Intermittent fasting can reduce appetite if you don't do it the right way

Intermittent fasting is an eating pattern which involves regular periods of fasting and eating. In this diet plan, one needs to fast for 10, 12, 14 or 16 hours, depending how the body responds to fasting. Whenever you feel hungry, it is important that you feed yourself and not starve. It is when you do the latter that it may show negative side effects like slow metabolism and lost appetite. Every diet plan comes with a set of pros and cons. It is only when you follow them with the right pattern that the likes of intermittent fasting and keto diet show effective results.

When you follow this diet plan diligently and do not starve your body when hungry, it may offer health benefits like weight loss, better digestion, detoxification and even reversal of type 2 diabetes. However, drinking coffee or tea during the fasting period, and fasting for as long as 16 hours can lead to loss of appetite.

1. Loss of appetite: Studies have found that intermittent fasting may reduce appetite over time, and this may help with weight loss too. But, nutritional deficiencies, fatigue, headache and lack of energy are likely to follow. The body needs good food and nutrition to function effectively throughout the day, and lack of it will simply do way more harm than good.

Also read:Weight Loss: Kareena's Nutritionist Explains How You Can Make The Right Diet Choice

2. Disturbed sleep: For some people, sleeping on an empty stomach may be difficult. One is quite likely to feel hungry at 11 pm or 12 in the midnight, if the dinner was done at 7 pm or 8 pm. During the initial few days or weeks of intermittent fasting, it may get difficult to adapt to the change in eating pattern. And since one is simply not allowed to eat food in fasting phase, sleep may be disturbed.

3. Increased cravings, mood swings and irritability: Even though intermittent fasting is liberal in terms of carbs, fats and protein, the fasting period of it works just like calorie restriction. So, practicing portion control and eating healthy, preferably low-calories foods is what you need to effectively lose weight. Increased cravings, mood swings and irritability are some of the top side effects of calorie-restrictive diets.

Do not starve yourself to fast in intermittent fastingPhoto Credit: iStock

Also read:5 Mistakes You Need To Avoid When Satisfying Hunger Pangs Between Meals

4. Slow metabolism: Elongated fasting periods and lack of sufficient nutrition during the eating phase can slow down body's metabolism in case of intermittent fasting. Experts suggest that this kind of diet plan must be avoided by people with diabetes, those with history of eating disorders like anorexia and bulimia, and pregnant or breastfeeding women.

5. Too much reliance on caffeine: Some health experts recommend drinking tea or coffee during eating phase of intermittent fasting. Over a period of time, these stimulants can make you go for hours without feeling the need to eat. Too much reliance on coffee during the fasting phase may become an inevitable side effect of intermittent fasting.

To make intermittent fasting work for you, it is important that you eat healthy, filling and nutritious foods during eating phase. Cut down on the duration of fasting phase if your body craves food. Avoid unhealthy snacking and be physically active; regular exercise is a must.

Also read:Weight Loss: Ever Tried A Wall Workout? Try This Unique Routine Which Can Be Done In Just 10 Minutes!

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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Intermittent Fasting: Increased Cravings And Other Side Effects You Cannot Ignore - NDTV

Just one year ago, Joanne Morgan struggled to walk down the stairs without grimacing in pain, she struggled to enjoy playing with her children due to constant exhaustion caused by her aches and pains and slow recovery after major surgery.

Now, the 32-year-old Co Down woman has a spring in her step and has never felt better after shedding 5 stone, 5 lbs in just 7 months.

Joanne credits WW, the new Weight Watchers with helping her lose weight and keep it off, as well as improving her quality of life tenfold.

Having struggled with her weight on and off for years, Joannes frustration at not being able to shed the pounds increased after she underwent a hysterectomy in January 2019.

I didnt know what weight I was when I started WW I just knew I had a lot of weight on. The year before I started, I got out of hospital on New Year' s Day, I had to have a hysterectomy and I sort of was in a rough wee place at the start of last year. I just wasnt 100% and I knew myself I had the weight on and I was sort of trying to get it off but it wasnt coming off and I was really stressing myself out about it.

An unexpected trip to visit her brother and newborn baby in Australia gave Joanne a whole new outlook and she started to realise she had the mental drive to lose weight if she was really focused.

Whilst I was there [in Australia] I went for this walk along the coast and I just thought to myself how lucky I was to have my children and things like that. My friend had joined WW the week I left for Australia and I told her I would join when I was ready. I kept getting told as well by the surgeon and the doctors to give myself a year's recovery and I did, and as soon as I did that and I got my head and my hormones right, after Christmas-the first week of January, I joined WW and never looked back.

At her heaviest Joanne was 16stone 1lb and set herself a goal of losing 5 stone 5lbs, and she achieved that, in just 7 months using the WW programme. Joanne says it was bad food choices which led her to pile on the pounds, particularly her fondness for chocolate and takeaways, but now, she still enjoys both, just in moderation.

My downfall was basically bad choices with food, anything convenient, couldnt be bothered cooking dinner tonight, we will get McDonalds, we will get Friar Tucks, takeaways and chocolate were the two things that I pinpointed as my issue.

The best thing about WW is still being able to have your treats and you can easily track everything, everything is so easy to find on the tracker app and you can carry over some of your points if you know you have a meal out or drinks coming up at the weekend, you can still enjoy those things and lose weight.

WW is definitely an easy plan to follow, its not tough and you have so much variety. I would be obsessed with chocolate bars and what I do now is instead of having say a Snickers, I would have two Skinny Whip bars and its still less points than a Snickers, Im very much I need my chocolate fix every day but on WW I can have that.

As well as her svelte new figure, with losing the weight, also came added health benefits for the mum-of-two, who struggled for years with chronic pain/

I would have suffered from chronic pain in my back, I broke my tail bone quite a few times and have had surgery on my right shoulder twice, and the left one wouldnt be that great either. But I was getting reflexology and dry needling done for the aches and pains, but once I started to lose the weight I cut down on those appointments, the pain subsided and now I would get the dry needling done maybe only once a month.

She also believes daily walks have helped improve her mobility and helped with the weight loss.

I walked the bit out as well, I walk once a day minimum, if its my day off Ill try and get two smaller walks in and it keeps my head right as well. If I was in a bad place and it was usually over my health and not having the energy to do the things like not being able to do what I want to do with my children because I was constantly tired. But now with the weight off Im jumping out of the bed. I used to have to walk downstairs sideways due to the pain in my back and my legs and the weight didnt help that so I feel so much better now.

Despite the temptation that surrounds her daily whilst working in a busy fast-food cafe, Joanne says she was kept on track by her local WW coach Deirdre Murdock.

My WW coach Deirdre Murdock was so supportive, everyone that is thinking of going to WW in the Newry/Warrenpoint area, Deirdre is brilliant, shes so authoritative, she gives brilliant advice and words of wisdom, were always waiting every week for her wee one liners. When lockdown came I had hit the three stone off and I thought Im not giving up on her either because she is so good and I didnt want to let her down, never mind myself.

I was made redundant from my job last year and I thought I was just getting myself together before I got that wee job in the cafe and I felt it wasnt probably the right job for me to go into with the weight on but it suited with the children and school hours but I still managed to lose the weight.

Urging anyone who was in a similar position of wanting to lose weight but unsure of how to get started, the Newry woman added: First of all, as long as your head is in it and youre ready to do it for you. And just stop making excuses! I made excuses for years as to why I was putting on a few pounds here and there and its not doing you any good. Just be ready, be prepared to give it your all. WW is so manageable and so realistic, there is nothing you cant have in moderation, but you need to be in control.

Are you a lover of Style, Beauty or Interiors? Maybe you want the latest tips on keeping fit, eating right, organising your home and staying well, not to mention all the latest showbiz goss and the craic around town then follow Belfast Live's brand new lifestyle page Be.

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Everyone says to me you did so well because I work in a fast-food cafe and the temptation is real with the goujons and big fat fries and I could have carried that on but I didnt, its a lot about self-control and a positive mindset."

Link:
Weight loss success for Co Down mum who shed more than five stone in just seven months - Belfast Live

weight-lossBy Bunmi Sofola

Most people struggle to lose weight and their efforts are not helped by the numerous myths surrounding losing weight. Here are some of them:

Myth 1: Missing breakfast is a good way to lose weight youll have heard that breakfast is the most important meal of the day and its true. When youre asleep you are fasting, and its important to break this fast by eating when you wake up. If you dont, youll miss out on much-needed vitamins and minerals. You could also end up feeling hungry later in the day and start snacking on bad foods, therefore increasing your calorie consumption.

Myth 2: You always gain weight when you quit smoking: Nicotine can increase your metabolism, but only slightly. The problem occurs when people who give up smoking replace a cigarette with bad food. However, if you chew sugar-free gum or snack on vegetables, this can prevent weight gain. You could also try keeping your hands occupied or having a bath to distract yourself.

Myth 3: Working out on an empty stomach burns more fat: The idea that exercise without eating will make your workout more efficient isnt true. In fact, research shows that youre more likely to burn fat throughout the day if you can eat something before you hit the gym. Try having a piece of fruit or yogurt 30 minutes before your workout.

Myth 4: Low-fat and fat-free foods are better for you: However, tempting it is to opt for reduced-fat items, they are no better for you, and can sometimes be worse. To make for fat being removed from foods, other ingredients are used such as sugar, flour, thickeners, and salt, all of which can add calories. Low-fat and fat-free versions can also be less satisfying, meaning you could end up eating more food in its most natural form is best and portion control is key.

Myth 5: Yo-yo dieting will wreck your metabolism. While low-calorie and a yo-yo dieting can have an effect on your metabolism, its not true that these changes are permanent. Your metabolism will naturally go up and down throughout life, but if you stop dieting, it will eventually return to normal. Its not wise to try out fad diets all the time. They are hard to maintain and once you stop dieting, its likely the weight will return.

Myth 6: Cutting carbs will help you lose weight. Stopping eating carbohydrates all-together isnt good for your health. Carbs are a necessary part of your diet and provide vital energy. In the short term, eliminating them can result in the loss of water weight rather than fat. Furthermore, carb-free diets can lead to bad breath, fatigue, and headache. Eating a small portion of bread, pasta, or potatoes with a meal will not make you put on weight.

Myth 7: Eating before bed causes weight gain: People used to say that having a big meal before going to bed would cause you to pack on the pounds. But timing wont make a difference. A calorie is a calorie no matter when you eat it. The problem arises when people snack late in the evening to overcome stress or boredom, or to satisfy cravings. After-dinner treats tend not to be controlled and are often unhealthy foods such as chocolate or crisps. Try giving yourself a cut-off time each evening when you tell yourself to stop snacking.

Myth 8: Eating little and often will make you burn more fat. Many dieters think that eating small meals throughout the day is key to shedding pounds. Some claim that it keeps your metabolism going and starves off hunger, but theres no actual evidence of this. A study found that switching from three daily meals to six didnt help weight loss. In fact, it made people want to eat more. You are better off cutting down on your number of calories per day, regardless of when and how often you eat.

Myth 10: No pain, no gain. Ever heard the rumour that when exercising you have to feel pain for it to be working/ Experts are adamant that this is untrue as well as harmful. Its normal to expect some soreness a day or two after exercising, but not to feel pain during your workout. If you do, youre probably doing it incorrectly or may already have an injury. Stop, rest, and see if the pain disappears. If it doesnt, consult your doctor.

Vanguard

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Coping with the myths of losing weight - The Streetjournal

Today, there are a huge number of books, articles on the Internet and magazines on how to eat properly in order to get a dream figure. Materials have been compiled, including by nutritionists, but often in their content you can find many myths in which it is high time to stop believing.

Image via: pxhere.com Saturated fats, the dangers of which many nutritionists shout about, are actually very beneficial because they normalize hormones of both sexes and help the absorption of fat-soluble vitamins. Animal fats are also considered to be rich sources of energy, which the body can use in stressful situations. Another thing is that there are too many of them in the human diet. Thus, trans fats are used to preserve the freshness of products as long as possible, and during heat treatment they acquire even more pronounced carcinogenic properties. That is why you should limit yourself to baking with margarine and fast food.

Cholesterol contained in eggs can be both harmful and beneficial, which depends, as in the previous case, on its amount. It is able to fill holes on the inner walls of blood vessels, stimulate cell growth and become a reservoir of energy during explosive activity, for example, when running uphill. The human body has not learned to throw away cholesterol, and in the meantime, people consume more and more food with its content every year, which leads to problems with the cardiovascular system and atherosclerosis. Man has always eaten eggs. In addition to essential trace elements and vitamins, they contain phospholipids, with the help of which bad cholesterol is dissolved and further removed from the body. But in everything you need to know when to stop.

Calories are energy that is needed even during sleep, so you should stop calculating them when planning your diet. Energy ensures the correct functioning of the heart muscle, lungs and other organs, is involved in the digestion and absorption of food, and is also responsible for the safety of muscles and cell division. If the body does not receive it, it switches to the economy mode, slowing down metabolic processes. It is necessary to create a calorie deficit exclusively by increasing physical activity.

Low-carb diets, dangerous according to some experts, are the easiest, most satisfying and effective way to lose those extra pounds. Moreover, they speed up the metabolism, and calories begin to burn more intensively.

Diet is a very individual thing, so the method in which it is proposed to eat in small portions, but more often, is not suitable for everyone. The number of visits to the refrigerator during the day does not matter at all. What matters is what kind of food is on the plate.

Link:
Five weight loss myths that even nutritionists often broadcast - The Times Hub

We all want our children to be healthy and to love their bodies how can parents help them if they need to lose weight? TODAY Parents experts weigh in on how to talk to kids about their weight without having them hate you, or themselves.

Nearly one in five U.S. children are "obese," according to a 2016 report from the National Center for Health Statistics, as defined as having a Body Mass Index (BMI) at or above the 95th percentile.

Though some professionals differ as to how much obesity directly affects health, the Center for Disease Control lists high blood pressure and cholesterol, type 2 diabetes, asthma, sleep apnea, joint problems, and fatty liver disease as some of the possible complications of childhood obesity. The CDC also warns that obese children face a greater risk of anxiety and depression, low self-esteem, and bullying.

Now, there is also evidence that obesity can make the complications of COVID-19 more severe even in young people.

How can parents address obesity in a child without causing them to feel ashamed or embarrassed?

Never miss a parenting story with the TODAY Parents newsletter! Sign up here.

The American Academy of Pediatrics defines children with BMIs between the 85th and 95th percentile are considered "overweight." Those with BMIs over the 95th percentile are defined as "obese."

Children with BMIs between the 5th and 85th percentiles are generally considered to be at a "healthy" weight, and experts do not recommend talking about weight specifically with them. Instead, make a point to talk generally about health, physical fitness, and nutrition, parenting and child development expert Dr. Deborah Gilboa told TODAY Parents.

"You want to talk about food and fitness just like you teach your kids about allowance and chores and money things they're going to need to know as adults," she said. "We should do that no matter what their weight is."

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Gilboa said it is important for all kids to be aware of how much of what she called "tushie time" they have in their lives which includes not just time spent sedentary while on screens, but also "puzzles and books and just sitting around."

Pediatrician Dr. Tobi Amosun, medical director of Nashville's Academy Children's Clinic, acknowledged that BMI is an imperfect measurement of overall health and physical fitness; many factors go into obesity, including a family's structure and socioeconomic status, depression and anxiety, and even whether a family lives in a neighborhood where children can walk to and from school.

Depending on your family's race and ethnicity, Amosun said, a "healthy" BMI range might be higher or lower, and if your child is very active and athletic or has a larger frame, they might have a higher BMI but be very healthy.

If your child's BMI is over the 85th percentile, first take family history, where they are in their growth, and their physical activity into account. Then, if you determine that a change needs to be made in your home and lifestyle, follow these guidelines:

If you have an obese child in preschool or elementary school, you can naturally limit their food choices by limiting what you buy and make available to them in your home. Instead of talking about the number on the scale, talk about the content and quality of their food choices and their activity level without any sense of value judgment or shame, Gilboa said.

"Focus on wanting their bodies to work well without getting tired or wearing out, to keep up their energy," she said.

New York City-based dietician and intuitive eating expert Shana Spence told TODAY Parents she doesn't believe it's ever a good idea to label foods as "good" or "bad," especially to children. "They can take that kind of message into adulthood," she said, and it sets them up for a problematic relationship with food.

Instead, she advocates teaching children mindful or intuitive eating practices, which adults can role model as soon as children begin eating solid foods.

"What I recommend to parents first is sitting down to have meals," said Spence. "I don't think we realize how much we rely on grab-and-go food in this country. I know we're all running around, so sometimes we have to, but especially with kids it's super important to get them to start really thinking about what they're eating."

When you sit down and make yourself focus and be present in the moment while eating a meal or snack without phones or other gadgets nearby, Spence advised you more naturally ask yourself, Do I really want this?

"A lot of time, we eat just because it's convenient. We're not really thinking about what we're putting in our body," said Spence. "For instance, potato chips are delicious and are fine as a snack, but if you aren't thinking about it, you are probably eating more than you normally would."

Mindful eating, whether for children or adults, is about really figuring out the foods that work for our bodies and being aware of how they make us feel, Spence said. For example, if your child plays sports, teach them to think about how what they eat before practice or a game affects how their bodies feel and perform.

"Don't teach kids to 'diet,'" Spence said. "Replace that word with the idea of 'mindful eating' instead."

Mindful eating is even more important to reinforce in older children and teenagers who are more likely to want to eat while playing video games or on their computers instead of sitting down at a table for every snack or meal.

Spence recommended continuing to encourage older kids to focus and be present when they are eating, and she suggested distinguishing foods as "nutrient-dense" or not instead of "good" or "bad."

In older children, the way you talk about obesity matters, and it's important to know your own child and how they receive information surrounding weight and body size, said Amosun.

When she approaches a conversation about weight with a teenager, she begins by asking questions like, "How do you feel about your body size or shape?" This helps her keep the conversation neutral and non-judgmental. Sometimes, she said, teens will answer with frustrations not about their weight at all, but about their height or their proportions.

"I think the main thing is to know how to frame things in a way that's not about the child as much as it is about looking at their health," Amosun said.

With younger children, the conversation can focus on feeding their bodies to be able to keep up with their friends on the playground, but in teenagers, it can be more nuanced.

Amosun said she emphasizes that the goal is to feel good about their bodies, no matter what they look like. "Everybody looks different; all bodies look differently," she said. "I tell my patients, 'I want you to feel strong and confident in your body not just physically strong, but mentally and emotionally too.

"I have plenty of girls who are round and curvy, and they love their bodies," Amosun said. "They're healthy, and I tell them, you know what? Great. Make sure you exercise and eat a good diet."

Originally posted here:
How to talk to kids about losing weight without them hating you (or themselves) - Yahoo News

By: Rachel Bleier September 23, 2020

If you want to swing like Bryson, you need to assess your body first.

Getty Images

You just watched Bryson win the U.S. Open with a bulked-up frame and a bombers mentality. Now youre sold on getting huge and adding yards to your game.

Youve bought the protein, youre planning your workouts and you know this is going to make you a better golfer. Right?

Not so fast.

While its great that youre committed to improving your game for the long haul, there are a few things you need to know before just jumping into a Bryson-like fitness regimen.

In a recent interview with golf performance coach Joey D Diovisalvi, he said the average golfer needs to be completely honest with where they are physically before starting any fitness routine. For the pros, this isnt a hobby, Diovisalvi said. Average people are not professional athletes.

So check your idea that you can do what the top one percent of golfers do at the door. While we all like to think we can do whatever the pros do, we cant. The main difference being, the pros have been building their swings and training their bodies to swing at maximum speeds for their entire lives while we average Joes have not.

Bryson was able to bulk up the way he did because he put in years of work, has his diet down to a science, and had a solid foundation for his swing before he started the process.

As much as you want to go out and smash it off the tee like Bryson, or any other Tour pro, your body likely lacks the necessary mobility, flexibility, strength and/or stability to do so safely.

Diovisalvi recommends using a pros swing as a template for your own swing rather than trying to mimic a pros swing outright. He also suggests choosing what specifically about the pros swing you want to add to your own move.

If you want to swing like Bryson, you probably want more speed. To swing faster, you probably need to work on your mobility and your strength. Improved mobility will help your range of motion and give you the ability to get into better positions and strength will help you be more explosive.

Using what Diovisalvi calls small screens to assess where your body stands physically and where you need to improve will help you come up with a training program that will get you closer to your goal of swinging like Bryson, or your preferred Tour pro.

Once youve identified where you need to improve, you can build a program that will set you on a path to improving your swing. Like anything worth doing, this will take a lot of work, so dont get discouraged if youre not seeing immediate results. And whatever you do, dont compare yourself to a Tour pro during this process its not a fair comparison because everyones body is different, and youre likely not playing, training or otherwise working on your body and game 24/7.

It took Bryson over a year and a half of two-a-day workouts and speed sessions to change his body and swing.

Getty Images

It all comes down to doing whats right for your body and what will help you achieve your goal. If you dont believe us, take it from Bryson.

Im doing what I think is right for my body, Bryson said of his transformation. Some people may want to lose weight. Some people may want to get more flexible. I just want them to know anything is possible if you work hard.

In all honesty, you probably wont ever get to the level of swinging it like Bryson or Dustin Johnson or Rory McIlroy, but with the right goals and progressions you can get closer to swinging like your favorite golfer.

The key is figuring out where youre starting from and building a program that is right for your body. From there, hard work is all you need to start achieving your goals of swinging (somewhat) like a Tour pro.

Link:
Why the average golfer shouldnt try to swing like Bryson DeChambeau, or any other Tour pro - Golf.com

For all types, if you're struggling to lose weight, I often recommend omitting both gluten and dairy, as these foods can be inflammatory.

Anti-inflammatory foods are also important for promoting hormone balance and digestive function, especially for Warriors, Anchors, and Trailblazers. Begin by omitting sensitivities and incorporating more anti-inflammatory foods and spices, such as turmeric, ginger, blueberries, pineapple, and celery.

Protein is key for Anchors to support adrenal function, while Protector types may want to limit their intake of red meat in favor of more easily digested proteins.

You'll want to omit sugar, refined carbohydrates, and alcohol if you're a type who struggles with Candida overgrowth, most commonly Anchors and Protectors. This type of yeast overgrowth can cause bloating, fatigue, joint pain, and weight gainbut it's often a latent infection overlooked at most doctors' visits.

See original here:
Struggling To Lose Weight? This MD Says Knowing Your "Weight Loss Type" Will Help - mindbodygreen.com

About 2 years ago, I wrote my first commentary for Medscape on obesity, a topic that is both close to my heart and something we encounter ubiquitously in clinical practice. I was thrilled to see hundreds of responses pouring in.

But the excitement quickly faded as I started reading through the comments.

"Making [obesity] a disease only gives cover to the obvious and excuses the obese individuals from owning up to their responsibilities in modifying their behavior."

"Please don't medicalize everything. Only you decide what and how much to shove down your throat."

"Eat too much, don't exercise, and most people will get fat."

"Get off the video games and TV, online streaming, etc., and take care of your priorities, for god's sake."

And the worst: "Would someone please show me a picture of an obese POW or obese person in a concentration camp?"

Judging from these comments, you'd think that treating obesity is simple, that the patient simply needs to make some quick and easy modifications to their behavior.

Interestingly, the results of a Medscape survey showed that HCPs are seeing an average of 60-70 patients with obesity/overweight every month, and that these HCPs are recommending dietary modification for about 85% of patients. And guess what? Rates of obesity are still rising.

Take a moment to think about that. Can you think of any other medical condition where 85% of those afflicted are unable to adhere to physician recommendations? Is there any medical condition where 85% of those afflicted are unmotivated to improve their health? Would 85% of those with myocardial infarction refuse to go for cardiac rehabilitation, or 85% of those with COPD continue to smoke?

So, what makes obesity so different? Could it be that 85% of patients with obesity don't all suffer from gluttony, laziness, or a pervasive lack of willpower? Perhaps the underlying, bitter truth is that we are doing a shoddy job of identifying the real causes of obesity and keeping up with evidence-based medicine.

Let's take a look at the reader comments and see what the evidence says.

The majority of people who commented on my first piece stated in some form that people with obesity have an addiction to food and that the blame lies completely with them.

The term "addiction" not only has strong, negative social connotations but also has precise medical definitions that cannot be used loosely. Although some models suggest similarities between substance use disorder and chronic consumption of energy-dense foods causing changes in the brain's reward pathway, the use of food addiction as a diagnostic category is premature.

The model rests on the central assertion that some categories of foods or specific nutrients exert a direct effect on the brain, enacting changes that ultimately hijack reward-related behaviors. However, central features of substance addiction do not plausibly translate to food and consumption. The validity of measures such as the Yale Food Addiction Scale has come under question with arguments that warrant classification of obesity as a distinctive disease phenotype rather than an expression of strong habits and preferences. "Food addiction" as a concept needs to be considered as a distinct entity from obesity, as conditions such as bulimia nervosa that meet the criteria of hedonic dependence on food do not necessarily translate into obesity.

What is the definition of efficacy? Effective control of diabetes is achieved when an individual's A1c is < 7.0%. Effective control of blood pressure is when blood pressure is at target. Depending on the starting point, a single medication may not be enough to bring a patient to the glycemic or blood pressure target. Often, we require multiple medications in addition to lifestyle modifications in order to achieve these targets. Why is it, then, that we expect a weight loss of 50-80 lb with a single medication for patients with obesity?

We treat diabetes and hypertension to goals that are not in the normal range for blood sugars or blood pressure, but rather to a level that mitigates the occurrence of complications arising from these conditions. So why are we so fixated on weight loss targets that involve a specific number on the scale or an ideal body weight rather than the recommended 5%-10% weight loss recommended by guidelines?

Unrealistic expectations or being dismissive of the weight loss achieved can dangerously undermine its benefits. Patients already often expect weight loss that is two to three times greater than what can realistically be achieved. Clinicians must help patients accept more modest weight loss outcomes. This highlights the need for personalized care that considers the patient's specific profile.

It's time to move away from an ideal body weight target and toward a healthy body weight concept to avoid disappointment and premature discontinuation of medications when they have actually worked but not to the degree that was expected.

No one would choose to be unhealthy. We might think we are doing our part by counseling patients on lifestyle modification, but it needs to be much, much more than a cursory, patronizing "Eat less and move more."

A study evaluating audio recordings of 40 primary care physicians counseling 461 of their patients with obesity/overweight found that only 13% of patients received counseling that went beyond "eat less and move more." Only 5% of patients were encouraged to book a follow-up visit to discuss results. When pushed into a corner, it's easy for clinicians to turn the blame on patients and say that they are the ones at fault. We need to do more than this for our patients with obesity.

Multiple comments reflected all types of macronutrient-based approaches, meal replacement strategies, dietary patterns (eg, Nordic, Ornish, vegetarian, low glycemic index, etc.), intermittent fasting, and intensive lifestyle intervention techniques. All of these approaches produce the caloric deficit required to initiate weight loss, but sustaining the loss may be difficult over the long term because of compensatory mechanisms that promote positive calorie intake by increasing hunger and the drive to eat.

To date, no single nutrition intervention has been shown to best sustain long-term weight loss, and literature continues to support the importance of long-term adherence, regardless of the intervention. In fact, according to the US Preventive Services Task Force, it is not the diet itself but the support and attention patients receive while on it that make it effective. Individualized nutrition consultation by a registered dietitian has been shown to result in greater weight loss compared with usual care or written documentation, highlighting the role of individualized dietary plans performed in a multidisciplinary setting as one of the best ways to administer medical nutrition therapy for those seeking weight loss.

I sincerely hope that the few statements about the lack of obesity in WWII concentration camps do not reflect our community as a whole. Surely, we are not purporting that human beings undergo abject starvation and the associated mental trauma just for the sake of losing weight, are we?

Weight loss is not just a number on the scale, and those losing weight due to starvation experience not only the loss of adipose tissue but also significant multicomponent malnutrition and sarcopenia, not to mention the biopsychosocial ramifications.

As medical professionals, we pride ourselves in providing the best care for our patients. We would never treat a patient with a heart attack on the basis of our personal beliefs, so why do we do so for our patients with obesity? We need to have a structured, multidisciplinary, evidence-based approach that acknowledges the far-reaching effects of obesity, tackles the issue bereft of all bias and stigma, and encourages healthy and realistic goals, conceding that there may be triumphs and disappointments along the way, as with any chronic condition. Blaming patients will lead to little benefit.

I'd like to end with what was perhaps my favorite comment that the article received:

"People often reserve their harshest judgments for those conditions about which least is known."

Akshay B. Jain, MD, is a clinical endocrinologist who has practiced in three countries, focusing on mitigating the complications of diabetes and obesity. He is fluent in six languages and has spoken at more than 500 programs internationally.

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Obesity and the Bitter Pill of Truth - Medscape