11.5: Dietary, Behavioral, and Physical Activity Recommendations for Weight Management

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Learning Objectives

• Explain the complementary actions of dietary changes and increased physical activity level on health.
• Formulate an exercise plan that fits your 
  lifestyle
   and that follows the 2008 Physical Activity Guidelines for Americans.

We have just considered the gravity of the 

obesity

 problem in America and worldwide. How is America combating its weight problem on a national level and have the approaches been successful?

Successful weight loss is defined as individuals intentionally losing at least 10 percent of their body weight and keeping it off for at least one year.Wing, R. R. and J. O. Hill. “Successful Weight Loss Maintenance.” Annu Rev Nutr 21 (2001): 323–41. Accessed October 8, 2011. http://www.ncbi.nlm.nih.gov/pubmed/11375440?dopt=Abstract. Results from 

lifestyle

 intervention studies suggest fewer than 20 percent of participants are successful at weight loss. An evaluation of successful weight loss, involving more than fourteen thousand participants published in the November 2011 issue of the International Journal of 

Obesity

 estimates that more than one in six Americans who were overweight or 

obese

 were successful in achieving long-term weight loss.Kraschnewski, J. L. et al. “Long-Term Weight Loss Maintenance in the United States.” Int J Obes 34, no. 11 (2010): 1644–54. http://www.ncbi.nlm.nih.gov/pubmed/20479763. However, these numbers are on the high end because many similar studies report fewer than 10 percent of participants as successful in weight loss.

The National Weight Control Registry (NWCR) tracks over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year. Their research findings are that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking.)The National Weight Control Registry. “Research Findings.” Accessed October 8, 2011. http://www.nwcr.ws/Research/default.htm. Although there are a great 

variety

 of approaches taken by NWCR members to achieve successful weight loss, most report that their approach involved adhering to a low-

calorie

, low-fat diet and doing high levels of activity (about one hour of exercise per day). Moreover, most members eat breakfast every day, watch fewer than ten hours of television per week, and weigh themselves at least once per week. About half of them lost weight on their own and the other half used some type of weight-loss program. In most scientific studies successful weight loss is accomplished only by changing the diet and by increasing physical activity. Doing one without the other limits the amount of weight lost and the length of time that weight loss is sustained. On an individual level it is quite possible to achieve successful weight loss, as over ten thousand Americans can attest. Moreover, losing as little as 10 percent of your body weight can significantly improve health and reduce 

disease

 risk.National Heart, Lung, and Blood Institute. “Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and 

Obesity

 in Adults: The Evidence Report.” Obes Res 6 supplement (1998): 51S–210S. http://www.ncbi.nlm.nih.gov/books/NBK2003/. You do not have to be overweight or 

obese

 to reap benefits from eating a healthier diet and increasing physical activity as both provide numerous benefits beyond weight loss and maintenance.

Evidence-Based Dietary Recommendations

The 2010 Dietary Guidelines for Americans offers specific, evidence-based recommendations for dietary changes aimed at keeping 

calorie

 intake in balance with physical activity, which is key for weight management. These recommendations include:US Department of Agriculture. 2010 Dietary Guidelines for Americans. 2010. Accessed October 7, 2011. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines 2010.pdf.

• Increase intake of whole grains, vegetables, and fruits. Scientific evidence demonstrates that adults who have a higher intake of whole grains, mainly those high in dietary fiber, have lower body weights compared to adults who eat a smaller amount of whole grains. Moreover diets incorporating more whole grains reduce chronic 
  disease
   risk . A higher intake of fruits and vegetables is scientifically shown to protect against weight gain in adults and there is some evidence that this is also true for children and adolescents.
• Reduce intake of sugar-sweetened beverages. There is good evidence that reducing consumption of sugar-sweetened beverages, especially in children and adolescents, decreases body weight and reduces chronic 
  disease
   risk.
• Monitor intake of 100 percent fruit juice for children and adolescents, especially those who are overweight or 
  obese
  . There is some evidence that increased intake of 100 percent juice exacerbates weight problems in children and adolescents who are already overweight or 
  obese
  .
• Monitor 
  calorie
   intake from alcoholic beverages for adults. Drinking in 
  moderation
   is not linked to weight gain; however, excessive intake of alcohol over time is associated with weight gain.

Evidence-Based Behavioral Recommendations

In addition to the dietary recommendations, the 2010 Dietary Guidelines for Americans offers specific evidence-based recommendations that address behavioral changes aimed to keep 

calorie

 intake in balance with physical activity. The recommendations include:

• Focus on the total number of calories consumed. Reducing 
  calorie
   intake improves health and aids in weight management.
• Monitoring food and caloric intake. Being more aware of the calories in foods and beverages by reading the 
  Nutrition Facts panel
   is helpful for consumers to monitor intake. Vigilant monitoring of food and caloric intake assists in weight management.
• When eating out, choose smaller portions or lower-
  calorie
   options. As mentioned in an earlier section of this chapter, eating out more often, especially at fast food restaurants, contributes to weight gain. The Dietary Guidelines advise people that when they are eating out to order smaller portions, share meals when possible, or take home part of the meal.
• Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories. Having less on your plate helps you eat less.
• Eat a nutrient-dense breakfast. The old adage that “breakfast is the most important meal of the day” holds true when you consider that not eating breakfast is associated with higher body weights, especially among children and adolescents. Moreover, eating a nutrient-dense breakfast has in some scientific studies been shown to stimulate weight loss.
• Limit screen time. In children, adolescents, and adults, the sedentary activities of watching television and spending time on the computer are linked to increased overweight and 
  obesity
  . The Dietary Guidelines recommend children and adolescents spend no more than one to two hours daily watching television, playing electronic games, or using the computer (other than for homework).US Department of Agriculture. 2010 Dietary Guidelines for Americans. 2010. Accessed October 7, 2011. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines 2010.pdf.

Evidence-Based Physical Activity Recommendations

The other part of the 

energy balance

 equation is physical activity. The 2010 Dietary Guidelines are complemented by the 2008 Physical Activity Guidelines for Americans issued by the Department of Health and Human Services in an effort to provide evidence-based guidelines for appropriate physical activity levels. The 2008 Physical Activity Guidelines provide guidance to Americans aged six and older about how to improve health and reduce chronic 

disease

 risk through physical activity. Increased physical activity has been found in scientific studies to lower the risk of heart 

disease

, stroke, high blood pressure, 

Type 2 diabetes

, colon, breast, and lung cancer, falls and fractures, depression, and dying early. Increased physical activity not only reduces 

disease

 risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance. The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in elsewhere):US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Accessed October 8, 2011. http://www.health.gov/paguidelines/guidelines/chapter2.aspx.

• Even small amounts of activity are beneficial to your health.
• More substantial health benefits are obtained by doing at least two hours and thirty minutes per week of moderate-intensity, or one hour and fifteen minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof. Aerobic activity has better benefits if performed for at least ten minutes at a time, spread throughout the week.
• More extensive health benefits occur when moderate aerobic physical activity is increased to five hours per week of moderate-intensity, or to two hours and thirty minutes of vigorous-intensity aerobic physical activity, or a combination thereof. Additional health benefits are gained by going beyond these recommended amounts of physical activity.
• Muscle-strengthening activities at moderate or high intensity involving all major muscle groups two or more days per week provides additional health benefits to aerobic exercise.

The 2008 Physical Activity Guidelines broadly classify moderate physical activities as those when “you can talk while you do them, but can’t sing” and vigorous activities as those when “you can only say a few words without stopping to catch your breath.”US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Accessed October 8, 2011. http://www.health.gov/paguidelines/guidelines/chapter2.aspx.

Table 11.5.1$\mathrm{11.5.}1$: Moderate and Vigorous Physical Activities

Moderate Activities	Vigorous Activities
Ballroom/line dancing	Aerobic dance
Biking on level ground	Biking (more than 10 miles per hour)
Canoeing	Heavy gardening (digging, hoeing)
Gardening	Hiking uphill
Baseball, softball, volleyball	Fast dancing
Tennis (doubles)	Jumping rope
Walking briskly	Martial arts (karate)
Water aerobics	Race walking
Using hand cyclers	Jogging or running
	Sports with running (basketball, hockey, soccer)
	Swimming laps
	Tennis (singles)
	Ice hockey

Source: US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. http://www.health.gov/paguidelines/.

Interactive 11.5.1$\mathrm{11.5.}1$

To get started on ramping up your physical activity or following a new exercise program use the toolkit, “Be Active Your Way” available from HHS: www.health.gov/paguidelines/a...tiveguide.aspx.

Campaigns for a Healthy-Weight America

On a national level, strategies addressing overweight and 

obesity

 in the past have not been all that successful as 

obesity

 levels continue to climb. However, in the recent past (2007–2011) several newly created initiatives and organizations are actively reinforcing strategies aimed to meet the challenge of improving the health of all Americans.

In 2010 the national campaign to reduce 

obesity

 was reinforced when First Lady Michelle Obama launched the “Let’s Move” initiative, which has the goal of “solving the challenge of childhood 

obesity

 within a generation so that children born today will reach adulthood at a healthy weight.”The White House, Office of the First Lady. “First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise a Healthier Generation of Kids.” February 9, 2010. www.whitehouse.gov/the-press-...obama-launches -lets-move-americas-move-raise-a-healthier-genera. Another campaign, “Campaign to End 

Obesity

,” was recently established to try to enable more Americans to eat healthy and be active by bringing together leaders from academia and industry, as well as public-health policy-makers in order to create policies that will reverse the 

obesity

 trend and its associated diseases. It remains to be seen whether these new initiatives will finally help improve American health.

Video Link 11.5.1$\mathrm{11.5.}1$: View this brief video on the Campaign to End 

Obesity

.

The “Small-Change” Approach

Currently, most people are not 

obese

 in this country. The gradual rise in overweight is happening because, on average, people consume slightly more calories daily than they expend, resulting in a gradual weight gain of one to two pounds a year. In 2003 the idea was first published that promoting small 

lifestyle

 changes to reduce weight gain occurring over time in all age groups may better reduce 

obesity

 rates in the American population.Hill, J. O. “Can a Small-Changes Approach Help Address the 

Obesity

 Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.” Am J Clin Nutr 89, no. 2 (2009): 477–84. http://www.ajcn.org/content/89/2/477.long. Scientific studies have demonstrated that asking people to increase the number of steps they take each day while providing them with pedometers that count the steps they take each day successfully prevented weight gain. A “small-changes” study published in the October 2007 issue of Pediatrics evaluated whether families that made two small 

lifestyle

 changes, which were to walk an additional two thousand steps per day and to eliminate 100 kilocalories per day from their typical diet by replacing dietary sugar with a noncaloric sweetener, would prevent weight gain in overweight children.Rodearmel, S. J. et al. “Small Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.” Pediatrics 120, no. 4 (2007): e869–79. http://pediatrics.aappublications.or...20/4/e869.long. The results of this study were that a higher percentage of children who made the small changes maintained or reduced their BMI in comparison to children of families given a pedometer but not asked to also make physical activity or dietary changes.Rodearmel, S. J. et al. “Small Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.” Pediatrics 120, no. 4 (2007): e869–79. http://pediatrics.aappublications.or...20/4/e869.long. Several more studies funded by the National Institutes of Health and USDA are ongoing and are evaluating the effectiveness of the “small-changes” approach in reducing weight gain.

In 2009, a report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council proposed that the “small-changes” approach when supported at the community, industry, and governmental levels will be more effective than current strategies in gradually reducing the 

obesity

 rate in America.Hill, J. O. “Can a Small-Changes Approach Help Address the 

Obesity

 Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.” Am J Clin Nutr 89, no. 2 (2009): 477–84. http://www.ajcn.org/content/89/2/477.long. The HHS encouraged the approach and launched a “Small Step” website in 2008.

Key Takeaways

• Successful weight loss is defined as when individuals intentionally lose at least 10 percent of their body weight and keep it off for at least one year.
• Although there is a great 
  variety
   of approaches to achieve successful weight loss most report that it involves adhering to a low-
  calorie
  , low-fat diet and doing high levels of activity (about one hour of exercise per day).
• The 2010 Dietary Guidelines for Americans recommendations are based upon scientific evidence.
• The other part of the 
  energy balance
   equation is physical activity. The 2010 Dietary Guidelines were complemented by the 2008 Physical Activity Guidelines for Americans issued by the HHS in an effort to provide evidence-based guidelines for appropriate physical activity levels.
• On a national level, strategies addressing overweight and 
  obesity
   in the past have not been all that successful as 
  obesity
   levels continue to climb. However, in the recent past (2007–2011) several newly created initiatives and organizations are actively reinforcing strategies that aim to meet the challenge of improving the health of all Americans.

Discussion Starters

1. Discuss ways to address the childhood 
   obesity
    problem in your own community.
2. Calculate your EER by using the formula in this chapter and determine whether your average daily intake of calories falls below, meets, or exceeds your EER.

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