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May 30

Modifying exercise programs Fitness professionals …

As you know, one size doesn't fit all when it comes to exercise, so if you have a client with, or at risk of, pelvic floor problems, it's important to tailor their exercise program to suit their needs.

As a fitness professionalyour challenge will be to consider:

Modifying an exercise program for a high risk clientwill ensuretheirpelvic floor is protected fromfurther damage.This is no different to an injury to any other one of their muscle groups.

For example,if your client has an injuredankle,it is essential to give that ankle time to heal,before returning to exercise or sport.This would be done by modifying theirexercise programtorebuildthe strength, flexibility and stability of theirankle, until the healing process is complete.

The same is the case for the pelvic floor, whichshould be protected from further damage, whilst allowing the client a suitable timeframe to get back in control.

TheContinence Foundation has developed a simple screening tool to help you identify clientswith, or at risk of, pelvic floor problems.

These can be used at your initialconsultation, to helpidentify what kind of exercise program would suit their pelvic floor fitness needs.

Exercises that increase intra-abdominal pressure have the potential to place more stress on the pelvic floor, and should be avoided or modified for clients with, or at risk of, pelvic floor problems.

Examples of these exercises include:

abdominal exercises (e.g. sit ups, curl ups, crunches, double leg lifts, exercises on machines)

Exercises that place downward force or pressure on the pelvic floor can also stress the pelvic floor. Examples of these exercises include:

running

As a general rule:

You may also want to see:

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May 27

The best way to lose weight boils down to these three things

March 5, 2018, 6:10 PM UTC/ UpdatedMarch 9, 2018, 9:19 PM UTC

By Samantha Cassetty, RD

Call it what you will: An eating plan, a lifestyle, a diet, a philosophy, but few things garner such heated debate as how to lose weight. The truth is, whether youre on a low-carb keto program, devoted to the Paleo lifestyle, all in to the Whole 30 or remain committed to low-fat eating, these plans have more in common than you think. Whats more, follow any one of them religiously, and youll likely notice results.

In a new study, Stanford University researchers put more than 600 overweight adults on either a healthy low-fat or low-carb diet. It turns out, participants had similar levels of weight loss success on each plan. Researchers looked for clues (such as insulin levels and gene patterns) to see if there are any factors that might make someone more successful on either diet, but after combing through the data, they were not able to make any connections. Since it may take years before scientists discover individual traits that could lead to more success on one plan compared to another, for now, we can learn a lot and lose a lot! by recognizing the dieting advice that all experts agree on.

Here are three commandments that cross over all types of weight-loss approaches.

Considering that only 1 in 10 Americans meet their produce requirements, its pretty safe to say you need to eat more veggies. And no matter what food philosophy you subscribe to, veggies are a big part of the program. Vegetables have a lot going for them: They fill you up for very few calories, and they flood your body with the nutrients it needs to fight diseases, like heart disease, type 2 diabetes, and some cancers.

If you follow food trends, you might think you have to fall in love with cauliflower and kale to reap all the rewards that veggies offer, but that isnt the case. Be it broccoli, sweet potatoes, carrots, red peppers, cabbage, spinach, or any other vegetable, the idea is to eat a variety of them and find plenty of ways to enjoy their goodness. So if you just cant stomach steamed Brussels sprouts, try them roasted, or give sauted Brussels sprouts a try. If raw zucchini isnt your thing, see if you like it spiralized into noodles or grilled on a grill pan.

Considering that only 1 in 10 Americans meet their produce requirements, its pretty safe to say you need to eat more veggies.

Using a layered approach is another great way to build a good veggie habit. For example, start with a food you already enjoy say, pasta and layer some veggies into your bowl. This can help you explore a new food with one you already love eating, and from there, you can try new ways to savor it. Take spinach, for instance. After trying it with pasta, you may want fold it into an omelet or another favorite food, or explore it on its own with different cooking techniques (sauted or steamed) or different flavor additions (garlic or golden raisins). The possibilities are limitless!

You can blame biology for your sweet tooth. Were hardwired to have a preference for sweets, and this drive is universal and begins early on, according to research on the subject. Sugar makes food taste good, so food companies add it to everything from breads to soups to salad dressings to cereals, yogurts and more. This adds up to way too much sugar!

On average, Americans consume more than 19 teaspoons of sugar per dayfar in excess of the American Heart Associations 6 teaspoon limit for women and 9 teaspoon limit for men. This is not doing your waistline any favors, which is why every weight loss plan advocates eating less sugar.

There has been some confusion that a low-fat diet means you can feast on low-fat cookies and other treats, but this, again, is the food manufacturers influence. The true intent of low-fat dining is to eat more healthful foods that are naturally low in fat: fruits, vegetables, beans, lean proteins and whole grains.

There is plenty of research to support a low-fat lifestyle, just as there is strong evidence that you can lose weight by cutting carbs. Different approaches work for different people, but if you want to slim down, cutting back on added sugars is consistent advice across all programs.

One more note on added sugars: Whether you call it agave, cane juice, maple syrup, brown rice syrup, fruit juice concentrate, date sugar or any of the 61 names for added sugar, they all spell trouble for your health and your waistline.

Im in favor of any program that promotes whole foods over hyper-processed fare, and this is one thing the popular diet plans can agree on. Overly processed foods have been linked to weight gain, perhaps because many unhealthy packaged foods (think: potato chips, ice cream, frozen pizza, cookies and the like) lack the fiber found in many whole foods, including vegetables. Fiber helps fill us up, and research suggests that by simply adding more fiber to your menu, you can lose weight nearly as well as a more complicated approach. Consistently choosing whole foods is one way to do this.

Whole foods include fruits, vegetables, beans, nuts, seeds, whole grains, eggs, seafood, chicken and so on. Food philosophies may differ around which of these foods to emphasize, but thats okay, since the evidence shows that there isnt a single best way to lose weight. The goal is to select an approach that feels sustainable to you. If you can easily live without pasta, perhaps a low-carb method centered around veggies and quality proteins, like seafood, chicken, and lean beef would be a good fit. Vegans and vegetarians can lose weight by choosing fruits, vegetables, whole grains and plant proteins. Nut lovers may do well shedding pounds with a Mediterranean-style menu. Whatever diet appeals to your appetite and way of life, focusing on whole foods is something that all plans promote.

Samantha Cassetty is a registered dietitian in New York City. For more great tips that make it easier to eat well and live better, follow her on Instagram, Facebook and Twitter.

Want more tips like these? NBC News BETTER is obsessed with finding easier, healthier and smarter ways to live. Sign up for our newsletter and follow us on Facebook, Twitter and Instagram.

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May 23

HCG Printable Food List | Hcg Diet

HCG Printable Food List

HCG diet may be the combination Really Low Calorie Diet (500 cals) and HCG Drops. The dietary plan program prohibits drinking and smoking over the weight loss regime. To be able to achieve the best results through the dietary plan program, dieters should follow HCG diet chart for monitoring, recording his/her everyday weight loss results, consumption of calories, miscellaneous activities etc. HCG diet Chart mainly includes food list, monitoring sheets and weight loss updates.

Keep in mind that on Phase three of the HCG Diet, you do a minimal-carb diet, not always a minimal-fat diet. When you are food shopping, avoid things listed as low fat because frequently occasions they contain more carbohydrates. Also bear in mind that such things as alcohol, bread, popcorn, pasta, cereal and oatmeal arent permitted on Phase 3. Individuals are high carb meals. Among the finest one easy listing of approved meals to nibble on throughout the protocol diet. Clearly high proteins are key, no sugar, no starches and lots of fruits you cannot eat reason for high sugar content.Plus Im not sure the number of calories meals have in order to ensure that it stays all under 500 calories each day. Any quick reference guides available anybody can publish a hyperlink to?Any minimal error during HCG diet protocol will count toward your objectives. You have to focus on all you are permitted to consume to offer the dream figure you always aspired to have.

Which HCG Meals Are Okay To Consume?

Your options to attain a minimum of twenty to thirty pounds in a 3 week period diet are extremely tightly mounted on intelligent control around the HCG diet permitted meals.The way to succeed in HCG diet would be to live an organised existence. You need to be careful enough when using the things in order to avoid undesirable fat consumption. The dieters frequently finish up in a confusing situation to find the best product on their behalf while theyre in HCG diet. Here, an entire shopping list is offered for that dieters convenience.Among the primary steps you can take to start trading for achievement will be prepared. Its very easy to keep on track if you have a fridge filled with Phase 2 friendly meals to select from! Do your favor and become prepared applying this grocery list as helpful tips for make certain youve everything its important to be effective and achieve your weight loss goal!

Suggested Dosage:

Take 10 drops 3 occasions each day underneath the tongue and hold for 1-2 minutes. Avoid eating or drink for ten minutes after or before taking drops and wait the whole half an hour later on before eating. Not suggested for kids under 18 years old. Whenever you consume a really low-calorie diet and go ahead and take drops or injections simultaneously, you are able to lose up to and including pound or even more each day. A minimum of thats the claim. When following a HCG diet you follow a strict 500 calorie diet regime.

Congratulations in your weight loss! Enjoy your brand-new body and eating routine. You might now start another round if more weight loss is preferred. Can start Phase 2 if youre planning on more models.The 2nd 1 / 2 of maintenance is known as Maintenance 2. Youll be gradually adding sugars and starches in for your diet.Both phases need stick to the 2-lb steak day rule: if youre greater than 2 lbs over your last injection weight or perhaps your last drop weight, you have to perform a steak day tomorrow. Your protein options arent restricted to just meat any longer! Nuts make a particularly good treats on phase 3. Regrettably, beans continue to be not allowed because of their high starch content, but vegetarians can use them carefully.

Hcg Printable Food List You can observe and discover an image of Hcg Printable Food List using the best picture quality here. Discover much more about Hcg Printable Food List that make you feel more comfortable. We provides awesome assortment of hi-def Hcg Printable Food List picture, images and photo. Download this Hcg Printable Food List collection picture, images and photo free of charge which are shipped in hi-def. You can observe some short lists of HCG Maintenance meals here.Or, you can aquire a full listing of about 1,000 meals, drinks, condiments, etc suggesting whether or not they are permitted around the first 3 days of HCG Maintenance.

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May 16

HCG Diet – Soboba Medical Weight Loss Group

Here are some of our testimonials from satisfied patients who came to our clinic and tried some our services here at Soboba Medical Weight Loss.

I never felt so positive about myself. I just came to Soboba Weight Loss 4 months ago and I lost more than 25 pounds. I feel better, I sleep longer and I become happier person.

-Tania S.

Irvine, CA

Disclaimer: Results may vary from person to person. This website does not provide medical advice.These statements have not been evaluated by the Food and Drug Administration. SOBOBA Medical Weight loss program is not intended to diagnose, treat, cure or prevent any disease.

Here is another one of our testimonials:

This program really taught me things that I never knew about weight loss. I am now over 50 pounds lighter and I have so much more energy to spend with my grandkids!!

-Robert S.

La Jolla, CA

Disclaimer: Results may vary from person to person. This website does not provide medical advice.These statements have not been evaluated by the Food and Drug Administration. SOBOBA Medical Weight loss program is not intended to diagnose, treat, cure or prevent any disease.

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HCG Diet - Soboba Medical Weight Loss Group

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May 16

Long-term weight loss maintenance | The American Journal of Clinical Nutrition | Oxford Academic

ABSTRACT

There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity (1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 25 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.

The perception of the general public is that no one ever succeeds at long-term weight loss. This belief stems from Stunkard and McLaren-Humes 1959 study of 100 obese individuals, which indicated that, 2 y after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb) or more (1). More recently, a New England Journal of Medicine editorial titled Losing Weight: An Ill-Fated New Years Resolution (2) echoed the same pessimistic message.

The purpose of this paper is to review the data on the prevalence of successful weight loss maintenance and then present some of the major findings from the National Weight Control Registry (NWCR), a database of more than 4000 individuals who have indeed been successful at long-term weight loss maintenance.

Wing and Hill (3) proposed that successful weight loss maintainers be defined as individuals who have intentionally lost at least 10% of their body weight and kept it off at least one year. Several aspects of this definition should be noted. First, the definition requires that the weight loss be intentional. Several recent studies indicate that unintentional weight loss occurs quite frequently and may have different causes and consequences than intentional weight loss (4,5). Thus, it is important to include intentionality in the definition. The 10% criterion was suggested because weight losses of this magnitude can produce substantial improvements in risk factors for diabetes and heart disease. Although a 10% weight loss may not return an obese to a non-obese state, the health impact of a 10% weight loss is well documented (6). Finally, the 1-y duration criterion was proposed in keeping with the Institute of Medicine criteria (7). Clearly, the most successful individuals have maintained their weight loss longer than 1 y, but selecting this criterion may stimulate research on the factors that enable individuals who have maintained their weight loss for 1 y to maintain it through longer intervals.

There are very few studies that have used this definition to estimate the prevalence of successful weight loss maintenance. McGuire et al (8) reported results of a random digit dialing survey of 500 adults, 228 of whom were overweight or obese [body mass index (BMI) 27 kg/m2] at their maximum nonpregnant weight. Of these 228, 47 (20.6%) met the criteria for successful weight loss maintenance: they had intentionally lost at least 10% of their body weight and maintained it for at least 1 y. On average, these 47 individuals had lost 20.7 14.4 kg (45.5 lb; 19.5 10.6% from maximum weight) and kept it off for 7.2 8.5 y; 28 of the 47 had reduced to normal weight (BMI

Survey data such as these have the perspective of a persons entire lifetime and thus may include many weight loss attempts, some which were successful and some unsuccessful. It is more typical to assess success during one specific weight loss bout. In standard behavioral weight loss programs, participants lose an average of 710% (710 kg) of their body weight at the end of the initial 6-mo treatment program and then maintain a weight loss of 56 kg (56%) at 1-y follow-up. Only a few studies have followed participants for longer intervals; in these studies, 1320% maintain a weight loss of 5 kg or more at 5 y. In the Diabetes Prevention Program (9), 1000 overweight individuals with impaired glucose tolerance were randomly assigned to an intensive lifestyle intervention. The average weight loss of these participants was 7 kg (7%) at 6 mo; after 1 y, participants maintained a weight loss of 6 kg (6%), and, at 3 y, they maintained a weight loss of 4 kg (4%). At the end of the study (follow-up ranging from 1.8 to 4.6 y; mean, 2.8 y), 37% maintained a weight loss of 7% or more.

Thus, although the data are limited and the definitions varied across studies, it appears that 20% of overweight individuals are successful weight losers.

Although it is often stated that no one ever succeeds in weight loss, we all know some people who have achieved this feat. In an effort to learn more about those individuals who have been successful at long-term weight loss, Wing and Hill (10) established the National Weight Control Registry in 1994. This registry is a self-selected population of more than 4000 individuals who are age 18 or older and have lost at least 13.6 kg (30 lb) and kept it off at least 1 y. Registry members are recruited primarily through newspaper and magazine articles. When individuals enroll in the registry, they are asked to complete a battery of questionnaires detailing how they originally lost the weight and how they now maintain this weight loss. They are subsequently followed annually to determine changes in their weight and their weight-related behaviors.

The demographic characteristics of registry members are as follows: 77% are women, 82% are college educated, 95% are Caucasian, and 64% are married. The average age at entry to the registry is 46.8 y. About one-half of registry members report having been overweight as a child, and almost 75% have one or two parents who are obese.

Participants self-report their current weight and their maximum weight. Previous studies suggest that such self-reported weights are fairly accurate (slightly underestimating actual weight) (11,12). In the NWCR, participants are asked to identify a physician or weight loss counselor who can provide verification of the weight data. When, in a subgroup of participants, the information provided by participants was compared with that given by the professional, the self-report information was found to be very accurate.

Participants in the registry report having lost an average of 33 kg and have maintained the minimum weight loss (13.6 kg) for an average of 5.7 y. Thirteen percent have maintained this minimum weight loss for more than 10 y. The participants have reduced from a BMI of 36.7 kg/m2 at their maximum to 25.1 kg/m2 currently. Thus, by any criterion, these individuals are clearly extremely successful.

Previously, we reported information about the way in which registry participants lost their weight (10); interestingly, about one-half (55.4%) reported receiving some type of help with weight loss (commercial program, physician, nutritionist), whereas the others (44.6%) reported losing the weight entirely on their own. Eighty-nine percent reported using both diet and physical activity for weight loss; only 10% reported using diet only, and 1% reported using exercise only for their weight loss. The most common dietary strategies for weight loss were to restrict certain foods (87.6%), limit quantities (44%), and count calories (43%). Approximately 25% counted fat grams, 20% used liquid formula, and 22% used an exchange system diet. Thus, there is variability in how the weight loss was achieved (except that it is almost always by diet plus physical activity).

The earliest publication regarding the registry documented the behaviors that the members (n = 784) were using to maintain their weight loss (10). Three strategies were reported very consistently: consuming a low-calorie, low-fat diet, doing high levels of physical activity, and weighing themselves frequently. Recently, a fourth behavior was identified: consuming breakfast daily (13). Each of these behaviors is described below. Registry members reported eating 1381 kcal/d, with 24% of calories from fat. In interpreting their data, it is important to recognize that 55% of registry members report that they are still trying to lose weight and to consider that dietary intake is typically underestimated by 2030%. Thus, registry members are probably eating closer to 1800 kcal/d. However, even with this adjustment, it is apparent that registry members maintain their weight loss by continuing to eat a low-calorie, low-fat diet.

More recently, we have examined other aspects of their diet. Of particular interest is the fact that 78% of registry members report eating breakfast every day of the week (13). Only 4% report never eating breakfast. The typical breakfast is cereal and fruit. Registry members also report consuming 2.5 meals/wk in restaurants and 0.74 meals/wk in fast food establishments.

Another characteristic of NWCR members is high levels of physical activity. Women in the registry reported expending an average of 2545 kcal/wk in physical activity, and men report an average of 3293 kcal/wk (10). These levels of activity would represent 1 h/d of moderate-intensity activity, such as brisk walking. The most common activity is walking, reported by 76% of the participants. Approximately 20% report weight lifting, 20% report cycling, and 18% report aerobics.

Registry members also reported frequent monitoring of their weight (10). More than 44% report weighing themselves at least once a day, and 31% report weighing themselves at least once a week. This frequent monitoring of weight would allow these individuals to catch small weight gains and hopefully initiate corrective behavior changes.

The vigilance regarding body weight can be seen as one aspect of the more general construct of cognitive restraint (ie, the degree of conscious control exerted over eating behaviors). Registry members are asked to complete the Three Factor Eating Inventory (14), which includes a measure of cognitive restraint. Registry members scored high on this measure (mean of 7.1), with levels similar to those seen in patients who have recently completed a treatment program for obesity, although not as high as eating-disordered patients. These findings suggest that successful weight loss maintainers continue to act like recently successful weight losers for many years after their weight loss.

Registry participants are followed over time to identify variables related to continued success at weight loss and maintenance. Findings from the initial follow-up study (15) indicated that, after 1 y, 35% gained 2.3 kg (5 lbs) or more (7 kg on average), 59% continued to maintain their body weight, and 6% continued to lose weight.

Participants who regained weight (>2.3 kg) were compared with those who continued to maintain their body weight to examine whether there were any baseline characteristics that could distinguish the two groups. The single best predictor of risk of regain was how long participants had successfully maintained their weight loss (Table 1). Individuals who had kept their weight off for 2 y or more had markedly increased odds of continuing to maintain their weight over the following year. This finding is encouraging because it suggests that, if individuals can succeed at maintaining their weight loss for 2 y, they can reduce their risk of subsequent regain by nearly 50%.

TABLE 1

Duration of weight loss maintenance and 1-y risk of weight regain among successful weight losers1

TABLE 1

Duration of weight loss maintenance and 1-y risk of weight regain among successful weight losers1

Another predictor of successful weight loss maintenance was a lower level of dietary disinhibition, which is a measure of periodic loss of control of eating. Participants who had fewer problems with disinhibition [ie, scores

Several key behavior changes that occurred over the year of follow-up also distinguished maintainers from regainers. Not surprisingly, those who regained weight reported significant decreases in their physical activity, increases in their percentage of calories from fat, and decreases in their dietary restraint. Thus, a large part of weight regain may be attributable to an inability to maintain healthy eating and exercise behaviors over time. The findings also underscore the importance of maintaining behavior changes in the long-term maintenance of weight loss.

Another variable that has been examined in the registry is the presence of a triggering event leading to participant successful weight loss. Most registry participants reported a trigger for their weight loss (83%). Medical triggers were the most common (23%), followed by reaching an all time high in weight (21.3%), and seeing a picture or reflection of themselves in the mirror (12.7%).

Because medical triggers have been shown to promote long-term behavior change in other areas of behavioral medicine (16), we examined whether individuals who reported medical triggers were more successful than those who reported nonmedical triggers or no triggers. A medical trigger was defined broadly and included, for example, a doctor telling the participant to lose weight and/or a family member having a heart attack. Findings indicated that people who had medical reasons for weight loss also had better initial weight losses and maintenance (17). Specifically, those who said they had a medical trigger lost 36 kg, whereas those who had no trigger (17.1%) or a nonmedical trigger (59.9%) lost 32 kg. Medical triggers were also associated with less regain over 2 y of follow-up. Those with medical triggers gained 4 kg (2 kg/y), whereas those with other or no medical triggers gained at a significantly faster rate, averaging 6 kg in both groups.

These findings are intriguing because they suggest that the period following a medical trigger may be an opportune time to initiate weight loss to optimize both initial and long-term weight loss outcomes.

The topic of dieting consistency was also recently examined in the registry. Participants were asked whether they maintained the same diet regimen across the week and year, or if they tended to diet more strictly on weekdays and/or nonholidays (18). Few people said they dieted more strictly on the weekend compared with the rest of the week (2%) or during holidays compared with the rest of the year (3%). Most participants reported that their eating was the same on weekends and weekdays (59%) and on holidays/vacations and the rest of the year (45%). The remaining groups reported that they were stricter during the week than on weekends (39%) and during nonholiday times compared with holidays (52%).

We evaluated whether maintaining a consistent diet was related to subsequent weight regain after 2 y. Interestingly, results indicated that participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within 5 lb over the subsequent year than participants who dieted more strictly on weekdays. A similar relationship emerged between dieting consistency across the year and subsequent weight regain; individuals who allowed themselves more flexibility on holidays had greater risk of weight regain. Allowing for flexibility in the diet may increase exposure to high-risk situations, creating more opportunity for loss of control. In contrast, individuals who maintain a consistent diet regimen across the week and year appear more likely to maintain their weight loss over time.

We also examined different patterns of weight change among registry participants followed over time. We were particularly interested in evaluating whether participants who gained weight between baseline and year 1 were able to recover over the subsequent year. We found that few people (11%) recovered from even minor lapses of 12 kg. Similarly, magnitude of weight regain at year 1 was the strongest predictor of outcome from year 0 to 2. Participants who gained the most weight at year 1 were the least likely to re-lose weight the following year, both when recovery was defined as a return to baseline weight or as re-losing at least 50% of the year 1 gain.

Although participants gained weight and recovery was uncommon, the regains were modest (average of 4 kg at 2 y), and the vast majority of participants (96%) remained >10% below their maximum lifetime weight, which is considered successful by current obesity treatment standards.

These findings, nonetheless, suggest that reversing weight regain appears most likely among individuals who have gained the least amount of weight. Preventing small regains from turning into larger relapses appears critical to recovery among successful weight losers.

Results of random digit dial surveys indicate that 20% of people in the general population are successful at long-term weight loss maintenance. These data, along with findings from the National Weight Control Registry, underscore the fact that it is possible to achieve and maintain significant amounts of weight loss.

Findings from the registry suggest six key strategies for long-term success at weight loss: 1) engaging in high levels of physical activity; 2) eating a diet that is low in calories and fat; 3) eating breakfast; 4) self-monitoring weight on a regular basis; 5) maintaining a consistent eating pattern; and 6) catching slips before they turn into larger regains. Initiating weight loss after a medical event may also help facilitate long-term weight control.

Additional studies are needed to determine the factors responsible for registry participant apparent ability to adhere to these strategies for a long period of time in the context of a toxic environment that strongly encourages passive overeating and sedentary lifestyles.

RRW is the cofounder of the National Weight Control Registry (with James O Hill). RRW coauthored the manuscript with SP, who is a coinvestigator of the National Weight Control Registry. RRW and SP have no financial or personal interest in the organizations sponsoring this research.

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May 15

How to Lose 20 Pounds In 2 Weeks: Effective Plan to Lose …

If you want to lose 20 pounds in 2 weeks, then its essential that you have an effective and healthy plan for rapid weight loss. Losing weight quickly can help you to kick-start a long-term diet plan if you need to quickly shed weight and then keep off extra pounds. As with any effective diet plan to lose extra fat from your body safely, you need to take into consideration your own health. That is why the best ways to lose weight fast should combine lifestyle changes, exercising, and being physically active.

Having the goal to lose 20lbs in a couple of weeks is certainly a good goal to have if you are overweight and have weight-related health issues. However, it is not always a good idea to try and lose a large amount of weight in just two weeks, so you may need more time for that. Rapid weight loss can take a toll on your health and cause other unwanted health complications. Therefore, if you plan to use a fast weight loss program, you should speak to a qualified medical professional.

In this article, you will find out how to lose a lot of weight in the shortest time possible. You will find out healthy ways to help shed extra pounds in no time at all and you may already start to look slimmer within a few weeks.

Extreme dieting measures could help you lose weight rapidly but you need to follow an effective plan to make sure your body gets all the nutrients it needs.

You need to realize that you didnt gain 20 pounds in 2 weeks so losing this weight in a short period of time can be a great challenge. It is certainly possible to lose 10 pounds of weight in one week but it will not be pure body fat and some of it will be water weight.

Losing 20 pounds in just 2 weeks will require a very low calorie diet which is not the best approach if you want to lose weight and keep it off.

According to the American Journal of Clinical Nutrition, very low calorie diets lead to a fast weight loss. However re-feeding after such extreme dieting leads to fast and excessive weight regain.28 The most sensible approach is to develop effective habits that will help you lose weight gradually and keep it off.

In this detailed article I am going to give you the best possible information on how to lose weight fast and keep it off. Youll learn about the most effective ways, based on science, to lose weight and develop eating habits to keep it off.

Here are the steps you need to take to lose as much as 20 pounds in 2 weeks.

One of the best ways to lose weight quickly in 2 or 3 weeks is to lower your daily calorie intake.

Lowering your calorie intake helps to speed up weight loss as you will burn more energy than you consume. To lower your calorie intake in order to lose 20 pounds fast, you can swap foods for healthier options, limit your intake of saturated fats, and eat smaller portions.

Consuming fewer calories every day will help you lose 20 or even 30 pounds at a steady, healthy pace and boost your general health at the same time. According to the National Heart, Lung, and Blood Institute, you should reduce your daily calorie intake by 500 to 750 calories per day to lose significant weight in a couple of weeks.1

Doctors from the National Health Service recommend some healthy food swaps to help lower calorie intake and lose weight faster.29 Here are some examples to help you lose as much as 30 pounds in a month:

For more information on how to tweak your diet to speed up the effectiveness of your weight loss plan, please read my article on the best hacks for speedy weight loss.

If you want to make sure and lose as much as 20 or 30 pounds in a month you should change your eating habits.

Changing your eating habits helps with rapid weight loss because it helps you develop positive habits that contribute to weight loss at a regular pace.

For example, one way to help speed up weight loss and lose unnecessary pounds is to drink a glass of water before each meal. Dr. Arefa Cassobhoy on WebMD reported on a study into the effects of drinking water and obesity. The study found that drinking 16-oz. of water 30 minutes before a meal helped severely overweight people shed extra pounds easier and faster.2

Another habit that can help to lose a lot of pounds in a couple of weeks is to start the day with protein. Starting your day with eggs for breakfast or consuming lean meat, milk, or nuts are all great sources of protein that will keep you feeling fuller for longer and give you plenty of energy. This reduces the temptation to snack during the day and helps boost weight loss in a 2 or 3-week diet program.

You can also lose weight much quicker in 2 or 3 weeks if you are careful about when and why you eat. A study published in the Journal of Occupational and Environmental Medicine found that emotional eating is associated with body weight gain. It was found that eating due to emotional responses caused people to become overweight and obese.3

There are many effective ways to beat emotional eating. These include reducing stress and anxiety, getting plenty of sleep, and eating proper amounts of dietary fiber and protein.

Eating small frequent meals will help you lose 20 or even 30 pounds faster.

Rather than skipping meals during the day, you might find that eating small frequent meals throughout the day helps you lose weight at a proper pace. However, there is some controversy whether people wanting to beat the battle of the bulge quickly should eat 3 or 6 small meals during the day.

For example, in 2015 the journal Nutritional Reviews reported that eating frequent meals seems to help people lose excess fat and reduce overall body weight.4 But, the journal Obesity found that in their study, eating 3 meals a day or 6 meals a day had no overall impact on weight loss. The report found that total calorie intake in a day was the most important factor when it comes to fast weight loss.5

So, if you are looking to lose several pounds of body weight as fast as possible using an effective diet plan, you could try to see which of these methods work best for you.

Reducing portion size should help you start losing pounds of body fat in 2 weeks.

Eating smaller portions at lunchtime and in the evening can help to reduce energy intake and help you lose weight and keep the weight off.

A study published in the American Journal of Clinical Nutrition found that when individuals ate smaller portions for lunch, their daily energy intake was reduced by 30%. The researchers concluded that eating smaller portions can help to treat and prevent obesity. The study highlighted the fact that portion sizes in restaurants are getting larger and most people finish their large entrees.25

Another study showed that one way to control portion sizes and lose weight quickly is to eat more foods that are low-density energy sources and limit high-density energy foods. For example, having more vegetables and lean protein and less fatty foods can help reduce energy intake from meals and thus help you lose weight much quicker.26

You could also try using a portion control plate for your meals at home to help you greatly reduce portion size to eat healthier meals and lose weight. You might not lose 20 pounds of body weight in 2 weeks with this method, but it is a safe and healthy way to control body weight.

To shed more pounds of body fat in 2 weeks, you should also limit your intake of unhealthy carbohydrates.

Unhealthy carbs that can make losing body weight difficult include simple carbohydrate sources such as white bread and pasta, cakes, pastries, and sugar. Low carb diets have many proven health benefits that include more than just losing weight fast.

When lowering your carb intake, you should remember not to cut out healthy carbs that are classed as complex carbohydrates. These include wholegrain bread, brown rice, whole-wheat pasta, beans, vegetables, and fruits. Dr. Kathleen Zelman on WebMD says that fiber in food helps to control weight and can lower your risk of heart disease and colon cancer.6

Dr. Zelman recommends switching to whole grains as much as possible and avoiding foods that have added or refined sugars. You should also eat plenty of fruit and vegetables every day and include beans and legumes in your diet.

You should avoid junk food and limit sugar consumption to lose weight quickly.

Junk food and foods with added sugar not only have very low nutritional value but they can make it very difficult to slim down very fast in a short period of time.

The University of Michigan reported on a study showing a correlation between fast food and increased body mass index, weight gain and obesity. The study also found that people get heavier as the number of fast food outlets increase.7

Cutting out sugary foods and sodas can also help you lose a lot of weight in two weeks. Dr. Laura Martin on WebMD says that limiting foods containing refined sugars will help a person lose weight and reduce levels of obesity.8

You can also lose several pounds quicker by increasing your daily water intake.

Drinking more water doesnt just help lose weight from around your waist but it prevents the symptoms of dehydration. Water is also one of the best ways to flush toxins out of your system and boost the health of your kidneys.

A study published in the Journal of Natural Science, Biology and Medicine reported that drinking 1.5 liters of water every day helps to reduce body weight, body fat, and body mass index. The researchers concluded that drinking water can be a useful and cheap way for obese persons to lose weight quicker.9

You dont just have to stick to plain water to lose a lot of weight in a few weeks. You can easily make your own calorie-free flavored water that will help boost your weight loss plan in 2 weeks.

To reach your goal of losing a lot of excess body weight in 2 weeks, you should also make some lifestyle changes along with sticking to an effective plan to lose weight fast. Lifestyle changes to help lose weight are just as important as reducing calorie intake when it comes to getting rid of body weight in a matter of a few weeks.

Here are 4 lifestyle changes that doctors recommend to boost the effectiveness of your weight loss plan.

While it is important to exercise regularly every week, staying active throughout the day will help to accelerate how quickly you lose weight.

A study in the journal Mayo Clinic Proceedings found that non-exercised activity thermogenesis (NEAT) can help to significantly increase calorie expenditure. It was found that NEAT movements can also protect a person from cardiovascular disease and reduce obesity in people who have difficulty exercising.10

Here are some easy ways to increase NEAT movements throughout the day and help burn fat quicker in a couple of weeks.

If you are serious about losing a lot of weight in a short space of time, then getting plenty of sleep is essential.

Although a hectic work schedule and stress can make getting to sleep difficult, there are many positive health benefits of getting proper rest during the night.

Dr. Melinda Ratini on WebMD says that lack of sleep is linked to weight gain and obesity. For example, feeling well-rested reduces food cravings and gorging on high-carb snacks. Also, getting the right amount of sleep helps to balance your hormones naturally and reduce fat by increasing your metabolism.11

To help improve your sleep patterns to stop fat accumulating in your body, here are some helpful tips to lose as much as 20 pounds in 2 weeks:

If you really want to shift those extra pounds of body weight in two or three weeks, you should find ways of reducing stress in your daily activities.

According to Dr. William Blahd on WebMD, stress increases cortisol levels in the body which can increase the desire for sugary, fatty foods. This can also increase your risk of high blood pressure, cardiovascular diseases, or diabetes.12

Dr. Blahd recommends some easy ways to deal with stress at home and increase the effectiveness of your weight-loss program:

To make sure and lose as many pounds as possible in a two-week period, it is very important to keep yourself motivated.

Having strong motivation will help you stick to your weight-loss plan even when it seems that results arent what you expected.

Doctors from the Mayo Clinic say that long-term weight loss is only achieved through making permanent changes to your eating habits and lifestyle. To keep yourself motivated to lose weight quickly and keep it off, this is what they suggest:30

When looking to lose a lot of weight in the short-term, its necessary to boost your weight-loss plan with healthy exercise. Getting regular exercise is not only good for your heart but it will help to burn even more calories.

Here are some of the best way to burn off extra body fat that has accumulated around your face, waistline, or other parts of your body.

Increasing the amount of walking you do every day will help to shed pounds from your body in no time at all.

A study published in the International Journal of Obesity and Related Metabolic Disorders reported that brisk walking for 30 minutes on most days of the week was an effective part of a weight-loss plan.13

How can you include walking as part of your plan to lose weight fast and start seeing results within two weeks? In my article on how walking can help lose weight, you will find out how many calories you can burn if you add 10,000 steps to your day.

Ways to increase your steps daily include:

High-intensity interval training (HIIT) is an excellent way to quickly lose weight and see results within a short space of time.

HIIT training involves short bursts of intense exercise followed by short recovery periods. For example, it could be 30-40 seconds of hard sprinting followed by 30-40 seconds of light jogging.

According to the Journal of Obesity, high-intensity intermittent exercise or training has been shown to significantly increase aerobic and anaerobic fitness. It also helps the body get rid of excess fat quicker. HIIT exercises can also help to boost cardiac health and reduce the symptoms of type-1 and type-2 diabetes.14

For more information on how you can use interval training to speed up weight loss, please read my article on using interval training to lose fat quicker.

Lifting weights is another proven way to see quick results when wanting to lose extra pounds in a two-week period.

Lifting weights as well as kettlebell workouts help to not only burn calories very quickly but they also build muscle mass which helps to burn even more calories.

A study from Europe reported that heavy-resistance exercise during intense workouts boosts muscle metabolism.15 An increase in your resting metabolic rate also helps to burn calories even when you are resting.

Before starting a program of intense, heavy-resistance exercising, you should speak to a qualified medical professional to get advice.

According to the Centers for Disease Control and Prevention, there are some other ways that can help you lose body weight quickly when used in conjunction with an effective weight-loss plan. Some of these include:31

So far, this article has concentrated on the 3 main principles on how to achieve a goal of losing 20 pounds in two weeks. However, there are some specific weight-loss diets that help to lose a lot of weight in just a few weeks.

The ketogenic diet is a low carb high fat diet that restricts the intake of carbs to help boost the bodys fat-burning potential. Usually, people who start a carb-restrictive diet see rapid weight loss in the first few weeks of dieting. The journal Experimental & Clinical Cardiology reported that a keto diet can help to reduce body mass and body mass index in obese individuals.15

There is one thing that you need to be aware of when dropping carbs from your diet: many of the foods that contain carbs also contain beneficial nutrients and vitamins.

For example, if you eliminate whole grains and brown rice you are going to miss out on nutrients such as b vitamins and magnesium. These are important nutrients for the energy production in your body so you will get tired easily.

The 3-hour diet can help you lose weight quickly without having to cut out many of your favorite foods. According to Dr. Michael Dansinger on WebMD, the 3-hour diet involves eating small portions of food every 3 hours and limiting calories intake to just over 1,400 calories a day. Dr. Dansinger says that visible results are often seen within the first 2 weeks.16

Intermittent fasting, or the 5:2 diet, will help you see quick results to help reach your weight-loss goals quicker. Intermittent fasting involves eating normally for 5 days in the week and restricting calorie intake to 600 calories on 2 non-consecutive days. According to the International Journal of Obesity, far from being a fad diet, intermittent fasting can help achieve weight loss that stays off as long a person sticks to the diet.17

You can find more information about this diet in my article Intermittent Fasting 5:2 Principles, Science and How To.

When searching the internet for ways to lose 20 pounds in 2 weeks, you will come across many unsafe methods to lose weight quickly.

In your diet plan to lose extra weight in under a month, you should avoid skipping meals as a regular habit. For example, a study published in the American Journal of Clinical Nutrition reported that although skipping breakfast can help reduce daily calorie intake, it can increase inflammation in the body.27

Dr. Kathleen Zelman on WebMD reports that breakfast helps improve blood sugar levels and gives the body a needed boost for the day. You also get important vitamins and nutrients from breakfast and reduce the tendency to snack. People who eat breakfast every day are able to lose weight and keep it off.18

Leaving out one or more meals during the day shouldnt be confused with intermittent fasting. Intermittent fasting doesnt involve skipping meals but reducing calorie content on 2 days of the week. However, most 5:2 diets include 3 low-calorie meals during the fasting days that contain a good amount of vitamins and minerals.

If you are trying to lose a lot of pounds in a short space of time, you should stay clear of fad diets. Fad diets may give quick results, but the extra pounds usually pile on very quickly after the diet is finished.

According to the University of Pittsburgh Medical Center, fad diets usually promise quick dieting results with little or no effort. They usually restrict important food groups and can be difficult to maintain. Fad diets can also cause various health complications like kidney stones, high blood pressure, and cardiovascular issues.19

Diet pills will not help you lose 20 pounds in two weeks. Because diet pills and supplements are generally expensive, they could help you lose hundreds of dollars in a month rather than pounds of body fat. According to Dr. Gary Vogin on WebMD, there is only scant evidence that weight-loss pills have a minimal effect when it comes to dieting. Some natural products may help to boost metabolism or stimulate fat burning, but they wont in themselves help you lose weight quickly.20

Starvation diets and extreme fasting are unsafe ways to get rid of a lot of weight in a week or two. According to Dr. Kathleen Zelman on WebMD, even though starvation diets result in rapid weight loss, they can also cause loss of muscle tissue and may even cause your body to burn calories slower. You may find that at the end of the diet, you put on more weight than you lost.21

Doctors from WebMD also say that creams and other so-called weight-loss devices are just as effective and scientifically proven as voodoo spells.22

So, when it comes to losing 20 lbs in 2 weeks, what is the bottom line? Although it is feasible that a person could lose many pounds of body fat in a couple of weeks, these generally involve risky methods of dieting.

To achieve your perfect body weight and maintain good health, you should reduce calorie intake over a period of many weeks, make positive lifestyle changes, and exercise regularly. After all, extra weight was gained over a long period of time.

By making some simple calculations, doctors from the Mayo Clinic advise on the dangers of trying to lose too much weight in a very short space of time.

For example, the Mayo Clinic says that every pound of body fat contains 3,500 calories.23 So, to lose 20 lbs of fat in 14 days, you would have to lose about 1.5 lbs. of fat a day. This means burning on average 5,000 calories more than you consume per day. You also need to be aware that initially you will lose water weight and not just fat.

How many hours per day will you have to work out to lose 20 lbs. in 2 weeks? The Mayo Clinic says that high impact aerobic exercising burns about 650 calories an hour.24 Therefore, you would have to work out for about 7 hours of intense exercise every day for 2 weeks to lose 20 lbs.

The bottom line when it comes to losing a lot of weight rapidly is this: stick to safe and healthy methods of losing weight that will boost your health and help you reach your perfect body weight.

After you have reached your ideal body weight, it is important to maintain that weight. Researchers from the National Heart, Lung, and Blood Institute say that there are 3 ways to maintain a healthy weight. These are:

If you need to lose a lot of weight quickly in the space of a few weeks, you should speak with your doctor first. Your doctor will carry out a medical checkup to check your general health and recommend a diet and exercise regime that will help you achieve your weight-loss goals.

Your doctor will also check for any underlying health conditions that could affect the type of weight-loss plan that will be most effective for you. This includes checking your blood pressure, blood sugar levels, and any signs of joint pain and stiffness.

Also, if you start feeling fatigued, dizzy, lightheaded, or have an increase in watery bowel movements, or generally unwell while on your weight-loss program, you should speak to your doctor.

Read these related articles:

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May 15

13 Best Drinks To Lose Weight Fast – VKOOL

The secret to lose weight is not only focusing on what to eat but also about caring what to drink. Maybe popular energy drinks, fruit juices, and soft drinks are loaded with carbohydrates and added sugars that can destroy your weight loss plan.

If you want to lose some extra pounds, then maybe you already know that the best way to do is combining exercising with a healthy, nutritious, and balanced diet plan. Nevertheless, there are some drinks that can speed up the fat burning process and help to lose weight faster than you could in normal, and here you will find 13 out of the best drinks to lose weight that you should integrate into your daily diet if you want to get fit fast without using any supplements, drugs, or pills which can lead to dangerous side effects.

The first out of drinks to lose weight I want to show you is coconut water a tasty drink that many people love, especially in summer.

Coconut watercontains more electrolytes than most energy drinks and fruit juices without artificial flavorings plus and extra sugar.

This juice can help tospeed up your metabolism naturallyand give you more energy. Thus, you can stay strong and energetic throughout the day while still can lose weight faster.

This drink is recommended not only because the thickness of the smoothiekills your appetitebut also because yogurt is loaded with calcium.

Many researchers discovered that you can lose 81% more belly fat and 61% fat if you add yogurt to your daily diet because the calcium yogurt contains can help you burn fatand also limit the amount of fat that your body produces.

Try to add Greek Yogurtto your smoothies, as well as some whey protein and fruits to make your smoothies more powerful for weight loss!

Whey protein can help your body release appetite suppressing hormones that restrain your cravings.

In a recent research, people who drank either casein or whey, 90 minutes later, were allowed to eat freely at a buffet table. The fact is that they ate significantly less calories than those who did not drank casein or whey.

Milk is a very rich source of calcium, which can boost the fat loss process by increasing fat breakdown in fat cells. This does not mean that you should drink too much milk every day. What you should do is adding milk to your daily diet in moderation to speed up your weight loss process.

Plain old water is also one of the best drinks to lose weight that gives you amazing result that you never dare thought before! Actually, your body needs a lot of water to facilitate the fat breakdown inside your body. Drinking water helps to flush out toxins and energize your body throughout the day so that your body will be able to perform at its best. You should remember that drinking gallons of water is not the only answer for losing weight. You still need to facilitate an appropriate exercise regime and go on a proper diet. Drinking water will help to keep your body lean, clean, and help all of the organs inside your body work properly instead of working overtime.

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13 Best Drinks To Lose Weight Fast - VKOOL

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May 15

Journals – JAMA

ContextPopular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.

ObjectiveTo compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.

Design, Setting, and ParticipantsTwelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.

InterventionParticipants were randomly assigned to follow the Atkins (n=77), Zone (n=79), LEARN (n=79), or Ornish (n=76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.

Main Outcome MeasuresWeight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and nonhigh-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.

ResultsWeight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05 mean weight loss was as follows: atkins kg confidence interval to zone ci learn and ornish not statistically different among the groups. at months secondary outcomes for group were comparable with or more favorable than other diet>

ConclusionsIn this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

Trial Registrationclinicaltrials.gov Identifier: NCT00079573

The ongoing obesity epidemic,1 along with its health costs and consequences2 and the health benefits of weight loss,3-6 have been well established. National dietary weight loss guidelines (ie, energy-restricted, low in fat, high in carbohydrate)7 have been challenged, particularly by proponents of low-carbohydrate diets.8,9 However, limited evidence has been available to effectively evaluate other diets.10,11

Several recent trials compared low-carbohydrate vs traditional low-fat, high-carbohydrate weight-loss diets.12-16 A meta-analysis that pooled the results of these early trials concluded that low-carbohydrate, nonenergy-restricted diets were at least as effective as low-fat, high-carbohydrate diets in inducing weight loss for up to 1 year.17 However, most of these trials were limited by combinations of small sample sizes, high rates of attrition, short durations, or limited diet assessment.

For the A TO Z (Atkins, Traditional, Ornish, Zone) Weight Loss Study, we selected 4 diets3 popular and substantially different diets and 1 diet based on national guidelinesrepresenting a spectrum of carbohydrate intake: Atkins8 (very low in carbohydrate), Zone9 (low in carbohydrate), LEARN18 (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition; low in fat, high in carbohydrate, based on national guidelines), and Ornish19 (very high in carbohydrate). The primary study objective was to examine the effects of diets and gradations of carbohydrate intake on weight loss and related metabolic variables in overweight and obese premenopausal women.

Participants were recruited from the local community, primarily through media advertisements. Premenopausal women aged 25 to 50 years were invited to enroll if their body mass index (calculated as weight in kilograms divided by height in meters squared) was 27 to 40, body weight was stable over the previous 2 months, and medications were stable for at least 3 months. Women were excluded if they self-reported hypertension (except for those whose blood pressure was stable using antihypertension medications); type 1 or 2 diabetes mellitus; heart, renal, or liver disease; cancer or active neoplasms; hyperthyroidism unless treated and under control; any medication use known to affect weight/energy expenditure; alcohol intake of at least 3 drinks/d; or pregnancy, lactation, no menstrual period in the previous 12 months, or plans to become pregnant within the next year. Race/ethnicity data were collected by self-report to be used for descriptive purposes and possible ancillary analyses of subgroups. All study participants provided written informed consent. The study was approved annually by the Stanford University Human Subjects Committee.

Participants were enrolled in 4 cohorts, with the first cohort starting in February 2003 and the last cohort starting in September 2004. Randomization was conducted in blocks of 24 (6 per treatment group) and occurred by having a blinded research technician select folded pieces of paper with group assignments from an opaque envelope. Participants were assigned 1 of 4 diet books: Dr Atkins' New Diet Revolution,8Enter the Zone,9The LEARN Manual for Weight Management,18 or Eat More, Weigh Less by Ornish.19

Each diet group attended 1-hour classes led by a registered dietitian once per week for 8 weeks and covered approximately one eighth of their respective books per class. The same dietitian taught all classes to all groups in all 4 cohorts and was rated by participants at the end of the 8-week sessions for enthusiasm and knowledge of the material (rating scale of 1-5, from strongly disagree to strongly agree, respectively). The LEARN program is intended to be a 16-week program and, therefore, the 8 weeks of guidance through this book reflected an accelerated time frame, which was necessary to match the time frame given for the other 3 diet groups. Efforts to maximize retention in the study included e-mail and telephone reminders for appointments, e-mail or telephone contact from staff between the 2- and 6-month and between the 6- and 12-month data collection points, and incentive payments of $25, $50, and $75 for completing the 2-, 6-, and 12-month data collection, respectively.

Each group received specific target goals according to the emphasis of the assigned diet. The Atkins group aimed for 20 g/d or less of carbohydrate for induction (usually 2-3 months) and 50 g/d or less of carbohydrate for the subsequent ongoing weight loss phase. The Zone group's primary emphasis was a 40%-30%-30% distribution of carbohydrate, protein, and fat, respectively. The LEARN group was instructed to follow a prudent diet that included 55% to 60% energy from carbohydrate and less than 10% energy from saturated fat, caloric restriction, increased exercise, and behavior modification strategies. The primary emphasis for the Ornish group was no more than 10% of energy from fat. Additional recommendations given for physical activity, nutritional supplements, and behavioral strategies were consistent with those presented in each diet book.8,9,18,19 The guidelines for the Zone and LEARN diets incorporated specific goals for energy restriction, while for the Atkins and Ornish diets, there were no specific energy restriction goals.

A range of behavior modification techniques were discussed during the 2-month classes. The Ornish and Zone books suggest some stimulus-control strategies but on the whole do not emphasize behavior modification, whereas both the Atkins and LEARN books suggest multiple strategies, such as relapse preparation and planning strategies and goal setting. Overall, the LEARN manual has the greatest emphasis on behavior modification strategies.

Process and Outcome Measures

All data were collected at baseline, 2, 6, and 12 months.

Diet and Physical Activity Data. Dietary intake data were collected by telephone-administered, 3-day, unannounced, 24-hour dietary recalls using Nutrition Data System for Research software, versions 4.05.33, 4.06.34, and 5.0.35 (Nutrition Coordinating Center, University of Minnesota, Minneapolis). Data collectors were trained and certified by the Nutrition Coordinating Center. The recalls occurred on 2 weekdays and 1 weekend day per time point, on nonconsecutive days whenever possible. Local foods not found in the comprehensive database were added to the database manually. A food amounts booklet was used to assist participants with portion size estimation. Energy expenditure was assessed using the well-established Stanford 7-day physical activity recall.20

Anthropometric Data. Height was measured to the nearest millimeter using a standard wall-mounted stadiometer. Body weight was measured to the nearest 0.1 kg on a calibrated clinical scale. Waist and hip circumference were measured to the nearest millimeter by standard procedures using a 150-cm anthropometric measuring tape.21 Whole-body fat (percentage of body mass) was determined by dual-energy x-ray absorptiometry using pencil-beam mode on the Hologic QDR-2000 (first 3 cohorts) and, later, the array mode on a Hologic QDR 4500 densitometer (last cohort) (Hologic Inc, Waltham, Mass).

Metabolic Measures. Blood samples were collected after a 10-hour or longer fast. Plasma total cholesterol and triglycerides (free glycerol blank subtracted) were measured enzymatically using Stanford Clinical Chemistry Laboratoryestablished methods.22,23 High-density lipoprotein cholesterol (HDL-C) was measured by liquid selective detergent followed by enzymatic determination of cholesterol.24 Low-density lipoprotein cholesterol (LDL-C) was calculated according to the methods described by Friedewald et al.25 Lipid assays were monitored by the Lipid Standardization Program of the Centers for Disease Control and Prevention and were consistently within specified limits (monthly coefficients of variation were all 3.1%). The nonHDL-C measure was defined as total cholesterol value minus HDL-C value.26 Total plasma insulin in serum was measured by radioimmunoassay.27 Blood glucose was measured using a modification of the glucose oxidase/peroxidase method.28,29

Resting blood pressure was measured 3 times at 2-minute intervals as described elsewhere30; the initial reading was discarded and the last 2 readings were averaged. Clinic and laboratory staff members were blinded to treatment assignment.

The primary objective was to test whether any of the 4 diets, representing a spectrum of carbohydrate intake, was more effective than any other in 12-month weight loss. The selected minimal clinically significant between-group difference in weight change was 2.7 kg (6 lb, approximately 3% for a 180-lb individual). Based on previous trials, we projected a 6.3-kg SD of weight change.31,32 The primary analysis was conducted applying intention-to-treat methods with baseline values carried forward for missing values. Thus, with 4 treatment groups and a projected 75 participants per group, the study was designed to have 80% power to detect a 2.7-kg difference for 12-month weight change between groups.

Dietary composition data (energy intake; percentage carbohydrate, fat, and protein; and grams of saturated fat and fiber) were analyzed using raw, unadjusted means (SDs) (ie, no imputation for missing data). Between-group differences in dietary intake at each time point were tested by analysis of variance (ANOVA). For weight and for all secondary outcome measures, analyses were conducted using all time points and all diets and were tested for diet grouptime (log time +1) interactions in a mixed model using autoregressive covariance structure (SAS version 9.1.3 with Service Pack 3, SAS Institute Inc, Cary, NC). Triglyceride data were log-transformed to attain normal distributions for testing; for ease of interpretation, values presented in the text and figures are untransformed.

Differences among diets for 12-month changes from baseline were tested by ANOVA. For statistically significant ANOVAs, all pairwise comparisons among the 4 diets were tested using the Tukey studentized range adjustment. Statistical testing of changes from baseline to 2 months and to 6 months using pairwise comparisons are presented for descriptive purposes.

For exploratory purposes, ancillary analyses were conducted to determine the effect of diet group assignment on secondary outcomes at 12 months after adjusting for changes in weight loss using linear regression. Also for exploratory purposes, all analyses of weight and secondary outcome measures were tested using only available data, without using baseline values carried forward for missing data or other imputation methods. There were no substantive differences in any of these findings compared with the analyses with baseline values carried forward and, therefore, only the primary analyses are presented. Multiple regression was used to examine potential interactions between race/ethnicity and diet group for effects on weight loss; there were no significant interactions. All statistical tests were 2-tailed using a significance level of .05.

Participant enrollment began in February 2003, and the study ended in October 2005. Figure 1 shows participant flow; Table 1 shows baseline characteristics.

In all 4 diet groups, 85% to 89% of participants attended at least 75% of their assigned classes (6 of 8). Attendance was not different by diet group (P=.68). Retention at 12 months was 88%, 77%, 76%, and 78% for the Atkins, Zone, LEARN, and Ornish groups, respectively, and was not significantly different among groups (P=.30). Participant ratings for class instructor enthusiasm and knowledge of material were very high for both among all diet groups and were not significantly different among groups; average scores ranged from 4.4 to 4.7 on a scale of 1 to 5, with 5 as the highest rating.

Dietary Intake and Energy Expenditure

Total energy intake was not different among diet groups at baseline or any subsequent time point (P>.40 for all) (Table 2). However, relative to baseline, there was a significant mean decrease in reported energy intake at all postrandomization time points (P<.001 and kcal at months respectively for all groups combined.>

There were no significant group differences at baseline in percentage of energy from carbohydrate, fat, or protein or in grams of saturated fat or fiber, except for a borderline significant difference in percentage of energy from fat between Atkins and LEARN (P=.05) (Table 2). At subsequent time points the diets were statistically different in carbohydrate content, progressing from low to high across the Atkins, Zone, LEARN, and Ornish groups. This same pattern was observed for fiber intake. The reverse pattern, higher to lower intakes, was statistically significant for protein, fat, and saturated fat at all time points. Between-group differences in patterns of nutrient intake were largest at 2 months. At 12 months, the patterns of nutrient differences between groups were still present, but the magnitude of differences was diminished.

Total energy expenditure was slightly higher for the Ornish group vs the other 3 groups at baseline but was not significantly different among groups at any subsequent time point (Table 1). Relative to baseline, there was a modest and significant mean increase (P<.05 in energy expenditure at all time points for groups combined: and kcal per day months respectively.>

Weight and Anthropometric Outcomes

Mean 12-month weight change was 4.7 kg (95% confidence interval [CI], 6.3 to 3.1 kg) for Atkins, 1.6 kg (95% CI, 2.8 to 0.4 kg) for Zone, 2.2 kg (95% CI, 3.6 to 0.8 kg) for LEARN, and 2.6 kg (95% CI, 3.8 to 1.3 kg) for Ornish and was significantly different for Atkins vs Zone (Figure 2). At the 2- and 6-month intermediate time points, the weight change for the Atkins group was significantly greater than for all other groups (P<.05 weight change among the zone learn and ornish groups did not differ significantly at any time point. pattern of changes in body mass index percentage fat waist-hip ratio paralleled although between-group differences months achieve statistical significance for or>

Results generated by 84% of the study population (n=262) with baseline blood samples (Atkins, n=70; Zone, n=65; LEARN, n=63; and Ornish, n=64) were available for testing. Four of the LDL-C values could not be calculated because of triglyceride concentrations greater than 400 mg/dL (4.52 mmol/L) and were treated as missing data. At all time points, the statistically significant findings for HDL-C and triglycerides concentrations favored the Atkins group (Table 3). Changes in LDL-C concentrations at 2 months favored the LEARN and Ornish diets over the Atkins diet; however, these differences diminished and were no longer significant at 6 and 12 months. Non-HDL-C differences among groups were not significant at any time point.

Insulin, Glucose, and Blood Pressure Outcomes

Insulin and glucose measurements were obtained from the same aforementioned 84% of the total sample for lipids. Neither the overall trajectory (ie, across all time points) nor the 12-month differences were significantly different among groups for either fasting insulin or fasting glucose concentrations (Table 3).

Parallel to the group changes in weight, the decrease in mean blood pressure levels was largest in the Atkins group at all time points. At 12 months, the decrease in systolic blood pressure was significantly greater for the Atkins group than for any other group. For diastolic pressure, the only significant pairwise difference at 12 months favored the Atkins over the Ornish group.

Ancillary Analyses of Diet Group Effects Independent of Changes in Weight

For the 249 participants who completed the full 12-month protocol, we examined the independent effect of diet group on secondary outcomes after adjusting for 12-month changes in weight using linear regression. Each of the statistically significant 12-month differences between diet groups (ie, triglycerides, HDL-C, and systolic and diastolic blood pressure; Table 3) remained statistically significant after including weight loss in the model; however, the level of significance was diminished.

Compared with women who were assigned to follow diets having higher carbohydrate content, women assigned to the diet with the lowest carbohydrate content had more weight loss and more favorable changes in related metabolic risk factors at 2 and 6 months. The finding of greater weight loss for the Atkins diet continued through 12 months, reaching statistical significance in comparison with the Zone diet. There were no significant differences in weight loss at any time point among the Zone, LEARN, and Ornish diets. Although the weight loss in the Atkins group was greater than that of other groups, the magnitude of weight loss was modest, with a mean 12-month weight loss of only 4.7 kg.

Many concerns have been expressed that low-carbohydrate weight-loss diets, high in total and saturated fat, will adversely affect blood lipid levels and cardiovascular risk.34-36 These concerns have not been substantiated in recent weight-loss diet trials. The recent trials, like the current study, have consistently reported that triglycerides, HDL-C, blood pressure, and measures of insulin resistance either were not significantly different or were more favorable for the very-low-carbohydrate groups.12-16

The exception to this pattern has been LDL-C concentrations. Two of the most consistent findings in recent trials of low-carbohydrate vs low-fat diets have been higher LDL-C concentrations and lower triglyceride concentrations in the low-carbohydrate diets.17 Although a higher LDL-C concentration would appear to be an adverse effect, this may not be the case under these study conditions. The triglyceride-lowering effect of a low-carbohydrate diet leads to an increase in LDL particle size, which is known to decrease LDL atherogenicity.37-39 In the current study, at 2 months, mean LDL-C concentrations increased by 2% and mean triglyceride concentrations decreased by 30% in the Atkins group. These findings are consistent with a beneficial increase in LDL particle size, although LDL particle size was not assessed in our study. In addition, we examined nonHDL-C concentrations as an alternate indicator of atherogenic lipoproteinsa variable not substantially influenced by changes in triglyceride concentrations26and observed no significant differences among groups at any time point.

Therefore, we interpret these findings to suggest that there were no adverse effects on the lipid variables for women following the Atkins diet compared with the other diets and, furthermore, no adverse effects were observed on any weight-related variable measured in this study at any time point for the Atkins group. Further examination of the dietary effects on lipid variables would benefit from analyses of lipoprotein particle subfractions and follow-up of longer than 12 months.

Our study and the study by Dansinger et al16 were similar in several design features, including similar number and types of treatment groups and the same duration. Despite the similarities in design, several conclusions differed between the trials. Dansinger et al reported that weight loss at 12 months did not differ by diet group but only by level of adherence, regardless of diet type. In addition, Dansinger et al reported improvements within groups over 12 months for cardiac risk factors but did not report any significant differences between groups. In contrast, we observed statistically significant differences among diet groups for both weight loss and risk factors at 12 months.

These differences are likely attributable to at least 2 factors. One factor concerns the different study populations: our study was restricted to women aged 20 to 50 years who did not have diabetes and were not taking medications for cardiac risk factors, whereas the population in the study by Dansinger et al was much broader in its inclusion criteria. A second likely factor was differences in statistical power; in the study by Dansinger et al, 93 of 160 enrolled participants completed the trial (42% attrition at 12 months; ie, n=21-26 per treatment group); in the current study, 248 of 311 women completed the trial (20% attrition; ie, n=58-68 per treatment group).

The current study examined whether risk factor responses to diets were independent of weight loss. After statistically adjusting for weight loss differentials among groups, the secondary outcome differences among groups at 12 months that were significant in the unadjusted model remained significant in the adjusted model, although the level of significance was diminished. This supports a combined effect of benefit for the very-low-carbohydrate Atkins diet attributable to both increased weight loss and dietary composition. However, our study was not designed to specifically address this ancillary question. Krauss et al38 recently addressed this issue directly in a study testing diets that ranged from low to high carbohydrate intake under conditions of weight stability followed by conditions of weight loss. Improvements in lipids and lipoproteins were greater for participants in the very-low-carbohydrate diet during the weight-stable phase but were greater for those in the high-carbohydrate diet after weight loss and restabilization; overall the low-carbohydrate and weight-loss effects were reported to be equivalent but not additive under the tightly controlled conditions of this study.

The 4 study diets used in our study differed significantly in composition beyond carbohydrate content. Protein, fat, and saturated fat followed a continuum across diets, inverse to carbohydrate content. In a series of recent weight-loss trials that substituted either protein for fat while holding carbohydrate constant40,41 or protein for carbohydrate while holding fat constant,38,42,43 the higher-protein diets led to improvements in weight loss, triglycerides, and HDL-C and increased satiety. In the OmniHeart study, under weight-stable conditions, blood pressurelowering benefits were observed for a high-protein relative to a high-carbohydrate diet.44 Therefore, the reported effects of the current study should be interpreted as resulting from the combination of macronutrient changes that occur when following low- vs high-carbohydrate diets, not just changes in carbohydrates alone. For example, greater satiety from the higher protein content of the Atkins diet may have contributed to the benefits observed for that group, although satiety was not assessed.

The amount of weight loss at 12 months relative to baseline among all groups was modest at 2% to 5%. However, even modest reductions in excess weight have clinically significant effects on risk factors such as triglycerides and blood pressure and, therefore, can have an important public health impact at the population level.4-6,45,46 Greater success with long-term weight loss is likely dependent on a number of factors beyond macronutrient composition, including improved behavioral strategies, longer-term structured guidance, greater emphasis on increasing energy expenditure (ie, regular physical activity), and addressing societal and environmental factors, such as portion sizes of restaurant meals.45,47-49

Strengths of the current study relative to previous trials include a larger sample size, a 12-month duration, lower attrition rates, the contrast of 4 rather than 2 diets differing in carbohydrate content, and the significant differences in macronutrient intake achieved by the diet groups. Although adherence to the 4 sets of dietary guidelines varied within each treatment group and waned over time, especially for the Atkins and Ornish diets, we believe that the adherence levels obtained are a fair representation of studying the diets and variations in macronutrient intake under realistic conditions and, therefore, increase the external validity of the findings. Other strengths include the extensive dietary assessment and the comprehensive health and risk factor data collected. The restriction of our study to premenopausal women allowed us to avoid possible interactions of effects with sex and menopausal status, but because of our focus on this population, generalizations of findings to other populations should be made with caution.

This study also has several limitations. Menstrual cycle timing was not taken into consideration for blood sampling for lipid analyses, which likely increased within-person variability and diminished the ability to detect between-group differences. Moreover, weight-loss trajectories for each group had not stabilized at 12 months; the trajectories of weight change between 6 and 12 months suggest that longer follow-up would likely have resulted in progressively diminished group differences. Other limitations included the lack of a valid and comparable assessment of individual adherence to the 4 different diets, the lack of data on whether participants had familiarity using any of the specific study diets prior to enrolling in the trial, and the lack of assessment of satiety.

In this study of overweight and obese premenopausal women, those assigned to follow the Atkins diet had more weight loss and more favorable outcomes for metabolic effects at 1 year than women assigned to the Zone, Ornish, or LEARN diets. Concerns about adverse metabolic effects of the Atkins diet were not substantiated within the 12-month study period. It could not be determined whether the benefits were attributable specifically to the low carbohydrate intake vs other aspects of the diet (eg, high protein intake).

While questions remain about long-term effects and mechanisms, these findings have important implications for clinical practice and health care policy. Physicians whose patients initiate a low-carbohydrate diet can be reassured that weight loss is likely to be at least as large as for any other dietary pattern and that the lipid effects are unlikely to be of immediate concern. As with any diet, physicians should caution patients that long-term success requires permanent alterations in energy intake and energy expenditure, regardless of macronutrient content.

Corresponding Author: Christopher D. Gardner, PhD, Hoover Pavilion, N229, 211 Quarry Rd, Stanford, CA 94305-5705 (cgardner@stanford.edu).

Author Contributions: Drs Gardner and Balise had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Gardner, Kraemer, King.

Acquisition of data: Gardner.

Analysis and interpretation of data: Gardner, Kiazand, Alhassan, Kim, Stafford, Balise, Kraemer, King.

Drafting of the manuscript: Gardner, Kiazand, Balise, Kraemer, King.

Critical revision of the manuscript for important intellectual content: Gardner, Kiazand, Alhassan, Kim, Stafford, Kraemer, King.

Statistical analysis: Gardner, Alhassan, Stafford, Balise, Kraemer.

Obtained funding: Gardner, King.

Administrative, technical, or material support: Kiazand.

Study supervision: Gardner.

Financial Disclosures: None reported.

Funding/Support: This investigation was supported by National Institutes of Health grant R21AT1098, by a grant from the Community Foundation of Southeastern Michigan, and by Human Health Service grant M01-RR00070, General Clinical Research Centers, National Center for Research Resources, National Institutes of Health.

Role of the Sponsor: None of the funding agencies played any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.

Acknowledgment: We gratefully acknowledge the work of the study staff who worked with participants in recruitment, intervention, and data collection, including Rise Cherin, MS, RD, Kathryn Newell, MS, Suzanne Olson, MS, Jennifer Morris, PhD, Jane Borchers, MS, RD, Laurie Ausserer, MS, Ellen DiNucci, MA, Kelly Boyington, Jana Stone, Andrea Vaccarella, RD, Noel Segali, RD, and Gretchen George, MS, RD, all of Stanford University, as well as the staff of the Stanford University Hospital General Clinical Research Center.

AtkinsR.Dr Atkins' New Diet Revolution.New York, NY: Harper Collins; 2002

SearsB, LawrenW.Enter the Zone.New York, NY: Harper Collins; 1995

BrownellKD.The LEARN Manual for Weight Management.Dallas, Tex: American Health Publishing Co; 2000

OrnishD.Eat More, Weigh Less.New York, NY: Harper Collins; 2001

American College of Sports Medicine.Physical Fitness Testing and Interpretation.Philadelphia, Pa: Williams & Wilkins; 2000

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May 15

USC Bariatric Surgery/Weight Loss Management Center | A …

At the heart of our program is a multidisciplinary approach to help our patients achieve successful long-term weight loss. Our team of endocrinologists, dietitians, social workers, psychologists, psychiatrists, nurses and surgeons work alongside patients to create a personal weight loss plan. This collaboration helps patients maintain weight-loss results and achieve long-term improvements for metabolic disorders.

The program is led by world-renowned surgeons who have published more than 350 papers and book chapters. Our team focuses on the evaluation and treatment of severe morbid obesity and the complications associated with conditions such as Type 2 diabetes, hypertension, degenerative disc disease, sleep apnea and hyperlipidemia.

The reputation of our program has earned us numerous accolades, including being named a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Accredited Comprehensive Center and receiving the Center of Excellence distinction from Blue Cross-Blue Shield, Cigna, Aetna and Health Net, among others. Ours is one of the few programs in Southern California to have received the highest ratings from national independent health-care rating organizations based on quality and outcomes.

As an academic medical center, we take care to be clear with our patients about the costs for our services. Our patient navigators work with patients to help them fully understand their financial options and the requirements of their insurance carriers.

Unlike other bariatric surgery offerings that charge patients a program fee in addition to surgical fees to cover the nutritional, medical, and psychiatric care required for successful long-term weight loss, there is no additional or hidden cost for the support of our multidisciplinary team.

Successful weight loss surgery involves far more than the surgeons exceptional skill. It requires changes in diet and lifestyle and even changes in the way patients think about themselves, who they can be, and what they can achieve.

One of the reasons Keck Medicine of USCs metabolic and bariatric surgery program has achieved recognition as a Center of Excellence is the emphasis the entire team places on patient education, support and empowerment. USC Bariatric Surgery Program patients can see Keck Medicine surgeons at both Keck Hospital of USC in Los Angeles and USC Verdugo Hills Hospital in La Caada.

The program starts out well before any surgical consultation by ensuring that every potential patient has the information he or she needs to make the best possible decisions. All prospective patients must attend a free seminar hosted by USC physicians to make sure they fully understand their surgical and non-surgical weight loss options. Attendees are able to ask questions and hear directly about the experiences of successful patients from the challenges to the triumphs.

These free seminars are held in two locations for the convenience of the prospective patients, at the Pasadena Hilton and at Keck Hospital. A full schedule can be viewed here.

Bariatric surgery patients face more than the physical challenges of getting back into action after a procedure. There are the emotional challenges of establishing and committing to new habits and the social challenges of friends or family members reacting in surprising ways to new achievements. Our surgeons, nurses, social workers and dietitians create a unique health plan for each patient. Keck Medicine also offers a monthly support group so patients can talk about their concerns and triumphs with people who understand exactly what theyre going through.

We have performed several thousand procedures with best outcomes and no mortalities following laparoscopic gastric bypass procedures.

Patient I: Before and After

Recent published data in the New England Journal of Medicine (1,2) has shown that weight-loss surgeries, in particular laparoscopic gastric bypass and sleeve procedures, are more effective than medical therapies in the treatment of Type 2 diabetes in the morbidly obese patient. In certain cases where the diabetes has been recently diagnosed, it is possible to discontinue all medications after successful surgery.

Ref: 1-N Engl J Med 2012; 366:1577-15852-N Engl J Med 2012; 366:1567-1576

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May 14

POPSUGAR Fitness – YouTube

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