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Secrets of weight loss By Dr.D.Gunasingh
1. Secrets of Weight Loss
• Dr. D.Gunasingh MD,DCH,
• HOD/Professor of
Pediatrics
• TRIHMS(Tomo Riba
Institute of Health and
Medical Sciences )
• Retd Professor of
Pediatrics,
• Madras Medical College.
3. • Globally, more than 1.9
billion adults are
overweight and 650
million are obese.
• In India, more than 135
million individuals were
affected by obesity.
4. Indian Scenario
Nutritional Status of Adults (age 15-49
years)
NFHS-4
(2015-16)
NFHS-3
(2005-
06)
Women whose Body Mass Index (BMI)
is below normal (BMI < 18.5 kg/m2)
22.9 35.5
Men whose Body Mass Index (BMI) is
below normal (BMI < 18.5 kg/m2) (%)
20.2 34.2
Women who are overweight or obese
(BMI ≥ 25.0 kg/m2)
20.6 12.6
Men who are overweight or obese (BMI
≥ 25.0 kg/m2) (%)
18.9 9.3
5.
6. Definition
• The term "obesity" refers
to an excess of fat.
However, the methods
used to directly measure
body fat are not available
in daily practice. For this
reason, The body mass
index (BMI)which
provides an estimate of
body fat that is
sufficiently accurate for
clinical purposes.
7. World Health Organization.
Classification of body mass index
• Underweight – BMI <18.5 kg/m2
• Normal weight – BMI ≥18.5 to 24.9 kg/m2
• Overweight – BMI ≥25 to 29.9 kg/m2
• Obesity – BMI ≥30 kg/m2
• Obesity class I – BMI 30 to 34.9 kg/m2
• Obesity class II – BMI 35 to 39.9 kg/m2
• Obesity class III – BMI ≥40 kg/m2 (also referred to as severe,
extreme, or massive obesity)
• BMI classifications are based upon risk of cardiovascular disease.
For Asians define overweight as a BMI between 23 and 24.9 kg/m2
and obesity as a BMI >25 kg/m2.
• BMI: body mass index; NIH: National Institutes of Health; WHO:
8. Waist circumference
• ≥ 102 cm for men and
• ≥ 88 cm for women indicative of increased
cardio metabolic risk . Waist circumference
measurement is unnecessary in patients with BMI
≥35 kg/m2 as almost all individuals with this BMI
also have an abnormal waist circumference and
are already at a high risk from their adiposity.
• A waist circumference ≥31 in (80 cm) in Asian
females and ≥35 in (90 cm) in Asian males is
considered abnormal.
13. Classification in children Adolescents
• for children between 2 and 18 years of age
• Normal weight – BMI between the 5th and 85th
percentile for age and sex.
• Overweight – BMI between the 85th and 95th
percentile for age and sex.
• Obese – BMI ≥95th percentile for age and sex.
• Severe obesity –
• BMI ≥120 per cent of the 95th percentile,
• OR a BMI ≥35.
• OR approximately the 99th percentile.
15. Environmental
• Sedentary lifestyle
• Caloric intake that is greater than needs.
• Environmental factors explain only part of
obesity risk, but are important targets for
treatment because they are potentially
modifiable
16. • Increasing trends in high glycemic index of foods.
• Sugar-containing beverages.
• Larger portion sizes for prepared foods.
• Fast food service .
• Diminishing family presence at meals.
• Decreasing structured physical activity.
• Shortened sleep duration
• Lack place for physical activity
18. Night-eating syndrome
Consumption of at
least 25 per cent (and
usually more than 50
per cent) of daily energy
between the evening
meal and the next
morning .
It is a well known
pattern of disturbed
eating in the obese
19.
20. syndrome
ssyndrome features
Albright hereditary osteodystrophy
(Pseudohypoparathyroidism type
1a)
Short stature, short metacarpals and
metatarsals, round facies, mild
cognitive deficit
Alström Blindness, deafness, acanthosis
nigricans, type 2 diabetes, primary
hypogonadims
,normal cognition
Bardet-Biedl Mental retardation, hypotonia,
retinitis pigmentosa, polydactyly,
hypogonadism deafness, renal
diseas
Cohen Mental retardation, microcephaly, small
hands and feet, cryptorchidism,
hypotonia and failure to thrive in
infancy
Prader-Willi Microcephaly, short stature, hypotonia,
almond- shaped eyes,, early failure to
thrive with hyperphagia and increased
weight gain by 2-3 years,
22. Is there evidence for a set point that regulates human body weight?
Manfred J Müller,1 Anja Bosy-Westphal,1 and Steven B Heymsfield2
• Searching for the genetic background of
excess weight gain in a world of abundance is
misleading. Environmental factors have to be
addressed to tackle population-wide, non-
syndromic human obesity.
29. Four Types of Input to the Hypothalamus
Hypothalamus contains HUNGER and SATIETY centre
Paraventricular, Dorsomedial, and Arcuate nuclei of the
Hypothalamus also play a major role
• Neural input from the cerebral cortex
• Neural input from the limbic system
• Peptide hormones from the GI tract
• Adipocytokines from adipose tissue
30.
31. HUNGER AND SATIETY
CENTRE
FEEDING SATIETY
CENTRE CENTRE
LATERAL NUCLEI
OF
HYPOTHALAMUS
VENTROMEDIAL
NUCLEI OF
HYOTHALAMUS
INHIBITION
FOOD INTAKE
37. Management
• While it can be
challenging to make the
lifestyle changes
needed to lose weight
and improve your
health, if you set goals
and commit to them,
you can be successful
38. Multidisciplinary care
Physicians address medical issues
Dieticians help patients gradually learn to eat less
and incorporate healthier foods into
their diets.
Exercise specialists teach practical ways to integrate
physical activity into day-to-day life
Behavioural therapists
change;
help patients mentally prepare for the
process of lifestyle change and address
barriers to
Nurses can help patients feel comfortable in a
medical setting and assist in the
management of medical complications
42. Initial treatment
• Combination of diet, exercise, and behavioural
modification.
• All patients who would benefit from weight loss
should receive counselling on diet, exercise, and
• goals for weight loss.
• The behavioural modification component
facilitates adherence to diet and
• exercise regimens, and includes regular self-
monitoring of food intake, physical activity, and
weight.
43. Dietary therapy
Tailoring a diet that reduces energy intake below
energy expenditure
• Many types of diets produce modest weight
loss.
• Balanced High protein, low-calorie, low-
fat/low-calorie, moderate-fat/low-calorie, or
low-carbohydrate diets, Mediterranean diet.
Dietary adherence is an important predictor of
weight loss, regardless of the type of diet
chosen
44.
45. Balanced Diet
• A balanced diet should provide around 50-
60% of total calories from carbohydrates,
preferably from complex carbohydrates,
about 10-15% from proteins and 20-30%
from both visible and invisible fat.
• dietary fibre, antioxidants and
phytochemicals which bestow positive
health benefits.
• Antioxidants such as vitamins C and E,
beta-carotene, riboflavin and selenium
protect the human body from free radical
damage.
• Other phytochemicals such as
polyphenols, flavones, etc., also afford
protection against oxidant damage.
• Spices like turmeric, ginger, garlic, cumin
and cloves are rich in antioxidants.
46. Eat to loose weight
• Metabolic studies using
state-of-the-art
techniques have
concluded that most
adults will lose weight
when fed <1000 kcal/day.
Thus, even subjects who
are concerned that they
are
• "metabolically resistant"
to weight loss will lose
weight if they comply
with a diet of 800 to 1200
47. Relapse
• Although many individuals
have success losing weight
with diet, most
subsequently regain
• much or all of the lost
weight.
• Since long-term adherence
to a weight-maintaining
diet is probably the most
important determinant of
success, the optimal
weight-maintaining diet will
depend upon preference
and individual factors.
48. Management
E-estimating energy expenditure
WHO Criteria
Step 1: Estimate basal metabolic rate
Men 18 to 30 years = (0.0630 x actual weight in kg + 2.8957) x 240 kcal/day
Men 31 to 60 years = (0.0484 x actual weight in kg + 3.6534) x 240 kcal/day
Women 18 to 30 years = (0.0621 x actual weight in kg + 2.0357) x 240 kcal/day
Women 31 to 60 years = (0.0342 x actual weight in kg + 3.5377) x 240 kcal/day
Step 2: Determine activity factor
Activity level Activity factor
Low (sedentary) 1.3
Intermediate (some regular exercise) 1.5
High (regular activity or demanding job) 1.7
Step 3: Estimate total energy expenditure
Total energy expenditure = Basal metabolic rate x activity factor
49. • Approximately 22 kcal/kg is required to maintain a
kilogram of body weight in a normal-weight
adult.
• The expected or calculated energy expenditure
for a woman weighing 100 kg is approximately 2200
kcal/day. The variability of ±20 per cent could give
energy needs as high as2620 kcal/day or as low as
1860 kcal/day.
An average deficit of 500 kcal/day should result in an
• initial weight loss of approximately 0.5 kg/week (1
lb./week).
50. Low-calorie versions of healthy diets
• Mediterranean
diet
• Olive oil(MUFA)a high
consumption of
vegetables, fruits,
legumes, and grains; a
moderate consumption of
milk and dairy products,
mostly in the form of
cheese; and a relatively
low intake of meat and
meat products
51. The ketogenic diet
• is a very low-carb, high-
fat diet that shares many
similarities with the Atkins and
low-carb diets. It involves
drastically reducing carbohydrate
intake and replacing it with fat.
This reduction in carbs puts your
body into a metabolic state
called ketosis. ketogenic diet may
help to control hunger and may
improve fat oxidative metabolism
and therefore reduce body
weight.
52. Paleo diet
• is a dietary plan based on
foods similar to what
might have been eaten
during the Palaeolithic
era, which dates from
approximately 2.5 million
to 10,000 years ago.
• A paleo diet typically
includes lean meats, fish,
fruits, vegetables, nuts
and seeds — foods that in
the past could be obtained
by hunting and gathering.
53. Paleo diet
What to eat
• Fruits
• Vegetables
• Nuts and seeds
• Lean meats, especially grass-
fed animals or wild game
• Fish, especially those rich in
omega-3 fatty acids, such as
salmon, mackerel and albacore
tuna
• Oils from fruits and nuts, such
as olive oil or walnut oil
What to avoid
• Grains, such as Rice, wheat,
oats and barley
• Legumes, such as beans,
lentils, peanuts and peas
• Dairy products
• Refined sugar
• Salt
• Potatoes
• Highly processed foods in
general
Calorie counting and portion sizes are not
emphasized.
54. Paleo diet
• 1) increased satiety-- may facilitate a
reduction in energy consumption under ad
libitum dietary conditions;
• 2) increased thermogenesis--higher-protein
diets are associated with increased
thermogenesis, which also influences satiety
and augments energy expenditure
• 3) Increasing of fat-free muscle--in some
individuals
55. Intermittent fasting
• Including alternate-day fasting
and time-restricted feeding,
have been used as approaches
to weight loss, although
evidence for their efficacy is
mixed. The mechanisms by
which intermittent fasting
(including TRF) affect health are
incompletely understood but
may include improved insulin
sensitivity and anti
inflammatory effects.
56. Follow up
• No matter which diet or dietary pattern is chosen,
continued surveillance by both clinician and
• patient are essential for treatment success. Return
visits with the clinician, dietician, or behaviourist
• should be scheduled at regular intervals to assess
barriers, discuss next steps, and offer
encouragement. If weight loss is less than 5 per
cent in the first six months, something else should
• be tried.
57. Exercise• Although less potent than
dietary restriction in
promoting weight loss,
increasing energy
expenditure through physical
activity is a strong predictor
of weight loss maintenance.
• Physical activity should be
performed for approximately
30 minutes or more, five to
seven days a week, to
prevent weight gain and to
improve cardiovascular
health. The physical activity
should be gradually
increased over time as
tolerated.
58. Behaviour modification
• Behaviour modification or behaviour therapy
is one cornerstone in the treatment for
obesity.
• The goal of behavioural therapy is to help
patients make long-term changes in their
eating behaviour by modifying and monitoring
their food intake, modifying their physical
activity, and controlling cues and stimuli in
the environment that trigger eating
59. Pancreatic lipase inhibitor approved for long-term use
Orlistat 120 mg 3 times daily
with fat-containing
meals.
A reduced dose of 60
mg¶ is an option for
patients who do not
tolerate 120 mg.
Cramps, flatulence, faecal
incontinence, oily spotting,
absorption of fat-soluble
vitamins may be reduced
Combination of phentermine-topiramate approved for long-term
use
Phenterm
ine-
topiramat
e
Initial: 3.75 mg
phentermine/23 mg
topiramate once daily in
the morning for 14 days.
Dry mouth, taste disturbance,
constipation, paraesthesias,
depression, anxiety, elevated
heart rate, cognitive
disturbances, insomnia
60. Combination of bupropion-naltrexone approved for long-term use
Bupropion-
naltrexone
Week 1: 1 tablet (8 mg naltrexone/90 mg bupropion)
once daily.Week 2: 1 tablet twice daily.Week 3: 2
tablets in morning and one tablet in evening.Week
4: 2 tablets twice daily.
Maximum daily dose: 4 tablets (32 mg
naltrexone/360 mg bupropion);
Contraindicated
in patients with
uncontrolled
hypertension,
seizure disorder,
eating disorder,.
GLP-1 agonist approved for long-term use
Liraglutide
Initial: 0.6 mg subcutaneously daily.
Increase at weekly intervals (1.2, 1.8, 2.4 mg)
until recommended dose of 3 mg daily; re-
evaluate after 16 weeks.
◊
Monitor blood glucose in
diabetic patients and
adjust co-administered
sulfonylureas (eg,
reduce dose by 50
percent) and other anti-
diabetic medications as
needed to prevent
potentially severe
hypoglycemia.
61. Benzphetamine
Initial: 25 mg once daily; may titrate
up to 25 to 50 mg one to 3 times
daily.
Applies to all sympathomimetic agents:
Due to their side effects and potential for
abuse, we suggest not prescribing
sympathomimetics for weight loss.
If prescribed, limit to short-term (≤12 weeks)
use.
Adverse effects include increase in heart rate,
blood pressure, insomnia, dry mouth,
constipation, nervousness.
Abuse potential due to amphetamine-like
effects.
May counteract effect of blood pressure
medications.
Avoid in patients with heart disease, poorly
controlled hypertension, pulmonary
hypertension, or history of addiction or drug
abuse.
Contraindicated in patients with a history of
CVD, hyperthyroidism, glaucoma, MAO
inhibitor-therapy, agitated states, pregnancy,
or breast feeding.
Maximum dose: 50 mg 3 times daily.
Diethylpropion
Immediate release: 25 mg 3 times
daily before meals.
Controlled release: 75 mg every
morning.
Phentermine
Immediate release: 15 to 37.5 mg
daily or divided twice daily.
Orally disintegrating tablet (ODT): 15
to 37.5 mg once daily in the
morning.
Phendimetrazine
Immediate release: 17.5 to 35 mg 2
or 3 times daily, 1 hour before
meals.
Maximum dose: 70 mg 3 times daily.
Sustained release: 105 mg daily in
the morning.
62. Drug of choice
• For most patients, liraglutide is preferred first-
line pharmacotherapy. If there is an
inadequate response to liraglutide or it is not
tolerated, and treatment with a different drug
is considered, we switch to orlistat, although
side effects often limit its use. Phentermine
(as a single agent) is also an effective,
inexpensive, and widely prescribed option
63. Devices
• There are several types of devices approved
for use in the treatment of obesity.
• The use of one of these devices may be
considered for use in those patients in whom
medications are ineffective or not tolerated,
for those patients who are unable or unwilling
to undergo bariatric surgery, or as a bridging
therapy prior to bariatric surgery.
64. Laparoscopic adjustable gastric
banding
• The system is used for weight loss
in severe obesity in those who
have been obese for at
• least five years and for whom
nonsurgical weight loss methods
have not been successful.
• They must be willing to make
major changes in their eating
habits and lifestyle. Patients must
• have a BMI of >40 kg/m , BMI >35
kg/m with one or more weight-
related complications, or
• be at least 100 pounds over their
estimated ideal weight. LAGB is
discussed in detail
• elsewhere.
65. Electrical stimulation (vagal blockade)
systems –
• These systems deliver
small electrical pulses to
block transmission of nerve
signals in the vagus nerve
66. Intragastric balloon systems –
• With these techniques,
saline filled balloons are
placed in
• the stomach to take up
space and produce a
sensation of satiety.
67. Gastric emptying (aspiration) systems
• – A surgically placed
gastrostomy tube is used
to
• drain a portion of the
stomach contents after
every meal, decreasing
the calories absorbed
68. Hydrogels –
• Considered medical
devices, hydrogels are
orally administered
products, taken
• twice daily before
meals, which expand in
the stomach and
intestines to create a
sensation of
• satiety.
69. THERAPIES NOT RECOMMENDED
• Liposuction
• Weight loss from
liposuction appears to be
of a short term nature
with little long term
effect.[2] After a few
months fat typically
returns and
redistributes.[2] Liposuctio
n does not
help obesity related
metabolic disorders
like insulin resistance.
71. MAINTENANCE OF WEIGHT LOSS
• the regaining of lost weight, is a
common problem in treating
people with obesity .
• Characteristics of those who are
likely to succeed in maintaining
weight loss include frequent self
weighing,
• a larger initial weight loss (> 2 kg
in four weeks), frequent and
regular attendance at a weight
loss program, a belief that their
weight can be controlled,
consumption of a reduced calorie
• (eg, 1400 kcal/day) low-calorie
diet, regular physical activity, and
participation in a lifestyle
intervention program
72. Message
• Never go to any
parties/restaurant
• Never eat processed
food/junk food
• Start looking into label on
the food
• Avoid going to super market
• Never eat in front of
media/reading .Eat only in
the dining table
• Early to sleep…early to wake
up
• Never forced feed
73. Message
• Buy lot of vegetable/fruits.
Avoid fruits/tuber with high
calories
• Avoid fried/baked items
completely. Eat low energy-
density food.
• Eat based on your hungry.
Eat slowly .Use small plates
• Today is right day. Get up
start walking .Never sit
continuously for more than
20-30 minutes
76. Secrets
• Accept the reality. You
are having chronic
disease that has no cure
but with your
cooperation it can be
easily managed.
• The diet restriction &
exercise should be
followed life long. You
will have healthy happy
life.
