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<meta name="citation_author" content="Victoria Mank">
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Excessive Weight Loss</span></h1><p class="contribs">Jaime K, Mank V.</p><p class="fm-aai"><a href="#_NBK603752_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-140317.s1"><h2 id="_article-140317_s1_">Definition/Introduction</h2><p>With global obesity on the rise, the number of dietary, surgical, exercise, lifestyle, and pharmacological approaches to weight loss has expanded. Although these modalities share a common goal of body mass reduction, results differ in amounts of weight loss, sustainability, and the potential for long-term maintenance. There is no single definition of "excessive" weight loss; however, weight loss >10% of body weight has been defined as "large" weight loss.<a class="bibr" href="#article-140317.r1" rid="article-140317.r1">[1]</a> Loss of approximately 5% to 10% of body weight over 6 months has improved glycemic control and clinically reduced blood pressure and cholesterol. Losing more than this, or weight loss at faster rates, may improve overall health but may increase the possibility of health risks.<a class="bibr" href="#article-140317.r2" rid="article-140317.r2">[2]</a><a class="bibr" href="#article-140317.r3" rid="article-140317.r3">[3]</a><a class="bibr" href="#article-140317.r4" rid="article-140317.r4">[4]</a></p></div><div id="article-140317.s2"><h2 id="_article-140317_s2_">Issues of Concern</h2><p>Weight loss is an important component of addressing medical concerns about obesity; it also affects physical appearance, athletic pursuits, and personal motivators.<a class="bibr" href="#article-140317.r5" rid="article-140317.r5">[5]</a><a class="bibr" href="#article-140317.r6" rid="article-140317.r6">[6]</a> Options for achieving weight loss goals include diet, surgery, and medication; however, short-term versus long-term success in weight loss varies.</p><p>
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<b>Dietary Options</b>
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</p><p>A multitude of fad diets have emerged. Some of the most popular include the following:</p><ul><li class="half_rhythm"><div>The ketogenic diet</div></li><li class="half_rhythm"><div>The Atkin’s diet</div></li><li class="half_rhythm"><div>The paleolithic diet</div></li><li class="half_rhythm"><div>Intermittent fasting <a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> </div></li></ul><p>
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<b>Medication Options</b>
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</p><p>The following weight loss medications have been approved by the US Food and Drug Administration (FDA) and demonstrated effectiveness in weight reduction:</p><ul><li class="half_rhythm"><div>Orlistat (1999)</div></li><li class="half_rhythm"><div>Phentermine and topiramate (2012)</div></li><li class="half_rhythm"><div>Naltrexone and bupropion (2014)</div></li><li class="half_rhythm"><div>Liraglutide (2014)</div></li><li class="half_rhythm"><div>Semaglutide (2021) <a class="bibr" href="#article-140317.r8" rid="article-140317.r8">[8]</a><a class="bibr" href="#article-140317.r9" rid="article-140317.r9">[9]</a> </div></li></ul><p>
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<b>Surgical Options</b>
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</p><p>Bariatric surgeries, including sleeve gastrectomy, gastric bypass, gastric band, and duodenal switch, alter gastrointestinal anatomy, reduce gastric size, and change absorptive patterns. These surgeries can lead to >20% total weight loss in upwards of 90% of patients by 2 years postoperatively, and 70% of those individuals have been able to maintain that weight loss at 10 years.<a class="bibr" href="#article-140317.r10" rid="article-140317.r10">[10]</a><a class="bibr" href="#article-140317.r11" rid="article-140317.r11">[11]</a> </p><p>Whether weight loss occurs rapidly or gradually over time, it can be linked to various challenges, including macronutrient and micronutrient deficiencies, electrolyte imbalances, metabolic shifts, psychological effects, bone density changes, and even death.<a class="bibr" href="#article-140317.r12" rid="article-140317.r12">[12]</a><a class="bibr" href="#article-140317.r13" rid="article-140317.r13">[13]</a><a class="bibr" href="#article-140317.r14" rid="article-140317.r14">[14]</a> The rate at which weight loss is achieved has associated risks and benefits. Recognizing and addressing these risks, often with the assistance of skilled professionals in a multidisciplinary approach, is crucial in fostering a customized, sustainable, and comprehensive approach to weight loss that prioritizes the overall well-being of an individual.<a class="bibr" href="#article-140317.r15" rid="article-140317.r15">[15]</a></p></div><div id="article-140317.s3"><h2 id="_article-140317_s3_">Clinical Significance</h2><p>
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<b>Dietary Risks of Excessive Weight Loss</b>
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</p><p>Many dietary interventions have been created to achieve desired weight loss. Many reduce caloric intake, with some diets excluding macronutrients or specific food groups altogether. Fad diets have also gained popularity, claiming to reduce weight quickly.<a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> Three major categories of diets include the following:</p><ul><li class="half_rhythm"><div>Diets decreasing or increasing macronutrient composition<b> </b>(eg, low-carbohydrate, low-fat, or high-protein diets)                                                                                                                                                  </div></li><li class="half_rhythm"><div>Diets restricting caloric intake based on timing (eg, fasting and intermittent fasting)                                          </div></li><li class="half_rhythm"><div>Diets restricting entire food groups<b> </b>(eg, vegetarian, vegan, or carnivore diets)</div></li></ul><p>Some of the most heavily studied of these diets include the ketogenic diet, Atkins diet, paleolithic diet, intermittent fasting, and vegetarian and vegan diets.<a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> </p><p>
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<b>Ketogenic Diet</b>
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</p><p>The ketogenic diet, popularized in the 1920s, involves restricting carbohydrate intake to <50 g daily (the recommended daily value of carbohydrates is 130 g).<a class="bibr" href="#article-140317.r16" rid="article-140317.r16">[16]</a><a class="bibr" href="#article-140317.r17" rid="article-140317.r17">[17]</a><a class="bibr" href="#article-140317.r18" rid="article-140317.r18">[18]</a> This diet is often used by individuals wishing to lose weight rapidly in the short term, with some reports of people losing up to 9.9 pounds (4.5 kg) in 2 weeks and up to 57.3 pounds (26 kg) if maintained over 2 years.<a class="bibr" href="#article-140317.r19" rid="article-140317.r19">[19]</a><a class="bibr" href="#article-140317.r20" rid="article-140317.r20">[20]</a> </p><p>Risks include vitamin and mineral deficiencies.<a class="bibr" href="#article-140317.r19" rid="article-140317.r19">[19]</a> For individuals undergoing a 12-week ketogenic diet, magnesium, calcium, iron, phosphorus, and potassium levels were found to be less than the recommended values. Although this was not evident in serum levels at the end of the study, it could indicate deficiencies if the ketogenic diet were extended beyond those 12 weeks.<a class="bibr" href="#article-140317.r21" rid="article-140317.r21">[21]</a> Hypercalciuria and renal stones have also been reported as long-term adverse effects of the diet.<a class="bibr" href="#article-140317.r22" rid="article-140317.r22">[22]</a> Short-term risks include gastrointestinal effects such as nausea, vomiting, and decreased energy. These symptoms usually last from a few days to up to 2 weeks and are sometimes referred to as the "ketogenic flu."<a class="bibr" href="#article-140317.r23" rid="article-140317.r23">[23]</a> </p><p>
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<b>Atkins Diet</b>
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</p><p>The Atkins diet, created in the 1960s, is similar to the ketogenic diet, restricting carbohydrates and promoting increased fats and proteins.<a class="bibr" href="#article-140317.r24" rid="article-140317.r24">[24]</a> However, it differs in that it slowly increases carbohydrates through different program phases. The first 2 weeks of the diet constitute an induction phase, with <20 g of carbohydrates consumed daily (even less than the ketogenic diet). In the second phase, carbohydrates are increased to 40 to 90 g daily, ideally for life.<a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> </p><p>A study comparing females who lost similar amounts of weight through different diets over 8 weeks determined that those on the Atkins diet were found to be at risk for deficiencies in thiamine, folic acid, vitamin C, and zinc.<a class="bibr" href="#article-140317.r25" rid="article-140317.r25">[25]</a> These deficiencies can be dangerous, with possible symptoms such as ataxia and peripheral neuropathy.</p><ul><li class="half_rhythm"><div>Thiamine deficiency can lead to nystagmus.                                                                                                         </div></li><li class="half_rhythm"><div>Folate deficiency has been associated with cognitive impairment, dementia, and depression.                                       </div></li><li class="half_rhythm"><div>Zinc deficiency has been linked to poor wound healing, dermatological symptoms, and easy bleeding.                     </div></li><li class="half_rhythm"><div>Vitamin C deficiency manifests as fatigue, muscle cramping, gingival inflammation, and gingival hypertrophy in some cases.<a class="bibr" href="#article-140317.r26" rid="article-140317.r26">[26]</a><a class="bibr" href="#article-140317.r27" rid="article-140317.r27">[27]</a><a class="bibr" href="#article-140317.r28" rid="article-140317.r28">[28]</a><a class="bibr" href="#article-140317.r29" rid="article-140317.r29">[29]</a></div></li></ul><p>
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<b>Paleolithic Diet</b>
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</p><p>The paleolithic diet, introduced in the 1980s, focuses on eliminating processed foods and only consuming lean meats, fruits, nonstarchy vegetables, nuts, and seeds while restricting dairy products.<a class="bibr" href="#article-140317.r30" rid="article-140317.r30">[30]</a> Individuals adhering to this diet over 12 weeks were found to have weight loss as high as 4% to 6% of their starting body weight.<a class="bibr" href="#article-140317.r31" rid="article-140317.r31">[31]</a> There is limited research regarding long-term adherence and sustainability. Because this diet is rich in potassium, there is a concern for hyperkalemia in individuals with renal impairment.<a class="bibr" href="#article-140317.r32" rid="article-140317.r32">[32]</a> Other risks associated with this diet include calcium deficiency, with consumption of 50% less than the daily recommended value.<a class="bibr" href="#article-140317.r33" rid="article-140317.r33">[33]</a> This deficiency may not be harmful in the short term; however, long-term calcium deficiency has been associated with osteopenia and osteoporosis.<a class="bibr" href="#article-140317.r34" rid="article-140317.r34">[34]</a><a class="bibr" href="#article-140317.r35" rid="article-140317.r35">[35]</a> </p><p>
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<b>Vegetarian and Vegan Diets</b>
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</p><p>The vegetarian diet, characterized by eliminating meat, seafood, and poultry, is followed for various reasons, including ethical considerations, religious beliefs, cultural motivations, and health concerns.<a class="bibr" href="#article-140317.r36" rid="article-140317.r36">[36]</a> Risks associated with this diet include an increased risk of certain micronutrient deficiencies, including B12, calcium, zinc, iron, vitamin E, and some fatty acids.<a class="bibr" href="#article-140317.r37" rid="article-140317.r37">[37]</a> These microdeficiencies often manifest as anemia, reduction in bone density, fatigue, and sometimes growth delays in children.<a class="bibr" href="#article-140317.r38" rid="article-140317.r38">[38]</a> Similar risks are associated with the vegan diet, which eliminates all animal products from the diet.<a class="bibr" href="#article-140317.r39" rid="article-140317.r39">[39]</a> </p><p>
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<b>Intermittent Fasting</b>
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</p><p>Intermittent fasting, thought to improve metabolic and glycemic control, is defined as abstinence from food for a given amount of time followed by a meal. There are many different approaches, including alternating days in which food is consumed or limiting food consumption to a time window such as 8 hours.<a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> Short-term risks identified over 1 to 3 months include headache, lethargy, and dizziness secondary to lack of fluid, hypoglycemia, and, in some cases, electrolyte imbalances.<a class="bibr" href="#article-140317.r40" rid="article-140317.r40">[40]</a> </p><p>
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<b>Fluid and Caloric Restriction</b>
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</p><p>Rapid weight loss, induced by intense dieting, extreme exercise, fluid restriction, medication use, or fasting without electrolyte supplementation, can lead to a series of adverse effects with electrolyte derangements, decreased athletic performance, hormone imbalance, and potential organ damage.<a class="bibr" href="#article-140317.r12" rid="article-140317.r12">[12]</a><a class="bibr" href="#article-140317.r41" rid="article-140317.r41">[41]</a> </p><p>Intermittent and long-term fasting can result in sodium, potassium, and uric acid imbalances due to fluid shifts, reduced electrolytes, and reduced water uptake.<a class="bibr" href="#article-140317.r42" rid="article-140317.r42">[42]</a><a class="bibr" href="#article-140317.r43" rid="article-140317.r43">[43]</a><a class="bibr" href="#article-140317.r44" rid="article-140317.r44">[44]</a> These shifts are typically transient, and electrolyte levels tend to normalize once the body reestablishes fluid balance.<a class="bibr" href="#article-140317.r45" rid="article-140317.r45">[45]</a> Athletes often employ fluid or calorie restrictions over short periods to induce rapid weight loss. This method is often used in combat sports to rapidly lose weight, pass a pre-competition weight test, and perform in a lower-weight class. The use of laxatives, diuretics, and sweating via saunas represent additional approaches athletes use to achieve rapid weight loss, with most weight loss attributed to water weight.<a class="bibr" href="#article-140317.r46" rid="article-140317.r46">[46]</a> Contestants can lose up to 6% of total body weight quickly, regaining as much as possible after weigh-in but before a competition.<a class="bibr" href="#article-140317.r47" rid="article-140317.r47">[47]</a> </p><p>Fluid and calorie restriction usually begins 2 days before a competition, although it can be more or less depending on the athlete.<a class="bibr" href="#article-140317.r48" rid="article-140317.r48">[48]</a> Termed "weight cycling," this method adversely affects physical health and performance. Other detrimental effects include emotional lability with increased tension, anger, and confusion.<a class="bibr" href="#article-140317.r49" rid="article-140317.r49">[49]</a> In some cases, testosterone levels decreased, while ammonia, uric acid, and insulin serum levels increased following weight cycling.<a class="bibr" href="#article-140317.r50" rid="article-140317.r50">[50]</a> Although the long-term effects remain unclear, eating disorders such as binge eating have been reported to be associated with this method of weight loss, affecting individuals long after they are done competing.<a class="bibr" href="#article-140317.r51" rid="article-140317.r51">[51]</a> Screening for such disorders may prove advantageous in providing early intervention, resources, and support. </p><p>Fluid restriction can also lead to elevations in serum creatinine. Such practices can lead to acute kidney injuries, and if dehydration persists, the severity of these injuries may worsen over time. These acute shifts have not been associated with sustained weight loss. If individuals adhere to well-balanced diets without restricting fluids, electrolyte disturbances are less likely.<a class="bibr" href="#article-140317.r52" rid="article-140317.r52">[52]</a><a class="bibr" href="#article-140317.r53" rid="article-140317.r53">[53]</a> Beyond these short-term concerns, weight loss may also introduce metabolic risks. </p><p>
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<b>Metabolic Changes</b>
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</p><p>Homeostasis occurs in each human body at a different level of weight. Each person has a resting metabolic rate, defined as the rate of energy production and expenditure needed to function while at rest.<a class="bibr" href="#article-140317.r54" rid="article-140317.r54">[54]</a> After weight loss, the resting metabolic rate slows, likely to counter weight loss and return to homeostasis.<a class="bibr" href="#article-140317.r55" rid="article-140317.r55">[55]</a> It is hypothesized that due to this phenomenon of "metabolic adaptation," weight regain is likely even after weight is lost.<a class="bibr" href="#article-140317.r56" rid="article-140317.r56">[56]</a><a class="bibr" href="#article-140317.r57" rid="article-140317.r57">[57]</a> Alterations in body mass can cause a shift in homeostasis, influencing the delicate balance of anorexogenic and orexigenic hormones that regulate satiety and hunger.<a class="bibr" href="#article-140317.r58" rid="article-140317.r58">[58]</a> This can lead to changes in the body's ability to sense satiety.<a class="bibr" href="#article-140317.r59" rid="article-140317.r59">[59]</a></p><p>Anorexogenic hormones, such as leptin, peptide YY, and cholecystokinin, play a crucial role in signaling satiety, communicating to the brain that the body does not require additional calories. Orexigenic hormones, like ghrelin, stimulate hunger. During dieting and caloric restriction periods, orexigenic hormones increase, and anorexigenic hormone levels decrease.<a class="bibr" href="#article-140317.r60" rid="article-140317.r60">[60]</a> Even after weight loss, the drive to eat remains heightened, potentially indicating the risk of weight regain.<a class="bibr" href="#article-140317.r61" rid="article-140317.r61">[61]</a> Hormone levels may never revert to their pre-dieting states. These ongoing hormonal imbalances increase individuals' challenges in maintaining long-term weight loss.<a class="bibr" href="#article-140317.r59" rid="article-140317.r59">[59]</a><a class="bibr" href="#article-140317.r58" rid="article-140317.r58">[58]</a> </p><p>Thyroid hormones, T3 and T4, have been identified as contributors to weight loss, with medications and supplements targeting thyroid hormones becoming another method utilized. Desiccated thyroid extract can be used to treat hypothyroidism in individuals, but it has also been shown to aid in weight loss compared to individuals taking levothyroxine.<a class="bibr" href="#article-140317.r62" rid="article-140317.r62">[62]</a> Some thyroid hormones, such as T3, promote energy expenditure in their active state. For thyroid hormones to become active, they must convert from their inactive form, T4, to their active form, T3.</p><p>With weight loss, there is a reduction in the peripheral conversion of the prohormone to T3. Despite this decrease in conversion, individuals with higher baseline levels of free T3 and T4 have been associated with larger weight loss over time.<a class="bibr" href="#article-140317.r63" rid="article-140317.r63">[63]</a> This implies that, alongside alterations in anorexogenic and orexigenic hormones, the balance of thyroid hormones may also play a role in an individual's weight loss.<a class="bibr" href="#article-140317.r63" rid="article-140317.r63">[63]</a> Desiccated thyroid hormone has become an aid in weight loss, and numerous other weight loss medications are currently available.<a class="bibr" href="#article-140317.r62" rid="article-140317.r62">[62]</a> </p><p>
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<b>Risks Associated With Weight-Loss Medications</b>
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</p><p>Medications, including orlistat, phentermine and topiramate, naltrexone and bupropion, liraglutide, and semaglutide, have obtained FDA approval for weight loss in the United States, and all are effective for weight loss.<a class="bibr" href="#article-140317.r8" rid="article-140317.r8">[8]</a> FDA guidelines recommend that consideration for these medications include a body mass index (BMI) >30 or ranging from 27 to 30 with an obesity-related comorbidity (type 2 diabetes, hypertension, or any other disease secondary to obesity).<a class="bibr" href="#article-140317.r64" rid="article-140317.r64">[64]</a> </p><p>There are both over-the-counter and prescription anti-obesity medications. One over-the-counter weight loss option in the United States is orlistat, which was FDA-approved in 2007.<a class="bibr" href="#article-140317.r65" rid="article-140317.r65">[65]</a> Although not approved for weight loss, other medications have demonstrated weight reduction effectiveness. Desiccated thyroid extract, used in treating hypothyroidism, has been shown to reduce weight by at least 4 lb (1.8 kg) over 6 months compared with individuals taking levothyroxine.<a class="bibr" href="#article-140317.r62" rid="article-140317.r62">[62]</a> Medications, such as diuretics and laxatives, are often used in sports for rapid weight loss but are ineffective long-term and are not FDA-approved for this use.<a class="bibr" href="#article-140317.r66" rid="article-140317.r66">[66]</a> </p><p>When weight loss medications are considered, individuals should be educated that they will likely be on anti-obesity medicines for life, as obesity is a chronic disease, often relapsing if pharmacotherapy is ceased.<a class="bibr" href="#article-140317.r64" rid="article-140317.r64">[64]</a> Sustained results are demonstrated when individuals actively engage in lifestyle modifications such as dieting and exercise concurrently with medication.<a class="bibr" href="#article-140317.r67" rid="article-140317.r67">[67]</a> Despite weight loss medications effectively causing >5% body weight loss in most individuals, undesirable adverse effects are common. </p><ul><li class="half_rhythm"><div><b>Phentermine and topiramate:</b> A prescription appetite suppressant combining the weight loss medication phentermine and the anti-epileptic medication topiramate.<a class="bibr" href="#article-140317.r64" rid="article-140317.r64">[64]</a> Although it has proven efficacious in long-term weight loss, it is contraindicated in pregnancy, with a reported risk of oral cleft palate or cleft lip in infants in the first trimester.<a class="bibr" href="#article-140317.r68" rid="article-140317.r68">[68]</a><a class="bibr" href="#article-140317.r69" rid="article-140317.r69">[69]</a> Individuals considering this medication should undergo pregnancy testing before it is prescribed. Other risks include dizziness, constipation, dry mouth, and inattention.<a class="bibr" href="#article-140317.r70" rid="article-140317.r70">[70]</a> </div></li></ul><ul><li class="half_rhythm"><div><b>Naltrexone and bupropion:</b> A prescription weight loss medication that decreases appetite and cravings. It has been linked with dizziness, anxiety, insomnia, and, in some cases, psychosis. It also lowers the seizure threshold, increasing the risk of seizures. Other more common adverse effects include hypertension, nausea, and vomiting.<a class="bibr" href="#article-140317.r71" rid="article-140317.r71">[71]</a> </div></li></ul><ul><li class="half_rhythm"><div><b>Liraglutide:</b> A prescription medication glucagon-like peptide-1 analog, delaying gastric emptying and increasing satiety.<a class="bibr" href="#article-140317.r72" rid="article-140317.r72">[72]</a> It has been linked with gastrointestinal symptoms such as nausea and vomiting. It also has an increased risk of pancreatitis. In animal models, the development of medullary thyroid cancer has occurred. Although this has not been found in human studies, liraglutide is contraindicated if a family history is present.<a class="bibr" href="#article-140317.r73" rid="article-140317.r73">[73]</a> </div></li></ul><ul><li class="half_rhythm"><div><b>Semaglutide:</b> A prescription glucagon-like peptide-1 analog, demonstrating a total weight loss of 14.9% over a 68-week study.<a class="bibr" href="#article-140317.r74" rid="article-140317.r74">[74]</a> Risks include hypoglycemia and gastrointestinal side effects such as nausea, vomiting, and abdominal cramping. Like liraglutide, there is a small risk of pancreatitis and thyroid cancer in animal studies; however, studies did not demonstrate any associated risk in humans.<a class="bibr" href="#article-140317.r75" rid="article-140317.r75">[75]</a></div></li></ul><ul><li class="half_rhythm"><div><b>Orlistat:</b> An over-the-counter medication in the United States, it reduces fat absorption by up to 30%. This medication is mainly associated with gastrointestinal adverse effects. It has been shown to cause fatty stools, fecal urgency, incontinence, and increased defecation. These adverse effects decrease the longer an individual stays on the drug.<a class="bibr" href="#article-140317.r76" rid="article-140317.r76">[76]</a> </div></li></ul><p>Considering these potential side effects, weight loss medications should be chosen to fit the patient's best interests and needs.<a class="bibr" href="#article-140317.r77" rid="article-140317.r77">[77]</a> This can lead to successful, sustained weight loss in many individuals.<a class="bibr" href="#article-140317.r67" rid="article-140317.r67">[67]</a> In some cases, patients have even utilized weight loss medications to avoid weight regain postbariatric surgery.<a class="bibr" href="#article-140317.r78" rid="article-140317.r78">[78]</a> Other individuals may be more appropriate for bariatric surgery than medication alternatives. Bariatric surgery may be appropriate for individuals who meet certain criteria, such as a BMI >40 or greater than 35 with a comorbidity, but it is associated with risks. </p><p>
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<b>Bariatric Surgery Risks</b>
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</p><p>Bariatric surgery, coming into existence in the 1950s, has become a method for rapid weight reduction exceeding 20% of total body mass in some cases.<a class="bibr" href="#article-140317.r10" rid="article-140317.r10">[10]</a><a class="bibr" href="#article-140317.r79" rid="article-140317.r79">[79]</a> Surgery may be appropriate for individuals who have a BMI >40 or >35 with an underlying health condition, such as diabetes mellitus.<a class="bibr" href="#article-140317.r80" rid="article-140317.r80">[80]</a> The 2 most common bariatric surgeries performed worldwide are the sleeve gastrectomy and the gastric bypass.<a class="bibr" href="#article-140317.r81" rid="article-140317.r81">[81]</a> </p><p>The sleeve gastrectomy removes a portion of the stomach, including the fundus. This leaves a small, more slender gastric pouch attaching the esophagus to the duodenum, restricting the amount of food able to be stored in the stomach.<a class="bibr" href="#article-140317.r82" rid="article-140317.r82">[82]</a> With food restriction in the stomach, weight loss is achieved by reducing the quantity of food consumed and adequately absorbed during each meal.</p><p>Gastric bypass involves restricting the size of the gastric pouch and rerouting that pouch to the jejunum, bypassing the duodenum and most of the stomach. This creates less space for caloric absorption.<a class="bibr" href="#article-140317.r83" rid="article-140317.r83">[83]</a> By decreasing the space, less food is consumed due to the sensation of satiety also occurring, leading to decreased caloric intake.</p><p>Like any surgery, there are short- and long-term risks. Postoperative complications do occur but are low at 2.12% in sleeve gastrectomy patients and 3.02% in gastric bypass patients.<a class="bibr" href="#article-140317.r84" rid="article-140317.r84">[84]</a> Early complications (within 30 days postoperatively) can include bleeding at suture or staple lines, abscesses, and infections. Pancreatitis has also been reported in a small percentage of patients, ranging from 0.4% to 1.04%, but it is hypothesized that patients with choledocholithias before bariatric surgery are at higher risk.<a class="bibr" href="#article-140317.r85" rid="article-140317.r85">[85]</a> Perioperative mortality rates are low, ranging from 0.03% to 0.2%, much improved from rates in the early 2000s.<a class="bibr" href="#article-140317.r10" rid="article-140317.r10">[10]</a> When considering bariatric surgery for patients, multidisciplinary team members should counsel patients on the benefits and the risks of surgery and do a thorough preoperative physical examination, laboratory evaluation, and medical history to identify appropriate candidates.</p><p>Aside from immediate postoperative complications, chronic long-term complications include nutrient deficiencies secondary to anatomical changes that can be present for life. Iron, vitamin B12, copper, and calcium malabsorption after gastric bypass likely occur due to bypassing the duodenum and proximal jejunum, where much of the absorption occurs.<a class="bibr" href="#article-140317.r86" rid="article-140317.r86">[86]</a><a class="bibr" href="#article-140317.r87" rid="article-140317.r87">[87]</a> Copper deficiency often mimics B12 deficiency, making it more difficult to identify. Anemia has also been reported after bariatric surgery, which in part may be secondary to decreased iron absorption and folic acid absorption.<a class="bibr" href="#article-140317.r88" rid="article-140317.r88">[88]</a> B12 deficiency has also been linked to macrocytic anemia, with long-term deficiency resulting in neurologic symptoms such as paresthesias and ataxia. Obtaining a baseline complete blood count and metabolic panel before surgery aids in determining if patients are at higher risk for chronic deficiencies. Follow-up laboratory evaluation is provider-dependent but is often performed in routine postoperative follow-ups to ensure no significant abnormalities are present.</p><p>Dumping syndrome (accelerated gastric emptying after meals) has also been reported amongst bariatric patients, especially those with gastric bypass, with resolution usually by 2 years postsurgery.<a class="bibr" href="#article-140317.r89" rid="article-140317.r89">[89]</a><a class="bibr" href="#article-140317.r90" rid="article-140317.r90">[90]</a> Although the pathophysiology is still uncertain, it is thought to be secondary to the rapid movement of chyme due to alterations in anatomy preventing digestion. Symptoms can be improved with small, frequent meals instead of large ones. Patients should receive counseling on this possible risk.<a class="bibr" href="#article-140317.r91" rid="article-140317.r91">[91]</a> Often, bariatric surgeries are completed with a multidisciplinary approach to the patient, involving multiple specialties. Some of these specialists include nutritionists and dieticians who provide assistance with supplementation as needed, primary care clinicians who manage underlying comorbidities, weight-loss coaches, and exercise trainers. Continuous follow-up reviews and guides patient progress. </p><p>
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<b>Muscle and Bone Mass Effects</b>
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</p><p>Regardless of how weight is lost, it is not limited to only the loss of adipose tissue. It can also affect fat-free mass, such as muscle and bone. During a 16-week weight loss program that included individuals with a BMI >30, on average, 13% of baseline weight was lost. Total lean mass was also reduced by 3.8%. Despite the reduction in lean mass, however, strength did not seem to be adversely affected.<a class="bibr" href="#article-140317.r92" rid="article-140317.r92">[92]</a> Moderate exercise and strength training have been suggested to combat muscle reduction. Over 12 months, 2 groups underwent weight loss with either calorie restriction or exercise. Both groups lost a similar amount of weight. Utilizing MRI, muscle mass was significantly decreased in the calorie restriction group but not in the exercise group.<a class="bibr" href="#article-140317.r93" rid="article-140317.r93">[93]</a> This implies that by incorporating exercise and caloric restriction into a weight loss regimen, individuals can decrease fatty tissue while preserving muscle mass. </p><p>In addition to decreased muscle mass, rapid loss of adipose tissue reduces the load on the skeletal system over time, leading to a higher risk of osteoporosis.<a class="bibr" href="#article-140317.r94" rid="article-140317.r94">[94]</a> Throughout a 24-week caloric restriction diet, women averaging the age of 38 years lost more than 16 kg. At the end of those 24 weeks, they had significantly decreased bone mineral density along the femoral neck and greater trochanter.<a class="bibr" href="#article-140317.r95" rid="article-140317.r95">[95]</a> Even greater bone loss has been associated with weight loss in individuals not obese at baseline.<a class="bibr" href="#article-140317.r96" rid="article-140317.r96">[96]</a> Weight reduction in postmenopausal women is associated with bone mineral loss ranging from 1% to 4% compared with premenopausal women.<a class="bibr" href="#article-140317.r94" rid="article-140317.r94">[94]</a> These findings raise concern for potential fractures or even increased morbidity and mortality. As part of counseling patients in weight loss, education must be provided on the risks of osteoporosis, with weight training being a vital exercise method to reduce the risk for osteoporosis. </p><p>
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<b>Death</b>
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</p><p>Restrictive diets have been associated with an increased risk of death. For example, low-carbohydrate diets, such as Atkins, are significantly associated with increased all-cause mortality.<a class="bibr" href="#article-140317.r97" rid="article-140317.r97">[97]</a><a class="bibr" href="#article-140317.r98" rid="article-140317.r98">[98]</a> A prospective cohort study in Japan determined that a low-carbohydrate diet supplemented with high animal protein and fat and a high-carbohydrate diet supplemented with low animal protein and fat were both associated with increased mortality. In contrast, a low-carbohydrate diet supplemented with high plant protein and fats was associated with a lower mortality rate. This suggests that carbohydrate reduction may not increase the risk of death, but rather, the diet as a whole increases the mortality rate.<a class="bibr" href="#article-140317.r99" rid="article-140317.r99">[99]</a> When considering restrictive diets, patients and multidisciplinary weight-loss team members should be aware of the risks and benefits of the diet chosen.</p><p>Beyond the diets themselves, the magnitude of weight loss may also be associated with mortality. In 2010, a longitudinal cohort study analyzed weight loss in 6117 Americans 50 years and older over 3 years. It recorded 1602 deaths occurring within that period. There was an association between weight loss of 15% or more and increased risk of death from any cause. This was regardless of the maximum BMI at the time of death.<a class="bibr" href="#article-140317.r100" rid="article-140317.r100">[100]</a> This implies that large amounts of weight loss may be detrimental to an individual by increasing the risk of death. Underlying comorbidities may further exacerbate the risk of mortality. The rapid and large fluctuations in weight commonly seen in eating disorder patients may also play a role in these risks. </p><p>Psychiatric disorders, which can manifest in the form of an eating disorder, can cause rapid weight loss.<a class="bibr" href="#article-140317.r101" rid="article-140317.r101">[101]</a> Eating disorders can be associated with rapid weight changes, often related to severe restriction or significant purging. Anorexia nervosa and bulimia are 2 of the most common eating disorders, resulting in numerous medical complications such as electrolyte abnormalities, kidney disease, hematemesis, elevated liver transaminases, and even death.<a class="bibr" href="#article-140317.r102" rid="article-140317.r102">[102]</a> These disorders can be seen in all stages of life and can lead to death in severe cases.<a class="bibr" href="#article-140317.r103" rid="article-140317.r103">[103]</a> Driven by an individual's fear of weight gain, these diseases have considerable morbidity and mortality.<a class="bibr" href="#article-140317.r104" rid="article-140317.r104">[104]</a> These findings exemplify that weight loss can also be associated with psychological risks. A multidisciplinary team should carefully monitor and assess an individual's mental health when considering weight loss for a patient.</p><p>
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<b>Psychological Effects</b>
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</p><p>Weight loss has been associated with psychological disturbances, including depression, anxiety, binge eating, and an obsession with food.<a class="bibr" href="#article-140317.r105" rid="article-140317.r105">[105]</a> Rapid weight loss, while it can be successful in the short term, is challenging to sustain and can lead to secondary effects such as irritability, fatigue, and anger.<a class="bibr" href="#article-140317.r106" rid="article-140317.r106">[106]</a> In bariatric surgery patients, depressive symptoms and impulsivity in association with food have led to suboptimal results regarding weight loss and maintenance.<a class="bibr" href="#article-140317.r107" rid="article-140317.r107">[107]</a><a class="bibr" href="#article-140317.r108" rid="article-140317.r108">[108]</a> These psychological difficulties can be lessened with the help of cognitive behavioral therapy or psychotherapy, helping patients find tools to grapple with their challenges.<a class="bibr" href="#article-140317.r109" rid="article-140317.r109">[109]</a> Weight loss requires a multidisciplinary approach, with a team of healthcare professionals who can hone in on specific challenges each patient may experience.</p></div><div id="article-140317.s4"><h2 id="_article-140317_s4_">Nursing, Allied Health, and Interprofessional Team Interventions</h2><p>As the variety of diets, surgeries, and weight loss medications expand, individuals are increasingly inclined to engage in weight loss without understanding the associated risks.<a class="bibr" href="#article-140317.r59" rid="article-140317.r59">[59]</a><a class="bibr" href="#article-140317.r110" rid="article-140317.r110">[110]</a> Body mass reduction, if desired by an individual, can be achieved in numerous different ways. Many fad diets have been associated with nutrient deficiencies, at least in the short term, and these diets have proven difficult to maintain in the long term.<a class="bibr" href="#article-140317.r7" rid="article-140317.r7">[7]</a> Metabolic shifts in satiety and hunger hormones also have a role in long-term weight maintenance and can potentially increase the likelihood of weight regain.<a class="bibr" href="#article-140317.r111" rid="article-140317.r111">[111]</a> Bariatric surgery can be effective but does not come without significant risks, the possibility of surgical complications, and the tendency for nutrient deficiencies.<a class="bibr" href="#article-140317.r10" rid="article-140317.r10">[10]</a> Weight loss medications are effective but have adverse effect profiles that patients should be properly educated on.<a class="bibr" href="#article-140317.r64" rid="article-140317.r64">[64]</a> The risk of death also increases with some of the weight loss methods.<a class="bibr" href="#article-140317.r100" rid="article-140317.r100">[100]</a> </p><p>Individuals should receive adequate education before choosing a weight loss plan.<a class="bibr" href="#article-140317.r112" rid="article-140317.r112">[112]</a> Recognizing that no one-size-fits-all approach is paramount, as each individual is unique, driven by different motivators, and possesses distinct physiological and psychological needs.<a class="bibr" href="#article-140317.r113" rid="article-140317.r113">[113]</a> This complexity necessitates a collaborative team of professionals with diverse knowledge to guide individuals effectively. This multidisciplinary team can include primary care managers, endocrinologists, surgeons, psychiatrists, psychologists, dieticians, nutritionists, nurses, pharmacists, physical therapists, and personal trainers. Together, the team can enhance patient outcomes by pooling diverse expertise and adopting varied approaches to wellness. This interprofessional approach acknowledges each patient's unique needs and leverages various healthcare professionals' strengths to create a more effective and tailored weight loss strategy.<a class="bibr" href="#article-140317.r114" rid="article-140317.r114">[114]</a></p><p>Weight loss education can start at a nursing or primary care clinician's level with counseling regarding lifestyle modifications. Bloodwork can be assessed to determine if a patient needs extra dietary supplementation due to deficiencies in vitamins or minerals. Counseling can start small by encouraging a daily dietary plan, exercise diary, and lifestyle modifications. In addition to the primary care clinician, a nutritionist can be consulted to provide additional expertise and expand on dietary options. This collaboration provides different insights and helps break down and create a plan for healthy weight loss. Follow-up via messaging and in-office visits every 2 weeks or more often, depending on the patient's needs, can benefit long-term weight loss success.<a class="bibr" href="#article-140317.r112" rid="article-140317.r112">[112]</a><a class="bibr" href="#article-140317.r115" rid="article-140317.r115">[115]</a> </p><p>Follow-up can be short-term (days to weeks) or long-term (months to years) based on the patient's needs.<a class="bibr" href="#article-140317.r116" rid="article-140317.r116">[116]</a> Supportive psychotherapy and group therapy have also proven helpful. Psychiatrists and psychologists can add strategies that incorporate mental health and improve psychological barriers to weight loss, such as depression and anxiety.<a class="bibr" href="#article-140317.r109" rid="article-140317.r109">[109]</a><a class="bibr" href="#article-140317.r117" rid="article-140317.r117">[117]</a> </p><p>Patients with weight loss challenges that require more than support, diet, and lifestyle changes may benefit from weight loss medications in conjunction with the above strategies. Clinical pharmacists can assist with counseling and continuously follow up on medications, determining the correct dosage and type of weight loss medication for individuals.<a class="bibr" href="#article-140317.r118" rid="article-140317.r118">[118]</a> By fostering a holistic understanding of the complexities involved and providing a tailored support program with an interprofessional team, patients can make informed choices prioritizing their short- and long-term weight loss goals to successfully achieve their desired results. </p></div><div id="article-140317.s5"><h2 id="_article-140317_s5_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-140317.s6"><h2 id="_article-140317_s6_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-140317.r1">Tahrani AA, Morton J. Benefits of weight loss of 10% or more in patients with overweight or obesity: A review. <span><span class="ref-journal">Obesity (Silver Spring). </span>2022 Apr;<span class="ref-vol">30</span>(4):802-840.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35333446" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35333446</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-140317.r2">Koliaki C, Spinos T, Spinou Μ, Brinia ΜE, Mitsopoulou D, Katsilambros N. Defining the Optimal Dietary Approach for Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults. <span><span class="ref-journal">Healthcare (Basel). </span>2018 Jun 28;<span class="ref-vol">6</span>(3)</span> [<a href="/pmc/articles/PMC6163457/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6163457</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29958395" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29958395</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="article-140317.r3">Panuganti KK, Nguyen M, Kshirsagar RK. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Obesity. [<a href="https://pubmed.ncbi.nlm.nih.gov/29083734" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29083734</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="article-140317.r4">Ryan DH, Yockey SR. Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. <span><span class="ref-journal">Curr Obes Rep. </span>2017 Jun;<span class="ref-vol">6</span>(2):187-194.</span> [<a href="/pmc/articles/PMC5497590/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5497590</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28455679" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28455679</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="article-140317.r5">Poulimeneas D, Anastasiou CA, Kokkinos A, Panagiotakos DB, Yannakoulia M. Motives for weight loss and weight loss maintenance: results from the MedWeight study. <span><span class="ref-journal">J Hum Nutr Diet. </span>2021 Jun;<span class="ref-vol">34</span>(3):504-510.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33493356" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33493356</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="article-140317.r6">Manore MM. Weight Management for Athletes and Active Individuals: A Brief Review. <span><span class="ref-journal">Sports Med. </span>2015 Nov;<span class="ref-vol">45 Suppl 1</span>(Suppl 1):S83-92.</span> [<a href="/pmc/articles/PMC4672016/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4672016</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26553496" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26553496</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="article-140317.r7">Tahreem A, Rakha A, Rabail R, Nazir A, Socol CT, Maerescu CM, Aadil RM. Fad Diets: Facts and Fiction. <span><span class="ref-journal">Front Nutr. </span>2022;<span class="ref-vol">9</span>:960922.</span> [<a href="/pmc/articles/PMC9294402/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9294402</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35866077" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35866077</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="article-140317.r8">Idrees Z, Cancarevic I, Huang L. FDA-Approved Pharmacotherapy for Weight Loss Over the Last Decade. <span><span class="ref-journal">Cureus. </span>2022 Sep;<span class="ref-vol">14</span>(9):e29262.</span> [<a href="/pmc/articles/PMC9579826/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9579826</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36277516" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36277516</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="article-140317.r9">Pilitsi E, Farr OM, Polyzos SA, Perakakis N, Nolen-Doerr E, Papathanasiou AE, Mantzoros CS. Pharmacotherapy of obesity: Available medications and drugs under investigation. <span><span class="ref-journal">Metabolism. </span>2019 Mar;<span class="ref-vol">92</span>:170-192.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30391259" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30391259</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="article-140317.r10">Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. <span><span class="ref-journal">JAMA. </span>2020 Sep 01;<span class="ref-vol">324</span>(9):879-887.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32870301" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32870301</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="article-140317.r11">Grover BT, Morell MC, Kothari SN, Borgert AJ, Kallies KJ, Baker MT. Defining Weight Loss After Bariatric Surgery: a Call for Standardization. <span><span class="ref-journal">Obes Surg. </span>2019 Nov;<span class="ref-vol">29</span>(11):3493-3499.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31256357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31256357</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="article-140317.r12">Pi-Sunyer FX. Short-term medical benefits and adverse effects of weight loss. <span><span class="ref-journal">Ann Intern Med. </span>1993 Oct 01;<span class="ref-vol">119</span>(7 Pt 2):722-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8363205" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8363205</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="article-140317.r13">McCarthy D, Berg A. Weight Loss Strategies and the Risk of Skeletal Muscle Mass Loss. <span><span class="ref-journal">Nutrients. </span>2021 Jul 20;<span class="ref-vol">13</span>(7)</span> [<a href="/pmc/articles/PMC8308821/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8308821</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34371981" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34371981</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="article-140317.r14">Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. <span><span class="ref-journal">J Strength Cond Res. </span>2022 Oct 01;<span class="ref-vol">36</span>(10):2970-2981.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33677461" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33677461</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-140317.r15">Foster D, Sanchez-Collins S, Cheskin LJ. Multidisciplinary Team-Based Obesity Treatment in Patients With Diabetes: Current Practices and the State of the Science. <span><span class="ref-journal">Diabetes Spectr. </span>2017 Nov;<span class="ref-vol">30</span>(4):244-249.</span> [<a href="/pmc/articles/PMC5687103/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5687103</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29151714" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29151714</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-140317.r16">Crosby L, Davis B, Joshi S, Jardine M, Paul J, Neola M, Barnard ND. Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. <span><span class="ref-journal">Front Nutr. </span>2021;<span class="ref-vol">8</span>:702802.</span> [<a href="/pmc/articles/PMC8322232/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8322232</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34336911" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34336911</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-140317.r17">Batch JT, Lamsal SP, Adkins M, Sultan S, Ramirez MN. Advantages and Disadvantages of the Ketogenic Diet: A Review Article. <span><span class="ref-journal">Cureus. </span>2020 Aug 10;<span class="ref-vol">12</span>(8):e9639.</span> [<a href="/pmc/articles/PMC7480775/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7480775</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32923239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32923239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-140317.r18">Wheless JW. History of the ketogenic diet. <span><span class="ref-journal">Epilepsia. </span>2008 Nov;<span class="ref-vol">49 Suppl 8</span>:3-5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19049574" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19049574</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-140317.r19">Masood W, Annamaraju P, Khan Suheb MZ, Uppaluri KR. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jun 16, 2023. Ketogenic Diet. [<a href="https://pubmed.ncbi.nlm.nih.gov/29763005" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29763005</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-140317.r20">Vranceanu M, Pickering C, Filip L, Pralea IE, Sundaram S, Al-Saleh A, Popa DS, Grimaldi KA. A comparison of a ketogenic diet with a LowGI/nutrigenetic diet over 6 months for weight loss and 18-month follow-up. <span><span class="ref-journal">BMC Nutr. </span>2020;<span class="ref-vol">6</span>:53.</span> [<a href="/pmc/articles/PMC7513277/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7513277</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32983551" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32983551</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-140317.r21">Kenig S, Petelin A, Poklar Vatovec T, Mohorko N, Jenko-Pražnikar Z. Assessment of micronutrients in a 12-wk ketogenic diet in obese adults. <span><span class="ref-journal">Nutrition. </span>2019 Nov-Dec;<span class="ref-vol">67-68</span>:110522.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31445313" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31445313</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-140317.r22">Choi JN, Song JE, Shin JI, Kim HD, Kim MJ, Lee JS. Renal stone associated with the ketogenic diet in a 5-year old girl with intractable epilepsy. <span><span class="ref-journal">Yonsei Med J. </span>2010 May;<span class="ref-vol">51</span>(3):457-9.</span> [<a href="/pmc/articles/PMC2852806/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2852806</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20376903" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20376903</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-140317.r23">Lin A, Turner Z, Doerrer SC, Stanfield A, Kossoff EH. Complications During Ketogenic Diet Initiation: Prevalence, Treatment, and Influence on Seizure Outcomes. <span><span class="ref-journal">Pediatr Neurol. </span>2017 Mar;<span class="ref-vol">68</span>:35-39.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28188074" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28188074</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-140317.r24">Mahdi GS. The Atkin's diet controversy. <span><span class="ref-journal">Ann Saudi Med. </span>2006 May-Jun;<span class="ref-vol">26</span>(3):244-5.</span> [<a href="/pmc/articles/PMC6074441/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6074441</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16861858" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16861858</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-140317.r25">Churuangsuk C, Griffiths D, Lean MEJ, Combet E. Impacts of carbohydrate-restricted diets on micronutrient intakes and status: A systematic review. <span><span class="ref-journal">Obes Rev. </span>2019 Aug;<span class="ref-vol">20</span>(8):1132-1147.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31006978" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31006978</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="article-140317.r26">Frank LL. Thiamin in Clinical Practice. <span><span class="ref-journal">JPEN J Parenter Enteral Nutr. </span>2015 Jul;<span class="ref-vol">39</span>(5):503-20.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25564426" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25564426</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="article-140317.r27">Reynolds EH. The neurology of folic acid deficiency. <span><span class="ref-journal">Handb Clin Neurol. </span>2014;<span class="ref-vol">120</span>:927-43.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24365361" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24365361</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="article-140317.r28">Grüngreiff K, Gottstein T, Reinhold D. Zinc Deficiency-An Independent Risk Factor in the Pathogenesis of Haemorrhagic Stroke? <span><span class="ref-journal">Nutrients. </span>2020 Nov 19;<span class="ref-vol">12</span>(11)</span> [<a href="/pmc/articles/PMC7699494/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7699494</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33228216" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33228216</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="article-140317.r29">Maxfield L, Daley SF, Crane JS. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Nov 12, 2023. Vitamin C Deficiency. [<a href="https://pubmed.ncbi.nlm.nih.gov/29630239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29630239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="article-140317.r30">Singh A, Singh D. The Paleolithic Diet. <span><span class="ref-journal">Cureus. </span>2023 Jan;<span class="ref-vol">15</span>(1):e34214.</span> [<a href="/pmc/articles/PMC9957574/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9957574</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36843707" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36843707</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="article-140317.r31">Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. <span><span class="ref-journal">Diabetologia. </span>2007 Sep;<span class="ref-vol">50</span>(9):1795-1807.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17583796" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17583796</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="article-140317.r32">Palmer BF, Clegg DJ. Achieving the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxicity. <span><span class="ref-journal">Mayo Clin Proc. </span>2016 Apr;<span class="ref-vol">91</span>(4):496-508.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26948054" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26948054</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="article-140317.r33">Osterdahl M, Kocturk T, Koochek A, Wändell PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. <span><span class="ref-journal">Eur J Clin Nutr. </span>2008 May;<span class="ref-vol">62</span>(5):682-5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17522610" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17522610</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="article-140317.r34">Fujita T. Calcium paradox: consequences of calcium deficiency manifested by a wide variety of diseases. <span><span class="ref-journal">J Bone Miner Metab. </span>2000;<span class="ref-vol">18</span>(4):234-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10874605" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10874605</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="article-140317.r35">Karaguzel G, Holick MF. Diagnosis and treatment of osteopenia. <span><span class="ref-journal">Rev Endocr Metab Disord. </span>2010 Dec;<span class="ref-vol">11</span>(4):237-51.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21234807" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21234807</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="article-140317.r36">Leitzmann C. Vegetarian nutrition: past, present, future. <span><span class="ref-journal">Am J Clin Nutr. </span>2014 Jul;<span class="ref-vol">100 Suppl 1</span>:496S-502S.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24898226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24898226</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="article-140317.r37">Craig WJ, Mangels AR., American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. <span><span class="ref-journal">J Am Diet Assoc. </span>2009 Jul;<span class="ref-vol">109</span>(7):1266-82.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19562864" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19562864</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="article-140317.r38">Hargreaves SM, Raposo A, Saraiva A, Zandonadi RP. Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains. <span><span class="ref-journal">Int J Environ Res Public Health. </span>2021 Apr 12;<span class="ref-vol">18</span>(8)</span> [<a href="/pmc/articles/PMC8069426/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8069426</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33921521" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33921521</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="article-140317.r39">Craig WJ. Health effects of vegan diets. <span><span class="ref-journal">Am J Clin Nutr. </span>2009 May;<span class="ref-vol">89</span>(5):1627S-1633S.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19279075" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19279075</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="article-140317.r40">Shalabi H, Hassan AS, Al-Zahrani FA, Alarbeidi AH, Mesawa M, Rizk H, Aljubayri AA. Intermittent Fasting: Benefits, Side Effects, Quality of Life, and Knowledge of the Saudi Population. <span><span class="ref-journal">Cureus. </span>2023 Feb;<span class="ref-vol">15</span>(2):e34722.</span> [<a href="/pmc/articles/PMC9998115/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9998115</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36909028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36909028</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="article-140317.r41">Rankin JW. Weight loss and gain in athletes. <span><span class="ref-journal">Curr Sports Med Rep. </span>2002 Aug;<span class="ref-vol">1</span>(4):208-13.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12831697" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12831697</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="article-140317.r42">Ogłodek E, Pilis Prof W. Is Water-Only Fasting Safe? <span><span class="ref-journal">Glob Adv Health Med. </span>2021;<span class="ref-vol">10</span>:21649561211031178.</span> [<a href="/pmc/articles/PMC8369953/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8369953</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34414015" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34414015</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="article-140317.r43">James LJ, Shirreffs SM. Fluid and electrolyte balance during 24-hour fluid and/or energy restriction. <span><span class="ref-journal">Int J Sport Nutr Exerc Metab. </span>2013 Dec;<span class="ref-vol">23</span>(6):545-53.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24413436" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24413436</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="article-140317.r44">Attarzadeh Hosseini SR, Sardar MA, Hejazi K, Farahati S. The effect of ramadan fasting and physical activity on body composition, serum osmolarity levels and some parameters of electrolytes in females. <span><span class="ref-journal">Int J Endocrinol Metab. </span>2013 Spring;<span class="ref-vol">11</span>(2):88-94.</span> [<a href="/pmc/articles/PMC3693661/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3693661</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23825979" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23825979</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="article-140317.r45">Pahl MV, Vaziri ND, Akbarpour F, Afrasiabi A, Friis R. Effect of rapid weight loss with supplemented fasting on serum electrolytes, lipids, and blood pressure. <span><span class="ref-journal">J Natl Med Assoc. </span>1988 Jul;<span class="ref-vol">80</span>(7):803-9.</span> [<a href="/pmc/articles/PMC2625789/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2625789</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3404561" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3404561</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="article-140317.r46">Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: physiological, psychological and performance effects. <span><span class="ref-journal">J Int Soc Sports Nutr. </span>2012 Dec 13;<span class="ref-vol">9</span>(1):52.</span> [<a href="/pmc/articles/PMC3607973/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3607973</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23237303" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23237303</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="article-140317.r47">Martínez-Aranda LM, Sanz-Matesanz M, Orozco-Durán G, González-Fernández FT, Rodríguez-García L, Guadalupe-Grau A. Effects of Different Rapid Weight Loss Strategies and Percentages on Performance-Related Parameters in Combat Sports: An Updated Systematic Review. <span><span class="ref-journal">Int J Environ Res Public Health. </span>2023 Mar 15;<span class="ref-vol">20</span>(6)</span> [<a href="/pmc/articles/PMC10048848/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10048848</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36982067" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36982067</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="article-140317.r48">Lingor RJ, Olson A. Fluid and diet patterns associated with weight cycling and changes in body composition assessed by continuous monitoring throughout a college wrestling season. <span><span class="ref-journal">J Strength Cond Res. </span>2010 Jul;<span class="ref-vol">24</span>(7):1763-72.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20555285" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20555285</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="article-140317.r49">Filaire E, Maso F, Degoutte F, Jouanel P, Lac G. Food restriction, performance, psychological state and lipid values in judo athletes. <span><span class="ref-journal">Int J Sports Med. </span>2001 Aug;<span class="ref-vol">22</span>(6):454-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11531040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11531040</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="article-140317.r50">Degoutte F, Jouanel P, Bègue RJ, Colombier M, Lac G, Pequignot JM, Filaire E. Food restriction, performance, biochemical, psychological, and endocrine changes in judo athletes. <span><span class="ref-journal">Int J Sports Med. </span>2006 Jan;<span class="ref-vol">27</span>(1):9-18.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16388436" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16388436</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="article-140317.r51">Brownell KD, Rodin J. Medical, metabolic, and psychological effects of weight cycling. <span><span class="ref-journal">Arch Intern Med. </span>1994 Jun 27;<span class="ref-vol">154</span>(12):1325-30.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8002684" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8002684</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="article-140317.r52">Trivic T, Roklicer R, Zenic N, Modric T, Milovancev A, Lukic-Sarkanovic M, Maksimovic N, Bianco A, Carraro A, Drid P. Rapid weight loss can increase the risk of acute kidney injury in wrestlers. <span><span class="ref-journal">BMJ Open Sport Exerc Med. </span>2023;<span class="ref-vol">9</span>(2):e001617.</span> [<a href="/pmc/articles/PMC10314685/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10314685</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37397266" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37397266</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="article-140317.r53">Allison S. Fluid, electrolytes and nutrition. <span><span class="ref-journal">Clin Med (Lond). </span>2004 Nov-Dec;<span class="ref-vol">4</span>(6):573-8.</span> [<a href="/pmc/articles/PMC4951996/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4951996</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15656483" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15656483</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="article-140317.r54">Plaza-Florido A, Alcantara JMA. Resting Metabolic Rate of Individuals. <span><span class="ref-journal">Metabolites. </span>2023 Aug 08;<span class="ref-vol">13</span>(8)</span> [<a href="/pmc/articles/PMC10456516/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10456516</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37623870" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37623870</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="article-140317.r55">Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. <span><span class="ref-journal">Obesity (Silver Spring). </span>2016 Aug;<span class="ref-vol">24</span>(8):1612-9.</span> [<a href="/pmc/articles/PMC4989512/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4989512</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27136388" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27136388</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="article-140317.r56">Martins C, Roekenes J, Gower BA, Hunter GR. Metabolic adaptation is associated with less weight and fat mass loss in response to low-energy diets. <span><span class="ref-journal">Nutr Metab (Lond). </span>2021 Jun 11;<span class="ref-vol">18</span>(1):60.</span> [<a href="/pmc/articles/PMC8196522/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8196522</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34116675" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34116675</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="article-140317.r57">Johannsen DL, Knuth ND, Huizenga R, Rood JC, Ravussin E, Hall KD. Metabolic slowing with massive weight loss despite preservation of fat-free mass. <span><span class="ref-journal">J Clin Endocrinol Metab. </span>2012 Jul;<span class="ref-vol">97</span>(7):2489-96.</span> [<a href="/pmc/articles/PMC3387402/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3387402</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22535969" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22535969</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="article-140317.r58">Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. Long-term persistence of hormonal adaptations to weight loss. <span><span class="ref-journal">N Engl J Med. </span>2011 Oct 27;<span class="ref-vol">365</span>(17):1597-604.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22029981" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22029981</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="article-140317.r59">Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. <span><span class="ref-journal">Med Clin North Am. </span>2018 Jan;<span class="ref-vol">102</span>(1):183-197.</span> [<a href="/pmc/articles/PMC5764193/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5764193</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29156185" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29156185</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="article-140317.r60">Tacad DKM, Tovar AP, Richardson CE, Horn WF, Krishnan GP, Keim NL, Krishnan S. Satiety Associated with Calorie Restriction and Time-Restricted Feeding: Peripheral Hormones. <span><span class="ref-journal">Adv Nutr. </span>2022 Jun 01;<span class="ref-vol">13</span>(3):792-820.</span> [<a href="/pmc/articles/PMC9156388/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9156388</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35191467" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35191467</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="article-140317.r61">Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. <span><span class="ref-journal">Int J Obes (Lond). </span>2015 Aug;<span class="ref-vol">39</span>(8):1188-96.</span> [<a href="/pmc/articles/PMC4766925/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4766925</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25896063" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25896063</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="article-140317.r62">Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. <span><span class="ref-journal">J Clin Endocrinol Metab. </span>2013 May;<span class="ref-vol">98</span>(5):1982-90.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23539727" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23539727</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="article-140317.r63">Liu G, Liang L, Bray GA, Qi L, Hu FB, Rood J, Sacks FM, Sun Q. Thyroid hormones and changes in body weight and metabolic parameters in response to weight loss diets: the POUNDS LOST trial. <span><span class="ref-journal">Int J Obes (Lond). </span>2017 Jun;<span class="ref-vol">41</span>(6):878-886.</span> [<a href="/pmc/articles/PMC5461198/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5461198</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28138133" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28138133</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="article-140317.r64">Tchang BG, Aras M, Kumar RB, Aronne LJ. Pharmacologic Treatment of Overweight and Obesity in Adults. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. <span class="ref-journal">Endotext [Internet].</span> MDText.com, Inc.; South Dartmouth (MA): Aug 20, 2024. [<a href="https://pubmed.ncbi.nlm.nih.gov/25905267" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25905267</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="article-140317.r65"><span class="ref-journal">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</span> National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jun 4, 2020. Orlistat. [<a href="/pmc/articles/PMC547852/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC547852</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31644205" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31644205</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="article-140317.r66">Kiningham RB, Gorenflo DW. Weight loss methods of high school wrestlers. <span><span class="ref-journal">Med Sci Sports Exerc. </span>2001 May;<span class="ref-vol">33</span>(5):810-3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11323553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11323553</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="article-140317.r67">Mordes JP, Liu C, Xu S. Medications for weight loss. <span><span class="ref-journal">Curr Opin Endocrinol Diabetes Obes. </span>2015 Apr;<span class="ref-vol">22</span>(2):91-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25692921" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25692921</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="article-140317.r68">Johnson DB, Quick J. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Mar 27, 2023. Topiramate and Phentermine. [<a href="https://pubmed.ncbi.nlm.nih.gov/29489234" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29489234</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="article-140317.r69">Hernandez-Diaz S, Huybrechts KF, Desai RJ, Cohen JM, Mogun H, Pennell PB, Bateman BT, Patorno E. Topiramate use early in pregnancy and the risk of oral clefts: A pregnancy cohort study. <span><span class="ref-journal">Neurology. </span>2018 Jan 23;<span class="ref-vol">90</span>(4):e342-e351.</span> [<a href="/pmc/articles/PMC5798655/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5798655</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29282333" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29282333</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="article-140317.r70">Lei XG, Ruan JQ, Lai C, Sun Z, Yang X. Efficacy and Safety of Phentermine/Topiramate in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis. <span><span class="ref-journal">Obesity (Silver Spring). </span>2021 Jun;<span class="ref-vol">29</span>(6):985-994.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33864346" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33864346</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="article-140317.r71">Naltrexone + bupropion (Mysimba). Too risky for only modest weight loss. <span><span class="ref-journal">Prescrire Int. </span>2015 Oct;<span class="ref-vol">24</span>(164):229-33.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26594724" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26594724</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="article-140317.r72">Shah M, Vella A. Effects of GLP-1 on appetite and weight. <span><span class="ref-journal">Rev Endocr Metab Disord. </span>2014 Sep;<span class="ref-vol">15</span>(3):181-7.</span> [<a href="/pmc/articles/PMC4119845/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4119845</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24811133" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24811133</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="article-140317.r73">Jensen TM, Saha K, Steinberg WM. Is there a link between liraglutide and pancreatitis? A post hoc review of pooled and patient-level data from completed liraglutide type 2 diabetes clinical trials. <span><span class="ref-journal">Diabetes Care. </span>2015 Jun;<span class="ref-vol">38</span>(6):1058-66.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25504028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25504028</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="article-140317.r74">Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF., STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. <span><span class="ref-journal">N Engl J Med. </span>2021 Mar 18;<span class="ref-vol">384</span>(11):989-1002.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33567185" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33567185</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="article-140317.r75">Nagendra L, Bg H, Sharma M, Dutta D. Semaglutide and cancer: A systematic review and meta-analysis. <span><span class="ref-journal">Diabetes Metab Syndr. </span>2023 Sep;<span class="ref-vol">17</span>(9):102834.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/37531876" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37531876</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="article-140317.r76">Filippatos TD, Derdemezis CS, Gazi IF, Nakou ES, Mikhailidis DP, Elisaf MS. Orlistat-associated adverse effects and drug interactions: a critical review. <span><span class="ref-journal">Drug Saf. </span>2008;<span class="ref-vol">31</span>(1):53-65.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18095746" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18095746</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="article-140317.r77">Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. <span><span class="ref-journal">JAMA. </span>2016 Jun 14;<span class="ref-vol">315</span>(22):2424-34.</span> [<a href="/pmc/articles/PMC5617638/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5617638</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27299618" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27299618</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="article-140317.r78">Edgerton C, Mehta M, Mou D, Dey T, Khaodhiar L, Tavakkoli A. Patterns of Weight Loss Medication Utilization and Outcomes Following Bariatric Surgery. <span><span class="ref-journal">J Gastrointest Surg. </span>2021 Feb;<span class="ref-vol">25</span>(2):369-377.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33420652" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33420652</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="article-140317.r79">Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy. <span><span class="ref-journal">Metabolism. </span>2018 Feb;<span class="ref-vol">79</span>:97-107.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29307519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29307519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="article-140317.r80">Dimitrov DV, Ivanov V, Atanasova M. Advantages of bariatric medicine for individualized prevention and treatments: multidisciplinary approach in body culture and prevention of obesity and diabetes. <span><span class="ref-journal">EPMA J. </span>2011 Sep;<span class="ref-vol">2</span>(3):271-6.</span> [<a href="/pmc/articles/PMC3405394/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3405394</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23199162" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23199162</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="article-140317.r81">Ozsoy Z, Demir E. Which Bariatric Procedure Is the Most Popular in the World? A Bibliometric Comparison. <span><span class="ref-journal">Obes Surg. </span>2018 Aug;<span class="ref-vol">28</span>(8):2339-2352.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29512038" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29512038</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="article-140317.r82">Rosen DJ, Dakin GF, Pomp A. Sleeve gastrectomy. <span><span class="ref-journal">Minerva Chir. </span>2009 Jun;<span class="ref-vol">64</span>(3):285-95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19536054" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19536054</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="article-140317.r83">Mitchell BG, Collier SA, Gupta N. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Nov 9, 2024. Roux-en-Y Gastric Bypass. [<a href="https://pubmed.ncbi.nlm.nih.gov/31985950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31985950</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="article-140317.r84">Woźniewska P, Diemieszczyk I, Hady HR. Complications associated with laparoscopic sleeve gastrectomy - a review. <span><span class="ref-journal">Prz Gastroenterol. </span>2021;<span class="ref-vol">16</span>(1):5-9.</span> [<a href="/pmc/articles/PMC8112272/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8112272</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33986881" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33986881</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="article-140317.r85">Hussan H, Ugbarugba E, Porter K, Noria S, Needleman B, Clinton SK, Conwell DL, Krishna SG. The Type of Bariatric Surgery Impacts the Risk of Acute Pancreatitis: A Nationwide Study. <span><span class="ref-journal">Clin Transl Gastroenterol. </span>2018 Sep 12;<span class="ref-vol">9</span>(9):179.</span> [<a href="/pmc/articles/PMC6134111/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6134111</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30206217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30206217</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="article-140317.r86">Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. <span><span class="ref-journal">Circ Res. </span>2016 May 27;<span class="ref-vol">118</span>(11):1844-55.</span> [<a href="/pmc/articles/PMC4888907/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4888907</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27230645" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27230645</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="article-140317.r87">Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. <span><span class="ref-journal">Obes Surg. </span>2010 Apr;<span class="ref-vol">20</span>(4):447-53.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20101473" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20101473</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="article-140317.r88">Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. <span><span class="ref-journal">World J Diabetes. </span>2017 Nov 15;<span class="ref-vol">8</span>(11):464-474.</span> [<a href="/pmc/articles/PMC5700383/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5700383</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29204255" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29204255</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="article-140317.r89">D'hoedt A, Vanuytsel T. Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review. <span><span class="ref-journal">Acta Gastroenterol Belg. </span>2023 Jul-Sep;<span class="ref-vol">86</span>(3):417-427.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/37814558" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37814558</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="article-140317.r90">Matteo MV, Gallo C, Pontecorvi V, Bove V, De Siena M, Carlino G, Costamagna G, Boškoski I. Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction. <span><span class="ref-journal">J Pers Med. </span>2022 Oct 06;<span class="ref-vol">12</span>(10)</span> [<a href="/pmc/articles/PMC9605651/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9605651</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36294803" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36294803</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="article-140317.r91">Hui C, Bauza GJ. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Dumping Syndrome. [<a href="https://pubmed.ncbi.nlm.nih.gov/29261889" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29261889</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="article-140317.r92">Henriksen M, Christensen R, Danneskiold-Samsøe B, Bliddal H. Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. <span><span class="ref-journal">Arthritis Rheum. </span>2012 Feb;<span class="ref-vol">64</span>(2):438-42.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22161649" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22161649</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="article-140317.r93">Weiss EP, Racette SB, Villareal DT, Fontana L, Steger-May K, Schechtman KB, Klein S, Ehsani AA, Holloszy JO., Washington University School of Medicine CALERIE Group. Lower extremity muscle size and strength and aerobic capacity decrease with caloric restriction but not with exercise-induced weight loss. <span><span class="ref-journal">J Appl Physiol (1985). </span>2007 Feb;<span class="ref-vol">102</span>(2):634-40.</span> [<a href="/pmc/articles/PMC4376253/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4376253</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17095635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17095635</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="article-140317.r94">Shapses SA, Riedt CS. Bone, body weight, and weight reduction: what are the concerns? <span><span class="ref-journal">J Nutr. </span>2006 Jun;<span class="ref-vol">136</span>(6):1453-6.</span> [<a href="/pmc/articles/PMC4016235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4016235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16702302" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16702302</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>95.</dt><dd><div class="bk_ref" id="article-140317.r95">Andersen RE, Wadden TA, Herzog RJ. Changes in bone mineral content in obese dieting women. <span><span class="ref-journal">Metabolism. </span>1997 Aug;<span class="ref-vol">46</span>(8):857-61.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9258265" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9258265</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="article-140317.r96">Nguyen TV, Sambrook PN, Eisman JA. Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. <span><span class="ref-journal">J Bone Miner Res. </span>1998 Sep;<span class="ref-vol">13</span>(9):1458-67.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9738519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9738519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>97.</dt><dd><div class="bk_ref" id="article-140317.r97">Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. <span><span class="ref-journal">PLoS One. </span>2013;<span class="ref-vol">8</span>(1):e55030.</span> [<a href="/pmc/articles/PMC3555979/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3555979</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23372809" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23372809</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="article-140317.r98">Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. <span><span class="ref-journal">Ann Intern Med. </span>2010 Sep 07;<span class="ref-vol">153</span>(5):289-98.</span> [<a href="/pmc/articles/PMC2989112/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2989112</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20820038" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20820038</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="article-140317.r99">Akter S, Mizoue T, Nanri A, Goto A, Noda M, Sawada N, Yamaji T, Iwasaki M, Inoue M, Tsugane S., Japan Public Health Center-based Prospective Study Group. Low carbohydrate diet and all cause and cause-specific mortality. <span><span class="ref-journal">Clin Nutr. </span>2021 Apr;<span class="ref-vol">40</span>(4):2016-2024.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33046262" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33046262</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="article-140317.r100">Ingram DD, Mussolino ME. Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. <span><span class="ref-journal">Int J Obes (Lond). </span>2010 Jun;<span class="ref-vol">34</span>(6):1044-50.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20212495" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20212495</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>101.</dt><dd><div class="bk_ref" id="article-140317.r101">Brown ML, Levinson CA. Core eating disorder fears: Prevalence and differences in eating disorder fears across eating disorder diagnoses. <span><span class="ref-journal">Int J Eat Disord. </span>2022 Jul;<span class="ref-vol">55</span>(7):956-965.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35567750" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35567750</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>102.</dt><dd><div class="bk_ref" id="article-140317.r102">Gravina G, Milano W, Nebbiai G, Piccione C, Capasso A. Medical Complications in Anorexia and Bulimia Nervosa. <span><span class="ref-journal">Endocr Metab Immune Disord Drug Targets. </span>2018;<span class="ref-vol">18</span>(5):477-488.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29848283" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29848283</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>103.</dt><dd><div class="bk_ref" id="article-140317.r103">Luca A, Luca M, Calandra C. Eating Disorders in Late-life. <span><span class="ref-journal">Aging Dis. </span>2015 Feb;<span class="ref-vol">6</span>(1):48-55.</span> [<a href="/pmc/articles/PMC4306473/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4306473</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25657852" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25657852</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>104.</dt><dd><div class="bk_ref" id="article-140317.r104">Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. <span><span class="ref-journal">Am J Med. </span>2016 Jan;<span class="ref-vol">129</span>(1):30-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26169883" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26169883</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>105.</dt><dd><div class="bk_ref" id="article-140317.r105">Miller-Kovach K, Hermann M, Winick M. The psychological ramifications of weight management. <span><span class="ref-journal">J Womens Health Gend Based Med. </span>1999 May;<span class="ref-vol">8</span>(4):477-82.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10839702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10839702</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>106.</dt><dd><div class="bk_ref" id="article-140317.r106">Hall CJ, Lane AM. Effects of rapid weight loss on mood and performance among amateur boxers. <span><span class="ref-journal">Br J Sports Med. </span>2001 Dec;<span class="ref-vol">35</span>(6):390-5.</span> [<a href="/pmc/articles/PMC1724425/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1724425</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11726472" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11726472</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>107.</dt><dd><div class="bk_ref" id="article-140317.r107">Geerts MM, van den Berg EM, van Riel L, Peen J, Goudriaan AE, Dekker JJM. Behavioral and psychological factors associated with suboptimal weight loss in post-bariatric surgery patients. <span><span class="ref-journal">Eat Weight Disord. </span>2021 Apr;<span class="ref-vol">26</span>(3):963-972.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32472495" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32472495</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>108.</dt><dd><div class="bk_ref" id="article-140317.r108">Barbuti M, Carignani G, Weiss F, Calderone A, Fierabracci P, Salvetti G, Menculini G, Tortorella A, Santini F, Perugi G. Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study. <span><span class="ref-journal">Eat Weight Disord. </span>2023 Jun 02;<span class="ref-vol">28</span>(1):49.</span> [<a href="/pmc/articles/PMC10237075/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10237075</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37266717" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37266717</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>109.</dt><dd><div class="bk_ref" id="article-140317.r109">Juchacz K, Kłos P, Dziedziejko V, Wójciak RW. The Effectiveness of Supportive Psychotherapy in Weight Loss in a Group of Young Overweight and Obese Women. <span><span class="ref-journal">Nutrients. </span>2021 Feb 06;<span class="ref-vol">13</span>(2)</span> [<a href="/pmc/articles/PMC7914739/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7914739</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33562001" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33562001</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>110.</dt><dd><div class="bk_ref" id="article-140317.r110">Lowe MR, Timko CA. Dieting: really harmful, merely ineffective or actually helpful? <span><span class="ref-journal">Br J Nutr. </span>2004 Aug;<span class="ref-vol">92 Suppl 1</span>:S19-22.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15384317" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15384317</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>111.</dt><dd><div class="bk_ref" id="article-140317.r111">Farhana A, Rehman A. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 10, 2023. Metabolic Consequences of Weight Reduction. [<a href="https://pubmed.ncbi.nlm.nih.gov/34283511" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34283511</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>112.</dt><dd><div class="bk_ref" id="article-140317.r112">Ostovan MA, Zibaeenezhad MJ, Keshmiri H, Shekarforoush S. The impact of education on weight loss in overweight and obese adults. <span><span class="ref-journal">Int Cardiovasc Res J. </span>2013 Sep;<span class="ref-vol">7</span>(3):79-82.</span> [<a href="/pmc/articles/PMC3987437/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3987437</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24757627" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24757627</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>113.</dt><dd><div class="bk_ref" id="article-140317.r113">Kim JY. Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance. <span><span class="ref-journal">J Obes Metab Syndr. </span>2021 Mar 30;<span class="ref-vol">30</span>(1):20-31.</span> [<a href="/pmc/articles/PMC8017325/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8017325</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33107442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33107442</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>114.</dt><dd><div class="bk_ref" id="article-140317.r114">Greaves C, Poltawski L, Garside R, Briscoe S. Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. <span><span class="ref-journal">Health Psychol Rev. </span>2017 Jun;<span class="ref-vol">11</span>(2):145-163.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28281891" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28281891</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>115.</dt><dd><div class="bk_ref" id="article-140317.r115">Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer D. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study. <span><span class="ref-journal">Clin Obes. </span>2016 Apr;<span class="ref-vol">6</span>(2):124-32.</span> [<a href="/pmc/articles/PMC5111761/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5111761</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26815638" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26815638</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>116.</dt><dd><div class="bk_ref" id="article-140317.r116">Gunnarsson BK, Hansdottir I, Bjornsdottir E, Birgisdottir EB, Arnadottir AT, Magnusson B. [The short-and long term effect of multidisciplinary obesity treatment on body mass index and mental health]. <span><span class="ref-journal">Laeknabladid. </span>2016 Feb;<span class="ref-vol">102</span>(2):83-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26863254" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26863254</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>117.</dt><dd><div class="bk_ref" id="article-140317.r117">Geniş B, Kayalar A, Dönmez A, Coşar B. Effect of Structured Cognitive-Behavioral Group Therapy on Body Weight, Mental Status and the Quality of Life in Obese and Overweight Individuals: A 16-Week Follow Up Study. <span><span class="ref-journal">Turk Psikiyatri Derg. </span>2022 Spring;<span class="ref-vol">33</span>(1):11-21.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35343577" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35343577</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>118.</dt><dd><div class="bk_ref" id="article-140317.r118">Haverkamp K, Newberry P, Baker J. Impact of a pharmacist-run weight loss medication management service. <span><span class="ref-journal">J Am Pharm Assoc (2003). </span>2022 May-Jun;<span class="ref-vol">62</span>(3):883-888.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34872859" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34872859</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Kerry Jaime declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Victoria Mank declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK603752_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Kerry Jaime</span><sup>1</sup>; <span itemprop="author">Victoria Mank</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Tripler Army Medical Center</div><div class="affiliation"><sup>2</sup> Tripler Army Medical Center</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">February 29, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Jaime K, Mank V. Risks Associated With Excessive Weight Loss. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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