Yes, you can reach and maintain a healthy weight. Despite the discouraging news of failures in many diet programs and America’s growing problem with obesity, researchers are finally beginning to pin down just which strategies work—and which fail—to help long-term weight control.
Let’s start with the bad news. “You are what you weigh” is one of the more pervasive—and destructive—messages of contemporary American culture. But ironically, our preoccupation with the numbers on the scale and our excessive admiration for the slender figure seem to be leading to an increase in obesity. During the final two decades of the 20th century, the share of the adult U.S. population considered either overweight or obese jumped from 47 percent to 61 percent. Worse yet, the share weighing in as frankly obese rose from 15 percent to 27 percent during the same period.
Though many Americans have difficulty managing their weight, it’s not for lack of trying. An estimated 50 million will go on diets this year, seeking advice from books, TV diet gurus, support groups, and clinical programs. Women’s magazines report that 95 percent of their female readership is on a diet. Desperate dieters have turned the weight-loss business into a booming industry, with annual revenues of more than $33 billion. However, while some will succeed in shedding those extra pounds, some studies show that perhaps as few as 5 percent manage to keep them off. A report from the National Center of Health Statistics warns that “weight reduction through calorie-restricted dieting . . . ultimately [is] not very effective.”
Hold on! Does this mean diets don’t work? Of course not. “Diets do work. It’s the maintenance programs that don’t work,” says Dr. Arthur Frank, Medical Director of the George Washington University Obesity Management Program. “Most people who do get involved with a weight-loss program stay with it. Most people who stay with it do, in fact, lose weight. The problem is that most people still have a difficult problem maintaining weight at the new lower level.” The notion that diets don’t work is a round-about way of saying that there are no magic ways to keep pounds off permanently; obesity is a chronic condition that requires lifelong attention.
Tip-Offs of Rip-Offs
When it comes to weight-loss schemes, the Food and Drug Administration warns you to be particularly skeptical of claims containing words and phrases like:
In addition, the studies showing that most people regain the weight they lose may not apply to most of us. These studies have been done in clinical programs on people with the most severe weight problems. “Most people who are successful in losing weight do so on their own,” says Dr. Xavier Pi-Sunyer, Director of the Division of Endocrinology and Nutrition at St. Luke’s-Roosevelt Hospital, New York, and Professor of Medicine at Columbia University. “They are seldom included in studies. We also have very little data about how people do one-on-one with a physician, dietitian, or nutritionist.” So do-it-yourself dieters may have more reason to be optimistic about their chances for success.
Instead of a quick fix, self-starters tend to be motivated to change their overall eating patterns, with better long-term results. Still, the secret lies in finding the nutritional strategy that works best for you. “Adults and children with weight problems need tools for making better decisions about how to lose weight,” says Judith Stern, ScD, RD, Professor in the Departments of Nutrition and Internal Medicine at the University of California, Davis. A healthy skepticism is a good place to start. Beware of claims of weight-loss miracles: “Lose weight while you sleep;” “Eat all you want and get thin;” “This secret method will work where others fail.” If a diet claim seems too good to be true, it probably is.
The sections that follow are designed to help you sort through and discard the diet claims that are confusing, costly, misleading, even hazardous to your health. They will help you choose a weight-loss plan that is suited to your individual needs. The next chapter focuses on effective techniques for maintaining a healthy weight, once you achieve it.
An understanding of the basic causes of overweight can help you analyze your own strengths and weaknesses and choose a diet plan that will maximize your chances of success. To some extent, obesity is hereditary; but scientists now believe that heredity accounts for only a third of the problem, with the remaining two-thirds stemming from cultural factors.
Though every culture in the world has overweight individuals, the problem is most pervasive in America. “The United States is one of the richest countries in the world, giving us a bounty of food at relatively little cost,” says Dr. Frank, co-author of the 1995 National Academy of Sciences dieting guidelines. “In addition, we have perfected snack food. The difference in snack-food consumption between this country and western Europe is enormous. For example, Americans eat more than twice as many calories in snack foods than do the French.” Overall, our rich and diverse food supply tends to be high in fat, sugar, and calories.
In addition, over the years Americans have come to expect larger portions. “A ‘normal’ meal to us looks massive to foreigners,” says Dr. Pi-Sunyer. “We’ll scarf down a 12-ounce slab of beef without thinking; while most of the world would be happy with 4 ounces. We think nothing of a three-scoop ice cream cone, yet elsewhere one small scoop of sherbet is considered a luxury.” Adds Judith Stern, “You can super-size anything for 35 cents in most convenience stores or fast food places.” In the land of 64-ounce shakes, things certainly have raged out of control.
Inactivity is also a culprit. Most Americans lead sedentary lifestyles, relying on cars rather than walking, watching sports instead of playing them, plowing through paperwork rather than fields. The upshot? “We eat more and exercise less; we take in more calories and expend fewer. We’re like a car with too much gasoline,” says Dr. Pi-Sunyer.
- The Genetic Thermostat
- In the Eyes of the Beholder
- Why Do You Really Eat?
- The “D” Word
- Focus on Dietary Fat
- Boost Your Fiber
- Calories Still Count
- The Bad News About Sugar
- Matching the Diet with Your Needs
- Tips for Do-It-Yourselfers
- Weight Watchers
- Jenny Craig
- Diet Center
- Checking Out the Enrollment Programs
- Clinical Programs (Liquid fasts)
- Potentially Dangerous Diet Strategies
The Genetic Thermostat
Some people will never be able to achieve the American ideal of super-slimness, no matter how healthfully they eat or how regularly they exercise. It’s just not in the genetic cards. Studies have shown conclusively that an individual’s body size and shape is genetically coded as surely as the color of the eyes. The body’s normal weight range varies considerably among individuals and is overwhelmingly determined by heredity. The weight to which your body naturally inclines is like a preselected temperature on a thermostat. Your genetic makeup guides your body towards its natural weight through both hunger cues and metabolism. “Obesity is not simply the lack of self-control,” says Dr. Pi-Sunyer.
Although the genetic mechanisms underlying obesity are still largely unknown, our understanding is rapidly increasing. Scientists have recently discovered a gene which, when mutated, is associated with great obesity in mice. “These animals cannot get to a normal body composition,” says Dr. Dale R. Romsos, Professor of Nutrition, Department of Food Science and Human Nutrition, Michigan State University, who was involved in the groundbreaking research. “If you restrict the mice’s food intake, you make them smaller, but they are still obese. They do lose body weight, but in tissue, not in fat.” The gene is similar to one in humans. “It may be a contributing factor in a subset of obese humans, but it is very unlikely to be the problem in a person who is 10 or 15 pounds overweight,” says Dr. Romsos.
This discovery is only the beginning of unravelling the genetics of weight control. “Human obesity springs from numerous genes, and it is likely that a combination of as many as 20 or more may be involved,” says Dr. Pi-Sunyer. Nor does a genetic predisposition automatically yield obesity. In certain environments, people with a genetic inclination towards obesity might never be overweight. But combined with the cultural factors in the U.S. where food is plentiful, diets are high in fat, and people tend to be sedentary, a genetic tendency towards obesity can blossom to its full potential.
In the Eyes of the Beholder
Being severely overweight carries with it a social stigma unlike any other health condition. A person with asthma or diabetes is not “blamed” for his or her condition. But Americans regard obesity “as a disease of willful misconduct,” explains Dr. Frank. “This view holds that you are fat because you are not a good person, you have misbehaved.” As a result, dieters tend to punish themselves when the results they seek are not achieved; they feel like they’re “cheating” when they go off their regimen. Worse yet, our worship of the svelte has produced an alarming increase in eating disorders. Efforts to acquire the “ideal” body are leading more and more people, especially women, to diet at the cost of their health.
To combat this social stigma, the idea of fat—or size—acceptance has gained a growing following. Groups such as Largesse and the National Association to Advance Fat Acceptance promote “size esteem” and work to dispel the “myth” that overweight people are less disciplined than others. Instead of thinking thin, they say, “think health.” Adopt the philosophy of Dr. John P. Foreyt of Baylor University: “Not everyone can be skinny, but everyone can be healthier.”
There is wisdom in this for us all. Before embarking on a weight-loss program, it really is important to try to separate social pressures from valid medical reasons for improving nutrition. This involves answering three questions: 1) Should I be worrying about my weight at all? 2) If so, what are the motivations leading me to overeat? 3) What type of weight-loss program will offer me the best chance of success?
About half of the American population is not overweight at all. So before plunging into a diet, we should all carefully analyze our motives and our need to lose weight.
The medical definitions of weight problems are based on deviations from standard height/weight charts that measure Body Mass Index, or BMI:
|•||“Overweight:” 10 to 20 percent higher than normal, or a BMI of 25 to 29|
|•||“Obesity:” 20 percent or more above normal weight, or a BMI of 30 to 39|
|•||“Morbid obesity:” 50 to 100 percent over normal weight, a BMI of 40 or above, or sufficiently overweight to have severe problems with health or normal functioning.|
However, many experts today discard the notion that there is such a thing as an “ideal” weight, a predetermined number to which everyone of a certain age and height should aspire. The concept of “healthy” weight—which varies from person to person depending on genetic background, health condition, and age—is beginning to win acceptance.
There’s a natural tendency for dieters to weigh themselves often, perhaps several times a day. But, be prepared: Your weight goes up and down throughout the day depending on your activity level and food and fluid intake. Even your day-to-day weight will fluctuate, due to varying degrees of fluid retention. Women tend to gain “water weight” during their menstrual periods, and both men and women tend to retain extra fluids after eating sodium-rich foods. Instead of torturing yourself with these meaningless changes, it is probably best to weigh yourself less often, perhaps once a week in the beginning, and once a month thereafter. Another approach is to average your daily weights to obtain one weekly figure. Or, plot your weight on a graph each day, and look for a gradual downward slope, ignoring the occasional sharp peaks and dips.
For the most accurate readings:
Standard weight tables can be off by as much as 20 to 30 pounds for any given person, notes Dr. Covert Bailey in The New Fit or Fat.The height/weight table may say 120 pounds is ideal for a person of your age and height. But if you currently weigh 160, your family history, activity level, and lifestyle may make 140 or 145 a more reasonable goal. In addition, your weight is only a very rough indicator of the amount of fat your body contains, and most physicians believe the percentage of your weight that comes from fat tissue is far more important than your total body weight (which includes not only fat but also muscles, bones, and bodily fluids). Height/weight tables could indicate that a lean, but very muscular person is “overweight,” while a person whose weight is within the “normal” range might actually be carrying around more fatty tissue than is healthy.
Some of the best indicators of whether you need to change your eating patterns have nothing to do with numbers. Some people have abandoned the scales entirely, preferring to rely on signs such as these:
|•||How do you feel? Energetic and vibrant, or drained and wiped out? Are you able to walk up a few flights of stairs without panting? Can you accomplish the daily tasks you need to?|
|•||Do you have health problems such as back pain, diabetes, or high blood pressure that would improve with weight loss?|
|•||Can you “pinch an inch” of fat at your waist or behind your arm?|
|•||What is your overall muscle tone? Are you flabby?|
|•||How well do last year’s clothes fit?|
|•||Has your doctor actually said you should lose some weight?|
If you’ve been overweight since childhood or adolescence, you may not even know what a “healthy” weight for you would be. The point at which excess pounds become a significant danger to your health is signaled by your Body Mass Index (BMI) and your waist-to-hip ratio, both of which tell whether you’re heavy enough to be at increased risk of heart disease. For detailed advice on gauging your “personal best” weight level, see “Setting a Healthy Goal.”
Why Do You Really Eat?
If you’ve decided you do need to lose weight, due to your own assessment or that of your doctor, it’s helpful to begin by examining your current eating patterns. Human beings don’t eat simply because they are hungry. “People eat because of stress, fatigue, and distraction,” says Dr. Frank. “People eat for social, cultural, and religious reasons. They eat at festivals and because it’s their birthday. They eat because their friends or family are eating.” Evidently, there are powerful psychological forces governing the way we eat. These enormously confounding motivations are the reason it’s so difficult for people to control their eating behavior. It’s not simply a matter of willpower.
This doesn’t mean that emotional eating is always a bad thing. Real adults in the real world have high-stress days, and occasional overeating can bring well-deserved comfort and pleasure. What’s important is to identify this behavior when it occurs. This will help you sort out emotional cues from actual hunger signals, and help you pinpoint the reasons you eat when you are not hungry.
What type of eater you are can affect what type of eating modification you should make. Consider the following types, described by an article in the August 1994 Harvard Health Letter:
• Restrained eaters: These people eat less than the recommended minimum calorie counts, but still think they weigh too much. They may need objective evaluation by an outside source. It might be that their body image needs revising more than their diet.
• Moderate eaters: People in this group don’t consciously restrict the kinds or quantities of foods they eat, but naturally limit their calorie intake. They might need to improve their nutrition, but not necessarily in order to lose weight.
• Binge eaters: Some people severely restrict the amount and types of food they eat, then periodically binge out of anxiety, stress, or boredom. They may need to incorporate the connection between food and emotions into their diet plans by making sure they derive enough pleasure and emotional satisfaction from their everyday meals. If carried to extremes, this pattern can lead to yo-yo dieting and even bulimia.
• Unrestrained eaters: This group tends to consume large amounts of high-calorie, high-fat foods in one sitting, and may feel uncomfortably full later on. They may be out of touch with the body’s signals that they have had enough to eat. Consulting a professional nutritional counselor may be helpful.
Strategies for Successful Weight Loss
Wherever you fall on the eating spectrum, you need to choose an eating plan—whether it’s a commercial plan like Weight Watchers or one you devise yourself—that suits your needs and cravings. Do you need the control of weighing and measuring every bite you eat, or do you need the freedom to eat whatever quantities of low-fat, nutritious foods satisfy your hunger? Do you feel most in control when you eat 3 square meals a day, or when you “graze” on 5 or 6 small meals throughout the day? Have long-standing eating habits suddenly started adding on pounds that a fresh approach could take off? Do you need to ease into a new eating plan gradually, adapting to new low-fat, high-fiber foods week by week, or would you be more motivated by a single clean sweep of all the junk in your diet? Doing what works for you may not be the same thing that worked for your best friend or your spouse.
When it comes to improving your eating patterns, any change is better than none at all. The “Shape Up America!” campaign launched by former Surgeon General C. Everett Koop promotes the benefits of even modest weight loss. “Eat sensibly. Exercise regularly. Drop a few pounds. Shape up,” Koop advises. Remember, a little will go a long way for your long-term health and your self-image.
The “D” Word
The word “diet” is often interpreted as “a temporary regimen that leads to permanent weight loss,” rather than its original meaning of “how one eats.” The effectiveness of “a temporary regimen” to lose weight has been questioned by certain weight-control specialists. Some research seems to show that yo-yo dieting, the common cycle of repeatedly losing and regaining weight, may be as bad for you as weighing too much in the first place. Other studies find it poses no risk (other than that of incessant frustration). A growing anti-diet movement urges people to throw away their calorie counters and concentrate on modifying their eating patterns. Meanwhile, the diet industry continues to thrive.
Fat-Reducing Strategies for Weight Loss
The difference between the pro-diet and anti-diet factions is, however, largely a matter of semantics. The fact is, if you want to lose weight, you’re going to have to become conscious of and carefully control what you eat for a period of time, and monitor what you eat thereafter. Whether you consider this a diet or not really doesn’t matter.
Focus on Dietary Fat
In determining the success of a weight-loss program, fat consumption is one of the main factors. Researchers found that the percentage of fat in the diet was the single strongest predictor of weight gain among 294 adults monitored for 3 years by Memphis State University investigators. By contrast, total calorie consumption had only a weak relationship to weight gain for women, and none at all for men. In another approach, researchers at the University of Illinois at Chicago switched 18 women volunteers from a diet that derived 37 percent of its calories from fat—roughly the fat content of the average American’s diet—to a diet that was only 20 percent fat. Over the 20-week experiment, the women lost 4 to 5 pounds, even though they increased their caloric intake.
Of course, calories can’t be completely ignored. Take in a massive excess, and you will surely gain weight, even if not a single calorie comes from fat. Nevertheless, from a weight-loss standpoint, a low-fat diet is ideal because it minimizes the amount of fat readily available for your body to store. Excess dietary fat can be pumped directly into your fatty tissue. Proteins and carbohydrates, on the other hand, are usually burned up immediately. They’ll be converted to fat when present in sufficient quantities, but that requires extra (calorie-burning) work in the process. Researchers are finding that, for certain overweight people, eating excessive amounts of carbohydrates can add to the problem. For many of us, however, carbohydrates remain distinctly preferable to fat.
But how low is low? The American Heart Association, the National Academy of Science, the American Cancer Society, and many other groups recommend that we get a maximum of 30 percent of our calories from fat (with no more than 10 percent of total calories from saturated fats). Another body of nutrition experts, including Nathan Pritikin and Dr. Dean Ornish, suggest that even lower levels of fat (10 to 20 percent of total calories) are much better than 30 percent, and can actually reverse existing heart disease.
If you decide to aim for the low end of this range, it might be advisable to consult your doctor. And totally eliminating fat is not only impractical, but extremely unwise. Our bodies do require a small amount of fat for lubrication, essential fatty acids, and fat-soluble vitamins. The necessary amount is all too easy to come by, however; so limiting all pure fats (butter, margarine, and cooking oils) and high-fat foods (full-fat dairy products, fatty red meats, pastries, and nuts) should be a key part of your weight-loss strategy. This doesn’t mean that you should always avoid high-fat foods—only that you should balance them with lower-fat foods such as grains, vegetables, and fruits.
The “Nutrition Facts” labels make it easier to determine exactly how much fat is in the food you are eating. They indicate how many grams of fat one serving contains. Each gram contributes about 9 calories toward the total number of calories per serving—more than twice as many calories as protein or carbohydrates. To determine what percentage of the calories in a food comes from fat (if it’s not already listed on the label), multiply the weight of the fat (in grams) by 9, then divide by the total number of calories in a serving. Or, for a simpler rule of thumb, just aim for a total daily intake of no more than 30 to 50 grams. Most people can lose weight at this level.
What about foods that are not labeled with nutrition information? Fruits, vegetables, berries, grains, legumes (peas and beans), and egg whites generally have little fat. (Avocados, olives, nuts, soybeans, and seeds are exceptions.)
Best Bets for Fiber
|Size of Serving||Fiber Content|
|Bran cereal||1 cup||6 to 21 grams|
|Beans (baked)||1/2 cup||10 grams|
|Blackberries||3/4 cup||7 grams|
|Baked potato||1 large (8 ounces)||6 grams|
|Winter squash, cooked||1 cup||6 grams|
|Cranberries||1 cup||5 grams|
|Split peas, cooked||1/2 cup||5 grams|
|Artichoke, cooked||1||4 grams|
|Kiwi fruit||1 medium (4 ounces)||4 grams|
|Orange||1 small (6 ounces)||4 grams|
Boost Your Fiber
Fiber has many benefits, but one stands out when you’re losing weight: It fills out the stomach and intestinal cavity, producing a feeling of fullness. Fiber is found chiefly in nonprocessed foods such as whole grains, beans, peas, fruits, and vegetables. Fiber may be added to processed foods in the form of bran, which is the outer coating from a grain such as wheat or oats.
The typical American diet is high in processed foods, most of which contain little or no fiber. Most people get only around 11 grams of fiber per day, while 20 to 30 grams are needed to get real health benefits. If your current diet is low in fiber, it’s important to increase your intake gradually over a period of weeks or months (a sudden jump can cause bloating, cramping, and gas). Try having a small serving of a high-fiber, low-fat cereal with your breakfast; as your system becomes used to the higher fiber levels, start substituting whole-grain breads, cereals, and pastas for refined (white flour, low fiber) varieties. Increase your consumption of fresh fruits and vegetables, and eat edible peels and skins (apples, potatoes) instead of trimming them.
Calories Still Count
Your body needs a certain number of calories per day to maintain bodily functions—referred to as your Basal Metabolic Rate (BMR). You can estimate your BMR by multiplying your current weight (in pounds) by 10 for women, 11 for men. For example, a woman who weighs 120 pounds would require about 1,200 calories per day just to maintain her bodily functions. You’ll also need some percentage of calories above your BMR to provide energy for your daily activities; the percentage will vary widely based on your metabolism and activity level. A moderately fit and active person might need 30 to 50 percent more calories than her BMR to maintain her current weight. Example: a 120-pound woman would need approximately 1,680 calories per day [1,200 + (1,200 x 40%) = 1,680]. A person who is very fit and exercises frequently might burn as much as 100 to 200 percent more than his or her BMR.
If your goal is to lose weight, you’ll need to take in fewer calories than you use up, or burn off extra calories through exercise, or both. If you choose to decrease calories, aim for the amount needed daily to maintain your target weight, not current weight. Most experts recommend that women take in a minimum of 1,200 calories and men a minimum of 1,600 per day. Lower calorie levels are unlikely to supply all the essential nutrients you need, and may slow down your metabolism, making weight loss even more difficult. For gradual weight loss, some professionals recommend a daily calorie target of 10 times your weight. At this level, they say, you can expect to lose half a pound per week.
The Bad News About Sugar
The “empty calories” of sugar have gained a bad reputation—and with good reason. Too much sugar can thwart weight loss almost as surely as too much fat. If fact, the February 2000 issue of the Journal of Nutrition reports that while America’s fat consumption has dropped since the 1960s from 42 percent to 34 percent, obesity has continued to rise, suggesting that something besides dietary fat is at work. Many researchers are now pointing the finger at sugar. The U.S. Department of Agriculture says that people consuming 2,000 calories a day should eat no more than 10 daily teaspoons of added sugar—about the amount in one can of soda. Yet government surveys show that Americans actually eat an average of 20 extra teaspoons a day. (The added sugar count does not include foods with natural sugar, such as fruit and milk). Marketers have jumped on the low-fat bandwagon by creating “fat-free” and “cholesterol-free” products, only to replace the fat with loads of sugar and refined starches. When you consider that 10 teaspoons of sugar have about 160 calories, it doesn’t take many sodas or “fat-free” cookies to blow your diet.
Some researchers have even begun to question whether low-fat diets are really the best route to weight loss. A 1998 article in The American Journal of Clinical Nutrition reported that, in the long run, daily fat consumption within a range of 18 to 40 percent had little effect on the amount of body fat. Researchers can’t explain this phenomenon for sure, but some suspect that a low-fat, high-sugar diet may trigger a cycle of intense cravings and weight gain. Whatever the reason, it’s a good bet that at least some dieters are replacing fat with sugar-laden, high-calorie foods. A better strategy is to swap a few fat and sugar calories for high-fiber fruits and vegetables. If you’re prone to sugar cravings, pay close attention to the way certain foods affect you. If you’re hungry a couple hours after eating a particular item or you later crave even more sugar, it was probably the wrong food for you. And remember that the taste of artificial sweeteners can trigger sugar cravings about as easily as the real thing can.
Once you’ve decided it’s time to shed some extra pounds, the big question is How? The basic principles—less fat, fewer calories, more fiber—are enshrined in hundreds of dieting schemes, all of them clamoring for your attention. At any given time, there are over 450 diet books in print. Each year, thousands of commercial diet centers enroll 8 million Americans in some kind of structured weight-loss program. All these choices can be grouped into four categories:
|•||Do-it-yourself efforts that involve “going solo,” or using diet books and support groups as aids|
|•||Nonclinical programs that employ counselors to teach weight loss and nutrition|
|•||Clinical programs, where licensed doctors may offer drugs or surgery|
|•||One-on-one consultation with a registered dietitian|
The choices can be overwhelming because the weight-loss industry is largely unregulated. However, help is available in the form of guidelines on safe and effective dieting issued by The Institute of Medicine, an arm of the National Academy of Sciences. “The current system is chaos,” says Dr. Frank, co-author of the guidelines. “None of these programs gives any information.” To give dieters a basis for choosing the right program, the guidelines call on weight-loss programs to issue comprehensive data about patients’ long-term weight loss, improvements in obesity-related diseases, and improved health practices.
The guidelines recommend that you:
|•||Pick a program that incorporates your individual needs|
|•||Ask a trusted health care professional if the program is sound and appropriate|
|•||Carefully assess your health before and during weight loss|
|•||Remember that programs promising results without dieting and exercise won’t work|
|•||Make sure the company requires breastfeeding women, children, and patients with any chronic disease to undertake weight loss only under medical supervision|
|•||Check that sufficient exercise is part of the program.|
Matching the Diet with Your Needs
Choosing a diet depends a lot on your personal needs. “At the extremes, the decision is easy,” says Dr. Frank. “If you weigh 350 pounds and you are recovering from your second heart attack, it’s dangerous for you to go to Weight Watchers. If you are 15 pounds overweight, 23 years old, and in good health, it doesn’t make sense for you to go into a clinical program.” However, most people fall between such extremes. The program you choose, counsels Dr. Frank, depends on your personal view, and how much time, money, and effort you’re willing to put in.
“There is no one best way to lose weight,” says Dr. Pi-Sunyer. “People are individuals and they do it different ways.” To determine which type of diet—self-created, a commercial program, or a book—suits your personality, ask yourself the following questions:
Does the diet fit my lifestyle? Any diet should include foods you like, eaten when and where you prefer. Personal input in meal-planning gives most people a sense of self-control and motivation. Some people, however, would rather be relieved of decisions and purchase food directly from a program.
Will I be eating the same foods as my family? Eating unfamiliar or tiny servings of food while your family dines on its regular fare can be hard to keep up. Such a stringent or limited diet can make you feel deprived, resentful, and rebellious.
Is a variety of foods from all food groups included, with no total exclusions? Even fats and sugars should be allowed in moderation. When you cut back on certain types of foods too far, it can be difficult to meet your nutritional needs.
Can you afford the weight-loss plan you’ve chosen? Take into account the cost of membership, weekly fees, food, supplements, maintenance, and counseling. Check if the costs are covered under health insurance. Beware of programs that require large sums of money up front. A pay-as-you-go system is safer.
Do I need someone to talk to about my goals? Professional counseling can help you learn how to control your eating habits and provide structured support. However, if you’re self-motivated, just talking to your spouse or a close friend may give you the support you need.
Do I need group support and encouragement? Many studies show that people who diet with the help of support groups are more likely to control their weight successfully. A support group doesn’t have to be a commercial program; it could be a community-based group or just a group of friends.
Do I need to learn how to prepare low-calorie, low-fat meals? If you don’t understand food labels, food preparation methods, or nutrition, seeking help is advisable.
Are the recommended foods easily found at any regular grocery store? For some, going to specialty or health food stores is bound to prove tiresome after a while.
Do I have time to put a program together by myself?
Tips for Do-It-Yourselfers
If you’re the go-it-alone type, keep these tactics in mind. You’ll need to make up for the support that comes automatically with enrollment in a program.
Find a good time to start. “I’m going on a diet tomorrow,” is a sentence that often heralds failure because it’s sparked by a momentary impulse (or guilt after a triple-decker ice cream cone) rather than a well-thought-out plan. Weight loss is tough, and you should give it the same careful consideration you would give to changing your career or buying a house. Think it through. Create a plan that really suits your lifestyle. Find a starting date during a relatively quiet time in your life, not while you’re also moving to another state or dealing with a crisis at work.
Create a diet “campaign.” Some people prefer to start with an exercise program, and add nutritional changes later on. For others, the reverse strategy works best. And for “all or nothing” types, starting both programs on a particular day can increase motivation.
Choose a good book for companionship. Some people prefer a diet plan book, while others do best with a low-fat, low-calorie cookbook. For a guide to the leading diet books, see “How to Pick a Nutritional Plan.” For the experts’ advice on cookbooks, see “How the Most Popular Cookbooks Measure Up on Health.”
Check with your doctor if you have any medical problems. You need to make sure that the eating and exercise strategies you’ve chosen are suitable and safe.
Decide whether you need a “quick start.” Quick-start programs, in which you change your eating habits drastically for a few weeks, are likely to deliver the most dramatic changes on the scale. For example, The Bloomingdale’s Diet starts off with 3 days of vegetable-only menus. This helps you break with your former eating patterns and gives you a chance to appreciate the appealing flavors to be found in very low-calorie foods. Other food groups are then reintroduced one by one. This kind of food plan requires a good deal of concentration during the initial phase and may not be suitable if you’re pressed for time. For many people, however, this approach serves as a great motivator. After you’ve lost those first exciting five pounds, you can modulate the plan into one you can continue life long.
Consider “gradualism.” This strategy works best for people who don’t have too much weight to lose, and those who can accept the idea of slow—but steady and permanent—change. One approach is to modify one daily meal at a time. For example, during the first week, you can concentrate on low-fat low-calorie dinners, assembling menus and creating tasty meals. In the second week, you can turn to lunch, and so on. Or, you can tackle one food group at a time. A switch to low-fat dairy products is a good start. The second week, pay attention to lower fat meats and fish, and to learning how to create one or two vegetarian dinners a week. (Be careful, though: Some vegetarian recipes are amazingly high in fat.)
Comparing the Top Four Plans
|Plan: Assigns point values to foods. Members receive a daily allotment of points, typically 22 to 29, that averages 1,250 to 1,500 calories a day. Daily or weekly points may be saved for later use at a special meal or occasion. Programs are also available for vegetarians, teenagers, and breastfeeding mothers.
Location Options: Attend group meetings or participate in the “at-home” program
Approximate Cost: There is an initial membership fee ($17 to $20), plus a fee for each meeting attended ($10 to $14). Members who attain their “goal weights” become lifetime members, and can attend meetings for free as long as they maintain their new weights. WW markets several types of processed foods not necessarily low in calories but designed to fit easily into the program. Use of WW foods is completely optional.
Rate of Loss: The number of food points you’re allowed per day depends on how fast you wish to lose weight; the program recommends a maximum loss of 1-1/2 to 2 pounds per week. You set your own goal weight based on a Weight Watchers height/weight chart. If you lose more than this, you’ll be instructed to slow down the rate of loss. This practice, unique among the programs, fits with current medical thinking about the hazards of too-rapid weight loss.
Meetings: Weekly meetings, which feature a “weigh in” for each member (confidential) and various activities such as motivational videos, discussions, and distribution of program materials and recipes.
Counseling: Each counselor employed by Weight Watchers is a former client who has achieved and maintained his or her goal weight on the program. Gaining the weight back is grounds for dismissal.
Exercise: Encourages moderate exercise in combination with the diet plan.
|Plan: Requires dieters to buy and consume only company-brand foods (except for a few items such as fresh dairy products and produce). Prepackaged meals are said to help dieters learn “portion control” while freeing them from the necessity of weighing, measuring, and preparing food. Daily intake ranges from 1,000 to 2,600 calories. Clients have the option of switching to regular foods after achieving half of their targeted weight loss.
Location Options: Clients have the option of going to a Jenny Craig Center or joining the “Right at Home” program, which provides weekly consultations over the telephone.
Approximate Cost: For the weight-loss program, there’s a one-time registration fee of $199. The weight-loss-plus-maintenance program carries a $349 one-time charge. Jenny Craig foods cost about $10 to $12 per day. (The cost drops as you approach your goal weight and start eating some regular foods.) Supplemental vitamins are additional. Also offered are optional products such as cookbooks and video tapes.
Rate of Loss: The average weekly loss is 1 to 2 pounds for women; 2 to 3 pounds for men. Goal weight determined by client and BMI chart.
Meetings: No group meetings.
Counseling: Uses one-on-one counseling for clients at the center or over the phone.
Exercise: Exercise is encouraged.
|Plan: Requires dieters to buy and consume only company-brand foods (except for a few items such as fresh dairy products and produce). Daily minimum intake ranges from 1,200 to 1,500 calories.
Location Options: NutriSystem has shifted most of its business to its on-line weight-loss center.
Approximate Cost: There is no enrollment fee for nutrisystem.com members. The advertised cost of food is $49.95 per week plus shipping costs.
Rate of Loss: Average loss of 1-1/2 to 2 pounds per week.
Meetings: Members can participate in on-line discussions with other nutrisystem.com members.
Counseling: Members are assigned a personal counselor who they interact with privately on-line.
Exercise: Encourages exercise.
|Plan: The “Exclusively You” is based on supermarket food and provides a daily minimum intake of 1,000 calories; buying company-brand food is optional. Vitamin and fiber supplements are included during the reducing phase. The more rigorous “Concept 1000” plan provides 1,000 calories a day from three meal replacements (shakes or bars) and one regular meal.
Location Options: Clients can go to a local Diet Center franchise or they can join Diet Center Online.
Approximate Cost: Fees average $30 to $50 per week, with additional fees for “Concept 1000” meal replacements. Weight maintenance averages $100 per year. Diet Center offers a line of frozen main dishes, along with other products, but these purchases are not mandatory.
Rate of Loss: Estimated to be 2 pounds per week.
Meetings: No group meetings.
Counseling: Daily weigh-ins with a diet counselor (flexible).
Exercise: Encourages exercise by setting and monitoring exercise goals.
Don’t forget fluids. Drinking the equivalent of eight glasses of water a day is recommended for everyone, but especially for those trying to lose weight. The fluids fill you up, prevent the shakiness and fatigue of dehydration, and give you something to put in your mouth when you’re trying to forget about eating.
Eat slowly and savor your food. Give your internal “portion control” monitor a chance to get through to you. Some foods, such as vegetables prepared without added fat, can be eaten in large quantities to satisfy hunger and prolong the pleasure of a meal. Pastas, potatoes, bread, and rice are filling foods that round out a meal, but should not be eaten with abandon. Other foods, such as cheeses, meat, and sweets, give extra zing to meals and, in very small portions, can be part of a weight-loss plan.
Keep track of your progress. The scale helps some people and tyrannizes others. If you find that the number on the scale affects your self-esteem for the day, find another way to measure progress. Try on a once too-tight skirt or pair of jeans each morning. Or keep a food diary of what you eat each day. Tracking progress is important. It’s a reminder that you’ve started a change, and rewards you with a hint of the final results.
Don’t punish yourself. If you “fall off the wagon” and indulge (or even overindulge) in something you think you shouldn’t have eaten, it’s not a disaster. An episode of uncontrolled eating does not mean that you or your diet failed. Learning to climb back on the wagon is a key to long-term success.
Survive the “plateaus.” While the first pounds often come off quickly, many dieters hit plateaus where their weight remains steady for weeks even though their fat and calorie counts are low. Getting through these periods requires a bit of faith and “stick-to-it” spirit. Your metabolism is making noble efforts to keep up your fat levels, in the mistaken belief that starvation is near. But weight loss will start again once this plateau is passed.
Get the right support. You may need to advise your spouse and friends on how to help you. They shouldn’t appoint themselves your “diet cop”—this will only bring out the rebel in most people. But neither do they need to tempt you unnecessarily by insisting you taste their dessert or order something “more exciting” in restaurants.
Reward yourself. Small treats and large pleasures will help you celebrate everything from sticking with your plan on Day One to reaching your target weight, along with whatever small markers you create in between. Some people find going into a store and trying on clothes they could never wear before is a great reward—even when they’re not ready to buy. Others give themselves free time—an hour to sit in the sun and dream; an afternoon at the movies; a walk in the park at sundown—for whatever they truly enjoy.
Customer Satisfaction with the Leading Diet Programs
Consumer Reports asked readers to tell about the problems they encountered with different weight-loss programs.
Did the program have higher costs than you were led to believe?
Extra more likely: Jenny Craig (47%), Nutri-System (47%).
Extra less likely: Weight Watchers (7%), HMR (17%).
Was there strong pressure to buy the program’s products?
More pressure: Jenny Craig (55%), Nutri-System (55%).
Less pressure: Weight Watchers (5%).
Was there strong pressure to join or stay in the program?
More pressure: Nutri-System (34%), Jenny Craig (31%).
Less pressure: Medifast (11%), Weight Watchers (12%).
Was the dieting method artificial and difficult to incorporate into daily life?
More artificial: Medifast (40%), Optifast (37%), Nutri-System (31%).
Less artificial: Weight Watchers (6%).
Were you always hungry?
More hunger: Medifast (22%).
Less hunger: Weight Watchers (10%).
Checking Out the Enrollment Programs
Cost, comfort, and common sense are the basics to look for when shopping for a commercial program. These plans generally attract women who have a moderate weight problem and men who are moderately to seriously overweight. All the top four commercial weight-loss programs—Diet Center, Jenny Craig, Nutri-System, and Weight Watchers—include a low-calorie diet of about 1,000 to 1,500 calories a day and some kind of supportive counseling.
None of the top four emerges as better at helping individuals to lose weight and keep it off, according to a 1994 Consumer Reports survey of 95,000 readers who had attempted to lose weight in the past 3 years. Overall, however, Weight Watchers tended to be the clear favorite among those polled. It costs less than the others, emphasizes healthful dietary habits, encourages relatively slow weight loss, and generally appears to provide the most satisfying support. In contrast, Nutri-System and Jenny Craig cost more and are more likely to use high-pressure sales tactics. But, as Deralee Scanlon, RD points out in Diets That Work: “The monetary aspect does not in itself lessen the potential effectiveness of a program—in fact, some people take these programs more seriously precisely because of the financial investment.”
Clinical Programs (Liquid fasts)
These are the most drastic weight-loss programs, designed for people with a serious problem. No one should go on a liquid-fast program without a compelling medical reason to do so. Liquid fasts are generally appropriate only for people with a BMI in the 30s, or people with BMIs in the high 20s who have a serious weight-related risk factor, such as severe high blood pressure or diabetes. For long-term maintenance of healthier weight, the programs are no better than any other. They are available only through hospitals or doctors’ offices and require regular physical checkups and blood tests. Three popular liquid-fast programs include: Health Management Resources (HMR), Medifast, and Optifast. Medical complications may include such “adjustments” as dizziness, sensitivity to cold, slower heart rate, brittle nails, rashes, fatigue, diarrhea or constipation, muscle cramps, and bad breath. They generally cost between $2,000 and $3,000.
Liquid diets a la Oprah Winfrey, who lost 67 pounds on the Optifast program and gained it all back, show that short-term solutions are meaningless without long-term change. These days, Oprah has replaced diet shakes with a personal chef, focusing on intensive exercise and nutritional changes she can follow for life, rather than just a goal weight. “Changing the way you think about food is the first step toward achieving and maintaining a desirable weight,” Oprah writes in the best-seller In the Kitchen with Rosie (which contains delicious low-fat, low-sugar, low-salt recipes you can cook yourself, even if you can’t afford a private cook).
Potentially Dangerous Diet Strategies
In the diet industry, anything goes. “Appetite-suppressing eyeglasses” boast colored lenses that are said to project an image on the retina that dampens the desire to eat. “Magic weight-loss earrings” are custom-fitted to the purchaser to stimulate, it is claimed, the acupuncture points controlling hunger. (Neither has been proven effective.) Much of the diet advice you encounter may be misleading, and some of it can be downright dangerous. Beware of the following weight-loss wonders.
Diet Pills. Over-the-counter “diet aids” really do work—but only for a while. They contain stimulants that decreases your appetite, and/or mild diuretics which cause you to eliminate fluids more quickly than normal. These pills can temporarily cause your weight to drop, but they won’t eliminate body fat. As soon as you stop taking them, your weight is likely to bounce back to its previous level. Until recently, many diet pills contained phenylpropanolamine (PPA), a stimulant chemically similar to amphetamine. But the FDA is now taking steps to remove the drug from all products after researchers discovered that PPA slightly increased the risk of bleeding in the brain among women who used the drug for weight control or nasal decongestion. Other over-the-counter diet aids that pose dangers include herbal formulas containing ephedra or aristolochic acid, and supplements containing tiratricol, a potent thyroid hormone.
The side effects of diet pills can range from the mild—dizziness, nausea, and increased urination—to the severe—chest pain, heart attack, liver and kidney damage, stroke, seizures, and even death. The pills can be dangerous for people with heart problems, thyroid disease, and high blood pressure. “Pills are not the answer,” says Dr. Pi-Sunyer. “The answer is diet and exercise. There is effort involved in weight loss.”
Very Low-Calorie Diets. Studies show that people who lose weight slowly over a reasonable amount of time are more likely to keep the weight off. A weight-loss diet of at least 1,200 calories a day works best for most people. Consuming less than this can deprive you of essential nutrients. New studies suggest that diets very low in fat may actually endanger your health. Diets very low in calories (less than 1,000 calories a day) can also be harmful and should be attempted only under the care of a doctor. If you lose more than 1 or 2 pounds per week, you’re almost certainly losing muscle, not just fat tissue. Make sure the diet you choose allows you enough food to keep you from feeling overly hungry.
Fasting. As with very low-calorie diets, when you fast, you lose muscle before fat. After a day or two of fasting, many people succumb to a high-calorie binge. Long-term fasting is hazardous, since it weakens your immune system and places a strain on vital organs.
Skin Patches. These “diet patches,” which supposedly contain an appetite suppressant, have not been proven safe or effective. The Food and Drug Administration has seized millions of these products from promoters.
Diuretics. The weight you lose is only water weight. The loss is temporary and doesn’t include any fat. Diuretics can promote dangerous dehydration and cardiac problems.
Electrical muscle stimulators. These devices, which have legitimate medical uses in physical therapy, have no place in weight loss or body toning. You just can’t zap off the fat. When used incorrectly, the devices can cause electrical shocks and burns.
For Severe Obesity, Surgery Is a Last Resort
For those suffering from severe obesity, losing weight isn’t just a matter of wanting to look good in a swimsuit. Over the long term, this condition is associated with a shorter lifespan and several serious illnesses, including diabetes, heart disease, breathing problems, arthritis, and gallbladder disease. If your best dieting efforts have failed, a last—and drastic—option is to have what doctors call bariatric, or obesity, surgery. This operation reduces the volume of food the stomach can hold from 4 cups to about one-half cup. You may be a candidate for obesity surgery if you:
|•||Have a BMI above 40|
|•||Are carrying an extra 100 pounds if you’re a man, or 80 pounds if you’re a woman|
|•||Have a BMI between 35 and 40 and suffer from a life-threatening condition such as diabetes or heart disease|
|•||Are committed to lifelong follow-up exams with your doctor|
|•||Are committed to lifelong behavioral changes, such as taking vitamin supplements and avoiding certain foods|
|•||Are not trying to become pregnant, which should be delayed until your weight becomes stable|
The most important requirement, however, is to thoroughly explore the risks. As with any abdominal surgery, there is always a chance of excessive bleeding, infection, and allergic reaction to anesthesia. Other complications include an intolerance to high-fat foods, lactose intolerance, and bouts of vomiting, diarrhea, and intestinal discomfort.
In the long run, many surgery patients lose about 60 percent of the pounds they need to reach their ideal weight. However, obesity surgery by itself is not a magic cure. Ultimate success still depends on the patient’s commitment to exercise and low-calorie foods.