Weight Management

Overview

What Is It?

Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don't succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Americans are obsessed with both food and dieting. As a nation, we love to eat. We eat out often, when meals are often higher in fat and calories than meals eaten at home; we eat larger portions; and we indulge in dozens of delicious "new" food products found on our grocery store shelves every year.

But we also spend billions of dollars a year on commercial weight-loss products and services hoping for a quick fix to our weight problem. And what a problem: with all that eating, the Centers for Disease Control and Prevention (CDC) reports that 68 percent of the nation is living with overweight or obesity. What's more, dieting is failure-prone, and the statistics are even worse when it comes to those who can keep the weight off.

The answer to this weight loss/weight gain cycle lies in how you manage your weight on a day-in, day-out basis. Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don't succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Unfortunately, it's not just all that tempting food that stands in the way of your efforts to achieve or maintain a healthy weight. Technology has altered Americans' lifestyle. Most of us, most of the time can be found sitting—in front of a computer or TV, in a car, at a restaurant. About a quarter of adults—and an even greater percentage of women—report they are sedentary and engage in no physical activity during leisure time, and less than half exercise regularly. And as women age, their tendency to be sedentary steadily increases.

Having overweight increases your risk for many diseases. If you have overweight, you are more likely to develop heart disease and stroke, the leading causes of death for both men and women in the United States.

People with overweight are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, also a risk factor. They're twice as likely to develop type 2 diabetes—a major cause of death, heart disease, kidney disease, stroke, amputation and blindness—as those who do not have overweight.

Additionally, several types of cancer are associated with having overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Having overweight can also cause problems such as gout (a joint disease caused by excess uric acid), gallbladder disease or gallstones, sleep apnea (interrupted breathing during sleep), and osteoarthritis, or wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.

It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds on diets and even fewer succeed in maintaining that weight loss. An estimated 90 percent of dieters regain the weight in five years. One reason is that many factors other than overeating can play a part in weight, including your genetic makeup, cultural influences and natural hormonal and neurologic regulators.

Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Thus, weight loss should not be your only or even your primary goal if you are concerned about your health. Instead, the success of your weight-management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors, such as reduced blood pressure, cholesterol and blood sugar levels, as well as by new, healthy lifestyle habits. In fact, some experts believe that weight is not the sole cause of the diseases associated with having overweight, but that the accompanying unhealthy foods and sedentary lifestyles also contribute to these diseases.

On the flip side, some women are underweight, despite having tried to achieve or maintain a healthy weight. Having a metabolism that burns too many calories can be as dangerous as having overweight. Women who are below their healthy weight are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.

A Word About Teens

Teenage girls today feel a lot of pressure from the media, friends and sometimes their own parents to be very slim. This pressure can create a distorted body image, making them see themselves as fat when they are not fat, or they see themselves as fatter than they really are.

According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight-control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.

Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent girls from developing adequate muscle tone. If the diet doesn't provide enough calcium or vitamin D, bones may not lay down enough calcium, which may increase the risk of osteoporosis later in life.

The flip side to teenagers feeling pressured to be thin is that some may have legitimate concerns about their weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a healthcare professional or dietitian whether you carry too much body fat for your age and height. If you need to lose weight, follow the sensible guidelines laid out here. Depending on your age, your healthcare professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.

Diagnosis

The weight management techniques discussed here are straightforward. But if you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities or suffer from a chronic condition, consult a healthcare professional before beginning any effort to reduce your weight or increase your activity level.

If you are healthy, you may not need to consult a healthcare professional before launching a weight management program but you might want to talk to a professional who specializes in this area. These include:

• Nutritionist. There is no accepted national definition for the title "nutritionist." Some states have a statutory definition of nutritionist saying that the RD credential is not required for certification as a nutritionist, but is required for licensing as a dietitian. In general, the license or certification as a dietitian can be obtained with a bachelor's degree, a related supervised practice experience component and an exam (or proof of RD status with the Commission on Dietetic Registration), while the nutritionist licensure or certification typically requires a master's degree or higher.
  
  Make sure any nutritionist you see is licensed by a state agency. Nutritionists and dietitians evaluate the diets and nutritional habits of clients and help structure more healthful eating patterns and weight management strategies based on their patients' health needs, food selection and calorie goals. Nutritionists do not usually advise patients with chronic illnesses, disorders and other disease conditions.
• Registered dietitians (RD). An RD after someone's name indicates a dietitian who has completed academic and practice requirements established by the American Dietetic Association, including a bachelor's degree, an accredited pre-professional experience program, successful completion of a national credentialing exam and ongoing continuing professional development. A registered dietician may have a master's degree and advanced training in certain subspecialties, such as diabetes education.
• Endocrinologist. Endocrinology is the field of medicine involving the body's chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity as well as diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions and growth and gonadal disorders.
• Personal trainer. Trainers provide one-on-one exercise-related goal-setting help, motivation, professional expertise and personalized attention—all key components of reaching your personal health and fitness goals. A personal trainer should be certified by an accredited professional organization such as the American Council on Exercise, the American College of Sports Medicine or the American Aerobics and Fitness Association. Keep in mind that personal trainers vary greatly, not only in educational background and cost, but also in personal philosophy, training and consulting practices.

Lose, Maintain or Gain?

To determine if you are at a healthy weight, you or your healthcare professional can calculate your body mass index (BMI), which describes body weight relative to height and is strongly correlated with total body fat content in adults. Your BMI equals your weight in kilograms divided by your height in meters squared. Or you can divide your weight in pounds by your height in inches squared and then multiply by 703.

The following chart shows body mass indices for people of various heights and weights. To determine your BMI, find the row that most closely approximates your weight. Read across the row until it crosses the column closest to your height.

Having a BMI between 18.5 and 24.9 is considered within the healthy range; 25 to 29.9 is considered having overweight; 30 or more is considered having obesity; and 40 or greater is considered extreme obesity. An exception is athletes, who have more muscle mass and less body fat than normal. They might have a BMI as high as 30 and yet not have obesity. BMI is also adjusted for age and gender in people under age 18.

If your BMI falls under 18.5, you may be underweight; if so, you may want to ask your healthcare professional to assess your health.

For more information on calculating your BMI and how to achieve and maintain a healthy weight, visit the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight program.

Your healthcare professional might also measure your body composition, which is the percentage of lean muscle and fat. The most common test is the use of a caliper-like device to measure skinfold thickness and subcutaneous fat, which lies just under the skin at targeted sites such as the back of your upper arm, waist or thigh. The accuracy of skinfold thickness measurements depend on the skill of the examiner and may vary widely.

Or, your healthcare professional may conduct a bioelectrical impedance analysis (BIA) test. There are two forms of BIA. Using one form, the patient stands on a special scale with footpads and a harmless amount of electrical current is sent through her body to calculate the percentage body fat. The second type of BIA involves the use of a portable instrument called an impedance analyzer to transmit a noninvasive, low-frequency electrical current through electrodes placed on the patient's hand and foot with a gel. The change in voltage between electrodes is measured, and the patient's body fat percentage is calculated.

In addition, because abdominal fat is an independent predictor of disease risk, you or your healthcare professional should measure your waist. Women with a waist circumference over 35 inches (and men over 40 inches) have the greatest risk of developing insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and strokes).

Your healthcare professional may also ask you about chest pain, faintness or dizziness, bone or joint pain and any medications you may be taking. He or she will probably check the health of your heart and joints, measure your blood pressure and determine if you have a hernia or diabetes. These issues may affect how vigorously you should exercise or what types of exercises you should avoid.

If you have heart disease or cardiovascular risk factors, you may be asked to take an exercise stress test. During this test, you walk on a treadmill while a healthcare professional monitors your heart's activity.

In some cases, your healthcare professional may suggest you start a weight management program. You may receive this recommendation if you have high blood pressure, blood sugar or cholesterol, and/or overweight or have a high percentage of body fat.

Your healthcare professional can advise you about a weight-loss program suited to your weight and health goals. He or she also may refer you to a nutritionist or registered dietician and/or fitness professional or to a hospital-based weight-management or fitness class to provide guidance while you're getting started.

Treatment

The key to weight management is incorporating three strategies into lifelong practices—eating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the millions of American women who are trying to lose weight, a minority use this method.

The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.

Eating for Weight Management

Keeping in mind the biological reason we eat—to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it—is a good way to think about food.

Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that "dieting" is not the answer to weight management. The best "diet" is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.

You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.

Your basal metabolic rate (BMR) is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to www.bmi-calculator.net/bmr-calculator. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.

A more accurate method is to keep a detailed food diary over a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day—several books and websites provide calorie counts for thousands of foods—and use that figure as a starting place for weight maintenance or weight loss.

After you've determined how many calories per day you should eat, plan daily menus. A registered dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat which, in most cases, should be based on the sensible guidelines set forth by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines, available at www.healthierus.gov/dietaryguidelines, aim to help Americans lose weight in an effort to reduce the risk of obesity-related chronic diseases. The guidelines recommend balancing calories with physical activity and encourage Americans to eat more healthful foods, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products and seafood, and to consume less sodium, saturated fats, trans fats, added sugars and refined grains.

The easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of lean meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and get three cups of low-fat milk products like yogurt or cheese daily.

These guidelines will help reduce your calories and fat and increase the fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as "off limits," chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:

• Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.
• Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.
• Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.
• Focus on nutrient-dense foods. The 2010 Dietary Guidelines suggest replacing foods that contain sodium, solid fats, added sugars and refined grains with nutrient-dense foods and beverages. These foods include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, poultry, eggs, beans and nuts and seeds.

Healthcare professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2010 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day.

Strategies for reducing saturated fat and cholesterol include:

• Get 10 percent of less of your fat from saturated fat sources such as red meats, processed meats, organ meats or high-fat dairy products.
• Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.
• Use lean cuts of meat and trim excess fat.
• Substitute skim and low-fat milk for high-fat dairy foods.
• Broil, bake or boil foods instead of frying.
• Increase your consumption of fruits, vegetables and whole grains.

You've probably heard of "good" fats and "bad" fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils. Monounsaturated fats also are found in avocados, nuts and olives.

Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.

Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of polyunsaturated fatty acids include soybean, corn and cottonseed oils.

When an unsaturated fat is solidified—into margarine, for example—the process turns it into partially hydrogenated oils, which contains trans fatty acids.

The Skinny On Fad Diets

Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don't work in the long term because they're impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.

It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn't have sufficient nutrients.

High-protein, low-carbohydrate diets are still used by some people for weight loss. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body's source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables.

Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.

Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.

Carbohydrates stored in the body are packed with water. That's why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.

Many people on low-carbohydrate diets eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.

Many healthcare professionals believe that rather than adhere to a low-carbohydrate diet, it's healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.

Choosing A Diet Plan

With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:

• Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.
• Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.
• Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is a minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it's not nutritionally adequate, and you'll be in danger of nutrient deficiencies.
• Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you about nutrition and healthy eating habits.
• Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.
• Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.

The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:

• The plan is touted as requiring no sacrifice—no exercise or no change in your eating habits.
• No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective.
• Testimonialsand case histories of people who have supposedly been successful on the plan are offered as "proof" of its effectiveness. A few successes don't prove the plan will work for everyone.
• The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.
• The plan is promoted as "cleansing" the body of "toxins" to let the body's "natural" curative powers help in your weight loss efforts.

Today's most popular weight-loss programs vary greatly. No single diet is appropriate for everyone, so you'll want to weigh factors that vary by plan, such as types of food you can eat, reliance on supplements or drugs, calorie levels allotted and support offered.

Popular Weight-Loss Plans

• Mediterranean-Style Diet
  
  The Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.
  
  The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.

• Weight Watchers
  
  This diet program, one of the most popular among healthcare professionals, has helped millions of people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthy—long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two options—weekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight—what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for trimming calories. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools and customized sites for men and women. Exercise is stressed as part of the program.
  
  In the past, Weight Watchers used a system that assigned point values to each food. Dieters were allowed to consume a specific number of points per day based on their weight, and members weren't given much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, type of food. However, with the Points Plus program launched in 2010, dieters get more direction on how to make healthy food choices. The program still focuses on calorie restriction, but it encourages members to choose healthful foods that are high in nutrients and low in sugar and fat.
• NutriSystem
  
  This diet is based mostly on NutriSystem's prepackaged foods and involves reducing participants' calorie intake to an average minimum of 1,200 calories per day for women and 1,500 for men. The NutriSystem program is now completely at-home—participants have the option to go online to chat with one of their weight loss counselors about diet and exercise. While the program was developed by registered dietitians and health educators with input from physicians, there have been some complaints in the media that the counselors are not highly trained. If you are concerned about this, you may want to ask about credentials at your center, and always discuss any diet plan with your healthcare professional.
  
  Because clients eat prepackaged meals, they have few food decisions to make. Thus they're not learning how to make choices in the real world or change their lifestyles. The program also sells vitamin and mineral supplements.
• Jenny Craig
  
  This program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides calorie recommendations depending on your gender and current weight. Clients can attend weekly lifestyle classes and receive one-on-one counseling or choose an at-home program that allows for consultations via phone. As their comfort level grows, clients are given the option to transition to regular foods.
  
  Jenny Craig emphasizes increased physical activity, changing ingrained eating habits and learning how to balance meals and food choices. The program was developed by registered dietitians and psychologists with input from physicians.
  
  Relying on prepackaged foods makes dining out and socializing difficult and de-emphasizes behavior modification and lifestyle change that are very important to long-term weight loss. Also, Jenny Craig makes "weight-loss supplements" an integral part of the system. While vitamin and mineral supplements may be helpful to overall health, no herbal or enzymatic supplements should be relied upon for weight loss.
• Liquid Fasting Programs (Optifast, HMR and New Directions)
  
  These programs consist of a highly structured dieting approach that combines medical, behavioral and nutritional knowledge and skills to support weight loss. The medical team (physician, registered nurse, dietitian or psychologist) provides medical supervision for the dieter in an out-patient medical setting. The diets use vitamin-fortified liquid-meal replacements or prepackaged foods to achieve a reduced calorie intake. Part of the structure includes mandatory weekly group sessions that support the weight-loss efforts and promote positive eating behaviors. In some settings, one-on-one counseling is available.
  
  The programs emphasize changes in lifestyle behaviors to support weight loss including daily physical activity and menu planning. Once the diet is completed, the patient transitions back to a recommended, healthy eating plan. In many locations, exercise physiologists are available to help design personal exercise plans.
  
  During the weight-loss phase of the programs, dieters use only the meal replacement products. Because of this, some dieters find it difficult to transition from liquid to regular food. The support of the trained program staff is essential to this transition. Most programs emphasize that the maintenance phase of these programs is the key to success with long-term weight maintenance.
  
  Due to the close contact with medical professionals, these programs are beneficial for individuals with significant weight to lose or for those with serious health problems associated with their weight. Participation involves the approval of your healthcare professional. Some locations may also offer the opportunity to utilize prescription weight-loss medications.
• Low-Carb Diets
  
  These trendy diets, including the Atkins, Sugar Busters and Protein Power plans, claim that carbohydrates—and not fat or an overindulgence in calories—are what make people gain weight. They go against the recommendations of the U.S. Department of Agriculture (USDA), the American Heart Association, the American Dietetic Association and the American Diabetes Association.
  
  Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of the Atkins Diet can provide more fullness with meals and snacks. Foods containing simple carbohydrates are restricted, so blood sugar surges after a high-carbohydrate meal doesn't occur, helping control appetite. This also prevents blood sugar levels from rapidly plummeting, which contributes to hunger.
  
  These diets rebel against the past decade's message for healthy eating—moderate fat; increased whole grains, fruits and vegetables; and moderate amounts of protein. These recommendations are based on scientific evidence that eating a well-balanced diet will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, diets high in animal protein continue to raise concern of possible increased risks for certain cancers.
  
  Several recent studies found that high-protein diets have no proven effectiveness in long-term weight reduction and may damage health of those who stay on them for a long time.
  
  Note: Because prolonged ketosis (a side effect of high-protein diets) can lead to kidney damage, people with a family history of renal disease or who have renal problems should avoid high-protein diets.

• The Zone
  
  This diet relates excess weight to both overeating and/or to unbalanced consumption of calories from the carbohydrate, fat and protein groups. In the Zone, your diet is exactly one-third lean protein, two-thirds fruits and vegetables and a dash of monounsaturated fat. The diet claims that this is "the metabolic state in which the body works at peak efficiency." The diet consists of one gram of fat for every two grams of protein and three grams of carbohydrates.
  
  Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods. This diet is most likely successful because it restricts caloric intake enough to lose weight. The average person eating in the Zone consumes no more than 800 to 1,200 calories a day. Some critics consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.
• South Beach Diet
  
  The South Beach Diet is sometimes lumped in with low-carb diets like Atkins, but it differs in some significant ways. It focuses on replacing "bad carbs" with "good carbs" and "bad fats" with "good fats." It restricts simple carbohydrates, such as refined sugar and enriched grains, but permits complex, fiber-rich carbohydrates such as whole-grain bread and brown rice. It also allows more vegetables and focuses on the "glycemic index," which relates to how quickly the body digests foods. Simple carbs digest quickly and cause spikes in blood sugar. It recognizes that while foods rich in "bad fats" may help control the hunger cycle, they also contribute to high cholesterol and heart disease. So the South Beach Diet replaces them with foods rich in unsaturated fats and omega-3 fatty acids, such as lean meats, nuts and fish. The three-phase diet ends with a maintenance phase to help you learn how to maintain a healthy weight.
• Flat Belly Diet
  
  The Flat Belly Diet follows many of the same principles as the Mediterranean diet but also emphasizes how much and how often you should eat. It starts with a four-day "jump start" and then has a four-week plan that focuses on: eating an unsaturated fat at every meal; limiting meals to 400 calories per meal; and eating every four hours during the day. It teaches you how to eat a balanced diet with proper portions of vegetables, fruits, whole grains, nuts and seeds, low-fat dairy products and low-fat proteins, such as fish, poultry and beans. It also includes an exercise plan to help you manage your weight.
• Single-Food Diets
  
  Diets that push grapefruit or eggs, cabbage soup or oranges have surfaced over the years. These diets are dangerous because they're unbalanced nutritionally and rely on too few calories.
• Liquid Meal Replacement Diets
  
  These liquid meal replacements, such as Slim-Fast, are milk-based products that have added vitamins and minerals. If "balanced" is defined as containing adequate amounts of the nutrients the government has established as the Reference Daily Intakes (RDIs), then Slim-Fast meets the requirements. Slim-Fast users get a daily menu of three snacks, two shakes or meal bars and one balanced meal, customized to their tastes.
  
  Recent research shows that meal-replacement diet plans such as Slim-Fast work. A landmark 10-year study demonstrated that the Slim-Fast Meal Replacement Plan helped individuals lose weight and maintain body weight long-term. Participants weighed an average of 33 pounds less after 10 years than a matched group.After analyzing studies comparing several types of restricted-calorie diets, the American Dietetic Association issued a practice guideline concluding that structured meal-replacement plans could be at least as effective for losing weight as reduced-calorie diets and sometimes more effective. The guidelines also suggest that, for adults living with overweight or obesity who struggle with food selection and portion control, one or two daily meal replacements fortified with vitamins and minerals and supplemented with self-selected meals and snacks may be a successful weight loss and maintenance strategy.

Using Medication to Lose Weight

Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional and exercise regimen.

Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight-loss program that includes dietary therapy and physical activity. Currently available prescription medications include:

• phentermine (Adipex-P, Fastin, Ionamin, Obenix, Oby-Cap, Teramine, Zantryl)
• diethylpropion (Tenuate, Tepanil)
• phendimetrazine (Adipost, Bontril, Melfiat, Obezine, Phendiet, Plegine, Prelu-2)
• orlistat (Xenical)

Most prescription weight-loss drugs are FDA-approved for short-term use only, usually less than 12 weeks. Orlistat (Xenical) is the only drug approved for long-term use. Orlistat also is now available over the counter under the brand name Alli in 60 mg pills, half the strength of the prescription dosage in Xenical, making it the first FDA-approved over-the-counter weight loss drug. Like Xenical, Alli blocks digestion of about 25 percent of the fat eaten at a meal. Orlistat has been found to be safe and effective in combination with a low-fat (less than 30 percent fat), low-calorie diet and can help people lose 50 percent more weight than dieting alone.

Safety is an issue with some weight-loss medications. The drug sibutramine (Meridia) was removed from the market in 2010 because studies showed an increased risk for heart problems, including non-fatal heart attack and stroke. The FDA is also reviewing reports of serious liver injury in people taking orlistat. No definite association has been established, but people taking orlistat should watch out for any symptoms of liver injury, such as weakness, fatigue, fever, jaundice or brown urine and report these signs to their doctors.

Most of these drugs decrease appetite by affecting levels of certain brain neurotransmitters that affect appetite. Orlistat does not act directly on the central nervous system but instead blocks an enzyme essential to fat digestion so your body doesn't absorb fat. In general, combining weight loss medications with an increase in activity level and a decrease in calories can help you lose 10 pounds more than what you might lose with nondrug obesity treatments.

If you are, may be or could become pregnant or are nursing, be sure to tell your healthcare professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.

Before you take any product for weight loss, be sure to discuss it with your healthcare professional first. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight. These over-the-counter drugs, except for Alli, and herbs have not been approved by the FDA and may cause significant health complications and even death.

Surgery

For clinically severe obesity, your healthcare provider may recommend surgery for weight loss. Many people, including some healthcare professionals, wrongly believe that people with obesity merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a healthcare professional. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:

• have tried other methods of weight loss (changes in eating behavior, increased physical activity and/or drug therapy) and are still living with severe obesity
• have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)
• understand the procedure, risks of surgery and effects after surgery
• are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve—and maintain—desired results

There are several types of bariatric surgery:

• Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes referred to as "stomach stapling," the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.
• Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.

Other less common procedures include:

• Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a "gastric sleeve" that is attached to the small intestine, completely bypassing the duodenum and upper small intestine.
• Biliopancreatic diversion with duodenal switch is a similar procedure, but a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin. This procedure is generally used for people who have a body mass index of 50 or more.

All procedures can lead to complete remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.

While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.

Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.

Most people undergoing bariatric surgery have rapid and extreme weight loss. It often helps patients lose as much as 50 percent of their excess body weight. Just over half of people who undergo weight loss surgery have kept the weight off five years after the procedure.

After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don't adjust your eating habits, you won't lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your healthcare professional and you will likely need nutritional supplements for the rest of your life.

Trying To Gain Weight?

For the underweight woman who needs to gain weight, either for health reasons or appearance's sake, the journey can be difficult. Weight gain can be more difficult than weight loss. The underweight woman may have a higher metabolism, fewer fat cells or a genetic tendency to be leaner. She may also be taller, or just not care about food.

Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity—like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn't give up exercise because it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:

• Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you'll be more likely to enjoy your meals and snacks without feeling stuffed.
• Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins and minerals, in addition to calories. These include dairy foods, nuts, peanut butter or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid. And watch your use of added sugars and saturated and trans fats.
• Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice, nuts and seeds. Dip crackers, chips and fresh vegetable relishes into high-calorie dips made with low-fat cheese, low-fat sour cream, mashed beans or salad dressings made with mono- or unsaturated oils. Space out snacks during the day so you don't spoil your appetite for later meals.

Physical Activity is Key to Weight Management

Daily physical activity is essential to weight management. Exercise not only burns calories, it also tempers your appetite, boosts metabolism, improves sleep and provides psychological benefits, such as an increased feeling of control and self-esteem, as well as reducing stress.

If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or have a chronic health condition, consult a healthcare professional before increasing your physical activity. Notify your healthcare professional about any chest pain, faintness or dizziness, or bone or joint pain you're experiencing and any medications you're taking.

Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. The best kinds of exercises for burning calories are moderate- to vigorous-intensity physical activities. The calories burned per hour are listed for a 140-pound healthy woman.

Moderate-intensity activities include:

• hiking (386 calories)
• light gardening/yard work (302 calories)
• dancing (319 calories)
• golf, walking and carrying the clubs (244 calories)
• bicycling, less than 10 mph (370 calories)
• tennis, singles (386 calories)
• walking, 3.5 mph (370 calories)
• yoga (336 calories)

Vigorous-intensity physical activities include:

• aerobics, high-impact (445 calories)
• calisthenics (512 calories)
• running/jogging, 5 mph (580 calories)
• swimming (580 calories)
• bicycling, 12-14 mph (554 calories)
• racquetball, casual (445 calories)
• skiing, downhill (554 calories)
• weight lifting, vigorous (400 calories)

While you and your healthcare professional should set up a detailed exercise plan based on your individual health status, the 2010 Dietary Guidelines recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.

If you have been inactive, you need to work up slowly to this amount so you don't get injured or overly fatigued and then become discouraged. Start with five or 10 minutes (or whatever you're comfortable with) every other day, adding one minute every other session. Low- to moderate-intensity physical activity, like housework, gardening and walking the dog provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with more vigorous activities like brisk walking or jogging, singles tennis or other racquet sports, aerobics classes, ice or roller skating, swimming or cycling.

Because the goal of moderate to vigorous physical activity is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds.

Your heart rate should be about 50 to 85 percent of its maximum, which is your age subtracted from 220.

If you're out of shape or older than 60, aim for an intensity at the lower end of the 50 to 85 percent range of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.5 for the lower end of the range and 0.85 for the higher end. For example, if you're 70:

• 220 - 70 = 150 (this would be your maximum heart rate for one minute)
• 150 / 6 = 25 (this would be your maximum heart rate for 10 seconds)
• 25 x 0.50 = 12.5 (this would be 50 percent of your maximum, or the lower end of where your 10-second heart rate should be when you're exercising)
• 25 x 0.85 = 21.25 (this would be 85 percent of your maximum, or the higher end of where your 10-second heart rate should be when you're exercising).

The following chart illustrates recommended heart rate counts based on your age. (These are rates per minute; use the instructions above to convert your 10-second count to heart beats per minute.)

An easier way to judge intensity is the "talk test." You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.

Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance, not only improves muscular strength and endurance but raises metabolism, enabling you to burn more calories.

Make sure you take a few minutes to warm up before doing any kind of exercise and stretch when you finish.

It's best to incorporate a combination of both types of exercise into your lifestyle— moderate to vigorous physical activities to burn fat and strength training to build muscle. Neither is as effective alone.

At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with weight gain.

Some Techniques May Not Live Up to Expectations

Spot exercising, or training particular areas of your body, won't reduce body fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms or thighs have been reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could potentially be dangerous for people with circulation problems.

Liposuction is an increasingly popular technique to reduce fat in specific areas on the body. Liposuction, also called lipoplasty or suction lipectomy, is a surgical procedure that vacuums out fat from beneath the skin's surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck. But depending on how much fat is removed, liposuction may not lead to weight loss, and it definitely won't change any behaviors associated with weight gain. It is also not an appropriate strategy for everyone, as age and skin tone can play a role in how successful the technique will be.

Get Your Mind In Gear

Another key to successful weight loss is incorporating behavioral strategies into your new eating and exercise activities. These include learning about nutrition, planning what to eat and making sure you eat regularly to end impulsive and thoughtless eating.

Some specific and helpful behavioral strategies include:

• Set the right goals. Your goals should focus on specific dietary and exercise changes, such as, "I will eat five servings of fruits and vegetables every day this week," or, "I will work up to being able to walk briskly for 30 minutes at a time," rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of regaining the weight.
• Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely such as attending the cinema or taking an hour for yourself. Don't use food as a reward!
• Keep a food and exercise diary. Many behavioral psychologists believe it's necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.
• Monitor your weight sensibly. Keep track of your weight, but don't weigh too often. One day's diet and exercise patterns won't have a measurable effect on the scale the next day, and your body's water weight can change from day to day, which may frustrate you and derail your efforts.
• Join a support group. Weekly meetings with a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.
• Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.
• Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate unhealthy eating. In some cases, you can avoid those cues; don't go to that Mexican restaurant where you always eat too many chips, for example. For situations that can't be avoided, however, such as the business lunch or an argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.
• Change the way you go about eating. There are a variety of tricks—from using a smaller plate to eating more slowly—that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu and other similar efforts can all help.
• When eating out, don't feel compelled to finish your entire meal if portion sizes are too large. The steady growth of food portion sizes served both in restaurants and at home has encouraged the overeating that is fueling the obesity epidemic in the United States, according to survey by the American Institute for Cancer Research.
• Appropriate portion size is very important. When dining out, for instance, try to take home at least half of your dish. You can ask the waiter to box up half of it before you start eating. When eating at home, serve your plate and leave the remaining food in the kitchen; do not place it on the table. Half your plate should be filled with vegetables, one quarter with a protein and one quarter with grain products such as whole-grain bread, pasta, whole-grain rice and cereals. Never, ever, supersize any kind of fast food or takeout meal.

Prevention

It's best to use weight management techniques before you become overweight, to prevent weight gain in the first place. The federal government issues helpful dietary guidelines, spelling out how much and which food you should eat and how much you should exercise to stay healthy. The guidelines, which are revised every five years (most recently updated in 2010), are widely used by healthcare professionals, food makers and educators, and also form the basis of the well-known U.S. Department of Agriculture (USDA) Food Pyramid used to teach healthy eating habits based on food groups such as grains, vegetables and fats.

The 2010 Dietary Guidelines recommend:

1. Addressing the obesity epidemic in the United States by reducing calorie intake and increasing physical exercise
2. Be physically active most days of the week
3. Letting the Food Pyramid guide your food choices
4. Eating a variety of grains daily, especially whole grains
5. Eating a variety of fruits and vegetables daily
6. Keeping food safe from foodborne illness
7. Choosing beverages and foods that limit intake of sugars
8. Choosing and preparing foods with less salt
9. Drinking alcoholic beverages in moderation
10. Choosing a diet low in saturated fat, trans fatty acids and cholesterol, and moderate in total fat

Specifically, the 2010 Dietary Guidelines recommend the following for adult women; to find the amounts that are right for you (exact amounts vary based on your age), visit the Food Pyramid Web site at www.MyPyramid.gov:

Meats and beans (Protein)

• Eat five ounces of protein every day (five and a half ounces if you are between the ages of 19 and 30) .Vary your choices of meats, poultry, fish, beans, peas, nuts and seeds).

Fruits, vegetables and milk

• Eat at least one and a half cups a day of fruit (two cups if you are between the ages of 19 and 30) and two-and-a-half cups a day of vegetables (two cups if you are age 51 or older).
• Eat a variety of fruits and vegetables every day and choose from all of the five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times per week. You may consume fresh, frozen, canned or dried; go light on fruit juices.
• Drink three cups per day of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese.

Carbohydrates

• Eat six servings (five servings if you are 51 or older) of grains (cereal, breads, crackers, rice or pasta) a day. At least three ounces should be whole grain, and the other three enriched or whole grain. One ounce equals about one slice of bread, one cup of cereal or one-half cup of cooked rice, cereal or pasta.
• Eat fruits and vegetables that are high in fiber and choose whole grains
• Try to avoid adding sugar or sweeteners to foods and beverages

Sodium and Potassium

• Do not consume more than 2,300 mg (approximately 1 teaspoon) of sodium per day. Reduce sodium intake to 1,500 mg per day if you are 51 or older, are African American, or have hypertension, diabetes or chronic kidney disease.
• Use little or no salt when preparing foods
• Eat fruits and vegetables high in potassium such as potatoes, sweet potatoes, soybeans, bananas and spinach.

Facts to Know

1. About 68 percent of the nation is living with overweight or obesity.
2. According to the CDC, there has been a dramatic increase in obesity in the United States over the past 20 years. In 2009, only the District of Columbia and Colorado had a prevalence of obesity less than 20 percent.
3. According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.
4. Obesity rates for children are 12.4 percent in those ages 2 to 5, 17 percent in those ages 6 to 11 and 17.6 percent in those ages 12 to 19.
5. Children and teens who have overweight often have a lifelong struggle with their weight and are at high risk for developing diabetes, high blood pressure, diseased arteries, damaged hearts and liver damage.
6. If a woman's waist circumference divided by her hip measurement is greater than 0.8, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This is especially true if her waist measurement is more than 35 inches. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.
7. If you eat 250 calories per day fewer than needed to maintain your weight and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.
8. Your basal metabolic rate (BMR) is the number of calories your body needs just to maintain its basic functions. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need. Several factors go into the calculation of your BMR, including your age, height, weight and gender. To get an idea of your BMR, go to https://www.bmi-calculator.net/bmr-calculator.
9. The CDC reports that compared with whites, African Americans have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher prevalence.
10. Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. The truth is, permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Questions to Ask

Review the following Questions to Ask about weight management so you're prepared to discuss this important health issue with your healthcare professional.

1. Do I need to lose or gain weight? How much? What should be my weight goal?
2. What is the average weight for a person of my height, body composition and fitness level?
3. Do I have any medical conditions that could affect my weight?
4. Could the medications I am taking affect my weight?
5. What types of health problems are associated with having overweight?
6. Based on my current weight and weight management goals, how many calories a day should I eat?
7. Should I follow a special diet plan or take a diet supplement?
8. What are the success rate, risks and benefits for this diet plan or diet supplement?
9. What are the best types of exercises for me?
10. What warning signals should I watch out for while I'm exercising?
11. Should I take a weight-loss drug? How effective is the drug you're recommending? What are its risks and potential side effects?
12. Can you recommend a hospital-based weight-management program or a registered dietitian who can help me put together a healthy eating plan?

Key Q&A

Lifestyle Tips

1. Know the difference between weight loss myths and facts
   Can you lose 20 pounds in a week? Not likely; a much more realistic goal is to lose one-half to two pounds per week. It's slower, but it's more likely to come off and stay off. Eat smaller, balanced meals instead of skipping meals to lose weight; it's more effective. Don't expect to "eat all you want" and still lose weight. You can eat a variety of foods, but the total amount of calories has to be less than you use every day. There is no such thing as "fat-burning" foods. Exercise is what you need instead.
2. How to control emotional overeating
   If you know you're likely to reach for food when you're anxious or upset, avoid strict diets. These tend to give you a sense of deprivation. Use a moderate diet with healthy snacks to keep you going. Make a point of noticing emotional triggers that make you want to eat—try writing them down. When they occur, grab a cool drink of water to give you a chance to think, then begin an activity you've decided to substitute for eating, such as a 15-minute walk, calling a friend, reading a chapter of a book you enjoy or using the computer.
3. Serve up your daily fruit and vegetable servings
   Fresh fruit and vegetables are good choices, but sometimes they spoil before a busy person can eat them. You can get canned fruits instead—look for those packed in water or juice, not heavy syrup. Frozen vegetables are OK too, but skip those packaged with cheese, butter or cream sauces. Try to eat one and a half to two cups of fruit and two to two and a half cups of vegetables daily. One cup of fruit or 100 percent fruit juice or half a cup of dried fruit can be considered one cup from the fruit group. One cup of raw vegetables, cooked vegetables or vegetable juice or two cups of leafy greens can be considered one cup from the vegetable group.
4. The lowdown on food labels
   According to the U.S. Food and Drug Administration (FDA), a fat-free food must have less than 0.5 grams (g) of fat per serving. Low-fat foods have 3 g or less per serving. Make sure you read the label to see how many servings there are! Reduced-fat or less-fat foods must have at least 25 percent less fat than the full-fat version. Light or "lite" foods may have at least one-third fewer calories and no more than half the fat of the full-fat version or no more than half the sodium content. However, you should always read labels to see what you're paying for!
5. Helping your overweight child
   Be supportive, not critical. Your child should understand that you love and value him or her at any weight. Don't let your well-intentioned influence turn into another source of stress that drives your child to eat for comfort. Your child knows better than anyone about his or her weight and needs your encouragement. Don't single your child out for lifestyle changes; put the whole family on a healthy diet with more physical activity. If your child is self-conscious about some activities, choose others. Don't put your child on any restrictive diet, except as specifically recommended by your healthcare professional.

Organizations and Support

For information and support on Weight Management, please see the recommended organizations listed below.

American Dietetic Association
Website: https://www.eatright.org
Address: 120 South Riverside Plaza, Suite 2000
Chicago, IL 60606
Hotline: 1-800-877-1600
Email: adaf@eatright.org

Council on Size and Weight Discrimination
Website: https://www.cswd.org
Address: P.O. Box 305
Mt. Marion, NY 12456
Phone: 845-679-1209
Email: info@cswd.org

National Association to Advance Fat Acceptance (NAAFA)
Website: https://www.naafa.org
Address: P.O. Box 22510
Oakland, CA 94609
Phone: 916-558-6880

Overeaters Anonymous
Website: https://www.oa.org
Address: P.O. Box 44020
Rio Rancho, NM 87174
Phone: 505-891-2664

Books

Body Blues: Weight & Depression
by Laura Weeldreyer

Breaking Free from Emotional Eating
by Geneen Roth

The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health
by T. Colin Campbell, Thomas M. Campbell II, Howard Lyman, and John Robbins

Eat, Drink, and Be Gorgeous
by Esther Blum and James Dignan

Fight Fat After Forty: The Revolutionary Three-Pronged Approach That Will Break Your Stress-Fat Cycle and Make You Healthy, Fit, and Trim for Life
by Pamela Peeke

Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health
by Gary Taubes

It's Not About Food: Change Your Mind; Change Your Life; End Your Obsession with Food and Weight
by Carol Emery Normandi and Laurelee Roark

Skinny Bitch
by Rory Freedman and Kim Barnouin

Strong Women Eat Well: Nutritional Strategies for a Healthy Body and Mind
by Miriam Nelson and Judy Knipe

Strong Women Stay Slim
by Miriam Nelson, Sarah Wernick, and Steven Raichlen

You Are More Than What You Weigh: Improve Your Self-Esteem No Matter What Your Weight
by Sharon Sward

You: The Owner's Manual
by Mehmet C. Oz and Michael F. Roizen

Spanish-language resources

The Hormone Foundation
Website: https://www.hormone.org/pacientes-y-cuidadores
Address: The Hormone Foundation
8401 Connecticut Avenue, Suite 900
Chevy Chase, MD 20815
Hotline: 1-800-HORMONE
Email: hormone@endocrine.org

Medline Plus: Weight Control
Website: https://www.nlm.nih.gov/medlineplus/spanish/weightcontrol.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

Weight-Control Information Network: National Institute of Diabetes and Digestive and Kidney Diseases
Website: https://www.niddk.nih.gov/health-information/informacion-de-la-salud/control-de-peso
Address: Weight-control Information Network
1 WIN Way
Bethesda, MD 20892
Hotline: 1-877-946-4627
Email: win@info.niddk.nih.gov