Ending diets that don’t work: how people actually lose weight.

Visualization is courtesy of TheVisualMD.com

This is certainly true of a problem that nags at the majority of Americans, their weight. No one can claim that weight loss isn’t a struggle. “But I’m on a diet” is the cry of countless people. These are not the same as countless thin people. Yet we can start to end the struggle by looking soberly at the part being played by conscious choices.

About one-third of Americans are overweight, and an additional third are obese. But the problem isn’t limited only to the US: obesity has become a global problem. More than one in ten persons, worldwide, is obese. Nor are overweight and obesity problems only of rich nations. About 65% of the world’s population lives in countries where the problems of being overweight kills more people than being underweight. And the costs of obesity are immense, in personal, societal, and economic terms. In the US, the medical care costs of obesity totaled about $147 billion in 2008.

Obesity is generally defined using the body mass index (BMI). BMI is an individual’s weight multiplied by 703 and then divided by twice his or her height in inches (BMI calculators are available online. Many doctors think your waist-to-hip ratio (WHR) is a better indication of disease risk. Your WHR, which is found by dividing the circumference of your waist by that of your hips, is a relatively good indicator of whether you have excessive visceral fat inside your abdomen. A ratio of under .8 for women or .9 for men is thought to be healthy.

Obesity factors. Our country’s current obesity epidemic is due to a “perfect storm” of cultural, social, economic, psychological, and economic factors. Getting older and your genetic inheritance are two set risk factors that influence your likelihood of becoming obese, but they don’t determine it.

Fortunately, other risk factors for obesity can be changed. Social and economic influences, like your regional culinary traditions, and the way you ate growing up play a big part. Surprisingly, lack of a good night’s sleep—7-8 hours is considered healthy for most people—is a factor in weight gain. What kind of food and how much food you eat, and the amount of physical activity you get, are vitally important. Eating “junk” food—highly processed foods, fast foods, and refined carbs like white sugar, white flour, and white rice—is a major risk factor.

Forget dieting. Although we are a nation of dieters, that has done little or nothing to stem the tide of obesity. Studies have shown that a minuscule percentage of dieters, generally less than 5%, are able to lose weight and keep it off for two years. In addition, the cycle of gaining and losing the same ten or twenty pounds places an unhealthy stress upon your body.

The best way to lose weight is to make long-term changes in the way you eat, changes you can live with for the rest of your life. There are many ways to do this. You can limit calories or portion sizes, or you may choose to limit certain foods (the unhealthy, fattening ones!) and emphasize others.

Ensure your daily diet includes whole, nutrition-dense foods like whole grains, good fats (olive oil and other foods with omega-3 fatty acids), lean protein, and whole fruits and vegetables.

If you do nothing else, do the two following things. First, avoid eating at fast-food restaurants; learn to make quick, healthy meals at home. Second: whether you’re single or in a family, make eating an occasion: sit down at the table for real meals and keep the TV off. Fast food and constant snacking are two major reasons for the obesity epidemic.

Exercise is your best friend when it comes to weight loss. If you haven’t exercised for a long time and are very out of shape, start out by exercising for just 10 minutes a day, and add on over time to build up to 30 minutes to an hour every day. Do both aerobic exercise (like walking, swimming, and cycling) and anerobic exercise (resistance training, weight lifting) for best results. Aerobic exercise has many benefits: it improves insulin sensitivity, strengthens your heart, gives you more energy, and much more. Anerobic exercise strengthens your muscles and boosts your metabolism so that you burn more calories, even when you’re not exercising.

If you dislike exercising, you can find other ways to become more physically active: do your own housework, plant a garden, dance to your favorite music, park farther away from work, take the stairs instead of the elevator, or find a sport you enjoy.

Surgical and Medicinal Solutions. There are many different types of gastric bypass surgery, but all involve bypassing part of your small intestine. If you have gastric bypass surgery, you still need to eat a healthy diet and exercise. So looking to surgery as a quick fix, or fantasizing that you can put off changing your habits because excess fat can be magically eradicated only leads to disillusionment.

Types of bariatric surgery include gastric bypass surgery, gastroplasty, and gastric banding. Bariatric surgery is risky and may only be considered if you have a BMI of 40 or higher or if your BMI is 35-39.9 and you have a serious weight-related health problem, such as diabetes or hypertension. It should also be kept in mind that the failure rate of people who have taken the surgery route, along with the risk of serious surgical complications, is no small problem. Even a tiny stomach can hold enough food to lead to obesity if your unhealthy habits don’t change.

Prescription weight-loss medications may be used if you have a BMI of 30 or higher or if your BMI is 27 or above and you have an obesity-related condition, such as hypertension, diabetes, or abnormal blood fat levels. There are two main types of weight-loss medications: appetite suppressants and lipase inhibitors. Appetite suppressants help you to lose weight by decreasing your appetite or by making you feel more full. Lipase inhibitors are drugs that reduce (by about one third) your body’s ability to absorb fat from the food you eat. Current research seems to indicate, however, that weight loss is modest for those using such drugs, on average less than ten pounds.

We are still left with the role of decisions and conscious choices. Look to the National Weight Control Registry (NWCR)
The NWCR tracks people who have lost large amounts of weight—and kept it off. Here’s what participants in the Registry have done to lose an average of 66 lbs. and keep it off for an average of 5.5 years.

Physical activity
• 94% increased their physical activity (most frequently through walking)
• 90% exercise, on average, about 1 hour per day
• 62% watch fewer than 10 hours of TV per week

Diet
• 98% modified their food intake in some way to lose weight
• 78% eat breakfast every day

Keeping track
• 75% weigh themselves at least once a week

Group support
• 55% lost weight with the help of some type of program
• 45% of registry participants lost the weight on their own

Start Early to Prevent Obesity. It will always be true that losing weight is much harder than not putting it on in the first place. There is no safety zone that is immune to this fact. Children who are obese are at risk for heart disease, diabetes, and more at an early age. Children too easily model their habits on their parents’ habits, and thus the cycle of obesity is passed on from one generation to the next.

Society has given us ways to remain more sedentary as we become a culture dependent on computers and video games, added to our addiction to television and eating out. Stress mounts every year. All of these factors have one thing in common. They make us exchange conscious choices for unconscious habits. The solution is staring us in the face: reclaim your right to decide who you will be and how you will live. There are no other shortcuts, even though millions of people hope and pretend that there are. The good news is that a conscious lifestyle is not just the healthiest but the happiest.