The Best Ways to Lose 20 Pounds

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Weight Reduction Medications and Programs
If you are uncertain what you put in your first order, you can let Nutrisystem pick the foods for you. A meta-analysis of 14 studies comprising 7, participants that reported the results of dominant genetic models indicated a 0. Aetna considers the following medically necessary treatment of obesity when criteria are met: These investigators reviewed available information on the short- and long-term effects of intervention treatment on body fat composition of overweight and obese children and adolescents and, to obtain a further understanding on how different body composition techniques detect longitudinal changes. Boy shares foul ball with another young fan at Detroit Tigers game. A recent study published in The American Journal of Clinical Nutrition found that a healthy Nordic diet seemed to have an impact on genes in abdominal fat, turning off genes related to inflammation. A total of 18 trials were identified, and 9 were included.

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The prevalence of hypertension led the U. National Institutes of Health NIH to propose funding to further research the role of dietary patterns on blood pressure. In the NHLBI worked with five of the most well-respected medical research centers in different cities across the U. The DASH study used a rigorous design called a randomized controlled trial RCT , and it involved teams of physicians, nurses, nutritionists, statisticians, and research coordinators working in a cooperative venture in which participants were selected and studied in each of these five research facilities.

The chosen facilities and locales for this multi-center study were: Two DASH trials were designed and carried out as multi-center, randomized, outpatient feeding studies with the purpose of testing the effects of dietary patterns on blood pressure. The standardized multi-center protocol is an approach used in many large-scale multi-center studies funded by the NHLBI.

A unique feature of the DASH diet was that the foods and menu were chosen based on conventionally consumed food items so it could be more easily adopted by the general public if results were positive.

The nutritional conceptualization of the DASH meal plans was based in part on this research. Two experimental diets were selected for the DASH study and compared with each other, and with a third: Magnesium and Potassium levels were close to the 75th percentile of U.

The DASH diet was designed to provide liberal amounts of key nutrients thought to play a part in lowering blood pressure, based on past epidemiologic studies. One of the unique features of the DASH study was that dietary patterns rather than single nutrients were being tested. Researchers have also found that the DASH diet is more effective than a low oxalate diet in the prevention and treatment of kidney stones, specifically calcium oxalate kidney stones the most common type.

Participants ate one of the three aforementioned dietary patterns in 3 separate phases of the trial, including 1 Screening, 2 , Run-in and 3 Intervention. In the screening phase, participants were screened for eligibility based on the combined results of blood pressure readings.

In the 3 week run-in phase, each subject was given the control diet for 3 weeks, had their blood pressure measurements taken on each of five separate days, gave one hour urine sample and completed a questionnaire on symptoms.

At this point, subjects who were compliant with the feeding program during the screening phase were each randomly assigned to one of the three diets outlined above, to begin at the start of the 4th week.

The intervention phase followed next; this was an 8-week period in which the subjects were provided the diet to which they had been randomly assigned. The first group of study subjects began the run-in phase of the trial in September while the fifth and final group began in January Alcohol was limited to no more than two beverages per day, and caffeine intake was limited to no more than three caffeinated beverages.

The minority portion of the study sample and the hypertensive portion both showed the largest reductions in blood pressure from the combination diet against the control diet. The hypertensive subjects experienced a drop of At the end of the intervention phase, Apart from only one subject on the control diet who was suffering from cholecystitis, other gastrointestinal symptoms had a low rate of incidence.

Like the previous study, it was based on a large sample participants and was a multi-center, randomized, outpatient feeding study where the subjects were given all their food. The day intervention phase followed, in which subjects ate their assigned diets at each of the aforementioned sodium levels high, intermediate and low in random order, in a crossover design.

The primary outcome of the DASH-Sodium study was systolic blood pressure at the end of the day dietary intervention periods. The secondary outcome was diastolic blood pressure. Study results indicate that the quantity of dietary sodium in the control diet was twice as powerful in its effect on blood pressure as it was in the DASH diet.

As stated by Sacks, F. The DASH diet and the control diet at the lower salt levels were both successful in lowering blood pressure, but the largest reductions in blood pressure were obtained by eating a combination of these two i.

The hypertensive subjects experienced an average reduction of From Wikipedia, the free encyclopedia. Available evidence does not support the use of whole body DEXA for managing obesity. There is currently no established role for whole body bioimpedance for weight reduction or other indications.

Nowadays, medicinal plants and natural treatments are becoming more and more popular. Diabetes has historically been treated with plants or plant-derived formulations in different cultures, mainly in China, Asia and India.

Different mechanisms for the anti-diabetic effect of plants have been proposed: The scientific evidences for most of these plants are still incomplete. The large market for plant remedies has resulted in an array of unauthorized products or marketed as dietary supplements and, at the same time, no reliable pharmaceutical-grade products are registered for this purpose. Borel et al conducted a prospective intervention study in viscerally obese men classified according to their glucose tolerance status.

The results showed insulin sensitivity improved in assocication with decreases inboth visceral VAT and subcutaneous adiposity SAT as well as improvement in CRF, regardless of baseline glucose tolerance. The results of this study also shoed that reduction in VAT was associated with an improvement in homeostasis model assessment of insulin resistance, whereas reduction in SAT was rather associated with improvement of the insulin sensitivity index of Matsuda.

Subjects were randomly assigned to placebo, 7. Mulholland et al stated that evidence from the literature supports the safe use of very-low-energy diets VLED for up to 3 months in supervised conditions for patients who fail to meet a target weight loss using a standard low-fat, reduced-energy approach.

There is, however, a need for longer-term outcomes on obesity and associated morbidities following a VLED. These researchers investigated longer-term outcomes from studies using VLED, with a minimum duration of 12 months, published between January and December Reference lists of studies and reviews were manually searched. Weight loss or prevention of weight gain and morbidities were the main outcomes assessed. A total of 32 out of articles met the inclusion criteria.

The duration of the studies ranged from 12 months to 5 years. Periods of VLED ranged from 25 d to 9 months. Several studies incorporated aspects of behavior therapy, exercise, low-fat diets, low-carbohydrate diets or medication.

Current evidence demonstrated significant weight loss and improvements in blood pressure, waist circumference and lipid profile in the longer term following a VLED. Interpretation of the results, however, was restricted and conclusions with which to guide best practice were limited due to heterogeneity between the studies. The authors concluded that the present review clearly identified the need for more evidence and standardized studies to assess the longer-term benefits from weight loss achieved using VLED.

Clinicians supposedly can screen for abnormally low metabolic rates, teach energy balance, and identify the precise caloric intake needed for weight loss. Clinical applications of indirect calorimetry include obesity treatment, as well as treating obesity related diseases such as diabetes, dysmetabolic syndrome X, hypothyroidism, hyperthyroidism, hypertension, cardiovascular disease, as well as sleep apnea. Under strict laboratory protocol, indirect calorimetry can also be used to measure basal metabolic rate.

Published studies of indirect calorimetry in weight management have focused on its accuracy Frankenfeld, et al. Difference in weight loss between the treatment and usual care group were —4. The investigators noted that study limitations include small sample size, short duration, and small treatment effect.

An additional issue is the generalizability of the findings, given that, at the time of the study, the Air Force had regulations that all personnel maintain a desired body weight and body fat percentage, or these individuals could be discharged from service. The investigators stated that future research is needed to determine the long-term efficacy of using indirect calorimetry as part of a comprehensive weight control program.

Close to one-half of cancer patients being evaluated in an outpatient cachexia clinic are noted to be hypermetabolic by indirect calorimetry. Whiting et al stated that capsaicinoids are a group of chemicals naturally occurring in chilli peppers with bioactive properties that may help to support weight management. These investigators conducted a meta-analysis investigating the potential effects of capsaicinoids on energy intake, clarified previous observations and formed evidence-based conclusions about possible weight management roles.

Medical databases Medline, Web of Knowledge and Scopus were systematically searched for papers. Of the 74 clinical trials identified, 10 were included, 8 of which provided results suitable to be combined in analysis participants. From the studies, 19 effect sizes were extracted and analyzed using MIX meta-analysis software. Data analysis showed that capsaicinoid ingestion prior to a meal reduced ad libitum energy intake by Study findings suggested a minimum dose of 2 mg of capsaicinoids is needed to contribute to reductions in ad libitum energy intake, which appears to be attributed to an altered preference for carbohydrate-rich foods over foods with a higher fat content.

The authors concluded that meta-analysis findings suggested that daily consumption of capsaicinoids may contribute to weight management through reductions in energy intake. Subsequently, there may be potential for capsaicinoids to be used as long-term, natural weight-loss aids. They stated that further long-term randomized trials are now needed to investigate these effects. In a systematic review, Onakpoya et al a evaluated the evidence for or against the effectiveness of glucomannan, a soluble fiber, in body weight reduction.

Hand searches of bibliography were also conducted. Outcomes of interest were body weight and BMI. A total of 18 trials were identified, and 9 were included.

There was a variation in the reporting quality of the included RCTs. A meta-analysis random effect model of 8 RCTs revealed a non-statistically significant difference in weight loss between glucomannan and placebo mean difference [MD]: Adverse events included abdominal discomfort, diarrhea, and constipation.

The authors concluded that the evidence from available RCTs does not show that glucomannan intake generates statistically significant weight loss. They stated that future trials should be more rigorous and better reported. Onakpoya et al b noted that several slimming aids being sold as food supplements are widely available.

One of them is pyruvate. Its effectiveness in causing weight reduction in humans has not been fully established. The objective of this systematic review was to examine the effectiveness of pyruvate in reducing body weight. Electronic and non-electronic searches were conducted to identify all relevant human RCTs.

The bibliographies of all located articles were also searched. No restrictions in language or time were applied. Two independent reviewers extracted the data according to predefined criteria.

A total of 9 trials were identified and 6 were included. All had methodological weaknesses. The meta-analysis revealed a statistically significant difference in body weight with pyruvate compared to placebo MD: The magnitude of the effect is small, and its clinical relevance is uncertain. Adverse events included gas, bloating, diarrhea, and increase in low-density lipoprotein LDL cholesterol.

The authors concluded that the evidence from RCTs does not convincingly show that pyruvate is effective in reducing body weight; limited evidence exists about the safety of pyruvate. They stated that future trials involving the use of this supplement should be more rigorous and better reported.

The labeling of Saxenda states that liraglutide should not be used with insulin FDA, It also states that the the effects of liraglutide on cardiovascular morbidity and mortality have not been established. The labeling states that the safety and efficacy of coadministration with other products for weight loss have not been established.

In addition, liraglutide has not been studied in patients with a history of pancreatitis. Liraglutide for chronic weight management is contraindicated in the following conditions: Trial data showed that liraglutide, in combination with a reduced-calorie diet and increased physical activity, resulted in significantly greater weight loss than diet and physical activity alone. The SCALE phase 3 clinical trial program of the safety and effectiveness of liraglutide for chronic weight management included three clinical trials that included approximately 4, obese and overweight patients with and without significant weight-related conditions FDA, All patients received counseling regarding lifestyle modifications that consisted of a reduced-calorie diet and regular physical activity.

Results from a clinical trial that enrolled patients without diabetes showed that patients had an average weight loss of 4. In this trial, 62 percent of patients treated with liraglutide lost at least 5 percent of their body weight compared with 34 percent of patients treated with placebo.

Results from another clinical trial that enrolled patients with type 2 diabetes showed that patients had an average weight loss of 3.

In this trial, 49 percent of patients treated with liraglutide lost at least 5 percent of their body weight compared with 16 percent of patients treated with placebo. The FDA approved labeling states that patients using liraglutide should be evaluated after 16 weeks to determine if the treatment is working FDA, If a patient has not lost at least 4 percent of baseline body weight, liraglutide should be discontinued, as it is unlikely that the patient will achieve and sustain clinically meaningful weight loss with continued treatment.

Saxenda is a glucagon-like peptide-1 GLP-1 receptor agonist and should not be used in combination with any other drug belonging to this class, including Victoza, a treatment for type 2 diabetes FDA, Saxenda and Victoza contain the same active ingredient liraglutide at different doses 3 mg and 1. However, Saxenda is not indicated for the treatment of type 2 diabetes, as the safety and efficacy of Saxenda for the treatment of diabetes has not been established.

Saxenda has a boxed warning stating that thyroid C-cell tumors have been observed in rodent studies with liraglutide but that it is unknown whether liraglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma MTC , in humans FDA, Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice.

It is unknown whether liraglutide causes thyroid C-cell tumors, including MTC, in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. The labeling states that liraglutide is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2 MEN 2 FDA, The labeling states that patients should be counseled regarding the risk of MTC with use of liraglutide and informed of symptoms of thyroid tumors e.

The labeling states that routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with liraglutide. Serious side effects reported in patients treated with liraglutide for chronic weight management include pancreatitis, gallbladder disease, renal impairment, and suicidal thoughts FDA, Liraglutide can also increase heart rate and should be discontinued in patients who experience a sustained increase in resting heart rate.

Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with liraglutide Novo Nordisk, After initiation of liraglutide, patients should be observed for signs and symptoms of pancreatitis including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting.

If pancreatitis is suspected, liraglutide should promptly be discontinued and appropriate management should be initiated. If pancreatitis is confirmed, liraglutide should not be restarted. Substantial or rapid weight loss can increase the risk of cholelithiasis; however, the incidence of acute gallbladder disease was greater in liraglutide-treated patients than in placebo-treated patients even after accounting for the degree of weight loss Novo Nordisk, If cholelithiasis is suspected, gallbladder studies and appropriate clinical follow-up are indicated.

When liraglutide is used with an insulin secretagogue e. The labeling recommends lowering the dose of the insulin secretagogue to reduce the risk of hypoglycemia. Renal impairment has been reported postmarketing, usually in association with nausea, vomiting, diarrhea, or dehydration, which may sometimes require hemodialysis Novo Nordisk, The labeling recommends using caution when initiating or escalating doses of liraglutide in patients with renal impairment.

Serious hypersensitivity reactions e. The labeling recommends that patients stop taking liraglutide and seek medical advice if symptoms of hypersensitivity reactions occur. Liraglutide should be discontinued in patients who experience suicidal thoughts or behaviors. Liraglutide should be avoided in patients with a history of suicidal attempts or active suicidal ideation. The labeling states that nursing mothers should either discontinue liraglutide for chronic weight management or discontinue nursing Novo Nordisk, The labeling states that the safety and effectiveness of liraglutide have not been established in pediatric patients and is not recommended for use in pediatric patients.

In addition, the cardiovascular safety of liraglutide is being investigated in an ongoing cardiovascular outcomes trial. Lingwood stated that there is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis BIA meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends.

These researchers reviewed the literature regarding the use of bioelectrical impedance in neonates. It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts. Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates. The authors concluded that further research is needed into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realize the full potential of this technology.

These investigators reviewed available information on the short- and long-term effects of intervention treatment on body fat composition of overweight and obese children and adolescents and, to obtain a further understanding on how different body composition techniques detect longitudinal changes. A total of 13 papers were included; 7 included a multi-disciplinary intervention component, 5 applied a combined dietary and physical activity intervention and 1 a physical activity intervention.

Body composition techniques used included anthropometric indices, BIA, and dual energy X-ray absorptiometry. Percentage of fat mass change was calculated in when possible.

Findings suggested, no changes were observed in fat free mass after 16 weeks of nutritional intervention and the lowest decrease on fat mass percentage was obtained. However, the highest fat mass percentage with parallel increase in fat free mass, both assessed by DXA was observed in a multi-component intervention applied for 20 weeks. The authors concluded that more studies are needed to determine the best field body composition method to monitor changes during overweight treatment in children and adolescents.

Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies.

These investigators performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. They included 50 published studies. Mean differences between BIA and reference methods gold standard [criterion validity] and convergent measures of body composition [convergent validity] were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity.

These investigators found strong evidence for a good reliability, i. However, test-retest mean differences ranged from 7. However, they stated that validity and measurement error were not satisfactory. Goldberg et al stated that the sensory and gastro-intestinal changes that occur with aging affect older adults' food and liquid intake.

Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of BIA to measure hydration in 19 older women in residential care: The authors concluded that if results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.

Buffa et al defined the effectiveness of bioelectrical impedance vector analysis BIVA for assessing 2-compartment body composition.

Selection criteria included studies comparing the results of BIVA with those of other techniques, and studies analyzing bioelectrical vectors of obese, athletic, cachectic and lean individuals. A total of 30 articles met the inclusion criteria. The ability of classic BIVA for assessing 2-compartment body composition has been mainly evaluated by means of indirect techniques, such as anthropometry and BIA. Classic BIVA showed a high agreement with body mass index, which can be interpreted in relation to the greater body mass of obese and athletic individuals, whereas the comparison with BIA showed less consistent results, especially in diseased individuals.

The authors concluded that specific BIVA is a promising alternative to classic BIVA for assessing 2-compartment body composition, with potential application in nutritional, sport and geriatric medicine. Haverkort et al noted that BIA is a commonly used method for the evaluation of body composition.

However, BIA estimations are subject to uncertainties. These researchers explored the variability of empirical prediction equations used in BIA estimations and evaluated the validity of BIA estimations in adult surgical and oncological patients. Studies developing new empirical prediction equations and studies evaluating the validity of BIA estimations compared with a reference method were included. Only studies using BIA devices measuring the entire body were included.

Studies that included patients with altered body composition or a disturbed fluid balance and studies written in languages other than English were excluded. To illustrate variability between equations, fixed normal reference values of resistance values were entered into the existing empirical prediction equations of the included studies and the results were plotted in figures.

Estimates of the FM demonstrated large variability range relative difference The authors concluded that application of equations validated in healthy subjects to predict body composition performs less well in oncologic and surgical patients.

They suggested that BIA estimations, irrespective of the device, can only be useful when performed longitudinally and under the same standard conditions. Gibson et al stated that VLEDs and ketogenic low-carbohydrate diets KLCDs are 2 dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent. To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, these researchers conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analog scales VAS before in energy balance and during while in ketosis adherence to VLED or KLCD.

Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry or more full or satisfied.

Ketosis appears to provide a plausible explanation for this suppression of appetite. The authors concluded that future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet. Bueno and colleagues examined the effect of replacing dietary long-chain triacylglycerols LCTs with medium-chain triacylglycerols MCTs on body composition in adults.

These researchers conducted a meta-analysis of RCTs, to examine if individuals assigned to replace at least 5 g of dietary LCTs with MCTs for a minimum of 4 weeks show positive modifications on body composition. Two authors independently extracted data and assessed risk of bias.

Weighted mean differences WMDs were calculated for net changes in the outcomes. These investigators assessed heterogeneity by the Cochran Q test and I 2 statistic and publication bias with the Egger's test. Pre-specified sensitivity analyses were performed. A total of 11 trials were included, from which 5 presented low risk of bias. The overall quality of the evidence was low-to-moderate. Trials with a cross-over design were responsible for the heterogeneity.

The authors concluded that despite statistically significant results, the recommendation to replace dietary LCTs with MCTs must be cautiously taken, because the available evidence is not of the highest quality. Changes in blood lipid levels were secondary outcomes. Identified trials were assessed for bias.

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