The diet prescription for obesity. What works?

Obesity is a chronic disease, and in most cases weight reduction is the first treatment for its concomitant conditions of hyperlipidemia, diabetes, and hypertension. Weight-reduction diets are controversial in both the popular press and among clinicians treating hyperlipidemia and obesity. Both high-carbohydrate/low-fat and higher-protein/low-carbohydrate diets will produce loss of body fat if the calorie level is low enough. But selecting effective diet prescriptions for bariatric patients requires understanding of both the science and art of nutrition. Low-calorie diets, protein-sparing modified fasts, and modified-carbohydrate diets seem to be the most effective for patient compliance, and modified-carbohydrate plans are probably necessary for maintenance of the weight loss.

Treatment of obesity in the elderly.

Obesity is a common form of malnutrition among the elderly. Excessive weight gain is associated with decreased physical activity and a progressive decline in caloric requirements for weight maintenance. Obesity increases the risk of myocardial infarction, stroke, hypertension, noninsulin-dependent diabetes, osteoarthritis of the lower extremities and several types of cancer. Specific guidelines are recommended for weight-loss programs used in the elderly. While calories from dietary fats and carbohydrates are restricted, a protein intake of approximately 70 g per day is desirable. Exercise is an important part of the weight-loss program and contributes to a general sense of well-being. Limitation of motion may necessitate innovative forms of exercise for elderly patients.

Effects of a six-week, low-fat diet on serum cholesterol, body weight, and body measurements.

This study was done to determine if significant weight loss, decrease in body measurements, and lowering of serum lipids and blood pressure could be shown in people on a low-calorie, low-fat, high-fiber diet over a period of six weeks. Forty-one people (33 females and 8 males) between the ages of of 37 and 55 years old participated in a six-week calorie-controlled, low-fat, low-sodium, high-fiber diet using foods available in supermarkets. Participants also exercised moderately. The average weight loss was 10.3 pounds, or 5.8% of the original average weight. The body mass index decreased 1.7-a 6.0% decrease for women and a 5.3% decrease for men. The average of five body measurements decreased 4.9%. Total cholesterol decreased 16%, LDL-C decreased 12%, and HDL-C decreased 18%. All of these decreases were statistically significant at P < .001. No significant difference was noted in blood pressures at the start and completion of the study, as both values were in the normal range. This relatively short period of dieting using 1200 calories for women and 1500 calories for men, along with moderate exercise, shows that reasonable weight loss and a tendency toward lowering lipid values can be obtained. Weekly monitoring by physicians and their office staffs can enhance this process. Continued accountability and support for lifelong behavior changes are probably necessary to maintain reasonable body weight in these patients.