Overview of Gradual Weight Loss and Dietary Weight Loss Methods

(III) Adopting a gradual approach

If you lack sufficient willpower and do not need to lose a significant amount of weight, then do not adopt extreme, harsh diets.

To lose weight, you can first examine your eating habits for any problems, such as eating too many snacks, eating too quickly, or not exercising enough. After correcting these issues, if you still need to reduce your intake of regular meals, you can follow these principles.

The whole process should be gradual. You can start with small-scale food restriction (restricting only one type of food is enough to ensure a daily reduction of 1255.2 to 1673.6 kilojoules (300 to 400 kilocalories) in intake), and then spend 2 to 3 weeks studying the results of the food restriction.

If the results are not satisfactory, the scope of the food restriction can be expanded. At this point, there is no need to immediately take the big risk of following a "weight loss diet", weighing each food item and checking the calorie content of each dish.

There are two methods that can be used.

Eat a variety of foods, but in small amounts.

- Create a list of foods that are restricted or prohibited from consumption, and ban them one by one.

(iv) Weight loss is not the only goal of weight loss.

Because weight is easy to measure, people have developed the misconception that weight change is a necessary prerequisite for changing obesity.

However, in many cases, changes in obesity characteristics are more important.

Some people believe that obesity is just a symptom, like asthma. If the patient does not feel difficulty breathing and only increases the amount of air exhaled, then it is not a big deal.

Similarly, if an obese patient feels well (has normal bodily functions), he/she is not necessarily required to lose weight.

While this view may be somewhat extreme, the fact that obese patients have corrected their previous unhealthy lifestyle habits, and that some patients with bulimia nervosa have stopped binge eating, can undoubtedly be considered the first step towards successful weight loss.

Some people try for a year but don't lose weight, so they think they have no hope of losing weight.

However, from another perspective, after a year of hard work, correcting previous bad habits and preventing weight gain can be considered a success.

Dietary weight loss method

This chapter not only discusses nutrition, but also touches on physiology, behavior, and cooking... It doesn't just dictate how many joules of calories you should eat or require you to memorize a few recipes. It will also tell you how food can help you lose weight, how to choose weight-loss foods, how to cook them, when to eat, and when to stop. In short, it aims to help you eat well, eat your fill, stay healthy, and have plenty of energy, but without gaining weight.

Under normal circumstances, healthy people maintain a dynamic balance between the calories they consume from food and the calories they burn; otherwise, they will either lose or gain weight.

Obesity is the result of a positive energy balance. The principle of dietary therapy is to restrict food intake so that the body consumes more energy than it takes in, thus creating a negative energy balance and resulting in weight loss.

The simplest way to control calorie intake is through starvation therapy, which involves fasting, dieting, and reducing food intake. However, each method has an unavoidable problem: hunger. As a result, many weight loss plans have been forced to stop.

Moreover, fasting and semi-starvation therapy have serious drawbacks, damaging health and even endangering life.

This chapter aims to teach you how to choose and prepare food by analyzing its nutritional components, so that your body can obtain sufficient nutrients without becoming excessively hungry, and minimize the discomfort that weight loss can cause.

I. Dietary Therapy

The Mozi (a classic Chinese text) records: "In the past, King Ling of Chu favored men with slender waists, so all of King Ling's ministers refrained from eating more than one meal a day."

The Book of the Later Han Dynasty, Biography of Ma Fang Liao, states: "King Chu was fond of slender waists, and many people in the palace starved to death," indicating that the Chinese people already knew and used "dieting to lose weight" a long time ago.

With the exception of a very small number of cases caused by genetics and endocrine disorders, the vast majority of obesity is caused by excessive intake of nutrients from the diet and insufficient physical activity.

Therefore, dietary control plays an extremely important role in the treatment of obesity.

Dietary therapy is divided into three types based on the amount of energy consumed each day: ① Fasting, also known as abstinence or complete starvation therapy, in which the energy intake is 0; ② Very low calorie diet, with a daily energy intake of 2510.4 to 3347.2 kJ (600 to 800 kcal); ③ Low calorie diet, with a daily energy intake of 3347.2 to 6276 kJ (800 to 1500 kcal).

(I) Fasting Therapy

Fasting has been used as a treatment for obesity, especially morbid obesity, for over 70 years, but research on its benefits to the human body during and after weight loss is scarce.

Weight loss plans conducted under the supervision of a doctor can have inconsistent, and sometimes even contradictory, results.

For some obese individuals, short-term fasting yields no results, and long-term fasting is only temporarily effective.

Most patients regained their original weight some time after the fast ended, and some even exceeded their previous weight.

Fasting can cause many adverse reactions, such as severe ketosis, hyperuricemia, excessive consumption of lean body tissue, hyponatremia, hypokalemia, hypoglycemia, neutropenia, hair loss, and excessive loss of phosphate and magnesium by the kidneys.

While prolonged fasting can result in rapid and continuous weight loss, fasting is dangerous.

Therefore, long-term complete fasting must be carried out under the close supervision of a doctor, and patients must be carefully selected.

This can be considered for patients who are severely obese without comorbidities, are willing to cooperate, and are eager to achieve therapeutic effects.

Before fasting therapy, intermittent fasting therapy is used as a transition.

The duration of fasting should be determined according to the degree of obesity and age.

For those under 18 years of age, a fasting therapy of no more than 7 days is recommended, with an average of 4 to 5 days, while for obese adults, 5 to 14 days is preferable.

During the fast, it is especially important to stay in bed, avoid strenuous exercise, and use hypnotics and sedatives, and replenish adequate fluids.

Patients feel hungry in the first day or two of fasting, and after three or four days they develop mild ketosis, and the feeling of hunger gradually weakens until their appetite disappears completely.

Short-term starvation therapy is generally acceptable to determined patients and has a definite therapeutic effect, but it must be followed by a low-calorie diet in order to maintain and consolidate the therapeutic effect.

During total starvation therapy, there is significant loss of tissue protein, making it unsuitable for children in their growth and development period and obese adult patients with severe comorbidities.

Obese patients with gout should avoid starvation therapy because during starvation therapy, blood uric acid levels rise, and uric acid excretion is reduced due to the influence of ketone bodies, which may trigger an acute gout attack.

Once the starvation therapy stops, the large amount of uric acid excreted from the kidneys may lead to the formation of uric acid stones.

To slow down the loss of protein through catabolism, patients can consume 40-60 grams of eggs daily during periods of complete starvation.

(II) Very low calorie diet

Because complete fasting has adverse effects and is difficult for most people to accept, people began to develop a very low coloric diet (VLCD), which is about 3347.2 kilojoules (800 kilocalories) of calories per day.

This diet contains high-biological-value protein and is often used for patients with severe obesity and morbid obesity. Its purpose is to induce rapid weight loss while ensuring that the body's lean tissue is not affected by the protein, carbohydrates, and various essential vitamins and minerals supplied in the diet.

In the mid-1970s, this liquid diet for weight loss became popular internationally, and more than 50 kinds of protein-based weight loss foods were openly sold in stores. By the end of 1977, it had caused the deaths of more than 60 people.

These foods contain raw hides, collagen, hydrolyzed gelatin, saccharin, and artificial sweeteners.

These are mostly inferior products, and nutritionally they are low-biological-value proteins that lack essential amino acids.

Later, they developed an extremely low-calorie diet containing high biological value protein, a small amount of sugar, and a minimum amount of essential fatty acids, minerals, and vitamins.

One method is "protein-saving modified fasting," which provides 1.5 grams of protein per kilogram of ideal body weight per day.

The second is a "liquid formula diet" that provides about 50 to 70 grams of protein per day.

The former diet does not use any sugar and only allows lean meat, fish, and poultry. The only source of fat is also obtained from these foods.

Liquid diets use milk and egg-based formulas, and in addition to protein, they also contain small amounts of sugar and fat.

Both diets require the supplementation of vitamins and minerals.

Currently, very low-calorie diets can achieve weight loss effects equivalent to fasting therapy, while minimizing the side effects that occur during fasting.

There have been no deaths directly related to very low-calorie diets.

The weight loss effect of using a very low-calorie diet is related to the duration of treatment. It can reduce 7-10 kg in 4 weeks, an average of 20 kg in 12 weeks, and 30-40 kg in 19-24 weeks.

On average, I lost 2 kilograms per week.

During weight loss, blood ketone bodies increase, arterial blood tends to be acidic, blood cholesterol and triglycerides decrease, glucose tolerance improves, and insulin levels normalize.

Very low-calorie diets are not entirely without side effects.

Common side effects include hair loss, nail deformation, dry skin, cold body, muscle cramps, tinnitus, and constipation. There are also reports of vomiting, stomach upset, diarrhea, constipation, low blood pressure, dizziness, and amenorrhea, but these occur very rarely.

Therefore, obese patients must undergo electrocardiogram, chest X-ray, routine blood and urine tests, and blood biochemistry tests before receiving treatment to rule out contraindications.

Contraindications include acute myocardial infarction, cerebrovascular disease, various cancers, type I diabetes, liver and kidney disease, mental illness, and pregnancy.

If the patient has type 2 diabetes, they must be a patient who has stopped insulin therapy.

Excluding the above contraindications, this method can be considered for severely obese adults with an obesity rate of 60% or higher.