Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss is the main treatment for obesity, and there is substantial evidence this can prevent progression from prediabetes to type 2 diabetes with a 7–10% weight loss and manage cardiometabolic health for diabetic people with a 5–15% weight loss.
For weight loss to be permanent, changes in diet and lifestyle must be permanent as well. There is evidence that counseling or exercise alone do not result in weight loss, whereas dieting alone results in meaningful long-term weight loss, and a combination of dieting and exercise provides the best results. Meal replacements, orlistat, a very-low-calorie diet, and primary care intensive medical interventions can also support meaningful weight loss.
The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. The World Health Organization recommends that people combine a reduction of processed foods high in saturated fats, sugar and salt, and reduced caloric intake with an increase in physical activity. Both long-term exercise programs and anti-obesity medications reduce abdominal fat volume.
Self-monitoring of diet, exercise, and weight are beneficial strategies for weight loss, particularly early in weight loss programs. Research indicates that those who log their foods about three times per day and about 20 times per month are more likely to achieve clinically significant weight loss.
Permanent weight loss depends on maintaining a negative energy balance and not the type of macronutrients (such as carbohydrate) consumed. High protein diets have shown greater efficacy in the short term (under 12 months) for people eating ad libitum due to increased thermogenesis and satiety, however this effect tends to dissipate over time.
In 2008, between US$33 billion and $55 billion was spent annually in the US on weight-loss products and services, including medical procedures and pharmaceuticals, with weight-loss centers taking between 6 and 12 percent of total annual expenditure. Over $1.6 billion per year was spent on weight-loss supplements. About 70 percent of Americans' dieting attempts are of a self-help nature.
In Western Europe, sales of weight-loss products, excluding prescription medications, topped €1,25 billion (£900 million/$1.4 billion) in 2009.
Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or a combination of these. It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months or 5% in the last month. Another criterion used for assessing weight that is too low is the body mass index (BMI). However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person.
Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss. Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy.
Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia. Cachexia differs from starvation in part because it involves a systemic inflammatory response. It is associated with poorer outcomes. In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help. Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue.
Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates. Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including:
Malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores. Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer and type 1 diabetes. In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery. According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition. A high proportion (10–60%) of hospital patients are also at risk, along with a similar proportion in care homes.
Medical treatment can directly or indirectly cause weight loss, impairing treatment effectiveness and recovery that can lead to further weight loss in a vicious cycle. Many patients will be in pain and have a loss of appetite after surgery. Part of the body's response to surgery is to direct energy to wound healing, which increases the body's overall energy requirements. Surgery affects nutritional status indirectly, particularly during the recovery period, as it can interfere with wound healing and other aspects of recovery. Surgery directly affects nutritional status if a procedure permanently alters the digestive system. Enteral nutrition (tube feeding) is often needed. However a policy of 'nil by mouth' for all gastrointestinal surgery has not been shown to benefit, with some weak evidence suggesting it might hinder recovery. Early post-operative nutrition is a part of Enhanced Recovery After Surgery protocols. These protocols also include carbohydrate loading in the 24 hours before surgery, but earlier nutritional interventions have not been shown to have a significant impact.
Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people. Nutrient intake can also be affected by culture, family and belief systems. Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition.
Some popular beliefs attached to weight loss have been shown to either have less effect on weight loss than commonly believed or are actively unhealthy. According to Harvard Health, the idea of metabolic rate being the "key to weight" is "part truth and part myth" as while metabolism does affect weight loss, external forces such as diet and exercise have an equal effect. They also commented that the idea of changing one's rate of metabolism is under debate. Diet plans in fitness magazines are also often believed to be effective but may actually be harmful by limiting the daily intake of important calories and nutrients which can be detrimental depending on the person and are even capable of driving individuals away from weight loss.
Obesity is a risk factor for certain conditions, including diabetes, cancer, cardiovascular disease, high blood pressure, and non-alcoholic fatty liver disease. Reduction of obesity lowers those risks. A 1 kilogram (2.2 lb) loss of body weight has been associated with an approximate 1 millimetre of mercury (0.13 kPa) drop in blood pressure. Intentional weight loss is associated with cognitive performance improvements in overweight and obese individuals.
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Yaxley, A; Miller, MD; Fraser, RJ; Cobiac, L (February 2012). "Pharmacological interventions for geriatric cachexia: a narrative review of the literature". The Journal of Nutrition, Health & Aging. 16 (2): 148–54. doi:10.1007/s12603-011-0083-8. PMID 22323350. S2CID 30473679. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0052255/
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Payne, C; Wiffen, PJ; Martin, S (18 January 2012). Payne, Cathy (ed.). "Interventions for fatigue and weight loss in adults with advanced progressive illness". The Cochrane Database of Systematic Reviews. 1: CD008427. doi:10.1002/14651858.CD008427.pub2. PMID 22258985. S2CID 261730608. (Retracted, see doi:10.1002/14651858.CD008427.pub3, PMID 28387447) /wiki/Doi_(identifier)
Payne, C; Wiffen, PJ; Martin, S (18 January 2012). Payne, Cathy (ed.). "Interventions for fatigue and weight loss in adults with advanced progressive illness". The Cochrane Database of Systematic Reviews. 1: CD008427. doi:10.1002/14651858.CD008427.pub2. PMID 22258985. S2CID 261730608. (Retracted, see doi:10.1002/14651858.CD008427.pub3, PMID 28387447) /wiki/Doi_(identifier)
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National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
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National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
Itoh, M; Tsuji, T; Nemoto, K; Nakamura, H; Aoshiba, K (18 April 2013). "Undernutrition in patients with COPD and its treatment". Nutrients. 5 (4): 1316–35. doi:10.3390/nu5041316. PMC 3705350. PMID 23598440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705350
Itoh, M; Tsuji, T; Nemoto, K; Nakamura, H; Aoshiba, K (18 April 2013). "Undernutrition in patients with COPD and its treatment". Nutrients. 5 (4): 1316–35. doi:10.3390/nu5041316. PMC 3705350. PMID 23598440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705350
Itoh, M; Tsuji, T; Nemoto, K; Nakamura, H; Aoshiba, K (18 April 2013). "Undernutrition in patients with COPD and its treatment". Nutrients. 5 (4): 1316–35. doi:10.3390/nu5041316. PMC 3705350. PMID 23598440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705350
Itoh, M; Tsuji, T; Nemoto, K; Nakamura, H; Aoshiba, K (18 April 2013). "Undernutrition in patients with COPD and its treatment". Nutrients. 5 (4): 1316–35. doi:10.3390/nu5041316. PMC 3705350. PMID 23598440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705350
Mangili, A; Murman, DH; Zampini, AM; Wanke, CA (15 March 2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clinical Infectious Diseases. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562. https://doi.org/10.1086%2F500398
Mangili, A; Murman, DH; Zampini, AM; Wanke, CA (15 March 2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clinical Infectious Diseases. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562. https://doi.org/10.1086%2F500398
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National Cancer Institute (November 2011). "Nutrition in cancer care (PDQ)". Physician Data Query. National Cancer Institute. PMID 26389293. Retrieved 3 July 2013. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032688/
National Cancer Institute (November 2011). "Nutrition in cancer care (PDQ)". Physician Data Query. National Cancer Institute. PMID 26389293. Retrieved 3 July 2013. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032688/
National Cancer Institute (November 2011). "Nutrition in cancer care (PDQ)". Physician Data Query. National Cancer Institute. PMID 26389293. Retrieved 3 July 2013. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032688/
National Collaborating Centre for Acute Care (UK) (February 2006). "Malnutrition and the principles of nutrition support". Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK). {{cite book}}: |journal= ignored (help) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009169/
National Cancer Institute (November 2011). "Nutrition in cancer care (PDQ)". Physician Data Query. National Cancer Institute. PMID 26389293. Retrieved 3 July 2013. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032688/
National Cancer Institute (November 2011). "Nutrition in cancer care (PDQ)". Physician Data Query. National Cancer Institute. PMID 26389293. Retrieved 3 July 2013. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032688/
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