimal or no effect on humans.
Adverse side effects of orlistat include abdominal cramping, increased flatus formation, diarrhea, oily spotting, and fecal incontinence Hollander et al. These adverse effects may serve as a behavior modification tool to reduce the level of fat in the diet and presumably to reduce energy intake.
Orlistat has been shown to produce small reductions in serum levels of fat-soluble vitamins. The manufacturer recommends that a vitamin supplement containing vitamins A, D, E, and K be prescribed for patients taking orlistat.
A variety of drugs currently on the market for other conditions, but not approved by FDA for obesity treatment, have been evaluated for their ability to induce weight loss.
Metformin Lee and Morley, , cimetidine Rasmussen et al. Additional studies are needed to support these findings. Although chronic diseases often require treatment with more than one drug, few studies have evaluated combination therapy for obesity. Private practitioners have used various combinations in an off-label fashion.
The available data suggest that combination therapy is somewhat more effective than therapy with single agents. Combinations such as phentermine and fenfluramine or ephedrine and caffeine produce weight losses of about 15 percent or more of initial body weight compared with about 10 percent or less with single drug use.
However, due to reported side-effects of cardiac valve lesions and pulmonary hypertension, fenfluramine and dexfenfluramine are no longer available. Results of tests using combinations of phentermine with selective serotonin reuptake inhibitors mainly fluoxetine or sertraline have been reported in abstracts or preliminary reports Dhurandhar and Atkinson, ; Griffen and Anchors, These combinations produced weight losses somewhat less than that of the combination treatment of ephedrine-caffeine, but greater than that of treatment with single agents Dhurandhar and Atkinson, Anchors used the combination of phentermine and fluoxetine in a large series of patients and suggested that this combination is safe and effective.
Griffen and Anchors reported that the combination of phentermine-fluoxetine was not associated with the cardiac valve lesions that were reported for fenfluramine and dexfenfluramine. In , Congress passed the Dietary Supplement Health and Education Act, which exempted dietary supplements including those promoted for weight loss from the requirement to demonstrate safety and efficacy.
As a result, the variety of over-the-counter preparations touted to promote weight loss has exploded. Dietary supplements include compounds such as herbal preparations often of unknown composition , chemicals e. With the exception of herbal preparations of ephedrine and caffeine, none of these compounds have produced more than a minimal weight loss and most are ineffective or have been insufficiently studied to determine their efficacy.
Furthermore, while little is known about the safety of many of these compounds, there are a growing number of adverse event reports for several of them. Table summarizes the current safety and efficacy profile of a number of alternative compounds promoted for the purpose of weight loss.
Alternative Medicines, Herbs, and Supplements Used for Weight Loss. The combination of ephedrine and caffeine to treat obesity has been reported to produce weight losses of 15 percent or more of initial body weight Daly et al.
Both drugs are the active ingredients in a number of herbal weight-loss preparations. Weight loss is maximal at about 4 to 6 months on this combination, but body-fat levels may continue to decrease through 9 to 12 months, with increases in lean body mass Toubro et al.
This observation suggests that the combination may be a beta-3 adrenergic agonist Liu et al. Reports of cardiovascular and cerebrovascular events following use of ephedrine and caffeine to treat obesity have reached sufficient frequency that FDA and the Federal Trade Commission have begun to investigate the safety of this combination and have issued warnings to consumers.
In addition, FDA has proposed new regulations for the labeling of products containing ephedrine, which would require warning statements for potential adverse health effects. Use of ephedrine alone or in combination with caffeine has been associated with a wide range of cardiovascular, cerebrovascular, neurological, psychological, gastrointestinal, and other symptoms in adverse events reports Haller and Benowitz, ; Shekelle et al.
Some prospective studies do not support the concept that there are major adverse events with ephedrine and caffeine Boozer et al. Body weight, body fat, energy metabolism, and fat oxidation are regulated by numerous hormones, peptides, neurotransmitters, and other substances in the body.
Drug companies are devoting a large amount of resources to find new agents to treat obesity. Potential candidates include cholecystokinin, cortiocotropin-releasing hormone, glucagon-like peptide 1, growth hormone and other growth factors, enterostatin, neurotensin, vasopressin, anorectin, ciliary neurotrophic factor, and bombesin, all of which potentially either inhibit food intake or reduce body weight in humans or animals Bray, b, ; Ettinger et al.
Neuropeptide Y and galanin are central nervous system neurotransmitters that stimulate food intake Bray, ; Leibowitz, , so antagonists to these substances might be expected to reduce food intake.
Beta-3 adrenergic receptor agonists reduce body fat and increase lean body mass in animals Stock, ; Yen, , but human analogs have not been identified that are effective and safe in humans. Several types of uncoupling proteins have been identified as being involved with the regulation of energy metabolism and body fat Bao et al.
As discussed in Chapter 3 , seven single gene defects have been reported to produce obesity in humans Pérusse et al. A very small number of humans with this gene defect have been identified, and at least one responded to leptin Clement et al. Leptin levels are high in most obese individuals Considine et al.
It may be possible in the future to develop gene therapy or products that correct these defects in order to treat obesity. Although obesity drugs have been available for more than 50 years, the concept of long-term treatment of obesity with drugs has been seriously advanced only in the last 10 years.
The evidence that obesity, as opposed to overweight, is a pathophysiological process of multiple etiologies and not simply a problem of self-discipline is gradually being recognized—obesity is similar to other chronic diseases associated with alterations in the biochemistry of the body.
Most other chronic diseases are treated with drugs, and it is likely that the primary treatment for obesity in the future will be the long-term administration of drugs.
Unfortunately, current drug treatment of obesity produces only moderately better success than does diet, exercise, and behavioral modification over the intermediate term.
Newer drugs need to be developed, and combinations of current drugs need to be tested for short- and long-term effectiveness and safety. As drugs are proven to be safe and effective, their use in less severe obesity and overweight may be justified. The appropriateness of using weight-loss drugs in the military population requires careful consideration.
On average, a 5 to 10 percent weight loss can improve comorbid conditions associated with obesity, but it is not known if this degree of weight reduction by itself would improve fitness or if it could be expected to improve performance in all military contexts.
The side effects that are sometimes encountered might also restrict the use of weight-loss drugs in some military contexts. The frequency of known side effects of current weight-loss drugs is sufficiently low that the potential for adverse events would not seem to be a reason to avoid the use of these drugs by military personnel.
The use of available dietary supplements and herbal preparations to control body weight is generally not recommended because of a lack of demonstrated efficacy of such preparations, the absence of control on their purity, and evidence that at least some of these agents have significant side effects and safety problems.
The occurrence of potential adverse effects e. Although it would be expected that very few active duty military personnel would qualify for consideration for obesity surgery, a review of weight-management programs would not be complete without a discussion of this option.
For these individuals, obesity surgery may produce massive, long-term weight loss. Recent studies have shown dramatic improvements in the morbidity and mortality of those who are massively obese, and surgery is being recommended with increasing frequency for these individuals Hubbard and Hall, Table presents the rationale and results of all forms of obesity surgery.
Surgical Procedures Used for Treatment of Obesity in Humans. Individuals who are candidates for obesity surgery are those who 1 exhibit any of the complications of obesity such as diabetes, hypertension, dyslipidemia, sleep disorders, pulmonary dysfunction, or increased intracranial pressure and have a BMI above 35, or 2 have a BMI above Gastric bypass is currently the most commonly used procedure for obesity surgery.
Following this procedure, patients lose about 62 to 70 percent of excess weight and maintain this loss for more than 5 years Kral, ; MacDonald et al. Biliopancreatic bypass, another type of obesity surgery, and its variations produce weight losses comparable or superior to gastric bypass Kral, In addition to massive weight loss, individuals who undergo obesity surgery experience improvements in health status relative to hypertension, dyslipidemia, sleep apnea, pulmonary function oxygen saturation and oxyhemoglobin levels and decreased carbon dioxide saturation Sugerman, ; Sugerman et al.
Obesity surgery is, however, considered the treatment of last resort because of the short- and long-term complications associated with the surgery. Perioperative mortality is small but significant about 0.
Other potential side effects include vomiting, diarrhea, electrolyte abnormalities, liver failure, renal stones, pseudo-obstruction syndrome, arthritis syndrome, and bacterial overgrowth syndromes. The long-term success of weight management appears to depend on the individual participating in a specific and deliberate follow-up program.
Programs to aid personnel in weight maintenance or prevention of weight gain are appropriate when:. It helps the patient select a weight range within which he or she can realistically stay and, if possible, minimize health risks.
It provides an opportunity for continued monitoring of weight, food intake, and physical activity. It helps the patient understand and implement the principle of balancing the energy consumed from food with routine physical activity. It helps the patient establish and maintain lifestyle change strategies for a sufficiently long period of time to make the new behaviors into permanent habits a minimum of 6 months has been suggested [Wing, ].
Individuals who have achieved a weight-loss goal generally fall into one of two groups: those who see no point in participating in a maintenance program since they believe they know how to keep the weight off and those who remain open to change and improving their skills in weight management.
The critical role of the health care provider is to motivate the former group to learn the skills necessary for weight management. The skills necessary to:. As mentioned above, individuals who have lost weight need to make permanent lifestyle changes in order to maintain their loss.
To assist patients in making these changes, successful maintenance programs will include education on and assistance with the following factors Foreyt and Goodrick, , ; Kayman et al.
To the extent that the epidemic of obesity can be attributed to changes in our living and working environments the increased availability of calorie-dense foods and decreased opportunity to expend energy , public policy efforts may help prevent overweight and may assist those who are trying to lose weight or maintain weight loss Koplan and Dietz, Apart from the obvious need to increase energy expenditure relative to intake, none of the strategies that have been proposed to promote weight loss or maintenance of weight loss are universally recognized as having any utility in weight management.
The efficacy of individual interventions is poor, and evidence regarding the efficacy of combinations of strategies is sparse, with results varying from one study to another and with the individual. Recent studies that have focused on identifying and studying individuals who have been successful at weight management have identified some common techniques.
However, an additional factor identified among successful weight managers, and one not generally included in discussing weight-management techniques, is individual readiness, that is, strong personal motivation to succeed in weight management. Turn recording back on. National Library of Medicine Rockville Pike Bethesda, MD Web Policies FOIA HHS Vulnerability Disclosure.
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Show details Institute of Medicine US Subcommittee on Military Weight Management. Contents Hardcopy Version at National Academies Press. Search term. PHYSICAL ACTIVITY Increased physical activity is an essential component of a comprehensive weight-reduction strategy for overweight adults who are otherwise healthy.
TABLE Benefits of Physical Activity. Self-Monitoring and Feedback Self-monitoring of dietary intake and physical activity, which enables the individual to develop a sense of accountability, is one of the cornerstones of behavioral treatment.
Other Behavioral Techniques Some additional techniques included in behavioral treatment programs include eating only regularly scheduled meals; doing nothing else while eating; consuming meals only in one place usually the dining room and leaving the table after eating; shopping only from a list; and shopping on a full stomach Brownell and Kramer, Eating Environments A significant part of weight loss and management may involve restructuring the environment that promotes overeating and underactivity.
Eating habits that may promote overweight: 1. Eating few or no meals at home 2. Opting for high-fat, calorie-dense foods 3. Prepare meals at home and carry bag lunches 2. Learn to estimate or measure portion sizes in restaurants 3.
Learn to recognize fat content of menu items and dishes on buffet tables 4. Eliminate smoking and reduce alcohol consumption 5. Substitute low-calorie for high-calorie foods 6. Modify the route to work to avoid a favorite food shop.
Physical Activity Environment Major obstacles to exercise, even in highly motivated people, include the time it takes to complete the task and the inaccessibility of facilities or safe places to exercise.
Nutrition Education Management of overweight and obesity requires the active participation of the individual. DIET Weight-management programs may be divided into two phases: weight loss and weight maintenance.
Nutritionally Balanced, Hypocaloric Diets A nutritionally balanced, hypocaloric diet has been the recommendation of most dietitians who are counseling patients who wish to lose weight. Meal Replacement Meal replacement programs are commercially available to consumers for a reasonably low cost.
Unbalanced, Hypocaloric Diets Unbalanced, hypocaloric diets restrict one or more of the calorie-containing macronutrients protein, fat, and CHO. High-Protein, Low-Carbohydrate Diets There has been considerable debate on the optimal ratio of macronutrient intake for adults.
Low-Fat Diets Low-fat diets have been one of the most commonly used treatments for obesity for many years Astrup, ; Astrup et al. High-Fiber Diets Most low-fat diets are also high in dietary fiber, and some investigators attribute the beneficial effects of low-fat diets to the high content of vegetables and fruits that contain large amounts of dietary fiber.
Very-Low-Calorie Diets Very-low-calorie diets VLCDs were used extensively for weight loss in the s and s, but have fallen into disfavor in recent years Atkinson, ; Bray, a; Fisler and Drenick, SUPPORT SYSTEMS Almost any kind of assistance provided to participants in a weight-management program can be characterized as support services.
Counseling and Psychotherapy Services Psychological and emotional factors play a significant role in weight management. Patient-Led Groups Nonprofessional patient-led groups and counseling, such as those available with organized programs like Take Off Pounds Sensibly and Overeaters Anonymous, can be useful adjuncts to weight-loss efforts.
Commercial Groups Certain commercial programs like Weight Watchers and Jenny Craig can also be helpful. Other Community Resources Many communities offer supplemental weight-management services. This test along with the salivary comprehensive described above will give a degree evaluation of your weight problem.
Slightly different diet plans will be recommended depending on if you have a variant of the following allele s :. Knowing which allele variants you have is how we can optimize your weight loss journey and help overcome possible predispositions so you can reach ongoing weight maintenance.
Knowing your genetic makeup can help you understand your risks and help you make better decisions about your environment and diet choices. You have a say in which genes are turned on and off.
Studies have shown that systemic inflammation increases as percent body fat increases. Prioritizing a diet and lifestyle that is focused on reducing inflammation may be necessary if your inflammatory markers are elevated.
Factors that increase inflammation are poor diet, food sensitivities, toxin exposures, stress, and lack of sleep. We will focus on these areas to get your inflammation under control to help speed up your metabolism. Copyright © All rights reserved.
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