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INTRODUCTION

Dead foods, processed foods, refined sugars and fats tax your system rather than serving it. As they cause your blood sugar to spike and plummet, clog your colon, poison your blood and cause constipation, your body is compromised. How can you tell when your body is having trouble eliminating toxins? There are eight warning signs to watch for:. You already know that your diet is critical to your health, but do you know what your ideal diet should look like?

Make sure at least 80 percent of your calories are from high-quality, healthy foods. You can add some indulgences into the remaining 20 percent of your calories, but remember, the more high-quality foods you eat, the better it is for you, your body and your health. High-quality foods should consist of unprocessed foods like fruits, vegetables, nuts and beans and whole grains. Cook sparingly with oils, and choose healthier alternatives such as safflower or olive oil.

Other diet tips to keep in mind:. Weight loss friendly foods are those that keep you feeling satisfied longer and help you burn calories. They go through the right metabolic pathways to support your weight loss. Here is a list of foods you should focus on to optimize your weight loss:. Apple cider vinegar, when taken with a meal, can help you feel fuller. It has also been shown to reduce blood sugar spikes after meals.

Avocados are loaded with fiber and potassium. Including avocados in salad can increase the uptake of nutrients from the other vegetables by up to 15 times. Beans and legumes are high in protein, resistant starch and fiber, all of which help you feel fuller. Lentils, black beans, kidney beans, garbanzo beans and white beans are all great choices. Packed with antioxidants, a single cup of blueberries is filled with four grams of fiber and only 84 calories.

Packed with omega-3 fatty acids, they are also high in fiber, soaking up liquid and expanding in your stomach. Chili peppers contain capsaicin, a substance which can increase fat burning and reduce appetite. It is also a natural anti-inflammatory. Coconut oil is unique among fats for its ability to boost feelings of satiety and help the body burn more calories. Cruciferous vegetables like broccoli, brussel sprouts, cabbage and cauliflower are higher in protein than other vegetables, very high in fiber and can help fight cancer.

You can enjoy dark chocolate in moderation. It contains healthy fats called MUFAs that help your metabolism burn more calories and fat, and it can also slow down your digestion so you can feel full and indulge less. Even for critics of fruit generally, the grapefruit is a good weight loss food, having been shown to have a direct impact on weight loss when eaten before meals. Green tea keeps you hydrated like water does, but it also contains antioxidants that help you burn calories and fat. Leafy greens like chards, collards, kale, mustard greens and spinach are low in carbohydrates and calories, and packed with antioxidants, fiber, minerals and vitamins.

You can eat a large volume of leafy greens to feel fuller without consuming as many calories. Choose almonds, pine nuts, walnuts or any other tree nut. As you consider how to distribute your calories throughout your day and evening, focus on how they break down into carbohydrates, fats and proteins. Deciding on what the right balance is depends on your personal goals and your physical state. Protein has the greatest range of overall metabolic benefits for weight loss, but how can you decide how to adjust carbohydrate and fat calories, and by how much?

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The Dietary Guidelines for Americans recommends that you balance your meals within these ranges:. Therefore, this should be your minimum baseline for weight loss. Remember that the quality of the calorie counts, so you need to make each calorie work as hard as it can for your body and your weight loss goals:. Drink three glasses of milk every day, or their equivalent. Most adults cannot properly digest milk. By William David, M.

Unhealthy carbs are a major cause of obesity Best suited for: During those 10 days, the program follows recipes that wean you off of unhealthy wheat and grains ASAP, while simultaneously teaching you how to recognize withdrawal symptoms because pretzel addiction is real! Press the reset button on your entire diet to help you find out exactly which foods are causing health issues Best suited for: Its regular appearance on the New York Times best-seller list solidifies its status as one of the best healthy eating books out there.

Buy It Now 5. Daily Dash for Weight Loss: To lose weight, eat more nutritionally dense foods Best suited for: 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.


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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.


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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.

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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.

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.

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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.

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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.

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. 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.

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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.

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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. 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. A very small number of humans with this gene defect have been identified, and at least one responded to leptin Clement et al.