Successful weight management is a cumulative process in which individuals have lost a minimum of 10% of their body weight and have successfully kept it off for one full year (Montesi et al., 2016). According to the obesity and data trends in the United States from 1990-2017, the adult obesity rate was approximately 30% in 29 states and equaled or exceeded 35% in a total of 7 states (Obesity rates & trend data, 2018). Obesity related health conditions including diabetes, hypertension and physical inactivity have risen to 15.2%, 43.5% and 34.4% respectively in certain states (Obesity rates & trend data, 2018). With rising influences of social factors and availability of calorically dense, nutritiously low food options coupled with biological factors and an overall greater rate of physical inactivity, weight loss has become a laborious task with reduced success of sustainability (Summerfield & Ellis, 2016). Behavioral and non-behavioral approaches can be utilized in the attempt to properly manage individual’s weight, while each method has it pros and cons.
Behavioral approaches to weight management
In order to quell the weight gain and regain epidemic, successful maintenance using behavioral methods including but not limited to lifestyle, training modifications, dietary modifications, cognitive components and, finally, changes to personality traits need to be examined (Montesi et al., 2016). One of the most important factors of success is feelings of satisfaction throughout the stages (Montesi et al., 2016).
One behavioral change that deserves elaboration is voluntary participation in physical activity or programmed exercise, which relates lifestyle, training modifications, and cognitive components of behavioral models for change. Whether it be aerobic or anaerobic in nature is a major contributor to overall energy balance and daily caloric expenditure (Wiklund, 2016). Due to the current state of affairs within the fitness and health industry, the efficacy of increased physical fitness as a successful modality for weight management has been all but lost. Social media and overall views on the need for physical activity have further perpetuated this concept as it is no longer enough to “just exercise”, as these efforts are seen as futile without “X” supplement or “X” diet being integrated simultaneously. Unfortunately, while the positives of social media have led many on a path to fitness, they also pose emotional disconnect to those who may be suffering from low self-esteem. Since attitudes of negativity towards overweight and obese individuals are still at large, voluntary participation in exercise programs, especially in a group setting, may be too daunting (Puhl & Heuer, 2010). This problem of weight discrimination adds further obstacles to those trying to improve their lifestyle, as even those who have gained control of BMI and personal body negativity have been shown to avoid exercising in public (Puhl & Heuer, 2010). This is the major reasoning behind certain fitness avenues such as Planet Fitness because of people’s want to be able to feel comfortable and supported while working out.
Another important factor in behavioral change would have to be nutritional changes. Dietary changes can have a major effect on a person’s health, energy levels, and overall wellbeing. When tested in relationship to the transtheoretical model of change, those who partook in educational sessions on modifying their nutrition, changes were seen in reduced fat intake, reduced caloric intake, and improvements in body profiles (de Menezes, Mingoti, Cardoso, Mendonca, & Lopes, 2014). Therefore, it may be a problem of lack of education on dietary changes, as studies show that individuals who partake in nutritional intervention educational programs have higher rates of success with modifying their diets (de Menezes et al., 2014).
Behavioral modification is no easy task for anyone, as change is always a constant battle, but behavioral modification houses the key to long-term success and failure minimization (Summerfield & Ellis, 2016). Each stage will be met with challenges, but if a person is ready for change, the likelihood that progression will occur is much higher (Summerfield & Ellis, 2016). These successful changes may even help individuals who need to take it one step further and are in need of bariatric surgery or anti-obesity drugs (Olson, Bond, & Wing, 2017). Proven adherence to lifestyle changes and weight loss increase the likelihood that pharmaceutical intervention and surgery can have greater success long-term at keeping weight off (Olson, Bond, & Wing, 2017).
Non-behavioral approaches to weight management
Increasingly in the past ten years, non-behavioral interventions such as pharmaceutical intervention, gastric banding, sleeve gastrectomy, biliopancreatic diversion, and gastric bypass surgery have been used for weight loss in hopes of long-term maintenance (Madura II & DiBaise, 2012). The outcome of the types of bariatric surgery is to restrict and/or downsize the bowels in order to increase malabsorption and help with long-term weight management (Madura II & DiBaise, 2012). Each surgery option would be weighed by the primary care physician along with the patient to determine which option would best suit the individual and their ability to follow protocols (Madura II & DiBaise, 2012). Along with undergoing the surgery itself and understanding complications, the doctor would take into consideration how the patient has been able to change mindset in nutrition, what their realistic expectations of surgery were, and how they can correct their current obesity-related habits (Madura II & DiBaise, 2012).
Gastric bypass is one of the more well-known bariatric surgeries and is traditionally the main option in the United States (Madura II & DiBaise, 2012). This surgery has a high level of success, as most patients lose 65% of excess weight and maintain 50% of that weight loss long term (Madura II & DiBaise, 2012). The cons of this surgery are representative of difficulties with the highly technical surgery, fat absorption issues forever after, micronutrient deficiencies, and, while uncommon, early complications that can be serious (Madura II & DiBaise, 2012). While micronutrient deficiencies can be corrected with supplements, patients must be mindful of this (Madura II & DiBaise, 2012). Long term, gastric bypass only has a 10-15% failure rate, which is why it has remained the most common bariatric surgery (Madura II & DiBaise, 2012).
While it may seem like a great last-ditch-effort choice to lose weight after all else has failed, bariatric surgery comes with many obstacles. First of all, despite the vast number of people who undergo bariatric surgery and the prevalence of it in the media, there are a limited number of qualified surgeons to perform such surgeries (Madura II & DiBaise, 2012). Patients may also struggle with changing their lifestyle, with psychological disorders, and with maintaining for years to come if they undergo the surgery early in life (Madura II & DiBaise, 2012).
Aside from surgery, another non-behavioral approach to weight loss could be using pharmaceutical adjuvant therapy or dietary supplements (Olson, Bond, & Wing, 2017; Summerfield & Ellis, 2016). The goal of the first method is to use anti-obesity drugs to assist with losing weight (Olson, Bond, & Wing, 2017). Note, the key word is assist. Alone, these drugs will not be a magic cure-all. However, when compounded with behavioral changes, anti-obesity drugs have a higher chance of helping lose initial weight and maintaining the weight loss (Olson, Bond, & Wing, 2017). The second method, dietary supplements, utilizes a combination of vitamins, minerals, herbs, extracts, and other metabolites to aid in weight loss (Summerfield & Ellis, 2016). While weight loss/fat burning supplements remain to be the highest selling supplements, many do not act on their claims and many are associated with adverse side effects (Summerfield & Ellis, 2016). It is always important to be mindful of supplement claims and truly research an ingredient and speak with medical practitioners prior to using any supplement (Summerfield & Ellis, 2016).
Similar to behavioral changes, non-behavioral changes are not overnight solutions. Especially in regard to surgical options, these decisions cannot be made lightly. Non-behavioral changes require just as much strength emotionally, planning for success, and following through on changes.
Conclusion
Behavioral changes versus non-behavioral changes are each met with positives and negatives, and in some cases may also work hand in hand to help individuals reach their goals. Positively, both behavioral and non-behavioral changes can help establish healthy patterns to long term success nutritionally, activity wise, and mentally. Negatively, behavioral changes may be met with emotional roadblocks and non-behavioral changes may be unreachable options for those in financial distress. Each approach will have a better chance at long term success for the individual if the commitment to change and the support system is available.
Disclaimer
All programs and articles provided are intellectual property of James Shmagranoff. No copies or redistribution of these is allowed without express permission from James Shmagranoff. James Shmagranoff is not a doctor and nothing contained within this article is to be taken as medical advice. Always follow the directions of your medical practitioner.
References
de Menezes, M.C., Mingoti, S.A., Cardoso, C.S., Mendonca, R.D., & Lopes, A. C. S. (2014). Intervention based on transtheoretical model promotes anthropometric and nutritional improvements—A randomized controlled trial. Eating Behaviors, 17, 37-44. Retrieved from https://www.ufsj.edu.br/portal2-repositorio/File/tecnologiasemsaude_pesquisa/interventionbasontranstheoreticalmodel2015(1).pdf
Madura II, J.A., & DiBaise, J.K. (2012). Quick fix or long-term cure? Pros and cons of bariatric surgery. F1000 Med Rep., 4. doi: 10.3410/M4-19
Montesi, L., El Ghock, M., Brodosi, L., Calugi, S., Marchesini, G., & Grave, R.D. (2016). Long-term weight loss maintenance for obesity: A multidisciplinary approach. Diabetes Metab Syndr Obes., 9, 37-46. doi:10.2147/DMSO.S89836
Obesity rates & trend data (September 2018). Retrieved from https://www.stateofobesity.org/data/
Olson, K., Bond, D., & Wing, R.R. (2017). Behavioral approaches to the treatment of obesity. Rhode Island Medical Journal, 21-24. Retrieved from http://www.rimed.org/rimedicaljournal/2017/03/2017-03-21-obesity-olson.pdf
Puhl, R.M., & Heuer, C.A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6) 1019-1028. doi:10.2105/AJPH.2009.159491
Summerfiled, L.M., & Ellis, S.K. (2016). Chapter 11: Lifestyle modification to promote health and weight management. Nutrition, exercise, & behavior: An integrated approach to weight management (3rd ed.)(pp.334). Boston, MA: Cengage Learning
Wiklund, P. (2016). The role of physical activity and exercise in obesity and weight management: Time for critical appraisal. Journal of Sport and Health Science, 5(2), 151-154. Retrieved from https://www.sciencedirect.com/science/article/pii/S2095254616300060
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