Tuesday, October 13, 2009

Weighty Matters

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When it comes to weight loss, the type of diet a person follows is not as important as counting calories. Researchers assigned 811 people to one of four diets. Each diet had different levels of fat, protein, and carbohydrate. After two years, the people in each group had lost about the same amount of weight. The Associated Press reported on the study Feb. 26, the same day it appeared in the New England Journal of Medicine.

What Is the Doctor's Reaction?

Did you ever wonder why there are so many diet books, diet ads and diet experts promoting different diets? This can only mean one thing: there is no single best diet. A new study supports this view.

In a study just published in the New England Journal of Medicine, researchers enrolled 811 overweight people and randomly assigned them to 4 calorie-restricted diets that varied in content of carbohydrate, fat and protein. Two were low in fat. One of them had high protein content while the other had moderate protein content. The other two diets were high in fat, one with high and one with moderate protein content.

In addition to the different diets, each study subject was offered individual and group counseling sessions focusing on strategies to lose weight. And, all subjects were encouraged to engage in at least 90 minutes of moderate intensity exercise each week.

A strength of this study was that it followed participants for 2 years. That's a longer duration of observation than most studies of weight loss.

The researchers found that no single diet was better than the others. Weight loss in all groups was modest. While the average study subject was about 50 pounds overweight, the average weight loss after 2 years was about 9 pounds. Even though the weight loss was not dramatic, this amount of weight loss is enough to reduce the risk of diabetes and it was associated with improved blood pressure and cholesterol levels.

Another finding of this research emphasizes a trend among dieters noted in prior research: early weight loss is rarely maintained. In the first 6 months of this study, study subjects lost an average of more than 13 pounds or 7% of their body weight. After a year, they began to regain weight. In fact, had the study continued past 2 years, it's quite possible that they would have regained all of the lost weight.

Finally, researchers noted that, in general, the more counseling sessions attended, the more weight was lost.

In my view, this study offers a number of lessons:

Calorie restriction is difficult, even among highly motivated and highly educated individuals who volunteered for this weight loss study.

Sticking to a specific diet is difficult. Food diaries and blood test measurements suggest that the assigned diets were not strictly followed by the majority of study participants. It may be unrealistic to expect even motivated people to follow any particular weight loss diet over the long-term.

No single macronutrient (carbohydrate, fat or protein) is crucial to the success or failure of a weight loss diet.

Counseling can play an important role in the success of weight loss efforts.

What Changes Can I Make Now?

Know your BMI. This is a measure of weight that accounts for height. If you are overweight or obese, take steps now to lose excess weight. For example:

Pay attention to what you're eating. Check nutrition labels and make small changes to reduce your intake of calories. For example, switch from whole milk to 2% milk (and eventually change to skim).

Choose a healthy diet that makes sense to you and that includes foods you like. The more radical the diet, the less likely you are to stick with it. Work with a nutritionist if you aren't sure about what diet to follow.

Be active in your everyday activities. Walk more. When you do drive, choose the parking spot that's farthest away from your destination. Take the stairs rather than the elevator.

Exercise regularly. This should be an important component of any weight loss program. I recommend more exercise than was advocated by this study. Aim for 45 to 60 minutes of moderate intensity exercise 4 or more days per week.

Consider taking a medication. If you are doing all you can with diet and exercise and still not losing excess weight, consider medications such as orlistat (Alli or Xenical) or sibutramine (Meridia) to help with weight loss. Talk with your doctor before taking any weight loss medication.

If your BMI is 40 or more, talk to your doctor about the risks and benefits of obesity surgery. This may especially important if you have medical problems related to your weight such as diabetes or hypertension.

What Can I Expect Looking to the Future?

In the future you can expect additional studies to identify better ways to discourage weight gain and to encourage weight loss. A novel, community-based approach is being studied in 200 towns in Europe in which prevention of excess weight in children is a focus for every citizen in each town. Early success suggests that this may indeed be "the next big thing" in weight loss programs.

We live in a time when obesity is considered an epidemic and obesity surgery is considered the only highly effective treatment. Identifying safe and effective weight loss programs has never been more important. Based on current projections regarding the rising prevalence of obesity, preventing and reversing obesity will become even more important in the future.

Source Citation:"Weighty Matters." Harvard Reviews of Health News. Harvard Health Publications Group, 2009. NA. Academic OneFile. Gale. BROWARD COUNTY LIBRARY. 13 Oct. 2009

Gale Document Number:A194532991

Disclaimer:This information is not a tool for self-diagnosis or a substitute for professional care.

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