To achieve weight loss, an energy deficit is required². Best practice recommends the following techniques for reducing dietary energy intake²:

The use of self-recorded food diary provides qualitative assessment of the diet, and can be used to help the individual identify meal frequency (night eating, snacking, meal skipping) perceptions and beliefs about emotional eating behavior (cognition), eating habits (behavior) and environmental challenges to following a healthy diet. Dietary advice should encourage healthy eating and emphasize the need to increase consumption of vegetables, beans, legumes, lentils, grain, unsweetened cereals and fiber, and to substitute low-fat dairy products and meats for high-fat alternatives.

It is recommended to avoid foods containing added sugars and solid fats, as well as consumption of sugary drinks and alcohol-containing beverages. Energy (calorie) restriction should be individualized to take into account nutritional habits, physical activity, co-morbidities and previous dieting attempts. Prescribing an energy-restricted diet may require the intervention of a nutritionist (dietician).

The recommended weight-reducing dietary regimen tailored to an individual’s need usually provides an energy deficit of 600 kcal/day A 600 kcal (2,600 kJ) daily deficit will predict a weight loss of about 0.5 kg weekly. Thus for an obese sedentary woman with a BMI of 32 kg/m2 and with an estimated daily intake of 2,100 kcal (8,800 kJ), a diet prescribing 1,400–1,600 kcal (6,000–7,000 kJ) would be appropriate².

Physical activity is part of an individual’s total energy expenditure.³ A long-term increase in physical activity, either through the activities of daily living or regular exercise, plays an important role in weight maintenance and increasing the amount of weight loss². However, increasing physical activity as a way of maintaining weight loss may be an attainable goal for many.

Maintenance of weight loss requires an average daily energy expenditure of 80% to 90% above resting metabolic rate (RMR).³ For example, someone with an RMR of 1500 kcal/day would need to expend about 1000 kcal/day in physical activity to meet this target.
Health benefits from regular physical activity over and above the effects on weight include cardiovascular improvements.³ The options for increasing physical activity include increases in daily exercise (walking, climbing stairs in addition to sports or fitness pursuits) or using lifestyle approaches in order to decrease sedentary behavior (e.g. television viewing)². Both methods can improve fitness and allow weight stability via reductions in intra-abdominal fat, and increased lean muscle as well as a decline in resting energy expenditure. Exercise advice should be personalized to the individual’s ability and health, and focus on a gradual increase in level and frequency².
Evidence suggests that aerobic and resistance exercises are beneficial for individuals with obesity and related morbidities². For this reason, all scientific guidelines recommend that at least 150 min/week of moderate aerobic exercise (such as brisk walking) should be combined with three weekly sessions of resistance exercise to increase muscle strength².

Weight loss can be induced through caloric restriction, but without approaches to ensure behavioral changes, body fat is likely to be regained.³

Although environmental factors contribute to an individual’s overweight status, individuals should learn how to make permanent lifestyle changes (eating and activity behavior) in order to hope for enduring weight loss.³ Behavior modification approaches often seek to help individuals recognize and get around environmental cues for sedentary behavior and overeating as a means to accomplish these lifestyle changes.

Individuals who are unable to make changes in eating habits on their own may benefit from referral to a behavior therapist.³

The goals are:³

• To help individuals modify their eating, activity, and thinking habits that predispose them to obesity
• To focus on specific pathways to achieve these goals, which may include identifying and removing barriers to develop better eating or activity habits

Self-monitoring refers to observing and recording a behavioral aspect, such as caloric intake, exercise sessions, and/or medication usage². It could also refer to tracking an outcome of these behaviors (e.g., changes in body weight). Self-monitoring of a behavior as part of behavioural therapy usually changes the behavior in the desired direction. Furthermore, it can produce records a Health Care Professional can review².