Ways
to Win at Weight Loss
by Marilynn Larkin
Americans trying to lose weight
have plenty of company. According to a 1995
report from the Institute of Medicine (IOM),
tens of millions of Americans are dieting at
any given time, spending more than $33 billion
yearly on weight-reduction products, such as
diet foods and drinks.
Yet, studies over the last two decades by the
National Center for Health Statistics show that
obesity in the United States is actually on
the rise. Today, approximately 35 percent of
women and 31 percent of men age 20 and older
are considered obese, up from approximately
30 percent and 25 percent, respectively, in
1980.
Many people who diet fail to lose weight--or,
if they do lose, fail to maintain the lower
weight over the long term. As the IOM report,
"Weighing The Options: Criteria for Evaluating
Weight-Management Programs," points out, obesity
is "a complex, multifactorial disease of appetite
regulation and energy metabolism."
A physician, dietitian or nutritionist can
help you set a reasonable
weight goal. To reach the goal
safely, plan to lose 1 to 2 pounds weekly by
consuming approximately 300 to 500 fewer calories
daily than usual (women and inactive men generally
need to consume approximately 2,000 calories
to maintain weight; men and very active women
may consume up to 2,500 calories daily).
Moderation, Variety and Balance
After determining a reasonable goal weight,
devise an eating plan based on the cornerstones
of healthful eating--moderation, variety and
balance, suggests Victor Herbert, M.D., J.D.,
professor of medicine and director of the Nutrition
Center at the Mount Sinai School of Medicine
and Bronx VA Medical Centers in New York City,
and member of the board of directors of the
National Council Against Health Fraud.
"Moderation means not eating too much or too
little of any particular food or nutrient; variety
means eating as wide a variety as possible from
each, and within each, of the five basic food
groups; and balance refers to the balance achieved
by following moderation and variety, as well
as the balance of calories consumed versus calories
expended," he explains. To lose weight, fewer
calories should be consumed than expended; to
maintain weight loss, the number of calories
consumed and expended should be about the same.
Because fat is the most concentrated source
of calories (9 calories per gram compared to
4 calories per gram for carbohydrate and protein),
it is usually the focus of weight-maintenance
and weight-loss diets. Limiting fat intake alone
will likely limit calories, as well. Just as
for the general population, weight-conscious
consumers should limit fat intake to no more
than 30 percent of total calories, according
to the Dietary Guidelines for Americans.
Alcoholic beverages also are a source of calories
(7 per gram of alcohol). Twelve ounces of regular
beer, for example, provides 150 calories; the
same amount of "light" beer, 105 calories. Five
ounces of wine or 1.5 ounces of 80-proof distilled
spirits provide 100 calories. But alcohol provides
few, if any, nutrients, so if you drink alcoholic
beverages and want to reduce your weight, consider
reducing or eliminating your alcohol intake.
In selecting your diet, follow the five basic
food groups and the recommended number of servings
from each as incorporated into the developed
by USDA and HHS. These groups are (1) bread,
cereal, pasta, and rice; (2) vegetables; (3)
fruits; (4) milk, yogurt and cheese; and (5)
meat, poultry, fish, dry beans, eggs, and nuts.
A sixth group (fats, oils and sweets) consists
mainly of items that are pleasing to the palate
but high in fat and/or calories; these should
be eaten in moderation.
Avoid low-calorie fad diets that exclude whole
categories of food such as carbohydrates (bread
and pasta) or proteins (meat and poultry). These
diets may be harmful because they generally
do not include all nutrients necessary for good
health. "Every fad diet that demands an unusual
eating pattern, such as emphasizing only a few
types of foods, deviates from one or more of
the guidelines of moderation, variety and balance,"
says Herbert. "The greater the deviation, the
more harmful the diet is likely to be."
FDA has approved
several prescription drugs for obesity.
The newest is Xenical
(orlistat), which FDA approved in April
1999.
Xenical is the first in a new class of
anti-obesity drugs known as lipase inhibitors.
Lipase is the enzyme that breaks down
fat for use by the body. Xenical interferes
with lipase function, decreasing fat absorption
by 30 percent. Since undigested fats are
not absorbed, there is less calorie intake,
which may have a positive effect on weight
control.
Other approved anti-obesity prescription
drugs available on the market include:
CLICK
HERE FOR MORE FDA APPROVED DIET PILLS
In mostly short-term studies of
obese adults following a calorie-restricted
diet, those who took the appetite suppressants
lost more weight on average than those
who took a placebo. The amount of weight
lost varied from study to study.
FDA approved the drugs only for
use with calorie-restricted diets. The
drugs are "not magic pills," warns Leo
Lutwak, M.D., Ph.D., of FDA's division
of metabolism and endocrine drug products.
"They don't work unless you make dietary
and exercise changes."
Also, they should be used only for a
few weeks partly because, aside from Xenical,
the drugs are addictive and have the potential
for abuse. They shouldn't be used in combination
with each other or with other drugs for
appetite control because such combinations
have not been evaluated for safety. And
the drugs should be used only in people
who are obese--not people looking to lose
a few pounds, Lutwak says.
"Weight-loss drugs are serious medicine
for a serious disease," he says.
Also, he points out that while obesity
may be associated with other serious diseases,
studies have never shown that weight loss
produced with the use of prescription
weight-loss drugs benefits obesity-associated
conditions. However, changes in diet and
activity may improve associated diseases,
such as diabetes and high blood pressure,
even with only modest changes in weight,
Lutwak says. |
Until September 1997, two other drugs, fenfluramine
(Pondimin and others) and dexfenfluramine (Redux),
were available for treating obesity. But, at
FDA's request, the manufacturers of these drugs
voluntarily withdrew them from the market after
newer findings suggested that they were the
likely cause of heart valve problems in a large
proportion of people using them. FDA recommended
that anyone taking the drugs stop and that they
contact their doctor to discuss their treatment.
The basic tenet of weight loss--to eat fewer
calories than you burn and to stay active--is
easy to say but, like most lifestyle changes,
not so easy to do. With realistic goals, and
a commitment to losing weight slowly, safely
and sensibly, the chances of long-term success
improve dramatically.
OTC
Diet Pills
The 1991/1992 Weight Loss Practices Survey,
sponsored by FDA and the National Heart, Lung,
and Blood Institute, found that 5 percent of
women and 2 percent of men trying to lose weight
use diet pills. Products considered by FDA to
be over-the-counter weight control drugs are
primarily those containing the active ingredient
phenylpropanolamine (PPA), such as Dexatrim
and Acutrim. PPA is available OTC for weight
control in a 75-mg controlled-release dosage
form. The medicine should be used in combination
with a restricted diet and exercise.
Using diet pills containing PPA will not make
a big difference in the rate of weight loss,
says Robert Sherman of FDA's Office of OTC Drug
Evaluation. "Even the best studies show only
about a half pound greater weight loss per week
using PPA combined with diet and exercise,"
he adds. Sherman cautions that the recommended
dosage of these pills should not be exceeded
because of the risk of possible adverse effects,
such as elevated blood pressure and heart palpitations.
Since PPA is also used as a nasal decongestant
in over-the-counter cough and cold products,
consumers should read the labels of OTC decongestants
to see if they contain PPA. They should not
take PPA in two products labeled for different
uses.
Sherman notes that FDA has received a small
number of reports indicating that PPA use might
be associated with an increased risk of stroke.
A large-scale safety study was begun in September
1994 to explore the possibility. Based on available
data, the agency does not believe that an increased
risk of stroke is a concern when PPA is used
at recommended dosages.
Regular exercise is important for overall health,
as well as for losing and maintaining weight.
There is evidence to suggest that body fat distribution
affects health risks. For example, excess fat
in the abdominal area (as opposed to hips and
thighs) is associated with greater risk for
high blood pressure, diabetes, early heart disease,
and certain types of cancer. Vigorous exercise
can reduce abdominal fat and thus lower the
risk of these diseases.
The Dietary Guidelines for Americans recommends
a half hour or more of moderate physical activity
on most days, preferably every day. The activity
can include brisk walking, calisthenics, home
care, gardening, moderate sports exercise, and
dancing. Regular exercise can help the body
use up calories consumed daily, as well as excess
calories stored as fat. Weight-bearing exercises
also help tone muscles and may reduce the risk
of osteoporosis.
To help consumers plan a healthful diet, FDA
and USDA have revamped food labels. By law,
most food labels now must display a Nutrition
Facts panel containing information about how
the food can fit into an overall daily diet.
Nutrition Facts state how much saturated fat,
cholesterol, fiber, and certain nutrients are
contained in each serving.
On the food label, %Daily Value shows what
percentage of a given nutrient is provided in
one portion for daily diets of 2,000 calories.
Whether or not a given food fits into a weight-loss
diet depends on what other foods you eat that
day. For most people, the goal is to select
a variety of foods that together add up to approximately
100 percent of the Daily Value for total carbohydrate,
dietary fiber, vitamins, and minerals; total
fat, cholesterol and sodium each may add up
to less than 100 percent.
Foods that claim to contain fewer calories
or less fat than similar servings of similar
products must show the difference on the label.
For example, on a container of low-fat cottage
cheese, the label would show that a serving
of the low-fat product contains 80 calories
and 1.5 grams of fat while regular cottage cheese
contains 120 calories and 5 grams of fat per
serving.
Camille Brewer, a registered dietitian and
nutritionist in FDA's Center for Food Safety
and Applied Nutrition, advises caution, however,
when choosing foods that are labeled "fat-free"
and "low-fat." Some of these foods, like "low-fat"
cakes and cookies, still may be high in calories
because of added sugars. So dieters should always
check the Nutrition Facts panel to get complete
information, she says.
Look for foods high in fiber, such as fruits,
vegetables, legumes and whole grains. Fiber
can be an important aid in weight maintenance
because eating enough of it can help make a
person feel full and thus not eat as much.
To see how the new label can help you stick
to your diet, see Dieters'
Label Checklist (Also available as a 119k
PDF)
"There
are no shortcuts--no magic pills," says Lori
Love, M.D., Ph.D., of the Food and Drug Administration's
Center for Food Safety and Applied Nutrition.
Losing weight sensibly and safely requires a
multifaceted approach that includes setting
reasonable weight-loss goals, changing eating
habits, and getting adequate exercise. Appetite
suppressants (diet pills) or other products
may help some people over the short term, but
they are not a substitute for adopting healthful
eating habits over the long term
.Marilynn
Larkin is a writer in New York City. Paula Kurtzweil,
a member of FDA's public affairs staff, also
contributed to this article.
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