We've heard the sobering statistics: More than 65 percent of American adults are overweight or obese. Some 17 percent of children and adolescents ages 2 through 19 are overweight. And nearly 1 in 5 children ages 6 through 11 struggles with weight issues.
The weight epidemic costs countless individuals their health and wellness, resulting in a public-health crisis and spawning a several-billion-dollar weight-loss industry. Clearly, many people need to lose weight to preserve their health. Fortunately, they have a number of options for doing it safely and effectively.
This discussion will explain how to set and meet healthy goals for weight that can be maintained over the long term.
- Why is weight management vital to good health?
- How do I determine my ideal weight?
- What is the most effective way to lose weight—and keep it off?
- How do popular weight-reduction plans stack up?
- How many calories should I consume each day to lose weight?
- Who should consult their doctors before trying to lose weight?
- Are there other ways to lose weight besides making behavioral/lifestyle changes?
- What about methods like fasting and "sweating it out"?
Research data have shown it time and again: Keeping our weight in check is vital to our overall health and wellness. Overweight people who lose weight—and those who maintain a healthy weight—may reduce their risk of developing many serious medical conditions, including:
- Cardiovascular disease
- Certain types of cancer
- High blood pressure
- High cholesterol
- Respiratory problems
- Gallbladder disease
A balanced and health-promoting lifestyle, which should include moderate physical activity, a balanced and healthful diet, adequate sleep, and effective stress management, can improve these conditions, lead to weight loss, and improve one's overall quality of life.
Because weight figures so prominently in our health, wellness, and overall quality of life, it's critical that people do what it takes to manage it. The good news is that people who are overweight can gain significant health benefits by losing only 5 to 10 percent of their total weight.
- Readers should note that while weight management can refer to both losing and gaining pounds, because most people seeking to "manage" their weight are striving to lose pounds, this content refers to weight loss only. People whose health dictates that they gain weight should speak with their physician or a dietitian.
Because healthy people come in all shapes, sizes, and weights, many weight-management experts now avoid using the term ideal weight—a concept derived from the height-weight tables once used by insurance actuaries—and instead focus on body mass index and waist circumference (or waist-hip ratio). These measurements better represent the degree and/or location of body fat, which is most important in determining health risk.
While the number on the scale can provide a general indication of whether a person's weight falls within a range that is healthy for him or her, the body mass index offers a more revealing look at someone's overall risk of disease and is widely accepted by all major health organizations for the classification of overweight and obesity. BMI is typically calculated in one of two ways:
- BMI = kg/m
2. Weight (kilograms) divided by height (meters) squared
- BMI = Weight (pounds) multiplied by 703, divided by height (inches) and divided again by height (inches)
Population data indicate that a BMI between 18.5 and 24.9 is considered healthy for most people, while those with BMIs between 25 and 29.9 are considered overweight and therefore at increased risk for developing weight-related illnesses. In general, the higher the BMI, the greater the risk.
People with BMIs of 30 or greater are considered to be obese, a category that is divided into three classes based on BMI:
- Class 1 = 30 to 34.9. High risk. Typically 30 to 40 pounds overweight
- Class 2 = 35 to 39.9. Very high risk. Typically 40 to 100 pounds overweight
- Class 3 = 40 or greater. Extremely high risk. Typically 100 pounds or more overweight
Because the accumulation of visceral fat (internal fat that collects around the organs and midsection) is thought to be associated with higher health risks than fat located elsewhere in the body, waist circumference is another good way to assess weight-related health risks. In general, men whose waists measure more than 40 inches and women with waist circumferences larger than 35 inches are at greater risk for many serious medical conditions than people who are smaller around the middle.
A healthcare provider, fitness consultant, or dietitian can help you properly determine your BMI and waist circumference, or you can calculate it yourself with the Centers for Disease Control and Prevention's BMI calculator.
When we cut through all the noise about weight loss, the bottom line is always the same: To lose weight, we must burn more calories than we take in. To keep it off, we must adopt permanent lifestyle changes. There are no miracle diets, surgeries, gadgets, pills, or potions that can change that physiological fact.
The first half of the weight-loss formula—burning calories—requires us to expend energy. Experts recommend an increase in physical activity for anyone trying to reach a healthy weight, including bariatric surgery patients. Physical activity burns calories, helps to sustain weight loss, improves many weight-related health issues, and improves overall well-being.
People attempting to lose weight or maintain weight loss should work toward engaging in 30 to 60 minutes of moderate physical activity most days of the week. A brisk walk is often just what the doctor ordered, but there are countless ways to get a comparable workout—no gym membership necessary. Click here to learn more about the health benefits of physical fitness.
The key to avoiding the lose-gain cycle also known as yo-yo dieting is to approach weight control not as a "diet" but as a change in lifestyle. Gradually add more physical activity and build to the recommended amounts. Gradually improve nutrition habits by selecting healthful foods, eating a balanced diet and reducing portions.
Think about aspects of your life that tend to trip you up in your quest for better health. Do you manage stress with food? Do you have a good support system? Do you have clear and achievable goals? These are good questions to ask ourselves when embarking on any lifestyle change.
If you have fallen victim to fad diets in the past, it is important to note that despite a popular belief to the contrary, there is no scientific evidence that yo-yo dieting causes permanent health or metabolism damage. Most people's bodies recover quickly when they return to healthful eating and activity levels.
Experts offer the following general suggestions to people striving to manage their weight:
Eating and drinking
- Keep in mind that foods that are heart-healthy are usually weight-friendly, too.
- Add more healthful food choices to your pantry, and remove less healthful ones.
- Drink plenty of water, and eat a variety of fresh fruits and vegetables.
- Eat only when you're hungry.
- Know what proper portions of food look like, and exercise portion control.
- Control between-meal snacking.
- Significantly reduce your intake of calorie-dense foods (those with high fat and/or sugar content that leave you hungry).
- Cut back on or eliminate sugary drinks.
- Tailor your eating to something you can stick with and that makes you feel satisfied. Remember that there are many ways to eat healthfully.
The mental component
- Avoid the "diet mentality" by internalizing the idea that new behaviors are for life, not for as long as it takes to achieve one weight-loss goal. Embrace the value of overall lifestyle change.
- Let go of any preconceived ideas about your ideal weight.
- Remember that it's never too late for overweight people to realize the health benefits that come with weight loss.
- When you are tempted by short-term gratification, focus on the long-term benefits of eating healthfully and getting enough exercise. You might also think about some short-term benefits of making the healthier choice, such as feeling successful and in control.
- Know that popular weight-loss programs are often presented in unrealistic and overly simplified terms.
- Eat with awareness by thinking about what you're putting into your body and the impact it will have on your weight and overall health.
- Tune into your body's hunger signals, and never let yourself get too hungry or too full.
- Remember that while weight loss can be challenging, it is achievable and many people are successful.
- Avoid all-or-nothing thinking. Know that slip-ups will happen and that all progress in the right direction is meaningful. Be kind to yourself, and feel good about the steps you're taking to improve your health.
- Assess your behaviors and vulnerable situations honestly, and strive to come up with practical solutions to areas that have tripped you up in the past.
- Look for new ways to respond to emotional and other nonhunger eating cues other than with food.
- Address personal issues surrounding eating, weight, and body image if you feel that those are hindering your success. It may be valuable to seek a counselor who specializes in these areas.
- Consider consulting a certified health coach, wellness counselor, or dietitian—or enrolling in a medical center-based, behavioral weight-management program, as all can provide helpful strategies, guidance, and motivation. In fact, in the largest and longest study* of weight-loss maintenance strategies to date, Duke University Medical Center researchers learned that personal contact—and, to a lesser degree, a computer-based support system—helped participants lose weight and keep it off for 2½ years.
* Journal of the American Medical Association, March 12, 2008
Popular weight-loss plans and programs generally fall into several categories:
- Balanced-deficit (low-calorie). Many specialists consider the balanced deficit or low-calorie diet (LCD) the cornerstone of weight management. Usually considered low- to moderate-fat diets, LCDs typically limit consumption to 1,200-1,800 calories per day and are adjusted according to an individual's body weight.
LCDs generally follow the guidelines established by national public-health entities such as the Department of Agriculture, the American Heart Association, and the American Dietetic Association, which provide food choices that contain healthful amounts of carbohydrates, proteins, and heart-healthy fats. These guidelines enable people to tailor their eating to their individual food preferences.
This approach is generally safe and effective for most people and typically results in a 5 to 10 percent reduction in body weight over a six-month period.
LCDs include Weight Watchers, the Duke Diet and Fitness Center eating plan, and many medical school-based programs.
- Very-low-calorie diets. These diets, which require specialized medical management, typically restrict calories to a maximum of 800 per day and are sometimes recommended for people whose health would benefit from initially rapid weight loss.
Because VLCDs are usually based on a special medically engineered, total meal-replacement product, people must spend significant time transitioning back to eating a balanced diet of regular foods. Those who transition from a VLCD to an LCD (and are committed to a balanced and healthful lifestyle) maximize the likelihood of maintaining their weight loss over the long term.
Interestingly, clinical studies show that after one year, the weight loss associated with LCDs and VLCDs is similar. In other words, people who have followed VLCDs regain more weight, on average, than those who have followed LCDs. Despite this, VLCDs are sometimes more beneficial for some people.
VLCDs include OPTIFAST and Health Management Resource.
- Low-carbohydrate. Generally high in protein and/or fat, low-carb diets, when followed under appropriate medical supervision, have been found to be a safe and effective method of short-term weight control. Long-term safety data are not yet available.
Experts stress the importance of choosing proteins that contain heart-healthy fats whenever possible, and they don't recommend embarking on a very low-carbohydrate diet without the supervision of a physician trained in weight management.
While there is no evidence that low-carb diets are bad for the heart—and some recent studies have shown them to be as effective as other types of diets—organizations including the American Heart and American Diabetic associations continue to recommend a balanced diet for the general public.
Low-carb plans include Atkins, South Beach, and Zone.
- Very-low-fat. Very-low-fat diets usually dictate that no more than 10 percent of one's daily calorie intake comes from fats and that people consume little or no saturated fat. Research has shown that very-low-fat diets may reduce—and sometimes reverse—heart disease, and under appropriate medical supervision, they may be a good option for some people. A drawback is that because they are generally a radical departure from common eating patterns, very-low-fat diets may be difficult to sustain over the long term.
Very-low-fat diets include Dean Ornish and Pritikin.
- Partial meal-replacement. Substituting shakes or bars for one or two meals per day has shown to be a very effective way to achieve a balanced-deficit (low-calorie) diet, and it is an accepted approach when meal replacements are part of a balanced and healthful diet, such as those recommended by the American Diabetic and American Heart associations.
Because meal replacements are portion controlled and nutritionally balanced, they eliminate the need to plan and prepare meals. This can be very helpful when situations arise that interfere with planned meals and can be an excellent strategy for busy people who might otherwise skip meals or opt for fast food. Experts recommend that people considering a meal-replacement strategy for weight loss consult a registered dietitian to ensure that their overall diet is nutritionally balanced and contains the appropriate amount of calories.
Substitution plans include Slim-Fast and Health Management Resources' partial meal-replacement option.
- Meal-delivery programs. While meal-delivery programs vary greatly in their nutritional content and ingredients (such as sodium and heart-healthy fats), studies have shown that providing prepackaged meals can provide structured, convenient, portion-controlled meals and can effectively generate weight loss.
Because many people report becoming bored with the selections, meal-delivery programs can be difficult to sustain over the long term. Experts recommend consulting a registered dietitian prior to beginning one to discuss nutritional adequacy and sustainable approaches to self-selected meal planning.
Packaged-meal plans include Jenny Craig, Nutri-System, Seattle Sutton's Healthy Eating, and Diet-to-Go.
Weight-management specialists realize that people have a lot of choices and that deciding on the path to follow can be daunting and confusing. They recommend that people look for a program that takes a sound, evidence-based approach to weight management and considers overall health and wellness from a realistic, patient-centered perspective.
People should avoid diets that:
- Seem too simple and/or promote rapid weight loss with no plan for maintaining a lifestyle
- Have too many rules about "good" and "bad" foods
- Claim to be the only way to manage weight, as credible programs acknowledge that there are many different ways for people to eat healthfully
Although the precise answer to this question varies from person to person because of different rates of metabolism (the burning of calories) and other factors, experts offer this rule of thumb: To lose approximately 1 pound per week, reduce the number of calories you currently eat each day by 500 calories and make a conscious effort to move more. In other words, to lose 1 pound, you must burn 3,500 calories.
Weight-management experts offering the following additional tips:
- Don't eat fewer than 1,200 calories a day without a physician's supervision.
- Avoid losing weight too rapidly—no more than 1 to 3 pounds per week. In addition to increasing the risk of a potentially dangerous electrolyte imbalance, "crash dieting" often results in fatigue, irritability, and feeling deprived, which may lead to overeating.
- Integrate physical activity—even something as simple as walking—into your weight-loss program to burn calories and improve the fat-to-lean loss ratio that naturally occurs during weight loss. Keep in mind that while it's difficult for people to gain muscle while they lose weight (regardless of the type of exercises they do), including resistance exercise as part of a balanced activity plan may improve mobility, balance, and the body's use of blood sugar.
Speak with a physician or dietitian before beginning any weight-loss program, particularly if you are in poor health or have been diagnosed with a medical condition.
Getting regular medical checkups is always a good idea, so plan to schedule one before starting a weight loss and exercise plan. This is especially important for:
- People with serious medical conditions, including conditions commonly associated with excess weight, such as hypertension, diabetes, and heart disease
- Patients undergoing chemotherapy, radiation treatment, and other taxing medical therapies that may cause them to require specialized nutrition
- Women who are pregnant or trying to become pregnant. In general, pregnant women should not try to lose weight. Women who are overweight should consider a weight-reduction program prior to becoming pregnant, as research indicates that women closer to a healthy weight range during pregnancy experience fewer complications.
- Women who are nursing and may require additional calories
- People suffering or recovering from eating disorders
If you have any questions or concerns about safely managing your weight, speak with a qualified medical professional.
When used in conjunction with a balanced and healthful lifestyle, several other interventions have been identified as useful weight-loss tools. Safe only under a doctor's supervision, they include:
Weight-loss surgery. Bariatric (weight-loss) surgery is typically recommended only for people who have been unsuccessful with other reasonable weight-loss efforts and whose BMIs are higher than 40 or those with BMIs higher than 35 in addition to significant weight-related health risks. Studies show that, for those who qualify, bariatric surgery is more effective in the long term than nonsurgical weight-reduction programs and that weight-related health issues (especially diabetes) are also very successfully reduced and frequently eliminated.
Several types of bariatric surgeries are available today; the type chosen is dictated by a patient's health status and individual circumstances and must be decided upon by that person and his or her bariatric surgeon.
Drug therapies. Medical professionals usually recommend drug therapies only for people with BMIs of at least 30—or greater than 27 in those suffering from significant weight-related health problems. Several types of drugs promote weight loss, including:
Appetite suppressants. These drugs typically target the brain's hunger center and may reduce the desire to eat. While their short-term use may be effective, most medical professionals do not typically prescribe appetite suppressants for weight control because of their limited efficacy and potentially addictive nature.
There are currently several prescription appetite suppressants approved for short-term use— including mazindol, diethylpropion, and phentermine—and one, Meridia(tm), approved for long-term use in treating obesity.
Meridia has demonstrated reasonable efficacy in multiyear trials and works primarily by targeting the brain's satiety mechanisms, making people feel full sooner and therefore reducing their desire to consume more calories. Because its most common side effect is increased blood pressure, this drug is not recommended for people with hypertension.
Lipase inhibitors. These drugs target the digestive system, not the brain, and prevent digestive enzymes from breaking down about one third of the dietary fat that is consumed so that the body cannot absorb it. The most common side effects of lipase-inhibiting drugs are "oily leakage" and loose stool, a result of the fat that passes undigested through the body. People who take these drugs must adhere to the manufacturers' specific nutritional recommendations.
Xenical(tm) and alli(tm) are two lipase inhibitors. Approved for long-term use in treating obesity, Xenical is a prescription drug that prevents the body from absorbing about one third of consumed calories that come from fat. Alli(tm), the first over-the-counter weight-loss drug approved by the Food and Drug Administration, contains about half the active ingredient found in Xenical and has similar side effects.
Studies have found Meridia, Xenical, and alli to be effective in promoting weight loss over a two-year period when combined with exercise and a healthful and balanced diet.
Consumers should note that, except for alli, there are no FDA-approved weight-loss aids available without a prescription. This means that the other available products have not been appropriately scientifically tested for safety or efficacy, despite claims of being "clinically tested" or "doctor-approved." Consumers should not use these products.
Liposuction. This procedure, which physically removes fat cells from the body, is not an approved method of weight control and is strictly intended for cosmetic enhancement. The use of liposuction as a weight-control method is extremely dangerous.
People who have lost a significant amount of weight, however, may wish to undergo liposuction or other cosmetic procedures, such as skin removal. These procedures should be performed only by a licensed professional with considerable experience treating people who have lost a lot of weight.
Fasting for weight loss should never be done.
As for losing weight by other means, consumers are barraged with options in the latest, greatest miracle category, from sauna suits and other unnecessary and expensive equipment to creams claimed to dissolve fat cells and herbal compounds purported to burn calories.
At best, these products create an illusion of weight loss, experts say; they are not safe, properly labeled, or medically researched. Consumers should avoid any product that is not FDA-approved.
Last reviewed on 1/28/10
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