Guidelines for Weight Loss
First federal guidelines for weight loss and obesity issued...
Obesity affects 97 million American adults; that's an overwhelming 55 percent of us, according to a press release issued in June 1998 by the National Institute of Health in Bethesda, MD. The guidelines, released by the National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) are intended to aid physicians in the identification, evaluation, and treatment of obesity.
Overweight individuals are at increased risk for hypertension, lipid disorders, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and other respiratory problems, and certain cancers. Obesity-related disease costs are rapidly approaching $100 billion per year.
According to the guidelines, assessment of obesity involves three key points--body mass index (BMI), waist circumference, and an individual patient's potential risk factors for diseases and conditions relevant to overweight.
Definition of overweight or obese is based on research which relates BMI to risk of death and illness: overweight is defined as a body mass index of 25 to 29.9 while obesity is defined as a BMI of 30 and above. The BMI number applies equally to men and women, however some very muscular individuals may have a high BMI without increased health risks. Recommendations include that all adults should have their BMI determined and those with normal BMI's should be reassessed every 2 years.
A new analysis of the National Health and Nutrition Examination Survey (NHANES III) reveals that as BMI levels rise, so does blood pressure and total cholesterol levels. But while cholesterol levels are increased, average HDL (good cholesterol) levels decrease. Women in the highest obesity category are at a risk four times greater than those with lower BMI's for either hypertension or high blood pressure.
Additional factors which should be considered when evaluating health risks include blood pressure or blood cholesterol and family history of obesity-related disease. Those with additional risk factors are considered at higher risk and should be prescribed more intense therapy to modify risk factors.
Waist circumference is also a valuable tool for assessing health risk; women whose waist measures over 35 inches and who have a high BMI are at greater risk for developing obesity-related diseases and conditions.
The most successful strategies for weight-loss, according to the report, include calorie reduction and behavior modification designed to improve eating habits and increase physical activity.
Recommendations for weight loss and activity:Begin a physical activity program
which progresses until at least 30 minutes or more per day
is achieved on most or all days of the week. A calorie-restricted diet should be
implemented together with a diet lower in dietary fat to
improve risk of heart disease. Lower fat consumption without
reducing caloric intake will not produce desired
weight loss. An initial goal for weight
reduction should be about a 10% reduction which will reduce
obesity-related risks; further weight loss can be attempted
if necessary after this reduction is obtained. A reasonable time line for
achieving a 10% reduction is six months with a weight loss
of 1-2 pounds per week. Maintenance of weight loss should
be a priority after the first six months of
treatment. Lifestyle therapy should be tried
for at least six months before intervention with
weight loss drugs. Patients given drug treatment for
obesity should have a BMI of 27 or greater with two
additional risk factors or 30 and above without additional
risk factors. Surgery for obesity should be used
only in carefully selected patients-- those with BMI
of 40 or more or those with BMI of 35 who have coexisting
conditions and for whom less invasive therapies have not
worked. Surgery should be considered as a last resort, as it
requires lifelong medical surveillance. Overweight and obese individuals
who do not desire to lose weight should be counseled
on strategies to avoid further weight
gain. Older adults should not be
precluded from a weight loss program based solely on
age.
The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults has been reviewed by 115 health experts at major medical and professional organizations. Free copies of consumer tips are available by writing to:
P.O. Box 30105
Bethesda, MD 20824-0105
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