Q-8) Patient reports an avoidance of carbohydrate in her diet as a means of realizing weight loss. She has achieved only nominal weight loss during the prior 6 months; however, she has noted a continuous decline in her energy and performance, as well as missed and irregular menstruations for 4 months. Diagnose and suggest ways to deal with the problem.
Answers
The most important component of an effective weight-management program must be the prevention of unwanted weight gain from excess body fat. The military is in a unique position to address prevention from the first day of an individual's military career. Because the military population is selected from a pool of individuals who meet specific criteria for body mass index (BMI) and percent body fat, the primary goal should be to foster an environment that promotes maintenance of a healthy body weight and body composition throughout an individual's military career. There is significant evidence that losing excess body fat is difficult for most individuals and the risk of regaining lost weight is high. From the first day of initial entry training, an understanding of the fundamental causes of excess weight gain must be communicated to each individual, along with a strategy for maintaining a healthy body weight as a way of life.
INTRODUCTION
The principle of weight gain is simple: energy intake exceeds energy expenditure. However, as discussed in Chapter 3, overweight and obesity are clearly the result 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 public, the multi-factorial etiology of overweight challenges practitioners, researchers, and the overweight themselves to identify permanent, effective strategies for weight loss and maintenance. The percentage of individuals who lose weight and successfully maintain the loss has been estimated to be as small as 1 to 3 percent (Andersen et al., 1988; Wadden et al., 1989).
Evidence shows that genetics plays a role in the etiology of overweight and obesity. However, genetics cannot account for the increase in overweight observed in the U.S. population over the past two decades. Rather, the behavioral 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. This chapter reviews 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, the elements of successful weight maintenance also will be reviewed since the difficulty in maintaining weight loss may contribute to the overweight problem. A brief discussion of public policy measures that may help prevent overweight and assist those who are trying to lose weight or maintain weight loss is also included.