DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy

Weight Loss

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ii

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Contents

3 Introduction

5 WhyDoSomePeopleGainExcessWeight

8 MeasuringExcessWeight

10 TheRisksofHavingExcessWeight

11 HowMuchShouldYouAimtoLose

15 EatingforWeightLossandGoodHealth

20 LiveaMoreActiveLife

23 Physician-SupervisedWeightLossOptions

28 StartingYourWeightLossJourney

29 Resources

Copyright 2013

Conrad amp Associates LLC

All Rights Reserved

No part of this book may be reproduced or transmitted in any form by any means electronic or mechanical including photocopying or recording or by an information storage and retrieval system without written permission except when permitted by law

Manufactured in the United States of America

DISCLAIMER This guidebook and DVD program is intended for informational purposes only with the understanding that no one should rely upon this information as the basis for medical decisions Anyone requiring medical or other health care should consult a medical or health care professional Any actions based on the information provided are entirely the responsibility of the user and of any medical or other health care professionals who are involved in such actions

The American College of Physicians (ACP) the Obesity Action Coalition (OAC) and Vivus Inc (Vivus) working with producers Conrad amp Associates and Alan Weiss Productions and writers Stephen Braun and Deborah Gobble have used reasonable efforts to include timely and accurate information in this guidebook and DVD Accordingly the ACP OAC Vivus the producers and the writers make no representations or warranties express or implied regarding the accuracy or completeness of the information provided herein and specifically disclaim any liability express or implied in connection therewith

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

2 3

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Introduction

About2outofevery3adultsintheUnitedStatesareaffectedbyobesityorbybeingoverweightThisexcessweightcanraiseyourriskoftype2diabetesstrokeheartandkidneydiseasecancerandevenearlydeath

ThegoodnewsisthatlosingevenamodestamountofweightmdashandkeepingitoffmdashcanhelpyouavoidthesehealthissuesandboostyouroverallqualityoflifeThefirststepistolearnmorewhichyouaredoingrightnowThemoreyouknowaboutwhypeopletendtogainexcessweightandwhatreallyworksforlosingweightandkeepingitoffthebetteryourchancesofsuccessThesecondstepistotalktoahealthcareproviderSheorhecangiveyouvaluablesupportandguidance

NowisthetimetostartthatconversationViewyourhealthcareproviderasacoachonyourjourneytoloseexcessweightandimproveyourhealthThisbookletandDVDcanhelptoo

InthisbookletandDVDprogramyoursquolllearn

bullWhysomepeoplegainexcessweight

bullNutritionandfitnesstips

bullHowobesitymedicationsmayhelpyoulose

excessweight

bullSurgicaloptionsforthetreatmentofsevereobesity

Excess weight can raise your risk of type

2 diabetes stroke heart and kidney

disease cancer and even early death

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

4 5

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Why Do Some People Gain Excess Weight

ThisisasimplequestionbuttheansweriscomplexThetruthisthatpeoplegainweightformanyreasonsBiologygeneticsemotionsandmodernculturecanallplayaroleLetrsquostakeacloserlookatsomeofthesefactors

OurBodyrsquosResponsetoFoodIfyoulookaroundyouseethatpeoplecomeinallshapesandsizesSomepeoplecanseeminglyeatanytypeoramountoffoodandnotgainweightForothersgainingweightistooeasyThisisbecausebodyweightiscontrolledbyaninnerldquothermostatrdquothatisinpartldquosetrdquobythegenesyouinheritfromyourparentsInfactalargeshareofa

personrsquostendencytodevelopobesitymaybedeterminedbyhisorhergenes

ThesegenescontrolhowfastyourbodyldquoburnsrdquocaloriesandhowhardoreasyitistogainweightHungereatingandweightarecontrolledbycomplexsystemsinyourbodyIfyoucutback

howmuchyoueatthesesystemsworkagainstyouYourbodymayburnfewercaloriesoryoumaybecomeveryhungryThisiswhyitcanbesodifficultforpeopletoloseexcessweightandkeepitoff

Biology genetics emotions and modern culture can all play a role in why people

gain weight

EmotionsEmotionscanalsoplayaroleinexcess

weightSomepeopledealwithstressanxietyordepressionbyeatingThismayhelptemporarilybutitcanalsomaketheproblemworseldquoEmotionaleatingrdquocanendupharmingyourmentalandphysicalhealthThatrsquoswhyfindingwaystocopewithfeelingsandemotionscanbeakeypartofanyefforttoloseweight

MedicinesAsideeffectofsomemedicinesisthattheycauseyoutogainweightSomedothisbymakingithardertoburnoffcaloriesorbymakingyoufeelmorehungryTalktoyourhealthcare

providerandseeifyourmedicinesmaybeaffectingyourweight

ThebottomlineisthatlosingweightisoftenmorecomplicatedthanjustldquoeatinglessandexercisingmorerdquoCuttingcaloriesandbeingmoreactiveareessentialbutotherkindsofchangesmaybeneededtoloseweightlong-termFortunatelytherearemanyhealthcareproviderswhocangiveyoutheguidanceandsupportyoumayneedtoloseweightandimproveyourhealth

Losing weight is often more

complicated than just ldquoeating less and

exercising morerdquo

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

6 7

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ModernLifeHumancravingstoeatevolvedwhenfoodwasscarceandactivitylevelswereveryhighWenaturallydesiresweethigh-caloriefoodsThesecravingswerehelpfulwhenfoodwaslimitedandhardtogetButinmostcountriestodayfoodisplentifulandmodernlifehasreducedtheneedforphysicalactivityInadditionportionsizesinmanyrestaurantsandsnackshopshavebecomemuchlargerandareoftenhigherincaloriesandfatthanfoodmadeathome

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ii

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Contents

3 Introduction

5 WhyDoSomePeopleGainExcessWeight

8 MeasuringExcessWeight

10 TheRisksofHavingExcessWeight

11 HowMuchShouldYouAimtoLose

15 EatingforWeightLossandGoodHealth

20 LiveaMoreActiveLife

23 Physician-SupervisedWeightLossOptions

28 StartingYourWeightLossJourney

29 Resources

Copyright 2013

Conrad amp Associates LLC

All Rights Reserved

No part of this book may be reproduced or transmitted in any form by any means electronic or mechanical including photocopying or recording or by an information storage and retrieval system without written permission except when permitted by law

Manufactured in the United States of America

DISCLAIMER This guidebook and DVD program is intended for informational purposes only with the understanding that no one should rely upon this information as the basis for medical decisions Anyone requiring medical or other health care should consult a medical or health care professional Any actions based on the information provided are entirely the responsibility of the user and of any medical or other health care professionals who are involved in such actions

The American College of Physicians (ACP) the Obesity Action Coalition (OAC) and Vivus Inc (Vivus) working with producers Conrad amp Associates and Alan Weiss Productions and writers Stephen Braun and Deborah Gobble have used reasonable efforts to include timely and accurate information in this guidebook and DVD Accordingly the ACP OAC Vivus the producers and the writers make no representations or warranties express or implied regarding the accuracy or completeness of the information provided herein and specifically disclaim any liability express or implied in connection therewith

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

2 3

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Introduction

About2outofevery3adultsintheUnitedStatesareaffectedbyobesityorbybeingoverweightThisexcessweightcanraiseyourriskoftype2diabetesstrokeheartandkidneydiseasecancerandevenearlydeath

ThegoodnewsisthatlosingevenamodestamountofweightmdashandkeepingitoffmdashcanhelpyouavoidthesehealthissuesandboostyouroverallqualityoflifeThefirststepistolearnmorewhichyouaredoingrightnowThemoreyouknowaboutwhypeopletendtogainexcessweightandwhatreallyworksforlosingweightandkeepingitoffthebetteryourchancesofsuccessThesecondstepistotalktoahealthcareproviderSheorhecangiveyouvaluablesupportandguidance

NowisthetimetostartthatconversationViewyourhealthcareproviderasacoachonyourjourneytoloseexcessweightandimproveyourhealthThisbookletandDVDcanhelptoo

InthisbookletandDVDprogramyoursquolllearn

bullWhysomepeoplegainexcessweight

bullNutritionandfitnesstips

bullHowobesitymedicationsmayhelpyoulose

excessweight

bullSurgicaloptionsforthetreatmentofsevereobesity

Excess weight can raise your risk of type

2 diabetes stroke heart and kidney

disease cancer and even early death

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

4 5

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Why Do Some People Gain Excess Weight

ThisisasimplequestionbuttheansweriscomplexThetruthisthatpeoplegainweightformanyreasonsBiologygeneticsemotionsandmodernculturecanallplayaroleLetrsquostakeacloserlookatsomeofthesefactors

OurBodyrsquosResponsetoFoodIfyoulookaroundyouseethatpeoplecomeinallshapesandsizesSomepeoplecanseeminglyeatanytypeoramountoffoodandnotgainweightForothersgainingweightistooeasyThisisbecausebodyweightiscontrolledbyaninnerldquothermostatrdquothatisinpartldquosetrdquobythegenesyouinheritfromyourparentsInfactalargeshareofa

personrsquostendencytodevelopobesitymaybedeterminedbyhisorhergenes

ThesegenescontrolhowfastyourbodyldquoburnsrdquocaloriesandhowhardoreasyitistogainweightHungereatingandweightarecontrolledbycomplexsystemsinyourbodyIfyoucutback

howmuchyoueatthesesystemsworkagainstyouYourbodymayburnfewercaloriesoryoumaybecomeveryhungryThisiswhyitcanbesodifficultforpeopletoloseexcessweightandkeepitoff

Biology genetics emotions and modern culture can all play a role in why people

gain weight

EmotionsEmotionscanalsoplayaroleinexcess

weightSomepeopledealwithstressanxietyordepressionbyeatingThismayhelptemporarilybutitcanalsomaketheproblemworseldquoEmotionaleatingrdquocanendupharmingyourmentalandphysicalhealthThatrsquoswhyfindingwaystocopewithfeelingsandemotionscanbeakeypartofanyefforttoloseweight

MedicinesAsideeffectofsomemedicinesisthattheycauseyoutogainweightSomedothisbymakingithardertoburnoffcaloriesorbymakingyoufeelmorehungryTalktoyourhealthcare

providerandseeifyourmedicinesmaybeaffectingyourweight

ThebottomlineisthatlosingweightisoftenmorecomplicatedthanjustldquoeatinglessandexercisingmorerdquoCuttingcaloriesandbeingmoreactiveareessentialbutotherkindsofchangesmaybeneededtoloseweightlong-termFortunatelytherearemanyhealthcareproviderswhocangiveyoutheguidanceandsupportyoumayneedtoloseweightandimproveyourhealth

Losing weight is often more

complicated than just ldquoeating less and

exercising morerdquo

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

6 7

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ModernLifeHumancravingstoeatevolvedwhenfoodwasscarceandactivitylevelswereveryhighWenaturallydesiresweethigh-caloriefoodsThesecravingswerehelpfulwhenfoodwaslimitedandhardtogetButinmostcountriestodayfoodisplentifulandmodernlifehasreducedtheneedforphysicalactivityInadditionportionsizesinmanyrestaurantsandsnackshopshavebecomemuchlargerandareoftenhigherincaloriesandfatthanfoodmadeathome

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

2 3

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Introduction

About2outofevery3adultsintheUnitedStatesareaffectedbyobesityorbybeingoverweightThisexcessweightcanraiseyourriskoftype2diabetesstrokeheartandkidneydiseasecancerandevenearlydeath

ThegoodnewsisthatlosingevenamodestamountofweightmdashandkeepingitoffmdashcanhelpyouavoidthesehealthissuesandboostyouroverallqualityoflifeThefirststepistolearnmorewhichyouaredoingrightnowThemoreyouknowaboutwhypeopletendtogainexcessweightandwhatreallyworksforlosingweightandkeepingitoffthebetteryourchancesofsuccessThesecondstepistotalktoahealthcareproviderSheorhecangiveyouvaluablesupportandguidance

NowisthetimetostartthatconversationViewyourhealthcareproviderasacoachonyourjourneytoloseexcessweightandimproveyourhealthThisbookletandDVDcanhelptoo

InthisbookletandDVDprogramyoursquolllearn

bullWhysomepeoplegainexcessweight

bullNutritionandfitnesstips

bullHowobesitymedicationsmayhelpyoulose

excessweight

bullSurgicaloptionsforthetreatmentofsevereobesity

Excess weight can raise your risk of type

2 diabetes stroke heart and kidney

disease cancer and even early death

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

4 5

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Why Do Some People Gain Excess Weight

ThisisasimplequestionbuttheansweriscomplexThetruthisthatpeoplegainweightformanyreasonsBiologygeneticsemotionsandmodernculturecanallplayaroleLetrsquostakeacloserlookatsomeofthesefactors

OurBodyrsquosResponsetoFoodIfyoulookaroundyouseethatpeoplecomeinallshapesandsizesSomepeoplecanseeminglyeatanytypeoramountoffoodandnotgainweightForothersgainingweightistooeasyThisisbecausebodyweightiscontrolledbyaninnerldquothermostatrdquothatisinpartldquosetrdquobythegenesyouinheritfromyourparentsInfactalargeshareofa

personrsquostendencytodevelopobesitymaybedeterminedbyhisorhergenes

ThesegenescontrolhowfastyourbodyldquoburnsrdquocaloriesandhowhardoreasyitistogainweightHungereatingandweightarecontrolledbycomplexsystemsinyourbodyIfyoucutback

howmuchyoueatthesesystemsworkagainstyouYourbodymayburnfewercaloriesoryoumaybecomeveryhungryThisiswhyitcanbesodifficultforpeopletoloseexcessweightandkeepitoff

Biology genetics emotions and modern culture can all play a role in why people

gain weight

EmotionsEmotionscanalsoplayaroleinexcess

weightSomepeopledealwithstressanxietyordepressionbyeatingThismayhelptemporarilybutitcanalsomaketheproblemworseldquoEmotionaleatingrdquocanendupharmingyourmentalandphysicalhealthThatrsquoswhyfindingwaystocopewithfeelingsandemotionscanbeakeypartofanyefforttoloseweight

MedicinesAsideeffectofsomemedicinesisthattheycauseyoutogainweightSomedothisbymakingithardertoburnoffcaloriesorbymakingyoufeelmorehungryTalktoyourhealthcare

providerandseeifyourmedicinesmaybeaffectingyourweight

ThebottomlineisthatlosingweightisoftenmorecomplicatedthanjustldquoeatinglessandexercisingmorerdquoCuttingcaloriesandbeingmoreactiveareessentialbutotherkindsofchangesmaybeneededtoloseweightlong-termFortunatelytherearemanyhealthcareproviderswhocangiveyoutheguidanceandsupportyoumayneedtoloseweightandimproveyourhealth

Losing weight is often more

complicated than just ldquoeating less and

exercising morerdquo

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

6 7

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ModernLifeHumancravingstoeatevolvedwhenfoodwasscarceandactivitylevelswereveryhighWenaturallydesiresweethigh-caloriefoodsThesecravingswerehelpfulwhenfoodwaslimitedandhardtogetButinmostcountriestodayfoodisplentifulandmodernlifehasreducedtheneedforphysicalactivityInadditionportionsizesinmanyrestaurantsandsnackshopshavebecomemuchlargerandareoftenhigherincaloriesandfatthanfoodmadeathome

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

4 5

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Why Do Some People Gain Excess Weight

ThisisasimplequestionbuttheansweriscomplexThetruthisthatpeoplegainweightformanyreasonsBiologygeneticsemotionsandmodernculturecanallplayaroleLetrsquostakeacloserlookatsomeofthesefactors

OurBodyrsquosResponsetoFoodIfyoulookaroundyouseethatpeoplecomeinallshapesandsizesSomepeoplecanseeminglyeatanytypeoramountoffoodandnotgainweightForothersgainingweightistooeasyThisisbecausebodyweightiscontrolledbyaninnerldquothermostatrdquothatisinpartldquosetrdquobythegenesyouinheritfromyourparentsInfactalargeshareofa

personrsquostendencytodevelopobesitymaybedeterminedbyhisorhergenes

ThesegenescontrolhowfastyourbodyldquoburnsrdquocaloriesandhowhardoreasyitistogainweightHungereatingandweightarecontrolledbycomplexsystemsinyourbodyIfyoucutback

howmuchyoueatthesesystemsworkagainstyouYourbodymayburnfewercaloriesoryoumaybecomeveryhungryThisiswhyitcanbesodifficultforpeopletoloseexcessweightandkeepitoff

Biology genetics emotions and modern culture can all play a role in why people

gain weight

EmotionsEmotionscanalsoplayaroleinexcess

weightSomepeopledealwithstressanxietyordepressionbyeatingThismayhelptemporarilybutitcanalsomaketheproblemworseldquoEmotionaleatingrdquocanendupharmingyourmentalandphysicalhealthThatrsquoswhyfindingwaystocopewithfeelingsandemotionscanbeakeypartofanyefforttoloseweight

MedicinesAsideeffectofsomemedicinesisthattheycauseyoutogainweightSomedothisbymakingithardertoburnoffcaloriesorbymakingyoufeelmorehungryTalktoyourhealthcare

providerandseeifyourmedicinesmaybeaffectingyourweight

ThebottomlineisthatlosingweightisoftenmorecomplicatedthanjustldquoeatinglessandexercisingmorerdquoCuttingcaloriesandbeingmoreactiveareessentialbutotherkindsofchangesmaybeneededtoloseweightlong-termFortunatelytherearemanyhealthcareproviderswhocangiveyoutheguidanceandsupportyoumayneedtoloseweightandimproveyourhealth

Losing weight is often more

complicated than just ldquoeating less and

exercising morerdquo

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

6 7

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ModernLifeHumancravingstoeatevolvedwhenfoodwasscarceandactivitylevelswereveryhighWenaturallydesiresweethigh-caloriefoodsThesecravingswerehelpfulwhenfoodwaslimitedandhardtogetButinmostcountriestodayfoodisplentifulandmodernlifehasreducedtheneedforphysicalactivityInadditionportionsizesinmanyrestaurantsandsnackshopshavebecomemuchlargerandareoftenhigherincaloriesandfatthanfoodmadeathome

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

EmotionsEmotionscanalsoplayaroleinexcess

weightSomepeopledealwithstressanxietyordepressionbyeatingThismayhelptemporarilybutitcanalsomaketheproblemworseldquoEmotionaleatingrdquocanendupharmingyourmentalandphysicalhealthThatrsquoswhyfindingwaystocopewithfeelingsandemotionscanbeakeypartofanyefforttoloseweight

MedicinesAsideeffectofsomemedicinesisthattheycauseyoutogainweightSomedothisbymakingithardertoburnoffcaloriesorbymakingyoufeelmorehungryTalktoyourhealthcare

providerandseeifyourmedicinesmaybeaffectingyourweight

ThebottomlineisthatlosingweightisoftenmorecomplicatedthanjustldquoeatinglessandexercisingmorerdquoCuttingcaloriesandbeingmoreactiveareessentialbutotherkindsofchangesmaybeneededtoloseweightlong-termFortunatelytherearemanyhealthcareproviderswhocangiveyoutheguidanceandsupportyoumayneedtoloseweightandimproveyourhealth

Losing weight is often more

complicated than just ldquoeating less and

exercising morerdquo

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

6 7

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

ModernLifeHumancravingstoeatevolvedwhenfoodwasscarceandactivitylevelswereveryhighWenaturallydesiresweethigh-caloriefoodsThesecravingswerehelpfulwhenfoodwaslimitedandhardtogetButinmostcountriestodayfoodisplentifulandmodernlifehasreducedtheneedforphysicalactivityInadditionportionsizesinmanyrestaurantsandsnackshopshavebecomemuchlargerandareoftenhigherincaloriesandfatthanfoodmadeathome

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Measuring Excess Weight

ThereareseveralwaysexcessweightcanbedeterminedSinceheightisproportionaltoweighthealthcareprovidersusetheBodyMassIndex(BMI)todeterminewhatisanexcessiveamountofweightforyourheightBMIusesyourweightandheighttogiveyouasinglenumber(seeFigure1)

ABMIbetween185and25isconsideredhealthyYouareconsideredoverweightifyourBMIisbetween25and30ObesityisdefinedasaBMIof30orhigherYoucanusetheBMIcharttofindoutifyourweightisoutsidethehealthyrange

AnothersignofexcessweightisthedistancearoundyourwaistThisiscalledyourwaist circumferenceTofinditwrapatapemeasurearoundyourwaistatthelevelofyourupperhipbones

bull Forfemalesawaistcircumference of35inchesorgreaterisconsidered unhealthy

bull Formenawaistcircumference of40inchesorgreaterisconsidered unhealthy

Somestudiesshowthatweightcarriedaroundyourmiddle(ldquobellyfatrdquo)maybeabiggerriskfactorforheartdiseasetype2diabetesandstrokethangeneralexcessweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

8 9

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450

Weight in pounds

4rsquo11rdquo

5rsquo0rdquo

5rsquo1rdquo

5rsquo2rdquo

5rsquo3rdquo

5rsquo4rdquo

5rsquo5rdquo

5rsquo6rdquo

5rsquo7rdquo

5rsquo8rdquo

5rsquo9rdquo

5rsquo10rdquo

5rsquo11rdquo

6rsquo0rdquo

6rsquo1rdquo

6rsquo2rdquo

6rsquo3rdquo

6rsquo4rdquo

6rsquo6rdquo

4rsquo10rdquo

Heig

ht in

feet

and

inch

es

Figure 1 BodyMass Index Chart

Underweight Healthy Overweight Obese

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

10 11

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The Risks of Having Excess Weight

YoumayknowthathavingexcessweightisnotgoodforyourhealthButyoumaynotrealizejusthowmanyserioushealthproblemsaredirectlylinkedtoexcessweightTheseproblemsinclude

bullType2diabetes(includingthe

risksofnervepain

amputationandblindness)

bullStroke

bullHeartdisease

bullHighbloodpressure

bullHighcholesterol

bullCancer

bullKidneydisease

bullInfertility

bullErectiledysfunction

bullArthritis

bullSleepapnea

bullMigraineheadaches

HavingasignificantamountofexcessweightmayalsoshortenyourlifeItisestimatedthata25-year-oldmanwithsevereobesitywilldie 12 years sooneronaveragethanasimilarmanofhealthyweight

How Much Should You Aim to Lose

Losingaslittleas5ofyourexcessweightcanreduceyourriskfordiabetesandotherconditionsLosingmoremayprovideevengreaterimprovementsinhealthandmayreduceyourriskfurtherIngeneralyourweightlossgoalsshouldbe

bullSpecific(bettertosayyouwillwalk

5daysaweekfor30minutesthan

tosimplysayyouwillldquoincrease

exerciserdquo)

bullRealistic(behonestaboutyour

abilitiesyourtimeandwhatyoutruly

enjoydoing)

bullFlexible(giveyourselfalittleldquowiggle

roomrdquotoallowforunforeseenevents)

TheNationalInstitutesofHealth(NIH)recommendsthatareasonableweightlossgoaltoachieveover6monthsistolosebetween1and2poundseachweekorabout10ofyourcurrentweight

Losing as little as of your excess weight can

reduce your risk for diabetes and other conditions

5

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

BMI ge 40 without other health problems

BMI ge 35 with other conditions associated with obesity

BMI ge 25

BMI ge 30 without other health problems

BMI 27 - 299 with other conditions associated with excess weight

Trea

tmen

t O

ptio

ns

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

12 13

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

GettingtoahealthyweightandstayingthereisnoteasyPeoplemayspendyearstryingdifferentdietsorplansButhealthyweightlossispossibleWhilecuttingcaloriesandbeingmoreactivearekeyinanyweightlossplanmanypeopleneedotherkindsofhelptoloseandmanageweightlong-term

TheNationalInstitutesofHealth(NIH)recommendsthattreatmentchoicesbeguidedbyyourBMIorothermeasuresofexcessweightAnotherimportantthingtoconsideriswhetheryouhaveanyotherhealthproblems(seeFigure2)

AgainyourbestbetistotalkwithyourhealthcareprovideraboutyouroptionsSheorhecancreateaweightlossldquoroad

maprdquothatisrightforyouIfyourproviderdoesnotwanttotalkaboutweightlossorifyoufeelyouneedextrasupportorguidancetherearemanywaystofindotherproviders(seetheResourcessectiononpage29ofthisbooklet)

Nomatterwhatoptionsyouchooseeveryonewhoisaffectedbyobesityorbybeingoverweightshould

bullReducecalories(fromfoodsandbeverages)reduce

portionsizesandfocusoneatinghealthyfoods

bullBephysicallyactive

bullModifybehaviorinwaysthathelpyouachieve

yourweightlossgoals

Surgery

Medicines

Lifestyle Modifications (Diet Physical Activity Behavior Change)

Figure 2

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

No matter how you intend to lose

weight eating healthy food is

vital

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

14 15

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Eating for Weight Loss and Good Health

NomatterhowyouintendtoloseweighteatinghealthyfoodisvitalNoplannopillandnosurgerywillsucceedunlessyoueatnutritiousfoodinportionsthatarerightforyouKnowingmoreaboutfoodandmealplanningcanmakeabigdifference

Tobehealthyyourbodyneedswaterandfourmajornutrients

bull carbohydrates(carbs)

bullproteins

bull fats

bullvitaminsandminerals

Mostfoodscontainacombinationofthesenutrients

CarbohydratesCarbohydratesorcarbsareyourmainsourceofenergyTherearethreetypesofcarbssimplecomplexandfiber

SimplecarbsarefoodsliketablesugarhoneyandthesugarsfoundinfruitandmilkComplexcarbsarefoundinvegetablesgrainsandcerealsandarealsocalledstarchesFiberincludesthestalksandleavesofvegetablesfruitskinsandiscontainedinwholegrainsFiberdoesnrsquotprovideenergybutithelpskeepyourdigestivetracthealthy

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

17

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

16

ProteinProteinisthebuildingblockofcellsandhelpsyourbodyrepairtissuesProteincomesfrombothplantsandanimalsMeatfishbeansnutsmilkandmilkproducts(suchascheeseandyogurt)peaslentilsandeggsaregoodsourcesofproteinYourbodyneedssomeproteineveryday

FatsYoualsoneedatleastsomefatinyourdietLiquidfatssuchasoliveoilandcanolaoiltendtobehealthierthanfatslikebutterandlardthataresolidatroomtemperature

Althoughyouneedsomefatinyourdietfatsarealsohigh-calorieProteinsandcarbohydratescontainabout4caloriespergramFathasmorethandoublethat9caloriespergram

VitaminsandMineralsManyAmericansdonrsquotgetenoughcalciumandvitaminDintheirdietsEveryoneneedstheseandothervitaminsandmineralsforstrongbonesandgoodhealth

Eatingmorevegetablesfruitswholegrainsandmilkproductscanhelpyougettheseessentialnutrients

Womenwhoarepregnantorbreastfeedingmayneedextravitaminsandminerals

WaterWeoftendonotrealizetheamountofextracaloriesweconsumethroughbeverageslikesodaandfruitjuicesOnaverageAmericanadultsconsumeabout400calorieseachdayfrombeveragesaloneWaterhoweverhaszerocaloriesandisneededforgoodhealth

Peoplewhoaretryingtomaintainahealthyweightareencouragedtodrinkwaterandotherno-caloriebeverages

Ingeneralitrsquosbesttolimithigh-carbfoodsanddrinkssuchasregularsodawhitebreadspastaandsugaryfoodslikecookiesandcakesOneadvantageofdietsthatarehigherinproteinmaybethatyoufeellesshungrythanyoudowithdietshighinsugarsorcarbs

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Get the ldquofullness messagerdquo It can take 15 minutes for your brain to get the message that yoursquove been fed So it can help to slow down stop eating for a moment and focus on the signals coming from your stomach and body

Reward success but not with food Patting yourself on the back when you achieve a goal is greatmdashbut choose non-food rewards such as going to a movie buying some music or getting a massage

19

Excess Weight and Your Health A Guide to Effective Healthy Weight LossExcess Weight and Your Health A Guide to Effective Healthy Weight Loss

18

Drink a glass of water before every meal

Eat smaller portions by

bull Putting food on a smaller platebull Taking smaller bitesbull Putting the forkspoon down between bites

Build a Healthy Meal Divide your plate with these proportions

Eat breakfastChoose a low-fat protein source (cottage cheese yogurt etc) as well as a whole grain and fruit or vegetable

Eat a fruit or vegetable with every meal

Read food labelsLook at how much fat sodium (salt) and calories a food has and whether the portion size is reasonable

Avoid regular sodas

Avoid mindless eating

bull Sit down to eatbull Donrsquot eat while watching TV or using the computerbull Eat slowly and chew your food well

Try to weigh yourself at a set time every few days and always use the same scale Expect that your weight will go up and down a bit and look for long-term trends rather than say an immediate loss after an exercise routine

Avoid food ldquotriggersrdquo Sometimes certain places or activities are linked to unhealthy eating such as coffee rooms that have snacks available Avoiding such places can help you avoid unplanned eating

tips for healthy eating

SERvInG SIzES foR fooD GRoupS

Lean Meat and Beans

3ozmeatfishandpoultry=deckofcards

3ozgrilledbakedfish=checkbook

2Tbsppeanutbutter=pingpongball

Milk

112ozcheese=4stackeddiceor2cheeseslices

12cupoficecream=12baseball

FatsOils

1tspmargarineorspreads=1die

Fruits and Vegetables

1mediumfruit=baseball

12cupoffreshfruit=12baseball

14cupraisins=largeegg

1cupofsaladgreens=baseball

1bakedpotato=fist

Grains

1cupofcerealflakes=fist

1pancake=disc

12cupofcookedricepastaorpotato=12baseball

1slicebread=cassettetape

1pieceofcornbread=barofsoap

1 serving looks likehellip

1 serving looks likehellip

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

IfyouarenotalreadyactivetalkwithyourhealthcareproviderbeforestartinganynewprogramofphysicalactivityWhateverkindofactivityyouchoosestartslowlyandbuildgraduallyForexampleyoucouldwalkjust5or10minutestwiceaweekThengraduallybuildupto30-60minutesfiveormoredaysaweekAlsoconsiderbuyingapedometerwhichletsyoutrackhowmanystepsyoutakeduringthedayTrytoworkuptoatleast10000stepseachday

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

20 21

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

The key to success is finding

activities you enjoy doing and that fit

with your lifestyle

Live a More Active Life

HavingexcessweightcanmakeithardertobeactivebutifyoustartslowlyyoucanmakerealprogressBeingactivecanhelpyoumaintainweightlossandimproveyourphysicalandmentalhealthForexamplestudiesshowthatpeoplewhoexerciseregularlyareina

bettermoodandarelessanxiousanddepressed

BeingmoreactivedoesnrsquotmeanyouneedtorunamarathonYoucouldstartwithmoderate-intensityactivitiessuchasbriskwalkingleisurelybikeridingdancingorlightswimmingMorevigorousactivitiesincludepowerwalkingjogginghikingandaerobicsAndeverydayactivitiesthatkeepyoumovingaregoodtooliketakingthestairsrakingtheleavesormowingthegrassThekeytosuccessisfindingactivitiesyouenjoydoingandthatfitwithyourlifestyle

OfcourseifyouareabletoandareinterestedgoingtoagymortakingsomekindofstrengthtrainingyogaorexerciseclasscanreallyhelpWorkingoutwithotherscankeepyoumotivatedandcanbefunaswellIfyouhavejointpainconsiderwateraerobicsorworkwithatraineronexercisesthatwonrsquotcausepainorinjury

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

22 23

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Physician-Supervised Weight Loss Options

FirstStepsWhereveryouareonyourweightlossjourneyworkingwithyourhealthcareprovidercanbeakeytosuccessItisimportanttobeopenwithyourhealthcareproviderandgiveherorhimasmuchinformationaspossibleHerearesometipsforyourfirstvisit

bullWritedownthefoodyouconsume

foroneweekinafooddiary

(donrsquotforgetsnacksanddrinks)

bull Listexerciseactivitiesyouenjoy

bull Listanymedicationsyoucurrently

take(mostpharmaciescanprintthis

informationforyouforfree)

bullWritedownanyfamilyhistoryofobesity-related

conditionssuchastype2diabetesorhigh

bloodpressure

YourprovidermaydirectyoutootherspecialistssuchasdietitiansorexercisespecialistswhocanhelpAdietitiancanhelpyouidentifyfoodtriggersplanmealsandshoppingandhelpyouchangebehaviorsrelatedtoweightgain

It is important to be open with your health

care provider and give her or him as

much information as possible

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

24 25

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

PrescriptionMedicinesforWeightLossRecentlynewmedicineshavebecomeavailablethatmayhelpyouloseexcessweightYourhealthcareprovider

canhelpyoudecideifaprescriptionweightlossmedicinemightberightforyouThesemedicinesaretypicallyonlyconsideredforpatientswithaBMIgreaterthan30(iftheyhavenootherhealthproblems)oraBMIgreaterthan27iftheyhaveotherweight-relatedhealthproblemssuchasdiabeteshighcholesterolorhighbloodpressure

Therearetwotypesofweight-lossmedicines

bullThosethatreduceyourfeelingsofhungerormakeyou

feelfullsoonerbyalteringchemicalsignalsinthebrain

bullThosethatblockfatfrombeingabsorbedbyyourbody

Lessabsorbedfatmeansfewercalories

Studiesshowthatpeopleusingsomeofthesemedicinescanexpecttoloseonaveragebetween5and11oftheirstartingweightandmaintainthisweightlossforatleast2yearsSomepatientstakingthesemedicineshavebeenshowntoloseupto20oftheirstartingweightwhichcanprovideevengreaterimprovementsinhealth

TalkwithyourhealthcareproviderabouttherisksandbenefitsoftakinganymedicinesAllmedicinescarry

someriskAnytypeofmedicine-basedplanshouldbeconsideredonlyaspartofanoverallweightmanagementprogramgiventoyoubyyourhealthcareproviderThisprogramshouldincludeeducationabouthealthyeatingphysicalactivityandaddressinganyemotionalissuesaroundfoodandweightthatyoumighthave New medicines

have become available that

may help you lose excess weight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

26 27

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

SurgicalOptionsforWeightLossWeightlosssurgeryalsoknownas bariatricsurgerymaybeanoptionif

youhaveasignificantamountofexcessweightThismeansaBMIof40andaboveoraBMIabove35ifyoualsohaveotherweight-relatedhealthproblemssuchasdiabetesorheartdiseaseYourhealthcareproviderwillhelpyoudecideifbariatricsurgerymightberightforyou

Surgeryoftenresultsinsignificantweightloss(asmuchas32ofstartingweightdependingontheproceduretype)andtheweighttendstoremainoffforyearsPatientswhohavebariatricsurgerymayalsohaveimprovementsinweight-relatedhealthproblemssuchashighbloodpressuresleepapneahighcholesterolandtype2diabetes

Inadditionbariatricsurgeryresultsinan89reductioninriskofearlydeathanda95improvedqualityoflife

Reported Health Improvements following Bariatric Surgery

Health condition Reported Effect

Type 2 diabetes 86 (went away or improved)

High blood pressure 79 (went away or improved)

Sleep apnea 86 (went away or improved)

High cholesterol 70 (improved)

Osteoarthritisdegenerative joint disease 41 (went away)

Threebasictypesofbariatricsurgeryareavailable

bullGastric Bypass Surgerythestomachispermanently

reducedtoanegg-sizedpouchwhichisreattachedto

theintestinebypassingmostofthestomachandthe

firstpartofthesmallintestine

bullAdjustable Gastric Bandinganadjustablebandis

placedaroundthestomachtolimittheamountoffood

youcancomfortablyeat

bullGastric Sleeveremovalofmostofthestomach

turningitintoanarrowtube

Thereisnoldquobestrdquoproceduremdashyourhealthcareproviderwillreferyoutoabariatricsurgeonwhowillworkwithyoutodecidewhichtypeofsurgerymightberightforyou

AswithanysurgerybariatricsurgeryinvolvessomeriskofcomplicationsWhenperformedbyanexperiencedsurgeonhoweverbariatricsurgeryhasaverylowincidenceofdeathandisassafeasothermajorsurgeriesTalkwithyoursurgeonaboutthepossiblerisksofeachprocedure

Remember bariatric surgery is not a ldquoquick fixrdquo It requires a life-long change in your lifestyle and eating habits Patients should not resume their previous eating habits after undergoing a surgical procedure Long-term follow-up with a health care provider is essential

As with weight loss medicines any type of bariatric surgery should be considered only as part of an overall program that focuses on healthy eating exercise and the emotional components of overeating

Long-term results are likely to be lower

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

28 29

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

Starting Your Weight Loss Journey

NowyouknowthathavingexcessweightgreatlyraisesyourriskforfuturediseaseandearlydeathButyoursquovealsolearnedthereishopeandthathavingexcessweightisnotachoiceormatterofwillpowerGenesandbiologyareinvolvedandmanyaspectsofmodernlifecanmakeiteasytogainweight

TheimportantthingisthatyoucanlearntochangeyourlifestyleloseexcessweightandbecomehealthierYoucanslowlymakebetterfoodchoicesandbuildmorephysicalactivityintoyourlifeMedicinesorsurgicaltechniquesmaybeoptionsforthosewithsignificantexcessweight

ControllingexcessweightisalifelongeffortbutyouhavetakenthefirststepsonyourjourneybyreadingthisbookletByworkingwithahealthcareprovideryoucanfindthebestpathtowardsuccessandthemanybenefitsofahealthyweight

American College of Physiciansacponlineorg

Obesity Action Coalitionobesityactionorg

Academy of Nutrition and Dieteticseatrightorg

American Diabetes Associationdiabetesorg

American Society of Bariatric Physiciansasbporg

American Society for Metabolic amp Bariatric Surgeryasmbsorg

Obesity Societyobesityorg

Weight-Control Information Networkwinniddknihgov

Your Weight Mattersyourweightmattersorg

Resources

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

30 31

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

American College of Physicians

TheAmericanCollegeofPhysicians(ACP)isanationalorganizationofinternistsmdashphysicianswhospecializeinthepreventiondetectionandtreatmentofillnessesinadultsEstablishedin1915ACPisthelargestmedical-specialtyorganizationandsecond-largestphysiciangroupintheUnitedStatesItsmembershipofover126000includesinternistsinternalmedicinesub-specialistsmedicalstudentsresidentsfellowsandalliedhealthprofessionalsMembersarephysiciansingeneralinternalmedicineandrelatedsubspecialtiesincludingcardiologyhematologyneurologypulmonarydiseaseoncologyinfectiousdiseasesallergyandimmunologyandgeriatricsInterniststreatthemajorityofadultsintheUnitedStatesLearnmoreattheACPwebsitewwwacponlineorg

Presenter

Obesity Action Coalition

TheObesityActionCoalitionisanon-profitorganizationdedicatedtogivingavoicetothoseaffectedbyexcessweightandobesityTheOACwasformedtobuildanationwidecoalitionofthoseaffectedtobecomeactiveadvocatesandspreadtheimportantmessageoftheneedforobesityeducationToincreaseobesityeducationtheOACoffersawidevarietyoffreeeducationalresourcesonobesitysevereobesitychildhoodobesityandweightbiasinadditiontoconsequencesandtreatmentsoftheseconditionsTheOACalsoconductsadvocacyeffortsthroughouttheUSonboththeNationalandstatelevelsandencouragesindividualstobecomeproactiveadvocatesFormoreinformationontheOACpleasevisitwwwObesityActionorg

Partner

Vivus Inc

Vivusisabiopharmaceuticalcompanydevelopinginnovativenext-generationtherapiestoaddressunmetneedsinobesitydiabetessleepapneaandsexualhealthforUSEuropeanandotherworldmarketsFormoreinformationaboutthecompanypleasevisitwwwvivuscom

FundingSupport

Credits

Excess Weight and Your Health A Guide to Effective Healthy Weight Losswasmadepossiblethroughtheexpertisefunding

timeandeffortsofmanycontributors

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

Photos pages 14 bottom 20 and 21 courtesy of the Yale Rudd Center for Food Policy amp Obesity

Excess Weight and Your Health A Guide to Effective Healthy Weight Loss

32

ContributorstotheDVD

Domenica Rubino MD

FounderandDirectorWashingtonCenterforWeightManagementandResearchArlingtonVirginia

MemberAmericanCollegeofPhysiciansDiplomateAmericanBoardofObesityMedicineDiplomateAmericanBoardofEndocrinologyDiabetesandMetabolism

Christopher D Still DO FACN FACP

MedicalDirectorCenterforNutritionandWeightManagementDirectorGeisingerObesityInstituteAssociateDeptofGastroenterologyampNutritionGeisingerHealthSystemDanvillePennsylvania

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen R BraunMedical Writerbraunmedicalmediacom

Guidebook DesignCinda Debbink Design Partnersdgdesignpartnerscom

Program Research and DevelopmentElizabeth T Conrad MD DABFP

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight

DVDINSIDE

Excess Weigh1048575 and Your Health

A Guide 1048575 o Effec1048575 ive Healthy Weigh1048575 Loss

HavingexcessweightisacomplexconditionGenesandbiologyplayakeyroleandmanyaspectsofmodernlifemakegainingweighteasy

Buthavingexcessweightraisesyourriskforfuturehealthproblemsand early death Thatrsquoswhy itrsquos important tolearn about your options for losing excess weight andimprovingyourhealth

ThisbookletandDVDprogramwillshowyouhowtomakebetterfoodchoicesandbuildmorephysicalactivityintoyour lifeYoursquollalso learnaboutmedicinesandsurgicaltechniquesthatmaybeoptionsforthosewithsignificantexcessweight

Byworkingwithyourhealthcareprovideryoucanfindthebesttreatmentplantohelpyousucceedandachievethemanybenefitsofahealthyweight