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The Art and Science of Weight Loss

Article in American Journal of Lifestyle Medicine · January 2015

DOI: 10.1177/1559827613520107

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AJLXXX10.1177/1559827613520107American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine

American Journal of Lifestyle Medicine Jan • Feb 2015

Editorial
Elizabeth Joy, MD, MPH

The Art and Science of Weight

Loss

U
nhealthy dietary intake and underpinnings. Our genetics certainly There are many components that play a
inadequate physical activity are play a pivotal role in behavior and role in successful behavior change, such
the foundation of many chronic behavioral consequences. Yet equally as knowledge, attitudes, beliefs, and
diseases that plague the human race. important is where we live and with barriers. What is important to note here
These behaviors have their roots firmly whom we live. The latter concept has is that knowledge alone is not enough! A
planted in a society that has increasingly become increasingly well developed in recent meta-analysis by Rose et al8 titled,
engineered physical activity out of our the past decade, where we have come to “Physician Weight Loss Advice and
lives, and made available food that is understand that people who associate Patient Weight Loss Behavior Change”
high in fat and calories. The combination with healthy friends (who eat better and found that physician counseling
has turned deadly for our society. Low move more), are in fact more likely to be regarding weight loss results in clinically
aerobic fitness, a consequence of healthy themselves.6 The converse also significant weight loss. Studies in the
sedentary lifestyle, is associated with a holds true, such that people who are meta-analysis generally included and
56% increased risk of heart disease,1 and obese tend to have obese friends.7 assessed the impact of a behavioral
a 35% increased risk of Alzheimer’s
dementia,2 compared with individuals . . . efforts to reverse trends in
with high cardiorespiratory fitness. It is
estimated that physical inactivity obesity . . . need to address not
accounts for 1 in 10 deaths worldwide;
and if physical inactivity could be only biology but also environment,
reduced by just 25%, 1.3 million deaths
could be averted each year.3 Likewise, social networks, and ultimately,
diets high in saturated fat are associated
with higher rates of heart disease.4,5
behaviors.
With such compelling evidence
regarding the risk of unhealthy dietary These findings suggest that efforts to component, such as motivational
intake and inadequate physical activity, reverse trends in obesity, and other interviewing, use of the 5 As (Assess,
along with the benefits of meeting chronic diseases resulting from diet and Advise, Agree, Assist, Arrange), and
recommended guidelines for diet and inactivity, need to address not only communication skills of the physician. It
activity, why does our society still biology but also environment, social also bears mentioning that the US
struggle with these behaviors and the networks, and ultimately, behaviors. Preventive Services Task Force
subsequent consequences? The answer Behavior change is one of those 14 recommends intensive lifestyle
to this question is long and complicated. letter phrases that is so easy to say, yet intervention for obese individuals
In the simplest of terms it can be so hard to do. Ask anyone who has tried seeking weight loss.9
explained from a socioecologic to quit smoking or lose weight, and they In this issue, Dr Janet Rankin10 has
perspective with firm biological will most likely tell you how hard it was. nicely summarized the literature on diet

DOI: 10.1177/1559827613520107. From Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah. Address correspondence to Elizabeth Joy, MD, MPH,
Clinical Outcomes Research, Intermountain Healthcare, 36 S. State Street, Salt Lake City, UT 84111; e-mail: [email protected].
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2014 The Author(s)

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 vol. 9 • no. 1 American Journal of Lifestyle Medicine

and exercise interventions aimed at patient by making an action plan principles, we can help our patients
improving body composition in promoting accountability and identifying achieve their goals and improve their
individuals with obesity. In it, she reports resources. This is the place for SMART health.
that the optimal diet to achieve a leaner goals—Specific, Measurable, Attainable,
physique is moderate in total calories, Realistic, and Time-based. The fifth A is
low in fat, and higher in lean protein. In “Arrange.” This may include arranging a References
addition, she concludes that exercise referral to a personal trainer or physical
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alone is insufficient to result in therapist, if needed. It may be to Cardiorespiratory fitness as a quantitative
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combination with the aforementioned the treatment plan, and assess progress. cardiovascular events in healthy men
dietary changes, 250 minutes per week Changes in healthcare coverage have and women: a meta-analysis. JAMA.
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change. “Assist” includes supporting the applying sound behavior change doi:10.1177/1559827613507879

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 American Journal of Lifestyle Medicine Jan • Feb 2015

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