Weight Control:

The Myths and Realities

Nutrition Scoreboard

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1 Anybody who really wants to can lose weight andkeep it off.

2 Weight loss is the cure for obesity.

3 In almost all cases, the quicker weight is lost, thequicker it’s put back on.

4 Weight-loss products and services must be shown tobe safe and effective before they can be marketed.

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[ KEY CONCEPTS AND FACTS ]

• The effectiveness of weight-control methods should begauged by their ability toprevent weight regain.

• That a weight-loss productor service is widely publi-cized and utilized doesn’tmean it works.

• Some people cannot loseweight and keep it off, nomatter how hard they try.

• Successful weight controlis characterized by grad-ual weight loss fromsmall, acceptable, andindividualized changes ineating and activity.

Answers to Nutrition Scoreboard

TRU

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1 If this claim were true, hardly anybody would beobese.

2 Maintenance of weight loss is the cure for obesity.

3 Quick weight-loss diets almost never work becauseweight lost is regained after the diet ends.

4 Unfortunately, many weight-loss products and ser-vices on the market have not been shown to be safeor effective. Laws and regulations do not fully pro-tect the consumer from the introduction of bogusproducts and services.

✔

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Baseball, Hot Dogs, Apple Pie, and Weight Control

Americans are preoccupied with their weight. On any given day, 40% of adults, anda majority of individuals who are overweight or obese, are trying to lose weight. Tohelp get the weight off, Americans spend over $33 billion annually (an average ofapproximately $120 per person each year) on weight-loss products and services. YetAmericans are gaining weight faster than they are losing it, and the incidence of obe-sity in the United States is on the rise.1 Roughly 5 to 10% of people who lose weightkeep it off.2 Consumers are paying handsomely for weight loss without experienc-ing the desired cosmetic changes or health benefits that come when weight loss ismaintained (Illustration 10.1).

Why do so many Americans fail at weight control? For some people, achievingpermanent weight reduction on their own may be truly impossible.3 For others, theproblem is the ineffective methods employed, not the people who use them.

Illustration 10.1Source: Reprinted by permission ofUniversal Press Syndicate.

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Weight Loss versus Weight Control

“Jess—did I hear you say you wanted to lose some weight? It happens I knowabout a terrific diet! A couple of months ago I went on Dr. Quick’s Amino AcidDiet and lost 15 pounds! You eat nothing but fish, papaya, and broccoli and the

pounds just melt away!”

Jess was shocked. Selma looked heavier than she did last year when they were inclass together.

“But Selma,” Jess inquired, “what happened to the weight you lost?”

“Oh, I gained it back. I ran out of willpower and started eating everything insight. I’m going to get back on track, though. Tomorrow I start the Slim

Chance Diet.”

Dietary torture and weight loss are not the cure for overweight. If losing weight wasall it took to achieve the cultural ideal of thinness, nobody would be overweight.Any popularized approach to weight loss (and some get pretty spectacular) that callsfor a reduction in caloric intake can produce weight loss in the short run. Thesemethods fail in the long run, however, because they become too unpleasant. Feelingsof hunger, deprivation, and depression that often occur while on a weight-loss dieteventually lead to a breakdown of control, eating binges, a return to previoushabits, and weight regain.4 Humans are creatures of pleasure and not pain. Anypainful approach to weight control is bound to fail. Improved and enjoyable eatingand exercise habits are needed to keep excess weight off, and quick weight-lossapproaches don’t change habits.

Unfortunately, many dieters think weight-control methods are successful if theylead to a rapid loss of weight.5 When the lost weight is regained, dieters tend to blamethemselves and not the faulty method. Blaming themselves for the failure, many peo-ple are ready to try other quick weight-loss methods. But they usually fail, too.6

The Business of Weight Loss] More than 29,000 weight-loss products and ser-vices are available. Some of these are shown in Illustration 10.2. Most of them eitherdon’t work at all or don’t prevent weight regain.7 “Quick fix” weight-loss approachesthat don’t lead to long-term changes in behavior are the primary reason approxi-mately 90 to 95% of people who lose weight gain it back. The demand for such prod-ucts and services is so great, however, that many are successful—financially.

One reason so many weight-loss products and services are available is thatalmost none of them work. If any widely advertised approach helped people loseweight and keep it off, manufacturers of bogus methods would go out of business.The weight-loss industry also thrives because of the social pressure to be thin. Manypeople try new weight-loss methods even though they sound strange or too good tobe true. Often people believe that a product or service must be effective, or it wouldn’tbe allowed on the market.8 Although reasonable, this belief is incorrect.

The Lack of Consumer Protection] The truth is that general societal standardsfor consumer protection do not apply to the weight-loss industry.9 No laws requirea product to be effective: in most cases, companies do not have to show that weight-loss products or services actually work before they can be sold. That’s why productslike herbal remedies, forks with stop and go lights, weight-loss skin patches, colored“weight-loss” glasses, electric cellulite dissolvers, mud and plastic wraps, and

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inflatable pressure pants are available for sale. These, like many other weight-lossproducts, do not work, and there is no reason why they should. Promotions for theproducts just have to make it seem as though they might work wonders on appetiteor body fat.

Furthermore, weight-loss products and services are usually not tested for safetybefore they reach the market. The history of the weight-loss industry is littered withabject failures: fiber pills that can cause obstructions in the digestive tract, very low-calorie diets and intestinal bypass surgeries that lead to nutrient-deficiency disease,amphetamines that can produce physical addiction, diet pills that cause heart valveproblems, and liquid protein diets that have led to heart problems and death from heartfailure.11 A brief history of weight-loss method failures is chronicled in Table 10.1.

Illustration 10.2There is no lack of weight-loss books and products. There is a lack of popular approaches that help people keep weight off.

REALITY CHECK

Do some foods have negativecalories?

You’re looking for a way to shed 10pounds you gained during freshman yearand are seriously thinking about addinggrapefruit and vinegar to your diet. Youhave heard these foods have “negativecalories” because they make the body

burn fat.Juanita:

I know vinegar cleans thegrease off windows.

Maybe it will melt awaymy fat, too.

Chuck: Vinegar and grapefruit areso sour—I bet they rev up

the metabolism so youburn fat.

Answers on next page

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Pulling the Rug Out] Fraudulent weight-loss products and services may be inves-tigated and taken off the market. Currently, the Federal Trade Commission (FTC)monitors deceptive practices and weight-loss claims on a case-by-case basis. It hasfiled suits against companies making exaggerated claims, and has identified the mostcommon dubious claims made by the industry (Table 10.2). The FTC performs mostinvestigations in response to consumer complaints. Illustration 10.3 shows threeexamples of products that were taken off the market and explains why.

Requirements for truth in labeling keep many bogus products from includingfalse or misleading information on their labels. These laws, however, do not keepoutrageous claims from being made on television or printed in pamphlets, books,magazines, and advertisements. Few companies get caught if they include false ormisleading information in weight-loss product ads.

ANSWERS TO REALITY CHECKDo some foods have negative calories?

Do some foods have negativecalories?

The vinegar, grapefruit, negative calorie mythlives on because it strikes many people as reasonable. Neither vinegar nor grapefruit, nor any other food has negative calories orcauses the body to gear up metabolism and

burn fat.10�

Juanita�

Chuck

TABLE 10.1

A BRIEF HISTORY OF DISCONTINUED WEIGHT-LOSS METHODS.It is possible that ephedra will be added to this list.

YEAR METHOD REASON FORDISCONTINUATION

1940s–1960s Amphetamines Highly addictive, heart and blood pressure problems

Vibrating machines Did not work

1970s Jejunoileal; bypass Often caused chronic diarrhea, surgery vitamin and mineral deficiencies,

kidney stones, liver failure, arthritis

Liquid protein diet Poor-quality protein caused heart failure, deaths

1990 Oprah Winfrey liquid diet success (she lost 67 pounds)

1991 Oprah Winfrey gains 67 pounds and declares “No more diets!”

1997 Phen-Fen (Redux) Heart valve defects, hypertension in lung vessels

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What if the Truth Had to Be Told?] Suppose the weight-loss industry had toinform consumers about the results of scientific tests of the effectiveness and safetyof weight-loss products and services. What if this information had to be routinelyincluded on weight-loss product labels (Illustration 10.4)? What do you think wouldhappen to consumer choices and the weight-loss industry? Increased federal enforce-ment of truth-in-advertising laws may help put an element of honesty into promo-tions for many weight-loss products. In addition, the FTC has proposed that claimsabout long-term weight loss “must be based on the experience of patients followedfor at least two years after they complete the [weight-loss] program.”13 If this pro-posal ever becomes law, it will change the weight-loss industry in the United States.

Diet Pills] Two types of prescription diet pills are currently approved for long-termuse in obese people in the United States. One is Meridia (sibutramine), and the otheris Xenical (orlistat).14 Meridia works by enhancing satiety (which reduces foodintake), and Xenical works by partially blocking fat absorption in the intestines.

Illustration 10.3A few examples of bogusweight-loss products thatwere removed from the market.

TABLE 10.2

LOADS OF FALSE AND MISLEADING WEIGHT-LOSS ADVERTISEMENTS APPEAR IN THEMEDIA. HERE IS A LIST OF THE TOP SIX FEATURES OF WEIGHT-LOSS ADS THAT MAKE FALSEOR MISLEADING CLAIMS.12

1. Use testimonials, before-and-after photos.

2. Promise rapid weight loss.

3. Require no special diet or exercise.

4. Guarantee long-term weight loss.

5. Include a “clinically proven” or “doctor approved” statement.

6. Make a “safe,” “natural,” or “easy” claim.

Fat magnet pills were purported to break into thousands of magnetic particles once swallowed. When loaded with fat, the particles simply flushed themselves out of the body. The FTC found the product too hard to swallow. The company took the product off the market and made $750,000 available for customer refunds.

“Blast” away 49 pounds in less than a month with Slim Again, Absorbit-All, and Absorbit-AllPlus pills claimed ads in magazines, newspapers, and on the Internet. The company got blasted by the FTC to the tune of $8 million for making fraudulent claims.

Take a few drops of herbal liquid, put them on a bandage patch, and voilà a new weight-loss product! The herbal liquid was supposed to reach the appetite center of the brain and turn the appetite off. Federal marshals weren’t impressed. They seized $22 million worth of patch kits and banned the sale of others.

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Both have side effects. Meridia may increase blood pressure and heart rate, causeheadaches, and lead to dry mouth. Xenical’s primary side effect is oily stools, whichare particularly bothersome if high-fat meals are consumed. Malabsorption of fatcaused by Xenical reduces absorption of a number of fat-soluble nutrients such asvitamin D, E, and beta-carotene.15

It is recommended that Meridia and Xenical be used in conjunction withreduced-calorie diets. Both effectively lower weight by an average of about 10%over a period of six months to a year. Weight regain after pill use stopsis common but not universal.16

Many other diet drugs are under development or testing.Much activity currently centers around leptin, a hormone pro-duced in fat cells, that may modify caloric intake or energyexpenditure, growth hormone, and other hormones that modifythe sensations of hunger or satiety. Even though people using pre-scribed diet drugs are carefully screened and monitored by med-ical professionals, serious side effects can develop. No diet drug isabsolutely safe, and none are known to cure obesity forever.17

Ephedra] Ephedra, or ma huang, was an over-the-counter dietpill and energy-booster. It was sold as a herbal product, often incombination with caffeine. With caffeine, ephedra appears to pro-mote weight loss for at least 6 months, but serious side effects(hypertension, irregular heartbeat, stroke, heart attack, seizure, andsudden death) are related to its use. The National Institutes of Healthdoes not recommend ephedra for weight control, and it can no longerbe sold for weight loss.

High-Protein Diets

“The high protein diet probably gets its allure from the naughtiness of its approach.”

—G. Taubes, journalist19

Do high-protein diets help people lose weight? Yes. Do they pose risks to health?Some. Do they help people maintain weight loss in the long run? No.

High-protein, low-carbohydrate diets can lead to weight loss, and mayimprove health status as a result (Illustration 10.5).20 A series of studies haveconcluded that such diets have no adverse effect, or a somewhat positiveeffect on blood lipids, glucose, insulin, and blood pressure.21 High-proteindiets promote weight loss by decreasing appetite. When the body is deprivedof carbohydrates, fats must be used as the body’s primary source of energy.Using fat to meet much of the body’s energy needs leads to increased bloodlevels of by-products of fat utilization, called “ketone bodies,” whichdecreases appetite. People often experience rapid weight loss when they firststart high-protein diets, and that can be very encouraging. The weight loss isprimarily due to water excretion. High-protein diets increase water needbecause the nitrogen component of much of the protein consumed is excretedfrom the body, diluted in urine.22

All is not well with high-protein diets, however. They are not recom-mended for people with liver or kidney problems, may promote heart dis-ease and prostate cancer, may leave glycogen stores nearly empty, and

The Amazing

BEEPOLLEN-GRAPEFRUITDIETDr. Quickfix

Consumer Protection Label

Effectiveness: Ineffective for

95% of users

Risks: Bee pollen may cause

adverse reactions in allergic

people. Weight regain may

exceed weight loss. If the diet

fails, people may blame them-

selves thereby precipitating

anxiety and self-doubt.

MELTS

AWAY

POUNDS OF

CELLULIT

E IN

JUST 10

DAYS!BEE P

OLLE

N-GRA

PEFRU

IT DIE

T

Illustration 10.4Just imagine what wouldhappen if weight-lossapproaches were required todivulge their effectivenessand risks.

The high-protein, low-carbohydratediet for weight loss has been aroundfor over a century. The first “Dr. Atkins”was William Banting, a London under-taker. He published a book on his ter-rific new diet in 1864. It was sopopular that dieting to this day isreferred to as “Banting” in England.23

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may cause nausea, headache, decreased stamina, and a reduced ability to concen-trate. Long-term consequences of high-protein diets on health are far from clear.24

What’s the primary limitation of high-protein diets as far as we know now? It’sa big one: they don’t work in the long run. As with other weight-loss diets requir-ing substantial changes in food intake, people revert to more pleasurable, usualdiets. As soon as carbohydrates are returned to the diet in normal amounts, appetitereturns and weight gain follows.

Organized Weight-Loss ProgramsThe mark of successful weight-loss programs is maintenance of weight loss in thelong term. Whether organized weight-loss programs such as Weight Watchers, Jenny

Craig, Overeaters Anonymous, or services provided by many medicallysupervised weight-loss clinics hit this mark is not known. Results ofstudies of the effectiveness of privately run weight-loss programs arerarely published. Programs requiring the largest changes in diet andlifestyle would be expected to have the lowest success rates in terms ofweight-loss maintenance. No weight-loss product, diet, program, orclinic that substantially alters usual eating and activity patterns has beenshown to result in a long-term loss of excess body fat in more than 5 to10% of people who use it.25

Drastic MeasuresFasting and surgery represent extreme approaches to body fat reduction.These approaches are riskier than weight-loss methods that produce agradual loss in weight.

Fasting] Sometimes people fast to lose weight, but this method is notrecommended unless the fast is closely supervised by medical profes-sionals. Abruptly stopping food intake not only does not foster long-term weight-loss maintenance, but it produces a high level of wear and

Newspaper headline in 2035: “Dietand exercise are the keys to weightloss.”—grabbed off the Internet

“The second day of a diet is alwayseasier than the first. By the secondday, you’re off it.”—Jackie Gleason

“My doctor told me to stop havingintimate dinners for four, unlessthere are three other people.”—Orson Welles

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Illustration 10.5High-protein diets don’t workin the long run, and theirlong-term consequences onhealth are not clear.

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tear on the gastrointestinal tract. Fasting causes “intestinal starvation” because itremoves a primary source of nutrients from the intestines—foods that are beingdigested. Without sufficient nutrients to maintain the gastrointestinal tract, mucusand cells lining the tract are lost and infection is more likely. Far from “cleansingthe system,” as the saying goes, fasting can clog up the lower intestines. Fasting canalso lead to a preoccupation with food and eating and a rapid rebound in weightonce the fast ends.26

Surgical Techniques] Weight control surgery is a method of last resort. It isreserved for very obese persons (BMI over 40 kg/m2) or for people with marked obe-sity (BMI over 35 kg/m2) whose weight jeopardizes their immediate health. Surgeryfor obesity is experiencing an increase in demand. Some people who don’t qualifyare gaining weight to get past BMI thresholds.27 Surgical techniques are expensiveand carry the risks associated with surgical interventions, such as infection oradverse reaction to anesthesia.28

Stomach Surgery} The idea for stomach surgery to control obesity came as a eurekamoment to surgeons who noticed that people having large segments of their stom-achs removed for cancer or severe ulcers lost a good deal of weight.29 Several sur-gical techniques reduce the size of the stomach and thereby limit the amount of foodpeople can eat. The technique that has the lowest failure rate (gastric bypass sur-gery) is shown in Illustration 10.6.30 In gastric bypass surgery, most of the stomachis stapled shut, leaving a pouch at the top that can hold about 2 to 4 tablespoons offood. A section of the small intestine that connects to the bottom of the stomach iscut off and attached as a drain for the stomach pouch. The loose end of the smallintestine is then reattached to the section of the small intestine that leads from thepouch. This way, digestive juices from the stomach and the upper part of the smallintestine are made available for digesting food. People who have their stomachs sta-pled can eat only a small amount of food. If they eat too much, they feel nauseousand vomit.

Gastric bypass surgery typically costs $20,000–$30,000 and leads to an aver-age weight loss of 100 pounds or more in very obese people. Most people (70%)maintain a 50% loss in body weight 5 years after the surgery.31 The surgery hasother benefits: it can cure type 2 diabetes and reduce the risk for heart disease andhypertension.32 The procedure is not foolproof. People can eat enough to separate

Illustration 10.6Gastric bypass surgery.

Unused portionof stomach

2-ouncepouch

Bypassed smallintestine

Moved smallintestine

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the staples and end up back in surgery. In addition, blocking off most of the stomachreduces vitamin B12 absorption and increases the risk of osteoporosis later in life.33

Liposuction} At a cost of over $3000 per surgery (prices vary by fat deposit site,inflation, and surgeon), fat deposits in the thighs, hips, arms, back, or chin can bepartially removed by liposuction. The procedure is the most common type of cos-metic surgery performed in the United States. Considered cosmetic, it is not intendedfor weight loss or to diminish health risks associated with obesity (Illustration 10.7).Surgical standards require that no more than 8 pounds of fat be removed by lipo-suction.34 If a person gains a good deal of weight after liposuction, fat will bedeposited to some extent in the breasts and other areas not operated on. Thesedeposits can lead to a return of an undesired body shape.35 In addition, surgeryalways carries a risk of infection and other complications, so it cannot be takenlightly.

Weight Loss: Making It LastPeople come in all sizes, and not everyone can change his or her body shape orweight. Some can, however, and the most effective ways to lose weight and keep itoff are known. Many weight-loss methods lead to a temporary reduction in bodyweight, but this is not the test of a successful method. An approach to weight losscan be considered successful only if it is safe, healthful, and prevents weight regain.Table 10.3 summarizes characteristics of weight-loss programs that promote main-tenance of weight loss. An approach that fosters dietary and exercise patterns thatprevent weight regain is best.37

Such methods take time, however, so they are not among the more popularapproaches. Because they cannot be sold as a product, the weight-loss industry isn’tvery interested in them. Nevertheless, these methods work in the long run for manyoverweight people. The key ingredients of these methods are small, acceptablechanges in diet and activity. These approaches focus on healthy eating and exercise

Illustration 10.7The effects of liposuction. The photograph on the left showsthe thighs of a woman before lipo-suction, and the photo on the rightshows the same woman’s thighsafter liposuction.

Custom M

edical Stock, Dr. I. Richard Toranto

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for a lifetime, rather than “dieting.” The goal is to achieve improvements in lifestyle,fitness, and health—not losing a certain number of pounds in a week.38 Simplethough they sound, such methods are the difference between those who lose weightand keep it off and those who don’t (see the “Health Action”).

The Importance of Small, Acceptable ChangesFor most people, excess body fat accumulates slowly over time. Consuming just anextra 50 calories a day, for example, will lead to a gain of approximately 5 poundsin a year. (Approximately 3500 excess calories will produce a weight gain of 1pound, and a 3500-calorie deficit will produce a loss of 1 pound in body weight inmany people.) Excess weight is rarely all gained over the course of a few weeks ormonths. Fat is put on slowly, and that’s the best way to take it off.

Gradual losses in body fat do not require dramatic changes in diet or activitylevel. Only small changes in diet and activity are needed. By cutting back foodintake by 100 calories per day, a person could lose 10 pounds in a year. Jogging 20minutes three times a week in addition to usual activity could take off another 10pounds in a year. Routinely engaging in more vigorous forms of exercise such ashandball or rowing can contribute to body fat loss, weight-loss maintenance, andfitness.40 The secret to success is including foods and activities that are enjoyed inthe lifestyle change package. To be lasting, the changes have to be acceptable, evenpreferable, to existing patterns (Illustration 10.8). Often this means that the changeshave to be small.41

TABLE 10.3

CHARACTERISTICS OFWEIGHT-LOSSPROGRAMS THATPROMOTE MAINTENANCEOF WEIGHT LOSS.36

1. Offer long-termapproach to beneficialchanges in diet andphysical activity.

2. Employ reduced-calorie, nutritionallyadequate diets.

3. Recommend foodsfrom all food groups.

4. Do not exclude certainfoods.

5. Employ relatively smalland acceptablechanges in usuallifestyle, dietary, andother behaviors.

6. Do not rely solely on drugs or herbalremedies.

HEALTH ACTION I Weight-Loss Maintainers versus Weight Regainers39

Weight-Loss Maintainers• Lose weight slowly by making small, acceptable changes in eating and activity.

• Consume regular meals.

• Exercise regularly.

• Make conscious efforts to avoid regaining weight.

• Avoid feeling deprived while changing habits (i.e., eat foods they like and undertake activities they enjoy).

• Use available sources of social support.

Weight Regainers• Are not committed to a gradual weight loss through behavioral changes.

• Change diet radically to lose weight.

• Exercise little. Have low muscle strength.

• Eat unconsciously in response to stress.

• Take diet pills.

• Do not seek out or have social support.

• Cope with problems by escape and avoidance.

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It should be mentioned that a minority of people are able to make drasticchanges in dietary intake (adopt a very low-fat diet, for example) or increase theirexercise level substantially and maintain these changes and lower body weight overtime.42 Such people tend to be the exceptions, however.

Identifying Small, Acceptable Changes] To identify changes in eating and activ-ity that have staying power, first list the weak points in your diet and activity. Dietaryweak points might include the consumption of high-fat foods due to eating out often,or relying on high-fat convenience foods that can be heated up in seconds. Anotherweak point might be skipping breakfast and overeating later in the day because ofextreme hunger. Weak points in physical activity might include driving instead ofwalking, not engaging in sports, or spending too little time playing outside.

For each weak point, identify options that seem acceptable and enjoyable. Aperson who enjoys broiled chicken with barbecue sauce might not mind eating thatat restaurants instead of fried chicken. That’s a change people can make if they planahead. A person who gets too full from a large serving of fries might be happierordering a small serving and not eating so many. A breakfast skipper might findgrabbing a piece of fruit and a slice of cheese for breakfast acceptable and doable.People who enjoy walking may not mind leaving the car or bus behind and lettingtheir feet carry them to class, the grocery store, or a friend’s house.

Many acceptable options for making small improvements in diet and activitymay be available (see the “Health Action—Small Changes That Make a Big Differ-ence”). The easiest changes to accomplish are the ones that should be incorporatedinto the overall lifestyle improvement plan. Some people, for example, lose weightand keep it off simply by consciously cutting down on portion sizes. Others avoideating too much at any meal and walk more. Simply adding breakfast helps some

Illustration 10.8Small, acceptable changes arethe key to a successfulweight-loss/weight-maintenance program.Try to find activities that youenjoy; get out there and play!

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HEALTH ACTION I Small Changes That Make a Big Difference44

• Use 50% less margarine or butter and mayonnaiseon foods.

• Choose low-fat varieties of foods (cheese, milk,yogurt, fish, poultry) that you like.

• Trim the fat off meats or buy lean meats.

• Eat small portions of high-calorie foods.

• Eat fried foods infrequently.

• Eat breakfast.

• Eat when you are hungry.

• Stop eating when you feel full.

• Take home chunks of the large portions of foodsserved in restaurants. Safely store the food and makeanother meal (or two) out of it.

• Regular-size your fast-food meals.

• Eat all the vegetables and fruits you want.

• Seek out and eat your favorite high-fiber foods.

• Cook at home.

• Walk to school.

• Bike to work.

• Take the stairs.

• Go outside and play.

people lose weight and maintain the loss.43 The easier the changes are to follow, themore likely they are to succeed.

Individualized plans that don’t work out often include unacceptable or unen-joyable changes. The changes may be too large or too different from the usual. Inthat case, go back to the drawing board and modify the plan to include smallchanges that are acceptable in the long run. Perhaps the original plan included jog-ging, but it turns out that jogging isn’t any fun. In that case, take jogging out of theplan! Replace it by any other physical activity that would be enjoyed. Midcoursecorrections should be expected. Some experimentation may be required to identifythe small changes that will last.

What to Expect for Weight Loss] If all goes well, weight loss will be gradualbut lasting. The pattern of loss should be somewhat like that graphed in Illustration10.9, where the person lost 18 pounds over 30 weeks. The pattern will includepeaks, valleys, and plateaus—not a straight downward curve. Sometimes a bit ofweight will be gained, and other times more weight than expected will be lost. It’smore important to enjoy and continue improved eating and activity patterns than toconcentrate on the number of pounds lost.

If diet and exercise behaviors are improved in acceptable ways, there is littleneed to become preoccupied with the number of calories consumed, the number ofcalories burned off in a bout of exercise, or the number of pounds lost last week.The goal is reached when the small changes become an enjoyable part of life on aday-to-day basis. Improved eating and activity patterns offer many benefits. Weightloss is only one of them.

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www linkswww.4woman.govThe home page of the National Women’sHealth Initiative can start your search forinformation on safe and effective commer-cial weight-loss programs.

www.mayoclinic.orgProvides reliable information on nutrition,health, and weight control. Check out “MyHealth Interests” if you want to loseweight.

www.ediets.comA commercial site offering personalizeddiet plans and other resources developedlargely by dietitians.

www.niddk.nih.gov/health/nutrit/win.htmThe Weight Control Information Networkprovides science-based information onweight control and nutrition. Call toll-free:1-877-946-4627.

www.shapedown.comThis commercial site provides backgroundinformation and methods for the testedShapedown Program for weight manage-ment in children and adolescents.

www.cyberdiet.comConstruct a personal menu plan and get anestimate of calories burned in physicalactivity at this site. Get free diet profile,

join for access to weight-loss servicesincluding menu planning, online supportgroup.

www.quackwatch.comCheck out “quacky” weight-loss productsand services.

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30Weeks

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Weightmaintenance

Illustration 10.9People who lose weight gradually are more likely tokeep it off than those wholose weight rapidly. The weight loss graphed hereaverages half a pound per week.

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Nutrition UP CLOSEWill You Maintain or Regain?

FOCAL POINT: People who lose weight and keep the pounds off share similar successful behaviors.

Have you recently lost weight?Answer the following questions

to find out if your current eat-ing and activity behaviors pro-

mote making the weight losspermanent.

YES NO

1. Do you usually eat breakfast?

2. Do you avoid skipping meals?

3. Do you plan ahead for snack and mealtime foods?

4. Do you prepare most of your meals at home?

5. Do you limit consumption of high-fat foods like butter, margarine, mayonnaise, and fried foods?

6. Do you consume high-calorie foods like desserts infrequently and in small portions?

7. Do you walk instead of drive whenever possible?

8. Do you engage in regular physical activities that you enjoy?

9. Do you seek social support to help maintain your weight loss?

10. Do you eat when you’re hungry and stop eating when you are full?

FEEDBACK (answers to these questions) can be found at the end of Unit 10.

Notes1. Obesity Trends, www.cdc.gov/nccdphp/

dnpa/obesity/trend/prev_bmi.htm,accessed 9/03.

2. Sarlio-Lahteenkorva SS, et al. A descrip-tive study of weight loss maintenance: 6and 15 year follow-up of initially over-weight adults. Int J Obesity 2000;24:116–25.

3. Marcus MD, Wing RR, Lamparski DM.Binge eating and dietary restraint inobese patients. Addict Behav 1985;10:163–8.

4. Goodrick GK, Foreyth JP. Why treat-ments for obesity don’t last. J Am DietAssoc 1991;91:234–47.

5. Womble L et al. Unrealistic weight lossgoals and feelings of failure. Presenta-tion at the North American Associationfor the Study of Obesity, Long Beach,CA, 2000 Nov.

6. Wooley SC, Garner DM. Obesity treat-ment: the high cost of false hope. J AmDiet Assoc 1991;91:1248–51.

7. Wooley and Garner, Obesity treatment.

8. Lustig A. Weight loss programs: failingto meet ethical standards? J Am DietAssoc 1991;91:1252–4.

9. Wooley and Garner, Obesity treatment.

10. Cunningham A, Marcason W. Is it pos-sible to burn calories by eating grape-fruit or vinegar?

11. Wadden TA, Stunkard AJ, Brownell KD.Very low calorie diets: their efficacy,

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Feedback for Unit 10The more checks you made in the “Yes” column, the greater the chances that you will maintainyour weight loss. Reflect for a moment upon any checks you made in the “No” column. Enactingsmall, acceptable changes in your eating and activity plan now may make the difference betweenmaintaining your weight loss or regaining the pounds.

safety, and future. Ann Intern Med1983;99:675–84.

12. Current trends in weight-loss advertis-ing. J Am Diet Assoc 2003;103:150.

13. Taubes G. Dietary approaches to weightcontrol. What works? ExperimentalBiology Annual Meeting, San Diego,April 14, 2003.

14. Yanovski SZ, Yanovski JA. Obesity. NEngl J Med 2002;346:591–602.

15. Yanovski and Yanovski, Obesity.

16. Yanovski and Yanovski, Obesity.

17. Yanovski and Yanovski, Obesity.

18. Yanovski and Yanovski, Obesity.

19. Taubes, Dietary approaches to weightcontrol.

20. Farnsworth E et al., Effect of high pro-tein, energy-restricted diet on body com-position, glycemic control, and lipidconcentrations in overweight and obesehyperinsulinemic men and women, Am JClin Nutr 2003;78:31–9; and LaymanDK et al., A reduced ratio of dietarycarbohydrate to protein improves bodycomposition and blood lipid profilesduring weight loss in adult women, JNutr 2003;133:411–7.

21. Bravata DM et al. Efficacy and safety oflow-carbohydrate diets. JAMA 2003;289:1837–50.

22. Bravata et al., Efficacy and safety oflow-carbohydrate diets.

23. Low-carb diet plans, Harvey-BantingDiet. www.lowcarb.ca/atkins-diet-and-low-carb-plans/harvey-banting.html,accessed 9/03.

24. Bravata et al., Efficacy and safety;Bonow RO, Eickel RH, Diet, obesity,and cardiovascular risk, N Engl J Med2003;348:2057–8; and Reddy ST et al.Effect of low-carbohydrate high protein

diet and acid-base balance, stone-forming propensity, and calcium metab-olism. Am J Kidney Dis 2002;40:265–74.

25. Goodrick and Foreyth, Why treatmentsfor obesity don’t last.

26. Polivy J. Psychological consequences offood restriction. J Am Diet Assoc1996;96:589–92.

27. Parker-Pope T. A desperate diet: puttingon pounds to qualify for weight losssurgery. Wall Street Journal, 7/8/03, p. D1.

28. Gastrointestinal surgery for severe obe-sity. The Weight-Control InformationNetwork, www.niddk.nih.gov/health/nutrit/nutrit.htm, accessed 8/03.

29. Gastrointestinal surgery for severe obe-sity (www.niddk.nih.gov/health/nutrit/nutrit.htm).

30. Gastrointestinal surgery (www.niddk.nih.gov/health/nutrit/nutrit.htm).

31. Gastrointestinal surgery (www.niddk.nih.gov/health/nutrit/nutrit.htm); andParker-Pope, A desperate diet.

32. Perugini RA et al. Weight loss surgeryeffective but can involve complications:case series. Arch Surg 2003;138:541–6.

33. Gastrointestinal surgery (www.niddk.nih.gov/health/nutrit/nutrit.htm); andPerugini et al., Weight loss surgery.

34. Liposuction comes of age, and Newliposuction technique faster, less invasive. www.healthfinder.gov, accessed 9/03.

35. Liposuction comes of age (www.healthfinder.gov); and Cohen S. Lipoly-sis: pitfalls and problems in a series of1246 procedures. Aesthetic Plast Surg1985;9:207.

36. Weinsier RL et al., Free-living energyexpenditure in women successful and

unsuccessful at maintaining a normalbody weight, Am J Clin Nutr 2002;75:499–504; St Jeor ST et al., A classifi-cation system to evaluate weight main-tainers, gainers, and losers, J Am DietAssoc 1997;97:481–8; and Position ofthe American Dietetic Association:weight management, J Am Diet Assoc2002;102:1145–55.

37. Position of the ADA: weight management.

38. Position of the ADA: weight management.

39. Weinsier et al., Free-living energy expen-diture; St Jeor et al., A classification sys-tem; and Position of the ADA: weightmanagement.

40. Schoeller DA et al., How much physicalactivity is needed to minimize weightgain in previously obese women? Am JClin Nutr 1997;66:551–6.

41. National Institutes of Health. Methodsfor voluntary weight loss and control.Nutr Today 1992;27:27–33.

42. Schoeller et al., How much physicalactivity is needed; and Shick SM et al.,Persons successful at long-term weightloss and maintenance continue to con-sume a low-energy, low-fat diet, J AmDiet Assoc 1998;98:408–14; and Culli-nen K, Caldwell M, Weight trainingincreases fat-free mass and strength inuntrained young women, J Am DietAssoc 1998;98:414–18.

43. Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfastin the treatment of obesity: a random-ized trial. Am J Clin Nutr 1992;55:645–51.

44. Rolls BJ., The super-sizing of America,Nutr Today 2003;38:42–53; andMcCrory MA et al., Biobehavioral influ-ences on energy intake and adult weightgain, J Nutr 2002;132:3830S–24S.

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