OUR WEIGHT AFFECTS OUR HEALTH, how we look, and our ability to move; and it can affect how we feel about ourselves. Too much weight contributes to arthritis from too much joint stress, diabetes from high blood sugar, and high blood pressure. Being underweight can weaken our immune system and make us less able to fight infection. Being underweight can also increase our likelihood of developing osteoporosis (thin bones), and in younger women it could affect fertility and result in menstrual problems. Thus being either overweight or underweight can have major effects on your life.
Special thanks to Bonnie Bruce, DrPH, RD, for her help with this chapter.
Being at a healthy weight can help us have better health and a better quality of life. It can help us manage symptoms such as lack of energy, joint pain, and shortness of breath. It can help us prevent or hold off related health problems such as diabetes and high blood pressure. In addition, maintaining a healthy weight can help you be more active and sleep better. In general, it can help you be able to do the things you want and need to do. In this chapter we spell out the truth about what defines a healthy weight, how to make changes, how to decide whether you should lose or gain weight, and how to maintain changes you make.
Most people’s weight tends to shift up and down over time, even over the course of a few days. So a healthy weight is not just one specific number on the scale or some sort of “ideal” number. There is no such thing as an “ideal” weight. A healthy weight is a range of pounds that is unique and personal. It is a range that will help you lower your risk of developing or further worsening health problems and help you feel good in your mind and your body.
Pinpointing your healthy weight range and deciding whether you want or need to change your weight depend on several things. These include your age, your activity level, your health, how much and where your body fat is located, and your family history of weight-related health problems, such as high blood pressure or diabetes.
To get a sense of a healthy weight range for you, look at Table 12.1 from the National Institutes of Health. It will give you your body mass index (BMI). Although not a perfect tool, the BMI is a useful, quick, and general guide for adults based on weight and height. For many people it relates to total body fat and health risks. In the table, simply find your height and follow that line to your weight. The heading on that column above your weight will give you your BMI. Then refer to Table 12.2, which tells you in BMI units the range where your current weight falls.
Another way to judge your weight is to use this rough rule of thumb. Give or take 10%, women should weigh about 105 pounds for the first 5 feet of height and another 5 pounds per inch after that; men should weigh about 106 pounds for the first 5 feet and an added 6 pounds per inch. For example, for a woman who is 5 foot 5 inches tall a healthy weight would be 125 pounds, and her healthy weight range would be roughly 112–138 pounds. Note that this weight range places her in the BMI “normal weight” class.
Table 12.2 Weight Classifications Based on Body Mass Index
Another way to judge your weight is to measure the distance around your waist (your “waist circumference”). If you are overweight and most of your body fat is around your waist (rather than on hips and thighs), you are at higher risk for heart disease, high blood pressure, and type 2 diabetes. For non-pregnant women, this means that health risks go up with a waist size that is more than 35 inches (88 cm). For men, this is a waist circumference that is greater than 40 inches (100 cm). To measure your waist correctly, stand and place a tape measure (one that is not old and stretched out) around your bare middle, just above your hipbone. Measure your waist just after you breathe out.
Reaching and maintaining a healthy weight may mean that you will need to make some changes in your eating habits and lifestyle. This is true whether you want to gain or lose weight. Now for an important bit of advice: you must decide to do this for yourself—not for friends or family. Make changes that you believe you can stick with for a long time. If you decide to make changes for someone other than yourself or plan for only short-term changes, you probably won’t succeed.
To get started, review the information about action planning in Chapter 2. If you think that you want to change your weight, consider asking your doctor to refer you to a registered dietitian for help. This is not something you need to do alone.
When making this decision, you must ask yourself two primary questions:
Why do I want to change my weight? The reasons for losing or gaining weight are personal and different for each of us. The most important reason for some may be physical health, but for others there may be personal or emotional reasons for wanting to change. To help you begin and to increase your chances of success, think about the reasons that make you want to gain or lose weight. Here are some examples:
To improve my symptoms (pain, fatigue, shortness of breath, and so on)
To manage my blood sugar
To have more energy to do the things I want to do
To feel better about myself
To change the way others think of me
To feel more in control of my health or my life
Jot your important reasons here:
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Am I ready to make lifelong changes? The next step is to find out whether this is a good time for you to start making changes in your eating and exercise. If you are not ready, you may be setting yourself up for failure. But the truth is that there will likely never be a “perfect” time. So take a look at your situation to see how things can work for you.
Consider the following:
Is there someone or something that can be supportive and make it easier for you to begin and continue with your changes?
Are there problems or obstacles that will keep you from becoming more active or changing the way you eat?
Will worries or concerns about family, friends, work, or other commitments affect your ability to carry out your plans successfully at this time?
Use Table 12.3 on page 206 to help you identify some of these factors. If you find barriers, use some of the problem-solving tools found in Chapter 2.
After you have thought about these issues, you may find that now is not the best or right time to start. If it is not, set a future date to revisit things. In the meantime, accept that this is the right decision for you at this time, and focus your attention on other goals. If you do decide that now is the right time, start by changing the things that are simplest, easiest, and most comfortable for you, using “baby steps.” This means working on only one or two things at a time; do not try to do too much too quickly. Remember, slow and steady wins the race.
Table 12.3 Factors Affecting the Decision to Gain or Lose Weight Now
A good starting point is to keep a diary of what you eat now and how much you exercise. Do this for a week. It will help you learn where you need to make changes. Write down:
What you eat and where you are eating
Why you are eating (are you hungry or just eating because you are bored?)
How you feel when eating (your mood or emotions)
Your exercise (what you are doing or not doing now)
You might also have a section in your diary for ideas about what you would like to do differently. Don’t worry; if all your ideas don’t work out right away, you can always go back to them. Our sample lifestyle tracking diary (see Table 12.4 on page 208) may be useful.
Two important ingredients for successfully changing your weight are to start small by taking “baby steps” and to make changes that you know will work. Whether you want to lose or gain weight, there is no getting around it; most people will need to change the amount and perhaps the way they eat. This may seem scary or even impossible, but by starting with things that are doable, you will be successful. This could mean that if you want to lose weight you will need to eat a little less or if you want to gain weight eat a little more. For instance, instead of eating ½ cup of rice, eat a few tablespoons less or a few tablespoons more. To help you eat less, try slowing down how fast you eat; to help you increase calories, spread out your eating over several small meals a day.
When you find things you want to change, start by choosing only one or two things at a time. Yes, we said this before but it is really important. Allow yourself time to get used to these changes and then slowly add more things you want to change. If you tell yourself you are going to walk 5 miles a day every day of the week and never eat potatoes or bread again, you won’t be able to stick with that for very long. It is likely you won’t lose weight, and you will feel frustrated and discouraged. But if you make a plan to have only one piece of toast at breakfast instead of two pieces and take two 10-minute walks 4 times a week and stick to it, you will be making good, long term changes that will lead you to success.
When you change your weight slowly over time, you have a better chance of maintaining that change. This is partly because your brain begins to recognize the changes you are slowly making as part of your regular routine or habit and not just a passing fad. The goal-setting and action-planning skills discussed in Chapter 2 will help with this. Remember, the best plan combines healthy eating and exercise and is a slow, steady plan that feels right to you.
A simple and practical plan to get you started is the 200 Plan. It involves making small daily changes in what you eat and in the amount of physical activity you do. You change what you do by 200 calories a day, which can add up to a 20-pound weight change over a year. The 200 Plan is a good way to balance eating and exercise and helps you make a long term change in your weight.
Table 12.4 Lifestyle Tracking Diary
In a few words, to lose weight, eat 100 fewer calories a day than you do now and burn off 100 calories a day more with extra exercise. If you would like to gain weight, add 100 calories while keeping your exercise level at the recommended 20 to 40 minutes most days of the week. Sticking to this kind of plan on a daily basis is essential for success.
Start by checking out the food guide on pages 186–192 which gives estimated serving sizes and calories. For example, you can see that a 1-ounce slice of bread has close to 100 calories. By not eating one of the slices of bread on your sandwich, right there you have cut out close to 100 calories. To easily eat 100 calories more, add about 2 tablespoons of nuts to your food intake over the day.
Add 20 to 30 minutes to your regular exercise routine, which could be walking, bicycling, dancing, or gardening. Take the stairs more and park farther away from the store or work. If time is an issue, doing your exercise in three 5 to 10-minute chunks of time over the day works just as well as doing it all at once.
Exercise can help you lose weight and keep it off. But it is very difficult to exercise enough to lose weight without also changing what you eat. Adding aerobic or cardio exercise is the best for weight loss. This is the kind of exercise that gets your heart pumping: walking, jogging, bicycling, swimming, and dance all do the trick. These kinds of exercises help you lose weight because they use the large muscles in the body that burn the most calories. The exercise guidelines (see Chapter 8) to get 150 minutes of moderate or brisk aerobic activity a week are the same for general health, weight loss, and keeping the weight off. Exercising in 10-minute bouts works as well as longer workouts. If you can add more minutes, that is even better.
It is true that the more calories you burn up with exercise, the more weight you can lose. However, that is only one part of the story. It is important to understand that the most success comes from making exercise and eating changes that become part of your daily life.
When you add more exercise to your routine, be honest with yourself about what you can do and what is safe and enjoyable for you. If you try to exercise too hard or too long for your body and health, you are more likely to have to stop because of an injury, fatigue, frustration, or loss of interest. The truth is that whatever you do to increase your physical activity to burn more calories will be helpful only if you do it regularly and at a pace that is good for you.
Some people become discouraged after awhile. The pounds may not melt off right away, or weight loss may stop. This may be true even if someone is still exercising and being careful about what they eat. There are many reasons why weight loss slows. Exercise may be building muscle as well as reducing fat. Muscle weighs more than fat, so you could be losing fat but the scale is not showing it. If you keep track of body measurements such as waist and hips or notice that your clothes fit better or are looser, this can be a signal that exercise is working. And remember, when you exercise regularly, even if you don’t lose weight, you are doing good things for your body. Regular aerobic exercise can help give you more energy and help a person who is pre-diabetic avoid diabetes. It can reduce blood glucose and blood fat (triglyceride) levels, increase good cholesterol, reduce risk of heart disease, and help with depression and anxiety.
Many studies show that eating fewer calories and being physically active are both important for successful weight loss. Just eating less is usually not enough. Being active will not only help you burn calories, but it will also help you build muscle (which burns more calories than fat) and give you more strength and zip. You will be able to move and breathe better, and your energy level will increase. You will find more information about exercise and tips for choosing activities that suit your needs and lifestyle in Chapters 6 through 8.
Set small, gradual weight loss goals. Break the total amount of weight you want to lose into small, reachable goals. Think in terms of, say, 1 to 2 pounds a week or 5 to 7 a month instead of looking at the total number, especially if you have a lot of weight you would like to lose. For most people, aiming to lose 1 to 2 pounds (0.5–1 kg) a week is realistic and doable. When you set small goals rather than large ones—say 5 pounds instead of 20 pounds—your goals become more possible and practical.
Identify the exact steps you will take to lose your weight. For example, walking 20 minutes a day 5 days a week, not eating between meals, and eating more slowly.
Keep on top of what is happening. Keep track of your weight on a schedule that works for you. Some people decide that when they regain say, 3 pounds, it is a signal to get back into action.
Think long-term. Instead of “I really need to lose 10 pounds right away,” tell yourself, “Losing this weight gradually will help me keep it off for good.”
Be “in the present” when you eat. By focusing on what you are eating and not what you are doing (such as watching television), you will more likely really enjoy the food, become satisfied sooner, and eat less.
Eat more slowly. If you take less than 15 or 20 minutes to eat a meal, you are probably eating too fast and not allowing yourself to feel the enjoyment of eating. You may be surprised to learn that many of us can both enjoy food more and eat less simply by eating more slowly. If you find it hard to slow down how fast you eat, try putting your fork down on the table between bites, and pick it up only after you have swallowed the food.
Become keenly aware of your stomach. Learn to become aware of when your stomach is just starting to feel full and to stop eating as soon as you get that signal. This will take attention and practice. When you do recognize the feeling of becoming full, remove your plate immediately or get up from the table if you can.
Portion out your food. Especially when first starting to make changes, measure out your portions—and do this frequently over time. It is amazing just how easily ½ cup of rice can “grow” to a 1-cup serving. When you can, use food products that are already in single-size portions.
Choose smaller portions. When eating away from home, select appetizers or first courses over main entrees, or order a child’s meal. This will help you eat fewer calories. Over a year, it takes only an extra 100 calories a day to put on 10 pounds. This is like eating only an extra third of a bagel a day. There are many published ranges of recommended serving sizes for different foods. The food guide on pages 186–192 lists some common serving sizes for a variety of foods, along with information on selected nutrients.
Clock yourself. Make it a habit to wait about 15 minutes before either taking another portion or starting to eat dessert or a snack. You’ll often find that this is enough time for the urge to eat or to continue eating goes away.
“I need to lose 10 pounds in the next 2 weeks.
I want to look good for a special event.”
Sound familiar? Almost everyone who has tried to lose weight wants it off fast. There are hundreds of weight loss diets promising fast and easy ways to lose weight. However, these promises are false. There is no “magic bullet.” If it sounds too good to be true, it probably is.
During the first few days of almost any weight loss plan, your body loses mostly water, along with some muscle. This can amount to 5 or even 10 pounds. Because of this, fad, and fast-weight-loss diets can say they are successful. But the pounds come right back on just as soon as you return to your old ways. Also, when you use fad diets, you may experience light-headedness, headaches, constipation, fatigue, and poor sleep, as such diets are often badly imbalanced in the kinds and amounts of foods allowed. Fat loss, what you really want to lose, typically comes about after a few weeks of eating fewer calories than your body needs.
Rather than wasting time with fad diets, do it right. Set small, realistic goals; do action planning; and use positive thinking and self-talk. (These activities are discussed in greater detail in Chapters 2 and 5.) The weight didn’t go on overnight. It won’t go away overnight.
“I just can’t seem to lose those last few pounds.”
Almost everyone reaches a time where weight loss stops (a plateau) despite continued hard work. This is frustrating and often makes us want to give up. Plateaus are often temporary. They can mean that your body now needs fewer calories and has adapted to its lower calorie intake and higher activity level. While your first impulse may be to cut your calories even further, this could actually make your body burn fewer calories, making more weight loss even harder.
This is a good time to ask yourself how much of a difference those last 1, 2, or even 5 pounds really makes. If you are feeling good and doing well with your blood sugar or cholesterol or other health issues, chances are you may not need to lose more weight. If you are relatively healthy, staying active, and eating a healthy diet, it is usually not bad to carry a few extra pounds. Also, you may have replaced some of your body fat with muscle, which will weigh more than fat—a type of weight gain that is good. However, if you decide that those pounds must go, try the following tactics:
Instead of focusing on weight loss, focus on staying at the same weight and not gaining any weight for at least few weeks; then go back to your weight loss plan.
Increase your physical activity. Your body may have adjusted to your lower weight and therefore needs fewer calories, so you may need to exercise more to burn more calories. Adding more exercise could help kick-start your body into burning more calories. (You can find tips for safely increasing your exercise in Chapter 6.)
Keep thinking positive. Remind yourself of how much you have achieved. (Here’s a tip: write that on sticky notes and post them where you will see them.)
“I always feel so deprived of the foods I love when I try to lose weight.”
You are a special person. This means that the changes you decide to make have to meet your special likes, dislikes, and needs. Unfortunately, our brains can get channeled into what we don’t want to do or should not be doing instead of being supportive or encouraging, especially when it comes to losing weight.
You think using both pictures and words. This calls for teaching yourself how to see things in a better light and telling your brain to stop thinking about certain things, and to replace those thoughts with positive ones that work for you (more on positive thinking can be found in Chapter 5). Here are a couple of examples:
Replace thoughts that include the words never, always, and avoid. Instead, tell yourself that you can enjoy things occasionally, “but a healthier choice is better for me most of the time.”
Tell yourself that you are retraining your taste buds and that making healthier choices can help you manage your weight and feel better.
“I eat too fast or I finish eating before everyone else and find myself reaching for seconds.”
If you are finishing meals in just a few minutes or before everyone else at the table, you are most likely eating too fast. You may be doing this for a number of reasons. You may be letting yourself get too hungry because too much time passes between meals or snacks and then you wolf food down when you finally do get to eat. You may be hurried, anxious, or stressed when you sit down to eat. Slowing down your eating pace can help you eat less and enjoy your food more. Here are some tips for cutting down your eating speed:
Do not skip meals; you will avoid becoming overly hungry.
Make it a game not to be the first person at the table to be finished eating.
After eating something, if you find yourself saying “I think that was good—I better have more to make sure,” that usually means you aren’t paying attention to what you eat. Work on thinking about what you are eating and how you are enjoying it. Practice this without things that take your attention away, such as friends, video games, or television.
Take small bites, chew slowly, and be sure to swallow each bite before taking another. Chewing your food well also helps you enjoy your food more and feel better after the meal by lessening heartburn or other digestive upsets.
Try a relaxation method about a half hour before you eat. Several methods are discussed in Chapter 5.
“I can’t do it on my own.”
Losing weight is challenging, and sometimes you just need some outside support and guidance. For help, you can contact any of the following resources:
A registered dietitian through your health plan, local hospital, or the Academy of Nutrition and Dietetics website, http://www.eatright.org
A support group such as Weight Watchers or Take Off Pounds Sensibly (TOPS), where you can meet other people who are trying to lose or maintain a healthy weight
A weight loss program offered by your local health department, hospital, health plan, community school, or employer
“I’ve been on a lot of diets before and lost a lot of weight. But I’ve always gained it back, and then some. It’s so frustrating, and I just don’t understand why this happens!”
This happens to many people. In fact, it is the downside of quick-weight-loss diets, because they typically involve drastic changes. They do not focus on lifelong changes in eating habits, exercise, and lifestyle. Typically, after you have gotten tired of the diet or have reached your goal weight, you return to your old ways, and the weight comes back on. Sometimes you even gain back more weight than you lost.
The key to maintaining a healthy weight is to develop healthy eating and exercise habits that you enjoy, that fit into your lifestyle, and that are part of a lifestyle that you can stick with. We have already given you many tips earlier in this chapter. Here are a few more:
Set a personal weight gain “alarm”—say, a specific number of pounds gained (perhaps 3 pounds). If you hit this mark, go back on your regular program. The sooner you start, the faster the newly added pounds will come off.
Monitor your activity level. Once you have lost some weight, exercise three to five times a week to improve your chances of keeping the weight off. Research suggests that to maintain weight loss, some people should be exercising nearly an hour a day—but no need to fear, this includes normal activities during the day as well as planned physical exercise. Also remember that increasing activity does not just mean exercising longer. It can mean going faster or doing something that is harder to do, such as walking uphill or swimming with paddles.
“I do OK keeping weight off for a short time. Then something happens beyond my control, and I stop caring about what I eat. Before I know it, I’ve slipped back into my old eating habits.”
Everyone is going to slip at one time or another; no one is perfect. If it was only a little slip, don’t worry about it. Just continue as if nothing happened and get back on your plan. If the slip is bigger, try to figure out why. Is there something that is taking a lot of your attention now? If so, weight management may need to take a back seat for a while. That’s OK. The sooner you realize this, the better; just try to set a date when you will restart your weight management program. You may even want to join a support group and stay with it for at least 4 to 6 months. If so, look for a weight loss support group that does the following:
It emphasizes healthy eating.
It emphasizes lifelong changes in eating habits and lifestyle patterns.
It gives support in the form of ongoing meetings or long-term follow-up.
It does not make miraculous claims or guarantees. (Remember, if something sounds too good to be true, it probably is.)
It does not rely on special meals or supplements.
Sometimes long-term health problems make it difficult to gain weight or keep it on. This could be because your condition or its treatment makes it hard for you to eat because you aren’t hungry, you are sad or depressed, your body is unable to use the food it gets, or it burns up calories faster than you can replace them.
When you aren’t hungry or have trouble eating, few foods sound appealing. This is when it is more important to eat anything rather than worry about whether the foods you choose are “healthful.” You need to eat for energy and strength and to support the body’s nutrition needs, and that overrides being sure that what you eat is “healthy.” During those times, feel comfortable about eating whatever you can; it will probably only be temporary and then you can return to healthy eating.
Here, too, slow and steady wins the race. Try the 200 Plan (see pages 207–208) by making sure to eat an extra 100 calories a day every day. This alone can result in a 10-pound weight gain over a year. Be sure to choose foods that you really enjoy, focusing on your favorites. Keep easy-to-fix or already-prepared foods handy so that you don’t need to spend much time cooking.
If you experience a continual or extreme weight loss or have trouble keeping weight on, you’re not alone. Let’s look at some common challenges and some ideas for dealing with them.
“I don’t know how to add calories to my current diet.”
Here are some ways to increase the calories and nutrients you eat without increasing the amount of food you need to eat:
Because fat gives us many more calories than carbohydrate or protein, choose foods that are higher in fat, but try to stick with foods that contain good fats (see page 191). For example, snack on calorie-rich foods such as avocados, nuts, seeds, or nut butter.
Eat dried fruit or nectars instead fresh fruit or regular juice.
Choose sweet potatoes instead of white potatoes.
Use whole milk instead of lower-fat dairy products, and instead of broth or water in soups and sauces.
Try a liquid supplement drink with or between meals.
Drink high-calorie beverages such as shakes, malts, fruit whips, and eggnogs.
Top salads, soups, and casseroles with shredded cheese, nuts, dried fruits, or seeds.
“I just don’t have much of an appetite.”
Check with your doctor or a registered dietitian to see if the following tips are appropriate for you.
Eat tiny meals or smaller meals several times a day.
Keep some nuts or dried fruit handy, and eat a few pieces each time you walk past the bowl.
Eat the highest-calorie foods first, saving lower-calorie foods for later (for example, eat buttered bread before cooked spinach).
Add extra whole milk or milk powder to sauces, gravies, cereals, soups, and casseroles.
Add melted cheese to vegetables and other dishes.
Use butter, margarine, or sour cream as toppings.
Consider keeping a snack at your bedside so that you can eat something if you wake in the middle of the night.
Other common problems related to making changes in your eating habits are also discussed in Chapter 11. More information on body weight can also be found in the resources listed at the end of this chapter.
People come in many shapes and sizes—some of which can affect their health and their symptoms, whether they carry too much weight or not enough. There is no such thing as a perfect or “ideal” weight, but rather there is a range of pounds that is good for us. Being in a healthy weight range helps us achieve overall health and well-being, both for our body and our mind. The smartest and best approach to achieving a healthy weight range involves both healthy eating and being active. Once you get to your healthy weight, keeping it in a good range for you is most important. Tailoring how to meet your needs and how to match your lifestyle is the best way. Choose realistic lifelong strategies that you can stick to instead of trying quick fixes, which most often do not work. Set your sights on success by building on small changes over time.
Ferguson, James M., and Cassandra Ferguson. Habits, Not Diets, 4th ed. Boulder, Colo.: Bull, 2003.
Hensrud, Donald D., ed. Mayo Clinic Healthy Weight for Everybody. Rochester, Minn.: Mayo Clinic Health Foundation, 2005.
Nash, Joyce D. Maximize Your Body Potential, 3rd ed. Boulder, Colo.: Bull, 2003.
Schoonen, Josephine Connolly. Losing Weight Permanently with the Bull’s-Eye Food Guide. Boulder, Colo.: Bull, 2004.
Healthy Weight Network: http://www.healthyweight.net/
National Weight Control Registry: http://www.nwcr.ws/
Shape Up America: http://www.shapeup.org/
Weight-control Information Network (WIN): http://win.niddk.nih.gov/index.htm