Do you need weight-loss coaching?

Harvard Heart Letter

Learning lifestyle changes that go beyond "eat less, move more" may help you shed pounds and dodge heart disease.

The start of a new year often rouses a new resolve to lose weight—a goal that's especially important for people prone to heart disease. Excess weight can boost blood pressure, blood sugar, and cholesterol values, all of which burden the heart.

Yet a fear of heart disease doesn't help most people lose weight. Knowing the -basics of a low-calorie diet and a fat-burning exercise regimen doesn't necessarily do the trick, either. But for many people, targeted behavior coaching that transforms their eating, exercise, and other habits—known as intensive lifestyle intervention—can make a difference.



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Targeted behavior coaching can help people learn and practice a range of weight-loss strategies.

In an intensive intervention program, you work closely with one or more trained experts, including dietitians, nutritionists, exercise professionals, health educators, and psychologists.

"The goal is to lose at least 1% of your body weight a week for the first four weeks," says George L. Blackburn, professor of nutrition at Harvard Medical School and director of the Center for Nutrition Medicine at Beth Israel Deaconess Medical Center. Reaching that goal requires a major lifestyle change, and that takes a lot of work, he adds.

In the following months, the goal is to lose 5% to 10% of your weight, which will counter high blood sugar, high blood pressure, and other problems that raise cardiovascular risk. The data to support this effort convinced the U.S. Preventive Services Task Force to recommend intensive behavioral counseling inter-ventions for people who are overweight or obese and have risk factors for heart disease.

Get with the program

Programs are available at many major medical centers throughout the country; your primary care provider may be able to recommend one. Be aware that the costs of these programs vary widely, and many are not covered by health insurance. But it's worth checking with your insurance plan; some may pay for several visits with a dietitian but not other services.

The program at Harvard-affiliated Massachusetts General Hospital, known as Healthy Habits for Life, costs $550 and includes 12 group support and education sessions, a customized eating plan, and two visits with a personal trainer. Some programs also include counseling by telephone, email, or text message.

One of the main benefits of participating in these programs is the group support -aspect. "It's a lot harder to stick to a program on your own, especially in an environment where everyone else is doing something else," Dr. Blackburn says. Having a partner at home to share healthy meals and be an exercise buddy also helps.

Making time to change

Dietitian Sonja Goedkoop, who leads some of the Healthy Habits group meetings, and Dr. Blackburn offer this advice on making lifestyle changes to foster weight loss:

  • Plan ahead. One challenge is to find the time to shop and make healthy meals, says Goedkoop. Pick one day a week to devote to planning, shopping, and prepping the coming week's lunches and dinners. "Otherwise, it's a constant battle not to fall into the habit of getting take-out," she says. When you get home from the grocery store, cut up your veggies and store them in clear containers at eye level, so you'll reach for them more often.

  • Go for convenience. Don't discount low-calorie frozen dinners. "They're the right portion size, and many of them are pretty tasty," Dr. Blackburn says. Supermarket salad bars can also save you time.

  • Pay attention to portion size. Measuring common foods like cereal, peanut butter, and salad dressing is key, so you aren't accidentally eating more than a serving. Using smaller plates, bowls, and even utensils also helps you to eat less.

  • Exercise in 10-minute bursts. Too busy to fit in a 30-minute workout? Ten-minute bursts of moderate activity are just as effective. Try brisk walking, a bike ride, or even just marching in place or doing jumping jacks.

  • Keep a food diary. Writing down everything you eat is a proven strategy for losing weight and keeping it off. Smartphone apps can make this task easier. Look for a user-friendly, free one that has a large database of foods (including store brands and chain restaurant menu items) and that lists both calories and nutrients, says Goedkoop. Two popular ones are Lose It! and My Fitness Pal.

  • Track your activity. Digital fitness monitors—whether worn as wristbands, clipped on clothing, or slipped into a pocket—can help. Basic ones measure your steps and calories, while others capture heart rate, skin temperature, and sleep patterns. Find one that reminds you to be more active throughout the day, like the Garmin Vivo, Dr. Blackburn recommends.

  • Step on the scale. Weigh yourself at least once a week, or even daily, as the practice has been shown to aid weight loss. But don't obsess over natural fluctuations of a pound or two from day to day.