How obese people can BE helped to lose wEIGHT

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In considering the treatment of obesity, two different aspects of the problem must be considered:

  • The initial problem, which is to help the overweight or obese person to reduce his or her weight to within the desirable range, where life expectancy is maximum.
  • The long-term problem of helping the now lean person to maintain desirable body weight. This is largely a matter of education, increasing physical activity and changing eating habits. The same guidelines for a prudent diet (discussed in section 7.3) apply to the slimmed-down, formerly obese, person as to anyone else.

The aim of any weight reduction regime is to reduce the intake of food to below the level needed for energy expenditure, so that body reserves of fat will have to be used. As discussed in section 5.2, the theoretical maximum possible rate of weight loss is 230 g per megajoule energy imbalance per week; for a person with an energy expenditure of 10 MJ/day, total starvation would result in a loss of 2.3 kg/week. In practice, the rate of weight loss is lower than this theoretical figure because of the changes in metabolic rate and energy expenditure that occur with changes in both body weight and food intake.

Very often, the first one or two weeks of a weight-reducing regime are associated with a very much greater loss of weight than this. Obviously, this cannot be due to loss of fat. It is due to loss of the water associated with glycogen (section Although it is not sustained, the initial rapid rate of weight loss can be extremely encouraging for the obese person. The problem is to ensure that he or she realizes that it will not, and indeed cannot, be sustained. It also provides excellent advertising copy for less than totally scrupulous vendors of slimming diets, who make truthful claims about the weight loss in the first week or two and omit any information about the later weeks and months needed to achieve goal weight.

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