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- Eat less: A daily deficit of 500 to 1000 calories is reasonable. This is the single most important component of therapy and most difficult to adhere to.
- Exercise a lot: Strenuous aerobic activity for over 200 minutes per week maintained over a long period of time with calorie restriction is effective. Physical activity conserves fat free mass, improves glucose tolerance and lipid profile. Fact: Moderate exercise like walking 45 minutes a day for 5 days a week has minimal effect on weight loss.
- Modify behavior to avoid temptation to engorge on food. This warrants life style change and altering emotional response to food. Self monitoring and social support are essential.
- Use drug therapy: Only two drugs have been approved by FDA for long term therapy.
- Sibutaramine causes anorexia by blocking neuronal monoamine uptake.
- Orlistat decreases fat absorption
- Get surgery if morbidly obese and nothing else helps.
- Gastric bypass to channel food directly into mid intestine thus decreasing absorption
- Gastric banding and stapling to diminish the size of the stomach
- Combination of bypass and stomach size reduction
The prescription of eat- less-exercise- more-modify- behavior is still the best choice but compliance has been pathetic. On average, a person on a weight reduction diet has tried and failed three to six other diets before. This failure has created an enormous market opportunity for fad diet authors and manufacturers. Some examples:
- Eat less carbohydrates ( Atkins, South beach)
- Eat less fats ( Ornish, Pritikin)
- Eat less of both ( Weight Watchers, Jennie Craig)
- Eat very low calorie diet:400 calories ( Optifast, Cambridge)