The principle of weight gain is simple: energy intake exceeds energy expenditure. However, overweight and obesity are clearly the results of a complex set of interactions among genetic, behavioral, and environmental factors. While hundreds, if not thousands, of weight loss strategies, diets, potions, and devices have been offered to the overweight UAE community, the multi-factorial aetiology of overweight challenges practitioners, researchers, and the overweight themselves to identify permanent, effective strategies for weight loss and maintenance. To put this into perspective, the percentage of individuals who lose weight and successfully maintain the loss has been estimated to be as small as one to three per cent.
Evidence shows that genetics plays a role in the cause of overweight and obesity. However, genetics cannot account for the increased weight gain observed in the UAE population over the past two decades. Rather, the behavioural and environmental factors that conspire to induce individuals to engage in too little physical activity and eat too much relative to their energy expenditure must take most of the blame. It is these factors that are the target of weight-management strategies. With this in mind, I want to weigh in and discuss the efficacy and safety of strategies for weight loss, as well as the combinations of strategies that appear to be associated with successful loss. In addition to the elements of successful weight maintenance I will also discuss the difficulty in maintaining weight loss may contribute to the overweight problem.
The use of behaviour and lifestyle modification in weight management is based on a body of evidence that people become or remain overweight as the result of modifiable habits or behaviours, and that by changing those behaviours, weight can be lost and the loss can be maintained. The primary goals of behavioural strategies for weight control are to increase physical activity and to reduce caloric intake by altering eating habits. In the past, behavioural approaches were applied as stand-alone treatments to simply modify eating habits and reduce caloric intake. However, more recently, these treatments have been used in combination with low-calorie diets, medical devices, medical nutrition therapy and education, exercise programs, monitoring, pharmacological agents, and social support to promote weight loss, and as a component of maintenance programmes, which I will go on to discuss further below.
Some additional techniques for weight loss include eating only regularly scheduled meals; doing nothing else while eating; consuming meals only in one place (usually the dining room) and leaving the table after eating; shopping only from a list; and shopping on a full stomach (Brownell and Kramer, 1994).
Further reinforcement techniques for portion control are also an integral part of the behavioural treatment of overweight and obesity. For example, there are non-invasive programmes available in the UAE that support long-term weight loss through a revolutionary gastric balloon that creates a feeling of fullness by taking up space in the stomach, providing patients with the chance to take a break from dieting and that all too familiar feeling of hunger.
Increased physical activity is an essential component of a comprehensive weight-reduction strategy for overweight adults who are otherwise healthy. One of the best predictors of success in the long-term management of overweight and obesity is the ability to develop and sustain an exercise programme. For a given individual, the intensity, duration, frequency, and type of physical activity will depend on existing medical conditions, degree of previous activity, physical limitations, and individual preferences. The benefits of physical activity are significant and occur even in the absence of weight loss. It has been shown that one of the benefits, an increase in high-density lipoproteins, can be achieved with a threshold level of aerobic exercise of 10 to 11 hours per month.
Almost any kind of assistance provided to participants in a weight-management programme can be characterised as support services. These can include emotional support, dietary support, and support services for physical activity. The support services used most often are structured in a standard way. Other services are developed to meet the specific needs of a site, programme, or the individual involved. With few exceptions, almost any weight-management program is likely to be more successful if it is accompanied by support services.
Despite the availability of pharmacologic therapies for Type 2 diabetes, the incidence of the metabolic disease continues to rise around the world. According to the International Diabetes Federation, 537 million adults are now living with diabetes worldwide, an increase of 16 per cent (74 million people) since 2019. And, by 2045, about 783 million people, or one in eight adults, will be living with diabetes worldwide, indicating that current treatment options are not sufficient. Additionally, diabetes is not only increasing globally but at a much faster rate in regions such as the UAE, where the population with diabetes is projected to increase to about 2.2 million by 2040.
What we must remember about the journey of weight loss is that no programme is a magic bullet and an effective programme is based on good healthcare and good science. What is needed is a proven solution that takes a holistic approach to losing weight.
Cynthia Bou Khalil is nutritional consultant and clinical manager excellence at Allurion
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