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A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. Our Medical Director, Dr. The authors stated that, although the benefit-risk profiles of sibutramine and orlistat appear positive, sibutramine continues to be monitored because of long-term safety concerns. The following indicates maximum ideal weight in shoes with one-inch heels based on body frame and height:. Call or book an appointment online today for your FREE consultation and see how you can lose weight fast and save more money!

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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. Mean differences were pooled and analyzed using inverse variance models with fixed effects. Heterogeneity between studies was calculated using I 2 statistic. No differences were seen in blood lipid levels. Many trials lacked sufficient information for a complete quality assessment, and commercial bias was detected. Although heterogeneity was absent, study designs varied with regard to duration, dose, and control of energy intake.

The authors concluded that replacement of LCTs with MCTs in the diet could potentially induce modest reductions in body weight and composition without adversely affecting lipid profiles. However, they stated that further research is needed by independent research groups using large, well-designed studies to confirm the effectiveness of MCT and to determine the dosage needed for the management of a healthy body weight and composition.

They performed a search of English-language articles in the PubMed and Embase databases through April 30, Differences in weight loss between FTO genotypes across studies were pooled with the use of fixed-effect models. A meta-analysis of 10 studies comprising 6, participants that reported the results of additive genetic models showed that individuals with the FTO TA genotype and AA genotype those with the obesity-predisposing A allele had 0. A meta-analysis of 14 studies comprising 7, participants that reported the results of dominant genetic models indicated a 0.

In addition, differences in weight loss between the AA genotype and TT genotype were significant in studies with a diet intervention only, adjustment for baseline BMI or body weight, and several other subgroups.

However, the relatively small number of studies limited these stratified analyses, and there was no statistically significant difference between subgroups. Hypoxic conditioning has been previously used by healthy and athletic populations to enhance their physical capacity and improve performance in the lead up to competition. Recently, HC has also been applied acutely single exposure and chronically repeated exposure over several weeks to over-weight and obese populations with the intention of managing and potentially increasing cardio-metabolic health and weight loss.

At present, it is unclear what the cardio-metabolic health and weight loss responses of obese populations are in response to passive and active HC. Exploration of potential benefits of exposure to both passive and active HC may provide pivotal findings for improving health and well-being in these individuals. These researchers carried out a systematic literature search for articles published between and Studies investigating the effects of normobaric HC as a novel therapeutic approach to elicit improvements in the cardio-metabolic health and weight loss of obese populations were included.

Inconclusive findings, however, exist in determining the impact of acute and chronic HC on markers such as triglycerides, cholesterol levels, and fitness capacity. The authors concluded that normobaric HC demonstrated observable positive findings in relation to insulin and energy expenditure passive , and body weight and BP active , which may improve the cardio-metabolic health and body weight management of obese populations.

However, they stated that further evidence on responses of circulating biomarkers to both passive and active HC in humans is needed.

The following indicates maximum ideal weight in shoes with one-inch heels based on body frame and height:. Clinical Policy Bulletin Notes. Links to various non-Aetna sites are provided for your convenience only. Weight Reduction Medications and Programs. Aetna considers the following medically necessary treatment of obesity when criteria are met: Weight reduction medications, and. Dexamethasone suppression test and hour urinary free cortisol measures if symptoms suggest Cushing's syndrome.

Rice diet or other special diet supplements e. American Obesity Association, C. Guidance for treatment of adult obesity. Accessed March 16, Long-term pharmacotherapy in the management of obesity. Gain and loss in weight. Department of Agriculture and U. Department of Health and Human Services. Nutrition and your health: Dietary guidelines for Americans. Eastern Orthodox Christians fast during specified fasting seasons of the year, which include not only the better-known Great Lent , but also fasts on every Wednesday and Friday except on special holidays , together with extended fasting periods before Christmas the Nativity Fast , after Easter the Apostles Fast and in early August the Dormition Fast.

Like Muslims, they refrain from all drinking and eating unless they are children or are physically unable to fast. Fasting is also a feature of ascetic traditions in religions such as Hinduism and Buddhism.

Mahayana traditions that follow the Brahma's Net Sutra may recommend that the laity fast "during the six days of fasting each month and the three months of fasting each year" [Brahma's Net Sutra, minor precept 30]. Weight loss diets that manipulate the proportion of macronutrients low-fat, low-carbohydrate, etc. Nutritionists also agree on the importance of avoiding fats, especially saturated fats, to reduce weight and to be healthier.

They also agree on the importance of reducing salt intake because foods including snacks , biscuits , and bread already contain ocean-salt, contributing to an excess of salt daily intake. The Dietary Guidelines for Americans is a set of recommendations about a healthy diet written for policy makers, nutrition scientists, and dieticians and other clinicians, produced by the US Department of Agriculture , in concert with the US Department of Health and Human Services and quintannually-revised.

The current guidelines are written for the period - and were used to produce the MyPlate recommendations on a healthy diet for the general public. One of the most important things to take into consideration when either trying to lose or put on weight is output versus input. It is important to know the amount of energy your body is using every day, so that your intake fits the needs of one's personal weight goal.

Someone wanting to lose weight would want a smaller energy intake than what they put out. There is increasing research-based evidence that low-fat vegetarian diets consistently lead to healthy weight loss and management, a decrease in diabetic symptoms [23] as well as improved cardiac health.

When the body is expending more energy than it is consuming e. The first source to which the body turns is glycogen by glycogenolysis. It is created from the excess of ingested macronutrients , mainly carbohydrates. When glycogen is nearly depleted, the body begins lipolysis , the mobilization and catabolism of fat stores for energy.

In this process, fats, obtained from adipose tissue, or fat cells , are broken down into glycerol and fatty acids , which can be used to generate energy. Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peertrainer. The latter include Overeaters Anonymous and groups run by local organizations. These organizations' customs and practices differ widely.

Some groups are modelled on twelve-step programs , while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.

A study published in the American Journal of Preventive Medicine showed that dieters who kept a daily food diary or diet journal , lost twice as much weight as those who did not keep a food log, suggesting that if you record your eating, you would be more aware of what you eat and, therefore you wouldn't eat as many calories. A review found that existing limited evidence suggested that encouraging water consumption and substituting energy-free beverages for energy-containing beverages i.

References given in main article. Fasting is when there is a long time interval between the meals. In dieting, fasting is not recommended, instead, having small portions of food after small intervals is encouraged. Lengthy fasting can also be dangerous due to the risk of malnutrition and should be carried out only under medical supervision.

During prolonged fasting or very low calorie diets the reduction of blood glucose, the preferred energy source of the brain , causes the body to deplete its glycogen stores. Once glycogen is depleted the body begins to fuel the brain using ketones, while also metabolizing body protein including but not limited to skeletal muscle to be used to synthesize sugars for use as energy by the rest of the body. Most experts believe that a prolonged fast can lead to muscle wasting, although some dispute this.

The use of short-term fasting, or various forms of intermittent fasting have been used as a form of dieting to circumvent this issue. While there are studies that show the health and medical benefits of weight loss, a study in of around Finns over an year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best. Many studies have focused on diets that reduce calories via a low-carbohydrate Atkins diet , Scarsdale diet , Zone diet diet versus a low-fat diet LEARN diet, Ornish diet.

The Nurses' Health Study , an observational cohort study , found that low carbohydrate diets based on vegetable sources of fat and protein are associated with less coronary heart disease. A long term study that monitored 43, Swedish women however suggests that a low carbohydrate-high protein diet, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, is associated with increased risk of cardiovascular disease.

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration in concluded [31] that fat-restricted diets are no better than calorie-restricted diets in achieving long term weight loss in overweight or obese people.

A more recent meta-analysis that included randomized controlled trials published after the Cochrane review [32] [33] [34] found that low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year.

These results can be understood because weight loss is mainly governed by daily caloric deficit and not by the particular foods eaten. Additional randomized controlled trials found that:. The American Diabetes Association recommended a low carbohydrate diet to reduce weight for those with or at risk of Type 2 diabetes in its January Clinical Practice Recommendations.

The diet based around this research is called the Low GI diet. Low glycemic index foods, such as lentils, provide a slower, more consistent source of glucose to the bloodstream, thereby stimulating less insulin release than high glycemic index foods, such as white bread.

The glycemic load is "the mathematical product of the glycemic index and the carbohydrate amount". In a randomized controlled trial that compared four diets that varied in carbohydrate amount and glycemic index found complicated results: Diets 2 and 3 lost the most weight and fat mass; however, low density lipoprotein fell in Diet 2 and rose in Diet 3.

Thus the authors concluded that the high-carbohydrate, low-glycemic index diet was the most favorable. A meta-analysis by the Cochrane Collaboration concluded that low glycemic index or low glycemic load diets led to more weight loss and better lipid profiles. However , the Cochrane Collaboration grouped low glycemic index and low glycemic load diets together and did not try to separate the effects of the load versus the index. From Wikipedia, the free encyclopedia.

Very low calorie diet. Weight loss effects of water. Medical research related to low-carbohydrate diets. Retrieved 29 November The American Journal of Clinical Nutrition. Retrieved 22 December Obesity Biographies of Disease. Retrieved 17 December Retrieved 20 June Chalem 5 September Retrieved 26 December The Father of the Low-Carbohydrate Diet". Retrieved 28 December