Steps toward behavioural weight loss and maintenance: a daily practice

INTRODUCTION

Definition and prevalence

WHO defines obesity as an excessive accumulation of body fat that may affect people’s health. This description is based on the BMI.¹ Similarly, according to WHO, BMI is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m²) as overweight BMI ≥25 and obesity BMI ≥30.²

Globally, obesity is considered the most common metabolic ailment with high prevalence. According to WHO, more than one billion people are considered overweight among them more than 30% are obese. This figure gives alarms to governments and health intuitions because of its continuous increase.³ However, the prevalence varies among countries, for instance, 19%, 16%, 5.9%, 0.6% prevalences have been found in the USA, Saudi Arabia, Singapore and Tanzania respectively in years between 1998-2000. This picture may relate the economic status with obesity, the richer the country the higher the prevalence of obesity. However, it seems that food habits may play a role in obesity.⁴

Determinants of the obesity

There are several reasons and factors implicated in obesity as a major health problem worldwide. According to a recent study by Phelan and colleagues, the causes of obesity can be broadly divided into two possible reasons and their contributing factors, which are listed in Table 1.⁵

The investigators concluded that overeating and lack of exercise were the most contributing factors of obesity among behavioral causes whereas genetic and psychological factors were among non-behavioral factors were showed the highest probabilities of obesity.

Risk and health consequences of obesity

The importance of obesity emerges from its effects on almost all organs and tissues including the brain. Table 2 summarizes the major health problems consequent obesity.³

From the above-mentioned report, obesity can lead to life-threatening diseases such as cancer and CVD. In addition, all other complications may affect the quality of human life. Therefore, this mini-review focused on the possible ways for reducing and maintaining body weight.

DISCUSSION

Steps toward bodyweight reduction

A 24-hour life cycle of a human can be considered as a model to show step-by-step what should be done to achieve proper body weight and maintain it. One-day model practice illustration (Figure 1).

Sleep-wake up and a few minutes later

Several studies were reviewed. The following points and advice were recommended.

The irregular sleep-wake system had been linked to disorganized eating patterns and hence body weight increased. Therefore, in time sleep and wake to contribute to weight loss. Quality of sleep and early waking up was shown to have an impact on body weight. A recent study highlighted that people sleeping 7-8 hours did not complain of any metabolic disturbances related to obesity. Sleeping at least 7 hours regularly played an important role in weight loss.^6,7 Short sleep hours have been linked to obesity due to elevated cortisol and low glucose tolerance, which, in turn, leads to fat accumulation.⁸

The breakfast

Some investigators highlighted the importance of breakfast for bodyweight loss seekers and what kind of food to eat.⁹

Skipping breakfast, per contra, has a negative impact on body weight. Accordingly, regular breakfast intake had a positive effect on reducing body weight and even keeping it maintained for the long term. A study about the effect of breakfast on body weight indicated that a great reduction in BMI by 61% accompanied by a reduction in body fat and waist circumference.¹⁰ An important observation positively related satiety to protein-rich food intake, fiber and water content.¹¹ Therefore, options for ideal breakfast can include some but not all coffee, egg, cereal rich in fiber, milk, soup and rice.¹²

The lunch

Timing of meals effectively induced weight loss, late lunch eaters suffered to lose weight.¹³ Therefore, the time one ate his lunch should keep it in mind to prevent weight gain. Fruits, vegetables and whole grains were found to be important sources of nutrients to maintain body weight and prevent weight gain. In addition, according to WHO recommendation protein, such as meat, fish and dairy products should account for 10-15% of energy intake.¹⁴ A lunch containing fruitage, considerable servings of miscellaneous vegetables and whole grains and meat or fish as a source of protein (10%) was recommended.

Snacks

Body weight gain had been associated with a lack of snacking between meals and skipping breakfast.⁶ In contrast, other studies showed that snacks were associated with weight gain.¹⁵ Nevertheless, low-calorie protein-contained snacks were recommended such as dairy products.¹⁶ However, salty and high-fat snacks should be avoided.¹⁷

The dinner

Leptin, a hormone that regulated satiety and hunger in humans by providing information to the brain when the stomach was empty was found to be at a high level when individuals were sleeping.¹⁸ Consequently, eating dinner helps to keep leptin levels in check. High-calorie breakfast compared to dinner was positively linked to weight management.¹⁹ Hence, it is advisable to eat a low-carbohydrate dinner early in the evening.

Water intake

Daily water intake was varied depending on temperature and climate. However, WHO recommended a 2.5 liter/day minimum for 70 kg humans.²⁰ A recent report linked increased water drinking and weight loss, which was thought to be due to the upregulation of atrial natriuretic peptide (ANP). ANP was responsible for activating proteins that boost fat catabolism.²¹

Exercise practice

As mentioned above, diet monitoring was a good practice to lose weight. However, increasing energy expenditure by exercise reduced body fat and promoted body composition, which was an advantage over diet restriction exclusively.²² Regular exercise was associated with weight loss despite the time of exercise.²³ Exercise accompanied with diet control enhanced muscle mass preservation.²⁴ Reducing the body fat will rationally increase the mass of the muscles proportionally or quantitatively.⁶ Therefore, to promote body shape, exercise should be performed regularly. Exercise training categorized into two main types: aerobic (walking, jogging or cycling) and resistance exercise such as weightlifting.²⁵ Cycling for 30-45 min three times a week significantly improved cardiorespiratory fitness and reduced body fat percentage.²⁴ Therefore, 30-45 min aerobic exercise thrice a week was recommended.

In addition to the effects of aerobic and resistance exercise alone or combined on body weight reduction, glycemic control of type 2 diabetes, enhanced physical fitness, improved mood. According to published data, resistance repetitions (rep) can increase gradually from 9 to 35 rep for a specific training, e.g., leg press, bench press, arm curl and squat on medium percentage.^25,26 Therefore, to maximize weight loss, an individual started with resistance training and then went to aerobic training. To prevent visceral fat accumulation following weight loss, exercise training was recommended.²⁷

Sleeping time

Circadian rhythm was represented by the sleep/wake cycle which was evident of internal timing system related to hormonal, biochemical and genetic factors. The main clock located in the hypothalamus of the brain was considered a master clock. This master clock was regulated by circadian oscillations in a single neuron. Environmental stimuli such as light can reset the circadian clock. Hormonal stimuli, such as cortisol can do the same.²⁸ This clock affected the metabolism of the liver by regulating the rhythm of enzyme transcription.²⁹ Therefore, sleeping at the right time for a reasonable duration effectively improved food metabolism.

Metabolism and endocrine disturbances, such as, reduced glucose and insulin metabolism, elevated cortisol level, increased ghrelin and decreased leptin have been linked to sleep restriction which increased hunger and appetite leading to obesity. Early sleep and early wake habit were scientifically proved to have effects on memory, academic performance.³⁰ In addition, short-period sleep had been linked to weight gain. Melatonin, a hormone that regulated sleep and wakefulness its secretion started at 9:00 PM and stopped at 7:30 AM. So, for these benefits early go to bed and early rise is golden advice. A mouse experiment revealed that nocturnal feeding resulted in weight gain, disturbed the metabolic regulatory system and changed in genes involved in metabolism.³¹ Hence, early sleep prevented obesity and regulateed food metabolism.

Other valuable tips

Accepting one’s body weight and confessing the problem, contributed to a positive outcome.³² To achieve effective weight loss, enroll in moderate to high intensity rather than low-intensity exercise.³³

Smartphone applications to monitor physical activity and calories intake such as, my fitness pal was found to help in weight loss and maintenance thereafter.³⁴ Pedometer’s bracelets were also linked to encouraging people to exercise and increasing their self-confidence.³⁵

The frequency and timing of meals were associated with weight control because regular meal intake prevented metabolic disturbance and its attributes such as obesity and diabetes.³⁶ However, every now and then attributes, such as intermittent fasting for about 16 hour improved metabolic indicators.³⁷

Therefore, regular meal intake with days of restrictions was recommended.

CONCLUSION

This mini-review focuses on providing ideal daily practice and behaviors through which people can lose weight and maintain it thereafter rather than the mechanism by which weight loss or gain occurred. Early go to bed and early rise, breakfast rich in protein and low in fibers, lunch full of protein, vegetables and whole-grain, low-calorie dairy products-based snacks, early light dinner, 30-45 min exercise are recommended to achieve weight loss and maintain it. In addition, continuous hydration by drinking water of at least 2.5 liters is distributed throughout the day.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. Fan H, Zhang X. Recent trends in overweight and obesity in adolescents aged 12 to 15 years across 21 countries. Pediatric Obesity. 2022;17(1).
2. 2. Wang SS, Brownell KD, Wadden TA. The influence of the stigma of obesity on overweight individuals. Int J Obesit. 2004;28(10):1333.
3. 3. Antonopoulos AS, Oikonomou EK, Antoniades C, Tousoulis D. From the BMI paradox to the obesity paradox: the obesity-mortality association in coronary heart disease. Obes Rev. 2016;17(10):989-1000.
4. 4. Formiguera X, Cantón A. Obesity: epidemiology and clinical aspects. Best Pract Res Clin Gastroenterol. 2004;18(6):1125-46.
5. 5. Caterson ID, Gill TP. Obesity: epidemiology and possible prevention. Best Pract Res Clin Endocrinol Metabol. 2002;16(4):595-610.
6. 6. Phelan SM, Burgess DJ, Burke SE, Przedworski JM, Dovidio JF, Hardeman R, et al. Beliefs about the causes of obesity in a national sample of 4소-year medical students. Patient Edu Counsel. 2015;98(11):1446-9.
7. 7. Kanagasabai T, Dhanoa R, Kuk JL, Ardern CI. Association between sleep habits and metabolically healthy obesity in adults: a cross-sectional study. J Obesity. 2017;2017:5272984.
8. 8. Sierra-Johnson J, Unden AL, Linestrand M, Rosell M, Sjogren P, Kolak M, et al. Eating meals irregularly: a novel environmental risk factor for the metabolic syndrome. Obesity (Silver Spring, Md). 2008;16(6):1302-7.
9. 9. Sekine M, Yamagami T, Handa K, Saito T, Nanri S, Kawaminami K, et al. A dose–response relationship between short sleeping hours and childhood obesity: results of the Toyama Birth COHORT Study. Child Care Health Develop. 2002;28(2):163-70.
10. 10. Timlin MT, Pereira MA, Story M, Neumark-Sztainer D. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (eating among teens). Pediatrics. 2008;121(3):638-45.
11. 11. Wyatt HR, Grunwald GK, Mosca CL, Klem ML, Wing RR, Hill JO. Long‐term weight loss and breakfast in subjects in the National weight control registry. Obesity. 2002;10(2):78-82.
12. 12. Wal JSV, Gupta A, Khosla P, Dhurandhar NV. Egg breakfast enhances weight loss. Int J Obesity. 2008;32:1545.
13. 13. Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutrit. 1995;49(9):675-90.
14. 14. Hwang H, Lee J. A study of teachers' breakfast and ideal breakfast types. Korean J Commun Nutrit. 1999;4(4):575-86.
15. 15. Berg MC, Jonsson I, Conner MT, Lissner L. Relation between breakfast food choices and knowledge of dietary fat and fiber among Swedish schoolchildren. J Adolesc Health. 2002;31(2):199-207.
16. 16. Garaulet M, Gómez-Abellán P, Alburquerque-Béjar JJ, Lee YC, Ordovás JM, Scheer FA. Timing of food intake predicts weight loss effectiveness. Int J Obesity. 2013;37(4):604.
17. 17. Sweitzer SJ, Briley ME, Roberts-Gray C, Hoelscher DM, Harrist RB, Staskel DM, et al. Lunch is in the bag: increasing fruits, vegetables and whole grains in sack lunches of preschool-age children. J Am Dietet Assoc. 2010;110(7):1058-64.
18. 18. Piernas C, Popkin BM. Snacking increased among U.S. adults between 1977 and 2006. J Nutrit. 2010;140(2):325-32.
19. 19. Bo S, DeCarli L, Venco E, Fanzola I, Maiandi M, DeMichieli F, et al. Impact of snacking pattern on overweight and obesity risk in a COHORT of 11- to 13-year-old adolescents. J Pediatr Gastroenterol Nutrit. 2014;59(4):465-71.
20. 20. Njike VY, Smith TM, Shuval O, Shuval K, Edshteyn I, Kalantari V, et al. Snack food, satiety, and weight. Adv Nutrit. 2016;7(5):866-78.
21. 21. Sofer S, Eliraz A, Kaplan S, Voet H, Fink G, Kima T, et al. Greater weight loss and hormonal changes after 6 months diet with carbohydrates eaten mostly at dinner. Obesity. 2011;19(10):2006-14.
22. 22. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity. 2013;21(12):2504-12.
23. 23. Gleick PH. Basic water requirements for human activities: Meeting basic needs. Water Int. 1996;21(2):83-92.
24. 24. Thornton SN. Increased hydration can be associated with weight loss. Front Nutr. 2016;3:18.
25. 25. Stiegler P, Cunliffe A. The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med. 2006;36(3):239-62.
26. 26. Willis EA, Creasy SA, Honas JJ, Melanson EL, Donnelly JE. The effects of exercise session timing on weight loss and components of energy balance: midwest exercise trial 2. Int J Obesity. 2020;44(1):114-24.
27. 27. Ballor DL, Poehlman ET. Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding. Int J Obes Relat Metab Disord. 1994;18(1):35-40.
28. 28. Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud'homme D, Fortier M, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147(6):357-69.
29. 29. Fleck SJ, Kraemer W. Designing resistance training programs, 4E: Human Kinetics; 2014.
30. 30. Hunter GR, Brock DW, Byrne NM, Chandler‐Laney PC, Corral P, Gower BA. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity. 2010;18(4):690-5.
31. 31. Reppert SM, Weaver DR. Coordination of circadian timing in mammals. Nature. 2002;418(6901):935-41.
32. 32. Lavery DJ, Lopez-Molina L, Margueron R, Fleury-Olela F, Conquet F, Schibler U, et al. Circadian expression of the steroid 15 α-hydroxylase (Cyp2a4) and coumarin 7-hydroxylase (Cyp2a5) genes in mouse liver is regulated by the PAR leucine zipper transcription factor DBP. Molecul Cell Biol. 1999;19(10):6488-99.
33. 33. Plihal W, Born J. Effects of early and late nocturnal sleep on priming and spatial memory. Psychophysiology. 1999;36(5):571-82.
34. 34. Eliasson AH, Lettieri CJ, Eliasson AH. Early to bed, early to rise! Sleep habits and academic performance in college students. Sleep Breathing. 2010;14(1):71-5.
35. 35. Ellacott KLJ, Morton GJ, Woods SC, Tso P, Schwartz MW. Assessment of feeding behavior in laboratory mice. Cell Metab. 2010;12(1):10-7.
36. 36. Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, et al. OASIS: the obesity awareness and insight scale. Obesity Med. 2018;9:38-44.
37. 37. Swain DP, Franklin BA. Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol. 2006;97(1):141-7.
38. 38. Turner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Informat Assoc. 2013;20(3):513-8.
39. 39. Findley K. Perceived effectiveness of fitness trackers among adults. Curr Issue Health. 2015.
40. 40. Jiang P, Turek FW. Timing of meals: when is as critical as what and how much. Am J Physiol Endocrinol Metabol. 2017;312(5):369-80.
41. 41. Coulthard JD, Pot GK. The timing of the evening meal: how is this associated with weight status in UK children? Br J Nutrit. 2016;115(9):1616-22.
42. 42. Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ, et al. Meal frequency and timing in health and disease. Proceed Natnl Acad Sci United States Am. 2014;111(47):16647-53.