Although obesity in itself is associated with increased morbidity and mortality, massive, poorly monitored weight loss and/or weight cycling can have equally dire consequences. Among the important potential complications to watch out for in the setting of weight loss are cardiac arrhythmias; electrolyte derangements, of which hypokalemia is the most important; hyperuricemia; and psychologic sequelae, including depression and the development of eating disorders (particularly binge-eating disorders).
The 3 major phases of any successful weight-loss program are as follows:
Before enrolling any patient in a weight-loss program, the clinician must have a clear idea of that individual’s expectations. Patients with unrealistic expectations should not be enrolled until these are changed to realistic and attainable goals. Using the pneumonic described, the clinician should guide the patient who seeks weight reduction to create SMART goals: Specific, Measurable, Attainable, Realistic, and Timely.
A specific goal has a much greater chance of being accomplished than a general goal. To set a specific goal, the patient must answer the following 6 W questions:
Also crucial is a clear assessment of the patient's level of motivation regarding the dietary, exercise, and behavioral changes required to maintain weight loss. This assessment should be completed before the patient is enrolled in a weight-loss program. Comprehensive, written, informed consent must be obtained and should address details of the expected weight loss and the required changes.
Because of the potential harm of attempting weight loss in an unsuitable candidate, all patients to be enrolled in any surgical, medical, or other weight-loss program must be exhaustively screened for underlying psychiatric, psychologic, and/or eating disorders.
Although many of the psychologic and psychiatric problems commonly associated with obesity are not contraindications to enrollment in a weight-loss program, clinicians and patients must be aware of these problems before enrollment. In addition, the clinician must ensure that any such problems are relatively stable, quiescent, or well managed before the patient begins a weight-loss program.
The national weight-loss database tracks indices and predictors in individuals with a sustained (≥5 y) weight loss of 15% or greater. The data indicate that sustained compliance with diet programs is by far a more important predictor of sustained weight loss than are consistently increased levels of physical activity. Caloric deficits are more important than any specific composition of dietary macronutrient.
According to a study by Blüher et al, patients regaining weight after initial weight loss on long-term dietary intervention continued to show long-lasting improvements in high-sensitivity C-reactive protein, adiponectin, fetuin, high-density lipoprotein cholesterol, progranulin, and vaspin, suggesting delayed effects of initial weight loss and/or continuous beneficial effects from switching to healthier diets
