9.2 – Dietary, Behavioral, and Physical Activity Recommendations for Weight Management

We have just considered the gravity of the obesity problem in America and worldwide. How is America combating its weight problem on a national level and have the approaches been successful?

Successful weight loss is defined as individuals intentionally losing 5-10 percent of their body weight and keeping it off for at least one year.¹ Results from lifestyle intervention studies suggest fewer than 20 percent of participants are successful at weight loss. An evaluation of successful weight loss, involving more than fourteen thousand participants published in the November 2011 issue of the International Journal of Obesity estimates that more than one in six Americans who were overweight or obese were successful in achieving long-term weight loss.² However, these numbers are on the high end because many similar studies report fewer than 10 percent of participants as successful in weight loss.

The National Weight Control Registry (N.W.C.R.) tracks over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year. Their research findings are that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking.)³  Although there are a great variety of approaches taken by N.W.C.R. members to achieve successful weight loss and weight loss maintenance, most report that their approach to weight loss involved adhering to a low-calorie ( high in low energy-dense foods), lower-fat diet and doing high levels of activity (about one hour of exercise per day).  About half of them lost weight on their own and the other half used some type of weight-loss program. In most scientific studies successful weight loss is accomplished only by changing the diet and by increasing physical activity. Doing one without the other limits the amount of weight loss and the length of time that weight loss is sustained.

For weight maintenance,  a national survey of 1165 individuals found that four specific behaviors seemed to predict weight maintenance success, but not necessarily initial weight loss. Those behaviors included:

1. Eat plenty of low-fat sources of protein

2. Follow a consistent exercise routine

3. Reward yourself for sticking to your diet or exercise plan

4. Remind yourself why you need to control your weight

On an individual level, it is quite possible to achieve successful weight loss, as many Americans can attest. but those who are successful make permanent changes in their lifestyle. Even with these changes, many people find that if their circumstances change, they find it difficult to maintain their change in weight. Moreover, losing as little as 10 percent of your body weight can significantly improve health and reduce disease risk.

^{1Wing, R. R. and J. O. Hill. “Successful Weight Loss Maintenance.” Annu Rev Nutr 21 (2001): 323–41. Accessed May 18, 2019.2}

^{2 Kraschnewski, J. L. et al. “Long-Term Weight Loss Maintenance in the United States.” Int J Obes 34, no. 11 (2010): 1644–54.Accessed June 30, 2019.}

^{3 The National Weight Control Registry. “Research Findings.” Accessed June 30, 2019.} 

Evidence-Based Dietary Recommendations

The 2015-2020 Dietary Guidelines for Americans offers specific, evidence-based recommendations for dietary changes aimed at keeping calorie intake in balance with physical activity, which is key for weight management. These recommendations include:

• Increase intake of whole grains, vegetables, and fruits. Scientific evidence demonstrates that adults who have a higher intake of whole grains, mainly those high in dietary fiber, have lower body weights compared to adults who eat a smaller amount of whole grains. In addition,  diets incorporating more whole grains reduce chronic disease risk. A higher intake of fruits and vegetables is scientifically shown to protect against weight gain in adults and there is some evidence that this is also true for children and adolescents.
• Reduce the intake of sugar-sweetened beverages. Choose water and other low-calorie beverages to quench thirst. There is good evidence that reducing consumption of sugar-sweetened beverages, especially in children and adolescents, decreases body weight and reduces chronic disease risk.
• Monitor intake of 100 percent fruit juice for children and adolescents, especially those who are overweight or obese. There is some evidence that increased intake of 100 percent juice exacerbates weight problems in children and adolescents who are already overweight or obese.
• Monitor calorie intake from alcoholic beverages for adults. Drinking in moderation is not linked to weight gain; however, excessive intake of alcohol over time is associated with weight gain.

In addition to the dietary recommendations above, Smethers and Rolls discussed specific evidence-based recommendations in, “Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns” published in the Medical Clinics of North America, 2018.

The recommendations include:

• Substitute low energy-dense foods for higher energy density foods.
• Add a low energy-dense first course. Start your meal with a broth-based soup or salad.
• Include low-fat proteins and fiber to increase satiety. 
• Decrease the energy density of the main course. Reduce unhealthy fats and add more fruits and vegetables.
• Limit added sugars to less than 10% of total energy. 
• Limit snacks to 200 calories per day and choose vegetables and fruits rather than energy-dense highly processed snacks.

Stress Management

We looked at Mindful Eating practices earlier.  Learning stress management and mindfulness techniques can help support weight loss.  For many of us, the combination of decreased sleep and increased perceived stress is a perfect set up to overeat. So what is stress? It is defined as a feeling of strain and pressure both physically and emotionally. Excessive stress can increase an individual’s risk for several chronic diseases. On the other hand, positive psychological stress can lead to motivation and can be experienced as a positive challenge or experience.

One of the strategies used to decrease excessive stress and help people maintain a healthy weight is social support. It is easier to stick with a change in eating plan when others are doing it with you. In addition, meditation, progressive muscle relaxation, Cognitive Behavior Therapy, guided imagery, and Acceptance and Commitment Therapy have all been used with some success.¹ There are many resources available at Penn State to help you learn stress management. You can choose self-help resources here. Counseling and Psychological Services( C.A.P.S. )is available if you are looking for professional help.  You can also make an appointment for free peer one-on-one services on the following topics:

• Nutrition/healthy eating
• Physical activity
• Sleep
• Stress (relaxation and time management)

Some simple changes you can make on your own include:

1. Getting adequate sleep. Adults aged 18-60 years need 7 hours of sleep. This may seem impossible with all of the commitments students have today, but adequate sleep reduces perceived stress.  Keep a regular sleep schedule. Being physically active can improve sleep quality. Unplug at least 1/2 hour prior to bedtime. Keep your room dark and cool for the best quality of sleep.
2. Take up a relaxation practice. Try meditation, progressive muscle relaxation, guided imagery, or yoga. All of these help the body relax at a deeper level. There are many apps available to get started with these practices.
3. Other ways to reduce stress include listening to music, being creative, laughter, and spending time with a dog, cat or another animal.  What do you do that could be added to this list? 
4. Examine your thoughts. If you decide to eat something, not on your food plan, what is your reaction? For many people, it is a feeling of failure that is followed by giving up on their plan of eating. Analyzing behavior chains can help you look at some of these thoughts. Analyze the case studies below and think of ways that Melanie and Steve might interrupt their chain of behavior and the thoughts they are telling themselves to reduce their stress and make different choices. 

 

Case Study one

Melanie is studying for an exam, it is Saturday night and she would rather be out with her friends. She is tired of studying and remembers the cookies that she made for everyone the day before.  She decides to eat just one cookie, but they taste so good, and the studying is SO hard, she keeps going back for one more. Eventually, she realizes she ate ALL the cookies. She tells herself, she will pay more attention to eating better after she takes all her exams. Melanie continues to eat other foods until she feels sick and stops studying for the evening.

Case Study two

Steve had been struggling with success in college. He had been a straight-A student in high school, but since he has come to Penn State, A’s have been pretty elusive. Steve had started getting less sleep (5 hours each night) so there would be more time to study. He was also working 20 hours each week, taking 18 credits, and was heavily involved in Thon.  Steve had never truly listened to what he was telling himself while he was studying, he realized that he was thinking, “I will never learn this material.” Followed by, “What is the point in studying?” Followed by, ” I am hungry, I will get some chips to help me study.” Steve had gained 15 pounds since he started college.

Physical Activity

The other part of the energy balance equation is physical activity. Increased physical activity has been found in scientific studies to lower the risk of heart disease, stroke, high blood pressure, Type 2 diabetes, colon, breast, and lung cancer, falls and fractures, depression, and dying early. Increased physical activity not only reduces disease risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance. The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in elsewhere):

• Substantial health benefits are obtained by doing at least two hours and thirty minutes per week of moderate-intensity, or one hour and fifteen minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof. Aerobic activity has better benefits if performed for at least ten minutes at a time, spread throughout the week.
• More extensive health benefits occur when moderate aerobic physical activity is increased to five hours per week of moderate-intensity, or to two hours and thirty minutes of vigorous-intensity aerobic physical activity, or a combination thereof. Additional health benefits are gained by going beyond these recommended amounts of physical activity.
• Muscle-strengthening activities at moderate or high intensity involving all major muscle groups two or more days per week provide additional health benefits to aerobic exercise.

Source: US Department of Health and Human Services. 2018 Physical Activity Guidelines for Americans. 2018.

^{1 Xenaki N, Bacopoulou F, Kokkinos A, Nicolaides NC, Chrousos GP, Darviri C. Impact of a stress management program on weight loss, mental health and lifestyle in adults with obesity: a randomized controlled trial. J Mol Biochem. 2018;7(2):78–84.}

 

Tables 9.2.1: Moderate and Vigorous Physical Activities

 

Strategies for a Healthy-Weight America

On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. Currently, the emphasis has shifted focus to making the healthy choices the “default” choice. Methods of achieving this goal could include changes in food policy to promote the planting of fresh fruits and vegetables, taxing unhealthy foods and subsidizing healthier choices, or changing the way our communities are built. How easy is it to make a healthy choice of food or activity in your home community?  Research has shown that as more fast food establishments open in a community, the frequency of consumption goes up for the population in that community. In addition, think about the last party or meeting you attended, what options were available that promoted healthy choices or even allowed a person to make a healthy choice?   Visit the CDC’s  Division of Nutrition, Physical Activity, and Obesity or Harvard’s School of Public Health Obesity Prevention websites for more information.

In the Centre region, a group of stakeholders got together and formed the community action group, Centre Moves. This is a great organization of community individuals working together to be more physically active and improve nutritional choices. Check out their website for more information on activities and ways to be involved in our region.