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Weight loss: Understanding the process and developing an individualized plan.

Today, people in the US struggle more with unintentional weight gain and obesity than ever before. There is, however, an abundance of weight loss information available to Americans based on various diets and exercise recommendations. A more comprehensive approach to sustainable weight loss often also requires nutritional education, behavioral counseling, anti-obesity medications, and surgical therapies.

According to the Obesity Medicine Association, diet and calorie restriction have a far more significant impact on successful weight loss than exercise. However, we cannot underestimate the importance of exercise for weight preservation and maintenance of muscle mass. In addition, people who experience gradual weight loss are more successful long term than those with rapid weight loss programs (US Centers for Disease Control). There are multiple genetic, biological, behavioral, and environmental factors contributing to abnormal weight and obesity. Possible obstacles to successful weight loss include a lack of sleep, FAD diets, consumption of alcohol, sweet beverages, stress, and an abnormal microbiome (flora in stool). Therefore, an individualized weight loss program in combination with a behavioral change, is considered to be the most successful and sustainable approach.

Low carbohydrate diets have been most beneficial in improving metabolic risk factors and maintaining healthy weight long term. In addition, low carbohydrate diets will produce modestly higher weight loss results than fat restriction diets during the first six months. Hunger control will be a challenge in the first eight weeks and can be overcome with appetite suppressing medications.

A very low-calorie regimen produces rapid weight loss, but it is difficult to follow long-term. Intermittent fasting diets (fasting for 8-24 hours between meals) are gaining popularity and are considered by some patients easier to follow. High-fat diets such as Adkins should be used with caution as saturated fats (margarine, shortening, processed red meat) are not required for nutritional balance and may contribute to worsening metabolic risk factors.

In any diet that restricts calories, it is crucial that the essential ingredients are included to preserve metabolic balance. Omega 3 and Omega 6 polyunsaturated fatty acids are essential for heart health, mental health, and the weight loss process. The source of Omega 3 acids comes from fatty fish, algae, and several high-fat plant foods. Omega 6 fatty acids are obtained from poultry, eggs, nuts, vegetable oils, and grains. The recommended consumption ratio of Omega 3/6 is 4 to 1. The typical American diet, however, has the ratio of 20 to 1 with an insufficient Omega 3 consumption. It is also imperative to include the six essential amino acids in the diet since we cannot synthesize them: histidine, lysine, cysteine, tryptophan, isoleucine, valine, methionine, tryptophan. Lysine is often deficient in a vegetarian diet and should be substituted regularly in weight loss programs based on a vegetarian diet.