Approaches

N Finer, Luton and Dunstable Hospital NHS Trust, Luton, UK

© 2005 Elsevier Ltd. All rights reserved.

Weight loss and weight loss maintenance require a decrease in energy intake (diet), an increase in energy expenditure (exercise and physical activity), or both. Dietary management should encourage healthy eating, that is, an appropriately balanced intake of macro-and micronutrients. For most obese individuals this will entail not just a decrease in total energy intake, but specifically a decrease in fat intake, together with an increase in complex carbohydrates, fruit, and vegetables. Myriad diets have been popularized as a means to reducing energy intake, but few are recommended as meeting the overall nutritional needs of an obese individual, and many are so restrictive that they clearly could not be followed for more than a few weeks. Increasing exercise and physical activity has benefits beyond those that result from the relatively modest amounts of extra energy expended. These include a beneficial protection from excessive loss of lean body tissue during dieting, improved fitness and psychological health, and a greater likelihood of long-term weight maintenance. Diet and exercise are core components of behavioral treatments; such treatments, based on learning theories, also aim to help individuals become aware of the behaviors that have led to their weight gain, and to develop strategies to alter them. Weight loss can be achieved successfully with all strategies; behavioral therapies that include a strong focus on increasing exercise and activity seem to offer the best chances of long-term success.

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