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Weight Loss for Life
The Weight-control Information Network (WIN)

How We Lose Weight

Weight-control Information Network

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Who should lose weight? Health experts generally agree that adults can benefit from weight loss if they are moderately to severely overweight (see the following weight-for-height chart below). Health experts also agree that adults who are overweight and have weight-related medical problems or a family history of such problems can benefit from weight loss. Some weight-related health problems include diabetes, heart disease, high blood pressure, high cholesterol levels, or high blood sugar levels. Even a small weight loss of 10 to 20 pounds can improve your health, for example by lowering your blood pressure and cholesterol levels. You do not need to lose weight if your weight is within the healthy range on the weight-for-height chart, you have gained less than 10 pounds since you reached your adult height, and you are otherwise healthy.

How We Lose Weight

Your body weight is controlled by the number of calories you eat and the number of calories you use each day. So, to lose weight you need to take in fewer calories than you use. You can do this by becoming more physically active or by eating less. Following a weight-loss program that helps you to become more physically active and decrease the amount of calories that you eat is most likely to lead to successful weight loss. The weight-loss program should also help you keep the weight off by making changes in your physical activity and eating habits that you will be able to follow for the rest of your life.

Types of Weight-Loss Programs

To lose weight and keep it off, you should be aware of the different types of programs available and the important parts of a good program. Knowing this information should help you select or design a weight-loss program that will work for you. The three types of weight-loss programs include: do-it-yourself programs, non-clinical programs, and clinical programs.

Do-It-Yourself Programs

Any effort to lose weight by yourself or with a group of like-minded others through support groups, worksite or community-based programs fits in the "do-it-yourself" category. Individuals using a do-it-yourself program rely on their own judgment, group support, and products such as diet books for advice (Note: Not all diet books are reliable sources of weight-loss information).

Non-Clinical Programs

These programs may or may not be commercially operated, such as through a privately-owned, weight-loss chain. They often use books and pamphlets that are prepared by health-care providers. These programs use counselors (who usually are not health-care providers and may or may not have training) to provide services to you. Some programs require participants to use the program's food or supplements.

Clinical Programs

This type of program may or may not be commercially owned. Services are provided in a health-care setting, such as a hospital, by licensed health professionals, such as physicians, nurses, dietitians, and/or psychologists. In some clinical programs, a health professional works alone; in others, a group of health professionals works together to provide services to patients. Clinical programs may offer you services such as nutrition education, medical care, behavior change therapy, and physical activity.

Clinical programs may also use other weight-loss methods, such as very low-calorie diets, prescription weight-loss drugs, and surgery, to treat severely overweight patients. These treatments are described below:

Very low-calorie diets (VLCDs) are commercially prepared formulas that provide no more than 800 calories per day and replace all usual food intake. VLCDs help individuals lose weight more quickly than is usually possible with low-calorie diets. Because VLCDs can cause side effects, obesity experts recommend that only people who are severely overweight (see weight-for-height chart) use these diets, and only with proper medical care. A fact sheet on VLCDs is available from the Weight-control Information Network (WIN).

Prescribed weight-loss drugs should be used only if you are likely to have health problems caused by your weight. You should not use drugs to improve your appearance. Prescribed weight-loss drugs, when combined with a healthy diet and regular physical activity, may help some obese adults lose weight. However, before these medications can be widely recommended, more research is needed to determine their long-term safety and effectiveness. Whatever the results, prescription weight-loss drugs should be used only as part of an overall program that includes long-term changes in your eating and physical activity habits. A fact sheet on prescription medications for the treatment of obesity is available from WIN.

You may consider gastric surgery to promote weight loss if you are more than 80 pounds overweight. The surgery, sometimes called bariatric surgery, causes weight loss in one of two ways: 1) by limiting the amount of food your stomach can hold by closing off or removing parts of the stomach or 2) by causing food to be poorly digested by bypassing the stomach or part of the intestines. After surgery, patients usually lose weight quickly. While some weight is often regained, many patients are successful in keeping off most of their weight. In some cases, the surgery can lead to problems that require follow-up operations. Surgery may also reduce the amount of vitamins and minerals in your body and cause gallstones. For additional information, a fact sheet on gastric surgery is available from WIN.

If you are considering a weight-loss program and you have medical problems, or if you are severely overweight, programs run by trained health professionals may be best for you. These professionals are more likely to monitor you for possible side effects of weight loss and to talk to your doctor when necessary.

Whether you decide to use the do-it-yourself, non-clinical, or clinical approach, the program should help you lose weight and keep it off by teaching you healthy eating and physical activity habits that you will be able to follow for the rest of your life.

Diet

The word "diet" probably brings to mind meals of lettuce and cottage cheese. By definition, "diet" refers to what a person eats or drinks during the course of a day. A diet that limits portions to a very small size or that excludes certain foods entirely to promote weight loss may not be effective over the long term. Rather, you are likely to miss certain foods and find it difficult to follow this type of diet for a long time. Instead, it is often helpful to gradually change the types and amounts of food you eat and maintain these changes for the rest of your life. The ideal diet is one that takes into account your likes and dislikes and includes a wide variety of foods with enough calories and nutrients for good health.

How much you eat and what you eat play a major role in how much you weigh. So, when planning your diet, you should consider: What calorie level is appropriate? Is the diet you are considering nutritionally balanced? Will the diet be practical and easy to follow? Will you be able to maintain this eating plan for the rest of your life? The following information will help you answer these questions.

Calorie Level

Low-calorie Diets. Most weight-loss diets provide 1,000 to 1,500 calories per day. However, the number of calories that is right for you depends on your weight and activity level. At these calorie levels, diets are referred to as low-calorie diets. Self-help diet books and clinical and non-clinical weight-loss programs often include low-calorie diet plans.

The calorie level of your diet should allow for a weight loss of no more than 1 pound per week (after the first week or two when weight loss may be more rapid because of initial water loss). If you can estimate how many calories you eat in a day, you can design a diet plan that will help you lose no more than 1 pound per week. You may need to work with a trained health professional, such as a registered dietitian. Or, you can use a standardized low-calorie diet plan with a fixed calorie level.

The selected calorie level, however, may not produce the recommended rate of weight loss, and you may need to eat more or less.

Good Nutrition

Make sure that your diet contains all the essential nutrients for good health. Using the Food Guide Pyramid and the Nutrition Facts Label that is found on most processed food products can help you choose a healthful diet. The Pyramid shows you the kinds and amounts of food that you need each day for good health. The Nutrition Facts Label will help you select foods that meet your daily nutritional needs. A healthful diet should include:

Adequate vitamins and minerals. Eating a wide variety of foods from all the food groups on the Food Guide Pyramid will help you get the vitamins and minerals you need. If you eat less than 1,200 calories per day, you may benefit from taking a daily vitamin and mineral supplement.

Adequate protein. The average woman 25 years of age and older should get 50 grams of protein each day, and the average man 25 years of age and older should get 63 grams of protein each day. Adequate protein is important because it prevents muscle tissue from breaking down and repairs all body tissues such as skin and teeth. To get adequate protein in your diet, make sure you eat 2-3 servings (see Figure 2) from the Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group on the Food Guide Pyramid every day. These foods are all good sources of protein.

Source: U.S. Department of Agriculture / U.S. Department of Health and Human Services

Note: A range of servings is given for each food group. The smaller number is for people who consume about 1,600 calories a day, such as sedentary women. The larger number is for those who consume about 2,800 calories a day, such as active men.

Adequate carbohydrates. At least 100 grams of carbohydrates per day are needed to prevent fatigue and dangerous fluid imbalances. To make sure you get enough carbohydrates, eat 6-11 servings (see Figure 2) from the Bread, Cereal, Rice, and Pasta Group on the Food Guide Pyramid every day.

A daily fiber intake of 20 to 30 grams. Adequate fiber helps with proper bowel function. If you were to eat 1 cup of bran cereal, 1/2 cup of carrots, 1/2 cup of kidney beans, a medium-sized pear, and a medium-sized apple together in 1 day, you would get about 30 grams of fiber.

No more than 30 percent of calories, on average, from fat per day, with less than 10 percent of calories from saturated fat (such as fat from meat, butter, and eggs). Limiting fat to these levels reduces your risk for heart disease and may help you lose weight. In addition, you should limit the amount of cholesterol in your diet. Cholesterol is a fat-like substance found in animal products such as meat and eggs. Your diet should include no more than 300 milligrams of cholesterol per day (one egg contains about 215 milligrams of cholesterol, and 3.5 ounces of cooked hamburger contain 100 milligrams of cholesterol).

At least 8 to 10 glasses, 8 ounces each, of water or water-based beverages, per day. You need more water if you exercise a lot.

These nutrients should come from a variety of low-calorie, nutrient-rich foods. One way to get variety -- and with it, an enjoyable and nutritious diet -- is to choose foods each day from the Food Guide Pyramid (see Figure 1).

Types of Diets

Fixed-menu diet. A fixed-menu diet provides a list of all the foods you will eat. This kind of diet can be easy to follow because the foods are selected for you. But, you get very few different food choices which may make the diet boring and hard to follow away from home. In addition, fixed-menu diets do not teach the food selection skills necessary for keeping weight off. If you start with a fixed-menu diet, you should switch eventually to a plan that helps you learn to make meal choices on your own, such as an exchange-type diet.

Exchange-type diet. An exchange-type diet is a meal plan with a set number of servings from each of several food groups. Within each group, foods are about equal in calories and can be interchanged as you wish. For example, the "starch" category could include one slice of bread or 1/2 cup of oatmeal; each is about equal in nutritional value and calories. If your meal plan calls for two starch choices at breakfast, you could choose to eat two slices of bread, or one slice of bread and 1/2 cup of oatmeal. With the exchange-type diet plans, you have more day-to-day variety and you can easily follow the diet away from home. The most important advantage is that exchange-type diet plans teach the food selection skills you need to keep your weight off.

Prepackaged-meal diet. These diets require you to buy prepackaged meals. Such meals may help you learn appropriate portion sizes. However, they can be costly. Before beginning this type of program, find out whether you will need to buy the meals and how much the meals cost. You should also find out whether the program will teach you how to select and prepare food, skills that are needed to sustain weight loss.

Formula diet. Formula diets are weight-loss plans that replace one or more meals with a liquid formula. Most formula diets are balanced diets containing a mix of protein, carbohydrate, and usually a small amount of fat. Formula diets are usually sold as liquid or a powder to be mixed with liquid. Although formula diets are easy to use and do promote short-term weight loss, most people regain the weight as soon as they stop using the formula. In addition, formula diets do not teach you how to make healthy food choices, a necessary skill for keeping your weight off.

Questionable diets. You should avoid any diet that suggests you eat a certain nutrient, food, or combination of foods to promote easy weight loss. Some of these diets may work in the short term because they are low in calories. However, they are often not well balanced and may cause nutrient deficiencies. In addition, they do not teach eating habits that are important for long-term weight management.

Flexible diets. Some programs or books suggest monitoring fat only, calories only, or a combination of the two, with the individual making the choice of both the type and amount of food eaten. This flexible type of approach works well for many people, and teaches them how to control what they eat. One drawback of flexible diets is that some don't consider the total diet. For example, programs that monitor fat only often allow people to take in unlimited amounts of excess calories from sugars, and therefore don't lead to weight loss.

It is important to choose an eating plan that you can live with. The plan should also teach you how to select and prepare healthy foods, as well as how to maintain your new weight. Remember that many people tend to regain lost weight. Eating a healthful and nutritious diet to maintain your new weight, combined with regular physical activity, helps to prevent weight regain.

Physical Activity

Regular physical activity is important to help you lose weight and build an overall healthy lifestyle. Physical activity increases the number of calories your body uses and promotes the loss of body fat instead of muscle and other nonfat tissue. Research shows that people who include physical activity in their weight-loss programs are more likely to keep their weight off than people who only change their diet. In addition to promoting weight control, physical activity improves your strength and flexibility, lowers your risk of heart disease, helps control blood pressure and diabetes, can promote a sense of well-being, and can decrease stress.

Any type of physical activity you choose to do -- vigorous activities such as running or aerobic dancing or moderate-intensity activities such as walking or household work -- will increase the number of calories your body uses. The key to successful weight control and improved overall health is making physical activity a part of your daily life.

For the greatest overall health benefits, experts recommend that you do 20 to 30 minutes of vigorous physical activity (see the following Activities Chart) three or more times a week and some type of muscle strengthening activity, such as weight resistance, and stretching at least twice a week. However, if you are unable to do this level of activity, you can improve your health by performing 30 minutes or more of moderate-intensity physical activity (see the Activities Chart) over the course of a day, at least five times a week. When including physical activity in your weight-loss program, you should choose a variety of activities that can be done regularly and are enjoyable for you. Also, if you have not been physically active, you should see your doctor before you start, especially if you are older than 40 years of age, very overweight, or have medical problems. A fact sheet on physical activity and weight control is available from WIN.

Behavior Change

Behavior change focuses on learning eating and physical activity behaviors that will help you lose weight and keep it off. The first step is to look at your eating and physical activity habits, thus uncovering behaviors (such as television watching) that lead you to overeat or be inactive. Next you'll need to learn how to change those behaviors.

Getting support from others is a good way to help you maintain your new eating and physical activity habits. Changing your eating and physical activity behaviors increases your chances of losing weight and keeping it off. For additional information on behavior change, you may wish to ask a weight-loss counselor or refer to books on this topic, which are available in local libraries.

What Works for You?

A variety of options exist to help you lose weight and keep it off. The key to successful weight loss is making changes in your eating and physical activity habits that you will be able to maintain for the rest of your life.

Additional Reading

The following information can be retrieved from the Weight-control Information Network (WIN)

Binge Eating Disorder. NIH Publication No. 94-3589. This fact sheet describes the symptoms, causes, complications, and treatment of binge eating disorder, along with a profile of those at risk for the disorder. 1993. Available from WIN.

Dieting and Gallstones. NIH Publication No. 94-3677. This fact sheet describes what gallstones are, how weight loss may cause them, and how to lessen the risk of developing them. 1993. Available from WIN.

Gastric Surgery for Severe Obesity. NIH Publication No. 96-4006. This fact sheet describes the different types of surgery available to treat severe obesity. It explains how gastric surgery promotes weight loss and the benefits and risks of each procedure. 1996. Available from WIN.

Physical Activity and Weight Control. NIH Publication No. 96-4031. This booklet explains how physical activity helps promote weight control and other ways it benefits one's health. It also describes the different types of physical activity and provides tips on how to become more physically active. Revised 1997. Available from WIN.

Prescription Medications for the Treatment of Obesity. NIH Publication No. 97-4191. This fact sheet presents information on appetite suppressant medications. These medications may help some obese patients lose more weight than with non-drug treatments. The types of medications and the risks and benefits associated with the use of these medications are described. Revised 1997. Available from WIN.

Very Low-Calorie Diets. NIH Publication No. 95-3894. Information on who should use a very low-calorie diet (VLCD) and the health benefits and possible adverse effects of VLCDs is provided in this fact sheet. 1995. Available from WIN.

Weight Cycling. NIH Publication No. 95-3901. Based on research, this fact sheet describes the health effects of weight cycling, also known as "yo-yo" dieting, and how it affects obese individuals' future weight-loss efforts. 1995. Available from WIN.

"Are You Eating Right?" Consumer Reports. October 1992, pp. 644-55. This article summarizes advice from 68 nutrition experts, including a discussion on weight control and health risks of obesity. Available from WIN.

"Losing Weight: What Works. What Doesn't" and "Rating the Diets." Consumer Reports. June 1993, pp. 347-57. These articles report on a survey of readers' experiences with weight-loss diets, discuss research related to weight control, and outline pros and cons of different diet programs. Available in public libraries.

"The Facts About Weight-Loss Products and Programs." DHHS Publication No. (FDA) 92-1189. This pamphlet provides basic facts about the weight-loss industry and what the consumer should expect from a diet program and/or product. Available from the Food and Drug Administration, Office of Consumer Affairs, HFE-88, Rockville, MD 20857.

"Nutrition and Your Health: Dietary Guidelines for Americans, Fourth Edition." Home and Garden Bulletin No. 232. 1995. This booklet answers some of the basic questions about healthy eating and the link between poor nutrition and disease. It stresses the importance of a balanced diet and a healthy lifestyle. Available from WIN.

A Report of the Surgeon General: Physical Activity and Health. 1996. Produced by the Centers for Disease Control and Prevention, this report compiles decades of research concerning physical activity and health. It addresses the nationwide health problems associated with physical inactivity and outlines the benefits of becoming more physically active. Available for $19.00 from the U.S. Government Printing Office, Superintendent of Documents, Washington, DC 20402; (202) 512-1800. Stock Number 017-023-00196-5.

Weight-control Information Network
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Bethesda, MD 20892-3665
(202) 828-1028
FAX: (202) 828-1028
Email: WIN@info.niddk.nih.gov
Internet: http://www.niddk.nih.gov/health/nutrit/win.htm
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The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, under the U.S. Public Health Service. Authorized by Congress (Public Law 103-43), WIN assembles and disseminates to health professionals and the general public information on weight control, obesity, and nutritional disorders. WIN responds to requests for information; develops, reviews, and distributes publications; and develops communication strategies to encourage individuals to achieve and maintain a healthy weight.

Publications produced by WIN are reviewed for scientific accuracy, content, and readability. Materials produced by other sources are also reviewed for scientific accuracy and are distributed, along with WIN publications, to answer requests.

This publication is not copyrighted. WIN encourages unlimited duplication and distribution of this information.

U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Public Health Service
National Institutes of Health

NIH Publication No. 98-3700
January 1998

e-text posted 9 April 1998
e-text last updated May 2000