Sonia Roman, … Arturo Pandoro, in Dietary Interventions in Liver Diseasein 2019

4.1.1 Obesity Goals, Weight Loss Goals, and Restriction of Energy

Losing weight through exercise and diet is the most effective strategy. It is important to think about achievable goals that will lead to an ongoing as well as healthy loss of weight. Since the majority of NAFLD patients are overweight or obese, a weight loss strategy that ranges from 5% to 10% of the initial weight in 6 months is recommended. 43 According to different therapeutic guidelines for NAFL/NASH (Table 1.1), a weight reduction of 3%-10 percent is anticipated. The improvement in steatosis is evident with a 3%-5 percent loss in body weight and a decrease of 7%-10% can be associated with improvement in the histopathological manifestations in NASH. 40 But, a weight loss >=10% is needed to end NASH and the regression of fibrosis. 44 Energy restriction through diet is required to reduce weight. So, it is recommended that energy levels be decreased by a minimum of 500 kcal/day, and then 1000 kcal/day , or 30% less of the total energy requirement. The energy intake recommended for women is 1200-1500 kcal/day and 1500-1800 kcal/day for men (considering the intensity of physical activity and personal requirements). The goal is to facilitate an effective weight loss program that amounts to around 0.5-1 kg/week. 43 In contrast, a dramatic weight decrease of >1.6 kg/week is not recommended because it may aggravate NASH and cause the growth the gallstones. 45

What is healthy weight loss?

Weight Management The search for a healthy balance

Jacqueline B. Marcus MS, RD, LD, CNS, FADA, in Culinary Nutrition 2013,

Diet Aids

The process of losing weight and keeping it off isn’t easy since it requires a conscious every day effort to track your calories and other activities. The lure of dietary aids can be a tempting. The use of potions and pills to lose weight quickly is much easier than exercising and dieting, regardless of the price. However, are they secure, and what are their long-term consequences?

Herbal and dietary supplements are commonly used to aid in weight loss. The United States, the Dietary Supplement and Health Education Act of 1994 (DSHEA) allows manufacturers to classify herbal products along with nutritional supplements, as food. However, it also allows producers to circumvent certain strict rules of the FDA. As a result, weight-loss aids do not have to meet the same rigorous guidelines as prescription medications or other over-the-counter medicines. Some are sold with limited proof of the effectiveness or safety. Manufacturers could make health claims from their own reviews and interpretation of studies , without FDA approval. However, the FDA may remove a products off its market if it’s discovered to be dangerous. This is crucially important in light of the variety of products that are available via the Internet. The US Federal Trade Commission (FTC) helps to monitor trafficking. A few of these diet supplements are shown on Table 10-2 (24-2724-27. There is no guarantee that they are efficient or safe, as are other options for eating and fitness, consumers should beware. Some potential long-term effects can be quite harmful.

There are a variety of prescription and over-the-counter medicines are on the market to fight the increasing health issue of weight gain. They do this by inhibiting the enzyme lipase , which is required to digest fats, numbing the taste buds; raising the brain chemical norepinephrine that signals satiety; suppressing appetite and other ways.

Potential side effects include decreased the absorption and utilization of vitamins that are fat-soluble, digestive problems, and an increase in cardiovascular and blood pressure. Even “Dieter’s Tea” which is readily accessible at some supermarkets, may cause extreme extreme dehydration and gastrointestinal issues, and in some cases, death.

Pulmonary Disease

LAURA E. NEWTON MA, RD, SARAH L. MORGAN MD, in Handbook of Clinical Nutrition (Fourth Edition), 2006

Respiratory Function

As body weight decreases and the body weight decreases, there is a decrease in the body’s capacity and size of the diaphragm as well as the respiratory muscles’ function. In emphysema the hyperinflated lungs alter the fiber size of respiratory muscle, and decrease their effectiveness. Due to malnutrition, the diaphragm, intercostal and accessory muscles are catabolized in order to gain energy, which results in lower inspiratory capacity. Infection, inflammation, as well as reduced protein intake result in the decrease in serum albumin. This lowers the oncotic pressure , resulting in the development of pulmonary swelling. Undernutrition also affects the pulmonary parenchyma by diminishing collagen creation in addition to increasing proteolysis. This may manifest as decreased production of surfactants, and even alveolar collapse.

Weight-loss surgery for women who are planning to have a baby: where do we stand currently?

Siara Teelucksingh … Surujpal Teelucksingh and Surujpal Teelucksingh Obesity as well as Obstetrics (Second Edition) 2020

Pregnancy outcomes after weight-reducing surgery

The advantages to reproductive health after weight-reduction surgery not only begin with the increase in fertility and improved sexual function but may also be extended to the outcomes of pregnancy also. In a case-control study that compared pregnancy outcomes among women who had undergone bariatric surgery versus similar BMI and age who had not undergone surgical procedures, they found some noteworthy advantages [47and 47]. These findings were comparable to those elaborated in a large analysis and review of the data of more than 8000 pregnancy outcomes post-bariatric surgery [49(49). In sum, when compared to those who underwent the bariatric procedure, there were reduced prevalences of gestational diabetes and pregnancy-induced hypertension, and significant reductions in neonates that were large for date. The need for an operation was also decreased (the amount of time needed for treatment ranging from 5 to 11). It was also evident that there is a tendancy to reduced postpartum hemorrhage with an amount needed to benefit of 21. The primary risk to the fetus was low in the case of dates (odds ratio: 2.16 with number of harms 21,), IUGR (odds ratio: 2.16 and number needed to cause harm in the range of 66) and preterm birth (odds ratio: 1.35 as well as the number of women who needed harm: 35). In the end, the results showed there was no change in the frequency of preeclampsia. For the neonate: needs for ICU involvement, congenital anomalies, and deaths were the same. On the other hand, there was moderately increased risk for low birth weight, preterm delivery, and high risk for small-for-gestational age. Even with this the study suggests that there could be continuing benefit into the teen years. So, there are reports from two studies looking at the growth of children born to parents following GBS which indicate that the benefits from maternal antiobesity surgery are transmitted to their children. In the study that was conducted in the southern region of Brazil, the rate of obesity among children born to 19 women before surgery was 55%. However, the figure dropped to 31% for children born to these women following bariatric surgery. In the second study, 118 children, aged 2-18 years, born to women following biliopancreatic bypass surgery were compared to children born before these women had surgery. It was also found that the antiobesity procedure performed on mothers confers advantages to the children they produce: the prevalence of overweight was reduced to that of the general population; obesity was decreased by 52%, and severe obesity was reduced by 45% [49-552 (Tables 31.3 and 31.4).

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