Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version.

This content does not have an Arabic version. Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Request Appointment. Healthy Lifestyle Weight loss. Sections Basics Weight-loss basics Diet plans The Mayo Clinic Diet Diet and exercise Diet pills, supplements and surgery In-Depth Expert Answers Multimedia Resources News From Mayo Clinic What's New.

Products and services. The Mayo Clinic Diet: A weight-loss program for life The Mayo Clinic Diet is a lifestyle approach to weight loss that can help you maintain a healthy weight for a lifetime.

By Mayo Clinic Staff. Enlarge image Close. Mayo Clinic Healthy Weight Pyramid. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry.

Show references Hensrud DD, et al. The Mayo Clinic Diet. Mayo Clinic; Hensrud DD, et al. Diabetes and the pyramid. In: The Mayo Clinic Diabetes Diet.

Frequently asked questions. Accessed March 4, Healthy diet adult. Mayo Clinic Diet. Department of Health and Human Services and U. Department of Agriculture. Accessed Oct. Healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: Behavioral counseling interventions.

Preventive Services Task Force. American Cancer Society guideline for diet and physical activity for cancer prevention. American Cancer Society. Perreault L. Obesity in adults: Dietary therapy. Products and Services The Mayo Clinic Diet Online A Book: The Mayo Clinic Diet Bundle.

See also Portion control Energy density Emotional eating. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book.

ART Healthy Lifestyle Weight loss In-Depth The Mayo Clinic Diet A weight loss program for life. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters.

About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. News Network.

Price Transparency. Medical Professionals. Clinical Trials. Mayo Clinic Alumni Association. Refer a Patient. Executive Health Program. International Business Collaborations. Supplier Information. Admissions Requirements.

Degree Programs. Research Faculty. International Patients. Financial Services. Community Health Needs Assessment. Financial Assistance Documents — Arizona. Financial Assistance Documents — Florida. While most of these diets have been promoted by nonscientists who have done little or no serious scientific research, some of the regimens have been subjected to rigorous studies Skov et al.

There remains, however, a lack of randomized clinical trials of 2 or more years' duration, which are needed to evaluate the potent beneficial effect of weight loss accomplished using virtually any dietary regimen, no matter how unbalanced on blood lipids.

In addition, longer studies are needed to separate the beneficial effects of weight loss from the long-term effects of consuming an unbalanced diet. These claims are unsupported by scientific data. Although these diets are prescribed to be eaten ad libitum, total daily energy intake tends to be reduced as a result of the monotony of the food choices, other prescripts of the diet, and an increased satiety effect of protein.

In addition, the restriction of CHO intake leads to the loss of glycogen and marked diuresis Coulston and Rock, ; Miller and Lindeman, ; Pi-Sunyer, Thus, the relatively rapid initial weight loss that occurs on these diets predominantly reflects the loss of body water rather than stored fat.

This can be a significant concern for military personnel, where even mild dehydration can have detrimental effects on physical and cognitive performance. For example, small changes in hydration status can affect a military pilot's ability to sense changes in equilibrium.

Results of several recent studies suggest that high-protein, low-CHO diets may have their benefits. In addition to sparing fat-free mass Piatti et al. Furthermore, a percent protein diet reduced resting energy expenditure to a significantly lesser extent than did a percent protein diet Baba et al.

The length of these studies that examined high-protein diets only lasted 1 year or less; the long-term safety of these diets is not known. Low-fat diets have been one of the most commonly used treatments for obesity for many years Astrup, ; Astrup et al.

The most extreme forms of these diets, such as those proposed by Ornish and Pritikin , recommend fat intakes of no more than 10 percent of total caloric intake. Although these stringent diets can lead to weight loss, the limited array of food choices make them difficult to maintain for extended periods of time by individuals who wish to follow a normal lifestyle.

More modest reductions in fat intake, which make a dietary regimen easier to follow and more acceptable to many individuals, can also promote weight loss Astrup, ; Astrup et al. For example, Sheppard and colleagues reported that after 1 year, obese women who reduced their fat intake from approximately 39 percent to 22 percent of total caloric intake lost 3.

Results of recent studies suggest that fat restriction is also valuable for weight maintenance in those who have lost weight Flatt ; Miller and Lindeman, Dietary fat reduction can be achieved by counting and limiting the number of grams or calories consumed as fat, by limiting the intake of certain foods for example, fattier cuts of meat , and by substituting reduced-fat or nonfat versions of foods for their higher fat counterparts e.

Over the past decade, pursuit of this latter strategy has been simplified by the burgeoning availability of low-fat or fat-free products, which have been marketed in response to evidence that decreasing fat intake can aid in weight control.

The mechanisms for weight loss on a low-fat diet are not clear. Weight loss may be solely the result of a reduction in total energy intake, but another possibility is that a low-fat diet may alter metabolism Astrup, ; Astrup et al.

Support for the latter possibility has come from studies showing that the short-term adherence to a diet containing 20 or 30 percent of calories from fat increased hour energy expenditure in formerly obese women, relative to an isocaloric diet with 40 percent of calories from fat Astrup et al.

Over the past two decades, fat consumption as a percent of total caloric intake has declined in the United States Anand and Basiotis, , while average body weight and the proportion of the American population suffering from obesity have increased significantly Mokdad et al.

Several factors may contribute to this seeming contradiction. First, all individuals appear to selectively underestimate their intake of dietary fat and to decrease normal fat intake when asked to record it Goris et al. If these results reflect the general tendencies of individuals completing dietary surveys, then the amount of fat being consumed by obese and, possibly, nonobese people, is greater than routinely reported.

Second, although the proportion of total calories consumed as fat has decreased over the past 20 years, grams of fat intake per day have remained steady or increased Anand and Basiotis, , indicating that total energy intake increased at a faster rate than did fat intake. Coupled with these findings is the fact that since the early s, the availability of low-fat and nonfat, but calorie-rich snack foods e.

However, total energy intake still matters, and overconsumption of these low-fat snacks could as easily lead to weight gain as intake of their high-fat counterparts Allred, Two recent, comprehensive reviews have reported on the overall impact of low-fat diets.

Astrup and coworkers examined four meta-analyses of weight change that occurred on intervention trials with ad libitum low-fat diets. They found that low-fat diets consistently demonstrated significant weight loss, both in normal-weight and overweight individuals.

A dose-response relationship was also observed in that a 10 percent reduction in dietary fat was predicted to produce a 4- to 5-kg weight loss in an individual with a BMI of 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.

The rationale for using high-fiber diets is that they may reduce energy intake and may alter metabolism Raben et al. The beneficial effects of dietary fiber might be accomplished by the following mechanisms: 1 caloric dilution most high-fiber foods are low in calories and low in fat ; 2 longer chewing and swallowing time reduces total intake; 3 improved gastric and intestinal motility and emptying and less absorption French and Read, ; Leeds, ; McIntyre et al.

Dietary fiber is not a panacea, and the vast majority of controlled studies of the effects of dietary fiber on weight loss show minimal or no reduction in body weight LSRO, ; Pasman et al.

Many individuals and companies promote the use of dietary fiber supplements for weight loss and reductions in cardiovascular and cancer risks. Numerous studies, usually short-term and using purified or partially purified dietary fiber, have shown reductions in serum lipids, glucose, or insulin Jenkins et al.

Long-term studies have usually not confirmed these findings LSRO, ; Pasman et al. Current recommendations suggest that instead of eating dietary fiber supplements, a diet of foods high in whole fruits and vegetables may have favorable effects on cardiovascular and cancer risk factors Bruce et al.

Such diets are often lower in fat and higher in CHOs. 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, The VLCDs used most frequently consist of powdered formulas or limited-calorie servings of foods that contain a high-quality protein source, CHO, a small percentage of calories as fat, and the daily recommendations of vitamins and minerals Kanders and Blackburn, ; Wadden, The servings are eaten three to five times per day.

The primary goal of VLCDs is to produce relatively rapid weight loss without substantial loss in lean body mass. To achieve this goal, VLCDs usually provide 1. VLCDs are not appropriate for all overweight individuals, and they are usually limited to patients with a BMI of greater than 25 some guidelines suggest a BMI of 27 or even 30 who have medical complications associated with being overweight and have already tried more conservative treatment programs.

Additionally, because of the potential detrimental side effects of these diets e. On a short-term basis, VLCDs are relatively effective, with weight losses of approximately 15 to 30 kg over 12 to 20 weeks being reported in a number of studies Anderson et al.

However, the long-term effectiveness of these diets is somewhat limited. Approximately 40 to 50 percent of patients drop out of the program before achieving their weight-loss goals. In addition, relatively few people who lose large amounts of weight using VLCDs are able to sustain the weight loss when they resume normal eating.

In two studies, only 30 percent of patients who reached their goal were able to maintain their weight loss for at least 18 months. Within 1 year, the majority of patients regained approximately two-thirds of the lost weight Apfelbaum et al.

In a more recent study with longer followup, the average regain over the first 3 years of follow-up was 73 percent. However, weight tended to stabilize over the fourth year.

At 5 years, the dieters had maintained an average of 23 percent of their initial weight loss. At 7 years, 25 percent of the dieters were maintaining a weight loss of 10 percent of their initial body weight Anderson et al. It appears that VLCDs are more effective for long-term weight loss than hypocaloric-balanced diets.

In a meta-analysis of 29 studies, Anderson and colleagues examined the long-term weight-loss maintenance of individuals put on a VLCD diet with behavioral modification as compared with individuals put on a hypocaloric-balanced diet. They found that VLCD participants lost significantly more weight initially and maintained significantly more weight loss than participants on the hypocaloric-balanced diet see Table Almost any kind of assistance provided to participants in a weight-management program can be characterized as support services.

These can include emotional support, dietary support, and support services for physical activity. The support services used most often are structured in a standard way.

Other services are developed to meet the specific needs of a site, program, or the individual involved. With few exceptions, almost any weight-management program is likely to be more successful if it is accompanied by support services Heshka et al. However, not all services will be productively applicable to all patients, and not all can be made available in all settings.

Furthermore, some weight-loss program participants will be reluctant to use any support services. Psychological and emotional factors play a significant role in weight management. Counseling services are those that consider psychological issues associated with inappropriate eating and that are structured to inform the patient about the nature of these issues, their implications, and the possibilities available for their ongoing management.

This intervention is less elaborate, intense, and sustaining than psychotherapy services. For example, it should be useful to help patients understand the existence and nature of a sabotaging household or the phenomenon of stress-related eating without undertaking continuing psychotherapy.

A counselor or therapist can provide this service either in individual or group sessions. These counselors should, however, be sufficiently familiar with the issues that arise with weight-management programs, such as binge eating and purging. Short-term, individual case management can be helpful, as can group sessions because patients can hear the perspective of other individuals with similar weight-management concerns while addressing their individual concerns Hughes et al.

Psychotherapy services, both individual and group, can also be useful. However, the costs of this type of service limits its applicability to many patients. Nevertheless, the value for individual patients can be substantial, and the option should not be dismissed simply because of cost.

Concerns about childhood abuse, emotional linkages to sustaining obesity fat-dependent personality , and the management of coexisting mental health problems are the kinds of issues that might be addressed with this type of support service.

The individual therapist can structure the format of the therapy but, as with counseling services, the therapist should be familiar with weight-management issues.

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. These programs have the advantages of low cost, continuing support and encouragement, and a semi-structured approach to the issues that arise among weight-management patients.

Their disadvantage is that, since the counseling is nonprofessional in nature, the programs are only as good as the people who are involved. These peer-support programs are more likely to be productive when they are used as a supplement to a program with professional therapists and counselors.

In Overeaters Anonymous, a variant of these groups is a sponsor-system program that pairs individuals who can help one another. Certain commercial programs like Weight Watchers and Jenny Craig can also be helpful.

Since commercial groups have their own agenda, caution must be exercised to avoid contradictions between the advice of professional counselors and that of the supportive commercial program.

Since the counselors in commercial programs are not likely to be professionals, the quality of counseling offered by these programs varies with the training of the counselors.

Many communities offer supplemental weight-management services. Educational services, particularly in nutrition, may be provided through community adult education using teaching materials from nonprofit organizations such as the American Heart Association, the American Diabetes Association, and government agencies FDA, National Institutes of Health, and U.

Department of Agriculture. Many community hospitals have staff dietitians who are available for out-patient individual counseling Pavlou et al.

However, the military's TRICARE health services contracts would need to be modified to include dietitian services from community hospitals or other community services since these contracts do not currently include medical nutrition therapy and therefore dietitian counseling. The family unit can be a source of significant assistance to an individual in a weight-management program.

For example, program dropout rates tend to be lower when a participant's spouse is involved in the program Jeffery et al. With simple guidance and direction, the involvement of the spouse as a form of reinforcement rather than as a source of discipline and monitoring can become a resource to assist in supporting the participant.

However, individual family members or the family as a group can become an obstacle when they express reluctance to make changes in food and eating patterns within the household.

Issues of family conflict become more complex when the participants are children or adolescents or when spouses are reluctant to relinquish status quo positions of control.

A variety of Internet- and web-related services are available to individuals who are trying to manage their weight Davison, ; Gray and Raab, ; Riva et al. As with any other Internet service, the quality of these sites varies substantially Miles et al.

An important role for weight-management professionals is to review such sites so they can recommend those that are the most useful. The use of e-mail counseling services by military personnel who travel frequently or who are stationed in remote locations has been tested at one facility; initial results are promising James et al.

The use of web-based modalities by qualified counselors or facilitators located at large military installations would extend the accessibility of such services to personnel located at small bases or stationed in remote locations.

Support is also required for military personnel who need to enhance their levels of physical fitness and physical activity. All branches of the services have remedial physical fitness training programs for personnel who fail their fitness test, but support is also needed for those who need to lose weight and for all personnel to aid in maintaining proper weight.

Support services should include personnel, facilities, and equipment, and should provide practical advice on how to begin and progress through physical training routines including proper use of training equipment and how to prevent musculoskeletal injuries , as well as advice on when and how to eat in conjunction with physical activity demands.

Success in the promotion of weight loss can sometimes be achieved with the use of drugs. Almost all prescription drugs in current use cause weight loss by suppressing appetite or enhancing satiety.

One drug, however, promotes weight loss by inhibiting fat digestion. To sustain weight loss, these drugs must be taken on a continuing basis; when their use is discontinued, some or all of the lost weight is typically regained. Therefore, when drugs are effective, it is expected that their use will continue indefinitely.

For maximum benefit and safety, the use of weight-loss drugs should occur only in the context of a comprehensive weight-loss program. In general, these drugs can induce a 5- to percent mean drop in body weight within 6 months of treatment initiation, but the effect can be larger or smaller depending on the individual.

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. Help Accessibility Careers.

As of , more than one-third of American adults have obesity, defined as having a body mass index BMI of 30 or higher. You can calculate your body mass by following these three steps:. Obesity can lead to a number of serious health problems, including heart disease, diabetes, stroke, and some types of cancer.

One method that can help a person lose weight is to limit the number of calories taken in through their diet. The other way is to burn extra calories with exercise. Combining exercise with a healthy diet is a more effective way to lose weight than depending on calorie restriction alone.

Exercise can prevent or even reverse the effects of certain diseases. Exercise lowers blood pressure and cholesterol, which may prevent a heart attack. In addition, if you exercise, you lower your risk of developing certain types of cancers such as colon and breast cancer.

Exercise is also known to help contribute to a sense of confidence and well-being, thus possibly lowering rates of anxiety and depression. Exercise is helpful for weight loss and maintaining weight loss. Exercise can increase metabolism, or how many calories you burn in a day.

It can also help you maintain and increase lean body mass, which also helps increase number of calories you burn each day. To reap the health benefits of exercise, it is recommended that you to perform some form of aerobic exercise at least three times a week for a minimum of 20 minutes per session.

However, more than 20 minutes is better if you want to actually lose weight. Burning calories a week can equals 10 lbs. of weight loss over the course of a year. To get an idea of how hard you are working, you can check your heart rate.

The basic formula for determining your target heart rate is to subtract your age from and then calculate 60 to 80 percent of that number. Talk to a trainer or your healthcare team to help you determine your best intensity for each workout. Those with special health concerns such as an injury, diabetes, or a heart condition should consult a physician before beginning any fitness program.

No matter what exercise program you implement, it should include some form of aerobic or cardiovascular exercise. Aerobic exercises get your heart rate up and your blood pumping. Aerobic exercises may include walking, jogging, cycling, swimming, and dancing.

You can also work out on a fitness machine such as a treadmill, elliptical, or stair stepper. Muscle, in turn, burns calories. Talk about a healthy feedback loop! Experts recommend working all the major muscle groups three times per week.

This includes:. Yoga is not as intense as other types of exercise, but it can help you lose weight in other ways, according to a recent study by researchers at the Fred Hutchinson Cancer Research Center.

The study found that people who practice yoga are more mindful about what they eat and, therefore, less likely to have obesity. The total amount of exercise you engage in during a day matters more than whether or not you do it in a single session. A female needs about 1, calories to maintain her weight.

The following list contains common activities and the approximate amount of calories burned per hour:. Talk to your doctor before you start a new exercise program, especially if you are planning on doing vigorous exercise.

This is especially important if you have:. People who have been very inactive for the recent months, who are overweight, or have recently quit smoking should also talk to their doctors before staring a new exercise program.

You should push yourself, so that your fitness level improves. However, pushing yourself too hard can cause you to injure yourself. Stop exercising if you start to experience pain or shortness of breath.

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY. Exercise burns calories, but many people claim it doesn't help you lose weight.

This article explores whether exercise really helps with weight loss. Cardio and weightlifting can help you lose weight and burn fat, but they may do so at a different pace and with different results.

Weight loss is a common goal, but you may want to know what a healthy rate for weight loss is. This article explains the factors that affect how long…. Walking is great for your health, but how much do you need to walk to aid weight loss?

This article tells you whether you can lose weight by walking 1…. If you don't have insurance, you may still be able to get free or low-cost health services. To learn more, find a health center near you.

This information on aiming for a healthy weight was adapted from materials from the Centers for Disease Control and Prevention CDC and the National Institutes of Health Weight-control Information Network WIN.

Reviewed by: Dennis Anderson-Villaluz, MBA, RD, LDN, FAND Lieutenant Commander, U. Public Health Service Nutrition Advisor, Division of Prevention Science Office of Disease Prevention and Health Promotion.

Kara Beckman, PhD ORISE Nutrition Policy Fellow Office of Disease Prevention and Health Promotion. Dana DeSilva ORISE Health Policy Fellow Office of Disease Prevention and Health Promotion. Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

Department of Health and Human Services Office of Disease Prevention and Health Promotion. MyHealthfinder Health Conditions Diabetes Watch Your Weight. Health Conditions Aim for a Healthy Weight.

The Basics Take Action. The Basics Overview Being at a healthy weight can help lower your risk for serious health conditions like type 2 diabetes, heart disease, and high blood pressure.

You can lose weight by getting more physical activity and eating fewer calories. Calories are a measure of the energy in the foods you eat. If you are at a healthy weight, take steps to stay at the same weight. You can stay at the same weight by getting regular physical activity and eating the right number of calories.

If you think you might be underweight, talk to your doctor or nurse about how to gain weight in a healthy way. To lose weight, try eating to fewer calories each day.

Health Benefits What can losing weight do for me? Take Action. Set realistic goals. Keep a food and activity diary. When you know your habits, it's easier to make changes. Get Active Get more physical activity.

Aim for at least minutes of moderate-intensity aerobic physical activity a week. For example, try going for a brisk walk several days a week. To get the most benefits, try to also do muscle-strengthening activities at least twice a week.

You can lift weights, climb stairs, or work in the garden—anything that makes your muscles work harder than usual counts. Check out these resources for more information: Staying Active at Any Size Physical Activity for a Healthy Weight.

Eat Healthy Eat healthy. Here are a few healthy eating tips: Fill half your plate with fruits and vegetables. Choose whole grains, fat-free or low-fat dairy products, and a variety of foods with protein, like eggs and beans.

Drink water or fat-free milk instead of soda or other drinks with added sugars. Read the Nutrition Facts label and choose healthier versions of your favorite foods that have fewer calories and less added sugar, saturated fat, and sodium.

Bring this shopping list of heart-healthy foods the next time you go food shopping. Check out these links to learn more: Try these menu planners for healthy meal ideas. Browse these recipes for new options. Download this fact sheet to help you build a healthy eating routine [PDF - 1.

Check out this info about healthy eating — including tips for cutting down on sodium salt , added sugars, and saturated fat. Portion Sizes Eat smaller portions. Here are some ideas for eating smaller portions: Plan your meals and snacks ahead of time. Stick to an eating schedule that works for you.

Read the label to find out how many servings are in a package. There may be more than 1!