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 Get the facts about weight loss. Discover what works for you to improve your chances of losing weight and keeping it off. According to research or other evidence, the following self-care steps may be helpful: |
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| Science Ratings | Nutritional Supplements | Herbs |
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Multivitamin-mineral (for very-low-calorie diets) |
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Beta-hydroxy beta-methylbutyrate (HMB) (for improving body composition only) |
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(-)-Hydroxycitric acid (HCA) Guar gum |
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| Reliable
and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies
suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal
or no scientific evidence. For a supplement, little scientific support and/or minimal health
benefit. |
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Medical options
Over-the-counter products such as Dexatrim Natural No Caffeine® and Dexatrim Natural No Ephedrine® are available to assist with weight loss.
Prescription medications commonly prescribed for weight loss include sibutramine (Meridia®), orlistat (Xenical®), and phentermine (Fastin®, Ionamin®). Stimulants, such as dextroamphetamine (Dexedrine®) and methamphetamine (Desoxyn®), are occasionally used.
Other treatment typically includes dietary changes to limit fat and calorie intake, increased exercise, and changes in eating habits or patterns. Severe cases might require surgical options to reduce the size of the stomach or to bypass a portion of the stomach and intestines.
Dietary changes that may be helpful
Breast-feeding
In a preliminary study, breast-feeding during infancy was associated with a reduced risk of
developing obesity during early childhood (ages three to four years).15
In a preliminary study, overweight individuals who adhered to a very-low-carbohydrate diet (25 grams per day initially, increased to 50 grams per day after a certain weight-loss target was achieved), with no limit on total calorie intake, lost on average more than 10% of their body weight over a six-month period.16 The participants also engaged in aerobic exercise at least three times a week, so it is not clear how much of the weight loss was due to the diet. Blood tests taken during the study suggested that the low-carbohydrate diet induced a condition called mild metabolic acidosis, indicating that long-term consumption of this diet may not be entirely safe. Individuals wishing to consume a very-low-carbohydrate diet for weight loss or for other reasons should be monitored by a doctor.
Calorie restriction
Calories in the diet come from fat, carbohydrate, protein, or alcohol. Weight-loss diets are
typically designed to limit calories either by restricting certain foods that are thought to
result in increased calorie intake, and/or by emphasizing foods that are believed to result in
reduced calorie intake. Some currently popular diets restrict fat while emphasizing fibre and a balanced
intake of healthy foods. Others restrict
carbohydrates, either to extremely low amounts as in the Atkins diet, or to a lesser degree, emphasizing foods
low in the glycaemic index or high in protein.
Discussions of the research on these diets follow; however, it should be remembered that no
diet has been proven effective for long-term weight loss, and many people find it difficult to
stay on most diets.17 18
Low-fat, low-calorie, high-fibre, balanced diets are recommended by many doctors for weight loss.19 According to controlled studies, when people are allowed to eat as much food as they desire on a low-fat diet, they tend to lose more weight than people eating a regular diet.20 However, low-fat diets have not been shown to be more effective than other weight-loss diets that restrict calories.21 Nonetheless, a low-fat, high-fibre, balanced diet has additional potential benefits, such as reducing the risk of chronic diseases including heart disease and cancer.22 23
Preliminary research indicates that people who successfully lost weight got less of their total calories from fat and more of them from protein foods. They also ate fewer snacks of low nutritional quality and got more of their calories from “hot meals of good quality.”24 Other preliminary studies find that dieters who maintain long-term weight loss report using fat restriction and eating a regular breakfast as key strategies in their success.25 26
Low-carbohydrate, high-protein diets
Low-carbohydrate, high-fat diets such as the Atkins diet are very popular among people trying
to lose weight. In a preliminary study, overweight individuals who adhered to a
very-low-carbohydrate diet (25 grams per day initially, increased to 50 grams per day after a
certain weight loss target was achieved), with no limit on total calorie intake, lost on
average more than 10% of their body weight over a six-month period.27 The
participants also engaged in aerobic exercise at least three times a week, so it is not clear
how much of the weight loss was due to the diet. An analysis of other preliminary studies of
this type of diet concluded that its effectiveness is primarily due to reduced calorie
intake.28 Recently, three controlled trials found people using low-carbohydrate,
high-fat diets lost more weight in six months than those using diets low in fat and
calories.29 30 31 However, 20 to 40% of these dieters did not
stay on their diets, and were not counted in the results. In addition, one of these trials
continued for an additional six months, at the end of which there was no longer a significant
difference in weight loss between the two diet groups. A recent 12-week controlled trial found
that overweight adolescents also lost more weight with a low-carbohydrate diet than with a
low-fat diet, even though they consumed 50% more calories than did the children on the low-fat
diet.32 That study suggests that the weight loss occurring on the Atkins diet is
not due entirely to calorie restriction. Blood tests suggest that low-carbohydrate diets
induce a condition called mild metabolic acidosis, which might increase the risk of
osteoporosis and kidney stones.
The effect of low-carbohydrate diets on cardiovascular risk is also an unresolved issue. The short-term studies discussed above found that blood cholesterol levels did not worsen with these diets. Other heart-disease risk factors (triglyceride levels and insulin sensitivity) actually improved with a low-carbohydrate diet. Some studies, however, have shown a worsening of certain cardiovascular risk factors in people using a low-carbohydrate, high-fat diet for up to one year. Adverse changes included increases in blood levels of homocysteine, lipoprotein(a), and fibrinogen,33 and a decrease in blood flow to the heart.34 Individuals wishing to consume a very-low-carbohydrate diet for weight loss or for other reasons should be monitored by a doctor.
Some research has investigated weight-loss diets that are high in protein, but moderate in fat and not as low in carbohydrate content as the diets discussed above. While this type of diet does not usually lead to greater weight loss than other diets when calorie intakes are kept equal,35 one controlled trial found greater body fat loss in women eating a diet almost equal in calories and fat but approximately twice as high in protein and lower in carbohydrate compared with a control group’s diet.36 Another controlled trial compared two diets similar in fat content but different in protein and carbohydrate content. People allowed to eat freely from the higher protein diet (25% of calories from protein, 45% calories from carbohydrate) consumed fewer calories and lost more weight compared with people eating the lower protein diet (12% of calories from protein, 59% calories from carbohydrate).37
One small study has shown that the most effective weight-loss diet for any particular person might depend on whether or not they have insulin resistance. In obese people with insulin resistance, weight loss was greater with a low-carbohydrate (40% of calories), high-fat (40% of calories) diet than with a high-carbohydrate (60% of calories), low-fat (20% of calories) diet. In contrast, obese people who did not have insulin resistance lost more weight on the high-carbohydrate, low-fat diet.
Low-glycaemic-index
foods
Diets that emphasise choosing foods with a low glycaemic index have been show to help control
appetite in some,38 39 40 though not all,41
controlled studies. A controlled study in two phases found no difference in weight loss
between a low- and a high-glycaemic-index diet in the first 12-week phase, but when the diets
were switched for a second 12-week phase, the low-glycaemic-index diet was significantly more
effective for weight loss.42 A preliminary study reported that obese children using
a low-glycaemic-index diet lost more weight compared with a similar group using a low-fat
diet.43
Fibre
Adequate amounts of dietary fibre are believed to be important for people wishing to lose
weight. Fibre adds bulk to the diet and tends to produce a sense of fullness, helping people
consume fewer calories.44 While research on the effect of fibre intake on weight
loss has not produced consistent results,45 a recent review of weight-loss trials
that did not restrict calories concluded that higher fibre diets improved weight-loss results,
especially in people who were overweight.46
Stabilizing food sensitivities
Although the relationship between food
sensitivities and body weight remains uncertain, according to one researcher, chronic food
allergy may lead to overeating and obesity.47
Long-term changes
People who go on and off diets frequently complain that it takes fewer calories to produce
weight gain with each weight fluctuation. Evidence now clearly demonstrates that the body gets
"stingier" in its use of calories after each diet.48 This means it becomes easier
to gain weight and harder to lose it the next time. Dietary changes need to be long term.
Lifestyle changes that may be helpful
Support
Many doctors give overweight patients a pill, a pep talk, and a pamphlet about diet and
exercise, but that combination leads only to minor weight loss.49 When overweight
people attend group sessions aimed at changing eating and exercise patterns, keep daily
records of food intake and exercise, and eat a specific low-calorie diet the outcome is much
more successful. Group sessions where participants are given information and help on how to
make lifestyle changes appear to improve the chances of losing weight and keeping it off. Such
changes may include shopping from a list, storing foods out of sight, keeping portion sizes
under control, and avoiding fast-food restaurants.
Exercise
According to most short-term studies, the effect of exercise alone (without dietary
restriction) on weight loss is small,50 51 partly because muscle mass
often increases even while fat tissue is reduced,52 and perhaps because some
exercising people will experience increased appetites. The long-term effect of regular
exercise on weight loss is much better, and exercise appears to help people maintain weight
loss.53 54 People who have successfully maintained weight loss for over
two years report continuing high levels of physical activity.55 Combining exercise
with healthier eating habits results in the best short- and long-term effects on weight
loss,56 57 and should reduce the risk of many serious
diseases.58 59 60
Avoid weight cycling
People who experience “weight cycling” (repetitive weight loss and gain)
have a tendency toward binge eating (periods
of compulsive overeating, but without the self-induced vomiting seen in bulimia), according to a review of numerous studies
focusing on weight loss.61 The researchers also found an association between weight
cycling and depression or poor body image. The
most successful weight-loss programmes (in which weight stays off, mood stays even, and no
binge eating occurs) appear to use a combination of moderate caloric restriction, moderate
exercise, and behaviour modification, including examination and adjustment of eating
habits.
Vitamins that may be helpful
Multiple vitamin
minerals
Diets that are low in total calories may not contain adequate amounts of various vitamins and
minerals. For that reason, taking a multiple vitamin-mineral supplement is advocated by
proponents of many types of weight-loss programmes, and is essential when calorie intake will
be less than 1,100 calories per day.62
Pyruvate
Pyruvate, a compound that occurs naturally in the body, might aid weight-loss
efforts.63 A controlled trial found that pyruvate supplements (22 to 44 grams per
day) enhanced weight loss and resulted in a greater reduction of body fat in overweight adults
consuming a low-fat diet.64 Three
controlled trials combining 6 to 10 grams per day of pyruvate with an exercise programme
reported greater effects on weight loss and body fat than that seen with a placebo plus the
exercise programme.65 66 67 Animal studies suggest that
pyruvate supplementation leads to weight loss by increasing theresting metabolic
rate.68
5-HTP
5-hydroxytryptophan (5-HTP), the precursor to the chemical messenger (neurotransmitter)
serotonin, has been shown in three short-term controlled trials to reduce appetite and to
promote weight loss.69 70 71 In one of these trials (a
12-week double-blind trial), overweight women who took 600 to 900 mg of 5-HTP per day lost
significantly more weight than did women who received a placebo.72 In a
double-blind trial with no dietary restrictions, obese people with type
2(non-insulin-dependent) diabetes who took 750
mg per dayof 5-HTP for two weeks significantly reduced their carbohydrate and fat intake.
Average weight loss in two weeks was 4.6 pounds, compared with 0.2 pounds in the placebo
group.73
7-KETO
The ability of 7-KETO (3-acetyl-7-oxo-dehydroepiandrosterone), a substance related to DHEA, to promote weight loss in overweight people has
been investigated in one double-blind trial.74 Participants in the trial were
advised to exercise three times per week for 45 minutes and to eat an 1,800-calorie-per-day
diet. Each person was given either a placebo or 100 mg of 7-KETO twice daily. After eight
weeks, those receiving 7-KETO had lost more weight and lowered their percentage of body fat
further compared to those taking a placebo. These results may have been due to increases in
levels of a thyroid hormone (T3) that plays a major role in determining a person’s
metabolic rate, although the levels of T3 did not exceed the normal range.
HMB
Biochemical and animal research show that HMB has a role in protein synthesis and might,
therefore, improve muscle growth and overall body composition when given as a supplement.
However, double-blind human research suggests that HMB may only be effective when combined
with an exercise programme in people who are not already highly trained athletes. Double-blind
trials found no effect of 3 to 6 grams per day of HMB on body weight, body fat, or overall
body composition in weight-training football players or other trained athletes.75
76 77 78 79 However, one double-blind study found
that 3 grams per day of HMB increased the amount of body fat lost by 70-year old adults who
were participating in a strength-training programme for the first time.80 A
double-blind study of young men with no strength-training experience reported greater
improvements in muscle mass (but not in percentage body fat) when HMB was used in the amount
of 17 mg per pound of body weight per day.81 However, another group of men in the
same study given twice as much HMB did not experience any changes in body composition.
Calcium
In a study of obese people consuming a low-calorie diet for 24 weeks, those receiving a
calcium supplement (800 mg per day) lost significantly more weight than those given a
placebo.82 Calcium was effective when provided either as a supplement, or in the
form of dairy products. In a second study, however, the amount of weight loss resulting from
calcium supplementation (1,000 mg per day) was small and not statistically
significant.83 In that study, participants' typical diet contained more calcium
than in the study in which calcium supplementation was more effective. Thus, it is possible
that calcium supplementation enhances weight loss only when the diet is low in calcium.
CLA
A double-blind trial found that exercising individuals taking 1,800 mg per day of conjugated
linoleic acid (CLA) lost more body fat after 12 weeks than did a similar group taking a
placebo.84 However, two other studies found that amounts of CLA from 0.7 to 3.0
grams per day did not affect body composition.85 86 Most double-blind
trials have found that larger amounts of CLA, 3.4 to 4.2 grams per day, do reduce body
fat;87 88 89 however, one double-blind study of experienced
strength-training athletes reported no effect of 6 grams per day of CLA on body fat, muscle
mass, or strength improvement.90
Fibre
Fibre supplements are one way to add fibre to a weight-loss diet. Several trials have shown
that supplementation with fibre from a variety of sources accelerated weight loss in people
who were following a low-calorie diet.91 92 93 94
Other researchers found, however, that fibre supplements had no effect on body weight, even
though it resulted in a reduction in food intake.95
Glucomannan
Supplementation with 3 to 4 grams per day of a bulking agent called glucomannan, with or
without a low-calorie diet, has promoted weight loss in overweight adults,96
97 98 while 2 to 3 grams per day was effective in a group of obese
adolescents in another controlled trial.99
HCA
(-)-Hydroxycitric acid (HCA), extracted from the rind of the Garcinia cambogia fruit
grown in Southeast Asia, has a chemicalcomposition similar to that of citric acid (the primary
acid in oranges and other citrus fruits). Preliminary studies in animals suggest that HCA may
be a useful weight-loss aid.100 101 HCA has been demonstrated in the
laboratory (but not yet in clinical trials with people) to reduce the conversion of
carbohydrates into stored fat by inhibiting certain enzyme processes.102
103 Animal research indicates that HCA suppresses appetite and induces weight
loss.104 105 106 107 However, a double-blind trial
found that people who took 1,500 mg per day of HCA while eating a low-calorie diet for 12
weeks lost no more weight than those taking a placebo.108 A double-blind trial of
Garcinia cambogia (2.4 grams of dry extract, containing 50% hydroxycitric acid) found
that the extract did not increase energy expenditure; it was therefore concluded that this
extract showed little potential for the treatment of obesity at this amount.109
Nonetheless, another double-blind trial found that using the same amount of
Garciniacambogia extract significantly improved the results of a weight-loss diet, even
though the amount of food intake was not affected.110
Amylase
inhibitors
Amylase inhibitors are also known as starch blockers because they contain substances that
prevent dietary starches from being absorbed by the body. Starches are complex carbohydrates
that cannot be absorbed unless they are first broken down by the digestive enzyme amylase and
other, secondary, enzymes.111 112 When starch blockers were first
developed years ago, they were found not to be potent enough to prevent the absorption of a
significant amount of carbohydrate.113 114 115 116
Recently, highly concentrated starch blockers have been shown to be more
effective,117 118 119 but no published human studies exist
investigating their usefulness for weight loss.
Blue-green
algae
Blue-green algae, or spirulina, is a rich source of protein, vitamins, minerals, and essential
fatty acids. In one double-blind trial, overweight people who took 2.8 grams of spirulina
three times per day for four weeks experienced only small and statistically nonsignificant
weight loss.120 Thus, although spirulina has been promoted as a weight-loss aid,
the scientific evidence supporting its use for this purpose is weak.
Chitosan
Chitosan is a fibre-like substance extracted from the shells of crustaceans such as shrimp and
crab. Animal studies suggested that chitosan supplementation reduces fat absorption, but
controlled human trials have found no impairment of fat absorption from supplementation with
2,700 mg of chitosan per day for seven days or 5,250 mg per day for four days.121
122 A double-blind study in Poland found that people taking 1,500 mg of chitosan
three times per day during a weight-loss programme lost significantly more weight than did
people taking a placebo with the same programme.123 Other studies using smaller
amounts of chitosan have reported no effects on weight loss.124 125
126
Chromium
The mineral chromium plays an essential role in the metabolism of carbohydrates and fats and
in the action of insulin. Chromium, usually in a form called chromium picolinate, has been
studied for its potential role in altering body composition. Chromium has primarily been
studied in body builders, with conflicting results.127 In people trying to lose
weight, a double-blind study found that 600 mcg per day of niacin-bound chromium helped some
participants lose more fat and less muscle.128 However, three other double-blind
trials have found no effect of chromium picolinate on weight loss,129
130 131 though in one of these trials lean body mass that was lost during a
weight-loss diet was restored by continuing to supplement chromium after the diet. A recent
comprehensive review combining the results of ten published and unpublished double-blind
studies concluded that chromium picolinate supplementation may have a small beneficial effect
on weight loss.132
DHEA
One double-blind trial found 100 mg per day of DHEA was effective for decreasing body fat in
older men,133 and another double-blind trial found 1,600 mg per day decreased body
fat and increased muscle mass in younger men,134 . However, DHEA has not been
effective for improving body composition in women or in other studies of men.135
136 137 138 139 140 141
142
Guar gum
Guar gum, another type of fibre supplement, has not been effective in controlled studies for
weight loss or weight maintenance.143 144 145
L-carnitine
The amino acid L-carnitine is thought to be potentially helpful for weight loss because of its
role in fat metabolism. In a preliminary study of overweight adolescents participating in a
diet and exercise programme, those who took 1,000mg of L-carnitine per day for three months
lost significantly more weight than those who took a placebo.146 A weakness of this
trial, however, was the fact that the average starting body weight differed considerably
between the two groups. A double-blind trial found that adding 4,000 mg of L-carnitine per day
to an exercise programme did not result in weight loss in overweight women.147
Soya
Animal and human studies have suggested that when soya is used as a source of dietary protein,
it may have several biological effects on the body that might help with weight
loss.148 A preliminary study found that people trying to lose weight using a
meal-replacement formula containing soya protein lost more weight than a group not using any
formula.149 However, controlled studies comparing soya protein with other protein
sources in weight-loss diets have not found any advantage of soya.150
151 152 When soya protein is used for other health benefits, typical daily
intake is 20 grams per day or more.
Whey
protein
Whey protein may aid weight loss due to its effect on appetite. In a preliminary study, people
were given 48 grams of either whey protein or milk protein (casein). Whey consumption resulted
in more hunger satisfaction and reduced the amount of food eaten 90 minutes later compared
with casein consumption.153 However, a double-blind study found that men taking 1.5
grams per 2.2 lbs body weight per day of whey protein for 12 weeks along with a low-calorie
diet and a strength training exercise programme lost the same amount of weight and body fat as
did a control group that followed a similar programme, but took a casein supplement instead of
whey protein.154
Herbs that may be helpful
Cayenne
Research has suggested that incorporating cayenne pepper into the diet may help people lose
weight. Controlled studies report that adding 6 to 10 grams of cayenne to a meal or 28 grams
to an entire day’s diet reduces hunger after meals and reduces calories consumed during
subsequent meals.155 156 Other controlled studies have reported that
calorie burning by the body increases slightly when 10 grams of cayenne is added to a meal or
28 grams is added to an entire day’s diet 157 158 159
However, no studies have been done to see if regularly adding cayenne to the diet has any
effect on weight loss.
Green
tea
Green tea extract rich in polyphenols (epigallocatechin gallate, or EGCG) may support a
weight-loss programme by increasing energy expenditure or by inhibiting the digestion of fat
in the intestine.160 161 Healthy young men who took two green tea
capsules (containing a total of 50 mg of caffeine and 90 mg of EGCG) three times a day had a
significantly greater energy expenditure and fat oxidation than those who took caffeine alone
or placebo.162 In a preliminary study of moderately obese individuals,
administration of a specific green tea extract (AR25) resulted in a 4.6% reduction in average
body weight after 12 weeks.163 The amount of green tea extract used in this study
supplied daily 270 mg of EGCG and 150 mg of caffeine. While caffeine is known to stimulate
metabolism, it appears that other substances besides caffeine were responsible for at least
part of the weight loss. Although the extract produced few side effects, one individual
developed abnormal liver function tests during the study. In another study, consuming
approximately 12 ounces of oolong tea (a semifermented version of green tea) daily for 12
weeks reduced waist circumference and the amount of body fat in a group of normal-weight to
overweight men.164 Additional studies are needed to confirm the safety and
effectiveness of green tea extracts for promoting weight loss.
Hoodia
One small, double-blind clinical study in humans found that hoodia latex and inner plant can
significantly reduce food intake. Available products are of unknown quality and much more work
remains to be done to determine if hoodia will be a sustainable, safe way to reduce
appetite.165
Yohimbine
The ability of yohimbine, a chemical found in yohimbe bark, to stimulate the nervous system,
166 167 and to promote the release of fat from fat cells,168
169 has led to claims that it might help weight loss by raising metabolic rate,
reducing appetite, or increase fat burning. Although a preliminary trial found yohimbine
ineffective for weight loss, a double-blind study found that women taking 5 mg of yohimbine
four times per day along with a weight-loss diet lost significantly more weight than those
taking a placebo with the same diet after three weeks.170 However, a similar study
using 18 mg per day of yohimbine for eight weeks reported no benefit to weight loss compared
with a placebo.171 A double-blind study of men who were not dieting reported no
effect of up to 43 mg per day of yohimbine on weight or body composition after six
months.172 All of these studies used pure yohimbine; no study has tested the
effects of yohimbe herb on weight loss.
Bitter
orange
Although historically used to stimulate appetite, bitter orange is frequently found in modern
weight-loss formulas because synephrine is similar to the compound ephedrine, which is known
to promote weight loss. In one study of 23 overweight adults, participants taking a daily
intake of bitter orange (975 mg) combined with caffeine (525 mg) and St. John’s wort
(Hypericum perforatum, 900 mg) for six weeks lost significantly more body weight and
fat than the control group.173 No adverse effects on heart rate or blood pressure
were found. Bitter orange standardised to contain 4 to 6% synephrine had an anti-obesity
effect in rats. However, the amount used to achieve this effect was accompanied by
cardiovascular toxicity and mortality.174
Coleus
Although no clinical trials have been done, there are modern references to use of the herb
coleus for weight loss.175 Coleus extracts standardised to 18% forskolin are
available, and 50 to 100 mg can be taken two to three times per day. Fluid extract can be
taken in the amount of 2 to 4 ml three times per day.
Guaraná
The herb guaraná contains caffeine and
the closely related alkaloids theobromine and
theophylline; these compounds may curb appetite and increase weight loss. Caffeine’s
effects are well known and include central nervous system stimulation, increased metabolic
rate, and a mild diuretic effect.176 In a double-blind trial, 200 mg per day of
caffeine was, however, no more effective than a placebo in promoting weight
loss.177 Because of concerns about potential adverse effects, many doctors do not
advocate using caffeine or caffeine-like substances to reduce weight.
Guggul
Coupled with exercise in a double-blind trial, a combination of guggul, phosphate salts,
hydroxycitrate, and tyrosine has been shown to
improve mood with a slight tendency to improve weight loss in overweight adults.178
Daily recommendations for guggul are typically based on the amount of guggulsterones in the
extract. A common intake of guggulsterones is 25 mg three times per day. Most guggul extracts
contain 5 to 10% guggulsterones and can be taken daily for 12 to 24 weeks.
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