We also did not consider the economic implications of interventions for weight loss in overweight and obesity, but we searched the literature on resource implications. Stores that list all the ingredients of your meal, like sandwich shops and smoothie shops, are a good bet. Not Helpful 4 Helpful See a personal trainer. Tell them you're interested in healthy weight gain. I wish I could help more but if the blocks are working then it's either the pain relief or the blocks.
Why Weight Gain Often Happens After Menopause
After the initial screening, there were insufficient RCTs that included only normal-weight participants. Yet, the evidence review centre identified numerous RCTs with a goal of preventing weight gain, but with study participants recruited from mixed-weight i.
The task force had the option to search for observational studies to address the first key question i. Given the potential for bias with lower-quality designs, the task force decided to use the indirect evidence from the RCTs to formulate the recommendations.
The evidence review focused only on intervention trials conducted in settings generalizable to Canadian primary care, feasible for conduct in primary care, or feasible for referral from primary care. Therefore, faith-based programs or studies conducted in specialist centres or educational settings were not reviewed. The research questions and analytical framework Appendix 2 were based on the review of RCTs of behavioural and pharmacologic interventions for weight loss by the US Preventive Services Task Force.
There were sufficient studies to assess the primary outcomes of weight maintenance or loss, and secondary outcomes of improvements in blood pressure, glucose and lipid levels and incidence of type 2 diabetes. Recommendations are graded according to the GRADE system, 18 which offers two strengths of recommendation: The strength of recommendations is based on the quality of supporting evidence, the degree of uncertainty about the balance between desirable and undesirable effects, the degree of uncertainty or variability in values and preferences, and the degree of uncertainty about whether the intervention represents a wise use of resources.
Strong recommendations are those for which the task force is confident that the desirable effects of an intervention outweigh its undesirable effects strong recommendation for an intervention or that the undesirable effects of an intervention outweigh its desirable effects strong recommendation against an intervention. A strong recommendation implies that most individuals will be best served by the recommended course of action.
Weak recommendations are those for which the desirable effects probably outweigh the undesirable effects weak recommendation for an intervention or undesirable effects probably outweigh the desirable effects weak recommendation against an intervention but appreciable uncertainty exists.
A weak recommendation implies that most people would want the recommended course of action but that many would not. For clinicians, this means they must recognize that different choices will be appropriate for each individual, and they must help each person arrive at a management decision consistent with his or her values and preferences.
Policy-making will require substantial debate and involvement of various stakeholders. Weak recommendations result when the balance between desirable and undesirable effects is small, the quality of evidence is lower, or there is more variability in the values and preferences of patients.
Evidence is graded as high, moderate, low or very low, based on how likely further research is to change our confidence in the estimate of effect. Box 2 12 contains a summary of the recommendations. These recommendations do not apply to people with eating disorders or who are pregnant.
Strong recommendation; very low-quality evidence. Weak recommendation; very low-quality evidence. Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with a BMI of 40 or greater, who may benefit from specialized bariatric programs.
For adults who are obese BMI 30— Strong recommendation; moderate-quality evidence. Weak recommendation; moderate-quality evidence. For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions orlistat or metformin aimed at weight loss. Interventions examined for prevention of weight gain included behaviourally based prevention interventions focused on diet, increasing exercise, making lifestyle changes or any combination of these.
These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally based interventions focused on diet, increasing exercise, making lifestyle changes or any combination of these. For adults who express concerns about weight gain or who are motivated to make lifestyle changes, practitioners should also consider offering or referring to prevention interventions and must help each person arrive at a management decision consistent with his or her values and preferences.
The recommendations do not apply to people with eating disorders or who are pregnant. We recommend measuring height and weight and calculating BMI at appropriate primary care visits. No studies of screening for weight issues in primary care were identified. The measurement of height, weight and calculation of BMI is nevertheless recommended, because there is strong evidence that adults tend to overestimate height and underestimate weight, 23 and there is increasing evidence that visual estimation by health providers is also relatively inaccurate.
It is also important to measure weight trajectories over time and intervene if people become overweight. Of the clinically feasible measures, BMI is the body composition measure most strongly associated with mortality. Other acceptable measures of obesity have been reviewed elsewhere and include waist circumference and waist-to-hip ratio. Classifying and describing obesity by associated health problems and mortality risk e.
Despite its limitations, BMI was selected as the preferred measure because it is inexpensive and easy to apply only height and weight are required to calculate BMI , no special training or equipment is required, and it can be used to monitor weight changes over time.
Evidence of possible harms from prevention interventions was sought in the evidence review, but not specifically for calculating BMI. The purpose of assessing BMI is to track changes in weight status over time, identify patients who may benefit from referral to obesity-management programs and to categorize patients with respect to overall cardiometabolic risk.
For example, current diabetes screening recommendations suggest that BMI and waist circumference be used together to estimate the future risk of type 2 diabetes. We recommend that practitioners not offer formal, structured interventions aimed at preventing weight gain in normal-weight adults. A new systematic review of primary care—relevant RCTs comparing weight-gain preventions with no treatment was conducted to inform the recommendations.
However, the mean difference in weight lost between the groups was minimal 0. The review identified evidence from 19 RCTs that focused on preventing weight gain in mixed-weight populations i. Trials of pharmacologic and surgical interventions were also excluded because these interventions were not considered relevant for prevention of weight gain among normal-weight individuals.
To ensure the trials included some adults of normal weight, the number or percentage of normal-weight participants needed to be specified, or at least one study arm needed a baseline mean BMI or a baseline mean BMI minus one standard deviation that fell within the normal range Behavioural interventions which generally included diet, exercise or other lifestyle components lasted between 3 and 12 months to up to 12 years.
Meta-analyses showed that intervention participants did not gain weight or gained less than controls. Overall, intervention participants lost an additional 0. Few long-term data exist to determine whether changes in weight are maintained after the interventions are completed.
One study that did examine longer-term weight maintenance after promotion of physical activity in primary care found that initial weight changes were not sustained 15 months after the intervention. No statistically significant reductions were found for systolic or diastolic blood pressure. Three studies recruited people at higher risk of cardiovascular disease, whereas the rest included people at average, low or unknown risk of cardiovascular disease.
All 19 RCTs were considered to be very low-quality and were downgraded for risk of bias, indirectness and publication bias details provided in the evidence review. There was no evidence that patients with different baseline characteristics such as age, sex, cardiovascular risk or baseline BMI responded differently to the interventions. Whereas the goal of the reviewed studies was to avoid weight gain, and therefore the fact that the intervention participants did not increase their weight is relevant, the very low quality of the studies identified and their uncertain generalizability to normal-weight populations pose substantial limitations.
No evidence indicated any harms associated with these preventive interventions. In making this recommendation against routinely offering or referring to interventions for weight-gain prevention, particularly in normal-weight individuals, the task force carefully considered the evidence of limited effectiveness, the balance of potential benefits and harms, and potential resource implications, as outlined in the decision table for prevention of weight gain Appendix 3.
This recommendation places a relatively high value on the importance of showing a clear net benefit before recommending programs for weight-gain prevention for the general population. Particular areas of concern were the lack of evidence of clinically meaningful prevention of short-term weight gain, the lack of evidence that weight was maintained over the long term, and the lack of evidence for effectiveness of preventive interventions in normal-weight populations specifically as compared with mixed-weight populations, in whom benefits may differ.
This recommendation places a relatively low value on the unproven possibility that programs for obesity prevention offered to the normal-weight population may reduce the long-term risk for obesity in that group. However, the task force has offered a weak recommendation, because practitioners should use their judgment in determining whether some normal-weight adults may still benefit from being offered or referred to interventions for weight-gain prevention.
Individuals who might be more likely to benefit from such referrals include those who are at higher risk of obesity or its consequences e. Structured interventions are intensive behavioural modification programs involving several sessions over weeks to months. Recommended interventions include behaviourally based interventions focused on diet, exercise or lifestyle changes, alone or in combination.
For adults who are overweight or obese, we recommend that practitioners offer or refer to structured behavioural interventions aimed at weight loss. Structured interventions are as defined in the previous recommendation. Meta-analyses of trials with behavioural interventions e. No trials reported on overall mortality or disease incidence, except for type 2 diabetes.
Effect of treatment on primary and secondary outcomes, compared with controls The trials included in the meta-analyses for this recommendation included participants with and without diabetes and other chronic conditions. Therefore, this recommendation applies to all populations, other than those at high risk for type 2 diabetes. People at high risk for type 2 diabetes are addressed in a separate recommendation.
Subgroup analysis by duration of intervention showed no difference based on duration. Weight-gain prevention has been proposed as an alternative strategy for managing overweight and obesity. Results of the task force review informing the obesity prevention recommendations are relevant for those interested in strategies for weight-gain prevention. No studies were identified reporting significant harms of behavioural interventions. No significant difference in frequency of any adverse event, serious adverse event or withdrawal due to adverse events was reported between intervention groups and controls.
Meta-analysis showed that participants who received the intervention lost an additional 2. The mean BMI score at baseline was 34—36 for patients in the pharmacologic trials. Three pharmacologic plus behavioural studies examined incidence of type 2 diabetes. Participants in the intervention group were less likely to receive a diagnosis of new-onset type 2 diabetes RR 0. Several concerns have led the task force to recommend against the routine use of pharmacologic treatments for management of overweight and obesity.
Participants receiving the intervention in pharmacologic trials were more likely to experience adverse events number needed to harm [NNH] 10 , gastrointestinal events NNH 5 and withdraw because of gastrointestinal and other harms NNH 32 , compared with those in the control group.
Most studies included a run-in period during which participants were required to reduce calories and encouraged to increase physical activity. In some cases, patients were stratified for inclusion based on the amount of weight lost during the run-in period.
Most studies provided no data on the proportion of participants excluded from trials after the run-in periods, and therefore the generalizability to the broader population is questionable. Finally, all control groups received some behavioural intervention.
Because of these concerns and the identified harms, the task force recommends against pharmacologic interventions for the management of overweight and obesity.
Yet, pharmacologic therapy may be warranted in some situations. Physicians will need to consider the potential for benefits and harms in advising those patients who may benefit from the addition of pharmacologic therapy to behavioural change e. As with behavioural interventions, personal values, preferences, experience and supports will be the main determinants of which interventions will be best suited for individual patients.
Two studies on behavioural interventions and four on pharmacologic plus behavioural interventions reported on weight maintenance. Results are consistent with other estimates in the literature.
The task force places a higher value on the evidence for short-term weight loss without important harms and on improvements in certain secondary health outcomes with behavioural interventions.
Given the large number of studies with consistent results, new studies of behavioural interventions are not expected to achieve substantially different results. The weak recommendation is due to the limited evidence on the long-term effectiveness of interventions on health indicators. For example, no data on clinically relevant outcomes, such as mortality, were identified.
The task force recommends against pharmacologic intervention to manage overweight and obesity, although some patients may prefer medications and be good candidates for pharmacologic treatment. Of note, all pharmacologic interventions in our review also included a behavioural component and therefore pharmacologic monotherapy without the behavioural intervention may not be as effective.
If treatment is implemented, patients should be aware that the magnitude of the average expected weight change is modest about 3 kg , although this change may be clinically meaningful, especially in those at higher risk of obesity-related complications.
For those at risk of type 2 diabetes, the potentially beneficial delay in the onset of diabetes was sufficient for the task force to offer a strong recommendation. The task force has developed a series of tools to help practitioners interpret these recommendations for their patients, which can be found at canadiantaskforce.
Disgusted is the only word I can think of right now! I have had a series of both facet block injections and steroid epidurals with my most recent one in August, I am very fit and worked hard most of my life to eat healthy, exercise at an intense level, and keep my weight in normal range. Facet blocks and steroid epidurals will make you gain weight and even though I've continued to exercise and watch my diet throughout my treatments, I have still gained lbs.
Some prescriptions like Lyrica will also make you gain wieght very quickly. I am finally pain free and while gaining weight after all my years of hard work in the gym bothers me, anyone that has had long term spine pain and suffering will agree that gaining weight needs to be a secondary concern.
Finding a treatment to reduce pain is critical and the most important issue. Doctors think some of our questions are trivial and do not tell us enough about ramifications of drugs or treatments. Be your own advocate. I don't intend to end up on the couch, in pain, and overweight reliant on drugs and shots the rest of my life. I have had 8 injections and 4 radiofrequencies in a 2 year span and have gained around 20 lbs.
I have gone from no exercise which I had lost all but 5 lbs baby wt to days a week 7 during holidays eliminating ice cream,chocolate and pop from my diet and no change so please don't tell me these things are the solution! I'm hoping eventually in time I will see some loss-6 months since last treatment. I sweat my butt off working out and have not given up that eventually I will see loss and try to tone any gain but still have a layer over the muscle I'm building.
If anyone has found supplements or treatment that do work please post! I also have had thease facet injcetions 4 times and each time i gained about 6 lbs what my pain doctor did for me was change one of my nerve pain medds and put me on another one instead witch the main side effect was loseing weight. The first month i lost 9 lbs and have been loseing weight ever since I have lost 2 stone 5ibs now but i have been watching what i am eating but not dieting. Over the last 6 years siene i hurt my back and all the different medds i did gain 5 stone 7lbs tho, but the new tablets he put me on helped me to lose weight and he told me that would happen i have not gained 1lbs since he put me on them Topiromate50mg one in morn and at night for my nerve pain i am on other pain medds for my other pain.
I have been on a 10 year journey with my condition. I have experienced weight gain after having epidural injections, but have been repeatedly told they don't causevsuch by neurologists. I too tried Topiramate Topmax. It is nicknamed Stupimax for its side effects. I had the side effects and would wave off anyone from this drug as a cornucopia for weight loss.
Visual halucinations and inability to finish your own sentences being the worst and not worth the weight loss achieved. I am sorry to here about the side effects you had ,I have had no side effects yet but it is good to here the good and bad about each medication because it can have a different effect an each person. I have had over the past three years around 6 epidoral's I also had knee and two hips replaced this last epidoral has made me gain a great deal of weight I have 5 detorated disco and disc bulge it is causing me not to heal from the surgeries, the onl;y good thing is I didn't gain this weight like I have now how long does it take to lose the weight very unconfortable I am only 4 11 tall please advise.
I wish I could excerise my right knee was done twice still bother's me then my right hip replaced and I am now in 7 mos since the left was done, my surgeon told me to go for the Epi's becuase the pain from the back goes to the legs still in alot of pain, so unhappy thank god I havemy husand I do things around the house go to the store's but I hurt bad I told my huband I will not go for another Epidoral I still have one knee to go It has been the worse 5 years of my life!
I don't mean to be a cry baby but I was a very active person I have gained about 35 lbs believe me I don't eat alot? I have just had my first steroidal injection and after reading this forum decided to call my doctor regarding weight gain. To my surprise he said "not common in epidural injections".
I also asked my daughter I started receiving the injections for lower back pain about 3 years ago and have gained 20 LBS. It is very hard as I am in 60's and always strived to be slim with exercise and eating right. Most of it is in the stomach area but also legs heavier. I still do the treadmill a few times a week for a couple of miles but just get very discouraged. I have heard instead of steroid they can use saline solution but don't think the results would be the same. If I would get the saline solution instead of the steroid, would I lose the weight that I've gained?
I need something for the pain but was wondering if anyone else had switched and then lost the weight. Have any of you lost hair due to your steroid injections? I am now seeing a pattern with my hair falling out after I have an injection!
And just recently put two and two together and think it is from the shots! If you stop the steroid injections then will all the weight you gained come off again? Most of mine is all around the stomach area. I have had 2 lumbar and one cervical injection in the last 8 weeks. I had one before going on vacation and thought I gained the 8 lbs from eating too much. I was a little underweight before Does anyone know how to get rid of the fat deposits?
That is exactly what it seems like. I too was told it wouldn't make me gain weight, but it certainly did. And the worse part of all I spent alot of money and got no pain relief whatsoever. I just had 2 SI joint injections and 2 epidural injections in a month. None did anything for my pain but, I too experienced about 10 pound weight gain but just attributed it to lack osf exercise of any kind due to continued pain.
I have also experienced blurred vision, anxiety, stomach problems. Due to the various conditions I have I never put 2 and 2 together. And now I am upset I didn't know about this before. I also take lyrica but have been on it about 4 years so the weight gain so suddenly can't be meds.
I am also experiencing increased hair loss. I've been dealing with this for 2 years now. The weight started almost immediately after my set of epiderals then my first few RF procedures in my L5-S1. That was 10 lbs. Then the binging on sweets started. I've always been under weight and preferered it that way.
But I was always able to run anywhere from miles a week. Now year 2 and another round of epiderals and RF procedures and another 10 lbs. I feel like I'm obese. I'm also tired of people telling me they can't tell I've gained weight but I needed it anyways. The last time I had a stomach was 25 yrs ago when I was pregnant with my youngest son.
I've never had to deal with a fat stomach and my weight goes in my butt and thighs. I'm more depressed over the weight then the fact I have no lower back, can't excercise due to this and I just found out after 2 yrs of PT, 18 ortho's and 2 yrs of injections I have no clue how to engage my core.
Maybe I can once again bend. Has anyone ever tried botox. All products Which Ensure is for me? Every ready-to-drink shake has: Contains milk and soy ingredients.
Please refer to the product label for the most current ingredient, allergen, and nutrient profile information. Is there a limit on how many servings of Ensure Plus one can consume each day?
Ensure products should not be consumed by people with galactosemia. Ensure Plus is rated 4. Rated 1 out of 5 by julianne from not healthy This product is not healthy as it is corn, milk and soy based. All of these products are GMO. It has sugar which we know is not good for us. Weight gain is determined by the physical and mental health of the patient not just by adding more calories in your diet.
It would be much better to prepare your own fruit and vegetable smoothie with added protein and oils for your added energy and nutrients. Rated 5 out of 5 by sue1 from This the best for maintaining weight plus no artificial sweetner I am so happy that Ensure Plus does not contain artificial sweetner as I and a few of my friends are actually allergic to the artificial sweetners.
Unfortunately, according to my allergist it is becoming more and more common as people are becoming allergic to the artificial sweetners. I drink two bottles per day to maintain my weight. It also is delicious and I thank the makers of Ensure Plus every day for without it I would not be doing as well as I am. Please don't ever change the formula for Ensure Plus.