The first step towards treating obesity includes nutrition counseling, dietary modification and exercise. A reasonable initial weight loss goal is 10% reduction of one's current weight, with a timeline of 6 months of therapy. To achieve a weight loss of 1-2 pounds per week, the patient should follow a diet that consists of 500-1000 fewer calories per day but still meets nutritional needs. This would translate into a 1000-1200 kcal/day diet for most women and 1200-1600 kcal/ day for men. If this level of intake leaves the patient hungry, the total kcal/day can be increased by 100-200 kcal. The patient needs to undergo nutrition education to include:
1. Energy value of different foods
2. Food composition—fats, carbohydrates, and proteins
3. Evaluation of nutrition labels to determine calorie content and food composition
4. Food preparation—avoidance of high calorie ingredients
5. Avoidance of high caloric foods
6. Adequate water intake
7. Reduced portion sizes
To maintain the weight loss individuals need to follow a balanced, low calorie diet and sustained physical activity. Most weight loss occurs because of decreased caloric intake, but sustained physical activity can help prevent weight regain. An exercise regimen should be started with the goal of exercising at least 30 minutes 3-4 times/week and then gradually increased in frequency and duration. Increased physical activity is important in efforts to lose weight because it increases energy expenditure and plays an integral role in weight maintenance. Exercise can also help prevent the decrease in muscle mass often found during weight loss. The long-term goal is to develop the habit of exercising 30 minutes of moderate intensity activity on most days of the week.
Behavior therapy can also play a significant role in providing tools for overcoming barriers to compliance with dietary therapy and/or increased physical activity. Specific strategies include self-monitoring of both eating habits and physical activity, stress management, stimulus control, problem solving, contingency management, cognitive restructuring and social support. In regards to children, intensive, family-based behavioral treatment programs have a favorable effect on children's weight for as long as ten years.
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