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High 5 Casino - The Home of Slots! The three steps for this method after finding the voids are locating and drilling holes, grout injection and post-testing the stabilized slabs. From Wikipedia, the free encyclopedia. This can reveal voids and other defects. Finally we evaluated 26 studies. CPR pays off in extra pavement life. Grand bay casino no deposit bonus codes creates a delay in wm 2022 spielplan symptom management. The land over which a public right of way exists is known as a highway; stamm sports dart although most highways have been made up into roads, and most easements of way exist over footpaths, the presence or absence of a made road has nothing to do with the distinction. It has been reported that "[p]roblems of transportation fc bayern wintertransfers and road conditions are the main factors that lead to road traffic accidents". Toll roads are also included. Health care literacy is the amount of basic health information people are able to understand. Archived from the original on

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Safety improvements such as traffic signs , crash barriers , raised pavement markers and other forms of road surface marking are installed.

When a single carriageway road is converted into dual carriageway by building a second separate carriageway alongside the first, it is usually referred to as duplication , [42] twinning or doubling.

The original carriageway is changed from two-way to become one-way, while the new carriageway is one-way in the opposite direction.

In the same way as converting railway lines from single track to double track , the new carriageway is not always constructed directly alongside the existing carriageway.

Like all structures, roads deteriorate over time. Deterioration is primarily due to accumulated damage from vehicles, however environmental effects such as frost heaves , thermal cracking and oxidation often contribute.

Potholes on roads are caused by rain damage and vehicle braking or related construction works. Pavements are designed for an expected service life or design life.

In some parts of the United Kingdom the standard design life is 40 years for new bitumen and concrete pavement. Maintenance is considered in the whole life cost of the road with service at 10, 20 and 30 year milestones.

When pavement lasts longer than its intended life, it may have been overbuilt, and the original costs may have been too high. When a pavement fails before its intended design life, the owner may have excessive repair and rehabilitation costs.

Some asphalt pavements are designed as perpetual pavements with an expected structural life in excess of 50 years. Many asphalt pavements built over 35 years ago, despite not being specifically designed as a perpetual pavement, have remained in good condition long past their design life.

Virtually all roads require some form of maintenance before they come to the end of their service life. Pro-active agencies use pavement management techniques to continually monitor road conditions and schedule preventive maintenance treatments as needed to prolong the lifespan of their roads.

These measurements include road curvature , cross slope , asperity , roughness , rutting and texture. Software algorithms use this data to recommend maintenance or new construction.

Maintenance treatments for asphalt concrete generally include thin asphalt overlays, crack sealing, surface rejuvenating, fog sealingfo, micro milling or diamond grinding and surface treatments.

Thin surfacing preserves, protects and improves the functional condition of the road while reducing the need for routing maintenance, leading to extended service life without increasing structural capacity.

Older concrete pavements that develop faults can be repaired with a dowel bar retrofit , in which slots are cut in the pavement at each joint, and dowel bars are placed in the slots, which are then filled with concrete patching material.

This can extend the life of the concrete pavement for 15 years. Distress and serviceability loss on concrete roads can be caused by loss of support due to voids beneath the concrete pavement slabs.

The voids usually occur near cracks or joints due to surface water infiltration. The most common causes of voids are pumping, consolidation, subgrade failure and bridge approach failure.

Slab stabilization is a non-destructive method of solving this problem and is usually employed with other Concrete Pavement Restoration CPR methods including patching and diamond grinding.

The technique restores support to concrete slabs by filing small voids that develop underneath the concrete slab at joints, cracks or the pavement edge.

The process consists of pumping a cementitous grout or polyurethane mixture through holes drilled through the slab.

The grout also displaces free water and helps keep water from saturating and weakening support under the joints and slab edge after stabilization is complete.

The three steps for this method after finding the voids are locating and drilling holes, grout injection and post-testing the stabilized slabs.

Slab stabilization does not correct depressions, increase the design structural capacity, stop erosion or eliminate faulting. It does, however, restore the slab support, therefore, decreasing deflections under the load.

Stabilization should only be performed at joints and cracks where loss of support exists. Visual inspection is the simplest manner to find voids.

Signs that repair is needed are transverse joint faulting, corner breaks and shoulder drop off and lines at or near joints and cracks.

Deflection testing is another common procedure utilized to locate voids. It is recommended to do this testing at night as during cooler temperatures, joints open, aggregate interlock diminishes and load deflections are at their highest.

Ground penetrating radar pulses electromagnetic waves into the pavement and measures and graphically displays the reflected signal. This can reveal voids and other defects.

It consists of drilling a 25 to 50 millimeter hole through the pavement into the sub-base with a dry-bit roto-hammer.

Next, a two-part epoxy is poured into the hole — dyed for visual clarity. Once the epoxy hardens, technicians drill through the hole.

If a void is present, the epoxy will stick to the core and provide physical evidence. Common stabilization materials include pozzolan -cement grout and polyurethane.

The requirements for slab stabilization are strength and the ability to flow into or expand to fill small voids. Colloidal mixing equipment is necessary to use the pozzolan-cement grouts.

The contractor must place the grout using a positive-displacement injection pump or a non-pulsing progressive cavity pump.

A drill is also necessary but it must produce a clean hole with no surface spalling or breakouts. The injection devices must include a grout packer capable of sealing the hole.

The injection device must also have a return hose or a fast-control reverse switch, in case workers detect slab movement on the uplift gauge.

The uplift beam helps to monitor the slab deflection and has to have sensitive dial gauges. Successful resealing consists of old sealant removal, shaping and cleaning the reservoir, installing the backer rod and installing the sealant.

Sawing, manual removal, plowing and cutting are methods used to remove the old sealant. Saws are used to shape the reservoir.

When cleaning the reservoir, no dust, dirt or traces of old sealant should remain. Thus, it is recommended to water wash, sand-blast and then air blow to remove any sand, dirt or dust.

The backer rod installation requires a double-wheeled, steel roller to insert the rod to the desired depth. After inserting the backer rod, the sealant is placed into the joint.

There are various materials to choose for this method including hot pour bituminous liquid, silicone and preformed compression seals.

Careful design and construction of roads can increase road traffic safety and reduce the harm deaths, injuries, and property damage on the highway system from traffic collisions.

On neighborhood roads traffic calming , safety barriers , pedestrian crossings and cycle lanes can help protect pedestrians, cyclists, and drivers.

Botts dots are not used where it is icy in the winter, because frost and snowplows can break the glue that holds them to the road, although they can be embedded in short, shallow trenches carved in the roadway, as is done in the mountainous regions of California.

For major roads risk can be reduced by providing limited access from properties and local roads, grade separated junctions and median dividers between opposite-direction traffic to reduce likelihood of head-on collisions.

The placement of energy attenuation devices e. Some road fixtures such as road signs and fire hydrants are designed to collapse on impact.

Light poles are designed to break at the base rather than violently stop a car that hits them. Highway authorities may also remove larger trees from the immediate vicinity of the road.

Speed limits can improve road traffic safety and reduce the number of road traffic casualties from traffic collisions. In their World report on road traffic injury prevention report, the World Health Organization WHO identify speed control as one of various interventions likely to contribute to a reduction in road casualties.

Road conditions are the collection of factors describing the ease of driving on a particular stretch of road, or on the roads of a particular locality, including the quality of the pavement surface , potholes , road markings, and weather.

It has been reported that "[p]roblems of transportation participants and road conditions are the main factors that lead to road traffic accidents".

For example, for autonomous vehicles such as self-driving cars , significant road conditions can include "shadowing and lighting changes, road surface texture changes, and road markings consisting of circular reflectors, dashed lines, and solid lines".

Various government agencies and private entities, including local news services, track and report on road conditions to the public, so that drivers going through a particular area can be aware of hazards that may exist in that area.

News agencies, in turn, rely on tips from area residents with respect to certain aspects of road conditions in their coverage area. Water management systems can be used to reduce the effect of pollutants from roads.

Road runoff is a major source of nickel , copper, zinc , cadmium , lead and polycyclic aromatic hydrocarbons PAHs , which are created as combustion byproducts of gasoline and other fossil fuels.

De-icing chemicals and sand can run off into roadsides, contaminate groundwater and pollute surface waters ; [65] and road salts can be toxic to sensitive plants and animals.

Roads are a chief source of noise pollution. In the early s it was recognized [ by whom? Regulations can restrict the use of engine braking.

Motor vehicle emissions contribute air pollution. Concentrations of air pollutants and adverse respiratory health effects are greater near the road than at some distance away from the road.

Traffic flows on the right or on the left side of the road depending on the country. Roads are generally built and maintained by the public sector using taxation although implementation may be through private contractors.

Public-private partnerships are a way for communities to address the rising cost by injecting private funds into the infrastructure. There are four main ones: Society depends heavily on efficient roads.

According to the New York State Thruway Authority, [80] some sample per-mile costs to construct multi-lane roads in several US northeastern states were:.

See List of countries by road network size. Eurasia, Africa, North America, South America, and Australia each have an extensive road network that connects most cities.

Eurasia and Africa are connected by roads on the Sinai Peninsula. Antarctica has very few roads and no continent-bridging network, though there are a few ice roads between bases, such as the South Pole Traverse.

Bahrain is the only island country to be connected to a continental network by road the King Fahd Causeway to Saudi Arabia.

Even well-connected road networks are controlled by many different legal jurisdictions, and laws such as which side of the road to drive on vary accordingly.

Many populated domestic islands are connected to the mainland by bridges. Even on mainlands, some settlements have no roads connecting with the primary continental network, due to natural obstacles like mountains or wetlands, remoteness, or general expense.

Unpaved roads or lack of roads are more common in developing countries , and these can become impassible in wet conditions. Most disconnected settlements have local road networks connecting ports, buildings, and other points of interest.

For long-distance trips, passengers usually travel by air and rent a car upon arrival. If facilities are available, vehicles and cargo can also be shipped to many disconnected settlements by boat, or air transport at much greater expense.

The island of Great Britain is connected to the European road network by Eurotunnel Shuttle — an example of a car shuttle train which is a service used in other parts of Europe to travel under mountains and over wetlands.

In polar areas, disconnected settlements are often more easily reached by snowmobile or dogsled in cold weather, which can produce sea ice that blocks ports, and bad weather that prevents flying.

For example, resupply aircraft are only flown to Amundsen—Scott South Pole Station October to February, and many residents of coastal Alaska have bulk cargo shipped in only during the warmer months.

Permanent darkness during the winter can also make long-distance travel more dangerous in polar areas. Continental road networks do reach into these areas, such as the Dalton Highway to the North Slope of Alaska, the R21 highway to Murmansk in Russia, and many roads in Scandinavia though due to fjords water transport is sometimes faster.

Large areas of Alaska, Canada, Greenland, and Siberia are sparsely connected. For example, all 25 communities of Nunavut are disconnected from each other and the main North American road network.

Road transport of people and cargo by may also be obstructed by border controls and travel restrictions. For example, travel from other parts of Asia to South Korea would require passage through the hostile country of North Korea.

Moving between most countries in Africa and Eurasia would require passing through Egypt and Israel, which is a politically sensitive area.

Some places are intentionally car-free , and roads if present might be used by bicycles or pedestrians. Additional intercontinental and transoceanic fixed links have been proposed, including a Bering Strait crossing that would connect Eurasia-Africa and North America, a Malacca Strait Bridge to the largest island of Indonesia from Asia, and a Strait of Gibraltar crossing to connect Europe and Africa directly.

From Wikipedia, the free encyclopedia. A demarcated land route with a suitable surface between places. This article is about a route, thoroughfare or way that supports travel by a means of conveyance.

For a place outside a port a ship can lie at anchor, see Roadstead. For public roads, see Highway. For other routes, see Thoroughfare.

For other uses, see Road disambiguation. History of road transport. Environmental impacts of roads. Right- and left-hand traffic.

The specific problem is: Cities list on the mainland not connected is either incomplete, America centric, or not formulated has examples.

Previous publications have shown that sleep deprivation may be associated with obesity and central adiposity.

Other behaviors also need to be assessed in this regard. Diets such as DASH or addition of components like gelatin, capsaicin, and green tea have been tried for weight maintenance, but they need more investigation to clarify their long-term effects.

Although the DASH diet has numerous health results, its effect on weight loss and maintaining it is still under dispute.

As its recommended servings are similar to those that have been discussed earlier, a lot more research is needed in this area.

Diets with a meal replacement approach have some limitations, which have been mentioned previously. Nutritional counseling can help overweight subjects to learn dietary behaviors for weight gain prevention.

It is more effective when a kind of healthy diet such as DASH is followed. We should note the limitation of these studies such as self-reported data, more proportion of men than women in the study, their design, no representative sample, dropout rate, motivated participants, and low dietary compliance.

Long-term maintenance of the lost body weight can be described as a success. Although meal replacement has beneficial effects on weight loss, it cannot guarantee weight maintenance.

It seems that consuming fewer calories helps people to maintain the weight loss. Some special behaviors are also associated with better weight loss maintenance.

Consuming a lower amount of sugar sweetened beverages, not being awake late at night, and consuming more healthy foods are some examples of such behaviors.

No special food can definitely promote weight maintenance. Therefore, there is a necessity to develop further research to find strategies in obesity management, focusing on the successful maintenance of weight loss.

All authors have read and approved the content of the manuscript. National Center for Biotechnology Information , U. J Res Med Sci.

Fatemeh Azizi Soeliman and Leila Azadbakht. Author information Article notes Copyright and License information Disclaimer. Box , Isfahan, Iran.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Diet, feeding behavior, weight loss. Meal replacement One of methods that have been used a lot for preventing weight gain is meal replacement.

Table 1 Meal replacement and weight maintenance. Open in a separate window. Different macronutrient compositions in the diet Some researchers have tried changing macronutrient percents to find the most effective dietary mixture for weight maintenance.

Table 2 Macronutrient component and weight maintenance. Dietary behaviors Comparison of patients who have maintained their weight loss more than re-gainers shows that the subjects in first group stay late less at night, have increased physical activity after weight loss, drink less sugar sweetened beverages, eat less calorie from protein, and they have more emotional support.

Special foods Some studies have assessed the effects of special foods on weight maintenance. Table 3 Diet, Food, and weight maintenance. Footnotes Source of Support: Do mental disorders and eating patterns affect long-term weight loss maintenance?

A comparison of meal replacements and medication in weight maintenance after weight loss. J Am Coll Nutr. The definition of weight maintenance.

Human biology of weight maintenance after weight loss. The effect of eating behavior on weight loss and maintenance during a lifestyle intervention.

Taking control of your personal eating and exercise environment: A weight maintenance program. Predictors of long-term weight maintenance.

A meta-analysis of US studies. Am J Clin Nutr. Successful weight-loss maintenance in relation to method of weight loss. Who does not gain weight?

Prevalence and predictors of weight maintenance in young women. Weight maintenance and relapse in obesity: Prevalence and predictors of weight-loss maintenance in a biracial cohort: Results from the coronary artery risk development in young adults study.

Am J Prev Med. Enhancing Long-term Weight Loss Maintenance: Efficacy of a meal replacement diet plan compared to a food-based diet plan after a period of weight loss and weight maintenance: A randomized controlled trial.

Value of structured meals for weight management: Risk factors and long-term weight maintenance. A structured diet and exercise program promotes favorable changes in weight loss, body composition, and weight maintenance.

J Am Diet Assoc. Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: A 6-mo randomized, controlled trial.

One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: Does diet composition matter?

Determining optimal approaches for weight maintenance: A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults.

Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. The effect of dietary glycemic index on weight maintenance in overweight subjects: Metabolic and behavioral compensations in response to caloric restriction: Implications for the maintenance of weight loss.

Better dietary adherence and weight maintenance achieved by a long-term moderate-fat diet. The effect of a high-MUFA, low-glycaemic index diet and a low-fat diet on appetite and glucose metabolism during a 6-month weight maintenance period.

Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults.

Factors associated with the maintenance or achievement of the weight loss goal at follow-up among participants completing an adapted diabetes prevention program.

Diabetes Res Clin Pract. Dietary energy density and successful weight loss maintenance. Psychobehavioural factors are more strongly associated with successful weight management than predetermined satiety effect or other characteristics of diet.

Weight maintenance 2 years after participation in a weight loss program promoting low-energy density food. Self-reported changes in dietary calcium and energy intake predict weight regain following a weight loss diet in obese women.

Amount of food group variety consumed in the diet and long-term weight loss maintenance. The dietary approaches to stop hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients.

A randomized crossover clinical trial. Dietary intakes associated with successful weight loss and maintenance during the weight loss maintenance trial.

No long-term weight maintenance effects of gelatin in a supra-sustained protein diet. Prolonged refeeding improves weight maintenance after weight loss with very-low-energy diets.

Green tea catechin plus caffeine supplementation to a high-protein diet has no additional effect on body weight maintenance after weight loss.

Green tea for weight loss and weight maintenance in overweight or obese adults. Cochrane Database Syst Rev. Body weight loss and weight maintenance in relation to habitual caffeine intake and green tea supplementation.

Effect of capsaicin on substrate oxidation and weight maintenance after modest body-weight loss in human subjects. Dietary strategies for successful weight loss and maintenance: Food selection and eating behaviour during weight maintenance intervention and 2-y follow-up in obese men.

Dietary protein, metabolism, and body-weight regulation: Weight management using a meal replacement strategy: Meta and pooling analysis from six studies.

Is there an optimal macronutrient mix for weight loss and weight maintenance? Best Pract Res Clin Gastroenterol. High protein intake sustains weight maintenance after body weight loss in humans.

Effects of diet composition on postprandial energy availability during weight loss maintenance. Dietary supplements and weight control in a middle-age population.

J Altern Complement Med. Dietary diversity within food groups: An indicator of specific nutrient adequacy in Tehranian women.

Azadbakht L, Esmaillzadeh A. Dietary energy density is favorably associated with dietary diversity score among female university students in Isfahan.

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Some places are intentionally car-free , and roads if present might be used by bicycles or pedestrians. Additional intercontinental and transoceanic fixed links have been proposed, including a Bering Strait crossing that would connect Eurasia-Africa and North America, a Malacca Strait Bridge to the largest island of Indonesia from Asia, and a Strait of Gibraltar crossing to connect Europe and Africa directly.

From Wikipedia, the free encyclopedia. A demarcated land route with a suitable surface between places. This article is about a route, thoroughfare or way that supports travel by a means of conveyance.

For a place outside a port a ship can lie at anchor, see Roadstead. For public roads, see Highway. For other routes, see Thoroughfare.

For other uses, see Road disambiguation. History of road transport. Environmental impacts of roads. Right- and left-hand traffic.

The specific problem is: Cities list on the mainland not connected is either incomplete, America centric, or not formulated has examples.

Please help improve this section if you can. September Learn how and when to remove this template message. Embankment transportation Gravel road List of countries by road network size List of roads and highways Pedestrian zone Road slipperiness Road transport Track bed Trade route.

Ways of the World: National Department of Transport South Africa. Archived from the original on Most of the provisions apply on all roads throughout Great Britain, although there are some exceptions.

The land over which a public right of way exists is known as a highway; and although most highways have been made up into roads, and most easements of way exist over footpaths, the presence or absence of a made road has nothing to do with the distinction.

Historically, a highway comprehended any path in which members of the public had the right to pass and re-pass without let or hindrance.

The term embraced footpaths, bridleways, driftways and so forth. The advent of the motor vehicle and its peculiar requirements has seen increasing distinctions between paths over which walkers and riders have a right of way and those ways that are predominantly used by motor vehicles.

The former may be usefully termed "rights of way" and are the subject of a separate entry in this web and the latter may be termed "highways.

A passage through the country for the use of the people. Roads are public or private. Public roads are laid out by public authority, or dedicated by individuals to public use.

The public have the use of such roads, but the owner of the land over which they are made and the owners of land bounded on the highway, have, prima facie, a fee in such highway, ad medium filum viae, subject to the easement in favor of the public Private roads are, such as are used for private individuals only, and are not wanted for the public generally.

Environment and Planning B: The New York Times. Conflict and Negotiation Over Public Space. Retrieved 18 November The first sidewalks appeared around to B.

Iran Chamber of Society. The Cambridge Ancient History. The Miracle of Islam Science 2nd ed. Rebecca and her daughters come to Rhayader. Victorian Powys for Schools.

Archived from the original Doc on July 9, Western Australia The Last Frontier. Archived from the original PDF on Constructing roads into forestry work areas.

Building the cities, towns, streets, highways and bridges in your neighborhood and in communities around the globe. International Society for Asphalt Pavements.

Frontiers of Knowledge and Practice. Transportation Association of Canada. Washington State Department of Transportation. Retrieved 24 March A compelling need for preserving city concrete streets led to the development of a methodology for scoping repairs and the undertaking of a comprehensive concrete pavement repair program in Grand Rapids, Michigan".

CPR pays off in extra pavement life. Georgia continues to be the leader in concrete pavement restoration, but as the word spreads other states are beginning to use this system to restore deteriorating pavements.

Towards Sustainable Transportation Systems , p. Rai, e-Infrastructure and e-Services for Developing Countries , p. The Ecology of Transportation: Managing Mobility for the Environment.

Proceedings of the National Academy of Sciences. The Rule of the Road: An International Guide to History and Practice. Australia CCG Update: Economic Trends and Outlook E.

Maps, Reports and history of gas tax in the United States. New York State Thruway Authority. Archived from the original on 1 July Retrieved 10 January Canadian Northern Economic Development Agency.

Glossary of road transport terms Road types by features. Cone penetration test Standard penetration test Monitoring well piezometer Borehole Crosshole sonic logging Nuclear densometer test Static load testing Trial pit.

Atterberg limits California bearing ratio Direct shear test Hydrometer Proctor compaction test R-value Sieve analysis Triaxial shear test Hydraulic conductivity tests Water content tests.

Slope analysis mass wasting landslide Deformation monitoring automated. Soil liquefaction Response spectrum Seismic hazard Ground—structure interaction.

Geotextile Geomembrane Geosynthetic clay liner Cellular confinement. Retrieved from " https: Webarchive template webcite links CS1 maint: Archived copy as title Webarchive template wayback links Articles with short description All articles with self-published sources Articles with self-published sources from December Articles with specifically marked weasel-worded phrases from April Articles needing cleanup from September All pages needing cleanup Cleanup tagged articles with a reason field from September Wikipedia pages needing cleanup from September Wikipedia articles with GND identifiers Wikipedia articles with NARA identifiers Wikipedia articles with NDL identifiers.

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On-site Cone penetration test Standard penetration test Monitoring well piezometer Borehole Crosshole sonic logging Nuclear densometer test Static load testing Trial pit.

After fat loss, thermogenesis reduces, and results in resistance to lose fat. A drop in hormones levels, such as leptin and thyroid hormones, causes the risk of increased energy intake after weight loss.

In this period, adipocytes face cellular stress and consequently renewed fat storage. The determinants of the ability of weight maintenance are genetic, behavior, and environment.

Among them, diet is the most important factor that influences the stability of body weight. It has been shown that a greater resting metabolic rate RMR at baseline, increased dietary restraint, and low frequency of dieting,[ 8 ] are associated with weight regain.

A meta-analysis in , revealed that using a very low energy die t VLED for weight loss or losing more than 20 kg are two predictors of weight maintenance,[ 9 ] however, one study that assessed the method of weight loss, declared that patients on VLED gain more weight after the end of the weight loss period, but a self-directed approach was more successful in this regard.

Adopting these behaviors as a habit needs supportive strategies by virtue of phone or email. As the studies are inconclusive, it seems necessary to plan programs in order to facilitate weight maintenance for long periods.

Although there are some review studies regarding the effects of different foods and diets on weight reduction, we are not aware of any review article regarding the effects of foods and diets on preventing weight regain after weight loss.

It seems that weight maintenance is as important as weight reduction nowadays. Therefore, we conducted a review of the available evidence to assess the effect of different diets on weight maintenance after weight loss.

To identify studies regarding weight maintenance, with an emphasis on dietary interventions, a complete search of articles was carried out by using PubMed and SCOPUS.

The studies were restricted to those in English. Articles from to were included. We found 75 articles. We excluded studies published only as abstracts and those involving behavioral therapy or exercise per se.

Finally we evaluated 26 studies. One of methods that have been used a lot for preventing weight gain is meal replacement. It is safe, efficient, cost-effective, and without any side effects.

Main meals and snacks can be replaced by these nutritionally balanced low-fat meals. Table 1 shows the meal replacement trials for weight maintenance.

Subsequently, they randomized participants to receive a structured meal plan combined with either two-meal replacements or orlistat and physical activity.

There was no significant difference in weight change between the groups during weight maintenance. The amount of weight regain was more in the MD group, but the percentage of participants who kept up their weight in this group was more than in the other group.

In a prospective intervention, patients randomly went on one of the two dietary interventions for weight loss: Group A, which consisted of an energy-restricted diet, and group B, which included an isocaloric diet, through which two meals per day were replaced.

Next, the patients were ordered the same calorie diets and had only one replacement per day for four years. The body weight reduced in both groups in the weight-loss period, but group B had a greater change and maintained their weight better.

Meal replacement — based dietary intervention compared to a structured diet and exercise program for both weight loss and maintenance had no distinctive influences on appetite, fullness, diet satisfaction, and quality.

The structured diet group lost significantly more weight and maintained greater weight loss, but they reported more physical activity too that may have affected the results.

There are some limitations when using this method. First of all, participants in most studies are volunteers and so more motivated. Second, they may not be able afford meal replacements.

Some researchers have tried changing macronutrient percents to find the most effective dietary mixture for weight maintenance. However, there is much contradictory data in this area.

Larsen and his colleagues showed that the rate of maintenance of weight loss were higher among participants who were assigned to the low-protein diets and to the high-GI diets compared to the high-protein diets and low-GI diets.

Significant weight gain was seen in a low protein-high GI group, but in a high protein — low GI diet weight reduction after weight loss continued.

However, there was no interaction between the protein and GI. Following an investigation by Wang et al. Unfortunately the sample size of this study was small.

An energy-restricted diet, with moderate fat, may have more advantages for weight maintenance rather than a low-fat one. In one recent study, the patients were randomized to a low carbohydrate breakfas t LCb or an isocaloric diet with a high carbohydrate and protein breakfas t HCPb.

In the weight maintenance period, the LCb group regained weight, but the HCPb group continued weight loss and they had lower craving score for sweet, high fat, carbohydrate or starch, and fast foods.

Weight change had a positive relationship with the craving score. Comparison of patients who have maintained their weight loss more than re-gainers shows that the subjects in first group stay late less at night, have increased physical activity after weight loss, drink less sugar sweetened beverages, eat less calorie from protein, and they have more emotional support.

Losing more weight during weight loss, monitoring weight, and choosing healthy foods are supposed to be important factors for successful weight maintenance.

Perceived hunger and cognitive control is different among weight regainers compaired to others. This diet includes consuming more vegetables, fruits, and low-fat dairy products.

Following this diet helps patients to achieve[ 35 , 36 ] and maintain weight loss and this effect has been related to dairy products rather than fiber.

Although gelatin has a short effect on hunger suppression, in comparison with milk protein it has no further effect on preventing weight gain.

It seems that a six-week re-feeding period after weight loss is more efficient in weight maintenance and improves dietary restraint in comparison to four weeks.

Some studies have assessed the effects of special foods on weight maintenance. For example, weight regain did not occur in individuals who had consumed green tea and caffeine mixture with an adequate or high-protein diet.

Only, in the group with an adequate protein intake, a higher hunger score and lower satiety was seen. Weight changes after capsaicin consumption was not significantly different from a placebo.

Respiratory quotient and resting energy expenditure was higher in the capsaicin group, but it had no relationship with weight regain and after treatment it returned to the normal level.

The findings from this review show that neither meal replacement nor macronutrient composition manipulation, have any positive effects on weight maintenance.

Sustaining lost weight needs some dietary pattern changes, including, healthy food choices and healthy lifestyle behaviors.

The relevant mechanisms consist of reducing the appetite and hunger by virtue of hormonal signals, improvement in body composition, and making individuals more satiated.

Meal replacement has been used for weight loss as a successful strategy. It can be the consequence of a different macronutrient composition or the number of meals that were replaced.

Dietary composition may have a role in preventing weight regain after weight loss. Low carbohydrate diets have been used a lot for weight loss, but their effects in long-term weight control are controversial.

Poor dietary compliance is one of the most common problems associated with these diets. They also have to be supplemented because of nutrient deficiency.

It has been shown that micronutrient dietary supplement consumption results in a lower body weight and resting metabolic rate in men and lower hunger level in females,[ 51 ] but there are no sufficient studies to assess their roles in preventing weight regain after weight loss.

Only the Nachtigal cohort study revealed that long-term use of vitamins B6 and B12, and chromium were significantly associated with lower weight gain.

Whether more dairy intake is a predictor of successful weight maintenance, is unclear. Dietary habits that can help obese persons to keep their lost weight are self-efficiency, cognitive control, monitoring weight, correct dietary choices, high levels of physical activity, eating more low calorie-dense foods, and lower portion size.

For example, various types of glucose monitors are used by patients with diabetes to track their blood sugar levels. Other devices can provide a more general set of information, such as a weight scale, blood pressure cuff , pulse oximeter , etc.

Less technological tools can include organizers, charts, and diagrams to trend or keep track of things such as amount of calories, mood, vital sign measurements, and more.

Barriers to monitoring can go unrecognized and end up interfering with effective self-care. Barriers can include knowledge deficits, undesirable self-care regimens, different instructions from multiple providers, and limitations to access related to income or disability.

Psychosocial factors such as motivation, anxiety , depression , confidence can also serve as barriers. Because self-care monitoring is conducted primarily by patients and their caregivers, it is necessary to work with patients closely on this topic.

Providers should assess the current self-care monitoring regimen and build off this to create an individualized plan of care.

When patients understand the symptoms that correspond with their disease, they can learn to recognize these symptoms early on. Then they can self-manage their disease and prevent complications.

Self-care management is defined as the response to signs and symptoms when they occur. Self-care management involves the evaluation of physical and emotional changes and deciding if these changes need to be addressed.

Changes may occur because of illness, treatment, or the environment. Once treatment is done, it needs to be evaluated to judge whether it would be useful to do again in the future.

Treatments are based on the signs and symptoms experienced. Treatments are usually specific to the illness.

Self-care management includes recognizing symptoms, treating the symptoms, and evaluating the treatment. For example, a patient with asthma may recognize the symptom of shortness of breath.

This patient can manage the symptom by using an inhaler and seeing if their breathing improves. Regular self-care monitoring is needed to identify symptoms early and judge the effectiveness of treatments.

Access to care is a major barrier affecting self-care management. Access to the health care system is largely influenced by providers.

Many people suffering from a chronic illness do not have access to providers within the health care system for several reasons.

Three major barriers to care include: Financial barriers impact self-care management. The majority of insurance coverage is provided by employers.

Loss of employment is frequently accompanied by loss of health insurance and inability to afford health care. In patients with diabetes and chronic heart disease, financial barriers are associated with poor access to care, poor quality of care, and vascular disease.

As a result, these patients have reduced rates of medical assessments, measurements of Hemoglobin A1C a marker that assesses blood glucose levels over the last 3 months , cholesterol measurements, eye and foot examinations, diabetes education, and aspirin use.

In addition, people with lower levels of education often lack resources to effectively engage in self-management behaviors.

Elderly patients are more likely to rate their symptoms differently and delay seeking care longer when they have symptoms. There are many reasons contributing to this difference in symptom experience.

Providers should be aware of the potential delay in provider-seeking behavior in elderly patients which could worsen their overall condition.

Prior experience contributes to the development of skills in self-care management. Experience helps the patient develop cues and patterns that they can remember and follow, leading to reasonable goals and actions in repeat situations.

This could lead to them recognizing their symptoms earlier, and seeking a provider sooner. Health care literacy is another factor affecting self-care management.

Health care literacy is the amount of basic health information people are able to understand. Health care literacy is the major variable contributing to differences in patient ratings of self-management support.

Individuals who can identify changes in their body are then able to come up with options and decide on a course of action. A poor healthcare experience may cause a patient to avoid returning to that same provider.

This creates a delay in acute symptom management. Providers must consider health literacy when designing treatment plans that require self-management skills.

A patient with multiple chronic illnesses may experience compounding effects of their illnesses. This can include worsening of one condition by the symptoms or treatment of another.

This limits the self-care management of their other illnesses. One condition may have more noticeable symptoms than others. Or the patient may be more emotionally connected to one illness, for example, the one they have had for a long time.

Stoplight and skill teaching allow patients and providers to work together to develop decision-making strategies. It separates signs and symptoms into three zones:.

The stoplight plan helps patients to make decisions about what actions to take for different signs and symptoms and when to contact their healthcare team with a problem.

The patient and their provider will customize certain signs and symptoms that fit in each stoplight category.

Skills teaching is a learning opportunity between a healthcare provider and a patient where a patient learns a skill in self-care unique to his or her chronic illness.

Other skills may be applied when there is an exacerbation of a symptom. An exacerbation of a symptom means that the symptom is in a worsened state or is different from what the patient normally experiences.

The patient should not only learn the purpose of self-care skills. It is also important to learn when to apply skills in daily management of a chronic illness and how the skill might be modified or changed when the patient experiences an exacerbation of a symptom.

For example, a patient newly diagnosed with persistent asthma might learn about taking an oral medicine for daily management, control of chronic symptoms and prevention of an asthma attack.

However, there may come a time when the patient might be exposed to an environmental trigger or stress that causes an asthma attack.

The patient starts to experience shortness of breath, chest tightness or wheezing. When this unexpected symptom occurs, the skill of taking daily medicines and the medicine that is taken may change.

Rather than taking an oral medicine daily, a different medication is needed for quick rescue and relief of symptoms. The rescue medication works quickly with an inhaler.

Knowing to choose the right medication and knowing how to take the medicine with an inhaler is a skill that is learned for the self-care management of asthma.

Here is a source on how to safely use a rescue inhaler: In skills teaching, it is important for the patient and provider to discuss skills and address any lingering questions.

It is important for the patient to know when and how a skill is to be implemented, and how the skill may need to be changed when the symptom is different from normal.

Learning self-care management skills for the first time in the care of a chronic illness is not easy, but with patience, practice, persistence and experience, personal mastery of self-care skills can be achieved.

Self-care practices are shaped by what are seen as the proper lifestyle choices of local communities. Health -related self-care topics include;.

A lack of self-care in terms of personal health, hygiene and living conditions is referred to as self-neglect.

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