Category Archives: Prepare For Weight Loss

How to Choose a Weight-Loss Program

I listed most of your weight-loss program options in Part 1 of this series. Now it’s time to make a choice. And it’s not easy sorting through all the options.

Straight away, I must tell you that women over 300 pounds (136 kg) and men over 350 pounds (159 kg) rarely have permanent success with self-help methods such as diet books, meal replacement programs, diet pills or supplements, and meal-delivery systems. People at those high weights who have tried and failed multiple different weight-loss methods should seriously consider bariatric surgery.

I respect your intelligence and desire to do your “due diligence” and weigh all your options: diet books, diet pills and supplements, bariatric surgery, meal replacement products (e.g., SlimFast), portion-control meal providers (e.g., NutriSystem), Weight Watchers, fad diets, no-diet diets, “just cutting back,” etc. You have to make the choice; I can’t make it for you. Here are some well-respected sources of advice to review before you choose:

For me personally, the “diet book” option is appealing. Why? Convenience. Low cost. Effectiveness. If I forget or don’t understand something, I can re-read it.

Since I’m a diet book author, you may consider me biased in favor of my own books, which are more about lifestyle modification than short-term dieting. If I didn’t think I could do better than the other books on the market, I wouldn’t have bothered to write my own.

So, please consider my Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer (2nd Edition). Click here for a description of the book. Click here for customer reviews. You can order the book at the AMD website, Amazon.com, Barnes & Noble, or check it out from your local library.

I’ve also published a free, online, stripped-down version of my healthy lifestyle program: the Do-It-Yourself Mediterranean Diet.

Also free is my Ketogenic Mediterranean Diet, which is very low-carb. It’s at my Diabetic Mediterranean Diet Blog, but it works as well for non-diabetics as for diabetics. The comprehensive version of Ketogenic Mediterranean Diet is available at Amazon.com, Barnes and Noble, and Smashwords.

I’m doing everything I can to help you live longer and healthier.

Whatever your choice, I wish you success and good health in 2012 and beyond!

Steve Parker, M.D.

Prepare For Weight Loss, Part 7: Creative Visualization

How will your life be different after you make a commitment and have the willpower to lose weight permanently?

Odds are, you will be more physically active than you are now. Exercise will be a habit, four to seven days per week. Not necessarily vigorous exercise, perhaps just walking for 30 or 45 minutes. It won’t be a chore. It will be pleasant, if not fun. The exercise will make you more energetic, help you sleep better, and improve your self-esteem.

After you achieve your goal weight, you’ll be able to cut back on exercise to three or four days per week, if you want. If you enjoy eating as much as I do, you may want to keep very active physically so that you can eat more. I must tell you that I rarely see anyone lose a major amount of weight and keep it off without a regimen including regular physical activity. I wish that weren’t the case, and probably you do too, but that is the reality I have witnessed. Please don’t think you’ll be an exception; the odds are overwhelmingly against you. Plan on regular exercise being a part of your new lifestyle.

Commitment and willpower will alter your relationship with food. You will eat to live, rather than live to eat. You have important things to do with your life, dreams to pursue, and so little time left. If you have no long-range goals and are unclear about your purpose for living, you are certainly not alone. I urge you to consult a spiritual adviser such as a minister, priest, or rabbi.

Food is a necessary and enjoyable tool that helps you achieve your goals and fulfill your purpose by keeping you strong and healthy. Chronic overindulgence is a distraction. Carrying excess baggage impedes your progress on life’s journey.

Your new relationship with food will involve two phases: 1) weight loss, and 2) maintenance of that loss.

During the weight-loss phase, you will occasionally feel deprived due to calorie restriction. Your willpower will be tested and sometimes broken. But you recover control and press on. You don’t have to swear off all your favorite foods, just limit them. You will learn to eat reasonable portions of varied, balanced nutrients. You learn to delay gratification. You eat real food that is readily available and good for everyone in the household. You don’t have to sit there sipping your dinner out of a can while others at the table eat baked chicken, broccoli, and bread.

You’re excited and enthusiastic at first, full of hope, particularly when you lose those first three or four pounds. You’re not expecting to lose six or 10 pounds per week as in the TV infomercials because you know those results are bogus or unsustainable. You’re happy losing one-half to one-and-a-half pounds weekly because you know the loss is fat, not water or intestinal contents. You’ve held a pound of butter (four sticks) in your hand—that’s what you’ve lost. And it’s quite an accomplishment. The excitement wears off after three to six weeks, but it’s easier to deal with since you knew it was coming. You focus on the long-term benefits and renew your commitment. It helps that you’re now getting compliments from your friends and co-workers.

After much dedicated effort on your part, you finally attain your goal weight. You feel good about yourself. You take pride, justifiably, in your hard work, discipline, and willpower. You look better, sleep better, have more energy, and have rewarded yourself with some new clothes. But this is a critical juncture with risk—the risk of regaining fat and returning to your starting point. You must successfully navigate the transition to “maintenance phase,” in which you confirm and solidify your weight loss achievement. This is the most puzzling, problematic, and frustrating area in the field of weight management. To some extent, you must chart your own course.

Your relationship to food in the maintenance phase will have certain characteristics, however. In your weight-loss phase, you had been converting 400–600 calories worth of fat into energy every day. Now that you have reached your goal weight and have the will to stay there, you have options. You can 1) start eating an extra 400–600 calories daily, 2) reduce your physical activity by 400–600 calories daily, or 3) mix No. 1 and No. 2 such that you increase your current calorie budget by 400–600 calories. This is our old friend, the Energy Balance Equation.

In view of exercise’s benefits, many people choose to eat more food and continue their exercise program. At this point, the natural inclination, sometimes overwhelming, is to eat more than 400–600 extra calories per day. And you know what will happen. You will need perhaps even more commitment and willpower to keep from slipping back into your old habits, into your lifestyle of the last 10 years. You vow to admit this reality: you can never again eat all you want, whenever you want, over sustained periods of time. You look at a brownie, a candy bar, or a piece of apple pie, and you ask yourself, “Do I really want to walk an extra hour or jog an extra three miles today to burn off those calories?” If so, enjoy. If not, remember what they say: “A moment on the lips, a lifetime on the hips.”

You vow also to admit this reality: you’re going to “fall off the wagon” occasionally and gain four, five, or more pounds of fat. But it’s not the end of the world. You’re not a failure. An extra five or eight pounds won’t hurt you one bit, physically. But you draw the line, stand up straight, hold your head high, and simply return to your weight-loss program for a month or two. You’ve done it before and know you can do it again.

Changing your lifestyle is like breaking a horse. You’re in for a rough ride and you’re going to get thrown a few times. But you pick yourself up, dust yourself off, and climb back on. With time and persistence, your will prevails.

After you commit to permanent weight loss and maintenance, you will likely find yourself eating different types of food than your usual fare. Most people settle into a routine and eat the same 10 or 12 meals over and over. Do you start the day with fried eggs, bacon, biscuits and butter? Perhaps one of your regular meals is fried chicken with mountains of mashed potatoes and gravy. Pizza and soda pop? Maybe you like a hamburger with large fries a couple days per week. During the maintenance phase of weight management, those meals are fine on occasion. But over the long run you will eat substitute meals that are lower in calories, incorporating more fruits, vegetables, and whole grains. As a result you will feel better, obtain more healthy anti-oxidants and other micronutrients, and keep your weight under control.

Steve Parker, M.D.

Prepare For Weight Loss, Part 6: Weight Goals

“This thing must be broken!”

Despite all the chatter about how to lose weight, few talk about how much should be lost.

If you are overweight, deciding how much weight you should lose is not as simple as it seems at first blush. I rarely have to tell a patient she’s overweight. She knows it and has an intuitive sense of whether it’s mild, moderate, or severe in degree. She’s much less clear about how much weight she should lose. If it’s any consolation, clinicians in the field aren’t always sure either.

Five weight standards have been in common usage over the last quarter-century:

  1. Metropolitan Life Insurance Company Height and Weight Tables from 1983
  2. Aesthetic Ideal Weights
  3. USDA/HHS Healthy Weights
  4. Realistic Weights
  5. Body Mass Index.

The Metropolitan Life Insurance Company Weight Tables list desirable or ideal weights that were felt at one time to be associated with maximum longevity. We know now that populations can be a bit heavier than the Metropolitan weights without impairment of health or longevity. The tables were controversial right out of the gate and are little used now; I mention them for historical interest.

Aesthetic Ideal Weights are somewhat personal, although clearly influenced by culture. You know without much thought at what weight you look your best. Whether others agree with you, and whether you could realistically hope to reach that weight, are entirely different matters.

If your personal Aesthetic Ideal Weight matches the Hollywood hunk or sex kitten actress du jour, prepare for failure. Thespians and models want to be thin because the camera puts weight on them. Many of our beloved photogenic celebrities workout three hours daily with a personaal trainer. And on top of that , many visit plastic surgeons.

I suggest you find a friend with your type of body frame and height who looks “normal” and healthy to you. What does he or she weigh? I also suggest validation of your Aesthetic Ideal Weight by a trusted adviser. Now you’ve got something to shoot for.

In 1995, the U.S. Department of Agriculture and U.S. Department of Health and Human Services issued a chart of Suggested Healthy Weight ranges. By the turn of the century, the USDA/HHS’s Dietary Guidelines for Americans had abandoned the Healthy Weight table, recommending the use of BMI instead.

A Realistic Weight goal is one that you have a reasonable expectation of achieving, accompanied by significant psychological or medical benefits. This standard is flexible. There is no weight chart to consult since your potential psychological or medical benefits are unique. These weights tend to be higher than the other benchmarks thus far reviewed.

The Realistic Weight concept accepts that you can feel better, look better, and have fewer medical problems while falling far short of the recommended “healthy” body mass index (BMI, discussed later). Many of the illnesses caused or aggravated by overweight are improved significantly by loss of only 5 or 10 percent of body weight. The concept admits the the body cannot always be shaped at will: much of your shape and fat distribution are genetically determined. If all your blood relatives, have big buttocks, thighs, and legs, you will also, although you do have control over degree.

For many people, the Realistic Weight concept is helpful and valid, and prevents the discouragement felt when performance falls short of ideal. Let’s not allow the perfect to be the enemy of the good. It’s not realistic to expect a 40-year-old mother of three to weigh the same as a 17-year-old girl with no kids.

Body Mass Index (BMI) is your weight in kilograms divided by your height in meters squared (kg/m2). To determine your BMI but skip the math, use an online calculator.

From a health standpoint, BMIs between 18.5 and 24.9 are the best for people under 65–75 years old. About a third of the United States population is at this healthy weight. If you are 5-feet, 3-inches tall, your maximum healthy weight is 140 pounds (BMI 24.9). If you are 5-feet, 9-inches tall, your maximum healthy weight is 169 pounds (BMI 24.9).

BMIs between 25 and 29.9 designate “overweight” and accurately describe about 35 percent of the U.S. population. A BMI of 30 or higher defines “obesity” and indicates high risk for poor health. About 30 percent of us are obese. At a BMI of 35 and above, the incidence of death and disease increases sharply.

The BMI concept is helpful to researchers and obesity clinicians, but the number doesn’t mean much yet to the average person on the street, nor to many physicians. It should be used more widely. Know your BMI. If it is under 25, any excess fat you carry is unlikely to affect your health and longevity; your efforts to lose weight would be purely cosmetic.

If we look only at older Americans, over 65–75 years old, being overweight, but not obese, seems to prolong life on average. Longest life spans are seen in these older people with a body mass index between 25 and 30. Disability rates are lowest for older Americans with a BMI around 24. So, if you are over 65, you may have less disability at a body mass index of 24, but you may die slightly earlier that someone with a BMI in the overweight range. These numbers, of course, apply only to groups of people defined by BMI, not to individuals.

So, how much weight should you lose?

As a medical man, I endorse the healthy BMI concept (BMI 18.5 to 24.9) while realizing you may have aesthetic reasons to shoot for the lower end of the range. If you have weight-related health issues, aim for a BMI of 18.5-24.9, with 25 to 30 as your fallback position. If you are over 65, consider a goal BMI between 25 and 30.

It’s important to set a weight goal. If you don’t know where you’re going, you’ll never get there.

Steve Parker, M.D.

Prepare For Weight Loss, Part 5: Supportive Social System

Success at any major endeavor is easier when you have a supportive social system. And make no mistake: losing a significant amount of weight and keeping it off long-term is a major endeavor.

As an example of a supportive social system, consider childhood education. A network of actors play supportive roles. Parents provide transportation, school supplies, a home study area, help with homework, etc. Siblings leave the child alone so he can do his homework, and older ones set an example. Neighbors may participate in carpooling. Taxpayers provide money for public schools. Teachers do their part. The school board oversees the curriculum, supervises teachers, and does long-range planning.

Success is more likely when all the actors work together for their common goal: education of the child. Similarly, your starring role in a weight-loss program may win an Academy Award if you have a strong cast of supporting actors. Your mate, friends, co-workers, and relatives may be helpers or hindrances. It will help if they:

  • give you encouragement instead of criticism
  • don’t tempt you with taboo foods
  • show respect for your commitment and willpower
  • give you time to exercise
  • go an a diet or exercise with you, if they are overweight or need exercise
  • understand why there are no longer certain foods in the house
  • appreciate the nutritious, sensible foods that are now in the house
  • forgive and understand when you occasionally backslide
  • gently remind you of your commitment when needed
  • reward you with compliments as you make progress
  • don’t compare your physique unfavorably with supermodels or surgically-sculpted bodies
  • don’t get jealous when you lose weight and are more attractive and energetic.

Your social support system can make or break your commitment and willpower. Ask them to help you.

Steve Parker, M.D.

Prepare For Weight Loss, Part 4: Starting New Habits

You already have a number of good habits that support your health and make your life more enjoyable, productive, and efficient. For example, you brush your teeth and bathe regularly, put away clean clothes in particular spots, pay bills on time, get up and go to work every day, wear your seat belt, put your keys or purse in one place when you get home, balance your checkbook periodically.

At one point, these habits took much more effort than they do now. But you decided they were the right thing to do, made them a priority, practiced them at first, made a conscious effort to perform them on schedule, and repeated them over time. All this required discipline. That’s how good habits become part of your lifestyle, part of you. Over time, your habits require much less effort and hardly any thought. You just do it.

Your decision to lose fat permanently means that you must establish some new habits, such as regular exercise and reasonable food restriction. You’ve already demonstrated that you have self-discipline. The application of that discipline to new behaviors will support your commitment and willpower.

Steve Parker, M.D.

Prepare For Weight Loss, Part 3: Free Will

The only way to lose excess fat weight is to cut down on the calories you take in, increase your physical activity, or do both.

Oh, sure. You could get a leg amputated, develop hyperthyroidism or out-of-control diabetes, or have liposuction or bariatric surgery. But you get my drift.

Although the exercise portion of the energy balance equation is somewhat optional, you must reduce food intake to lose a significant amount of weight. Once you reach your goal weight you will be able to return to nearly your current calorie consumption, and even higher consumption if you have increased your muscle mass and continue to be active.

Are you be able to reduce calorie intake and increase your physical activity temporarily? It comes down to whether we have free will. Free will is the power, attributed especially to humans, of making free choices that are unconstrained by external circumstances or by an agency such as divine will.

Will is the mental faculty by which one chooses or decides upon a course of action; volition.

Willpower is the strength of will to carry out one’s decisions, wishes, or plans.

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control. Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat. The existence of free will is confirmed for me by my education in religion and philosophy, my intuition, and most prominently, by my experience. I have seen hundreds of my patients lose weight and keep it under control. I didn’t do it for them. No other person, pill, or agency did it for them. They didn’t achieve success by being passive victims of external circumstances. They cut back on calories and increased activity levels through strength of will. They did it.

Read about other success stories at The National Weight Control Registry.

You can enhance your willpower and commitment to losing weight by learning about:

Steve Parker, M.D.

Prepare For Weight Loss, Part 2: The Energy Balance Equation

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?” Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good? Only one, but…

Where does the fat go when you lose weight dieting? Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat. Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism. Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour. Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue. So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat. Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity. Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity. Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity. Excess energy not used in resting metabolism or physical activity is stored as fat.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

minus the energy you burn in metabolism and activity,

determines your change in body fat.

Or, more succinctly:

Energy Intake minus Energy Expenditure Equals Change in Energy Stores

This is the Energy Balance Equation.

Energy is measured in calories. For example, if you eat 2,000 calories of energy daily, but burn up 2,300 calories daily, you will have a negative energy balance and your fat stores will go down. That is, you lose weight.

Now, a pound of body fat contains 3,500 calories, so you have a way to go before you lose a pound on the bathroom scale.

Overweight and obesity result from an imbalance between energy intake and expenditure.

It’s just that simple. The degree of this imbalance is quite small. Over the course of a year, you will gain three and a half pounds of fat just by adding a teaspoon of butter to your dinner roll every day, assuming all other variables are unchanged. Simply avoid a 10 minute walk daily for a year and you will gain five and a half pounds. Taking the walk and avoiding the teaspoon of butter sound easy, and they are, but if not done you will gain 35 pounds over the course of five years.

While we don’t have much control over our basal metabolic energy requirements (roughly 1,200–1,500 calories daily), many of us are able to adjust food intake and activity levels to strike a happy balance in the energy equation, minimizing unwanted fat. For a lucky few, that desirable balance is automatic and unconscious. The rest of us have to think about it, work at it, make it a priority at times.

Right now your balance is tipped in favor of excess energy stores (fat). It will soon be tipped in the other direction. You will convert fat to energy and lose weight in the process. Once you achieve your goal weight, the energy equation must be balanced again.

There is no doubt that the energy balance equation applies to you. People who swear they can’t lose weight on extreme low-calorie diets have been locked up (with consent) in university medical center metabolic wards with access to food strictly controlled by staff. On appropriate calorie-restricted diets, everyone loses weight. When an exercise program is added, they lose more weight.

Steve Parker, M.D.