Definition
Weight management is a plan to help an overweight or obese person reach and stay at a healthy body weight. Body mass index (abbreviated as BMI) is used to evaluate weight. This number is determined by dividing an individual's weight in kilograms by an individual's height in meters squared.
The National Institutes of Health, or NIH, has set BMI standards. If a person's BMI is 25.0 to 29.9 kg/m2, he or she is considered overweight. People are considered obese if their BMI is 30 to 39.9 kg/m2. A BMI of 40 kg/m2 or higher indicates extreme or morbid obesity.
What is the information for this topic?
Anyone who takes in more calories than the body burns can expect to put on weight. Overweight and obesity are complex conditions with various factors that interact. These factors fit into the following groups:
behavioral
cultural
genetic
metabolic
physiological
social
Impact of overweight or obesityOverweight and obesity put a person at risk for other health problems, such as:
back pain
breathing problems
coronary heart disease
diabetes
gallbladder disease
high blood pressure
osteoarthritis
some types of cancer
stroke
Obesity can even lead to an early death. The risk grows as the degree of obesity increases.
Weight management planThe first goal should be a 10% weight loss over a 6-month period. The rate of weight loss should be 1 to 2 pounds a week, because faster weight loss does not improve the long-term results.
After the first 6 months, additional weight management goals can be discussed with the healthcare professional. Some people may need to keep losing weight, while others may be ready to maintain their weight loss. No one treatment works for everyone.
NIH recommends these guidelines for the healthcare professional:
make changes to the treatment plan based on the person's preferences and responses
schedule regular office visits to track weight loss progress
set weight loss goals with the individual
understand how the treatment fits into other health care and self-care needs of the person
A successful weight management plan includes:
behavior therapy
dietary therapy
regular physical activity
The plan may also include medicine or surgery.
Dietary therapyDietary therapy works best when it meets the needs of the individual. In general, NIH recommends these guidelines.
A diet of 1,000 to 1,200 calories a day is appropriate for most women.
A diet of 1,600 calories a day is recommended for most men.
A diet of 1,600 calories a day may be right for women who exercise regularly or weigh over 165 pounds.
If the person does not lose weight on the 1,600-calorie diet, a diet of 1,200 calories a day may be recommended.
The healthcare professional may recommend adding 100 to 200 calories a day if the person is hungry.
Specific recommendations should be given to be sure that the person gets all essential nutrients.
Physical activityTo begin treating obesity, NIH recommends moderate levels of physical activity. The activity should last 30 to 45 minutes a day, 3 to 5 days a week. The activity should be started slowly and gradually increase in intensity. Some moderate physical activities are:
bicycling 5 miles in 30 minutes
doing water aerobics for 30 minutes
gardening for 30 to 45 minutes
raking leaves for 30 minutes
walking 2 miles in 30 minutes
SleepA number of studies have shown that reduced hours of sleep are associated with being overweight or obese. Teens should average 8 to 9 hours of sleep per night.
Behavior therapyBehavior therapy is used to overcome barriers to diet or physical activity. A good behavior therapy plan has these features:
focuses on what matters
includes seeing the healthcare professional often
includes self-monitoring, with appropriate rewards
is a partnership with the healthcare professional
sets reasonable goals
takes the person's attitudes, beliefs, and history into account
Medicine and surgeryPeople often try natural medications (herbs, vitamins or supplements) for appetite suppression. The Natural Medicines Comprehensive Database (NMCD) rates the following as "possibly effective" for weight loss:
caffeine,
calcium,
conjugated linoleic acid,
diacylglycerol,
fish oil,
whey protein.
Rated as "ineffective" for weight loss are:
blue-green algae,
garcinia,
glycerol,
guar gum,
inulin.
Rated as "likely ineffective" for weight loss:
tiratricol.
Those natural medicines rated by the NMCD as having "insufficient evidence" for using for weight loss include:
5-HTP,
7-keto-DHEA,
bean pod,
bitter orange,
bladderwrack,
carob,
chitosan,
chromium,
cola nut,
DHEA,
glucomannan,
green tea,
guarana,
guggul,
licorice,
magnolia,
mate,
phellodendron,
pyruvate,
soy, and
willow bark.
For short term (i.e., a few weeks only) appetite suppression, the following prescription drugs can be used under the supervision of a healthcare professional:
diethylpropion (i.e., Tenuate),
phentermine (i.e., Adipex-P),
mazindol,
phendimetrazine, or
benzphetmine.
The Food and Drug Administration, or FDA, has approved only two medicines for long-term use for weight loss. They are:
orlistat (i.e., Xenical), and
sibutramine (i.e., Meridia).
These medicines may be prescribed for people with a BMI of 27 to 29.9 who have two or more diseases. NIH suggests these two medicines can also be used by people with a BMI of 30 or higher.
Bariatric surgery is a procedure in which the size of the stomach is reduced in order to change the way food is absorbed. In the past, it was reserved for people with extreme (morbid) obesity, but now is sometimes used for people with more moderate degrees of obesity for whom other approaches have not worked. It requires a lifelong commitment to a very disciplined approach to eating.
ToolsNIH provides tools to aid in weight management, such as:
dietary information
guide to behavior change
guide to physical activity
weekly food and activity diary
weight and goal records
ContraindicationsNIH states that these groups of people should be excluded from weight loss treatment:
people who have serious illnesses that might be worsened by calorie restriction
people who have a serious uncontrolled psychiatric illness, such as major depression
women who are pregnant or breastfeeding
NIH also recommends that certain individuals be referred to specialists for weight loss as needed. These include people with a history of eating disorders, such as anorexia nervosa or bulimia. People who are currently abusing drugs should also be referred to a specialist.
Weight maintenanceAfter the person has reached his or her weight loss goal, weight maintenance needs to be lifelong. The person should have regular treatment to continue with these measures:
behavior therapy
dietary therapy
sleep
regular physical activity
Ongoing therapy can be given in a number of ways. The methods recommended by NIH include:
e-mail reminders
group meetings
regular visits with the healthcare professional
telephone communications
After successful treatment for obesity, the person can monitor his or her weight. Regular visits with the healthcare professional will also be needed. NIH recommends an appointment at 6 months and again one year after the start of the weight management plan. The professional will check the person's weight, BMI, and waist measurement during these visits. Any new or worsening symptoms should be reported.
Author: Terry Mason, MPH Date Written: 05/13/00 Medical Review: Todd Thames, MD Date Written: 9/26/2006 Reviewer: Walt Larimore, MD Date Reviewed: 10/6/2006
Contributors
Potential conflict of interest information for reviewers available on request
