Usually (although not always), prediabetes is associated with extra body fat. If you are overweight, losing even a few pounds can improve your health. As discussed in Chapter 1, the results of the Diabetes Prevention Program and other research studies tell us that weight loss can help prevent or delay the onset of type 2 diabetes.
If your goal is better health, you do not need to lose huge amounts of weight. Dropping a few pounds can have profound benefit. In a fascinating study among people at high risk for developing type 2 diabetes, losing only 5% of body weight (10 pounds for someone starting at 200 pounds) improved insulin sensitivity in the fat, muscle, and liver cells. This small weight loss also improved the function of the pancreas β-cells (the cells that produce insulin) and reduced the amount of fat in the liver. As weight loss continued first to 11% and then to 16% of starting weight, the participants experienced greater improvements. Their muscle cells became even more sensitive to insulin, they lost more fat from their livers, and the function of their β-cells improved even more. So even if you don’t see the positive effects of weight loss, they are likely occurring under the surface.
How Will Weight Loss Help You?
Preventing diabetes must be near the top of your list, but it’s unlikely to be your only reason to lose weight. The benefits are really too many to identify, but the following is a pretty good list. Spend a few minutes with it to find the reasons that are most important to you. You can create your list in your journal or a notebook or simply put a checkmark next to the benefits that matter most. Having a personalized list will help you with motivation, which commonly goes up and down and often without obvious reason. You will see that I’ve included benefits unrelated to your physical health. That’s because there are many powerful reasons to lose weight that are more emotional in nature.
• Lower insulin resistance, improve β-cell function, and reduce my risk for type 2 diabetes
• Improve my cholesterol and triglyceride levels
• Lower my blood pressure
• Reduce systemic inflammation, which is linked to chronic diseases like type 2 diabetes and heart disease
• Lower my risk for some types of cancer
• Improve sleep apnea
• Possibly reduce or discontinue some medications or prevent the addition of others
• Have less urinary incontinence
• Suffer less knee or back pain
• Increase fertility
• Feel more energetic
• Feel more confident
• Enjoy physical activity
• Enjoy shopping for clothing
• Be more comfortable crossing legs, sitting on the floor, etc.
• Improve sleep
• Be a good role model
• Other: ___________
• Other: ___________
• Other: ___________
When You’re DONE Trying to Lose Weight
I’ve known many people who have spent a lifetime trying to lose weight. They may have followed many strict diet plans to lose weight, only to gain it back when they end the diet. They repeat this cycle until they can no longer tolerate another weight loss plan. If your experience is similar and you’ve given up trying to lose weight, you can still benefit from living healthfully. Your weight is not everything when it comes to good health. While it is certainly important, there are many important lifestyle habits for you to focus your efforts and energy on. You’ll find them in each of the chapters of this book. Committing to healthful living and avoiding further weight gain are important and admirable goals. You may find that your motivation for weight loss inches upward as time goes on anyway. And if not, you’re still ahead by maintaining your current weight, being active, eating healthfully, tending to stress, and otherwise living healthfully.
Assessing Weight
Although we think of fat tissue as being inert blobs just sitting on our waist and hips, fat is actually very busy, metabolically speaking. Fat cells secrete hormones and other chemicals that create chronic low levels of inflammation. The amount of excess body fat you have is associated with your risk for prediabetes, type 2 diabetes, heart disease, gallstones, gastroesophageal reflux disorder, and some types of cancer.
There are several sophisticated ways to learn how much body fat you have, including magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry. These procedures are not practical for the average person and are typically reserved for research studies. When done properly, however, skinfold thickness measurements are very revealing. They are especially helpful as a tool to track your progress with a fitness or weight loss routine. If you belong to a gym or health club, there may be a trained fitness instructor capable of estimating your body fatness with skinfold measurements.
Health care professionals and researchers, however, typically assess weight with two quick measurements: body mass index (or BMI) and waist circumference.
Body Mass Index (BMI)
Body mass index is derived from a simple calculation based on your height and weight. It alone cannot identify your health risk or your level of body fatness. But it’s a pretty good tool to estimate your risk for weight-related health problems, including type 2 diabetes. In general, the higher your BMI, the greater your risk. BMI tends to overestimate body fatness in athletes and others who are very muscular, and it underestimates levels of body fat in individuals who have little muscle.
To quickly find your BMI, visit the website of the Centers for Disease Control and Prevention (CDC) or the National Heart, Lung, and Blood Institute (NHLBI). Both sites have BMI calculators that require nothing more than knowing your height and weight. You can also calculate your own with the following formula:
BMI = Weight in pounds/height in inches2 × 703.
Example: Bob weighs 200 pounds and is 5′10″ tall (70 inches tall). Bob’s BMI = 200/702 × 703 = 28.7 kg/m2. According to the chart below, Bob is classified as overweight.
How To Interpret Your BMI
The following chart is for adults only. For help in understanding your child’s BMI, talk to a health care professional.
It is worth noting that research suggests that Asian Americans have increased health risks beginning at a lower BMI. For this reason, some organizations classify a healthy weight for Asian Americans at a BMI of 18.5–22.9 kg/m2, an overweight BMI between 23 and 26.9 kg/m2, and an obese BMI at ≥27 kg/m2.
Waist Circumference
A second measure to categorize obesity and risk is your waist size. Excess body fat can land anywhere in the body, but research suggests that the fat around our midsections is especially harmful. The terms “belly fat” and “visceral fat” mean the same thing. Fat that accumulates around the internal organs can actually infiltrate these organs, causing fatty liver and excess fat in the pancreas, heart, and other organs not suited to fat storage.
How to measure your waist circumference
As a woman, I want to put my hands on the smallest part of my midsection and call that my waist. But this is not the proper location for an accurate assessment. My tape measure needs to be a bit lower. Follow these steps.
1. While standing, place a tape measure around your midsection directly above the tip of your hipbones.
2. Be sure that your tape measure is horizontal.
3. Breathe out normally and measure. Be careful that the tape measure is snug against your skin, but is not compressing your skin.
The NHLBI categorizes high risk as a waist measurement >40 inches for men and >35 inches for women. Interestingly, however, the American Institute for Cancer Research (AICR) finds that smaller waist sizes confer increased risk for many types of cancer. To lower the risk of a variety of cancers, the AICR recommends that men have waist sizes no larger than 37 inches and that women aim for waists of no more than 31.5 inches. And some ethnic populations may have an increased risk at even lower waist measurements. The Joslin Diabetes Center identifies target waistline goals for Asian American women at no more than 31.5 inches and no more than 35.5 inches for Asian American men.
Pick a Weight Loss Goal
Before vowing to reach your dream weight, consider all that you have just read. Any weight loss is better than none. Losing even as little as 5% of your starting weight has profound health benefits, as you saw in the study mentioned above. Plus, the amount of weight you keep off long term is much more important than the amount of weight you lose in the short term. I often tell my patients that I don’t care how much weight they lose; I care how much weight they keep off.
I encourage you to pick a modest weight loss goal. The goal for the DPP was to lose 7% of starting weight, but you should start with whatever reasonable goal you feel is right for you. Once you reach it, you can always pick a second goal, and then a third goal, and so on. Depending on many factors, including your starting weight and physical activity level, you will likely be able to drop 5–10% of your weight in 3–6 months. You can keep track of your weight on the chart on page 272 in Appendix B, in your journal, or on a smartphone app.
Weight Loss Basics
Just as I’ve said that there are many ways to a healthy plate, there are many ways to achieve weight loss. This chapter will review the basics. For individualized help, I recommend working with a registered dietitian nutritionist (RD or RDN). You can find one in your local area by visiting the website of the Academy of Nutrition and Dietetics (eatright.org) and entering your zip code after clicking on the “Find an Expert” tab.
Understanding Fats, Carbohydrates, Protein, and Calories
Fats, carbohydrates, and protein are macronutrients. Other than alcohol, these are the only nutrients that provide calories. Gram for gram, fat provides more than twice the calories of either protein or carbohydrate. There’s been a lot of debate over the years about which of these macronutrients should be restricted or emphasized in the diet to achieve the greatest weight loss. Some people have very strong opinions about low-fat or low-carb diets and can likely find good research to support their position. But there is research to support a variety of opinions. It’s important to look at the preponderance of the evidence before picking a side to stand firm.
When I look at the evidence as a whole, I see that a lot of diet types work. So much of it has to do with your preference. Generally, low-carb diets lead to more weight loss in the short term. But when studies last a year or longer, low-carb plans tend to produce no more and no less weight loss than other types of diets. The most important factor appears to be how adherent the dieter is to the plan. My preference is not to emphasize protein, fat, or carbohydrate. When we do so, I think we get lost in a bunch of gobbledygook that really makes no difference in the long run. I prefer instead to look at the food quality. That makes a difference in the short term and the long term. I emphasize fruits, vegetables, legumes, and whole grains over pretzels, white bread, soda, cookies, and toaster pastries—although all are rich in carbohydrates. When it comes to fats, I encourage foods rich in unsaturated fats like nuts, liquid oils, fatty fish, and avocado over butter, bacon grease, fatty meats, and baked goods, which are all sources of less healthful saturated fats. And when it comes to protein sources, I emphasize those that are lean, such as skinless poultry and low-fat dairy; contain heart-healthy fats, such as salmon and tuna; and are plant-based, such as lentils, tofu, and kidney beans. The truth is, most foods are sources of more than one of these macronutrients. For example, black beans provide both carbohydrates and protein. And salmon is a source of both protein and fat. Even olive and peanut oils, rich in unsaturated fats, contain some saturated fats, too. Without focusing on one macronutrient over another, it’s possible (and easier) to choose nutrient-dense, disease-fighting foods.
The Macronutrients
Macronutrient |
Notes |
Carbohydrate Fiber: A type of carbohydrate with many physiological benefits, including for colon health, cholesterol metabolism, and glucose metabolism. Sugar: Small carbohydrate molecules, found naturally in fruit, vegetables, and milk. Excessive added sugars are a problem for health. Starch: Larger carbohydrate molecules found in grains, legumes, and some vegetables. |
Provides 4 calories per gram (except for fiber and sugar alcohols). Only carbohydrate-containing foods contain dietary fiber. Carbohydrates have a greater effect on blood glucose levels after a meal compared to fats and protein. |
Fat Polyunsaturated fat: A type of unsaturated fat that when consumed in place of saturated and trans fats provides health benefits. It is common in nuts, salad dressings, and fatty fish. Monounsaturated fat: A second type of unsaturated fat that when consumed in place of saturated and trans fats confers health benefits. It is common in olive and canola oils, olives, and avocados. Saturated fat: Tends to raise LDL (bad) cholesterol levels and may increase insulin resistance. Saturated fat is found in animal fats, dairy fat, and solid and semi-solid fats like coconut oil and other tropical oils. Trans fat: A type of unhealthful fat that is linked to heart disease and type 2 diabetes. It’s created when food manufacturers partially hydrogenate oils to make packaged foods more shelf-stable. Trans fats may also be in fried foods. |
Provides 9 calories per gram. Consuming fat with your meals helps you absorb fat-soluble vitamins and phytonutrients. Experts recommend consuming only 5–10% of total calories from saturated fats, which could be as little as 8 grams daily on a 1,400-calorie diet and as much as 22 grams daily on a 2,000-calorie diet. Try not to eat factory-produced trans fats, and avoid anything with partially hydrogenated oils. |
Protein Protein is made up of essential and nonessential amino acids. The greatest sources of protein are all types of meat, milk, yogurt, cheese, and legumes. Vegetables, nuts, and grains also provide some protein. |
Provides 4 calories per gram. Of the three macronutrients, protein tends to help control appetite best. Recent research tells us that spreading protein out over the day helps with body composition. Instead of eating small amounts at breakfast and lunch and piling on the protein at dinner, eat more moderate portions at each of your three meals to better stimulate muscle synthesis. |
Calories Do Count
Without burning more calories than you consume, you cannot lose weight. There is a big difference in healthfulness between weight loss diets that consist primarily of lollipops and gumdrops and those consisting of a variety of whole foods. But even the unhealthful diet will result in weight loss if the calories are low enough. Indeed, we have seen the results of such a diet in the media when a university professor put himself on a calorie-restricted diet that contained little more than snack cakes, chips, cookies, and sugary cereals. Because he kept his calorie intake to less than 1,800 per day, he lost a significant amount of weight in just 2 months. The media also reported on a high school teacher who subsisted on a variety of foods from McDonald’s for 6 months and lost more than 50 pounds. These stories demonstrate that calories do indeed count.
This does not mean, however, that you need to count calories to make them count for you. You can trim calories from your diet and burn a few more during physical activity without ever having to count them. Most of my own patients and clients find that it’s helpful to get an idea of where their calories come from, so they may keep a calorie tally for a few days or longer. Others just need a ballpark idea.
While there are sophisticated formulas to estimate your calorie needs, you probably don’t need to break out your calculator. I favor the approach researchers took in the large federally funded Look AHEAD (Action for Health in Diabetes) trial, a weight loss study among people with type 2 diabetes. They didn’t use formulas or any fancy algorithm. They simply assigned a range of 1,200–1,500 calories daily to individuals weighing less than 250 pounds and a range of 1,500–1,800 calories daily to individuals who started the program weighing more than 250 pounds. If you are very active, you likely need more calories than if you are sedentary or only moderately active, so keep that in mind. For something more individualized, check out the Adults Energy Needs Calculator on the website of Baylor College of Medicine (https://www.bcm.edu/cnrc-apps/caloriesneed.cfm). You can also work with a registered dietitian nutritionist.
Metabolic Rate
Your metabolic rate is the rate at which your body uses calories. You will lose weight when you consume fewer calories than your body uses. Weight loss really is a numbers game. Unfortunately, the numbers game is complicated, so weight loss is rarely in a straight line. There is much about the body that we don’t understand. We don’t know why some people can cut calories and lose more weight than another person who appears to trim calories similarly. We don’t fully understand why sometimes lost weight so readily comes back. And we don’t know why some people boost exercise, consume fewer calories, and appear resistant to weight loss. There are hormonal changes, metabolic adaptations, and unknown factors that occur with weight loss or food restriction that make it harder for some people to lose weight and maintain that weight loss.
But we do understand what metabolic rate is, and there are three components to it:
1. Basal metabolic rate. This is the largest portion of your metabolic rate, accounting for about two-thirds of your daily calorie expenditure. These are the calories used to keep you alive and tend to basic bodily functions like breathing, maintaining body temperature, circulating blood, and repairing cells. Your weight and body composition drive your basal metabolic rate. The bigger you are, the greater your basal metabolic rate. When you lose weight, your basal metabolic rate drops.
2. Food processing. It takes calories to digest, absorb, and assimilate nutrients from food. This smallest component of your metabolic rate is referred to as the thermic effect of food (TEF). Contrary to some information, you do not burn more calories through the TEF by eating more often. The TEF is related to what you eat, not how many times you eat. If, for example, you consume 1,500 calories in three meals per day or eat that same food over six meals per day, your 24-hour metabolic rate will not differ.
3. Physical activity. You have the most control here. The more active you are, the more calories you burn. Activity includes both exercise for the purpose of exercise and physical activities of daily living—things like folding laundry, walking to answer the phone, fidgeting, etc.
Do Metabolism Boosters Work?
You’ve probably seen a long list of foods or tricks that supposedly rev your metabolic motor. Some are downright false. Others cause such a tiny spike in metabolic rate that they become more of a distraction to establishing healthful habits than a benefit to a weight loss plan. In short-term studies, both caffeine and spicy peppers boost metabolic rate slightly, but neither one has demonstrated long-term weight loss. When you drink very cold water, the body uses about an extra 12 calories to warm it up. That’s hardly enough to force yourself to drink icy water. Eating extra protein, sipping green tea, and taking supplements all make the list of diet tricks. Unfortunately, weight loss supplements are often dangerous, so I do not recommend them ever. The others are typically minimally helpful at best. My biggest gripe with these “metabolism-boosting tricks” is that they steer energy, focus, and effort to all the wrong places. Skip these time-wasters. You are much better off putting effort and time into meal planning, physical activity, visiting a farmer’s market, and eating mindfully.
Be Calorie Aware
If you choose to count calories for a few days or longer, you’ll need to read food labels, use measuring utensils, have a calorie database at your fingertips, and do a bit of math. There are many suitable calorie databases available, including the app LoseIt. When I’m looking for specific restaurant information, I use my web browser to search for the name of the restaurant and the word nutrition. For example, you’ll find what you want to know about your food at Panera Bread by searching for “Panera Bread nutrition.” Do the same for any chain restaurant.
Even if you choose not to track and record your calorie intake, it’s still important to be aware of calories. Say your goal is to eat about 1,500–1,800 calories per day. It’s smart to identify foods in your diet that are high in calories and low in calories. Make an effort to eat more that are low and fewer that are high. When you read a food label or look up a food in your database, ask yourself how does it fit into a healthful 1,500- to 1,800-calorie eating plan. That candy bar may not be delicious and satisfying enough for 240 calories once you learn that you can eat 3 chocolate kisses and a cup of light yogurt for fewer calories—and more nutrition.
Use Food Labels for Calorie Information
Don’t confuse the serving size on a food label as your portion size. You may serve yourself more or less food than the amount shown on the label as a single serving. The example above is fairly simple because you can count the exact number of crackers you eat. Sixteen crackers give you 260 calories. Eating only 4 crackers means you consume only 65 calories. And my calculator tells me that 10 crackers serve up about 163 calories. Consider how the total amount of calories in your portion of food fits into your total calorie allotment.
It’s not so easy to determine the portion size of most foods. You’ll need measuring cups for juice, soup, rice, and more. And you’ll need measuring spoons for cooking oils, salad dressings, and other condiments. A food scale may also be helpful.
Be Portion Savvy
I always say that nearly any food can fit into a healthful eating plan if the portion is small enough. I also warn my patients that even the most healthful foods can’t be eaten in unlimited quantities. Brown rice, nuts, and salmon are all wholesome, health-boosting foods, but if you ate them with abandon, you’d likely pack on some weight. Try these 11 portion control strategies.
• Use small dishes. Your smaller portions won’t look so tiny on a small plate or bowl. Serve lunch and dinner on 9-inch plates. Ladle hearty soups into cups that hold about 1 cup and brothy soups into bowls that hold slightly more. Look for 1/2-cup dishes for ice cream and other desserts.
• Purchase portion-control dishes. Portion-control dishes are easy to find in department stores, online, and in discount stores. With their innovative designs, they guide you to serve up the perfect portion. A few to look for include Fit & Fresh, Livliga, Precise Portions, and Slimware.
• Weigh and measure everything you eat for 5–7 days. Weighing and measuring your portion sizes will give you a sense of the amount of food you eat. Then each month, periodically weigh and measure everything again for a day or two to ensure that a 1/3-cup serving hasn’t expanded to 1/2 cup and a 1-cup serving didn’t grow to 1 1/2 cups. Recently, a patient reported sticking to her calorie goal, but admitted to not measuring her foods. When her weight didn’t budge, she agreed to measure everything for 1 week. That’s when her weight came down. She was eating more than she realized.
• Treat yourself to foods in single-serving portions. Skip the half-gallon containers of ice cream in favor of ice cream bars or sandwiches. Better yet, treat yourself now and then to a small cone or cup at a local ice cream parlor.
• Pre-portion tempting foods. Place crackers, chips, nuts, cookies, and other tempting foods into small containers or baggies to make selecting the proper portion completely effortless.
• Ask for help. I nearly always have someone else serve me dessert, so I’m not tempted to take a large portion. I also frequently ask my daughter to frost birthday cakes to help keep me off chocolate frosting until it’s time to cut the cake.
• Eat only from a dish. No reaching into a bag or a box and eating some unknown amount. Put a measured amount of food into a bowl, onto a plate, or even onto a napkin.
• Serve dinner from the kitchen counter. By serving meats and starches from the counter instead of the table, you deter second helpings. On the other hand, leave fruits and vegetables in easy-to-reach places to encourage eating more of these foods.
• Fill up on low-calorie foods. With more vegetables satisfying your appetite, you’ll have less need to eat large portions of higher-calorie foods.
• Eat fruits and vegetables at every meal and snack.
• Enjoy a glass of tomato or vegetable juice before a meal.
• Start your meal with a broth-based soup, a low-calorie vegetable salad, or a few steamed shrimp.
• Slow down. Sip water; enjoy the conversation; focus on the flavors, textures, and aromas of your food; put your fork down between bites; or use small utensils like an espresso spoon to eat ice cream, yogurt, and puddings.
• Try a low-calorie, portion-controlled meal. Research shows that meal replacements and portion-controlled meals can help with weight loss. Eating them now and then can help you relearn appropriate portions. Add a salad, some vegetables, or both to give you more nutrition and help you feel full longer. Here are a few guidelines (not hard and fast rules) to help you pick a prepared meal.
• No more than 400 calories, 3 grams saturated fat, and 600 mg sodium
• No trans fats at all
• At least 3 grams fiber, but preferably 5 or more
• At least 14 grams protein, but 25 is better
Know Your Hunger
A lot of things trigger us to eat and to overeat. Maybe you’re in the habit of having a snack when your kids come home from school. Watching TV commercials about food sends some people to the kitchen. And simply seeing candy in a candy dish prompts others to eat. Or happy, sad, or uncomfortable feelings provoke eating. Ideally, we eat to satisfy our hunger or to prevent being over-hungry later. For example, if dinner will be late, I often eat a snack around 5:00 P.M. when I break from my work. A piece of fruit, some reduced-fat cheese, or leftover vegetables give me a nutritional boost and keep me from being ravenous later.
To help you recognize your hunger and fullness signals and to help you learn the appropriate amount of food to eat, experiment with the Hunger Ruler below. Before, during, and after your meals, record the number that corresponds to your hunger. It’s good to start your meal when you are a bit hungry (level 3 or 4) and stop eating when you are no longer hungry and just full enough (level 6).
Hunger Ruler
1. Starving and irritable; being this hungry is painful
2. Very hungry, uncomfortable, and loud rumblings in your stomach
3. Hungry; wanting to eat
4. Just a little hungry
5. Neither hungry nor full
6. Just at that point of fullness; perfectly content
7. Just beyond fullness; you’ve had enough but could find room for a few more bites
8. Uncomfortable; wish you hadn’t had those last few bites; want to wear only loose clothing
9. Very uncomfortable and bloated
10. So full that it feels like Thanksgiving
Your notes might look something like this:
Before eating: 3
10 minutes into my meal: 4
After eating: 6
Think Before You Drink
It’s easy to mindlessly sip extra calories. Nearly zero-calorie coffee and tea balloon to hundreds of calories if you add syrups and cream. A single can of soda or glass of sweet iced tea provides about 150 calories. Fruit juices also have lots of calories, so pay attention to your serving size. A 4-ounce glass of juice is the equivalent of a small piece of fruit. Alcohol provides a double whammy of calories because alcoholic beverages contain calories, plus they cause lots of us to lose our inhibitions and eat more food than we would otherwise. Some good beverage choices are these:
• Water
• Unsweetened tea and coffee
• Tomato and vegetable juice
• Small glass of 100% fruit juice
• Low-fat and nonfat milk and soymilk
• Unsweetened plain or flavored sparkling water or seltzer
• Seltzer water with a splash of your favorite fruit juice
• Water infused with your favorite flavors such as cucumber and mint or blueberries and lavender
4 ounces lean roast beef: 200 calories
1 cup roasted broccoli prepared with olive oil: 71 calories
½ cup brown rice: 108 calories
Sliced tomato: 22 calories
Zero-calorie flavored seltzer: 0 calories
Total Calories: 401
6 ounces mostly lean roast beef: 277 calories
½ cup roasted broccoli prepared with olive oil: 36 calories
1 cup brown rice: 216 calories
12-ounce glass of fruit punch: 195 calories
Total Calories: 724 calories
Monitoring Your Weight
For most people, I favor self-weighing. But it can have disastrous effects for some. If you stand on the scale and use the number—whatever that number is—as information and feedback to your weight control efforts, then weighing is a good idea. But if the number affects your mood and if it offers judgment instead of information, don’t weigh yourself. The number on the scale cannot tell you a thing about your worthiness. It should not tell you that it’s a good day when you like the number and that it’s a bad day when you’re displeased with the number. It’s a number. That’s all it is. Don’t allow it to affect your self-esteem.
If you choose to weigh yourself, check the reliability of your scale. Stand on it three times without changing clothes, drinking water, or using the bathroom. Your scale is reliable enough if it gives the same number within 1 pound or so with each of the three tests. So if your scale weighs you at 177, 179, and 175, it’s unreliable. Either purchase a more reliable scale or plan to weigh yourself at the gym or the doctor’s office. Check your weight weekly or even more often. This way, you receive feedback for your plan and you can adjust your diet and exercise routine as necessary. But if the scale becomes a source of anxiety, weigh yourself less often or not at all. If you’re trying to maintain your weight, I recommend weighing yourself very often, so you can catch small gains before they become unmanageable.
Some reasons your weight may be elevated
The most obvious reason is that you’re eating more calories or burning fewer calories. But the obvious answer isn’t always the right answer. Sometimes the reason your weight is up a pound or two overnight has nothing to do with gaining fat. Here are some other reasons:
1. Your sodium intake is up. If you’ve eaten out more than usual where high-sodium fare is the norm or had extra-salty meals at home, your body will hold more fluid.
2. You added carbohydrates to a typical low-carb diet. If your body is used to subsisting on a fairly low carb intake, eating more carbs causes more glycogen and water storage.
3. You haven’t had a bowel movement.
4. Hormonal changes. A woman can expect to see a couple pounds of fluid changes because of her menstrual cycle.
Keep a Food Record
People who keep food records tend to lose more weight than people who don’t keep food records. And those who keep the most food records lose the most weight. Recording your food choices increases your awareness and makes you accountable to yourself. Feel free to use a notebook, a journal designed for tracking food intake, a computer spreadsheet, or a smartphone app. Below is an example of a food record, and there is a blank template in Appendix B on page 273.
Today’s goal: Eat fruit and/or vegetable at each meal and snack
Here are some tips to make the most of your food record.
• Make it convenient. Decide if you’ll do better electronically or with old-fashioned paper and pencil. Regardless, your record needs to stay with you, so keep that in mind.
• Identify what you need to record. If you’re trying to get a handle on emotional eating or mindless eating, you’ll benefit from including your location, activities, and emotions when you eat. If you’re tracking calories, add that to your food record. Make it easy on yourself by recording only what’s important to you. For that matter, if you have breakfast and lunch under control, make notes for dinner and snacks only.
• Record throughout the day. If you keep track of your food as you are about to eat it or at least immediately after eating it, you have a chance at this meal or the next one to alter your behavior. On the other hand, if you sit down at the end of the day to report back what you ate, you’ve lost all opportunity for immediate feedback and a chance at rectifying poor decisions.
• Be honest and thorough. Sometimes people choose not to keep a food record on the days they don’t eat according to plan. This practice is definitely unhelpful.
• Record beverages and nibbles. They add up. Once I helped a young mom identify that she was eating a few hundred calories extra every day by taking bites from her children’s plates. Once she nixed that, she dropped 10 pounds pretty quickly.
• Reflect daily. Give your food record an honest appraisal daily, and use your assessment to set a SMART eating goal for tomorrow. Choose something that you want to continue to do well or something that you want to do better. In the example above, the writer set the goal to eat fruits, vegetables, or both at each meal and snack.
• Reflect weekly or monthly. Make note of the positive changes you’ve achieved over time. Take a few minutes to feel the pride. Then vow to continue.
Steer Clear of Dubious Weight Loss Programs
There is lots of money to be made in weight loss programs and supplements. Because of this, there are plenty of unscrupulous people selling unhelpful and potentially dangerous programs and products. Generally, if something sounds too good to be true, it probably is. In fact, one study found that herbal and dietary supplements cause about 20% of liver toxicity cases. Keep in mind that if there were easy ways to lose weight, very few people would be overweight. Both losing weight and keeping weight off are hard. Watch out for weight loss programs with these red flags:
• They tell you that diet and exercise don’t matter. Or they say that calories don’t count.
• They claim that the program or product works for everyone. They don’t consider your preferences, health status, and individual needs.
• You’re instructed to eliminate a large list of foods or whole food groups.
• The program comes with a long list of diet rules.
• They promise very large weight loss or very rapid weight loss.
• They tell you that the weight loss is permanent.
• The “proof” of success is based on before and after photos and testimonials from dieters.
• They use sensational words like “breakthrough,” “secret formula,” and “miraculous.”
• The program is expensive, or they tell you that you must sign up right away because the price is about to increase.
Medical Weight Loss Treatments
If your risk for obesity-related health problems is very high, you may want to discuss various medical treatments with your health care provider.
Medications
There are several prescription weight loss medications available that help people lose weight when added to lifestyle changes. Most are pills that help suppress appetite. One drug (orlistat) inhibits fat digestion and absorption. Another weight loss medication (liraglutide) is a higher dose of a diabetes drug and is taken by injection. It keeps food in your stomach longer and helps you feel less hungry. Depending on the specific drug, participants in weight loss studies dropped an average of 4–14% of their starting weight after 1 year. While this is probably not enough to bring many people to their dream weights, this amount of weight loss is quite beneficial to health.
Weight Loss Surgery
Weight loss surgery, also called bariatric surgery or metabolic surgery, is a tool typically reserved for individuals with a BMI above 40 kg/m2 or with a BMI above 30 kg/m2 plus significant obesity-related health conditions or complications such as poorly controlled type 2 diabetes. There are different types of bariatric surgery, and each has a different average weight loss and different advantages and disadvantages. According to the Obesity Action Coalition, most people undergoing metabolic surgery will lose 10–35% of their presurgery weight within 2–3 years of the procedure. Some surgical procedures affect gut hormones that reduce appetite. Others do not. Even before much weight loss has occurred, some types of metabolic surgery result in better blood glucose control.
Weight Loss Devices
These devices are approved by the U.S. Food and Drug Administration to treat obesity.
• A gastric balloon is placed in the stomach to take up space and increase feelings of fullness with less food.
• A gastric emptying system involves placing a tube between the stomach and the outside of the abdomen to drain part of a meal after eating.
Each medication, type of surgery, and medical device comes with risks and potential side effects. Have a thoughtful conversation with your health care provider to ensure you make a wise and careful decision about the best treatment options for you.
Be Empowered
• Using the list on page 66, identify your motivators to lose weight.
• Select a reasonable weight loss goal.
• Identify a reasonable daily calorie range and at least three steps to achieve it.
• Create SMART goals around calorie-saving strategies.
• Keep a food record.
• If appropriate, initiate a conversation with your health care provider about medical weight loss strategies.