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Successful implementation strategies of weight loss individuals


     Obesity in America seems to be a constant conundrum of seeking efficient methods to reduce the prevalence of obesity.  Obesity accounts for approximately 300,000 deaths each year finding a solution to successful weight loss can help with this national epidemic. With 30% of the population clinically qualified as obese and 65% of people considered overweight many search for answers.  The amount of deception and confusion of weight loss methods used in society runs rampant!  A decisive, successful method has eluded researchers and dieters for years. The numerous diets, exercises and pills used in one’s attempt to achieve weight loss have been stifling to the dieter.  With the continued rise in obesity of adults and children in society, it is the attempt of this paper to research and view numerous approaches and to concisely detail an effective means to help anyone who desires to seek out an effective weight loss method.  According to the Centers for Disease and Control (CDC) obesity has raised three fold since 1980 among young people.  It is a growing epidemic that implores professionals to find definitive information to disseminate to the general public in a concerted effort to curtail the rise of obesity.

Webster’s dictionary defines a calorie as one for measuring the value of foods for producing heat and energy in the human body equivalent to the amount of heat required to raise the temperature of one kilogram of water to one degree celsius.

     Simplistically speaking, if a dieter was to attempt to seek weight loss simply consuming fewer calories than expended would result in weight loss.  However, the simplicity of the previous stated equations has not been so easy to implement to individuals .13

It has long been touted by diet gurus and/or scientists that there is only one means to appropriate weight loss of calorie deficiency.13 The debate has continued for decades as to the best approach/method to achieve calorie reduction and achieve weight loss.  Increased energy expenditure through exercise, decreased calorie intake through dietary restrictions or a combination of the 2 methods has been popular.  Numerous studies have substantiated the success of one of two or both of these methods when attempting weight loss.  However, the right or most effective means to weight loss seems to remain unclear to many individuals seeking weight loss.  The high rate of obesity and many attempts of people seeking weight loss and not achieving success has been a struggle for many to grasp.  It is well known that there is a strong correlation to psychological disorders such as bulimia and anorexia.  Weight loss at its very least, is a 2 pronged approach of manipulating psychology and physiology for a successful outcome. 

     This paper will attempt to research many different physiological components such as: calorie restriction (diet types), meal frequency, thyroid malfunctions, genes and psychological components such as: behavior modification, weight loss education, binge eating and escape theory.1, 2, 3,5,6,7,8,10,12,13 This paper is in no way a substitute for a thorough individualized medical examination of possible pertinent physiological or psychological malfunctions and/or disorders.  It is an honest attempt to research and evaluate different facets of successful and unsuccessful weight loss approaches within peer reviewed journal articles.  This article will help to distinguish between effective means of weight loss and specific steps people have taken to achieve them both physiologically and psychologically as well as what does and does not work. 


Research Question:  Why do individuals who have a sincere desire to achieve weight loss succumb to failure; is it strongly influenced by their physiological system or their psychological system?

Annotated Bibliography

1.  Dansinger L M, Gleason A J, Griffith L J, Selker P H, Schaefer J E. Comparison of the Atkins, Ornish, Weight Watchers and Zone diets for weight loss and heart disease reduction. JAMA. 2005; 293: 43-53.

Dansinger is a medical doctor noted for his expertise in research of obesity and childhood obesity. This study attempted to address the effectiveness of 4 popular diets used for people seeking weight loss and cardiac risk reduction.  The adherence of all diets was assessed on a 1 year assessment of weight reduced and kept off.  Overall dietary adherence rates were low, and subjects who did adhere to any of the four diets had greater weight loss and reduction in cardiac risk factors.  Amount of weight loss was associated with a self-reported dietary adherence level but none with diet type.  For each diet decreasing levels of weight loss were achieved with no significant differences between diets!  This study looks at 4 very popular diets commonly advocated by diet gurus, doctors or lay individuals.  The efficacy between the 4 of them did not differ for results of weight loss.  This indicated that diet type is insignificant pertaining to weight loss as long as a calorie deficit/reduction is achieved.


2.Finch A E, Linde A J, Jeffery W R, Rothman J A, King M C.  The effects of outcome expectations and satisfaction of weight loss and maintenance. Hlth Psyc. 2005; 24(6): 608-616.

This study examined the hypothesis that highly favorable outcome expectations promote weight loss and hinder weight maintenance.  A total of 349 adults were randomly assigned to 1 of 2 weight loss programs.  One gave an optimistic message focusing on the positive aspects of weight loss, the other gave a balanced message giving equal attention to positive and negative aspects of weight loss.  Participants changed their cognitions of weight loss based on the intervention treatment group they were in.  The research found that more favorable weight loss was associated with better weight loss.    Treatment method of positive outcome and satisfaction were both associated with weight loss.  Expectations of weight loss that were too high or unsatisfactory weight loss subjects did not maintain or lose weight compared to positive outcome or satisfied weight loss subjects.  This study gives concrete proof to the association of psychological happiness or satisfaction of weight loss and overall success.  This study suggest, an in-depth explanation of what to expect during weight loss attempts, the benefits of being positive with the process to avoid negative thinking or associations to weight loss endeavors.  Such negative thinking or negative associations in this study clearly demonstrated less success for weight loss.


3.  Maddock J. The relationship between obesity and the prevalence of fast food restaurants. Am J Health Prm. 2004; 19(2): 137-143.

Dr. Maddock is an associate professor at the University of Hawaii.  Dr. Maddock's research interests include reducing cancer morbidity and mortality through increasing understanding of the process of healthy behavior change.  This study examined 50 U.S. states, and excluding Alaska and including the District of Columbia.  Median income, population density, race, gender and age were all used.  The states ranked obesity, square miles per restaurant and population per restaurant.  In this study, the number of residents per fast food restaurant was strongly correlated to higher obesity rates.  States that ranked lower in obesity tended to have more residents per each fast food restaurant.  The study demonstrates environmental nutrition factors can and do influence the health or weight of an individual, state or country.  This study helps educational programs raise their awareness that environmental factors such as number of fast food restaurants per state/county, does affect the population’s obesity. 


4.  Kirk T, Crombie, Cursiter M. Promotion of dietary carbohydrates as an approach to weight maintenance after initial weight loss.  J Hum Nutr Dietet. 2000; 13: 277-285.

Kirk, Crombie and Cursiter have published numerous researched peer reviewed articles in nationally recognized journals. This study sought to evaluate the likelihood that an increase in carbohydrate to fat ratio would have a satiety-inducing effect which may be associated with less consumption of energy dense foods in the diet.  Twenty nine overweight or mildly obese male and female subjects were required to replace one meal each day with a serving of breakfast cereal.  This was followed by eating 4 weeks adlib on a high carbohydrate consumption diet.  Anthropometric measures were taken at 2 weeks and 6 weeks.  Mean weight loss at 2 weeks was 2.0kg, and remained at 6 weeks.    

This study showed that replacing a carbohydrate meal with a breakfast cereal led to moderate weight loss and followed by a high-carbohydrate phase sustained the weight loss. This study further substantiates weight loss can be achieved with less consumption of calories through fat intake and more ingested calories through carbohydrate intake.  Since fat calories is doubled the amount of carbohydrate weight loss is substantiated by reducing calories in this study and not the type of macronutrient ingested.


5.  Perri M G, Nezu A M, McKelvey F W, Shermer L R, Renjilian A D, Viegener B J.

Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol. 2001; 69(4):722-726.

This study compared two therapy programs for weight loss; a standard behavioral treatment without additional therapy contact + relapse prevention therapy or problem solving therapy.  All subjects had biweekly therapy groups and kept self monitoring eating and exercise diaries   No significant differences were observed with the standard behavioral treatment and relapse prevention.  However, subjects who were in the problem solving therapy demonstrated significantly larger and greater long term weight reductions than the behavioral and relapse prevention groups.  The problem solving therapy group had biweekly sessions that addressed eating and exercise related difficulties participants had since the last session.  The group leader showed each subject a solution for dealing with one of the problems addressed.  This study substantiates the psychology behind successful weight loss programs and how education of any possible pitfalls and ways to overcome these pitfalls can benefit the subject immensely as the subject seeks successful weight loss.


6.  O’Malley B, Hickey J, Nevens E. Thyroid dysfunction-weight problems and the psyche: the patients’ perspective. J Hum Nutr Dietet. 2000; 13:243-248. 

This study wanted to establish the extent to which thyroid dysfunction is relevant to weight loss success and the relevance to psychological factors.  Members of the British thyroid foundation were administered two questionnaires for hypothyroid and hyperthyroid patients.  The questionnaires specifically targeted views on weight and the experiencing of psychological symptoms.  The results showed 25% of individuals regained normal body weight on adequate treatment of Thyroxin but 75% did not.  80% of hypothyroid patients felt depressed pre-diagnosis and 80% remained even after adequate treatment.  This study illustrates that even patients who receive adequate treatment for thyroid dysfunction, especially the over weight, should receive dietary advice/counseling.  This study demonstrated that thyroid hormone manipulation more likely than not, does not always solve overweight issues.  And regardless of hypo or hyperthyroid physiological malfunctions, ultimately the regulation of calories ingested will be the determining variable to successful weight loss.   


7.Gorin A, Sherwood N, Jeffery R, Phelan S, Tate D, Wing R. Involving support partners in obesity treatment. J Consult Clin Psychol. 2005; 73(2):341-343.

In this study researchers examined how the number or success of weight loss partners influences participants.  A total of 202 participants were encouraged to invite up to 3 partners to attend treatment.  Weight loss at 6, 12 and 18 months were not associated with

the number of partners but rather the success of partner weight loss.  Participants with at least one successful weight loss partner lost more than 10% of body weight at 6 months lost the most amount at 6, 12 and 18 months compared to individuals without any successful partners and those participants who attended treatment alone.  This study further substantiates previously cited studies concerning environmental factors.  This study specified the environmental factors as positive people during weight loss attempts or maintenance.  Reviewing this study illustrates the significance a spouse will play on a dieter’s role of being a positive success or detrimental to the dieter’s success. 


8.  Blackburn S, Johnston L, Blampied N, Popp D, Kallen R. An application of escape theory to binge eating. Eur Eat Disorders Rev. 2006; 14:23-31.

The authors are noted experts in the field of psychology, conducting numerous researches in peer reviewed journals.  This study evaluated the application of escape theory to binge eating of 129 women.  Perfectionism strongly predicted adverse self awareness which, in turn, predicted negative effects.  Negative affect predicted levels of avoidance coping, which predicted levels of binge eating. This study substantiates the complexities involved with the psycho-social aspect of weight loss to satisfied feelings of psychology. 

Furthermore this demonstrates that individuals need to be cognizant of their psyche when eating for desired weight loss.


Mattson M P, Energy intake, meal frequency, and health: A neurobiological perspective. Annu Rev Nutr. 2005: 25 237-260.         


9.  This study evaluated size and frequency of meals on the health and longevity of laboratory animals.  The researchers evaluated food intake on life span, growth, reproduction, cancer diseases, type 2 diabetes, cardiovascular disease, neurodegenerative, psychiatric disorders and other diseases.  This study had accumulating data suggesting that meal size and frequency can affect mental health.  There is increased prevalence of insulin resistance in people with schizophrenia and chronic depression compared to the general population.  Overweight and insulin resistance have also been linked to bipolar disorder.  The possible implications for this may be nothing more than that people with psychiatric disorders eat more and exercise less.  However, it is possible that overeating is a contributing factor to the developing of these disorders.  This study demonstrates that patients with clinical depression have reduced insulin sensitivity compared to people without depression.  The study further nullifies that obesity can have a rippling effect upon continued eating in abundance of calories.  As one continues to gain weight, psychological disorders could, and from this study do, worsen. 


10. Trillou R C, Delgorge C, Menet C, Arnone M, Soubrie P. CBI cannabinoid receptor knockout in mice leads to leanness, resistance to diet-induced obesity and enhanced leptin sensitivity. Int J Obes. 2004; 28:640-648.

There is evidence that the implication of CB1 receptor subtype of the endocannabinoid system in the regulation of eating and fat deposition.  Increased brain activity can induce an increased food intake.   Cannabinoid receptors and their endogenous ligands have a variety of physiological functions: modulating pain, emotional behavior, cognition and feeding.  CB1 receptor blockade when implemented alone was shown to suppress food intake in mice.  CB1 male mice were compared to wild animals CB1 male mice in two feedings, 1 with a standard lab regimen 3.5kcal/g, 14.5% of energy as fat and 2. on a free choice consisting of both standard lab food intake and a high fat 4.9kcal/g. 49% of energy as fat.  When maintained on the standard diet, CB1 mice were lean.  At 5 months their body weight and adiposity are 24 and 60% lower than CB1 mice.  They are hypophagic; inactivation of CB1 receptors reduces plasma insulin and leptin levels, and enhances the response to intracerebroventicular leptin injection.  Loading CB1 mice with the obesity prone diet did not result in devolvement of obesity.  Additionally, the insulin resistance normally occurring in high fat, diet-fed mice is not present in CB1 mice.  This data suggests that stimulation of CB1 receptors is a key component in diet induced obesity.  CB1 receptor knockout mice are lean and resistant to diet induced obesity.  These results demonstrate CB1 receptors in the regulation of food intake and body weight suggests endocannabinoid affects leptin-regulated pathways.  This study supports a possible physiological approach to battling complications of obesity. 


11.  Jakicic J M, Wing R R, Winters-Hart C. Relationship of physical activity to eating behaviors and weight loss in women. Med Sci Sports Exerc. 2002:34(10)1653-1659.

John Jakicic is a professor at University of Pittsburgh and has authored or co-authored over 3 dozen articles of books, manuscripts and journals on weight loss.  Dr. Wing is a professor at Brown medical school and is the director of weight control and diabetes

research center in RI.  This study examined whether change in physical activity was associated with compliance to changes in dietary intake and eating behaviors in an 18- month weight loss program.  104 subjects were prescribed a 1200-1500 kcal and fat 20-30% diet and exercise progressed from 100-200min.  Subjects attended behavioral lessons throughout the study.  Weight, energy intake, and weight loss eating behaviors were assessed at 0 and 18 months.  Body weight decreased 7.8 +/- 7.5 kg, energy intake decreased and physical activity and eating behaviors associated with weight loss increased from 0-18 months.  The combination of changes in eating and physical activity behaviors can improve long-term weight loss compared to either behavior alone.  This study supports the premise that interventions specific to both behaviors will support long term weight loss. 


12.  Teixeira P, Going B S, Houtkooper B L, Cussler C Ellen, Martin J C, Metcalfe L L, Finkenthal R N, Blew M R, Sardinha B L, Lohman G T. Weight loss readiness in middle aged women: Psychosocial predictors of success for behavioral weight reduction. J Behav Med. 2002: 25(6) 499-523.

Dissatisfaction with body weight and body image are prevalent concerns among women in today’s society.  This study examined psychosocial correlations to short term 4 months changes in body weight in a lifestyle weight loss intervention.  This was a 2 year weight-

loss and weight-maintained lifestyle intervention.  168 women were included in the study dieting/weight history was assessed by a questionnaire specifically for this study.  Six of the questions included in this study asked the number of recent diets, years at current weight, recent weight losses, life frequency of +/- 10lbs weight fluctuations, age at which subjects started to control their weight and perceived pressure to maintain their weight.  The two strongest correlating variables to weight loss success in this study was diet attempts and body size dissatisfaction.  Individuals who indicated larger weight losses as acceptable lost significantly less weight by the end of the program, compared to subjects with less stringent evaluations.  Unrealistic expectations or negative self image/concept, a higher perceived distress from one’s weight were variables to successful weight loss in this study.  This study further supports the utmost need for weight loss program coordinators to address weight loss educational aspects of how much is realistic , what one needs to do to achieve success, the possible pitfalls that may be encountered, and a positive self image perspective.


13. Avenell A, Brown T J, McGee M A, Campbell M K, Grant A M, Broom J, Jung R T, Smith W C S. What are the long-term benefits of weight reducing diets in adults?  A systematic review of randomized controlled trials.  J Hum Nutr Dietet. 2004: 17 317-335.

This study was a meta analysis of 13 different databases of peer reviewed journals consisting of weight loss studies lasting at least a year or more.  Weight loss had to remain for at least a year to meet the criteria for this review.  Low fat diets produced the most significant weight losses up to 3 years.  Blood pressure, lipids and fasting plasma glucose improved with these diets after 1 year.  Four of the studies reviewed substantiated research that low fat diets may prevent type 2 diabetes and reduce antihypertensive medication for up to 3 years.  A very low calorie diet was associated  with the most weight loss after 1 year.  There was no evidence that showed low carbohydrate/protein sparing modified fasts were associated with greater long term weight loss than low calorie diets or very low calorie diets.  This study is in accordance with previous mentioned researched articles that diet calorie reduction is the most significant factor for successful weight reduction. The review of these many studies within this study support low calorie diets as the most effective method for long term weight reduction and maintenance.


14.  Iwao S, Mori K, Sato Y. Effects of meal frequency on body composition during weight control in boxers. Scand J Med Sci Sports 1996: 6 (5) 265-272.

The effects of meal frequency on the changes of body composition by food restriction was investigated in this study.  Twelve boxers were divided into two groups.  The first group ate two meals a day and the second group ate 6 meals a day.  Both groups ingested the same amount of calories during the study.  No difference in change of body weight was observed by food restriction between both groups, but a decrease in lean body mass was significantly greater in the 2 meals group compared to the 6 meals group.  These results suggest that the lower frequency of meals lead to a greater myoprotein catabolism, even if the same diet was consumed.  This study has profound implications to modern societal norms of eating. It indicates that desirable western eating patterns, infrequent eating would be counterproductive to weight loss through loss of lean muscle tissue, which helps regulate the basal metabolic rate (metabolism).


Clinical Implications

The search of many different approaches to weight loss is a continued misunderstanding among dieters.  With the inundation of quacks, phony or deceitful weight loss products, pills and or “new diets”, individuals become emotionally drained and continue to try new methods hoping or thinking, their new approach will be the ultimate remedy to their unsolved weight issues.  The results of the aforementioned research clearly illustrate that a dieter should have an informed approach to all that one may encounter during weight loss.  It is important for a dieter to know that the method of diet will have less success long term on their success and that a reduction in calories ingested will have the most benefit to their weight loss. 



It is very clear that people who have a support system of friends, family or colleagues when pursuing a weight loss approach will have a higher chance at success than attempting it alone.  It is evident from the research that a thorough, informative and educational process by a health professional of what to expect and how much too realistically expect will yield the dieter more success.  Additionally, a positive psyche before and during the process of weight reduction is imperative to weight loss success.  The evidence clearly states that types of diets are less to minimally dependent on weight loss success as overall calorie reduction is to successful weight loss.  This clearly cuts through all the confusion as to what is the best diet.  The research reviewed states less on the best type of diet and more on overall reduction of calories for weight loss success.  Confusion among the general public will still be prevalent as new diets and new or different approaches to weight loss evolve.  Some diets will be reinvented and some just brought back from previous forgotten attempts.  The health allied professional will still have to battle the plethora of ever evolving new or different approaches as individuals feel that they will succeed by following.  The issues or variables will always point back to evaluating the psychology of their weight loss approach and the calories consumed. 

Future Research

Future research needs to be conducted on the psychological mechanisms to individuals who express a sincere desire to lose weight, have been shown by a health allied professional of what steps to take, what positives and negatives to expect and why indeed, do they still succumb to failure?  The research presented here clearly illustrates the necessary steps numerous people have taken and have indeed achieved weight loss success.  However, the constant struggle of individuals within society to firmly desire weight loss and achieve their goal is an equation that remains unclear to the health allied professionals. 


By: J.D. Reber MS & BS Exercise Science and health promotion CSCS, NASM-CPT