SYNOPSIS of AFP's "Weight Loss Maintenance" by SAMUEL N. GRIEF, MD, and ROSITA L.F. MIRANDA, M

Losing weight can be hard, but often the real challenge is keeping it off. Some strategies for maintaining weight loss: http://bit.ly/VQsvk9 


Weight Loss Maintenance SAMUEL N. GRIEF, MD, University of Illinois at Chicago, Chicago, Illinois  ROSITA L.F. MIRANDA, MD, MS, Clay County Hospital, Flora, Illinois
Am Fam Physician. 2010 Sep 15;82(6):630-634.

     So after seeing this tweet from AFP and looking down at my belly I figured this would be a good article to read and review. Lets start with the facts and the stats. We are fat and we all want to be thin. It is killing us.Losing weight is hard and not fun. I can't remember which journal that was from.
     The best way to lose and maintain weight is by diet and exercise. The National Weight Loss Control Registry (NWCR) has found that the three most common factors in success are restricting certain foods, limiting quantity, and counting calories. Decreasing variety of food and not pigging out on weekends and holidays are also common traits of successful weight loss. Other common factors in successful patients are watching less TV, eating breakfast every day, exercising an hour a day, and monitoring their weight with a scale. 
     There is also a concept of "diet disinhibition" which is composed of three things; cognitive restraint, uncontrolled eating, and emotional eating. This refers to binge eating, common to those on overly restricted diets. This doesn't help.
     The two approved medications for weight loss (at the time of this publication) are Orlistat and Sibutramine. These have been shown to be effective in weight loss. Patients need to have a BMI over 30 or a BMI over 27 with medical comorbidities. Some of thee medications have side affects, like oily stool or heart valve problems, which is something to consider when choosing this route.
     Surgery is another option. There are several varieties , from bariatric to full on surgery. Patients have had, not only weight loss, but also remission of comorbid conditions from the procedure. Patients should have a BMI greater than 40 or greater than 35 with comorbid conditions. They also need to attempt a weight loss program, and dieting, for a set amount of time, and be unsuccessful. There is limited RCT's on these procedures and some studies even suggest that pharmacology is as effective as surgery.