Many people struggle with being overweight, or even obese. It's a common topic at office visits. As a doctor, I know that excess weight is associated with potentially serious health conditions — high blood pressure, high blood sugar, high cholesterol — not to mention sleep apnea, fatty liver disease, and back and knee problems, among other things. Patients may also worry about their appearance.
Whether a patient is at risk for medical problems due to being overweight, or if it's a personal health goal, then it's my job to provide counseling.
In my experience, most patients consider weight loss drugs or surgery only as a last resort. "I want to lose weight naturally," they say. Once we screen for (and treat) any contributing medical problems that could be causing weight gain (low thyroid function, polycystic ovarian syndrome, prediabetes, among others), or psychological issues (bulimia, binge-eating disorder, depression, anxiety), I encourage a diet-and-lifestyle approach for many reasons, among them my own personal experience.
A real-life weight loss story
A few years ago, I embarked on a personal weight loss journey. I had had two pregnancies back-to-back, and had gained considerable weight, to the point where my own body mass index was over 30 (obesity range). I was many months postpartum, and realized that the "baby weight" wasn't going anywhere. As a matter of fact, I had gained even more weight since my daughter was born.
At that point, I had a quandary many people can identify with: I was one of two working parents, with two kids under two. How on earth does one tackle weight loss when one is busy and distracted? What I did was fairly basic, and there is research to back up this approach:1
Here's what worked for me:
- I resigned myself to the fact that, hey, it took me 18+ months to put on the weight, so it would probably take 18+ months to lose it. As much as I knew about nutrition, I felt like I needed guidance. So I researched a bunch of popular diets and philosophies.
- I chose a well-rounded, nutritious diet plan consisting of a wide variety of fruits, vegetables, lean proteins, and healthy fats (and also very low in carbohydrates). It was a popular commercial diet, which I modified to suit my preferences (most of the diets out there are fairly similar). I never bought any of their prepared foods, and used their menu only as a guide, substituting what I liked or had in the pantry where necessary.
- I got a small pocket notebook, and started keeping track of everything that I ate. Each page represented a day's intake, and I counted calories, as best I could. Once a week, I weighed myself, and jotted that down as well.
- Exercise in those early days consisted of only a few minutes of sit-ups, pushups, and other in-place calisthenics at nighttime, after the kids had gone to sleep (and before they woke up again overnight).
- Yes, I had the occasional slice of cake, glass of wine, chunk of chocolate, piece of baklava (a major downfall), or other treats. I forgave myself those indiscretions, as well as any "vacations" from my dieting, logging, and exercising. I would just pick up where I left off and keep going. And going.
- There were stops and starts, and the scale went up and down, but over time, the pounds slowly, slowly came off. As the months went on, I was able to rejoin my gym and add once or twice-weekly workout sessions. As my muscle tone increased, so did my metabolism, and the weight came off faster.
- It took over two years, but I lost 50 pounds. In the three years since, I've maintained that weight loss within five pounds.
What does the science say about my approach? Let's take a look.
Diet and weight loss
Studies have shown that just about any diet will result in weight loss, if it's one that someone can follow.1,2 Esteemed Yale physician and nutrition expert David Katz examined over 58 popular diets and found that the most successful in terms of both weight loss and nutrition consist of "real food." By that he means plants, whole grains, nuts and seeds, as well as meat (ideally, from animals that ate plants). Basically, foods closer to nature. The other key is minimizing processed foods, including sugars and flours.3
Without realizing it, I followed Katz's advice: I ate mostly fruits and vegetables, nuts, seeds, and dairy. I occasionally had whole grains like quinoa or farro, even rice or corn chips. And, of course, an occasional treat. But I had sworn off sugars and flours, for the most part.
Behavior change and weight loss
It's hard to keep track of how much we eat. But a lot of research shows that when we keep track of intake, we eat less. This is called self-monitoring, and why writing down what I ate and weighed helped me.4,5,6 There are so many ways to do this nowadays: from the old-school paper-and-pencil method, to apps like MyFitnessPal, or the Weight Watchers points system.7
Another key approach: forgive your failures. Studies show that people who "mess up" their diet plan and then "give up" end up gaining, while people who forgive themselves and move on continue to lose. It's called self-acceptance.8,9 Look, we're human. Birthdays, office parties, weddings, random movie nights: they happen, and we celebrate by having the amazing chocolate cake, or Betsy's famous buffalo chicken dip, waaaay too much champagne, or buttered popcorn. Expect this, enjoy, and then move on.
Exercise and weight loss
Most major weight loss is followed by weight gain, as people revert to their old habits. But, some folks manage to keep it off. How do they do it? Researchers have found that maintaining a healthy diet, ongoing self-monitoring, plenty of self-acceptance, as well as a high level of physical activity are all associated with keeping the pounds off.10
When I feel like I'm slipping, I start logging again. Nowadays, I use an online fitness app on my phone to more easily keep track of my daily food intake. Red wine and dark chocolate are always in stock in our house, and that's OK. Exercise is important, too, but in my book, any and all physical activity counts. Two or three workouts a week help me maintain muscle tone and cardiovascular fitness. If I can't get to the gym, I run. If I can't run, I do something at home, like five minutes of in-place kickboxing moves, or dancing around the living room like a crazy person with my kids. I take the stairs wherever I am as often as possible. I use a carry basket at the grocery store, and switch from arm to arm while I shop: biceps curls! Hey, it all counts.
Staying at a healthy weight for life
The old adage is "eat less, exercise more," and this is still true, to some extent. But human beings are psychologically and sociologically complex creatures, and that adage is a lot harder to follow than it sounds. For average adults who do not have contributing medical or psychological issues, a nutritious plant-based diet low in processed foods and carbohydrates, consistent self-monitoring of intake and progress, forgiving oneself when expected lapses occur, all combined with regular physical activity, can result in weight loss for life.
- Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN Diets for change in weight and related risk factors among overweight premenopausal women. The A to Z Weight Loss Study: a randomized trial. JAMA, 2005.
- Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA, 2005.
- Katz and S. Meller. Can We Say What Diet Is Best for Health? Annual Review of Public Health, Vol.35.
- Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc., Jan. 2011.
- Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev., Nov. 2015, E-pub Aug 27, 2015.
- Hassan Y, Head V, Jacob D, Bachmann MO, Diu S, Ford J. Lifestyle interventions for weight loss in adults with severe obesity: a systematic review. Clin Obes, 2016.
- Levine DM, Savarimuthu S, Squires A, Nicholson J, Jay M. Technology-assisted weight loss interventions in primary care: a systematic review. J Gen Intern Med., Jan 2015, E-pub Aug 19 2014.
- Rogers JM, Ferrari M, Mosely K, Lang CP, Brennan L. Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes. Obes Rev., Jan. 2017.
- Ruffault A, Czernichow S, Hagger MS, Ferrand M, Erichot N, Carette C, Boujut E, Flahault C. The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: A systematic review and meta-analysis. Obes Res Clin Pract., 2016.
- Montesi L, El Ghoch M, Brodosi L, Calugi S, Marchesini G, Dalle Grave R. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes., Feb. 2016.
- Lifestyle: Medicine That Inspires, Huffington Post.