Weigh Less, Live Longer: Strategies for Successful Weight Loss

If you've struggled to lose weight, you're certainly in good company. Two of every three Americans are overweight a trend that's prompted us to spend about $50 billion on weight-loss products and services each year. More worrisome is the growing number of people whose weight is endangering their health. Since 1980, the prevalence of adults who have obesity* has doubled, from about 15% to 30%. Excess weight raises the risk of numerous health problems, including some of the nation's leading killers namely, heart disease, stroke, and certain cancers. In fact, experts fear that the rising obesity rates in today's children may mean the next generation will have a shorter life span than their parents.

Despite the many reports heralding discoveries of genes that cause obesity, most people recognize that environmental and social factors are largely to blame for Americans' expanding girth. Of course, the easy availability of high-calorie foods is part of the problem. Lack of regular exercise, combined with long commutes to largely sedentary jobs, is another. But there's a growing awareness that other factors, such as increased stress and lack of adequate sleep, can wreak havoc with the body's internal balancing system, which can also contribute to weight gain.

This report explores the various reasons people gain weight and what they can do to lose it. Many people have unrealistic expectations about how much weight they need to lose. Losing just small amounts of weight about 10% of your body weight can lead to improvements in your health. The emphasis has shifted more toward trying to eat a healthy diet, rather than trying to become thin. Exercise is important, too. Not only does exercise burn calories both while you're doing it and afterward (by boosting your metabolic rate), it also helps curb your appetite.

This report also provides details on the science behind many popular weight-loss diets, as well as information on programs to help people shed pounds, from organized self-help programs to medically supervised, hospital-based services. You'll learn which weight-loss supplement ingredients to avoid and which you might (cautiously) consider trying. Information on prescription drugs for weight loss is also included, as well as descriptions and illustrations of the two most common surgeries for weight loss. Finally, there's a section on weight-loss maintenance that includes tips on keeping weight off which can be just as challenging as losing weight in the first place.

*When possible, this report follows an emerging trend among medical experts, who prefer to use "person with obesity" instead of "obese person." This change reflects an effort to reduce bias against people who have this condition.

Are you overweight?

Health care providers use body mass index (BMI), an approximate measure of body fat based on a person's height and weight, to determine whether a person's weight falls within a healthy range (see below). Another simple measurement is waist circumference. There are also several methods of estimating the percentage of your weight that is fat, including skin-fold measurement, bioelectric impedance, and underwater weighing.

What's your BMI?

To calculate your BMI, follow these four steps:

Measure your height in inches (without shoes) and your weight in pounds (without clothing).
Multiply your weight by 703.
Divide that number by your height.
Divide again by your height.

http://nhlbisupport.com/bmi You can also use a Web-based calculator at or simply look up your BMI in Table 1. These categories were established after several studies examined the BMIs of millions of people and correlated them with rates of illness and death. The studies showed that the BMI range associated with the lowest rate of illness and death is approximately 1925 in men and 1825 in women, so people with BMIs in this healthiest range are considered to be of normal weight. Higher BMIs are associated with progressively higher rates of illness and death. People with BMIs of 2530 are considered overweight, and those with BMIs of 30 or higher are considered to have obesity. Obesity has been further subdivided into mild (BMI of 3035), moderate (3540), and severe (BMI of 40 and above). Severe obesity is roughly equivalent to being 80 pounds overweight if you are a woman or 100 pounds if you are a man.

If your BMI is lower than 18, you are considered underweight. Underweight people also have higher death rates than people of normal weight do, but many people in this category are underweight because they already have a severe illness, such as cancer, chronic infections, or anorexia.

Table 1: What's your body mass index?
The body mass index (BMI) is an index of weight by height. The definitions of normal, overweight, and obese were established after researchers examined the BMIs of millions of people and correlated them with rates of illness and death. These studies found that the BMI range associated with the lowest rate of illness and death is 1925.
Height	Weight in pounds
4'10"	91	96	100	105	110	115	119	124	129	134	138	143	167	191
4'11"	94	99	104	109	114	119	124	128	133	138	143	148	173	198
5'0"	97	102	107	112	118	123	128	133	138	143	148	153	179	204
5'1"	100	106	111	116	122	127	132	137	143	148	153	158	185	211
5'2"	104	109	115	120	126	131	136	142	147	153	158	164	191	218
5'3"	107	113	118	124	130	135	141	146	152	158	163	169	197	225
5'4"	110	116	122	128	134	140	145	151	157	163	169	174	204	232
5'5"	114	120	126	132	138	144	150	156	162	168	174	180	210	240
5'6"	118	124	130	136	142	148	155	161	167	173	179	186	216	247
5'7"	121	127	134	140	146	153	159	166	172	178	185	191	223	255
5'8"	125	131	138	144	151	158	164	171	177	184	190	197	230	262
5'9"	128	135	142	149	155	162	169	176	182	189	196	203	236	270
5'10"	132	139	146	153	160	167	174	181	188	195	202	209	243	278
5'11"	136	143	150	157	165	172	179	186	193	200	208	215	250	286
6'0"	140	147	154	162	169	177	184	191	199	206	213	221	258	294
6'1"	144	151	159	166	174	182	189	197	204	212	219	227	265	302
6'2"	148	155	163	171	179	186	194	202	210	218	225	233	272	311
6'3"	152	160	168	176	184	192	200	208	216	224	232	240	279	319
6'4"	156	164	172	180	189	197	205	213	221	230	238	246	287	328
BMI	19	20	21	22	23	24	25	26	27	28	29	30	35	40
	NORMAL						OVERWEIGHT					OBESE

What's your body shape?

Your body shape depends largely on where you tend to carry your weight, usually centered on either your waist or your hips and thighs. If you carry fat mainly around the middle of your body (known as "apple-shaped"), you're more likely to develop diabetes and related health problems than if you tend to be heavier around your hips and thighs ("pear-shaped"; see Figure 1). To measure your waist circumference, place a cloth tape measure around your bare abdomen just above your hipbones. Make sure the tape is snug and parallel to the floor. A waist circumference of more than 35 inches for women and more than 40 inches for men indicates a higher than normal risk. (See "Do you have metabolic syndrome?")

Figure 1: Apples and pears

Apples and pears

People who are "apple-shaped," or who store fat in the abdomen rather than the hips, are more prone to diabetes and cardiovascular disease than are those who are "pear-shaped," who tend to store fat in the hips and thighs.

What's your body fat percentage?

You can estimate your body fat percentage by several different methods, but be aware that these tools aren't always accurate and doctors don't consider them useful to guide treatment. In general, these methods tend to be less accurate in people with obesity than in people who are slightly overweight or at a normal weight. But some athletes and people who are trying to tone their bodies while losing weight may find it motivates them to keep tabs on their body fat percentage. Healthy adult men have body fat percentages between 10% and 25%, whereas the range for women is between 18% and 32%. Higher percentages are considered abnormal and consistent with obesity. In children, body fat percentages above 25% in boys and 30% in girls are associated with being overweight.

Skin-fold thickness. A technician or health professional uses calipers, a measuring instrument, to gauge the thickness of a fold of skin on the body at several different sites, such as the upper arms, waist, and thighs. The measurements are entered into a formula to produce an estimate of body fat percentage. This method gives a reasonable estimate, but results often vary when different people take the measurements, making this test not very reliable.

Bioelectric impedance. This test uses a small, harmless electrical current to measure the electrical resistance of the body, based on the principle that lean body mass conducts electricity faster than fat body mass. Special "body fat" scales that use this principle in combination with your height and weight can calculate your body fat percentage. Results can vary with the amount of water in your body and are considered unreliable in people with obesity.

Underwater weighing. This test, based on the principle that fat tissue is less dense than muscle and bone, uses a special bathtub-sized tank to weigh a person underwater. That weight is then compared to the person's weight on land; a formula identifies the percentage of body fat that would account for the difference. Underwater weighing is considered the most accurate method, but it is generally available only at universities and research facilities.

Weight and health

Excess body weight increases your risk for more than 50 different health problems (see Figure 2). These health conditions include the nation's leading causes of death heart disease, stroke, and certain cancers as well as less common ailments such as gout and gallstones.

Figure 2: Medical complications of excess weight

Medical complications of excess weight

Excess weight increases a person's risk of more than 50 different medical conditions that affect all the major systems of the body. One of the most common is type 2 diabetes, which can lead to serious complications in the heart, kidneys, nerves, and eyes.

A Harvard study that combined data from more than 50,000 men (participants in the Health Professionals Follow-up Study) and more than 120,000 women (from the Nurses' Health Study) revealed some sobering statistics about weight and health. The volunteers provided their height and weight, as well as details on their diets, health habits, and medical histories. Researchers tracked the volunteers over more than 10 years, noting the occurrence of illnesses and comparing those developments with each subject's BMI.

Obesity increased the risk of diabetes 20 times and substantially boosted the risk of developing high blood pressure, heart disease, stroke, and gallstones. Among people who were overweight or obese, there was a direct relationship between BMI and risk: the higher the BMI, the higher the likelihood of disease.

Greater weight, shorter life?

Journal of the American Medical Association Because excess weight plays a role in so many common and deadly diseases, overweight and obesity can cut years off your life. A study of more than one million adults showed that the lowest death rates were among men with a BMI of 23.5 to 24.9 and women with a BMI of 22 to 23.4. Severe obesity can lower life expectancy by an estimated 5 to 20 years, according to a 2005 report in the .

American Journal of Cardiology, In addition, several studies have hinted that low-calorie diets can slow the aging process. In one such study, published in 2006 in the researchers compared heart function in people who ate restricted-calorie diets (between 1,400 and 2,000 calories per day) with people who ate typical Western diets (between 2,000 and 3,000 calories daily). They found that the hearts of the people who ate low-calorie diets were more elastic and resembled those of younger individuals.

Sleep apnea: Serious complications that start with snoring

If you snore loudly and temporarily stop breathing many times during the night, waking suddenly with a snort or choke, you probably have sleep apnea, another common disorder that's more prevalent with overweight and obesity. Your bedmate will probably notice these symptoms, while you may not. People with sleep apnea don't realize they've been awakened because they don't become fully conscious, but these awakenings can disrupt sleep. Not only does sleep apnea often lead to daytime sleepiness, it also increases the risk of high blood pressure, heart attack, and stroke.

Health benefits of weight loss

Losing excess weight can make you feel better both physically and emotionally and can help you live a longer, healthier life. Especially encouraging is the fact that you don't have to lose a tremendous amount of weight to become healthier. Even a modest weight loss of 5%10% of your starting weight can lead to significant health benefits.

New England Journal of Medicine One major trial to show the benefits of lifestyle changes (including losing weight and exercising) was the Diabetes Prevention Program, published in the in 2002. It involved more than 3,200 people who were at risk for developing type 2 diabetes. Researchers found that people who lost just 7% of their weight and exercised about 30 minutes a day cut their risk of diabetes by nearly 60%.

Earlier, smaller studies offer additional evidence. In one, people with hypertension who lost a modest 10 pounds over 6 months reduced their systolic blood pressure by 2.8 mm Hg and their diastolic blood pressure by 2.5 mm Hg. These reductions in blood pressure were equivalent to the reductions brought about by treatment with blood pressure medications. Weight loss is so effective that many people with high blood pressure can stop taking blood pressure medicine after they lose weight, for as long as they are able to keep it off.

Why people become overweight

Everyone knows some people who can eat ice cream, cake, and whatever else they want and still not gain weight. At the other extreme are people who seem to gain weight no matter how little they eat. Why? What allows one person to remain thin without effort but demands that another struggle to avoid gaining weight or regaining the pounds he or she has lost previously?

On a very simple level, your weight depends on the number of calories you consume, how many of those calories you store, and how many you burn up (see "The calorie equation"). But each of these factors is influenced by a combination of genes and environment. Both can affect your physiology (such as how fast you burn calories) as well as your behavior (the types of foods you choose to eat, for instance). The interplay between all these factors begins at the moment of your conception and continues throughout your life.

The calorie equation

The balance of calories stored and burned depends on your genetic makeup, your level of physical activity, and your resting energy expenditure (the number of calories your body burns while at rest). If you consistently burn all of the calories that you consume in the course of a day, you will maintain your weight. If you consume more energy (calories) than you expend, you will gain weight.

Excess calories are stored throughout your body as fat. Your body stores this fat within specialized fat cells (adipose tissue) either by enlarging fat cells, which are always present in the body, or by creating more of them. If you decrease your food intake and consume fewer calories than you burn up, or if you exercise more and burn up more calories, your body will reduce some of your fat stores. When this happens, fat cells shrink, along with your waistline.

Genetic influences

To date, more than 400 different genes have been implicated in the development of overweight or obesity, although only a handful appear to be major players. Genes contribute to obesity in many ways, by affecting appetite, satiety (the sense of fullness), metabolism, food cravings, body-fat distribution, and the tendency to use eating as a way to cope with stress.

Science A 2006 report in that studied more than 900 people showed that those who have two copies of a specific gene variant (called Insig-2) were 22% more likely to have a BMI higher than 30. Researchers believe the gene variant affects the regulation of another gene involved in fat production. In follow-up studies of more than 9,000 people (including people with Western European ancestry, African Americans, and children), they found that about 10% carried two copies of the gene variant.

Proceedings of the National Academy of Sciences, In another 2006 study, published in the researchers studied the activity levels of three different genes in fat samples from people who were normal weight, overweight, or obese. They took fat samples from around the participants' internal organs and under their skin and found different levels of activity (known as gene expression) in the different samples. In overweight people, increased expression of two of the genes correlated with a tendency to be "apple-shaped." These and related studies have helped researchers better understand how and why obesity occurs. They may also spur the development of new weight-loss treatments.

The strength of the genetic influence on weight disorders varies quite a bit from person to person. Research suggests that for some people, genes account for just 25% of the predisposition to be overweight, while for others the genetic influence is as high as 70% to 80%. Having a rough idea of how large a role genes play in your weight may be helpful in terms of treating your weight problems (see "How much of your weight depends on your genes?").

How much of your weight depends on your genes?

Genes are probably a significant contributor to your obesity if you have most or all of the following characteristics:

You have been overweight for much of your life.
One or both of your parents or several other blood relatives are significantly overweight. If both of your parents have obesity, your likelihood of developing obesity is as high as 80%.
You can't lose weight even when you increase your physical activity and stick to a low-calorie diet for many months.

Genes are probably a lower contributor for you if you have most or all of the following characteristics:

You are strongly influenced by the availability of food.
You are moderately overweight, but you can lose weight when you follow a reasonable diet and exercise program.
You regain lost weight during the holiday season, after changing your eating or exercise habits, or at times when you experience psychological or social problems.

These circumstances suggest that you have a genetic predisposition to be heavy, but it's not so great that you can't overcome it with some effort.

At the other end of the spectrum, you can assume that your genetic predisposition to obesity is modest if your weight is normal and doesn't increase even when you regularly indulge in high-calorie foods and rarely exercise.

People with only a moderate genetic predisposition to be overweight have a good chance of losing weight on their own by eating fewer calories and getting more vigorous exercise more often. These people are more likely to be able to maintain this lower weight.

What are thrifty genes?

When the prey escaped or the crops failed, how did our ancestors survive? Those who could store body fat to live off during the lean times lived, and those who couldn't, perished. This evolutionary adaptation explains why most modern humans about 85% of us carry so-called thrifty genes, which help us conserve energy and store fat. Today, of course, these thrifty genes are a curse rather than a blessing. Not only is food readily available to us nearly around the clock, we don't even have to hunt or harvest it!

In contrast, people with a strong genetic predisposition to obesity may not be able to lose weight with the usual forms of diet and exercise therapy. Even if they lose weight, they are less likely to maintain the weight loss. For people with a very strong genetic predisposition, sheer willpower is ineffective in counteracting their tendency to be overweight. Typically, these people can maintain weight loss only under a doctor's guidance. They are also the most likely to require weight-loss drugs or surgery.

The prevalence of obesity among adults in the United States has been rising since the 1970s (see Figure 3). Genes alone cannot possibly explain such a rapid rise. Although the genetic predisposition to be overweight varies widely from person to person, the rise in body mass index appears to be nearly universal, cutting across all demographic groups. These findings underscore the importance of changes in our environment that contribute to the epidemic of overweight and obesity.

Figure 3: Trends in adult weight

Trends in adult weight

Percent of adults ages 2074* who were at a healthy weight, overweight, or obese

*Data are age-adjusted to the 2000 U.S. standard population.

Healthy weight, body mass index (BMI) = 18.524; overweight, BMI = 2529; obese, BMI ?30.

Cancer Trends Progress Report Sources: National Health and Nutrition Examination Survey (National Center for Health Statistics); 2005 Update (National Cancer Institute, 2005).

Environmental influences

Genetic factors are the forces inside you that help you gain weight and stay overweight; environmental factors are the outside forces that contribute to these problems. They encompass anything in our environment that makes us more likely to eat too much or exercise too little. Taken together, experts think that environmental factors are the driving force for the dramatic increase in obesity.

Environmental influences come into play very early, even before you're born. Researchers sometimes call these in-utero exposures "fetal programming." Babies of mothers who smoked during pregnancy are more likely to become overweight than those whose mothers didn't smoke. The same is true for babies born to mothers who had diabetes. Researchers believe these conditions may somehow alter the growing baby's metabolism in ways that show up later in life.

After birth, babies who are breast-fed for more than three months are less likely to have obesity as adolescents compared with infants who are breast-fed for less than three months.

Childhood habits often stick with people for the rest of their lives. Kids who drink sugary sodas and eat high-calorie, processed foods develop a taste for these products and continue eating them as adults, which tends to promote weight gain. Likewise, kids who watch television and play video games instead of being active may be programming themselves for a sedentary future (see "The trouble with TV: Sedentary snacking").

Many features of modern life promote weight gain. In short, today's "obesogenic" environment encourages us to eat more and exercise less. And there's growing evidence that broader aspects of the way we live such as how much we sleep, our stress levels, and other psychological factors can affect weight as well.

Other causes of obesity

Clearly, our responses to today's obesity-promoting environment, in tandem with genetic influences, are the most significant causes of overweight and obesity. But in some people, drug side effects, illnesses, and genetic disorders can also play a role.

When to see a doctor

Not everyone needs to see a doctor in order to lose weight, but some people might want to consider this route for two reasons. The first is to get professional guidance. If you haven't been able to lose weight on your own by dieting and exercising, your doctor may be able to help by making specific recommendations. The second reason to see a doctor is to be evaluated for health complications that might be associated with your excess weight. It's important to have a medical evaluation if you are over 40, or if you are younger and have any health problems. Such an assessment can provide you with added motivation to lose weight to help lower your blood pressure; to reduce your risk of developing heart disease, diabetes, or cancer; or to live a longer, healthier life.

Chances are, your primary care physician can perform this evaluation. Depending on what the doctor finds, he or she may refer you to a nutritionist or dietitian to assess your eating habits, or to a therapist to address any psychological issues that may be interfering with your ability to attain a healthy weight. If you have obesity or if you are overweight and have obesity-related conditions your doctor may refer you to a medical group that specializes in weight loss or to a hospital-based weight-loss center.

Medical evaluation for weight loss

Whether you start by seeing your own doctor or a weight-loss specialist, the evaluation will begin with your complete medical history. The doctor will ask you how long you've been overweight. This is an important question because it narrows down the possible causes of your excess weight as well as the effective treatments. If you have been overweight since childhood, you probably have a strong genetic predisposition to be overweight. A lifelong weight problem is usually harder to treat without drugs or surgery than one that developed in adulthood. On the other hand, if you've gained weight recently, a program of dieting, exercise, and behavior modification may be enough to help you lose weight and keep it off.

The doctor will also want to know what you have done on your own to lose weight. What diets have you tried? Did you lose weight on any of these plans? How long did you keep off the weight, and how much did you regain? This information can help your doctor determine strategies that might be more successful.

In addition to your personal history, the doctor will ask you about your family history. Are your biological parents overweight? Does obesity run in at least part of your family? If so, the chances are that genetics plays a large part in your problem. Do you have a family history of disorders that can be caused by obesity, such as type 2 diabetes, high blood pressure, or breast cancer? If so, you, too, are at high risk for these problems. In particular, you will be at higher risk for such conditions than if you were overweight but had no family history of them. Such information can also suggest whether you might need aggressive weight-loss treatments, such as medication or surgery.

As part of your medical history, the doctor will need to know the names of all the medications you have been taking. Several drugs can cause weight gain, increase appetite, or interfere with weight-loss efforts. If your weight gain came on soon after you began taking one of these drugs, it may be the cause of your problem. Depending on your condition, you may not be able to stop taking the drug. But if you can substitute or add another drug, you might be able to lose the extra weight.

Other important information concerns symptoms, both physical and emotional. Do you have any symptoms of obesity-related conditions such as heart disease, stroke, hypertension, or type 2 diabetes? Do you have mood swings or other symptoms of depression, such as insomnia? If so, you may need additional tests to evaluate and diagnose these problems. If you appear to have depression, anxiety, or an eating disorder, your doctor may refer you to a psychologist or psychiatrist.

Screening tests

After the medical history, you will need a physical examination and certain screening tests. Part of the physical exam is to measure your height and weight accurately in order to determine your BMI, which indicates the severity of your weight problem. The doctor may also measure the circumference of your waist and hips (see "What's your body shape?").

Even if you are only mildly overweight, abdominal obesity increases your risk for type 2 diabetes, heart disease, and stroke. Excess fat around the abdomen helps make the body resistant to insulin, the hormone that enables blood sugar to enter the cells where it can be used as fuel. When insulin doesn't act effectively, the pancreas secretes more of it; excess insulin increases blood pressure and triglycerides and lowers the level of HDL ("good") cholesterol.

The doctor will also take your blood pressure to check for hypertension and will draw blood to check for other problems, such as high levels of cholesterol, triglycerides, and glucose. High levels of LDL ("bad") cholesterol and triglycerides are risk factors for heart disease. An abnormally high level of glucose is a sign of type 2 diabetes. Finally, if the doctor suspects a hormonal abnormality, such as hypothyroidism or adrenal gland hyperactivity, he or she will test your levels of thyroid-stimulating hormone and cortisol.

Designing a treatment program

If you have a health problem related to being overweight, the doctor will recommend a treatment for that condition. You may need medication for high blood pressure, high cholesterol, type 2 diabetes, or other complications. If you have depression, your doctor may recommend an antidepressant, psychotherapy, or both before you start a weight-loss program. But treating the health problems associated with overweight cannot help you lose weight. You will need a weight-loss plan not only to reduce your weight, but also to aid in the treatment of any obesity-related problems.

The plan that your doctor recommends will depend on several factors, including your BMI, whether you have obesity-related health problems, and the degree of your past success in losing weight. If you are mildly overweight and in relatively good health, your doctor may be able to provide guidance on diet and exercise having you come in for regular office visits to monitor your progress and helping you overcome the common weight-loss plateaus. Or your doctor may recommend weight-loss programs offered locally by self-help organizations, companies, registered dietitians, or hospitals. You can find a registered dietitian in your area by calling the American Dietetic Association (see "Resources").

But in some cases for example, if you are extremely overweight or if you have obesity-related health problems and haven't been able to control your weight on your own a weight-loss program that involves dieting, exercise, and social support may not be enough. In such cases, your doctor will probably refer you to a weight-disorders specialist or to a hospital-based weight-loss program to consider whether one or more of the medical options, such as a very low-calorie diet, weight-loss medication, or bariatric surgery (see "Weight-loss surgery"), might be appropriate for you.

In discussing the various weight-loss options, your doctor may ask you about your goals and expectations: How much weight do you expect to lose? How much of an improvement in health and emotional well-being do you expect this weight loss to provide? The purpose of these questions is to find out how realistic your expectations are. Don't be surprised or get discouraged if your doctor tells you to set more modest goals. Your doctor will help you set realistic goals about how much weight you need to lose, how much you can expect to lose, and how much you can expect to keep off in the long run that is, for a year or more.

Such considerations are important because many overweight people begin a weight-loss program expecting to shed many more pounds than will be possible for them. In one study of women with obesity in a weight-loss program, the women said that they wanted to reduce their weight by 32%. That's significantly more than even the best weight-loss programs achieve with weight-loss drugs and diets. Most people who go through weight-loss programs lose 5%10% of their initial weight. Moreover, the National Institutes of Health (NIH) now defines a successful weight-loss effort as one in which a person loses and keeps off 10% or more of his or her initial weight.

How to lose weight

Eat less, exercise more. If only it were that simple! As most dieters know, losing weight can be very challenging. As we've seen, a range of influences can affect how people gain and lose weight. But a basic understanding of how to tip your energy balance in favor of weight loss (see Figure 5) is a good place to start.

Figure 5: A balancing act

A balancing act

To lose weight, you must take in less energy (fewer calories) through food than you expend through exercise and metabolism. Some diets may succeed (in the short term, at least) simply because they lead to a reduced calorie intake even if their methods are not explicitly grounded in calorie reduction.

Counting calories: Doing the math

Start by determining how many calories you should consume each day. To do so, you need to know how many calories you need to maintain your current weight. Doing this requires a few simple calculations.

First, multiply your current weight by 15 that's roughly the number of calories per pound of body weight needed to maintain your current weight if you are moderately active. Moderately active means getting at least 30 minutes of physical activity a day in the form of exercise (walking at a brisk pace, climbing stairs, or active gardening). Let's say you're a woman who is 5 feet, 2 inches tall and weighs 150 pounds, and you need to lose about 12 pounds to put you in a healthy weight range. If you multiply 150 by 15, you will get 2,250, which is the number of calories per day that you need in order to maintain your current weight (weight-maintenance calories). To lose weight, you will need to get below that total.

For example, to lose 1 to 2 pounds a week a rate that experts consider safe your food consumption should provide 5001,000 calories less than your total weight-maintenance calories. If you need 2,250 calories a day to maintain your current weight, reduce your daily calories to 1,2501,750. If you are sedentary, you will also need to build more activity into your day. In order to lose at least a pound a week, try to do at least 30 minutes of physical activity on most days, and reduce your daily calorie intake by at least 500 calories. However, calorie intake should not fall below 1,200 a day in women or 1,500 a day in men, except under the supervision of a health professional. Eating too few calories can endanger your health by depriving you of needed nutrients.

Calories from drinks
Beverage	Amount	Calories
Lemonade	8 ounces	60
White wine	4 ounces	100
Beer	12 ounces	150
Cola	12 ounces	154
Gin and tonic	8 ounces	171

Meeting your calorie target

How can you meet your daily calorie target? One approach probably the most accurate is to add up the number of calories per serving of all the foods that you eat, and then plan your menus accordingly. You can buy books that list calories per serving for many foods. In addition, the nutrition labels on all packaged foods and beverages provide calories per serving information. Make a point of reading the labels of the foods and drinks you use, noting the number of calories and the serving sizes. Many recipes published in cookbooks, newspapers, and magazines provide similar information.

If you hate counting calories, a different approach is to restrict how much and how often you eat, and to eat meals that are low in calories. Indeed, dietary guidelines issued by the American Heart Association stress common sense in choosing your foods rather than focusing strictly on numbers, such as total calories or calories from fat. Whichever method you choose, research shows that a regular eating schedule with meals and snacks planned for certain times each day makes for the most successful approach. The same applies after you have lost weight and want to keep it off. Sticking with an eating schedule increases your chance of maintaining your new weight.

What determines your metabolic rate?

Total metabolism is the rate at which you use energy (measured in calories) when you're exercising or doing anything else (including sleeping). Resting energy expenditure is the rate at which you burn calories when you are not being physically active. Resting energy expenditure varies from person to person and is affected by your age, sex, genetic makeup, psychological state, and level of physical activity. For example, pregnancy and illness both tend to increase resting energy usage. Both total metabolism and resting energy expenditure influence your weight by affecting how many calories you burn in the course of a day.

Some people focus on reducing the fat in their eating plan because, at 9 calories per gram, fat by weight contains more than twice as many calories as carbohydrates or proteins (4 calories per gram). By substituting lean cuts of meat for fatty ones, avoiding high-fat packaged foods and snacks, and refraining from fat-rich products such as butter, mayonnaise, and salad dressings, you can cut out dozens or even hundreds of calories per day. On the other hand, many people mistakenly think that cutting fat always means cutting calories. Some fat-free foods actually contain more calories than the regular versions because manufacturers use extra sugar to make up for the flavor lost in removing the fat. Moreover, low-fat or nonfat foods are not low-calorie if you consume them in large quantities.

Here are some guidelines to follow when straight calorie counting is impractical.

Eat foods that are filling and low in calories. That means meals and snacks made with whole grains, such as brown rice, whole-wheat bread, and oatmeal, as well as legumes, such as lentils and other beans.
When you eat meat, cut out fat and cut down portion sizes. Choose lean cuts of meat and modest amounts about 3½ or 4 ounces per serving.
Avoid fried foods. Frying foods adds fat and calories. For stovetop cooking, it's better either to stir-fry foods in nonstick pans lightly coated with a cooking-oil spray or to braise them in broth or wine. Baking, broiling, and roasting add no extra fat to your meals.
Use low-fat or nonfat dairy foods. Milk, yogurt, and cheese are good sources of protein and calcium, but the whole-milk versions of these dairy products are very high in fat.
Avoid fast foods. Hamburgers, chicken nuggets, French fries, and other fast-food meals and snacks tend to promote weight gain for two reasons. First, they are high in fat, calories, or both. Second, the "value meals" are often excessively large and tempt you to overeat.
Avoid high-fat and high-carbohydrate snacks. Both types of snacks are high in calories. Even snacks labeled "low-fat" are often high in calories because they contain large amounts of sugars and other carbohydrates.
Watch what you drink. Regular sodas, fruit juices, and, especially, alcoholic beverages are high in calories (see "Calories from drinks").
Eat scheduled meals and snacks. It may seem that skipping meals or cutting out snacks is a smart way to cut out calories, but doing either of these things can work against you. You need to eat regularly, even when you're on a diet. If you don't, you'll feel so hungry that you may give up in frustration.

One weight-loss method

If you are moderately overweight but not obese, here's one way to tip the energy balance in your favor.

If you are moderately active:

Multiply your weight by 15 to get the number of calories that you need each day to maintain your weight. For example, if you weigh 200 pounds, 200 15 = 3,000 weight-maintenance calories.
To lose 1 pound each week, you have to consume 500 fewer calories a day. Thus, for the above example, 3,000 500 = 2,500 calories per day.

If you are sedentary:

Follow the steps above, plus
Get 30 minutes of moderate to vigorous activity on most days. Activity of this intensity and duration will burn 150250 calories a day.

Physical activity: How much is enough?

If one person cuts back on calories without exercising and another person increases exercise without cutting back on calories, the first person would lose weight more quickly. That's because it's easier to cut 500 calories a day from your diet than it is to burn 500 extra calories through exercise. You'd have to walk or run about 5 miles a day or 35 miles a week to lose 1 pound of fat. But if you only cut back on calories, you're more likely to regain the weight you lose. Why? The body reacts to weight loss as if it were starving and, in response, slows its metabolism. When your metabolism slows, you burn fewer calories even at rest. When you burn fewer calories, three things can happen. If you continue eating fewer calories, you will either stop losing weight as quickly as you have been, or you'll stop losing weight altogether. If you increase your calorie consumption, you may actually gain weight more quickly than you have in the past. The solution is to increase your physical activity because doing so will counteract the metabolic slowdown caused by reducing calories.

A regular schedule of exercise raises not only your energy expenditure while you are exercising but also your resting energy expenditure that is, the rate at which you burn calories even when the workout is over and you are resting. Resting energy expenditure remains elevated as long as you exercise at least three days a week on a regular basis. Because it accounts for 60%75% of your daily energy expenditure, any increase in resting energy expenditure is extremely important to your weight-loss effort. The kinds of vigorous activity that can stimulate your metabolism include walking briskly for 2 miles or riding a bike uphill.

For people who have obesity and who have been sedentary, any amount of physical activity is beneficial, including walking, swimming, and water aerobics. But start out slowly, and gradually increase the pace and duration of such activities. Low-intensity activities such as taking a short walk or raking leaves won't raise your resting energy expenditure as much as high-intensity activities will, but they have other advantages. For one thing, they help reduce body fat and build muscles and muscle tissue burns more calories than fat does. Regular weight lifting also builds muscle and has a similar effect.

Another benefit of regular physical activity of any sort is that it temporarily curbs your appetite. Of course, many people joke that after a workout they feel extremely hungry and promptly indulge in a snack. But because exercise raises resting energy expenditure, people continue to burn calories at a relatively high rate. So a moderate snack after exercising does not erase the benefits of exercise in helping people control their weight.

Calories burned in each mile of walking or jogging
Body weight (pounds)	Calories
100	67
110	74
120	83
130	89
140	95
150	100
160	108
170	115
180	121
190	128
200	135
210	141
220	148

Starting an exercise program

Many people are daunted by the prospect of starting an exercise program, but it doesn't need to be overwhelming. One approach is to look at your schedule and determine where you can regularly fit in a 30-minute exercise session. For some people, this may mean getting up a half-hour earlier. For others, lunchtime or after work is most convenient. Your goal is to improve your health and lose pounds by doing 30 minutes or more of an activity that's moderately intense, five days a week. If you don't reach this goal at first, it's good to know that any increase in physical activity is better than none.

For some people, a less structured approach may work. You don't have to work out at the gym or participate in a sport, although some people find that these things help them stick to a routine. Many ordinary everyday activities count as moderate-intensity exercise: taking the stairs instead of the elevator, walking instead of driving, cutting the lawn with a push mower, or playing with the children. A significant plus for busy people is that the physical activity doesn't have to be done in a single session. You can break up the 30 minutes for example, by taking a 10-minute walk to the post office and later having a 20-minute bike ride with the kids. Research has shown that breaking up physical activity into 10-minute spurts throughout the day burns up at least as many calories as exercising in a single block of time. Once people get into the habit of setting aside time on most days for physical activity, they tend to be more open to new kinds of activities because they feel stronger and more capable of exerting themselves. People who had never considered taking up a new sport might find themselves wielding tennis racquets, strapping on cross-country skis, or joining a recreational volleyball team. Becoming more active over time helps the effort to keep pounds off.

Exercise prescription

Everyone is different, so there's no such thing as a one-size-fits-all exercise plan. But following this prescription is a good place to start, especially if you haven't yet made exercise part of your daily routine.

Increase the beat. Focus at first on activities or exercises that make the heart and lungs work harder. These include walking, jogging, swimming, cycling, dancing, gardening, playing racquetball, and a host of others.

Make it last. Aim for at least 30 minutes of activity in a day. If you can do it all at once, great. If not, three 10-minute bursts of activity are fine, too. Don't hesitate to go beyond that 30-minute target the longer you are active, the more you benefit.

Do it often. Be active on most days of the week.

It's okay to be moderate. Exercises or activities that are low to moderate in intensity are fine, and are safer for many people. If you like vigorous activity, do it.

Be strong. Add some weight lifting or other resistance exercises to your aerobic activities. Choose weights that let you do 1215 repetitions of exercises that work your arm, leg, shoulder, and hip muscles.

Limber up. Gentle stretches can warm up your muscles before exercise. They can also improve your balance and flexibility.

Behavior modification: Adopting healthier habits

Calorie restriction and exercise help many people lose weight, but only for as long as they keep up the effort. And the same environmental and psychological factors that accounted for the weight gain in the first place can play a role in causing someone to stop exercising or start consuming too many calories. The difficulty in sustaining a diet and exercise routine is one of the main reasons that people who lose weight fail to keep it off. But the difference between long-term success and failure is the ability to make the changes in your diet and activity level permanent.

Certain strategies are useful for everyone who wants to lose weight, regardless of the main causes or severity of their obesity. Many of the following strategies seem like common sense, but they are easily overlooked. You're most likely to follow them if you plan for them in advance.

Eat slowly. Chewing and swallowing your food at a leisurely pace can help you keep from overeating. Here's why: It takes about 20 minutes for your brain to "tell" you when you feel full. Until then, you continue to feel hungry and want to eat. If you eat quickly, you'll end up consuming more than you need to feel full. But eating slowly gives your brain the time it needs to signal that you've had enough.

Make changes gradually. Don't expect to change your diet and activity level overnight. Instead of switching all at once to a low-calorie eating plan, try gradually decreasing the calories of your meals and snacks. For example, start by cutting out snacking or limiting yourself to certain snacks at certain times of day (such as a mid-morning banana or a late-afternoon apple). Also, gradually reduce the calorie content of particular foods. For example, if you're used to drinking whole milk, first switch to milk with 2% fat; then, as you get used to the taste of less fat, go on to milk with 1% fat and finally to skim milk. Another strategy is to lower the calorie content of one meal at a time. In the first week, you might want to eat a low-calorie breakfast, but keep lunch and dinner the same as before. During the second week, you might reduce the calorie content of your lunch. Finally, you can begin eating low-calorie dinners.

Keep a record. Keeping a daily log of what you eat and what physical activities you engage in can help keep you motivated to stay with your diet and exercise plan. Looking over a week's worth of entries can tell you how successful you've been and can help you identify areas where you need to improve.

Seek social support. You'll find it easier to maintain behavioral changes if you have the support and encouragement of others. Social support can come in many forms and from various people. For starters, ask your family members to keep high-calorie foods out of the house, or at least to refrain from eating them in front of you. You might even try to enlist your family to eat the same meals you do. Exercise with someone else, or join a support group. The camaraderie can help keep your spirits up during the inevitable periods when you become discouraged with your progress.

Use a list when buying food. Stick to your grocery list, and steer clear of those aisles or areas with the kinds of calorie-dense foods that you need to avoid.

Out of sight, out of mind. At home, put the most tempting foods high up in the cupboard, at the very back of the fridge, or in other inconvenient spots. Replace the cookie jar and candy bowl with a fruit bowl. Never eat directly out of a large package; many small containers are better than a few large ones, because they provide convenient stopping points. And don't put out too many different varieties of the same kind of food you'll be tempted to sample from each one and eat a lot more than if you were faced with fewer choices.

Don't go all out when eating out. Eat a low-calorie snack before going out; you're less likely to go off your diet if you're feeling full when you get to the party or restaurant. Go elsewhere for after-dinner coffee so you are less tempted to segue right into dessert.

Make a plan for special occasions. Decide how much you're going to eat before an event, and do your best to stick with that plan. Set some limits before you go to the movies or watch the Sunday afternoon football games. It's so easy to mindlessly munch when you're in front of a screen of any kind.

Be a copycat. When eating with a group of people, look around. Who's eating the least? Who has the healthiest food on their plate? Model your eating habits on those people's.

Find physical activities that you enjoy. For example, if you don't like exercising outdoors on cold days, join a fitness club, or get an exercise bicycle and hand weights to use at home. If the problem is a time crunch, exercise in increments of 10 minutes whenever you have the time before work, after work, or during your lunch hour.

Reduce stress. If you overeat when you are under stress, find a stress-reduction method that works for you: meditation, relaxation techniques, listening to music, exercising, or talking to a friend.

Table 2: How to burn about 150 calories

Washing and waxing a car for 4560 minutes

Washing windows or floors for 4560 minutes

Playing volleyball for 45 minutes

Playing touch football for 3045 minutes

Gardening for 3045 minutes

Wheeling self in wheelchair for 3040 minutes

Bicycling 5 miles in 30 minutes

Dancing fast (social) for 30 minutes

Pushing a stroller 1½ miles in 30 minutes

Raking leaves for 30 minutes

Walking 2 miles in 30 minutes (15 min/mile)

Water aerobics for 30 minutes

Swimming laps for 20 minutes

Wheelchair basketball for 20 minutes

Basketball (playing a game) for 1520 minutes

Bicycling 4 miles in 15 minutes

Jumping rope for 15 minutes

Running 1½ miles in 15 minutes (10 min/mile)

Shoveling snow for 15 minutes

Climbing stairs for 15 minutes

Physical Activity and Health: A Report of the Surgeon General, Source: U.S. Department of Health and Human Services, 1996.

Popular diets

The answer to the perennial question "What's the best diet for losing weight?" is any diet that you can stick with for a long time. It should be as good for your overall health your heart, bones, colon, and psyche as it is for your waistline. It should offer plenty of good-tasting and healthy choices, banish few foods, and not require an extensive and expensive list of groceries or supplements.

Many different weight-loss diets have been in the limelight, from very low-fat diets (such as the Ornish and Pritikin diets) to low-carbohydrate diets (such as Atkins and South Beach) as well as combination diets (such as the Zone). Other trends include calorie-density diets (Volumetrics) and Mediterranean-style diets (such as Sonoma).

Here are short summaries of some of the most popular types, followed by a "bottom line" assessment of their effectiveness.

Low carbohydrate

Low fat

Correct carbohydrates

Perfect proportions and careful combinations

Calorie-density diets

Behavior change

Mediterranean style

The diet studies

Journal of the American Medical Association, What do scientists say about how the different diet plans compare? The results of studies often suggest that it's not the diet plan but whether you stick with it that makes the difference. For example, in a 2005 study published in the researchers randomly assigned a group of 160 overweight and obese adults to one of four popular diet plans: the Atkins diet, the Ornish diet, Weight Watchers, and the Zone diet. After one year, nearly half of the participants had dropped out of the study. But those who completed the study lost similar amounts of weight (about 5 to 7 pounds each, on average). They also lowered their blood levels of cholesterol and several other markers linked to heart disease and diabetes to a similar degree. People assigned to the Atkins and Ornish diets were more likely to drop out of the study, suggesting that many people found these plans too extreme. But for certain people, the structure of a restricted plan may be helpful.

British Medical Journal A similar study, published in the in 2006, compared four programs: the Slim-Fast plan (a meal-replacement approach), Weight Watchers, the Atkins diet, and Rosemary Conley's "Eat Yourself Slim" low-fat diet and fitness plan (which includes a weekly group exercise class). All the diets helped people shed pounds and fat, but many more than half of the participants dropped out of the study after eight weeks. About 45% of people in the Rosemary Conley and Atkins groups who completed the six-month study lost 10% of their body weight. For the Weight Watchers and Slim-Fast groups, success rates were slightly lower: only 36% and 21%, respectively, lost 10% of their weight.

Another line of evidence about effective weight-loss strategies comes from a few carefully controlled trials in which volunteers with obesity were blindly assigned to either a standard low-fat diet or a low-carb, high-protein diet. Over all, these trials showed that a low-carb, high-protein diet leads to quicker weight loss than a low-fat diet. In the studies that lasted for a year or longer, though, weight loss was about the same regardless of diet type. These studies focused primarily on weight, and were too short to track other important consequences of diet, such as heart disease, diabetes, bone strength, and cancer.

The overall results mask some startling individual differences. In one trial, on both low-carb and low-fat diets, some people lost weight while others gained. In the low-fat group, the range was from 53 pounds lost to 31 pounds gained. In the low-carb group, it was from 65 pounds lost to 18 gained.

The take-home lesson is that it is okay to experiment on yourself. If you give a diet your best shot and it doesn't work, maybe it wasn't the right one for you, your metabolism, or your situation. Don't get too discouraged or beat yourself up because a diet that "worked for everybody" didn't pay off for you. Try another.

The glycemic index and obesity

The glycemic index is a measure of how quickly the carbohydrate derived from a particular food is absorbed into your bloodstream. Of course, the amount of carbohydrate you eat also affects your blood sugar and insulin levels.

Doctors originally developed the index to help people with diabetes avoid foods that increase blood sugar too quickly, but some experts think it can also help people avoid obesity-related health problems.

The glycemic index ranks foods on a 100-point scale, with 100 being the fastest rate of absorption. Foods with sugars that are absorbed quickly have high glycemic indexes; those with sugars that are absorbed slowly have low glycemic indexes. When sugar is absorbed quickly, it increases the release of insulin, the hormone that transports sugar to the cells for fuel. Spikes in insulin levels, if they occur regularly, may promote insulin resistance, a condition in which the body doesn't respond normally to the hormone. When insulin doesn't function properly, levels of blood sugar and fats rise, increasing the risk for diabetes, coronary heart disease, and possibly stroke, kidney failure, and cancer.

In general, high-carbohydrate foods have the highest glycemic indexes; proteins and fats have glycemic indexes that are close to zero. Proponents of low-carbohydrate diets cite the glycemic index in justifying systematic reductions in carbohydrates. However, most scientists disagree. In cutting back on all foods with relatively high glycemic indexes, you would end up avoiding many healthy foods, including carrots (glycemic index of 71), sweet potatoes (glycemic index of 54), and brown rice (glycemic index of 55).

Some experts argue that people should avoid certain foods that are high on the glycemic index or should eat them only in moderation because they may cause insulin resistance and obesity, although this view remains controversial. The principal suspects are foods heavy in simple sugars, such as candy bars and cookies, and processed carbohydrate foods, such as potato chips, breakfast cereals, and many of the low-fat foods that are on the market. In addition to wreaking havoc with your insulin levels, such foods tend to be high in calories, and excess calories translate to excess pounds.

Glycemic indexes of popular foods
Food	Glycemic index
Yogurt, low-fat with artificial sweetener	14
Milk, whole	27
Kidney beans	27
All-bran cereal	30
Milk, skim	32
Yogurt, low-fat with fruit and sugar	33
Apple	36
Spaghetti, whole wheat	37
Chocolate	49
Rice, white	50
Banana	53
Rice, brown	55
Spaghetti, white	57
Bread, whole wheat	58
Cheese pizza	60
Ice cream	61
Bread, white	72
Corn flakes	77

Weight-loss programs

Each year, millions of Americans enroll in weight-loss programs. These include well-known commercial programs such Weight Watchers and Jenny Craig and organized self-help programs such as Overeaters Anonymous. Fewer people may be familiar with medically supervised programs, which include hospital-based programs or individual care from a physician. Internet-based commercial weight-loss programs have grown in popularity.

The commercial programs charge a fee for meetings. They offer nuts-and-bolts diet and exercise regimens and, in some cases, sell prepared foods and diet aids. The self-help programs tend to focus mainly on providing emotional support and encouragement in sticking with a weight-loss plan. Clinical programs, which are provided through a doctor's office or hospital clinic, offer comprehensive diet, exercise, and behavior-modification programs, supplemented as needed with prescription treatments, such as very low-calorie diets, weight-loss medications, and, increasingly, surgery.

It's important to note that none of the programs can guarantee that you will lose a particular amount of weight. With the exception of the clinical programs, these approaches are adjuncts to, not substitutes for, professional guidance for those who need it. Indeed, the self-help and commercial plans encourage participants to consult with health care professionals about weight-loss strategies. Here is a description of the various categories of weight-loss programs, what you can expect from them, and their relative costs.

Commercial programs

Like self-help programs, the commercial programs hold regular meetings to provide encouragement and support. But a significant difference between the two categories of program is money. The commercial programs charge fees to participate in meetings and also sell diet plans, as well as prepared foods and diet aids to go along with those plans.

Weight Watchers. The most popular of the commercial programs, Weight Watchers, has more than 25 million participants worldwide. The heart of the Weight Watchers program is its points system, which attempts to take the guesswork out of calorie counting. Weight Watchers scientists assigned a point value to various foods based on their calories, fat, and nutrients. When you start, the Weight Watchers staff will tell you, based on your weight, how many points you can eat each day to lose weight. You will also receive literature listing the point values of a wide range of foods. You can eat whatever you like, as long as you don't exceed your daily point total. There's no need to buy Weight Watchersbrand foods. The program encourages members not only to follow the points system, but also to get regular exercise.

Weight Watchers doesn't promise that you will lose a certain amount of weight on its points system. Two published trials showed that people who went to Weight Watchers meetings regularly lost about 5% of their weight over three to six months. Weight Watchers charges about $12 per meeting, although the fee varies slightly by region. Including membership fee, the approximate cost for three months is $167. Meetings are led by people who have successfully lost weight and kept it off through the Weight Watchers program. There is also an online version of the program, which costs about $65 for three months.

Jenny Craig. This is the other leading commercial weight-loss program, and it is only for women. Jenny Craig consists of about 640 weight-loss centers around the world. To get started, you visit a local Jenny Craig center and have your weight analyzed by a staff member. These staff members are not dietitians or other health professionals, but they're trained in the Jenny Craig program, which, according to the company, was developed by dietitians. Based on your weight, the staff member recommends a dieting, exercise, and behavior-modification program to help you lose about 1 pound a week.

In general, members are advised to eat three meals a day and three snacks, as well as to drink eight 8-ounce glasses of water each day and to increase their physical activity as much as they can. Jenny Craig also sells a wide array of packaged foods, diet aids, vitamin and mineral supplements, and even devices. One such device, used by many programs, is a pedometer, a small, pager-sized box you wear that counts the number of steps you take, helping you estimate your activity level. People have the option of preparing their own meals, but the prepared foods have been shown to help them stick with the diet. Adding together the membership fee and meal plan costs, the approximate cost for three months is $1,249.

Internet-based diet plans

These plans are another development in commercial weight-loss programs. Shape Up America!, a nonprofit weight-management organization, provides a list of online programs on its Web site (see "Resources"). Some of the better-known programs include eDiets, NutriSystem, DietWatch, and online programs from Weight Watchers and WebMD.

Obesity Research For example, the eDiets program, which charges $65 for three months, provides subscribers with lists of low-calorie recipes and foods based on the dieter's likes and dislikes. You then choose 1 of more than 20 different diets, for which you buy and make your own food. All the meal plans represent low-calorie diets designed to help you lose about a pound or 2 a week. The company also offers online chats with other subscribers and free e-mail advice from experts, including psychologists and dietitians. However, a 2004 study in compared eDiets with the LEARN (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) Program for Weight Management, a weight-loss program developed by a Yale University researcher; eDiets users lost just 1.1% of their weight after one year, whereas the LEARN users lost 4%.

Self-help programs

These nonprofit programs have local chapters around the country. They make no promises that they will help you lose any weight. However, they aim to improve your odds of doing so by holding regular (usually weekly) meetings where members share success stories and frustrations and offer one another encouragement and personal tips. Meetings are run by volunteer group leaders. Each self-help program has a different focus.

Overeaters Anonymous. This is a 12-step program modeled after Alcoholics Anonymous for people who suffer from compulsive overeating. The main purpose of the meetings is to help people stop overeating by exploring their underlying emotional issues. Overeaters Anonymous has chapters around the world. It is free, although members are asked to contribute what they can. A special feature of the program is a buddy system in which you have another member to call if you feel the urge to overeat. Whether this approach is appropriate or effective for overeaters remains controversial.

Take Off Pounds Sensibly (TOPS). This program takes a practical approach, giving members incentives to follow whatever diet plan has been recommended by their health care practitioners. One program that TOPS recommends is the "exchange" diet established by the American Dietetic Association and the American Diabetes Association, but TOPS asks that members check with their doctors first.

Upon joining, members record their weight and then compete to see who can lose the most. Winners get rewards. Weekly meetings begin with members weighing themselves (although not necessarily revealing their weight to the group) and then discussing their successes and difficulties in reaching their weight-loss goals. Some chapters arrange for doctors, nutritionists, and other weight-loss experts to speak at meetings. TOPS also holds retreats and rallies to give members extra incentives to stay with their weight-loss plans.

TOPS charges an annual membership of $24, as well as dues. The dues vary from chapter to chapter, but are usually less than $5 per month. Members receive a monthly magazine that contains low-calorie recipes as well as inspirational stories by members who have met their weight-loss goals.

Clinical programs

These programs are run by health care professionals, either in private practice or at hospital-based centers. Many of these programs are staffed by multidisciplinary teams that may include doctors, dietitians, exercise therapists, and psychologists or social workers, who provide a wide range of services, such as nutrition education, medical care, behavioral therapy, and guidance on exercise.

The mainstay of clinical programs used to be a very low-calorie diet of 800 or fewer calories a day, which is at least 400 calories per day less than conventional diets. Very low-calorie diets feature commercially prepared liquid formulas, such as Optifast, that replace all of the food in a patient's diet and induce a rapid loss of about 20% of his or her initial weight over 12 to 16 weeks as much as 5 pounds a week. This type of diet is considered appropriate only for patients with a BMI greater than 30 who need to lose weight quickly and for health reasons. Other clinical programs offered in the United States include Health Management Resources and Medifast/Take Shape for Life.

As part of the program, people on very low-calorie diets should have regular medical checkups to identify any adverse health effects. Patients should also have counseling to help them adjust to the diet, as well as guidance on how to reintroduce regular food once the diet is over. Many programs also offer support groups to help people maintain their weight loss by adhering to a low-calorie diet and getting regular physical exercise. Very low-calorie diet programs usually cost between $1,000 and $2,000 for three months.

Today, however, clinical programs are now inclined to recommend a more moderate low-calorie diet in conjunction with a program of exercise and behavior modification. For one thing, very low-calorie diets have been associated with complications in some people, including chemical abnormalities and irregular heartbeats. And in the long run, such diets are no more effective than conventional low-calorie diets in which people consume about 1,200 calories daily. For patients with obesity and for those who are overweight but at high risk for obesity-related complications clinical programs now often combine behavioral-based treatment with weight-loss medications or surgery.

Weight-loss aids: Buyer beware

American Family Physician, According to a 2004 review in Americans spent more than $1.3 billion on weight-loss supplements in 2001. Advertisements for weight-loss supplements seem to be everywhere television infomercials, popular magazines, even your e-mail inbox. "Eat the foods you love and still lose weight" and "Exercise in a bottle" are among the marketing ploys that sound too good to be true. And, for the most part, they are.

Take a look at the fine print on these products for the disclaimer that none of their statements have been verified by the FDA, which is responsible for ensuring the safety of all foods and medications on the market. In the case of medications, the FDA is responsible for testing effectiveness. For example, a cold medicine that claims to relieve nasal congestion must be proven to do so. However, weight-loss aids fall into a gray area in FDA regulation.

Weight-loss aids are neither foods nor drugs; rather, they are classed as dietary supplements. Congress created the category of dietary supplements under the Dietary Supplement Health and Education Act of 1994, in response to public pressure to loosen the FDA's tight control over a variety of products. As a result, individual nutrients, herbs, and "phytomedicinals" (plants supposed to have medicinal value) can be sold without being tested for effectiveness or safety, so long as they do not make direct health or therapeutic claims. Within these limits, manufacturers cannot say that their we

Weigh Less, Live Longer: Strategies for Successful Weight Loss

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