Weight Loss and Control

What Facts Should I Know about Weight Loss and Control?

The best way to lose weight is to consume fewer calories than you burn. Nutrition is by far the most important component in any weight loss strategy.
The best way to lose weight is to consume fewer calories than you burn. Nutrition is by far the most important component in any weight loss strategy.

Obesity is not simply the accumulation of excess body fat. Obesity is a chronic (long-term) disease with serious complications that is very difficult to treat. As such, it requires long-term treatment to lose weight and keep it off. There is no overnight solution. Effective, permanent weight loss takes some time.

The essential factors in losing weight and keeping it off are motivation, proper eating, exercise habits, and an appreciation of better health. Losing weight will help you feel better. It also will improve your health.

Obesity is the second leading cause of preventable deaths in the United States (tobacco is the first). People who are obese have much higher risks of many serious health problems than nonobese people. The most devastating of these health problems include the following:

How much weight do you have to lose before you notice?

The good news is that you don't have to reach your ideal weight to lower your risk of developing obesity-related medical problems.

  • Losing even 10% of your total body weight can significantly lower your risk.
  • If you weigh 250 pounds and lose 10% of your total body weight, losing those 25 pounds can have a meaningful positive effect on your health.
  • Losing 10% of your total body weight is a good goal to start with. You can always continue and lose more weight once you have reached your initial goal.

Nutrition 101

Weight gain is caused by consuming more calories than the body uses.

  • The average person uses as many as 2,500 calories daily, or 17,500 calories per week.
  • If you eat the amount your body needs, you will maintain your weight. It takes 3,500 extra calories to gain 1 pound.
  • To lose weight, you must consume fewer calories than your body uses. You must eat 3,500 calories less than you need, say 500 calories per day for one week, to lose 1 pound.

Calories count. It's important to understand where calories come from and how to make the smartest food selections. Here are some basics:

  • Foods are composed of the following three substances, in varying amounts:
    • Carbohydrates (four Calories per gram): Examples include grains, cereal, pasta, sugar, fruits, and vegetables.
    • Protein (four Calories per gram): Examples include legumes (beans, dried peas, lentils), seafood, low-fat dairy, lean meats, and soy products such as tofu.
    • Fats (nine Calories per gram): Examples include whole-fat dairy products, butter, oils, and nuts.

Alcohol is a separate fourth group (seven calories per gram).

A calorie is the amount of energy (heat) needed to raise the temperature of 1 gram of water by 1 degree Celsius. A kilocalorie (or Calorie with a capital C) is the amount of energy needed to raise the temperature of 1 kilogram of water by 1 degree Celsius.

  • The energy contained in food is measured in kilocalories but is commonly referred to on food packages and elsewhere as calories.
  • Most people underestimate the number of calories they consume by about 30%.
  • Calculate the number of calories you should consume each day to keep your weight the same.
    • If you are moderately active, multiply your weight in pounds by 15.
    • If you are sedentary, multiply by 13 instead.
    • To lose weight, you need to eat less than this number.

Excess calories from any source (even fat-free foods) will turn into body fat.

  • Any carbohydrate not immediately used for energy will be stored in the liver as glycogen for short-term use. The body has only a limited number of liver cells to store the glycogen. Whatever is left over will be converted to fat.
  • Excess protein and fat in the diet are also stored as fat.

Fat cells are no longer thought to be responsible only for energy storage and release.

  • They synthesize the hormone leptin, which travels to the hypothalamus in the brain and regulates appetite, body weight, and the storage of fat.
  • Leptin was first discovered in 1994. The exact way it works is not yet fully understood.
  • Disorders of leptin account for only a few cases of obesity, usually morbid (extreme) obesity.

How to Lose Weight

For most people who are overweight or obese, the safest and most effective way to lose weight is to eat less and exercise more. If you eat less and exercise more, you will lose weight. It's as simple as that. There are no magic pills. Diets that sound too good to be true are just that.

Effective weight loss plans include several parts. You will find tips for achieving these goals in the next sections.

  • Eating less: Unless you eat fewer calories than your body uses, you will not lose weight.
  • Physical activity: Any good diet plan will include physical activity. Physical activity burns calories and is one less opportunity to eat during the day. You should exercise for at least 30 minutes, five times a week. Regular exercise also has many other health benefits.
  • Change in habits and attitudes: Most people have enough willpower to lose weight for a few weeks. To lose enough weight to improve your health and keep it off, you will need to change the way you think about food and exercise. As you eat, try to understand some of the hidden reasons you eat. You can learn to spot situations in which you overeat and head off the overeating. You can learn to enjoy eating less and being active.
  • Support: Many people find that enlisting friends, family, and coworkers for support is helpful in losing weight. Others prefer groups such as Weight Watchers or Take Off Pounds Sensibly (TOPS) to keep them motivated. The important thing is to seek the support you need to achieve your goals.

Drastic changes in eating habits, such as not eating at all (fasting), are usually unsuccessful. Eating too few calories causes your metabolism to slow down, meaning the body burns fewer calories.

Don't believe claims about losing weight while you sleep or watch TV, or plans that claim to cause weight loss without dieting or exercise. Such gimmicks just don't work. They may even be unsafe or unhealthy.

Of special interest to women who have gained weight during pregnancy is that breastfeeding helps you shed some extra pounds. It is good for your baby too.

Eating Less

Pay attention to serving sizes (portion control). Read food labels to find out how many calories and fat calories are in a serving. Keep a food diary or log to find ways to eliminate extra calories.

Eat fewer calories. By decreasing calorie intake by 500 per day, you will lose 1 pound a week. One way to eat fewer calories is to limit your fat intake. No more than 30% of your daily calorie intake should be fat calories.

  • Foods that contain large amounts of fat might surprise you. Many types of baked goods, such as crackers, cookies, cakes, pancakes, waffles, pastries, and special breads, have high fat levels. So do many prepared, convenience, and take-out foods.
  • Fat-free foods are not necessarily low-calorie foods. Fat-free versions of popular snacks often contain simple carbohydrates that are rapidly absorbed and converted to body fat if consumed in excess.
  • Eat fat-free or low-fat dairy products such as cheese or frozen yogurt. Consider changing from whole milk to skim milk.
  • Substitute egg whites or a product such as Eggbeaters for whole eggs.
  • If you eat meat, eat it in moderation. Lean meats, skinless chicken and turkey, and seafood are good choices.
  • Avoid high-fat foods such as popcorn, potato chips, snack crackers and cakes, cookies, cakes, pizza, cold cuts and other fatty meats, pancakes, waffles, sour or sweet cream, cream cheese and other whole-fat cheeses, butters and oils, peanut butter, olives, oil-based sauces and salad dressings, nuts, special breads and pastries, and fried foods.
  • Replace high-fat foods with the same quantity of low-fat, low-calorie food.
  • Prepare foods with little or no oils, butter, or other fats.

Remember, however, that some fat is necessary for a healthy body and mind. Doing away with all fat is not desirable.

Low-fat foods such as vegetables, fruits, whole grains, and legumes will help you feel full. This helps you lose weight or control your weight.

Avoid sugary foods such as candies, jellies and jams, honey, and syrups. These foods offer little nutritional value and tend to be converted to fat quickly.

Limit alcoholic beverages, which provide empty calories -- calories that have no other nutritional value. Women should have no more than one alcoholic drink and men no more than two alcoholic drinks a day. An alcoholic drink is 4 ounces of wine, 12 ounces (one standard bottle or can) of beer, or ½ ounce of distilled liquor.

Don't stop eating altogether. Fasting may result in rapid weight loss, but most of this weight will be water and possibly even muscle. Your body slows its metabolism, making it very difficult to maintain any weight loss.

Healthy Meals for Weight Loss

Smart dietary guidelines

The American Heart Association recommends the following dietary guidelines, which are suitable for most adults.

  • Eat five or more fresh fruits and vegetables each day.
  • Eat six or more servings of grains (preferably whole grains) each day.
  • Eat fat-free and low-fat dairy, legumes, seafood, and lean meats.
  • Avoid foods with more than 2 grams of saturated fat per serving.
  • Balance your caloric intake with your energy expenditure.
  • Limit junk food, which is high in simple carbohydrates and low in nutrition.
  • Limit foods high in saturated fat and cholesterol. Eat less than 6 grams of salt each day.

General food preparation and meal planning tips: Try to eat servings of fruits and vegetables at every meal. Besides being delicious, they are full of nutrients and fiber. They may even help prevent certain cancers.

  • Boil, steam, bake, roast, or broil foods rather than frying in fat.
  • Use unsaturated fats, such as vegetable oils, rather than saturated fats such as butter, shortening, and lard.
  • Use olive oil spray rather than cooking oils to prepare foods.
  • Eat white meat chicken or turkey, lean meat, fish, or seafood. Trim the skin from poultry.
  • Use low-fat or nonfat dairy products.
  • To season foods, choose lemon or lime juice, vinegar, low-sodium soy sauce, plain tomato sauce, salsa and other sauces low in fat, or mustard. Use garlic, onions, ginger, and herbs and spices to flavor foods.
  • Avoid high-fat and high-calorie condiments such as mayonnaise, oil, ketchup, salad dressing, or prepared sauces.
  • Drink seltzer, water, caffeine-free soda, tea, or coffee with meals.

Breakfast suggestions

  • 1 cup of juice or fruit
  • Egg whites or an egg substitute scrambled or prepared as an omelet in olive oil spray
  • Oatmeal or any sugar-free cereal with 6-8 ounces of skim milk
  • Low-fat cream cheese, low-fat cottage cheese, or nonfat yogurt
  • Caffeine-free tea or coffee

Lunch suggestions

  • ½ cup of cooked vegetables, such as peas, string beans, asparagus, broccoli, summer squash, escarole, cauliflower, brussels sprouts, or carrots
  • ½ cup of a leafy vegetable, such as spinach, kale, or chard
  • Green salad, plain or seasoned with fat-free dressing, vinegar, lemon, or any combination of these (no oil) -- include greens and raw vegetables such as tomato, bell peppers, cucumber, sprouts, radish, onion, cabbage, mushrooms, and celery
  • ½ cup whole-grain pasta in meat-free tomato sauce
  • Sandwiches made of whole-grain or sourdough bread
    • 2 ounces of water-packed tuna or salmon
    • Two slices of a low-fat cold cut or deli meat
    • 1-2 ounces of low-fat cheese

Supper suggestions

  • ½ cup of cooked vegetables, such as peas, string beans, asparagus, broccoli, summer squash, cauliflower, brussels sprouts, or carrots
  • ½ cup of a leafy vegetable, such as spinach, kale, or chard
  • Green salad, plain or seasoned with fat-free dressing, vinegar, lemon, or any combination of these (no oil) -- include greens and raw vegetables such as tomato, bell peppers, cucumber, sprouts, radish, onion, cabbage, mushrooms, and celery
  • ½ chicken breast, baked, or four slices of turkey, skin removed
  • White fish, such as snapper or fillet of sole, baked or steamed in plain tomato sauce, lemon or both
  • Two slices of whole-grain or sourdough bread or ½ cup of a whole grain such as brown rice
  • 1/3 cup (or less) of fat-free yogurt or fat-free sour cream

For dessert

  • One small slice of cake or one cookie, low-fat or fat-free and cholesterol-free
  • ½ cup of fat-free ice cream or fat-free frozen yogurt
  • Fresh fruit

If you choose to drink alcohol, do so in moderation (no more than two drinks per day for men or one drink per day for women).

To satisfy hunger between meals, eat unlimited quantities of celery, lettuce, mushrooms, green or red peppers, asparagus, cauliflower, cucumber, and broccoli.

Eating away from home

When eating in a restaurant, plan ahead. Think about ordering low-fat, low-calorie foods. Remember that most restaurants serve portions much larger than an accepted serving size.

  • Ask for a doggy bag or take-out container when you order. As soon as the food comes, set aside half (or more) for future meals. Then eat what is left on your plate. This will help keep you from overeating.
  • Skip the breadbasket and the appetizer.
  • Ask for foods to be prepared without frying or sauces.
  • Avoid high-fat side orders such as french fries, coleslaw, and garlic bread.
  • Order salad dressings on the side and dip your fork in the dressing, then spear the salad.
  • Drink plenty of plain water.

Increasing Your Activity Level

Moderate physical activity, such as walking, helps you lose weight and keep your weight down. At least 30 minutes of exercise a day is recommended.

  • Try to exercise at least five days a week.
  • Not exercising will sabotage any weight loss plan. Add movement, even in short 10-minute bursts throughout your day to get in 30 minutes a day.
  • Simple measures such as parking at the far end of the parking lot and taking the stairs instead of the elevator eventually add up to help you lose weight.
  • Exercise strengthens your muscles and improves the function of your heart and lungs.
  • If you are obese, particularly if you are inactive or have medical problems, check with a health care professional before starting an exercise program.


When walking for weight loss, distance is important, not speed. Wear a pedometer to measure your steps and then find ways to add steps during your daily activity.

  • To exercise, walk at a pace and distance that puts no strain on the body. Set reasonable goals. If you walk until you become tired, you will be exhausted when you stop.
  • Walk with smooth, rhythmic motions at an easy pace.
  • Each time you walk, walk slowly for the first five minutes to warm up. After five minutes, walk for 10 minutes at a faster rate if you can. Do not overdo it. You may stop to rest at any time.
  • When you have walked for 10 minutes without stopping, your first goal has been reached. The new goal should be to walk for a little longer time (say, 12 minutes). Continue to set new goals without overdoing it. It is important not to walk too fast or too long.
  • Chart your progress.

Other activities

  • Ride your bicycle to work or to the store.
  • Buy an exercise bike and pedal while watching TV or talking on the phone. Keep track of your mileage.
  • Join an exercise class appropriate for your level of activity and your medical condition. Water aerobics is a popular choice. Start slow.
  • Even weekend chores use calories if you do them the physical way.
    • Skip the riding lawn mower and use a push mower.
    • Wash your car manually.
    • Use a rake, hoe, and shovel for gardening chores.

Exercise tips

  • To let your skin breathe during workouts, wear loose clothing. Wear comfortable jogging shoes or sneakers.
  • Drink plenty of water before and after exercising. This will replace water lost by perspiration and prevent dehydration. If you want to carry a water bottle, you can drink while exercising.
  • Check your pulse rate frequently (every five minutes) while exercising.
  • Normal resting pulse rate may vary between 60 and 90 beats per minute.
  • Your pulse should increase somewhat while exercising. The pulse rate may increase up to 120. It is normal to become somewhat short of breath. If you are so short of breath that you cannot speak comfortably, stop for a rest and then continue at a slower rate.
  • While exercising, make it a point not to hold your breath. Holding your breath deprives the body of oxygen. Inhale with one movement, and exhale with another.
  • Do not continue exercising if you feel pain. Stop and take a break. If you continue to feel pain, talk to a health care professional.
  • Keep a record of your activity. You will see progress over time.

Changing Your Habits and Staying Motivated to Fight Obesity

Changing your habits

  • Eat slowly and chew your food well. This helps you feel satisfied with less food.
  • The amount of food you eat is more important that the type of food. Think portion control. Familiarize yourself with official serving sizes, and measure and weigh foods accordingly.
  • Keep a record of when you eat, what you eat, and how much. This will help you spot situations in which you tend to overeat.
  • Avoid or limit comfort foods which are easily eaten foods (such as macaroni and cheese, ice cream, chocolate) that are used to modify your mood.
  • Don't give in to food cravings. These are typically foods with a high sugar content that cause your brain to release hormones that temporarily make you feel happy. These foods have addictive properties, so once you start eating them, it's difficult to stop.
  • Do not skip meals, especially breakfast. You will just be hungrier and more likely to overeat at the next meal.
  • Do not read or watch television while you eat.
  • Reduce your appetite by drinking one glass of water 30 minutes before each meal. If your stomach is not empty, food does not look as appetizing.
  • Drinking tea (especially green tea, white tea, and pu-erh tea) has also been suggested as a weight loss aid. Tea may contain caffeine, which acts as a stimulant. Tea also has no calories (assuming you don't add sugar or milk). Much like drinking water, drinking tea can make you feel full, thereby suppressing your appetite and reducing food cravings.
  • Stock your refrigerator with healthy, low-calorie foods. Snack on baby carrots instead of microwave popcorn. Don't keep high-fat snacks around the house.
  • Put a sign on the refrigerator that will help you think twice about snacking.
  • Reward yourself for specific achievements, such as exercising longer than you had planned or eating less of a tempting food. Of course, the reward should not be food.

Staying motivated

  • People often set unrealistic goals for themselves, only to feel guilt when they cannot stay on a diet or exercise program. Make changes in small steps. Look for small gains (that is, weight losses). Losing 1 pound a week is a reasonable goal.
  • Losing even 10% of your excess body weight can significantly lower your risk of obesity-related health problems. This is a good goal to start with.
  • Do not weigh yourself too often. Weigh yourself only once a week in the morning. An increase in weight of 1 pound or 2 may not be a true weight gain. It may be the result of water retention.
  • Group support programs such as Weight Watchers or TOPS (Take Off Pounds Sensibly) give you the support and encouragement of others with the same problem. They also promote healthy living practices.
  • For those who don't have the time to make it to support groups, there are now many free or low cost apps available for the iPhone, iPad, or Android which help determine and track calories, nutrition, and calorie expenditure. Try LoseIt!, Weight Watchers Mobile, Restaurant Nutrition, 40:30:30, Diet Point, or Noom Weight Loss Coach.
  • It is perfectly normal to go off your plan on occasion. Don't be too hard on yourself, and don't quit! Get back on track the next day.

Diet Plans: Beware

There are too many weight-loss diet plans to address each of them here. A few are discussed below.

Dean Ornish Diet

This is a very strict low-fat diet. Besides causing you to lose weight, it also decreases your cholesterol and has been scientifically proven to reverse coronary artery disease. Some people on this diet have decreased the size of the plaques in the arteries supplying the heart, thereby avoiding the need for open-heart bypass surgery.

The diet involves intensive lifestyle changes.

Caution: The American Heart Association cautions that very low-fat diets may increase triglycerides. Increasing exercise and taking a flaxseed or fish oil supplement can minimize this risk.

Very low-fat diets may be difficult for all but the most motivated and disciplined people.

The Atkins Diet

This diet restricts carbohydrates. The introduction phase (two weeks or more) restricts carbohydrates to less than 20 grams per day. This excludes most fruits and vegetables and relies on a diet of mostly animal fats and protein.

It is true that simple carbohydrates, such as sugar and white flour, pasta, and rice, and alcohol, are rapidly absorbed and cause weight gain when consumed in excess. They should be avoided by people who are overweight or obese.

On the other hand, complex carbohydrates such as whole grains, brown rice, fruits, vegetables, grains, beans, and soy products are rich in fiber, which slows their absorption. In moderation, they are excellent food choices for overweight and obese people. They should make up a significant proportion of the diet. And yet these are also strictly limited by the Atkins diet.

Numerous studies have shown that excess animal protein in the diet increases the risks of breast and prostate cancers, heart disease, kidney disease, and osteoporosis. Fats and proteins break down in the body to substances called ketones. The large amounts of fat and protein in the Atkins diet are likely to cause an excess of ketones in the body, a condition called ketosis.

Caution: This diet may not be appropriate for people with diabetes, and its safety in pregnant or breastfeeding women has not been established. It also establishes unhealthy eating habits.

The hCG Diet

Human chorionic gonadotropin is a hormone produced during pregnancy. This new diet plan claims that HCG can suppress appetite. The FDA, however, has not approved HCG for weight loss, and it must be prescribed by a physician. Over-the-counter preparations are often labeled as "homeopathic" but contain very little, if any, of the actual hormone. People lose weight on this diet because the plan calls for a restriction of calories to 500 per day. This is not healthy, and one is likely to regain any weight lost during the severe calorie restriction.

Medications and Surgery for Obesity

For people who are overweight and have been unable to lose weight with diet and exercise, consulting a weight-loss clinic may help. There are several prescription diet pills that are now available.

  • Sibutramine (Meridia) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in 1996. It may be recommended for people who are more than 30 pounds overweight. In clinical trials, people who took this drug lost an average of 5%-10% of their body weight. It may also help to keep weight off. It works by making the person feel full and thereby decreases food intake. It may cause an increase in blood pressure and should not be used by people who are on a number of other medications, such as antidepressants.
  • Orlistat (Xenical 120 mg by prescription or Alli 60 mg available over the counter) is a medication approved by the FDA in 1999. Your doctor may prescribe it if you weigh more than 30% over your healthy body weight or have a BMI greater than 30. Over one year, people who followed a weight-loss diet and took orlistat lost an average of 13.4 pounds, almost 8 pounds more than people who used diet alone to lose weight. It works by reducing the absorption of fat from the intestine. Diarrhea and incontinence of stool may be side effects of this medicine.
  • Lorcaserin (Belviq 10 mg one to two times daily) was just approved by the FDA in June 2012. It may be considered if your BMI is 30 or greater or if you have a BMI greater than 27 with weight-related conditions. Studies demonstrated that almost half of patients lost an average of 5% of their body weight when combined with diet and exercise (compared to 25% of patients with diet and exercise alone). Lorcaserin works by activating the serotonin 2C receptor in the brain, which helps you feel full after smaller portions. The most common side effects were headache, nausea, and dizziness.
  • Qsymia (combination of phentermine and topiramate) was just approved by the FDA in July 2012. It is only approved for those with a BMI greater than 27 with weight-related conditions. When combined with diet and exercise, studies have shown that half of the participants lost 10% of their body weight and four-fifths lost 5% (which equates to 12 pounds in a 227-pound person). Topiramate is associated with a high risk of birth defects such as cleft lip and palate. Phentermine (an appetite suppressant) was one of the ingredients in fen-phen and is associated with an elevation in heart rate. Because of these potentially serious side effects, Qsymia is only available through mail order. Other side effects include tingling, dizziness, alterations in taste, insomnia, dry mouth, and constipation.

Surgery to correct obesity (known as bariatric surgery) is a solution for some obese people who cannot lose weight on their own or have severe obesity-related medical problems. Generally, surgery is recommended only for morbidly obese people (body mass index 40 or greater) or for those with a BMI of 35 and greater or who have weight related-conditions. This generally means men who are at least 100 pounds overweight and women who are at least 80 pounds overweight.

Allison, D.B., et al. "Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP)." Obesity 20.2 Feb. 2012: 330-342. Epub 2011 Nov3.

Fidler, M.C., et al. "A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: the BLOSSOM trial." J Clin Endocrinol Metab 96.10 Oct. 2011: 3067-3077. Epub 2011 Jul27.

Gadde, K.M., et al. "Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial." Lancet 377.9774 Apr. 16, 2011: 1341-1352. Epub2011 Apr8.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. In: Dietary Guidelines for Americans, 2010. Chapter 3 – Foods and Food Components to Reduce. 7th Edition, Washington, DC: US Government Printing Office; 2010: 30-32. Available at <http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter3.pdf .> Accessed March 8, 2012.