Making sense of weight loss

Excess weight gain is a major international public health problem and Americans are among the heaviest people in the world. The prevalence of obesity in the United States has continued to increase over time, and data suggest the same is true in many other countries as well. Many people want to lose weight in order to improve their health and lower their risk of problems like heart disease and diabetes, but it can be hard to get started on a program that is healthy, sustainable, and not overly restrictive.

Many people find that although they initially lose weight by dieting, they quickly regain the weight after the diet ends. Because it so hard to keep weight off over time, it is important to have as much information and support as possible before starting a weight loss plan. You are most likely to be successful in losing weight and keeping it off when you believe that your body weight can be controlled. While it can be challenging to make the lifestyle changes needed to lose weight and improve your health, if you set goals and commit to them, you can be successful, especially if you develop a long-term relationship with a knowledgeable, supportive health care provider.

This article is intended for people who are interested in losing weight in a healthy way; it discusses how to get started with a weight loss plan, including changes in your behavior, what you eat, and weight loss medications. Weight loss surgery, which may be appropriate some people with obesity, is discussed in a separate article. 

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STARTING A WEIGHT LOSS PROGRAM

It can really help to find a health care professional who has experience in helping people lose weight and make the lifestyle changes needed to keep the weight off. This could be a doctor, nurse, or other provider like a nurse practitioner or physician assistant. Developing a relationship with this person will help improve your chances of long-term success, as they can help you figure out the best plan for you, monitor your process, and provide advice and support along the way.

Different approaches and plans work for different people, so it's important to try not to get discouraged and to keep trying until you find something that works for you. Be careful about misinformation online and weight loss clinics with questionable ethics. Nothing out there is magic. Losing weight takes hard work, and keeping it off requires a plan that is sustainable long-term.

The first step is to determine your starting point, which includes weighing yourself and measuring your waist circumference. The body mass index (BMI) is calculated from your height and weight (calculator 1 and calculator 2).

● A person with a BMI between 25 and 29.9 is considered overweight

● A person with a BMI of 30 or greater is considered to have obesity

The BMI measurement provides an estimate of a person's total body fat, which is why experts find it more useful for assessing cardiovascular risk than a person's weight alone. However, it's not a perfect measure because it does not factor in variability in body composition. While most professional medical societies continue to recommend using a person's BMI when assessing risk, an experienced health care provider will also consider other factors (including a person's overall health) when making recommendations for how to achieve and maintain a healthy weight.

In general, a waist circumference greater than 35 inches (88 cm) in females and 40 inches (102 cm) in males increases the risk of obesity-related complications, such as heart disease and diabetes. People with obesity and who have a larger waist size may need more aggressive weight loss treatment than others. Your health care provider can talk to you about your situation, how to set short- and long-term goals, and how to start working toward those goals.

Types of treatment — Based on your situation and medical history, your health care provider can help you determine what combination of weight loss treatments would work best for you. Treatments must include changes in lifestyle, physical activity, approach to eating, and, in some cases, weight loss medicines or a surgical procedure. Weight loss surgery, also called bariatric surgery, is reserved for people with obesity who have not had success with other approaches.

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SETTING A WEIGHT LOSS GOAL

It is important to set a weight loss goal. Your first goal should be to avoid gaining more weight. Once you know your starting point, it is helpful to create milestones and health-related goals in order to start tracking your success.

If you are overweight or have obesity, losing 5 percent of your body weight is a reasonable initial weight loss goal. In the longer term, losing more than 15 percent of your body weight and staying at this weight is an extremely good result. However, keep in mind that even losing 5 percent of your body weight leads to important health benefits, so although your ultimate weight loss goal may be greater, try not to get discouraged if you're not able to lose more than this initially.

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LIFESTYLE CHANGES

Programs that help you to change your lifestyle are usually run by psychologists, nutritionists, or other professionals. The goals of lifestyle changes are to help you change your eating habits, become more active, and be more aware of how much you eat and exercise, helping you to make healthier choices.

This approach to weight loss can be broken down into four parts:

● The triggers that make you want to eat

● Eating

● Setting goals and using rewards

● Integrating less sedentary (inactive) time and more active time into your day

Triggers to eat — Determining what triggers you to eat involves figuring out what foods you eat and where and when you eat them. To figure out what triggers you to eat, keep a record for a few days of everything you eat, the places where you eat, how often you eat, and the emotions you were feeling when you eat.

For some people, the trigger is related to a certain time of day or night. For others, the trigger is related to a certain place or activity, like sitting at a desk working or driving past a favorite fast-food outlet.

Eating — You can change your eating habits by breaking the chain of events between the trigger for eating and the act of eating. There are many ways to do this. For instance, you can:

● Use a smaller plate for meals

● Make a conscious effort to eat more slowly

● Add more colorful (non-white) foods to your meals

● Keep healthy snacks (like chopped raw vegetables, fruits, and nuts) around in case you get hungry between meals

The types of foods we eat on a regular basis are related to whether we gain or lose weight over time. Whole grains, fruits, vegetables, nuts, and yogurt are associated with maintaining a lower weight, while foods like french fries or chips, sugar-sweetened beverages, and red or processed meats are associated with weight gain. High fructose-containing beverages, trans fats, and highly processed foods are particularly harmful for health and maintaining a healthy weight.

Setting goals and using rewards — Rewarding yourself for good eating behaviors can help you to develop better habits. The idea is not to reward weight loss, but to reward yourself for changing unhealthy behaviors to healthy ones.

Do not use food as a reward. Some people find monetary rewards (eg, buying a new piece of clothing), personal care (eg, a haircut, manicure, or massage), or leisure activities (eg, watching a favorite TV show or playing a game) to work well. Giving yourself small rewards each time you make better eating choices helps reinforce the value of the good behavior.

It's important to set clear behavior goals as well as a time frame for reaching your goals. For example, you might set a goal to avoid snacking after a certain time every day for a week, with a longer-term goal to lose 5 percent of your weight by a certain date, and 10 or 15 percent by a later date. Reward small changes along the way to your final goal.

Other factors that contribute to successful weight loss — Changing your behavior involves more than just changing unhealthy eating habits; it also involves finding people around you to support your weight loss, reducing stress, and learning to resist temptations.

● Establish a "buddy" system – Having a friend or family member available to provide support and reinforce good behavior is very helpful. The support person needs to understand your goals.

● Learn to avoid temptations – When possible, avoid situations in which your ability to stick to healthy eating may be threatened. Not all situations are avoidable, so in addition, learning to be strong when tempted by food is an important part of your weight loss plan. As an example, you will need to learn how to say "no" and continue to say no when urged to eat at parties and social gatherings. Develop strategies for events before you go, such as eating before you go or taking low-calorie snacks and calorie-free drinks with you.

● Develop a support system – Having a support system is helpful when losing weight. This is why many commercial groups (ie, programs for which you pay to be a member) are successful. Family support is also essential; if your family or partner does not support your efforts to lose weight, this can slow your progress or even keep you from losing weight.

● Positive thinking – People often have conversations with themselves in their head; these conversations can be positive or negative. If you eat a piece of cake that was not planned, you may respond by thinking, "Well, it’s all over now, you've blown your diet!" and as a result, you may eat more cake.

A positive thought for the same event could be, "Well, I ate cake when it was not on my plan. Now I should do something to get back on track." A positive approach is much more likely to be successful than a negative one.

● Reduce stress – Although stress is a part of everyday life, it can trigger unhealthy eating habits in some people. It is important to find a way to get through these difficult times without eating or by choosing low-calorie food instead, like raw vegetables. It may be helpful to imagine a relaxing place that allows you to temporarily escape from stress. With deep breaths and closed eyes, you can imagine this relaxing place for a few minutes.

● Weight loss programs – Organized programs like Weight Watchers, Overeaters Anonymous, and Take Off Pounds Sensibly (TOPS) work for some people. As with all weight loss programs, you are most likely to be successful with these plans if you make long-term changes in how you eat.

Exercise and movement — While exercise alone is not likely to result in weight loss, getting regular physical activity has many other health benefits. In addition to improving physical health, it also lowers stress. You don't need to do intense exercise or go to the gym daily to get these benefits; even small changes, like taking the stairs instead of the elevator and making sure to get up frequently if you work at a desk, can improve your health.

If you are interested in starting an exercise routine but aren't sure where to start, your health care provider can help.

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CHANGING YOUR EATING HABITS

A calorie is a unit of energy found in food. Your body needs calories to function. If you are trying to lose weight, the goal of any eating plan is to burn up more calories than you eat.

How quickly you lose weight on a given calorie intake depends upon several factors, such as your age, sex, and starting weight. In general:

● Older people have a slower metabolism than young people, so it takes longer for them to lose weight.

● Males lose more weight than females of similar height and weight when dieting. This is because they have more muscle mass, which uses more energy.

● People who are extremely overweight lose weight more quickly than those who are only mildly overweight.

How many calories do I need? — The number of calories you need per day depends on your current (or target) weight, sex, and activity level. Your health care provider can help you figure out this number and how to modify your diet accordingly.

In general, it is best to choose foods that contain enough protein, carbohydrates, essential fatty acids, and vitamins. Try to avoid or at least limit alcohol, sugar-sweetened beverages (sodas and fruit drinks), and sweets (candy, cakes, cookies), since they have calories but generally lack important nutrients.

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Portion-controlled diets — One simple way to diet is to buy pre-packaged foods, like frozen low-calorie meals or meal-replacement canned drinks or bars. A typical meal plan for one day may include:

● A meal-replacement drink or breakfast bar for breakfast

● A meal-replacement drink or a frozen low-calorie (250 to 350 calories) meal for lunch

● A frozen low-calorie meal or other prepackaged, calorie-controlled meal, along with extra vegetables for dinner

This would give you 1000 to 1500 calories per day.

Low-fat diet — To reduce the amount of fat in your diet, you can:

● Eat low-fat foods. You can look at the nutrition label to see how much fat is each serving of a food 

● Count fat grams. For a 1500-calorie diet, this would mean about 45 g or fewer of fat per day.

If you try a low-fat diet, you should increase the amount of healthy carbohydrates in your diet (eg, whole grains, fruits, and vegetables).

Low-carbohydrate diet — Low- and very-low-carbohydrate diets (eg, Atkins diet, South Beach diet, or "ketogenic" diet) are effective for weight loss and have become popular ways to lose weight quickly.

● With a low-carbohydrate diet, you eat between 60 and 130 grams of carbohydrates per day.

● With a very-low-carbohydrate diet, you eat between 0 and 60 grams of carbohydrates per day (a standard diet contains 200 to 300 grams of carbohydrates).

Carbohydrates are found in fruits, vegetables, grains (including breads, rice, pasta, and cereal), alcoholic beverages, and dairy products. Meat and fish contain very few carbohydrates. If you try a low-carbohydrate diet, it's important to make healthy choices for fat and protein (eg, fish, nuts, beans); eating a lot of saturated fats (found in butter and red meat) can increase your cholesterol level and raise your risk of heart disease.

Mediterranean diet — The term "Mediterranean diet" refers to a way of eating that is common in olive-growing regions around the Mediterranean Sea. Although there is some variation in Mediterranean diets, there are some similarities. Most Mediterranean diets include:

● A high level of monounsaturated fats (from olive or canola oil, walnuts, pecans, almonds) and a low level of saturated fats (from butter).

● A high amount of vegetables, fruits, legumes, and grains (7 to 10 servings of fruits and vegetables per day).

● A moderate amount of milk and dairy products, mostly in the form of cheese. Use low-fat dairy products (skim milk, fat-free yogurt, low-fat cheese).

● A relatively low amount of red meat and meat products. Substitute fish or poultry for red meat.

● For those who drink alcohol, a modest amount (mainly as red wine) may help to protect against cardiovascular disease. A modest amount is up to one (4 ounce) glass per day for females and up to two glasses per day for males.

Which diet is best? — Studies comparing different types of diets have not found a single "best" weight loss diet for all people. However, any diet will help you to lose weight if you are able to stick with it. Following a very restrictive diet may help you lose weight quickly, but it's easy to gain the weight back as soon as you stop following the diet. Therefore, it is important to choose an eating plan that includes foods you like.

Fad diets — "Fad" diets often promise quick weight loss (more than 1 to 2 pounds per week) and may claim that you do not need to exercise or give up your favorite foods. Some fad diets cost a lot of money because you have to pay for seminars, pills, or packaged foods. Fad diets generally lack any scientific evidence that they are safe and effective, instead relying on "before" and "after" photos or testimonials.

Diets that sound too good to be true usually are. These plans are a waste of time and money and are not recommended. A health care provider can help you find a safe and effective way to lose weight and keep it off.