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DI E TARY G UID E L I N E S FO R AM E R IC AN S ,   2 0 0 5 13 c

Weight Management

OVERVIEW 

The prevalence of obesity in the  United States  has doubled in the past two decades. Nearly onethird of adults are obese, that is, they have a body mass index (BMI ) of 30 or greater. One of the fastest growing segments of the population is that with a BMI > 30 with

– accompanying comorbidities. Over the last two decades, the prevalence of overweight among children and adolescents has increased substantially; it is estimated that as many as 16 percent of children and adolescents are overweight, representing a doubling of the rate among children and tripling of the rate among adolescents. A high prevalence of overweight and obesity is of great public health concern because excess body fat leads to a higher risk for premature death, type 2 DI E TARY GUIDE L INE S FO R AM E R IC ANS ,   2 0 0 5

diabetes, hypertension, dyslipidemia, cardiovascular disease, stroke, gall bladder disease, respiratory dysfunction, gout, osteoarthritis, and certain kinds of cancers. 

Ideally, the goal for adults is to achieve and maintain a body weight that optimizes their health. However, for obese adults, even modest weight loss (e.g., 10 pounds) has health benefits, and the prevention of further weight gain is very important. For overweight children and adolescents, the goal is to slow the rate of weight gain while achieving normal growth and development. Maintaining a healthy weight throughout childhood may reduce the risk of becoming an overweight or obese adult. Eating fewer calories while increasing physical activity are the keys to controlling body weight. 

14

a These levels are based on Estimated Energy Requirements (EER) from the Institute of Medicine Dietary Reference Intakes macronutrients report, 2002, calculated by gender, age, and activity level for referencesized individuals. “Reference size,” as determined by IOM, is based on median height and weight for ages up to age 18 years of age and median height and weight for that height to give a BMI of 21.5 for adult females and 22.5 for adult males. 

b Sedentary means a lifestyle that includes only the light physical activity associated with typical daytoday life. 

c Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to miles per hour, in addition to the light physical activity associated with typical daytoday life

d Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per ho, in addition to the light physical activity associated with typical daytoday life.

e The calorie ranges shown are to accommodate needs of different ages within the group. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages.

accompanied by increased physical activity. For example, for most adults a reduction of 50 to 100 calories per day may prevent gradual weight gain, whereas a reduction of 500 calories or more per day is a common initial goal in weightloss programs. Similarly, up to 60 minutes of moderateto vigorousintensity physical activity per day may be needed to prevent weight gain, but as much as 60 to 90 minutes of moderateintensity physical activity per day is recommended to sustain weight loss for previously overweight people. It is advisable for men over age 40, women over age 50, and those with a history of chronic diseases such as heart disease or diabetes to consult with a healthcare provider before starting a vigorous exercise program. However, many people can safely increase their physical activity without consulting a healthcare provider. 7

KEY RECOMMENDATIONS  • To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. • To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. Key Recommendations for Specific Population Groups • Those who need to lose weight. Aim for a slow, steady weight loss by decreasing calorie intake while maintaining an adequate nutrient intake and increasing physical activity. • Overweight children. Reduce the rate of body weight gain while allowing growth and development. Consult a healthcare provider before placing a child on a weightreduction diet. • Pregnant women. Ensure appropriate weight gain as specified by a healthcare provider. • Breastfeeding women. Moderate weight reduction is safe and does not compromise weight gain of the nursing infant. • Overweight adults and overweight children with chronic diseases and/or on medication . Consult a healthcare provider about weight loss strategies prior to starting a weightreduction program to ensure appropriate management of other health conditions. 

Monitoring body fat regularly can be a useful strategy for assessing the need to adjust caloric intake and energy expenditure. Two surrogate measures used to approximate body fat are BMI (adults and children) and waist circumference (adults). 8  BMI is defined as weight in kilograms divided by height, in meters, squared. For adults, weight status is based on the absolute BMI level (fig. 2). For children and adolescents, weight status is determined by the comparison of the individual’s BMI with ageand genderspecific percentile values (see fig. 3 for a sample boys’ growth curve). Additional growth curves can be

7 For more information on recommendations to consult a healthcare provider, see Physical Activity and Public Health—A Recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine,  JAMA 273:402407, 1995. http://wonder.cdc.gov/wonder/prevguid/p0000391/P0000391.asp.

8 NIH Publication Number 004084, The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults,  U.S.  Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, October 2000. http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf

DI E TARY G UID E L I N E S FO R AM E R IC AN S ,   2 0 0 5 15

found at http://www.cdc.gov/growthcharts. BMI is more accurate at approximating body fat than is measuring body weight alone. However, BMI has some limitations. BMI overestimates body fat in people who are very muscular and underestimates body fat in people who have lost muscle mass. The relationship between BMI and body fat varies somewhat with age, gender, and ethnicity. In addition, for adults, BMI is a better predictor of a population’s disease risk than an individual’s risk of chronic disease. 8 For children gaining excess weight, small decreases in energy intake reduce the rate at which they gain weight (body fat), thus improving their BMI percentile over time. As another surrogate measure, waist circumference can approximate abdominal fat but should be measured very carefully. Fat located in the abdominal region is associated with a greater health risk than peripheral fat. 8

Some proposed calorielowering strategies include eating foods that are low in calories for a given measure of food (e.g., many kinds of vegetables and fruits and some soups). However, when making changes to improve nutrient intake, one needs to make substitutions to avoid excessive calorie intake. The healthiest way to reduce calorie intake is to reduce one’s intake of added sugars, fats, and alcohol, which all provide calories but few or no essential nutrients (for more information, see chs. 6, 7, and 9).

Special attention should be given to portion sizes, which have increased significantly over the past two decades (http://hin.nhlbi.nih.gov/portion/index.htm). Though there are no empirical studies to show a causal relationship between increased portion sizes and obesity, there are studies showing that controlling portion sizes helps limit calorie intake, particularly when eating caloriedense foods (foods that are high in calories for a given measure of food). Therefore, it is essential that the public understand how portion sizes compare to a recommended amount of food (i.e., serving) from each food group at a specific caloric level. The understanding of serving size and portion size is important in following either the DASH Eating Plan or the USDA Food Guide (see app. A). When using packaged foods with nutrient labels, people should pay attention