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Guidelines on Overweight and Obesity: Electronic Textbook
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Combined Therapy

To achieve the greatest likelihood of success from weight loss therapy, the combination of dietary therapy with an LCD, increased physical activity, and behavior therapy will be required. Inclusion of behavior therapy and increased physical activity in a weight loss regimen will provide the best opportunity for weight loss, and hopefully for long-term weight control. In order to achieve weight loss, such a regimen should be maintained for at least 6 months before considering pharmacotherapy.

Evidence Statement: Combined intervention of an LCD, increased physical activity, and behavior therapy provides the most successful therapy for weight loss and weight maintenance. Evidence Category C.

Rationale: Clinical trials have demonstrated that combining behavior therapy, LCDs, and increased physical activity provides better outcomes for long-term weight reduction than programs that use only one or two of these modalities. A lower-fat diet markedly improves the potential of physical activity to achieve a negative energy balance (317, 369, 434, 444, 582).  In addition, lower-fat diets that are also low in saturated fats reduce serum cholesterol levels, which would reduce CVD risk. It is difficult to achieve a negative energy balance and weight loss with physical activity of moderate duration and intensity in individuals who consume a high-fat diet and alcohol (583, 584). 

Recommendation: Weight loss and weight maintenance therapy should employ the combination of LCDs, increased physical activity, and behavior therapy. Evidence Category A.
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