A Harvard Medical School Special Health Report

Healthy Solutions to

Lose Weight
and Keep it Off

In this report:
Why you gain weight
A week’s worth of
calorie-controlled
menus and recipes
Warnings about weight
loss supplements
Surgery for weight loss

Special Bonus Section

10 habits to help you
lose weight

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healthy solutions to lose
weight and keep it off Contents
SPECIAL HEALTH REPORT
Overweight and obesity:
Medical Editor What’s behind the growing trend? . . . . . . . . . . . . . . . . . . . 2
Miguel Alonso-Alonso, M.D.
Instructor in Neurology, Harvard Medical School Why people become overweight. . . . . . . . . . . . . . . . . . . . . . . . . 2
Division of Cognitive Neurology, Beth Israel Genetic influences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Deaconess Medical Center Environmental influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Writer Other causes of obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Julie Corliss
Editor, Special Health Reports How excess weight affects your health. . . . . . . . . . . . . . . 11
Kathleen Cahill Allison More disability…and a shorter life?. . . . . . . . . . . . . . . . . . . . . 13
Art Director Health benefits of weight loss. . . . . . . . . . . . . . . . . . . . . . . . . 14
Heather Derocher
When to seek professional help. . . . . . . . . . . . . . . . . . . . 15
Production Editors
Mary Kenda Allen
Medical evaluation for weight loss. . . . . . . . . . . . . . . . . . . . . . 15
Melissa Rico Screening tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Illustrators
Designing a treatment program. . . . . . . . . . . . . . . . . . . . . . . . 16
Scott Leighton
Weight-loss basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Ed Wiederer
Counting calories: How many do you need? . . . . . . . . . . . . . . . 17
Published by Harvard Medical School
Physical activity: How much is enough?. . . . . . . . . . . . . . . . . . 18
Anthony L. Komaroff, M.D., Editor in Chief
Edward Coburn, Publishing Director Choosing the diet that fits you best . . . . . . . . . . . . . . . . . 21
Copyright ©2011 by Harvard University. Written permission is
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Harvard Health Publications What to eat: A week of daily menus. . . . . . . . . . . . . . . . . 24
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ISBN 978-1-935555-59-9 Keeping the weight off . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
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 Dear Reader,

It’s no secret that most American adults are overweight. But it’s no surprise either, considering
the way we live today. We have easy access to all sorts of tempting food day and night but
fewer opportunities to build physical activity into our daily routines, not to mention soaring
stress levels—all of which contribute to our growing girth.

Here’s my main message: stop blaming yourself or feeling ashamed about your weight. And
don’t despair, because it is possible to lose weight and keep it off over time. This report offers
a range of solutions that have worked for many people and can be tailored to your specific
needs. Take this challenge seriously, though, because overweight and obesity can lead to
serious medical problems.

Successful weight loss depends largely on becoming more aware of your behaviors and
starting to change them. Rather than willpower, this process demands skill power, which is
good news because you can learn new skills. The special section of this report, “10 habits to
help you lose weight,” details these skills. Other chapters explore the health hazards of excess
weight, as well as the latest information about diets, exercise plans, structured programs,
medications, and surgery to foster weight loss. We’ve also included a week’s worth of healthy,
calorie-controlled menus (including a handful of recipes) to get you started.

If you have failed to lose weight in past attempts, don’t be discouraged. Perhaps the method
wasn’t right for you, or you weren’t ready to commit at that time. Before starting, make sure
you’re able to commit the time and effort you’ll need for this important cause. Don’t let
discouragement steal your energy to stick to your goals. Keep a positive attitude and focus on
your achievements. Try to be structured and rational in your approach, but remember that
some flexibility can help, too. The journey can be enjoyable and rewarding—and may even
inspire others around you.

The main focus of this report is on weight loss. But cultivating a healthy lifestyle, developing
positive ways to deal with the emotional aspects of eating, and being satisfied with your
body are also important for your overall well-being. Always keep in mind that the worth of
a person is not measured on the scale.

Good luck in this journey toward better health!

Sincerely,

Miguel Alonso-Alonso, M.D.

Medical Editor

Harvard Health Publications | Harvard Medical School | 10 Shattuck Street, Second Floor | Boston, MA 02115
 Overweight and obesity: What’s behind
the growing trend?
T he dire statistics are all too familiar by now: two in
three Americans are overweight, and one in three
is obese (to determine your status, see Table 2, page 4).
Since the late 1970s, the prevalence of adults who are
obese has more than doubled, from about 15% to 34%.
If this trend continues, fully half of Americans will
be obese by the year 2030. Carrying excess weight is
uncomfortable—both physically and emotionally—as
well as costly (see Table 1). It also puts you at a higher
risk of numerous health problems, including some of
the nation’s leading killers: heart disease, stroke, and
certain cancers.
In 2001, the U.S. government issued The Surgeon
General’s Call to Action to Prevent and Decrease Over-
weight and Obesity. But a decade later, the message
has only become more urgent as obesity rates (and
our nation’s health care expenses) continue to balloon.
Clearly, there’s no easy fix. But new ways to attack the
problem are in the works, as researchers continue to
tease out the reasons behind the obesity epidemic.
Why people become overweight
Although scientists have identified numerous genes
that contribute to obesity, environmental (that is,
social and lifestyle) factors are largely to blame for
Table 1 Costs of obesity
People who are overweight or obese pay more than people who
are normal weight largely because of medical expenses, which
include out-of-pocket and insurance-covered expenses of doctors’
visits and medications.
Annual cost of being Annual cost of
overweight being obese
Men $432 $2,646
Women $524 $4,879
Source: A Heavy Burden: The Individual Costs of Being Overweight and Obese in
the United States, The George Washington University School of Public Health and
Health Services Department of Health Policy, 2010.
2 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
Americans’ widening waistlines. The easy availability
of high-calorie foods is a big part of the problem. Lack
of regular exercise, combined with long commutes to
largely sedentary jobs, is another. Overarching soci-
etal influences such as government policies, the food
industry, and where you live and work play a role (see
Figure 1). So do personal experiences—for example,
increased stress and lack of adequate sleep can wreak
havoc with the body’s internal balancing system and
contribute to weight gain.
On a very simple level, your weight depends on
the number of calories you consume, how many of
those calories you store, and how many you burn up
(see “The calorie equation,” page 3). But each of these
factors is influenced by a combination of genes and
environment. Both can affect your physiology (such
as how fast you burn calories) as well as your behavior
(the types of foods you choose to eat, for instance).
The interplay among all these factors begins at the
moment of your conception and continues through-
out your life.
Genetic influences
For decades, the prevailing wisdom about the genetic
roots of obesity centered around the “thrifty geno-
type” hypothesis: namely, that most people inherit
genes that help them store fat efficiently—an evolu-
tionary adaptation that helped our ancient ancestors
survive during lean times, when the prey escaped and
the crops failed. But in today’s environment, these
genes are a curse rather than a blessing. With high-
calorie, inexpensive food available nearly around the
clock and no need to hunt or harvest it, these genes
predispose people to pack on pounds.
But researchers now recognize the limitations of
this theory. For one thing, genes were shaped by numer-
ous factors over the course of human evolution, such as
the need to hunt, to escape from predators, or to tol-
erate temperature extremes—not just the need to store
fat. Scientists also question whether famines were com-
mon and severe enough throughout history to select for
(that is, increase the frequency of) thrifty genes. What’s
more, many people today manage to stay slim even
while living in an obesity-promoting environment.
Researchers have refined their understanding
of obesity genes. According to a 2007 commentary
in the International Journal of Obesity, 127 different
genes have been linked to some aspect of obesity, 22 of
which have been verified by at least five studies. Each
of these genes appears to contribute to obesity by pro-
moting one of these five characteristics:
• a slow metabolism and low calorie-burning rate
• a tendency to overeat, because of poor control of
appetite and impaired ability to feel full
• a propensity to be physically inactive
• a slowed ability to burn calories from fat
• a tendency to develop a large number of fat cells and
to store high levels of fat in the body.
In a 2007 report in Science, researchers described
the first gene found to contribute to common types of
obesity, dubbed the fat mass and obesity-associated
(FTO) gene. They don’t know exactly what the gene
does in the body, but people who carry two copies of
a particular variant of this gene weigh an average of
about 7 pounds more and are about 70% more likely
to be obese compared with those who lack the variant.
However, biology is not destiny: both physical
activity and diet can blunt a genetic tendency to be
overweight. A study published in 2008 in Archives
of Internal Medicine looked at 704 Amish men and
women who had varying levels of daily activity. (Amish
people are good study subjects because they tend to
be genetically similar; they also eschew modern con-
veniences such as cars and electric appliances and are
therefore more physically active than average Ameri-
cans.) Researchers found that those with the FTO gene
variant who were less active were much more likely
to be overweight or obese. But those with the variant
who were also very active—they expended about 900
more calories per day compared with the least active
people—were not overweight. Another study looked
at 12 different genetic variants associated with obesity
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
The calorie equation
The balance of calories your body stores and burns depends
on your genetic makeup, your level of physical activity, and
your resting energy expenditure (the number of calories
your body burns while at rest). If you consistently burn all
of the calories that you consume in the course of a day, you
will maintain your weight. If you consume more calories
than you expend, you will gain weight.
Excess calories are stored throughout your body as fat.
Your body stores this fat within specialized fat cells (adipose
­tissue)— either by enlarging fat cells, which are always
present in the body, or by creating more of them. If you
decrease your food intake and consume fewer calories than
you burn up, or if you exercise more and burn up more calo-
ries, your body will reduce some of your fat stores. When
this happens, fat cells shrink, along with your waistline.
in more than 20,000 people, who reported their physi-
cal activity habits at work and leisure. The investigators
calculated a score for each person, based on how many
BMI-increasing genetic variants he or she had. Being
physically active reduced a person’s tendency toward
obesity by 40%, according to the findings, which were
published in PLoS Medicine in 2010.
Also in 2010, a study found evidence that a
Mediterranean-­style diet—shown to help promote
weight loss (see “The diet studies,” page 21)—could
counteract the genetic propensity for overweight
among people with variations of the FTO gene. In this
investigation, which piggy-backed on a study looking
at whether a Mediterranean-style diet could prevent
heart disease, researchers found that before starting
the intervention, people with a specific variant of the
FTO gene tended to be heavier than those without the
variant. However, after three years on the olive oil–rich
Mediterranean diet, those with the variant gained less
weight than those without it. Importantly, the effect
seemed to be diet-specific, as weight gain was smaller
for the Mediterranean diet than for a low-fat diet
with a similar amount of calories. This suggests that
dietary components could determine the expression
of a genetic risk for obesity. A related field of research
called nutrigenomics, which focuses on tailor­ing diets
to individual genetic characteristics, may yield addi-
tional practical suggestions in the future.
3
 The strength of the genetic influence on weight var-
ies quite a bit from person to person. In general, if one
or both of your parents or other close blood relatives
are significantly overweight, you’re much more likely
to become obese than a person without that family his-
tory. But that doesn’t necessarily mean you’re destined
to become overweight. Although you can’t change
your genes, you can control your environment—which
experts uniformly believe is the driving force for the
dramatic increase in obesity since the 1970s.

Table 2 What’s my BMI? Environmental

Health care providers use body mass index (BMI), an approximate measure of body fat based influences
on a person’s height and weight, to determine whether a person’s weight falls within a
healthy range. To determine your BMI, use the Web-based calculator at http://nhlbisupport. Genetic factors are the forces inside
com/bmi or simply look it up below. you that help you gain weight and
The BMI range associated with the lowest rate of illness and death is approximately 19 to stay overweight; environmental
24 in men and 18 to 24 in women, so people with BMIs in this healthiest range are considered
to be of normal weight. Higher BMIs are associated with progressively higher rates of illness factors are the outside forces that
and death. People with BMIs of 25 to 29 are considered overweight, and those with BMIs of contribute to these problems. They
30 or higher are considered obese. Obesity has been further subdivided into class 1 (BMI of
encompass anything in your sur-
30–34), class 2 (35– 40), and class 3 (40 and above). Class 3 obesity is roughly equivalent to
being 80 pounds overweight if you are a woman or 100 pounds if you are a man. roundings or lifestyle habits that
Height Body weight in pounds
make you more likely to eat too
much or exercise too little.
4’10” 91–115 119–138 143–162 167–186 191+
Environmental influences
4’11” 94–119 124–143 148–168 173–193 198+ come into play very early, even
5’0” 97–123 128–148 153–174 179–199 204+ before you’re born. Research-
ers sometimes call these in-utero
5’1” 100–127 132–153 158–180 185–206 211+
exposures “fetal programming.”
5’2” 104–131 136–158 164–186 191–213 218+ Babies of mothers who smoked
5’3” 107–135 141–163 169–191 197–220 225+ during pregnancy are more likely
5’4” 110–140 145–169 174–197 204–227 232+ to become overweight than those
whose mothers didn’t smoke.
5’5” 114–144 150–174 180–204 210–234 240+
The same is true for babies born
5’6” 118–148 155–179 186–210 216–241 247+ to mothers who had diabetes.
5’7” 121–153 159–185 191–217 223–249 255+ Researchers believe these condi-
5’8” 125–158 164–190 197–223 230–256 262+ tions may somehow alter the grow-
ing baby’s metabolism in ways that
5’9” 128–162 169–196 203–230 236–263 270+
show up later in life.
5’10” 132–167 174–202 209–236 243–271 278+ After birth, babies who are
5’11” 136–172 179–208 215–243 250–279 286+ breast-fed for more than three
6’0” 140–177 184–213 221–250 258–287 294+ months are less likely to be obese as
adolescents compared with infants
6’1” 144–182 189–219 227–257 265–295 302+
who are breast-fed for less than
6’2” 148–186 194–225 233–264 272–303 311+ three months.
6’3” 152–192 200–232 240–272 279–311 319+ Childhood habits often stick
6’4” 156–197 205–238 246–279 287–320 328+
with people for the rest of their
lives. Kids who drink sugary sodas
BMI 19–24 25–29 30–34 35–39 40+
and eat high-calorie, processed
NORMAL OVERWEIGHT
CLASS I CLASS II CLASS III foods develop a taste for these
OBESITY OBESITY OBESITY
products and continue eating them

4 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

as adults, which tends to promote weight gain. Like-
wise, kids who watch television and play video games
instead of being active may be programming them-
selves for a sedentary future (see “The trouble with
TV: Sedentary snacking,” page 9).
Many features of modern life promote weight
gain. In short, today’s “obesogenic” environment
encourages us to eat more and exercise less. And
there’s growing evidence that broader aspects of the
way we live—such as how much we sleep, our stress
levels, even whom we associate with—can affect
weight as well.
The food factor
According to the Dietary Guidelines Advisory Com-
mittee (a panel of 13 nutrition experts charged with
developing federal nutrition standards), Americans
are eating far more calories than they did in the past.
In 1970, Americans ate an average of 2,057 calories
Figure 1 Personal, environmental, and social factors that affect weight
Personal
factors
Community
influences
Calories in
(what you eat or drink)
Energy
balance
What you eat and how much you exercise is influenced by a
range of interconnected factors. Personal factors include your
age, gender, race, or ethnicity, as well as psychosocial issues (for
example, how you react emotionally to other people and stress).
Community influences refer to the various physical locations
you inhabit— home, school, and workplace—as well as where
you go to receive medical care, to exercise (outdoor spaces or
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
per day. By 2008, that figure had risen to 2,674. What’s
driving this trend? Experts say it’s a combination of
increased availability, bigger portions, and more high-
calorie foods.
Practically everywhere we go—shopping cen-
ters, sports stadiums, movie theaters—food is read-
ily available. You can buy snacks or meals at roadside
rest stops, 24-hour convenience stores, even gyms
and health clubs. Over the past 40 years, the number
of fast-food restaurants has increased by 147%. It’s no
secret that fast food and other food purchased away
from home tends to be higher in calories, fat, sugar,
and salt. A number of studies show that people who
eat at least one fast-food meal per week are more likely
to be overweight.
In the 1950s, fast-food restaurants offered one
portion size. Today, portion sizes have ballooned,
a trend that has spilled over into many other foods,
from cookies and popcorn to sandwiches and steaks.
Social
Societal norms
InfLuences and
values
Calories burned
(how much you move)
gyms), and to obtain food (supermarkets and restaurants).
Societal influences include government, public health,
agriculture, marketing, community design, and a range of
industries: food, beverage, physical activity, and entertainment.
Finally, social norms and values such as cultural definitions
of an “ideal” body, or family pressure to clean your plate,
represent yet another overarching layer of influence.
5
A typical serving of French fries from McDonald’s
contains three times as many calories than when the
franchise began. A single “super-sized” meal may con-
tain 1,500 to 2,000 calories—all the calories that most
women need for an entire day.
Very few people follow the federal dietary guide-
lines, which recommend dark green vegetables, orange
vegetables, legumes, fruits, whole grains, and low-fat
milk and milk products. Instead, we eat foods full
of refined grains, sugar, fat, and calories (see “What
Americans eat: Top 10 sources of calories in the U.S.
diet,” below).
For example, the guidelines recommend that
adults on a typical 2,000-calorie diet eat six servings
of grains (for example, a slice of wheat bread, a half-
cup of cooked rice, or a cup of cold cereal) per day.
At least half of those should be whole grains (100%
whole-wheat bread or brown rice, for instance). But
the average person eats eight servings of grains, and
most—all but one—of those servings are foods made
with refined grains, such as white bread, white rice,
and white pasta. And we eat nearly three times the
recommended amount of added sugars and sweeten-
ers: 30 teaspoons per day, instead of 8.
What Americans eat:
Top 10 sources of calories in the U.S. diet
1. Grain-based desserts (cakes, cookies, donuts,
pies, crisps, cobblers, and granola bars)
2. Yeast breads
3. Chicken and chicken-mixed dishes
4. Soda, energy drinks, and sports drinks
5. Pizza
6. Alcoholic beverages
7. Pasta and pasta dishes
8. Mexican mixed
dishes
9. Beef and
beef-mixed
dishes
10. Dairy desserts
Source: Report of the DGAC on the Dietary Guidelines for Americans, 2010.
6 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
fastfact
Since the 1980s, the percentage of children ages 2 to
11 who are overweight has nearly tripled, and rates rose
from 5% to 18% in those ages 12 to 19. In fact, experts
fear that the rising obesity rates in today’s children may
mean the next generation will have a shorter life span
than their parents.
The exercise equation
The government’s current recommendations for
exercise call for two-and-a-half hours of moderate-­
intensity exercise per week, or one-and-a-quarter
hours of vigorous activity per week (see “Physical
activity: How much is enough?” on page 18). But only
about half of Americans meet that goal (see Figure 2).
Our daily lives don’t offer many opportunities for
activity. Children don’t exercise as much in school,
often because of cutbacks in physical education
classes. Many people drive to work and spend much
of the day sitting at a computer terminal. Because we
work long hours, we have trouble finding the time to
go to the gym, play a sport, or exercise in other ways.
Instead of walking to local shops and toting shop-
ping bags, we drive to one-stop megastores, where we
park close to the entrance, wheel our purchases in a
shopping cart, and drive home. The widespread use of
vacuum cleaners, dishwashers, leaf blowers, and a host
of other appliances takes nearly all the physical effort
out of daily chores.
Stress, sleep, and other lifestyle issues
Obesity experts now believe that a number of different
aspects of American society may conspire to promote
weight gain. Stress is a common thread intertwining
these factors, which include time pressures, mental
health issues, and dysregulated sleeping and eating
patterns. For targeted advice to address these com-
mon problems, see the special section, “10 habits to
help you lose weight,” page 30.
■ Everyday stress. These days it’s commonplace
to work long hours and take shorter or less frequent
vacations. In many families, both parents work, which
makes it harder to find time for families to shop, pre-
pare, and eat healthy foods together. Round-the-clock
TV news means we hear more frequent reports of
child abductions and random violent acts. This does
more than increase stress levels; it also makes parents
more reluctant to allow children to ride their bikes to
the park to play. Parents end up driving kids to play
dates and structured activities, which means less activ-
ity for the kids and more stress for parents.
■ Emotional backlash. Stress often goes hand in
hand with anxiety and depression, both of which
can trigger emotional eating (see “Depression,” page
13). Sometimes, emotional eating morphs into out-
of-control overeating—a phenomenon that obesity
researchers refer to as disinhibition. Nearly every-
one overeats at least occasionally—for example, at
Thanksgiving dinner or after having a little too much
to drink (in addition to stress, alcohol is a common
trigger for disinhibition). But people who disinhibit
regularly may have binge eating disorder (see “What
is binge eating disorder?” on page 8). The flip side of
disinhibition is what experts call dietary restraint,
or the ability to control your eating habits. Not sur-
prisingly, research shows that a combination of high
dietary restraint and low disinhibition helps people
lose and keep off excess weight.
■ Time pressures. School, work, and family obliga-
tions often lead people to eat on the run and to sacri-
fice sleep, both of which can contribute to weight gain.
Waiting too long between meals tends to make people
eat more calories, according to a 2008 report from the
USDA’s Economic Research Service. For instance, a
person who normally eats about 2,000 calories a day
will eat about 52 extra calories if he or she waits five
hours between meals instead of four hours. The report
also found that longer work hours make the situation
worse: people who work 40 hours a week eat about
20% more calories than those who are unemployed, if
they leave four hours between meals. But if they wait
eight hours between meals, the calorie discrepancy
jumps to nearly 40%. The findings also suggest that
going longer stretches between meals tends to lower

Figure 2 Exercise and obesity rates in the United States

Prevalence of people who get the recommended amount of exercise Prevalence of people who are obese

55% or more 49–54% 44–58% less than 44%

Percentage of people who get the recommended amount of exercise

55% or more 49–54% 44–48% less than 44% 22% or less 23–25% 26–29% 30% or more
Percentage of people who get the recommended amount of exercise Percentage of people who are obese

In most states throughout the United States—all but those marked on the left map with gray—fewer than half of
the residents meet the government’s recommended levels of physical activity. Note that the states where fewer people
exercise tend to have the highest rates of obesity, as shown in the map on the right.
In 2009, only Colorado and Washington, D.C. had fewer than 20% of people who were classified as obese. In 33 states,
at least one in every four people was obese. In nine of those states (Alabama, Arkansas, Kentucky, Louisiana, Missouri,
Mississippi, Oklahoma, Tennessee, and West Virginia), 30% or more of the residents were obese.
Source: Centers for Disease Control and Prevention.

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 7


What is binge eating disorder?
An estimated 3% of Americans have binge eating disor-
der, which means they frequently gorge themselves—and
feel out of control while doing so. Other hallmarks of the
condition include eating quickly, often to the point of dis-
comfort; frequently eating alone; hoarding food and hiding
empty food containers; and feeling depressed, disgusted,
or upset about these behaviors. Binge eating disorder is
the most common eating disorder in the United States. It’s
more prevalent in women and is strongly linked to obesity,
although most people with obesity do not have binge eat-
ing disorder. Less than half of people with binge eating
disorder seek treatment for the problem, but psychother-
apy—particularly cognitive behavioral therapy—can
Increased help
(see “What is cognitive behavioral therapy?” hunger
on page 30).
Leptin
Ghrelin
Increased
oportunity to eat
diet quality: people
Sleep tend to consume more fat, sugar,
and alcohol ifdeprevation
they wait too long betweenAltered
meals.
Some researchers also think thatthermoregulation
the very act of
eating irregularly and on the run may contribute to
obesity. Neurological evidence indicates Increased
fatigue
that the
brain’s biological clock—the pacemaker that controls
numerous other daily rhythms in our bodies—may
also help to regulate hunger and satiety signals. Ide-
ally, these signals should keep our weight steady. They
should prompt us to eat more when our body fat falls
below a certain level or when we need more body fat
(during pregnancy, for example), and they should tell
us when we feel satiated and should stop eating. Close
connections between the brain’s pacemaker and the
appetite control center in the hypothalamus suggest
that hunger and satiety are affected by temporal cues.
Irregular eating patterns may disrupt the effectiveness
of these cues in a way that promotes obesity.
■ Speed eating. Eating quickly may make you eat
more food, as well. In a 2008 study, researchers asked
30 women to eat a large plate of pasta quickly, until
they were comfortably full. They gobbled down an
average of 646 calories in about nine minutes. On
another day, the women were served the same dish
butIncreased
told to eat it slowly and to put down their forks
between each bite. That time, they took a leisurely 29
caloric intake
minutes and ate 579 calories, on average. Despite eat-
Obesity
ing more calories during the fast eating session, the
women
Reduced
reported being more hungry and less satisfied
than they felt after the unhurried meal, as described in
energy
expenditure
the Journal of the American Dietetic Association.
Why does this happen? As you eat and drink and
your stomach fills, “stretch receptors” in the stom-
ach are activated. These signal the brain directly
through the vagus nerve that connects the brain to
the stomach. Then, as food enters your small intes-
tine, appetite hormones send an “I’m full!” signal

Figure 3 How sleep loss may lead to weight gain

Greater hunger

Increased caloric
More opportunity intake
to eat

Altered ability to
control body
temperature
Reduced energy
expenditure
Increased fatigue
Sleep deprivation Obesity

Staying up too late at night means you’ll have more opportunities to eat, but that’s not the only problem. Sleep deprivation can alter
your body’s metabolism, making you feel hungrier and slowing your metabolism. You’ll also feel more tired during the day, which means
you’re less likely to exercise.
Source: “Short sleep duration and weight gain: A systematic review,” Obesity 2008.

8 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

to your brain. Certain hormones may also activate
brain chemicals that produce a feeling of pleasure
after eating. By eating too quickly, the theory goes,
you don’t allow this intricate hormonal cross-talk
system enough time to work.
■ Not enough zzz’s. Similarly, a number of studies
reveal that the less you sleep, the more likely you are to
be overweight. The link appears to be especially strong
among children, according to a 2008 review of the
topic in the journal Obesity. Lack of sufficient sleep
tends to disrupt hormones that control hunger and
appetite, and the resulting daytime fatigue can make
you less motivated to exercise (see Figure 3).
A 2010 study in Annals of Internal Medicine that
tested the effect of restricted sleep on overweight, sed-
entary people offered more evidence. When the dieting
study volunteers slept for just 5.5 hours per night for
two weeks, the weight they lost was less from body fat
and more from lean body mass, compared with when
they were allowed to sleep 8.5 hours a night. This is
opposite to what is considered optimal during a diet
program, as lean body mass helps your metabolism
stay active so you can burn more calories. Ghrelin, a
hormone that stimulates appetite, and hunger levels
were higher during the low-sleep phase of the study.
■ Friends and family. The people with whom you
spend the most time certainly influence your lifestyle
choices. And a friend’s growing girth may affect your
waistline as well, according to several reports that
explore the “social contagion” theory of obesity. The
first was a 2007 study in The New England Journal of
Medicine that queried some 12,000 interconnected
people in the Framingham Heart Study. Research-
ers asked participants to identify their friends as part
of the follow-up of the landmark decades-long study.
They found that a person’s risk of becoming obese rose
by 57% if a friend became obese. A similar but smaller
increase occurred if a sibling or spouse became obese.
A subsequent analysis, also of Framingham study
data, calculated that a normal-weight person has a 2%
chance of becoming obese per year. But every obese
social contact that person has boosts that risk 0.5 extra
percentage points, which means that having four obese
contacts will double your risk of becoming obese. Why
this happens isn’t clear, although one likely explanation
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
is that your view of what is normal and appropriate to
eat changes if you have obese friends.
Other causes of obesity
Clearly, today’s obesity-promoting environment, in
tandem with genetic influences, is the most significant
cause of overweight and obesity. But in some people,
drug side effects, illnesses, and genetic disorders can
also play a role.
Drug side effects
Several prescription drugs can cause weight gain as a
side effect by increasing appetite or slowing metabo-
lism. These include corticosteroids such as hydro-
cortisone (used for a variety of conditions to reduce
inflammation); estrogen and progesterone (used in
oral contraceptives); anticonvulsants such as valproic
acid (Depakote, others); certain anticancer medica-
The trouble with TV: Sedentary snacking
The average American watches about four hours of tele­
vision per day, a habit that’s been linked to overweight
or obesity in a number of studies. Data from the National
Health and Nutrition Examination Survey, a long-term
study monitoring the health of American adults, revealed
that people who are overweight or obese spend more time
watching television and playing video games than people
of normal weight. Watching television more than two
hours a day also raises the risk of overweight in children,
even in those as young as three years old.
Part of the problem may be that people are watching tele-
vision instead of exercising or doing other activities that
burn more calories. (Watching TV burns only slightly more
calories than sleeping, and less than other sedentary pur-
suits such as sewing or reading.) But food advertisements
also may play a significant role. The average hour-long TV
show features about 11 food and beverage commercials,
which encourage people to eat. And studies show that eat-
ing food in front of the TV stimulates people to eat more
calories, and particularly more calories from fat. In fact, a
study that limited the amount of TV kids watched demon-
strated that this practice helped them lose weight—but
not because they became more active when they weren’t
watching TV. The difference was that the children ate more
snacks when they were watching television than when
doing other activities, even sedentary ones.
9
tions; and lithium (Eskalith, Lithobid) and clozapine
(Clozaril), used to treat psychiatric conditions.
Paradoxically, weight gain can also be a side effect
of some drugs used to treat conditions that result from
obesity itself. Among these drugs are insulin, glybur­
ide (DiaBeta and others), pioglitazone (Actos), and
rosiglitazone (Avandia) for diabetes, which is com-
mon among people with weight disorders.
Several antidepressants may cause patients to put
on weight, including tricyclic antidepressants such as
imipramine (Tofranil) or desipramine (Norpramin,
Pertofrane); monoamine oxidase inhibitors (MAOIs);
and selective serotonin reuptake inhibitors (SSRIs)
such as paroxetine (Paxil), citalopram (Celexa), esci-
talopram (Lexapro), sertraline (Zoloft), fluvoxamine
(Luvox), and fluoxetine (Prozac). When used to treat
depression, SSRIs may cause weight loss initially, but
within six months of treatment they can induce weight
gain in a significant number of patients. In a small
number of patients, SSRIs such as Prozac actually
cause weight loss, making them useful as a therapy for
weight disorders. Much more needs to be learned in
this area; the relationship between weight regulation
and serotonin (a key chemical communicator in the
brain and elsewhere in the body) is obviously complex.
Finally, a class of medications known as atypi-
cal antipsychotics can trigger significant weight gain.
These drugs, which include olanzapine (Zyprexa),
risperidone (Risperdal), quetiapine (Seroquel), and
aripiprazole (Abilify), were originally developed to
treat schizophrenia but are increasingly prescribed to
treat other mental disorders, including depression.
10 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
Illnesses that affect weight
A few illnesses that are characterized by an imbal-
ance or an abnormality in your endocrine glands can
also affect your weight. These include certain unusual
tumors of the pituitary gland, the adrenal glands, or
the pancreas; hypothyroidism (an underactive thy-
roid); and polycystic ovarian syndrome (a hormonal
imbalance that causes menstrual and fertility prob-
lems). However, in the vast majority of people, these
illnesses are not responsible for weight gain. Most are
extremely rare. Hypothyroidism, which is the most
common, is seldom the main reason for overweight
or obesity. Treatment with thyroid hormone, while
medi­cally necessary, does not usually cause a signifi-
cant weight reduction.
Genetic disorders
Obesity is also a symptom of some rare and complex
disorders caused by genetic defects. These obesity
syndromes usually appear in early childhood and are
tied to several additional medical problems. One such
disorder is Prader-Willi syndrome, a form of obesity
associated with mild mental retardation that occurs
in about one in 25,000 people and has been traced
to abnormalities in a group of genes on chromosome
15. People with this disorder are unusually short and
have primarily upper-body obesity. A less common
disorder, Bardet-Biedl syndrome, is similar to Prader-
Willi syndrome, but is caused by abnormalities in dif-
ferent genes. Several other rare genetic syndromes
cause obesity, but account for only a tiny fraction of all
weight disorders.
 How excess weight affects your health
If you’re carrying many extra pounds, you face a
higher-than-average risk of a whopping 50 different
health problems (see Figure 4). These health conditions
include the nation’s leading causes of death—heart dis-
ease, stroke, diabetes, and certain cancers—as well as
less common ailments such as gout and gallstones. Per-
haps even more compelling is the strong link between
excess weight and depression, because this common
mood disorder can have a profound, negative impact
on your daily life (see “Depression,” page 13).
A Harvard study that combined data from more
than 50,000 men (participants in the Health Profes-
sionals Follow-up Study) and more than 120,000
women (from the Nurses’ Health Study) revealed some
sobering statistics about weight and health. The volun-
teers provided their height and weight, as well as details
on their diets, health habits, and medical histories.
Researchers tracked the volunteers over more than 10
years, noting the occurrence of illnesses and compar-
ing those developments with each subject’s BMI.
Obesity increased the risk of diabetes 20 times
and substantially boosted the risk of developing high
blood pressure, heart disease, stroke, and gallstones.
Among people who were overweight or obese, there
was a direct relationship between BMI and risk: the
higher the BMI, the higher the likelihood of disease.
Heart disease and stroke
Some of the most common problems seen in people
who carry excess weight, such as high blood pressure
and unhealthy levels of cholesterol and other fats in the
blood, tend to occur together. Both can lead to con-
current health problems—namely, heart disease and
stroke. High blood pressure is about six times more
common in people who are obese than in those who are
lean. According to the American Heart Association, 22
pounds of excess weight boosts systolic blood pressure
(the first number in a reading) by an average of 3 mil-
limeters of mercury (mm Hg) and diastolic blood pres-
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
sure (the second number) by an average of 2.3 mm Hg,
which translates to a 24% increase in stroke risk.
A 2007 study in Archives of Internal Medicine
examined the connection between weight and heart
disease by pooling results from 21 different studies
involving more than 300,000 people. Being overweight
boosted the risk of heart disease by 32%, whereas obe-
sity increased the risk by 81%, the researchers found.
Although the adverse effects of overweight on blood
pressure and cholesterol levels could account for
45% of the increased heart disease risk, even mod-
est amounts of excess weight can increase the odds of
heart disease independent of those well-known risks,
the authors concluded.
Compared with people of normal weight, over-
weight people face a 22% higher risk of stroke. For
those who are obese, the increased risk rises to 64%,
according to a 2010 report in the journal Stroke, which
pooled results from 25 studies involving more than
two million people.
Diabetes
Overweight and obesity are so closely linked to dia-
betes, experts have coined the term “diabesity” to
describe the phenomenon. About 90% of people with
type 2 diabetes (the most common form of the dis-
Sleep apnea: Serious complications
that start with snoring
If you snore loudly and temporarily stop breathing many
times during the night, waking suddenly with a snort or
choke, you probably have sleep apnea, a common disorder
that’s more prevalent with overweight and obesity. Your
bedmate will probably notice these symptoms, while you
may not. People with sleep apnea don’t realize they’ve been
awakened because they don’t become fully conscious, but
these awakenings can disrupt sleep. Not only does sleep
apnea often lead to daytime sleepiness, it also increases the
risk of high blood pressure, heart attack, and stroke.
11
ease) are overweight or obese. The incidence of diabe-
tes rose dramatically—by nearly 65%—from 1996 to
2006. A high blood sugar level, the hallmark of diabe-
tes, is one of the features of metabolic syndrome (see
“Do you have metabolic syndrome?” on page 13). If
untreated or poorly controlled, diabetes can lead to a
number of grave health problems, including kidney
failure, blindness, and foot or leg amputations. Diabe-
tes is currently the seventh leading cause of death in
the United States.
Cancer
Some experts believe that obesity ranks as the second
leading cause of cancer death, after cigarette smoking.
A study by the American Cancer Society in The New
England Journal of Medicine that followed more than

Figure 4 Medical complications of excess weight

Neurological Psychological
• Headache • Depression
• Stroke • Anxiety
• Dementia, including Alzheimer’s • Eating disorders
• Vision loss from diabetes complications
• Pseudotumor cerebri (false brain tumor) Gastrointestinal
• Diabetic neuropathy • Reflux disease
• Esophageal cancer
Respiratory • Colon polyps
• Asthma • Colon cancer
• Sleep apnea • Fatty liver disease
• Pulmonary embolism • Cirrhosis
• Pulmonary hypertension • Liver cancer
• Gallstones
Urological • Gallbladder cancer
• Diabetic kidney disease
Pancreas
• Kidney cancer
• Diabetes (type 2)
• Pancreatitis
Circulatory
• Pancreatic cancer
• High blood pressure
• High cholesterol Nutritional
• Atherosclerosis • Vitamin D deficiency
• Irregular heartbeat • Other vitamin and mineral
• Heart attack deficiencies
• Heart failure
• Poor circulation Reproductive
• Leg and ankle swelling Women:
• Blood clots • Irregular menses
• Peripheral artery disease • Infertility
• Certain lymphomas • Polycystic ovarian syndrome
(lymph node cancers) • Ovarian cancer
• Endometrial cancer
Musculoskeletal • Cervical cancer
• Arthritis (especially hips,
• Breast cancer
knees, and ankles)
• Low back pain Men:
• Vertebral disk disease • Prostate cancer
• Infertility
• Erectile dysfunction

Excess weight increases a person’s risk of more than 50 different medical conditions that affect all the major systems of the body.
One of the most common is type 2 diabetes, which can lead to serious complications in the heart, kidneys, nerves, and eyes.

12 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

900,000 people for 16 years showed a link between
excess body weight and many different cancers. Among
people ages 50 and older, overweight and obesity may
account for 14% of all cancer deaths in men and 20% of
all cancer deaths in women. In both men and women,
higher BMIs were associated with a higher risk of
dying from cancer of the esophagus, colon and rectum,
liver, gallbladder, pancreas, or kidney. In men, excess
weight also increased the risk of dying from stomach
or prostate cancer. In women, deaths from cancer of
the breast, uterus, cervix, or ovary were elevated in
women with higher BMIs. A 2008 review article in The
Lancet reached similar conclusions.
Part of the problem may lie in the fact that people
who are very overweight are less likely to have cancer
screening tests such as Pap smears and mammograms.
A report in the International Journal of Obesity showed
that the larger the woman, the more likely she was to
delay getting a pelvic exam, largely because of negative
experiences with doctors and their office staff. In men,
screening tests such as prostate exams may be physi-
cally difficult if people are very overweight, particularly
if they tend to store fat in their hips, buttocks, or thighs.
Depression
Do people gain weight because they’re depressed, or
do they become depressed because they’re overweight?
A review of 15 studies found evidence that both sce-
narios are likely true. Obese people have a 55% higher
risk of developing depression over time compared
with people of normal weight, according to a 2010
study in Archives of General Psychiatry. Both condi-
tions appear to stem (at least in part) from alterations
in brain chemistry and function in response to stress.
But psychological factors are also plausible. In our
culture, thin equals beautiful, and being overweight
can lower self-esteem, a known trigger for depression.
Also, odd eating patterns and eating disorders, as well
as the physical discomfort of being obese, are known
to foster depression.
The study also found that depressed people have
a 58% higher risk of becoming obese. Elevated lev-
els of the stress hormone cortisol (common in peo-
ple with depression) may alter substances in fat cells
that make fat accumulation, especially in the belly,
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
Do you have metabolic syndrome?
Metabolic syndrome, a cluster of conditions that occur
together, also increases the risk of heart disease, stroke,
and diabetes. One of the key features is abdominal obesity.
If you have that problem, you’re more likely to have the
other characteristics.
You have metabolic syndrome if you have three or more of
these five traits:
• waist circumference more than 35 inches in women or
40 inches in men
• fasting blood triglyceride level of 150 milligrams/deciliter
(mg/dL) or higher
• HDL (“good”) cholesterol of less than 40 mg/dL in men
or less than 50 mg/dL in women
• systolic blood pressure (the top number of a reading) of
130 mm Hg or higher, or diastolic (the lower number) of
85 mm Hg or higher
• fasting blood sugar level of 100 mg/dL or higher.
(Note: You are considered to have a trait if you receive treatment for it, even
if your numbers are normal with this treatment.)
Source: National Heart, Lung, and Blood Institute.
more likely, according to one theory. Also, people
who feel depressed often feel too blue to eat properly
and exercise regularly, making them more prone to
gain weight. Finally, some medications used to treat
depression cause weight gain (see page 10).
More disability…and a shorter life?
Being overweight or obese can make just getting
around a challenge. Compared with people at a
healthy weight, those carrying extra pounds have a
harder time walking a quarter-mile, lifting 10 pounds,
and rising from an armless chair. The burden of these
problems appears to be greater than in years past,
probably because people are now obese for a greater
portion of their lives, experts speculate.
And because excess weight plays a role in so many
common and deadly diseases, overweight and obe-
sity can cut years off your life. In a 2006 study in The
New England Journal of Medicine that followed more
than half a million 50- to 71-year-olds for a decade,
researchers found an increase of 20% to 40% in death
rates among people who were overweight at midlife.
Among obese people, the death rate was two to three
13
times as high. A 2010 study in the same journal, which
pooled findings from 19 studies that followed 1.46
million white adults 19 to 84 years old for a similar
period of time, found that the risk of death increased
along with body size, ranging from 44% higher for
those who were mildly obese to 250% higher for those
with a BMI of 40 to 50.
Health benefits of weight loss
Losing excess weight can make you feel better both
physically and emotionally and can help you live a lon-
ger, healthier life. Especially encouraging is the fact
that you don’t have to lose a tremendous amount of
weight to become healthier. Even a modest weight loss
of 5% to 10% of your starting weight can lead to signifi-
cant health benefits. One small study found that people
with hypertension who lost a modest 10 pounds over
six months reduced their systolic blood pressure by 2.8
mm Hg and their diastolic blood pressure by 2.5 mm
Hg. These reductions in blood pressure were equiva-
lent to the reductions brought about by treatment with
some blood pressure medications. Weight loss is so
effective that many people with high blood pressure
can stop taking blood pressure medicine after they lose
weight, for as long as they are able to keep it off.
The first major trial to show the benefits of lifestyle
changes (including losing weight and exercising) was
14 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
the Diabetes Prevention Program, published in The
New England Journal of Medicine in 2002. It involved
more than 3,200 people who were at risk for devel-
oping type 2 diabetes. Researchers found that people
who lost just 7% of their weight and exercised about 30
minutes a day cut their risk of diabetes by nearly 60%.
More recent evidence comes from the Look
AHEAD (Action for Health in Diabetes) trial, a
federally funded study involving more than 5,000
overweight or obese people with diabetes at 16 cen-
ters across the United States. Half the participants
were randomly assigned to follow an intensive life-
style intervention that required them to eat less and
move more, with a goal of losing at least 7% of their
body weight within the first year. Specifically, they
ate ­portion-controlled diets (including liquid meal
replacements and frozen entrées) and were encour-
aged to walk or do other moderate-intensity exercise
(see Table 4), aiming for a goal of 175 minutes a week.
The other participants, who served as the control
group, received standard diabetes support and educa-
tion. On average, over four years, those in the treat-
ment group lost about 6% of their weight compared
with less than 1% in the control group. People in the
treatment group also became more fit and improved
their blood sugar and blood pressure values more than
those in the control group, as described in a 2010 arti-
cle in Archives of Internal Medicine.
 When to seek professional help
N ot everyone needs to see a doctor in order to lose
weight, but some people might want to consider
this route for two reasons. The first is to get profes-
sional guidance. If you haven’t been able to lose weight
on your own by dieting and exercising, your doctor
may be able to help by making specific recommenda-
tions. The second reason to see a doctor is to be evalu-
ated for health complications that might be associated
with your excess weight. It’s important to have a medi-
cal evaluation if you are over 40, or if you are younger
and have any health problems. Such an assessment can
provide you with added motivation to lose weight—to
help lower your blood pressure; to reduce your risk of
developing heart disease, diabetes, or cancer; or to live
a longer, healthier life.
Chances are your primary care physician can per-
form this evaluation. Depending on what the doctor
finds, he or she may refer you to a nutritionist or dieti-
tian to assess your eating habits, or to a therapist to
address any psychological issues that may be interfer-
ing with your ability to attain a healthy weight. If you
are obese—or if you are overweight and have obesity-
related conditions—your doctor may refer you to a
medical group that specializes in weight loss or to a
hospital-based weight-loss center.
Medical evaluation for weight loss
Whether you start by seeing your own doctor or a
weight-loss specialist, the evaluation will begin with
your complete medical history. The doctor will ask you
how long you’ve been overweight. This narrows down
the possible causes of your excess weight as well as the
effective treatments. If you have been overweight since
childhood, you probably have a strong genetic predis-
position to be overweight. A lifelong weight problem
is usually harder to treat without drugs or surgery
than one that developed in adulthood. On the other
hand, if you’ve gained weight recently, a program of
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
dieting, exercise, and behavior modification may be
enough to help you lose weight and keep it off.
The doctor will also want to know what you have
done on your own to lose weight. What diets have you
tried? Did you lose weight on any of these plans? How
long did you keep off the weight, and how much did
you regain? This information can help your doctor
determine which strategies might be more successful.
In addition to your personal history, the doc-
tor will ask you about your family history. Are your
biological parents overweight? Does obesity run in at
least part of your family? Do you have a family history
of disorders that can be caused by obesity, such as type
2 diabetes, high blood pressure, or breast cancer? If so,
you, too, are at high risk for these problems. In par-
ticular, you will be at higher risk for such conditions
than if you were overweight but had no family history
of them. Such information can also suggest whether
you might need aggressive weight-loss treatments,
such as medication or surgery.
As part of your medical history, the doctor will
need to know the names of all the medications you
have been taking. Several drugs can cause weight gain,
increase appetite, or interfere with weight-loss efforts.
If your weight gain came on soon after you began tak-
ing one of these drugs, it may be the cause of your
problem. Depending on your condition, you may not
be able to stop taking the drug. But if you can substi-
tute or add another drug, you might be able to lose the
extra weight.
Other important information concerns symptoms,
both physical and emotional. Do you have any symp-
toms of obesity-related conditions such as heart dis-
ease, stroke, hypertension, or type 2 diabetes? Do you
have mood swings or other symptoms of depression,
such as insomnia? If so, you may need additional tests
to evaluate and diagnose these problems. If you appear
to have depression, anxiety, or an eating disorder, your
doctor may refer you to a psychologist or psychiatrist.
15
Screening tests
After the medical history, you will need a physical
examination and certain screening tests. Part of the
physical exam is to measure your height and weight
accurately in order to determine your BMI, which
indicates the severity of your weight problem. The
doctor may also measure the circumference of your
waist and hips.
Even if you are only mildly overweight, abdominal
obesity increases your risk for type 2 diabetes, heart
disease, and stroke. Excess fat around the abdomen
helps make the body resistant to insulin, the hormone
that enables blood sugar to enter the cells, where it
can be used as fuel. When insulin doesn’t act effec-
tively, the pancreas secretes more of it; excess insulin
increases blood pressure and triglycerides and lowers
the level of HDL (“good”) cholesterol.
The doctor will also take your blood pressure to
check for hypertension and will draw blood to check
for other problems, such as high levels of cholesterol,
triglycerides, and glucose. High levels of LDL (“bad”)
cholesterol and triglycerides are risk factors for heart
disease. An abnormally high level of glucose is a sign
of type 2 diabetes. Finally, if the doctor suspects a hor-
monal abnormality, such as hypothyroidism or adre-
nal gland hyperactivity, he or she will test your levels
of various hormones, such as thyroid-stimulating hor-
mone and cortisol.
Designing a treatment program
If you have a health problem related to being over-
weight, the doctor will recommend a treatment for
that condition. You may need medication for high
blood pressure, high cholesterol, type 2 diabetes, or
other complications. If you have depression, your
doctor may recommend an antidepressant, psycho-
therapy, or both before you start a weight-loss pro-
gram. But treating the health problems caused by
overweight cannot help you lose weight. You will
need a weight-loss plan not only to reduce your
weight, but also to aid in the treatment of any obesity-
related problems.
If you are mildly overweight and in relatively good
health, your doctor may be able to provide guidance
16 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
on diet and exercise—having you come in for regular
office visits to monitor your progress and helping you
overcome the common weight-loss plateaus. Or your
doctor may recommend weight-loss programs offered
locally by self-help organizations, companies, regis-
tered dietitians, or hospitals. You can find a registered
dietitian in your area by calling the American Dietetic
Association (see “Resources,” page 48).
But in some cases—for example, if you are
extremely overweight or if you have obesity-related
health problems and haven’t been able to control
your weight on your own—a weight-loss program
that involves dieting, exercise, and social support
may not be enough. In such cases, your doctor will
probably refer you to a weight-disorders specialist or
to a ­hospital-based weight-loss program to consider
whether one or more of the medical options, such as
a very low-calorie diet, weight-loss medication, or
bariatric surgery (see “Weight-loss surgery,” page 42),
might be appropriate for you.
In discussing the various weight-loss options,
your doctor may ask you about your goals and expec-
tations: How much weight do you expect to lose? How
much of an improvement in health and emotional
well-being do you expect this weight loss to provide?
Don’t be surprised or get discouraged if your doctor
tells you to set more modest goals. Your doctor will
help you set realistic goals about how much weight
you need to lose, how much you can expect to lose,
and how much you can expect to keep off in the long
run—that is, for a year or more.
Such considerations are important because many
overweight people begin a weight-loss program
expecting to shed many more pounds than will be
possible for them. In one study of women with obe-
sity in a weight-loss program, the women said that
they wanted to reduce their weight by 32%. That’s
significantly more than even the best weight-loss
programs achieve with weight-loss drugs and diets.
Most people who go through weight-loss programs
lose 5% to 10% of their initial weight. Moreover, the
National Institutes of Health (NIH) now defines a
successful weight-loss effort as one in which a per-
son loses—and keeps off—10% or more of his or her
initial weight.
 Weight-loss basics

E at less, exercise more. If only it were that simple! As

most dieters know, losing weight can be very chal-
lenging. As this report details, a range of influences
can affect how people gain and lose weight. But a basic
understanding of how to tip your energy balance in
favor of weight loss is a good place to start.
most days, and reduce your daily calorie intake by at
least 500 calories. However, calorie intake should not
fall below 1,200 a day in women or 1,500 a day in men,
except under the supervision of a health professional.
Eating too few calories can endanger your health by
depriving you of needed nutrients.

Meeting your calorie target

Counting calories: How many How can you meet your daily calorie target? One
do you need? approach is to add up the number of calories per serv-
Start by determining how many calories you should ing of all the foods that you eat, and then plan your
consume each day. To do so, you need to know how menus accordingly. You can find calorie information
many calories you need to maintain your current on the nutrition labels on all packaged foods and bev-
weight. Doing this requires a few simple calculations. erages and in a number of books and Web sites (see
First, multiply your current weight by 15—that’s “Online options for dieters,” page 36).
roughly the number of calories per pound of body If you hate counting calories, a different approach
weight needed to maintain your current weight if you is to restrict how much and how often you eat, and
are moderately active. Moderately active means get- to eat meals that are low in calories. Dietary guide-
ting at least 30 minutes of physical activity a day in lines issued by the American Heart Association stress
the form of exercise (walking at a brisk pace, climbing common sense in choosing your foods rather than
stairs, or active gardening). Let’s say you’re a woman focusing strictly on numbers, such as total calories
who is 5 feet, 4 inches tall and weighs 155 pounds, or calories from fat. Whichever method you choose,
and you need to lose about 15 pounds to put you in research shows that a regular eating schedule—with
a healthy weight range. If you multiply 155 by 15, meals and snacks planned for certain times each
you will get 2,325, which is the number of calories day—makes for the most successful approach. The
per day that you need in order to maintain your cur-
rent weight (weight-maintenance calories). The older Table 3 Liquid calories
you are, the fewer calories you’ll need, since the rate Drink Amount Calories
at which people burn calories decreases each year. To
Sports drink 8 oz 50
lose weight, you will need to get below that total.
100% orange juice 8 oz 112
For example, to lose 1 to 2 pounds a week—a rate
that experts consider safe—your food consumption Sweetened lemon iced tea (bottled) 12 oz 120
should provide 500 to 1,000 calories less than your White wine 5 oz 120
total weight-maintenance calories. If you need 2,325 Red wine 5 oz 129
calories a day to maintain your current weight, reduce Beer 12 oz 140
your daily calories to between 1,325 and 1,825. If you
Gin and tonic 6 oz 143
are sedentary, you will also need to build more activity
Regular cola 12 oz 150
into your day. In order to lose at least a pound a week,
Latte (2% milk) 16 oz 220
try to do at least 30 minutes of physical activity on

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same applies after you have lost weight and want to
keep it off. Sticking with an eating schedule increases
your chance of maintaining your new weight.
Some people focus on reducing the fat in their eat-
ing plan because, at 9 calories per gram, fat by weight
contains more than twice as many calories as carbohy-
drates or proteins (4 calories per gram). By substituting
lean cuts of meat for fatty ones, avoiding high-fat pack-
aged foods and snacks, and refraining from fat-rich
products such as butter and partially hydrogen­ated fats,
you can cut out dozens or even hundreds of calories
per day. On the other hand, many people mistakenly
think that cutting fat always means cutting calories.
Some fat-free foods actually contain more calo­ries
than the regular versions because manufacturers use
extra sugar to make up for the flavor lost in removing
the fat. Moreover, low-fat or nonfat foods are not low-
calorie if you consume them in large quantities.
Here are some guidelines to follow when straight
calorie counting is impractical.
• Eat foods that are filling and low in calories. That
means meals and snacks made with whole grains,
such as brown rice, whole-wheat bread, and oatmeal,
as well as legumes, such as lentils and other beans.
• When you eat meat, cut out fat and cut down por-
tion sizes. Choose lean cuts of meat and modest
amounts—about 3½ or 4 ounces per serving.
• Avoid fried foods. Frying foods adds fat and calo-
ries. For stovetop cooking, it’s better either to stir-fry
foods in nonstick pans lightly coated with a cooking-
oil spray or to braise them in broth or wine. Baking,
broiling, and roasting add no extra fat to your meals.
• Use low-fat or nonfat dairy foods. Milk, yogurt, and
cheese are good sources of protein and calcium, but
the whole-milk versions of these dairy products are
very high in fat.
• Avoid fast foods. Hamburgers, chicken nuggets,
French fries, and other fast-food meals and snacks
tend to promote weight gain for two reasons. First,
they are high in fat, calories, or both. Second, the
“value meals” are often excessively large and tempt
you to overeat.
• Avoid high-calorie, low-nutrient snacks. Chips and
other deep-fried snacks are high in fat and therefore
calories. But even snacks labeled “low-fat” are often
high in calories because they contain large amounts
of sugars and other carbohydrates.
• Watch what you drink. Regular sodas, fruit juices,
and, especially, alcoholic beverages are high in calo-
ries (see Table 3).
Physical activity:
How much is enough?
If one person cuts back on calories without exercising
and another person increases exercise without cutting
back on calories, the first person would probably find
it easier to lose weight. That’s because it’s easier to cut
500 calories a day from your diet than it is to burn 500
extra calories through exercise. You’d have to walk or
run about five miles a day—or 35 miles a week—to
lose 1 pound of fat. But if you only cut back on calo-
ries, you’re more likely to regain the weight you lose.
Why? The body reacts to weight loss as if it were starv-
ing and, in response, slows its metabolism. When your

How to burn about 150 calories

• Wash and wax a car for
45–60 minutes
• Wash windows or floors for
45–60 minutes
• Play volleyball for 45 minutes
• Play touch football for 30–45 minutes
• Garden for 30–45 minutes
• Wheel self in wheelchair for
30–40 minutes
• Bicycle 5 miles in 30 minutes
• Dance for 30 minutes
• Push a stroller 1.5 miles in 30 minutes
• Rake leaves for 30 minutes
• Walk 2 miles in 30 minutes
• Do water aerobics for 30 minutes
• Swim laps for 20 minutes
• Play wheelchair basketball for
20 minutes
• Play basketball for 15–20 minutes
• Bicycle 4 miles in 15 minutes
• Jump rope for 15 minutes
• Run 1.5 miles in 15 minutes
• Shovel snow for 15 minutes
• Climb stairs for 15 minutes
Source: Physical Activity and Health: A Report of the
Surgeon General, U.S. Department of Health and
Human Services.

18 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu


What determines your metabolic rate?
Total metabolism is the rate at which you use energy
(measured in calories) when you’re exercising, sleeping, or
doing anything else. Resting energy expenditure is the rate
at which you burn calories when you are not being physi-
cally active. Resting energy expenditure varies from per-
son to person and is affected by your age, gender, genetic
makeup, psychological state, and level of physical activity.
For example, pregnancy and illness both tend to increase
resting energy usage. Both total metabolism and resting
energy expenditure influence your weight by affecting how
many calories you burn in the course of a day.
metabolism slows, you burn fewer calories—even at
rest. When you burn fewer calories, three things can
happen. If you continue eating fewer calories, you will
either stop losing weight as quickly as you have been,
or you’ll stop losing weight altogether. If you increase
your calorie consumption, you may actually gain
weight more quickly than you have in the past. The
solution is to increase your physical activity because
doing so will counteract the metabolic slowdown
caused by reducing calories.
A regular schedule of exercise raises not only your
energy expenditure while you are exercising but also
your resting energy expenditure—that is, the rate at
which you burn calories even when the workout is
over and you are resting. Resting energy expenditure
remains elevated as long as you exercise at least three
days a week on a regular basis. Because it accounts
for 60% to 75% of your daily energy expenditure, any
increase in resting energy expenditure is extremely
important to your weight-loss effort. The kinds of
vigorous activity that can stimulate your metabolism
include walking briskly for two miles or riding a bike
uphill. Even small, incremental amounts of energy
expenditure, like standing up instead of sitting down,
can add up.
■ The NEAT factor. Even when you’re not intention-
ally exercising, you’re still expending energy, whether
you’re lying on the couch or sitting in a chair jiggling
your legs. This so-called nonexercise activity ther-
mogenesis (or NEAT) may be one factor that sepa-
rates lean people from their heftier counterparts. For
ex­ample, a man who sits in front of a screen most of
the day (a computer at work and the television at night)
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burns far fewer calories during the day than one who
works as a cashier and plays guitar during his leisure
time—even if neither one does any formal exercise.
According to Dr. James Levine, the Mayo Clinic
researcher who first described and continues to study
this phenomenon, NEAT can vary between two peo-
ple of similar size by up to 2,000 calories a day. One
study that measured NEAT in lean and obese people
(all of whom were sedentary and had similar jobs)
found that obese people sat an average of two-and-a-
half hours more per day than lean people, while lean
people stood or walked more than two hours longer
each day than obese people.
If you’re not a natural “NEAT-o-type,” you can
train yourself to boost your NEAT throughout the
day. Pace around while you talk on the phone. When
possible, walk down the hall to talk to a co-worker
instead of e-mailing or phoning. Be less efficient
while cleaning the house by alternating tasks on dif-
ferent floors, so you have to go up and down the stairs
Exercise prescription
Everyone is different, so there’s no such thing as a one-
size-fits-all exercise plan. But following this prescription is
a good place to start, especially if you haven’t yet made
exercise part of your daily routine.
Increase the beat. Focus at first on activities or exercises
that make the heart and lungs work harder. These include
walking, jogging, swimming, cycling, dancing, gardening,
playing racquetball, and a host of others.
Make it last. Aim for at least 30 minutes of activity in
a day. If you can do it all at once, great. If not, three
10-minute bursts of activity are fine, too. Don’t hesitate
to go beyond that 30-minute target—the longer you are
active, the more you benefit.
Do it often. Be active on most days of the week.
It’s okay to be moderate. Exercises or activities that
are low to moderate in intensity are fine, and are safer for
many people. If you like vigorous activity, do it.
Be strong. Add some weight lifting or other resistance
exercises to your aerobic activities. Choose weights that
let you do 12 to 15 repetitions of exercises that work your
arm, leg, shoulder, and hip muscles, for instance.
Limber up. Gentle stretches can warm up your muscles
before exercise. They can also improve your balance
and flexibility.
19
more often. In effect, anything you can do throughout
the day that cuts the amount of time you spend in a
chair will help!
For people who are obese and haven’t exercised
much at all, any amount of physical activity is benefi-
cial, including walking, swimming, and water aerobics.
Walking is often a good choice because all you really
need is a good pair of shoes. However, a pedome­ter, a
small, pager-sized box you wear that counts the num-
ber of steps you take, can be helpful. People who use
pedometers tend to get more physical activity and also
lower their BMI and blood pressure levels, according
to a 2007 review article in The Journal of the American
Medical Association that pooled data from 26 different
studies. Having a goal of 10,000 steps per day was an
important predictor of success for increasing activity,
the researchers found.
But start out slowly, and gradually increase the
pace and duration of such activities. Moderate-­
intensity activities—such as taking a short walk or
raking leaves—won’t raise your resting energy expen-
diture as much as high-intensity activities will, but
they have other advantages. For one thing, they help
reduce body fat and build muscles—and muscle tissue
burns more calories than fat does. Regular weight lift-
ing also builds muscle and has a similar effect.
Another benefit of regular physical activity of
any sort is that it temporarily curbs your appetite. Of
course, many people joke that after a workout they feel
extremely hungry—and promptly indulge in a snack.
But because exercise raises resting energy expendi-
ture, people continue to burn calories at a relatively
high rate. So a moderate snack after exercising does
Table 4 Examples of moderate or vigorous activity
Moderate-intensity activities Vigorous-intensity activities
Walking fast Jogging or running
Doing water aerobics Swimming laps
Riding a bike on level ground or a few hills Riding a bike fast or on hills
Playing doubles tennis Playing singles tennis
Pushing a lawn mower Playing basketball
20 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
not erase the benefits of exercise in helping people
control their weight.
Starting an exercise program
Many people are daunted by the prospect of starting an
exercise program, but it doesn’t need to be overwhelm-
ing. One approach is to look at your schedule and deter-
mine where you can regularly fit in a 30-minute exercise
session. For some people, this may mean getting up a
half-hour earlier. For others, lunchtime or after work is
most convenient. Your goal is to improve your health
and lose pounds by doing 30 minutes or more of an
activity that’s moderately intense, five days a week. If you
don’t reach this goal at first, it’s good to know that any
increase in physical activity is better than none.
For some people, a less structured approach may
work. You don’t have to work out at the gym or par-
ticipate in a sport, although some people find that
these things help them stick to a routine. Many ordi-
nary everyday activities count as moderate-intensity
exercise: taking the stairs instead of the elevator, walk-
ing instead of driving, cutting the lawn with a push
mower, or playing with children. A significant plus for
busy people is that the physical activity doesn’t have
to be done in a single session. You can break up the 30
minutes—for example, by taking a 10-minute walk to
the post office and later having a 20-minute bike ride
with the kids. Research has shown that breaking up
physical activity into 10-minute spurts throughout the
day burns up at least as many calories as exercising in
a single block of time.
Once people get into the habit of setting aside
time on most days for physical activity, they tend
to be more open to new kinds of activi-
ties—because they feel stronger and more
ca­pable of exerting themselves. People who
had never considered taking up a new sport
might find themselves wielding tennis rac-
quets, strapping on cross-country skis,
or joining a recreational volleyball team.
Becoming more active over time helps the
effort to keep pounds off.
 Choosing the diet that fits you best
T he answer to the perennial question “What’s the
best diet for losing weight?” is any diet that you
can stick with for a long time. It should be as good
for your overall health—your heart, bones, colon,
and psyche—as it is for your waistline. It should offer
plenty of good-tasting and healthy choices, banish few
foods, and not require an extensive and expensive list
of groceries or supplements.
Scores of weight-loss diets have been in the lime-
light over the years. But relatively few diet strategies have
been carefully studied in controlled trials. They include
very low-fat diets (see below), such as the Ornish and
Pritikin diets; low-carbohydrate diets (see page 22), such
as Atkins and South Beach; and the Mediterranean diet
(see page 23), which has the added bonus of conferring
a number of potential health benefits.
The diet studies
Although most diets have both fans and foes, the real-
ity is that when it comes to shedding pounds, the key is
cutting calories—and it doesn’t really matter whether
Low-fat: Doesn’t taste great … and is less filling
Once the main strategy for losing weight, low-fat diets
were shoved aside by the low-carb frenzy. That’s not nec-
essarily a bad thing, since neither of the two foundations
on which low-fat diets were built—fat makes you fat, and
fat is bad for the heart—are very solid. Healthy fats can
actually promote weight loss, while some fats are good
for the heart and eliminating them from the diet can
cause problems.
Scores of low-fat diets have been promoted over the
years. One of the best known is Dr. Dean Ornish’s Eat
More, Weigh Less plan, which grew out of the cholesterol
hypothe­sis developed in the 1960s and ’70s. First, the idea
was to cut cholesterol from the diet, because it contributed
to heart disease. Then researchers realized that dietary
fat has an even bigger influence on heart disease, which
spurred the low-fat diet. Dr. Ornish’s diet originally focused
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those calories come mainly from steak, bread, or vege­
tables. Several studies comparing diets with different
ratios of fat, protein, and carbohydrates offer strong
evidence to support this claim. The most recent was
a study led by Harvard researchers, published in 2009
in The New England Journal of Medicine. The multi-
site study compared four different low-calorie diets
(high fat, high protein; high fat, average protein; low
fat, high protein; and low fat, average protein) in 811
overweight adults. Although all the participants lost
an average of about 13 pounds in the first six months
(about 7% of their initial weight), they started to
regain at the one-year mark. After two years, average
weight loss was the same in all groups.
An earlier study in The Journal of the American
Medical Association suggested that it’s not the spe-
cific diet that matters but whether you stick with it
that makes the difference. In this study, overweight
and obese adults were assigned to follow the Atkins
diet, the Ornish diet, Weight Watchers (see page 35),
or the Zone diet (which advocates a 40:30:30 ratio of
carbs, protein, and fats). After one year, nearly half
on preventing heart disease but has switched to emphasiz-
ing weight loss.
Since fat contains 9 calories per gram while carbohydrates
contain 4, you can theoretically double your food intake with-
out taking in more calories by cutting back on fatty foods and
eating more that are full of carbohydrates, especially water-
rich fruits and vegetables. Still, such a diet tends to be less
filling and flavorful than other diets, which lessens its long-
term appeal.
Keep in mind that the Ornish plan doesn’t stop at a
whole-grain, vegetarian, very low-fat (less than 10% of cal-
ories from fat) diet, but also includes exercise, stress man-
agement, and group support. The related Pritikin Principle
(which also originated in the 1970s) also limits dietary
fat to 10% of calories and is largely based on vegetables,
grains, and fruit.
21
of the participants had dropped out of the study. But
those who completed the study lost similar amounts
of weight (about 5 to 7 pounds each, on average). Of
note, they also lowered their blood levels of choles-
terol and several other markers linked to heart disease
and diabetes to a similar degree. People assigned to
the Atkins and Ornish diets were more likely to drop
out of the study, suggesting that many people found
these plans too extreme. But for certain people, the
structure of a restricted plan may be helpful.
In another comparison study, people who followed
a low-carb or a Mediterranean-style diet lost an average
of about 10 pounds, compared with a 6-pound aver-
age loss among those on a low-fat diet. The 2008 study,
published in The New England Journal of Medicine, also
found that people on a low-carb diet dropped their cho-
lesterol levels more than those in the other two groups,
while the Mediterranean-style dieters had better con-
trol of blood sugar levels. Your own food preferences,
as well as your specific health concerns, are important
to consider when choosing a diet, the authors suggest.
Yet another line of evidence about effective
weight-loss strategies comes from a few carefully con-
trolled trials in which volunteers with obesity were
blindly assigned to either a standard low-fat diet or
a low-carb, high-protein diet. Overall, these trials
Low-carbohydrate: Quick weight loss but long-term safety questions
First published in the 1970s, Dr. Atkins’ Diet Revolution
launched the low-carbohydrate diet craze, which enjoyed
a resurgence in the late 1990s. The diet is a carnivore’s
dream, focusing largely on high-protein meats and poul-
try (along with eggs and full-fat dairy products), while
banishing most carbohydrates such as bread, rice, and
pasta. One popular permutation of the low-carb diet is
the South Beach diet, which also restricts carbohydrates
but urges people to avoid saturated and trans fats (found
in meat and processed foods) and to favor healthier,
unsaturated fats (found in nuts and fish). It also allows
more whole grains, fruits, and vegetables, making it a
more balanced approach.
The low-carb eating strategy is based on the biological
fact that eating carbohydrates raises blood sugar levels,
which triggers an outpouring of insulin from the pancreas.
The theory goes a step further, claiming that high insulin lev-
els produce hunger, so people who eat carbohydrates take
22 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
showed that a low-carb, high-protein diet leads to
quicker weight loss than a low-fat diet. In the stud-
ies that lasted for a year or longer, though, weight loss
was about the same regardless of diet type. These stud-
ies focused primarily on weight, and were too short to
track other important consequences of diet, such as
heart disease, diabetes, bone strength, and cancer.
The overall results mask some startling individual
differences. In one trial, on both low-carb and low-fat
diets, some people lost weight while others gained. In
the low-fat group, the range was from 53 pounds lost
to 31 pounds gained. In the low-carb group, it was
from 65 pounds lost to 18 gained.
Experts advise people to keep the percentage of
their calories from major nutrients within the recom-
mended federal guidelines:
• Protein: 10% to 35%
• Carbohydrate: 45% to 65%
• Fat: 20% to 35%
You can use online calculators or cell phone appli-
cations (see “Online options for dieters,” page 36) to
find out how your own diet stacks up. Note that diets
that are less than 45% carbohydrate or more than
35% protein are hard to follow, and they’re no more
effective than other diets. In addition to possibly
in more calories and gain weight. The antidote to carbohy-
drates is fat, which is more satisfying and filling. So, people
on a high-fat diet eat less and lose weight. Low-carbohy-
drate diets also tend to cause dehydration. To make up for
the lack of carbohydrates in the diet, the body mobilizes its
own carbohydrate stores from liver and muscle tissue. In the
process, the body also mobilizes water, meaning that pounds
are shed as urine. The result is rapid weight loss, but after a
few months, weight loss tends to slow and reverse, just as
happens with other diets.
The American Heart Association cautions people against
the Atkins diet, because it is too high in saturated fat and
protein, which can be hard on the heart, kidneys, and bones.
The lack of fruits and vegetables is also worrisome, because
these foods tend to lower the risk of stroke, dementia, and
certain cancers. Most experts believe South Beach and other,
less restrictive low-carbohydrate diets offer a more reason-
able approach.
 Mediterranean-style: Healthy fats and carbs with a big side of fruits and vegetables
Just as there are “good carbs” and “bad carbs,” there are
good fats and bad fats. Mediterranean-style diets empha-
size good fats and good carbs.
Saturated fat, trans fat, and cholesterol are the bad guys.
Good fats are monounsaturated (found in olive oil, for exam-
ple) and polyunsaturated (found in such foods as fish, canola
oil, and walnuts). The Mediterranean diet advocated by Mol-
lie Katzen and Harvard professor Walter Willett in Eat, Drink,
& Weigh Less has a moderate amount of fat, but much of it
comes from healthful monounsaturated fats and unsaturated
omega-3 fats. It is high in carbohydrates, but most of the
increasing the risk of heart disease (see “Low-carb:
Quick weight loss but long-term safety questions,”
page 22), diets with very low carbohydrate levels may
have a negative effect on mood, according to several
studies. Various factors could explain this observa-
tion, including the fact that ­carbohydrate-rich diets
boost the brain’s level of serotonin, a neurotrans-
mitter that affects mood. But it’s also possible that a
low-carb diet is too challenging (and therefore dis-
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carbs come from unrefined, fiber-rich foods. It is also high in
fruits and vegetables, nuts, seeds, and fish, with only modest
amounts of meat and cheese.
People living in Mediterranean countries have a lower-
than-expected rate of heart disease. But the traditional life-
style in the region also includes lots of physical activity,
regular meal patterns, wine, and good social support. It’s
hard to know what relative role these different factors
play—but there is growing evidence that in and of itself,
the diet can reduce cardiovascular risk and the development
of diabetes.
heartening) to follow, given the abundance of bread,
pasta, rice, and fruit in the average American’s diet.
The take-home lesson is that it is okay to experi-
ment on yourself. If you give a diet your best shot
and it doesn’t work, maybe it wasn’t the right one for
you, your metabolism, or your situation. Don’t get
too discouraged or beat yourself up because a diet
that “worked for everybody” didn’t pay off for you.
Try another.
23
 What to eat: A week of daily menus

F or some people, the hardest part of losing weight

is deciding what and how much to eat. The follow-
ing seven-day plan features menus to guide your daily
eating choices, including recipes for healthy, calorie-
conscious entrees for dinner, lunch, and brunch.
One common problem dieters face is correctly esti-
mating portion sizes. To make sure you’re not eating too
much food, see “Quick tips for portion control,” page
25. And restaurant meals can easily derail your diet; see
“Restaurant meals: The dieter’s downfall,” page 27.
Note that the menus given here provide about
1,500 calories per day; you may need to adjust them to
meet your own calorie target (see “Counting calories:
How many do you need?” on page 17).

Day 1 Monday
RECIPE

Menus Calories 1,509

Tomato Vegetarian Stew
Carbohydrate 184 g
Breakfast Servings: 8 Serving size: about 2 cups
Protein 81 g
1 cup nonfat plain Greek yogurt* Fat 56 g
¾ cup blueberries Ingredients:
Sat 7g
2 tablespoons pecans Trans 0 8 ounces diced onion
Cholesterol 57 mg 1½ tablespoons trans free margarine
Lunch Sodium 1,504 mg 7 cups low-sodium vegetable stock
Large salad with 2 cups mixed Fiber 36 g
2 tablespoons minced garlic
greens, 3 ounces canned or fresh
salmon, cucumber and tomato slices, ½ teaspoon cumin
2 tablespoons olive oil, and ¼ teaspoon coriander
1 tablespoon red wine vinegar ¼ teaspoon cinnamon
1 small whole-wheat pita ¼ teaspoon red pepper flakes
Snack ¼ teaspoon salt
1 tablespoon peanut butter 1 pound cubed butternut squash
1 medium apple 2 pounds tomatoes, diced, or 2 (15½ ounces) cans
diced tomatoes
Dinner 8 ounces shredded carrot
Tomato Vegetarian Stew (see recipe at right)
1 pound spinach, shredded or chopped
1 whole-wheat dinner roll
1 (15½ ounces) can white or Great Northern beans, rinsed
1 cup skim milk
1 (15½ ounces) can black beans, rinsed
Snack ¼ cup fresh lime juice
¾ ounce dry roasted almonds
Preparation:
*Greek or strained yogurt, which is widely available in many supermarkets,
is much thicker than regular yogurt; it also has about twice as much pro-
Sauté onion in margarine until soft; add vegetable stock, garlic,
tein and is lower in sodium and carbohydrates. spices, squash, and tomatoes. Cook, covered, at a low boil 6
to 8 minutes. Add carrots and spinach. Simmer 5 minutes. Add
beans; simmer 2 minutes. Stir in lime juice; serve immediately.
Nutrition facts: Calories: 309, Fat: 6.3 g, Saturated fat: 1 g, Trans fat:
0.3 g, Carbohydrate: 50 g, Fiber: 13.8 g, Protein: 13.3 g, Cholesterol: 0,
Sodium: 304 mg

24 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

Day 2 Tuesday

Menus Calories 1,513 Quick tips for portion control

Carbohydrate 163 g
Breakfast Protein 83 g
2 scrambled egg whites with Fat 61 g 1 thumb tip = 1 teaspoon of
¼ cup red bell pepper cooked in Sat 12.4 g
2 teaspoons canola oil peanut butter, butter, or sugar
Trans 0
2 slices whole-wheat toast Cholesterol 125 mg
thumb tip finger fist
½ cup skim milk Sodium 1,505 mg
1 fresh orange Fiber 29 g
1 finger = 1 oz of cheese
Snack
¾ cup fresh strawberries thumb tip finger fist

Lunch 2 handfuls
1 fist = 1 cuphandful
palm
cereal,
Leek Soup (see recipe below) pasta, vegetables
thumb tip finger fist
Large salad with 2 cups romaine lettuce, ½ cup cannellini
beans, 1 tablespoon walnuts, 1 ounce feta cheese, thumb tip finger fist

2 teaspoons olive oil, and 1 tablespoon red wine vinegar

2 handfuls palm handful
2 small whole-wheat crackers 1 handful = 1 oz of nuts

Snack thumb tip finger fist

1 ounce whole-grain corn chips 2 handfuls palm handful

¼ cup salsa 2 handfuls palm handful

1 palm = 3 oz of meat,
Dinner fish, or poultry thumb tip finger fist

3 ounces pork tenderloin

2 handfuls palm handful
1 medium baked sweet potato
½ cup each of broccoli, cauliflower, and carrots stir-fried in
2 teaspoons olive oil
2 handfuls = 2 oz of pretzels
1 cup skim milk
2 handfuls palm handful

RECIPE

Leek Soup
Servings: 12 Serving size: 1 cup

Ingredients: Preparation:
2 tablespoons extra-virgin olive oil In stock pot, heat oil on medium heat and sauté garlic and
2 medium garlic cloves, minced leeks for about 3 minutes. Add chicken broth, water, carrot
slices, parsley, and black pepper. Bring to a gentle boil and
4 fresh leeks, sliced thin, rinsed well to remove grit
reduce heat to simmer for 30 minutes or more. Longer cooking
12 cups low-fat unsalted chicken broth time creates bolder flavor.
4 cups water Nutrition facts: Calories: 83, Fat: 4 g, Saturated fat: 0.8 g, Trans fat: 0,
1 medium carrot, sliced thin (or 4 baby carrots) Carbohydrate: 6.2 g, Fiber: 0.9 g, Protein: 5.8 g, Cholesterol: 27 mg,
Sodium: 145 mg
2 teaspoons chopped parsley
½ teaspoon black pepper

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 25

Day 3 wednesday
RECIPE

Menus Calories 1,519

Mushroom and Black Bean Burger
Carbohydrate 180 g
Breakfast Servings: 4 Serving size: 1 burger with roll
Protein 80 g
1 cup old-fashioned oatmeal Fat 62.7 g
Ingredients:
½ cup skim milk Sat 7.1 g
½ cup strawberries Trans 0 4 tablespoons canola oil, divided

2 tablespoons walnuts Cholesterol 96 mg 2 medium portobello mushrooms, diced

Sodium 1,424 mg ½ red onion, diced
Lunch Fiber 38 g
½ green bell pepper, cored, seeded, and diced
3 ounces turkey breast on
1 can (15 ounces) black beans, drained and rinsed
2 slices whole-wheat bread with lettuce and tomato and
1 tablespoon light mayonnaise ¼ teaspoon paprika
1 medium pear ¼ teaspoon garlic powder
¹∕8 teaspoon freshly ground black pepper
Snack
2 egg whites
2 tablespoons hummus
1 tablespoon honey mustard
1 cup baby carrots
1 tablespoon Worcestershire sauce
Dinner 6 tablespoons dried breadcrumbs
Mushroom and Black Bean Burger (see recipe at right) 4 whole-wheat buns
Salad of 1 cup arugula, red onion slices, 2 teaspoons olive oil,
Preparation:
and 1 tablespoon red wine vinegar
Heat 2 tablespoons oil in a large skillet over medium heat. Add
Snack mushrooms, onion, and bell pepper. Cook, stirring occasion-
1 ounce pistachios ally, until pepper begins to soften, 4 to 5 minutes. Add beans,
paprika, garlic powder, and black pepper. Cook, smashing
beans with the back of a spoon, 1 to 2 minutes more. Transfer
mixture to a bowl and mix in egg whites, mustard, Worcester-
shire sauce, and breadcrumbs. Shape into 4 patties. Wipe out
skillet; heat remaining 2 tablespoons oil over medium heat and
cook burgers until they are brown and feel firm, 6 to 7 minutes
each side. Place on buns.
Nutrition facts: Calories: 395, Fat: 17 g, Saturated fat: 1.6 g,
Trans fat: 0 , Carbohydrate: 51 g, Fiber: 9 g, Protein: 13 g,
Cholesterol: 0, Sodium: 500 mg

26 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

Day 4 Thursday
RECIPE

Menus Calories 1,492

Pumpkin Soup
Carbohydrate 177 g
Breakfast Servings: 6 Serving size: 1 cup
Protein 104 g
1 whole-wheat English muffin Fat 49 g
Ingredients:
2 tablespoons peanut butter Sat 5.6 g
1 cup chopped leeks, white parts only
½ cup skim milk Trans 0
Cholesterol 93 mg 2 apples, peeled and chopped
Lunch Sodium 1,398 mg 4 cups vegetable broth
Pumpkin Soup (see recipe at Fiber 27 g 1 medium sweet potato, peeled and chopped
right)
1 (16 ounces) can of pumpkin
3 ounces tuna in a small whole-wheat pita with fresh
chopped onion, celery, and 1 tablespoon light mayonnaise ½ teaspoon black pepper
¼ cantaloupe 2 teaspoons fresh chopped thyme
2 tablespoons fresh chopped chives
Snack
Preparation:
1 cup nonfat plain Greek yogurt with 1 tablespoon almonds
and 1 tablespoon granola In a large skillet, sauté leeks for 5 minutes. Add apples and
cook 2 more minutes. Add vegetable broth, sweet potato,
Dinner pumpkin, and black pepper. Simmer 20 minutes. Remove to
4 ounces baked chicken breast a cool place. When the mixture is cool, puree it in batches,
²⁄³ cup cooked whole-wheat couscous filling no more than ¹⁄³ of the blender with each portion.
Return the blended soup to the skillet and reheat to barely a
1 cup spinach and ½ cup carrot coins, stir-fried in
simmer. Add thyme and chives. Serve.
1 tablespoon olive oil
Nutrition facts: Calories: 100, Fat: 0.7 g, Saturated fat: 0.1 g, Trans
Snack fat: 0, Carbohydrate: 23 g, Fiber: 4.6 g, Protein: 2.3 g, Cholesterol: 0,
Sodium: 325 mg
1 banana

Restaurant meals: The dieter’s downfall

It’s hard not to overeat when dining out, mainly because
many restaurants dish up extra-large portions—often two
to three times what you may eat at home. And their offer-
ings often include much more oil, butter, and cream—and
therefore calories—than foods prepared at home (see
“1,000-plus–­calorie entrées,” below). The following
suggestions can help you avoid overindulging:
• Split an entrée with a dining companion, or order an
appetizer and soup or salad instead of a full meal.
• Ask your server to remove half of your meal and put it in
a doggie bag right at the start of the meal, so you won’t
be tempted to keep eating after you’re full.
• Steer clear of buffet-style restaurants or all-you-can-eat
dinners, because the wide variety of choices and unlim-
ited quantities often tempt people to overeat.
• Don’t be shy about asking your server to have your food
prepared as healthfully as possible. For example, ask for
your meat or fish to be broiled or grilled instead of deep-
fried or sautéed, and to have dressings or sauces served on
the side so you can control how much you add to your food.
1,000-plus–calorie entrées
Many restaurants feature dinner entrées that pack more
than 1,000 calories each, which is about two-thirds
(or more, if you’re trying to lose weight) the total number
of calories most women should eat in a day.
Entrée Calories
Applebee’s Pecan Crusted Chicken Salad 1,180
(with dressing)
Cheesecake Factory’s Fresh Fish Taco meal 1,130
Chili’s Steak and Portobello Fajitas 1,130
P.F. Chang’s Kung Pao Chicken 1,240
Pizza Hut’s Individual Pepperoni Pizza 1,070

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 27

Day 5 Friday
RECIPE

Menus Calories 1,511 Roasted Salmon and Asparagus with Red Wine
Carbohydrate 196 g
Breakfast and Blackberries
Protein 89 g
1 cup shredded Servings: 6 Serving size: 1 fillet and 6 ounces asparagus
Fat 44 g
wheat
Sat 6.8 g Ingredients:
1 cup skim milk Trans 0 1 cup cabernet sauvignon or other 6 skinless salmon fillets
½ cup blueberries Cholesterol 110 mg dry red wine (6 ounces each), preferably
Sodium 1,338 mg Alaskan wild-caught
Lunch 2½ cups blackberries, rinsed and
Fiber 28 g
1 veggie burger drained, divided 2 bunches asparagus, washed and
with 1 whole-wheat pita, 2 tablespoons minced shallots trimmed
½ cup black bean and corn salsa, 2 tablespoons minced fresh ginger Fresh ground pepper
lettuce, and tomato slices Olive oil in spray bottle or mister
2 tablespoons sugar, divided
½ cup skim milk
1 tablespoon trans-fat–free
Snack margarine
1 ounce dry roasted peanuts
Preparation:
Dinner In a food processor or blender, combine wine and 2 cups of the berries; puree.
Roasted Salmon and Asparagus Rub berry mixture through a fine strainer into a 1½- or 2-quart pan; discard
with Red Wine and Blackberries residue. Add shallots, ginger, and 1 tablespoon of the sugar. Bring berry mix-
(see recipe at right) ture to a boil over high heat and stir often until reduced to 1 cup, about 10
²∕³ cup cooked brown rice minutes. Remove from heat and stir in margarine and remaining 1 tablespoon
sugar. Set aside.
½ cup skim milk
Preheat oven to 450° F. Line 2 baking sheets with aluminum foil and spray with
¾ cup fresh pineapple
oil. Place salmon fillets on one baking sheet and asparagus on the other. Spray
both with oil and season with fresh ground pepper. Roast both pans about 10
minutes; salmon should be opaque in the center, and asparagus should be tender.
Divide salmon and asparagus among six plates. Spoon warm blackberry mixture
over all. Garnish with remaining whole blackberries.
Nutrition facts: Calories: 438, Fat: 22 g, Saturated fat: 3.6 g, Trans fat: 0, Carbohydrate: 17 g,
Fiber: 6 g, Protein: 39 g, Cholesterol: 104 mg, Sodium: 87 mg

Day 6 Saturday

Menus Calories 1,506 Dinner (at restaurant, about 800 calories)

Carbohydrate 114 g 5 ounces red wine
Breakfast
Protein 111 g 1 appetizer of mussels with tomato-based sauce
1 cup low-fat cottage cheese
Fat 53.8 g
6 ounces baked scrod
1 cup strawberries Sat 9.8 g
1 cup grilled asparagus
Trans 0
Lunch salad with 2 teaspoons olive oil and red wine vinegar
Cholesterol 157 mg
Salmon Sliders (see recipe, page 29)
Sodium 1,782 mg 1 dinner roll
Salad with 2 cups lettuce, ½ cup Fiber 22 g 1 cup raspberries
carrot strips, 3 slices red onion,
2 teaspoons olive oil, and 1 tablespoon red wine vinegar
1 cup skim milk

28 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

Day 7 Sunday
RECIPE
Calories 1,477
Menus Apple Barley Bake
Carbohydrate 183 g
Brunch Protein 80 g Servings: 8 Serving size: ¹∕8 pan
Omelet of 2 egg whites, Fat 56 g
1 ounce low-fat Swiss Sat 12.4 g Ingredients:
cheese, and ¼ cup fresh Trans 0 6 medium apples, peeled ½ teaspoon ground cardamom
mushrooms, cooked with Cholesterol 80 mg
1 teaspoon canola oil ¼ cup orange juice, chilled ½ teaspoon ground cinnamon
Sodium 1,901 mg
2 ounces turkey sausage ½ cup apple cider ½ teaspoon black pepper
Fiber 34 g
1 serving Apple Barley ½ cup cranberry juice 2 tablespoons honey
Bake (see recipe at right) 1 cup water ½ cup pearl barley, rinsed
2 tablespoons good-quality 3 tablespoons brown sugar,
Snack cocoa powder divided
¾ cup nonfat plain Greek yogurt with
1 teaspoon salt
1 cup melon balls

Dinner Preparation:
1½ cups whole-wheat pasta with 1 cup broccoli and Peel, core, and slice apples into ¼-inch slices; mix with orange juice
1 cup cauliflower, cooked in 2 teaspoons olive oil to keep them white. In a saucepan, heat the apple cider, cranberry
¹⁄ ³ cup tomato sauce juice, water, and cocoa powder. When this liquid simmers, add
1 tablespoon Parmesan cheese salt, cardamom, cinnamon, black pepper, honey, and barley. Cover
and simmer slowly for 25 minutes. Place apple slices into a lightly
1 whole-wheat dinner roll oiled baking pan. Sprinkle 1 tablespoon of the brown sugar over
the apples. Cover the apples with the cooked barley mixture and
Snack
sprinkle remaining 2 tablespoons brown sugar over the barley.
1 slice whole-wheat toast with
Bake at 300° F for 25 minutes.
1 tablespoon peanut butter
Nutrition facts: Calories: 164, Fat: 0.5 g, Saturated fat: 0, Trans fat: 0,
Carbohydrate: 40 g, Fiber: 4 g, Protein: 2 g, Cholesterol: 0, Sodium: 295 mg

RECIPE (Day 6)

Salmon Sliders
Servings: 4 Serving size: 1

Ingredients: Preparation:

4 salmon fillets, 1 tablespoon minced garlic Preheat oven to 300° F. Place salmon fillets in an oiled shallow
3 ounces each pan. Pour white wine over fish and sprinkle lightly with dry
1 tablespoon extra-virgin
or fresh dill. Cover with foil. Bake for 15 minutes. Meanwhile,
5 ounces white wine olive oil
sauté onion, mushrooms, and garlic in olive oil. Steam baby
½ cup dill sprigs or 1 cup packed baby spinach spinach. When fish is done, assemble slider: on each roll, place
1 tablespoon dry dill 4 whole-wheat dinner rolls 1 piece salmon, ¼ cup mushrooms and onion, a small amount
½ cup chopped 1 medium tomato, sliced of steamed spinach, and 2 tomato slices.
Vidalia onion Nutrition facts: Calories: 365, Fat: 17 g, Saturated fat: 3.4 g, Trans fat: 0,
Carbohydrate: 25 g, Fiber: 4 g, Protein: 22 g, Cholesterol: 47 mg,
1 cup thinly sliced crimini
Sodium: 237 mg
mushrooms

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 29

 Specia l S e c t i o n

10 habits to help you

lose weight
L
asting weight loss demands that you transform your eating haps with a friend or your part-
and exercise habits. But many other choices you make each ner acting as a coach (social
support), and finally give your-
 day, such as how much time you spend sleeping or surfing
self a treat once you achieve your
the Internet, can also make a difference. The 10 habits described goals (reward).
in this chapter can help you move toward your weight-loss goal.
Most target the common reasons people are overweight
(see “Why people become overweight,” page 2).
Don’t do all of these at once. nected. For instance, you may
1 Set small, specific, and
realistic goals.
Perhaps you’d like to be the same
size you were in high school or
Choose the one that seems the identify certain patterns you when you got married, but that
most feasible for you, and try need to adjust (behavior chain, would mean dropping more than
to stick with it for a week or so. see page 31), and try to change 50 pounds. Don’t go there—not
Once you’re doing it fairly con- them by making a plan (goal set- yet, at least. Set a more realis-
sistently, add another one. Over ting, at right) and tracking your tic goal of losing 5% to 10% of
time, you will realize that many progress (self-­m onitoring, see your weight, and give yourself
of these habits can be intercon- page 31). You can do that per- plenty of time and some flexibil-
ity to reach that goal, keeping in
mind that most people take at
What is cognitive behavioral therapy? least six months to achieve that
Cognitive behavioral therapy (CBT) is a form of personalized psychological degree of weight loss. Also try to
therapy that encourages people to discover and expose negative and unproduc- avoid generalized goals, such as “I
tive ways of thinking about specific problems (such as overeating) and to replace should eat less at dinner and exer-
them with more adequate thoughts in order to change behaviors. In CBT for
cise more.” Instead, set specific
obesity, therapists help their patients identify and change thoughts that main-
tain lifestyle habits that foster weight gain, as well as others related to personal and short-term (that is, daily or
issues, such as appearance, self-confidence, and quality of relationships. Experts weekly) goals, such as these:
claim that this specific type of therapy—focusing on thoughts as the root of the • I will choose a few dinner recipes
problem—can empower patients in the process of weight loss and its mainte-
(see pages 25–30) and shop for
nance, at least in the short run.
the ingredients on Sunday.

30 He a l t hy S o l u t i o n s t o L o s e We i g h t a n d K e e p i t O ff www.health.har vard.edu
 10 habits to help you lose weight | Special Section

• I will bring a healthy lunch from Figure 5 A sample behavior chain

home instead of going out at least
three times next week. Record TV show
Stayed up past
• I will call a friend to take a walk midnight watching TV ☞ to watch earlier
on another night
after work on Monday and
Wednesday. Trouble falling asleep. Use relaxation
☞

2
Woke up late, techniques
skipped breakfast to fall asleep
Start self-monitoring.
Studies suggest that many people Didn’t pack lunch,
are not aware of how many calo- went to fast-food
restaurant
☞ Pack your lunch
the night before
ries they eat or how much they
exercise. This is sometimes a rea- Stressed at work. Keep healthy snacks at
son behind unsuccessful attempts
Raided candy bowl
by reception desk
☞ work (100-calorie cracker
snack packs, fresh fruit)
to lose weight. Writing down
what you do can help you gain Felt discouraged, Plan in advance to
awareness of your behaviors and skipped going to gym ☞ meet a friend or
trainer at gym
track your changes toward spe-
cific goals. To keep tabs on your
eating and exercise, you can go
low-tech (a pocket-size note- ☞
book with a pen) or high-tech (a
smartphone app; see page 37).
The idea is to pinpoint areas you ☞
need to improve. A more detailed
food diary (see the sample on
page 33) that includes not just ☞
what and how much you eat, but
when, where, and why you eat,
can help you recognize bad hab- ☞
its, such as eating when you’re not
actually hungry but instead tired
or depressed. This type of chart- ☞
ing will also come in handy when
you develop your behavior chain
A behavior chain depicts a series of events that leads to an undesirable outcome. In this
(see next item). As part of self- example, the pink boxes describe specific events and the yellow boxes describe sugges-
monitoring, it’s also a good idea to tions to "break the chain." Fill in your own behavior chain in the blank version below it.
weigh yourself regularly (at least
weekly) and record the number. stances where you are more vulner- you will eat during them. Using the
After you get started with the able and more likely to give in to diary together with the behavior
diary, spend time looking back problem foods. Focus your atten- chain, you can pinpoint your spe-
carefully at your typical pattern. tion on those periods and plan in cific issues and develop targeted
You will be able to identify circum- advance what you will do and what strategies that work for you.

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 31

 Special Section | 10 habits to help you lose weight
3
Create a behavior chain.
A behavior chain is a tool thera-
pists use to help clients recog-
nize how a series of often minor
events can trigger an undesirable
outcome, such as overeating. To
make your own behavior chain,
use the blank one below the sam-
ple in Figure 5. To get started,
think back on a time when you ate
too much—well beyond the point
of feeling comfortably full. People
tend to do this type of non-hun-
ger eating in response to any of
three types of triggers:
• situations (such as being at a
5
movie theater, restaurant, or
cocktail party)
• emotions (such as feeling sad, anx-
ious, depressed, bored, or angry)
• negative thoughts (such as “I have
no willpower” or “I’ve already
blown my diet, so I might as well
give up”).
Start by filling in the overeat-
ing event in the last red link, then
work backward, adding the actual
events in the other red circles,
going as far back in the day as you
can recall—maybe even to the pre-
vious evening, as in the example.
Then go back and fill in the yel-
low links with ways that you can
“break the chain” the next time
you’re in a similar situation.
4
Find a support network.
Find at least one weight-loss
buddy—your spouse, a friend,
a relative, or a colleague—to
help motivate you and hold you
32 He a l t hy S o l u t i o n s t o L o s e We i g h t a n d K e e p i t O ff www.health. har vard.edu
accountable. In-person groups,
like those offered by Weight
Watchers or TOPS (see “Weight-
loss programs,” page 35) can serve
this purpose; so can online sup-
port groups. Some people find
periodic check-ins with a health
care professional—a physician,
nurse, dietitian, or therapist—
can provide that extra incentive
to keep on track. In particular,
cognitive behavioral therapy (see
“What is cognitive behavioral
therapy?” on page 30) has been
shown to foster weight loss in
some studies.
Energize your exercise.
Try one of the following sugges-
tions to reinvigorate (or jump-
start) your exercise routine:
• Take a brisk walk in your neigh-
borhood (or local mall, if the
weather’s bad). Aim for at least
20 minutes, which you can do
in two 10-minute increments. If
you enjoy walking, buy a pedo­
meter to track your progress and
see if you can gradually build up
to 10,000 steps per day.
• Try a new form of exercise. Swim
laps at a local pool; go dancing;
play Frisbee. Finding a form of
exercise that you really enjoy will
make it easier to stick to an exer-
cise routine—and incorporating
new types of exercise can keep
you challenged and less likely to
become bored.
• Look into different options for
structured exercise, such as a fit-
ness center, gym, or local recrea­
tion center. If possible, pay for a
one-day pass to see if you like the
place, and get a list of available
exercise classes, which might
include water aerobics, Jazzercise
or other dance and movement
classes, yoga, or tai chi.
• B orrow or rent a fitness DVD.
Note that many libraries have
collections, so you can check out
several at no cost. You can find a
wide variety of types, including
aerobics, kickboxing, strength
training, yoga, and Pilates.
• Plan an active outing with fam-
ily or friends, such as a hike in
the woods or a bike ride. If you
have a yard, gardening chores
such as mowing, raking, and
weeding also count as moder-
ate exercise.
6
Make sure you’re getting
enough sleep.
Most people need about eight
hours of sleep a night, but there’s
a lot of variability from person to
person—some people need more,
some less. You can tell if you’re
getting enough sleep if you wake
up feeling refreshed and ready
to go, rather than groggy and
grouchy. Insomnia—trouble fall-
ing asleep or staying asleep—is
very common. For more detailed
information on insomnia and
other sleep problems, see the
Harvard Special Health Report
Improving Sleep: A guide to a good
night’s rest (ordering information
on back cover).
 Food diary
Time Place With Activity Mood Hunger Amount Food Calories Fullness Filled
(record start (kitchen, whom (reading, (neutral, (0–5, with (if unknown, (after eating: out just
and end time of living room, (alone, or watching happy, tense, 0=no hunger, leave blank) 1=still hungry before
meal or snack) bedroom, with family, TV, talking, depressed, 5=starving) 2=quite satisfied or after
car, desk at friends, cooking) angry, bored, 3=uncomfortable) eating
work) colleagues) rushed, tired) (X=yes)

www.h e a l t h . h a r v a r d . e d u
Total:

Healthy Solutions to Lose Weight and Keep it Off

10 habits to help you lose weight | Special Section

33
 Special Section | 10 habits to help you lose weight
7
Eat breakfast—slowly and
mindfully—every morning.
Many people skip breakfast
because they’re too rushed or
they aren’t hungry. Try getting up
15 minutes earlier (which means
going to bed earlier so you don’t
sacrifice sleep time) to make time
for breakfast (see pages 24–30 for
some simple, healthy suggestions).
Practice eating slowly by put-
ting down your utensil or sipping
water, coffee, or tea between bites.
Ideally, you should spend at least
20 minutes for each meal, but that
may be more realistic during your
midday or evening meal; choose
one to get started. Set a timer to
check yourself.
Also, if you’re not hungry in the
morning, maybe you’re eating din-
ner too late, or perhaps snacking
into the wee hours. If that’s the case,
set a goal to not eat or drink any-
thing (except water) after 7 or 8 p.m.
8
Monitor and modify your
9
screen time.
People often complain that they
don’t have enough time to exercise
or to shop for and prepare healthy
meals. But in fact, most people
spend many hours watching TV
or using their computer for fun.
34 He a l t hy S o l u t i o n s t o L o s e We i g h t a n d K e e p i t O ff www.health. har vard.edu
Keep track of your screen time for
a week, then try scaling back the
number of hours by a quarter or
a third, and devote that time to
your weight-loss efforts. Another
idea is to work out while you’re
watching TV or a movie: set up
your treadmill or other exercise
equipment in front of the TV, or
squeeze in a little activity during
the commercials. Stand up or sit
on the floor and do some simple
exercises, like stretching, jump-
ing jacks, or push-ups and sit-ups
with bent knees. Grab a can of
soup or water bottle as a stand-in
for a small hand weight and do a
set of arm curls or other strength-
building exercises.
If you sit at a computer during
much of your work day, consider a
10
standing work station, which will
not only burn more calories but
also keep you more alert. If that’s
not feasible, try to get up and
move around at least every half
hour or so.
Shop smarter.
Chances are you’ve heard the
advice to never shop when you’re
hungry and to use a list to avoid
impulse buys. Go one step further
and make sure your list has ingre-
dients for at least three healthy
dinners and some nutritious, por-
table snacks, such as bananas,
baby carrots, or almonds. Having
the right foods at hand will help
you avoid pulling out the take-out
menus and raiding the snack-food
machine at work.
At the store, stick to the peri­
meter, where the least-processed
food is located (produce, dairy,
eggs, meats, and poultry). Seek
out the aisles with whole grains,
beans, and nuts, but steer clear
of those with sodas, chips, and
candy. If you don’t like to cook,
take advantage of the healthy pre-
pared foods that are now common
in many supermarkets, such as
roasted chicken, salad bar items,
and quick-cooking grains.
Reward yourself with
(nonfood) pleasures.
Treat yourself to a small reward
for working on one of these steps.
Buy yourself some flowers, music,
scented soap, or another nonfood
item you wouldn’t normally get for
yourself. When you’ve mastered
several steps, indulge in a bigger
reward such as a massage or facial,
or get tickets for a sporting event,
concert, or other performance.
 Weight-loss programs
E ach year, millions of Americans enroll in weight-
loss programs. These include well-known commer-
cial programs such Weight Watchers and Jenny Craig
(both of which have online versions) and organized
self-help programs such as Overeaters Anonymous.
Fewer people may be familiar with medically super-
vised programs, which include hospital-based pro-
grams or individual care from a physician. In addition,
many free online diet and exercise programs are now
available (see “Online options for dieters,” page 36).
The commercial programs charge a fee for meet-
ings. They offer advice on diet and exercise regimens
as well as online tools for tracking your weight and
food consumption. In some cases, they sell prepared
foods and diet aids. The self-help programs tend to
focus mainly on providing emotional support and
encouragement in sticking with a weight-loss plan.
Clinical programs, which are provided through a
doctor’s office or hospital clinic, offer comprehensive
diet, exercise, and behavior-modification programs,
supplemented as needed with prescription treatments
such as very low-calorie diets, weight-loss medica-
tions, and, increasingly, surgery.
None of the programs can guarantee that you will
lose a particular amount of weight. With the excep-
tion of the clinical programs, these approaches are
adjuncts to, not substitutes for, professional guidance
for those who need it. Indeed, the self-help and com-
mercial plans encourage participants to consult with
health care professionals about weight-loss strategies.
Following are descriptions of the different pro-
grams and what you can expect from them.
Commercial programs
Like self-help programs, the commercial programs
hold regular meetings to provide encouragement and
support. But a significant difference between the two
types of programs is money. The commercial pro-
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
grams charge fees to participate in meetings and also
sell diet plans, as well as prepared foods and diet aids
to go along with those plans. Costs for these programs
vary, depending on how long you commit to the pro-
gram, whether you attend meetings in person or online,
and whether you purchase the foods or diet aids. Check
with the specific organization for more information.
■ Weight Watchers. The most popular of the com-
mercial programs, Weight Watchers, has more than
25 million participants worldwide. As a member, you
receive a daily allotment of points (based on your
weight, age, gender, and other factors) to spend on
food, along with point values for a wide range of foods.
In late 2010, Weight Watchers introduced PointsPlus,
a revamped system that puts more emphasis on the
nutritional value of each food to assign point values.
On the old plan, a 100-calorie bag of cookies was two
points, the same as a 100-calorie apple. Under the new
plan, fruits and non-starchy vegetables are now zero
points. And foods high in protein and fiber have lower
point values than foods high in fat and refined carbo-
hydrates. The idea is to encourage people to eat more
healthful, nutrient-dense foods and fewer “empty”
calories from treats. There’s no need to buy Weight
Watchers–brand foods. The program also encourages
members to get regular exercise.
Two published trials showed that people who went
to Weight Watchers meetings regularly lost about 5%
of their weight over three to six months. Meetings are
led by people who have successfully lost weight and
kept it off through the Weight Watchers program.
■ Jenny Craig. The other leading commercial
weight-loss program, Jenny Craig, has more than 725
centers around the world. To get started, you visit a
local Jenny Craig center and have your weight ana-
lyzed by a staff member. These staff members are not
dietitians or other health professionals, but they’re
trained in the Jenny Craig program, which, according
to the company, was developed by dietitians. Based on
35
your weight, the staff member recommends a dieting,
exercise, and behavior-modification program to help
you lose about 1 pound a week.
In general, members are advised to eat three meals
and three snacks each day, as well as to drink eight
8-ounce glasses of water each day and to increase their
physical activity as much as they can. Jenny Craig also
sells a wide array of packaged foods, diet aids, vita-
min and mineral supplements, and even devices such
as pedometers. Members have the option of prepar-
ing their own meals, but the prepared foods have been
shown to help them stick with the diet.
Self-help programs
These nonprofit programs have local chapters around
the country. They make no promises that they will help
you lose any weight. However, they aim to improve
your odds of doing so by holding regular (usually
weekly) meetings where members share success stories
and frustrations and offer one another encouragement
and personal tips. Meetings are run by volunteer group
Online options for dieters
In addition to the Weight Watchers and Jenny Craig online pro-
grams, there are numerous other Web-based diet and exercise
programs, some of which are free. Similar programs are also
available for use on a smartphone (see “Smartphone applica-
tions to spur weight loss,” page 37). Most offer tools that allow
you to easily track your eating and exercise habits, count calories,
and chart your weight loss. Some have programs specifically
targeted to men or women, and many offer plans that follow
specific types of diets, such as low-carb, Mediterranean, or vege­
tarian. Most also feature online chats or discussion groups, and
some provide e-mail advice from experts, including psychologists
and dietitians. These are some of the better-known options:
• Calorie Counter (http://caloriecount.about.com)
• Calorie King (www.calorieking.com)
• DietWatch (www.dietwatch.com)
• eDiets (www.ediets.com)
• FitDay (www.fitday.com)
• NutriSystem (www.nutrisystem.com)
• SparkPeople (www.sparkpeople.com)
• Vtrim (www.uvm.edu/vtrim)
• WebMD (www.webmd.com/diet)
36 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
leaders. Each self-help program has a different focus.
■ Overeaters Anonymous. This is a 12-step program
modeled after Alcoholics Anonymous for people who
suffer from compulsive overeating. The main purpose
of the meetings is to help people stop overeating by
exploring their underlying emotional issues. Overeaters
Anonymous has chapters around the world. It is free,
although members are asked to contribute what they
can. A special feature of the program is a buddy system
in which you have another member to call if you feel
the urge to overeat. Whether this approach is appropri-
ate or effective for overeaters remains controversial.
■ Take Off Pounds Sensibly (TOPS). This program
takes a practical approach, giving members incentives
to follow whatever diet plan has been recommended
by their health care practitioners. One program that
TOPS recommends is the “exchange” diet established
by the American Dietetic Association and the Ameri-
can Diabetes Association, but TOPS asks members to
check with their doctors first.
Weekly private weigh-ins are followed by meetings,
during which members discuss their successes and
But how well do they work? A study published in Obesity
involving more than 2,800 members of the Kaiser Permanente
health plan revealed that people who followed a tailored
expert system lost more weight than those assigned to an
information-only plan. Both options were offered online only,
but while the information-only group received just factual
information about weight management and diet strategies,
the tailored system focused on a healthy diet and provided
tips targeted to the participant’s particular issues. For example,
those who believed overweight people lacked willpower were
given messages attempting to change that perception, and
those unable to exercise weren’t given exercise advice.
According to a review of Web-based interventions for weight
loss published in 2010 in Obesity Reviews, the frequency
of a user’s log-ins, self-monitoring occasions, chat room
attendances, and bulletin board posts was correlated with
losing weight or keeping it off in many studies. But there’s a
dearth of information on the long-term impact of Web-based
interventions, the authors noted.
It’s certainly worth checking out a few of the online pro-
grams. Even without proof of clear benefits from a specific
one, the very act of paying more attention to your eating
and exercise habits seems to help.
 Smartphone applications to spur weight loss
Smartphones such as the iPhone, Android, Blackberry,
and Palm WebOS can make it even easier to track your
eating and exercise, thanks to an ever-growing number of
applications (apps) designed for dieters that run on these
multipurpose computers.
Food diaries and supportive communities are proven factors
in successful weight control programs, and Lose It! (for
iPhone, free) offers both. You enter your height, weight, age,
gender, and target weight, and the app calculates your daily
caloric allotment. As you go through the day, you log in every
morsel you put into your mouth and each minute of physical
activity. The app draws from a very comprehensive database
of foods and physical activities to keep a running tab of the
calories you’ve consumed and expended and the number
remaining in the day’s allotment. It also computes your nutri-
tional intake in terms of calories, carbs, protein, saturated and
unsaturated fats, and sodium. To stay on track, you can set up
difficulties in reaching their weight-loss goals. Some
chapters arrange for doctors, nutritionists, and other
weight-loss experts to speak at meetings. TOPS holds
retreats and rallies to give members extra incentives to
stay with their weight-loss plans. It also features online
support. Members receive a monthly magazine that
contains low-calorie recipes as well as inspirational sto-
ries by members who have met their weight-loss goals.
Clinical programs
These programs are run by health care professionals,
either in private practice or at hospital-based cen-
ters. Many of these programs are staffed by multidis-
ciplinary teams that may include doctors, dietitians,
exercise therapists, and psychologists or social work-
ers, who provide a wide range of services, such as
nutrition education, medi­cal care, behavioral therapy,
and guidance on exercise.
The mainstay of clinical programs used to be a very
low-calorie diet of 800 or fewer calories a day, which is
at least 400 calories per day less than conventional diets.
Very low-calorie diets feature commercially prepared
liquid formulas, such as Optifast, that replace all of the
food in a patient’s diet and induce a rapid loss of about
20% of his or her initial weight over 12 to 16 weeks—as
much as 5 pounds a week. This type of diet is considered
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
e-mail notes to yourself reminding you to fill out the log. You
can also register on the Lose It! Web site to get support from
a community of people who’ve had success in losing weight.
Calorie Counter by FatSecret (for iPhone, Android, and
BlackBerry, free) is similar but less intuitive to use and does
less of the math for you.
iTreadmill (for iPhone, 99 cents), CardioTrainer (for Android,
free), and Endomondo Sports Tracker (for Android and
BlackBerry, free) use the phone’s GPS to turn your phone into
a pedometer and navigator.
Absolute Fitness (for most smartphones, $4.99) allows
you to log and manage your food intake, exercise, and
weight. It displays the nutritional composition of food and
the calorie expenditures of different activities. You set your
personal diet, exercise, and weight-loss goals, and the app
tracks your progress.
appropriate only for patients with a BMI greater than
30 who need to lose weight quickly for health reasons.
Other clinical programs offered in the United States
include Health Management Resources and Optifast.
As part of the program, people on very low-calorie
diets should have regular medical checkups to identify
any adverse health effects. Patients should also have
counseling to help them adjust to the diet, as well as
guidance on how to reintroduce regular food once the
diet is over. Many programs also offer support groups
to help people maintain their weight loss by adher-
ing to a low-calorie diet and getting regular physical
exercise. Very low-calorie diet programs usually cost
$1,000 to $2,000 for three months.
Today, however, clinical programs are inclined
to recommend a more moderate low-calorie diet in
conjunction with a program of exercise and behav-
ior modification. For one thing, very low-calorie diets
have been associated with complications in some peo-
ple, including chemical abnormalities and irregular
heartbeats. And in the long run, such diets are no more
effective than conventional low-calorie diets in which
people consume about 1,200 calories daily. For patients
with obesity—and for those who are overweight but at
high risk for obesity-related complications—clinical
programs now often combine behavior-based treat-
ment with weight-loss medications or surgery.
37
 Weight-loss medications
W eight-loss drugs are not for the mildly overweight
or those who just want to lose a few pounds to
improve their appearance. For people whose health
is at risk and who have failed to reduce their weight
through diet and exercise, drug therapy may increase
the odds of success. For many, however, the health
risks from these medications may not be worth the
few extra lost pounds.
Weight-loss medications have a history of serious
safety concerns. In the 1950s and 1960s, dieters took
amphetamines to quell their appetites and boost their
metabolism rates—until doctors realized that the pills
were addictive and caused paranoia. The combination
of fenfluramine and phentermine, popularly known as
“fen-phen,” was widely used in the mid-1990s. But fen-
fluramine and another drug, dexfenfluramine, were
linked to heart valve disease and pulmonary hyper-
tension, a potentially fatal form of high blood pressure
affecting the lungs. Both drugs were withdrawn from
the market in 1997. (Phentermine, the weaker but safe
half of fen-phen, is still used; see below for more details.)
That same year, sibutramine (Meridia), a drug with
a similar mode of action to fenfluramine, received FDA
approval. The drug boosts the availability of brain chem-
icals that make people feel full and revs up a person’s cal-
orie-burning rate a bit. But sibutramine also increases
blood pressure and heart rate, which raised concern that
it might make users more prone to heart attacks. In 2010,
a report in The New England Journal of Medicine con-
firmed those fears. Nearly 10,000 overweight or obese
people with heart disease, type 2 diabetes, or both took
sibutramine or a placebo (in tandem with a diet and
exercise program) for an average of 3.4 years. Research-
ers calculated that a person who took sibutramine faced
a one-in-70 chance (or one-in-52 chance if the person
already had heart disease) of having a nonfatal heart
attack or stroke. That risk overshadows the modest aver-
age weight loss among the sibutramine users, which
was just under 9 pounds after one year. Soon after these
38 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
findings were published, Abbott, the company that pro-
duced sibutramine, withdrew the drug from the market
at the request of the FDA.
Drugs designed to target different brain chemi-
cals that affect weight regulation have faced similar
challenges. One drug, rimonabant (Acomplia), was
marketed in Europe to help stifle the urge to over-
eat by blocking the same brain receptors that cause
the “munchies” in marijuana users. Although avail-
able in several European countries for a few years,
rimonabant sales were suspended by the European
Union in 2008. The FDA never approved the drug in
the United States, based on concerns that rimonabant
may leave people vulnerable to neurological and psy-
chiatric problems—including a higher risk of suicide.
As of early 2011, only a few medications are
approved for treating obesity (see Table 5). Of those,
phentermine and orlistat are the most commonly
prescribed. Phentermine, which is available as a
generic and under a number of brand names, includ-
ing ­Adipex-P and Iona­min, promotes weight loss by
decreasing appetite and ramping up metabolism. Clin-
ical studies have shown that on average, people taking
phentermine lose 4 to 22 pounds more than those tak-
ing a placebo over a six-month period. Because it can
speed heart rates, people with history of heart disease,
heart rhythm problems, stroke, or uncontrolled high
blood pressure shouldn’t take this drug. Although
phentermine is FDA-approved for only three months’
use, many doctors prescribe it for longer, provided the
person loses at least a pound a week for the first three
months. People who don’t lose at least 4 pounds after a
month on the drug aren’t likely to benefit from taking
it for longer periods of time.
Orlistat (Xenical, Alli) fosters weight loss by a
completely different route: blocking the action of an
enzyme that helps digest dietary fat. (Xenical is the
prescription-only version; Alli is a lower-dose version
available over the counter.) When taken with meals,
orlistat can prevent the absorption of up to 30% of the
fat you eat. Studies suggest that people taking orlistat
lose about 5% to 8% of their body weight over a year.
Although some 4 million people tried Alli during its
first year on the market, sales figures have been under-
whelming, according to news reports. One reason
may be orlistat’s possible side effects, which include
loose, more frequent, and sometimes hard-to-control
bowel movements. Orlistat also interferes with the
absorption of fat-soluble vitamins, so daily multivita-
min supplements (taken at least two hours before the
medi­cation) are recommended.
Other medications that are not specifically
approved for weight loss cause some people to shed
pounds. They include certain drugs used to treat
depression, seizures, and diabetes.
■ Antidepressants. Certain antidepressant drugs,
particularly bupropion (Wellbutrin), are sometimes
prescribed on a short-term basis because they’ve
been found to help some people lose weight. Most
doctors prescribe this medication only for people
who have mild to moderate obesity and also have
symptoms of depression. Short-term studies showed
that people taking bupropion lost about 4% to 5% of

Table 5 Medications used for weight loss

Generic name How it works Possible side effects Comments
(brand name)

FDA-approved for treating obesity

orlistat Cuts fat absorption in the
(Xenical, Alli*) intestine by up to 30%.
phentermine Increases levels of
(Adipex-P, Ionamin, norepinephrine; increases
others) energy expenditure;
suppresses appetite.
Approved for other indications but sometimes prescribed for weight loss
bupropion Increases levels of
(Wellbutrin, Zyban) norepinephrine and
dopamine and may help
control appetite.
exenatide Lowers blood sugar levels
(Byetta) and stimulates a sense
of fullness.
liraglutide Lowers blood sugar levels
(Victoza) and stimulates a sense
of fullness.
metformin Lowers blood sugar levels.
(Fortamet, Glucophage,
Glumetza, others)
topiramate Mechanism unknown.
(Topamax)
zonisamide Mechanism unknown.
(Zonegran)
*All medications are prescription-only except Alli, which is an over-the-counter (lower-dose) version of Xenical.
Oily stool leakage, gas,
bloating, malabsorption of
fat-soluble vitamins (A, D, E,
and K).
Rapid heartbeat and high
blood pressure, nervousness,
restlessness, diarrhea.
Dry mouth, agitation,
constipation or diarrhea,
headache, insomnia.
Acid or sour stomach,
belching, diarrhea, dizziness,
nervousness.
Headache, nausea, diarrhea.
Loss of appetite, metallic
taste in mouth, stomachache,
flatulence.
Vision problems, prickling or
tingling sensations, dizziness,
drowsiness, problems with
thinking and memory.
Drowsiness, loss of appetite,
upset stomach, vomiting,
dizziness.
People taking orlistat should take supplements of
fat-soluble vitamins and be closely monitored for
vitamin B¹² and iron deficiencies.
Should not be taken by people with a history
of heart disease, cardiac arrhythmia, stroke, or
uncontrolled high blood pressure. Heart rate and
blood pressure should be checked weekly for the
first four weeks and after any change in dosing.
Approved for treating depression (Wellbutrin) and
smoking cessation (Zyban).
Given by injection only; approved for treating
type 2 diabetes.
Given by injection only; approved for treating
type 2 diabetes.
One of the few drugs used to treat type 2 diabetes
that does not cause weight gain. Should not be
taken by people who have kidney or liver disorders.
Used to treat seizure disorders and migraines.
Especially helpful in treating weight gain caused by
antidepressants or other psychiatric medications.
Used to treat seizure disorders.

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 39

 OTC weight-loss supplements: Not worth the risk
Have you been tempted by the vast array of dietary supple-
ments available without prescription that promise to burn fat,
curb your appetite, and help you melt away the pounds? After
all, they’re made from herbs and other natural ingredients,
and they’re readily available in local stores or via the Internet,
so there’s no harm in trying one, right? Wrong.
Most popular weight-loss supplements are inadequately
tested for safety. Unlike the studies done on prescription
drugs to gain approval by the FDA, studies on supplements
typically include small numbers of volunteers and don’t last
very long. And supplements are far less closely regulated than
approved medications. Yet dozens contain undisclosed pre-
scription drugs—some of which are not approved for use in
this country, and many of which have serious, sometimes life-
threatening side effects, as reported by the FDA’s Initiative
Against Contaminated Weight Loss Products.
Supplements are far less closely regulated than
approved medications. Yet dozens contain
undisclosed prescription drugs—some of which
are not approved for use in this country.
Weight-loss aids fall into a gray area in FDA regulation.
They’re classified as dietary supplements, a category regu-
lated more like food than drugs, created in response to public
pressure to loosen the FDA’s tight control over a variety of
products. As a result, individual nutrients, herbs, and “phyto-
medicinals” (plants supposed to have medicinal value) can be
sold without being tested for effectiveness or safety, so long
as they do not make direct health or therapeutic claims. Within­
these limits, manufacturers cannot say that their weight-loss
aids will cure obesity or make you lose weight, but they can
make indirect claims—and this has led to a wide array of
unfounded assertions on labels and in advertisements.
But the FDA cannot take a product off the market unless
it is found to be unsafe. Because the agency cannot test
every one of the thousands of supplements on the market,
most face no danger of being removed. In 2004, however,
the FDA banned the sale of ephedra (ma huang in Chinese)
after the compound was linked to a number of deaths and
very serious side effects, including heart attacks, strokes,
and seizures. In 2001, ephedra products constituted fewer
than 1% of all dietary supplement sales, yet they were
responsible for 64% of all herb-related complications
reported to the U.S. Poison Control Centers during the same
year. Despite the fact that ephedra-containing supplements
are the only dietary supplements shown to help people lose
weight (at least for up to six months), the potential risks far
outweigh the benefits.
Despite the ban on ephedra itself, supplements containing
ephedra-like compounds (which include ephedrine, norephed-
40 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
rine, and methylephedrine) are widely available over the
Internet and in stores. They are often found in combination
with caffeine or plant sources of caffeine, such as guarana
and yerba mate, in weight-loss supplements. Note that two
other ingredients found in some supplements, bitter orange
and country mallow, contain chemicals related to ephedra
and should also be avoided.
In 2009, the FDA warned people to stop using Hydroxycut
products, which contain a variety of ingredients and were
marketed in various forms, including caplets and drink pack-
ets. The agency received 23 reports of serious liver injuries,
including one death, in people who took Hydroxycut products.
Other reported health issues included heart problems, sei-
zures, and serious muscle damage.
Also in 2009, the FDA’s Initiative Against Contaminated
Weight Loss Products identified more than 70 weight-loss
supplements (with names such as 5x Imelda Perfect Slimming
and Cosmo Slim), each of which contained one or more of the
following drugs:
• Sibutramine (Meridia), a weight-loss drug removed from
the market in 2010. Many products contained high levels of
this drug which can increase the likelihood and severity of
the listed health risks.
• Fenproporex, a stimulant drug not approved for marketing
in the United States. It can cause arrhythmia (a disorder of
your heart rate or rhythm) and possible sudden death.
• Fluoxetine (Prozac), a prescription-only antidepressant.
• Bumetanide (Bumex) and furosemide (Lasix), prescrip-
tion medications used to treat swelling and fluid retention
caused by heart, liver, or other diseases.
• Cetilistat, an experimental obesity drug, not approved for
marketing in the United States, that is known to cause gas-
trointestinal problems, including involuntary release of stool.
• Phenytoin (Dilantin, others), a prescription-only antisei-
zure medication.
• Phenolphthalein. A solution used in chemical experiments
and a suspected cancer-causing agent that is not approved
for marketing in the United States.
• Rimonabant. A weight-loss medication not approved in the
United States (see page 38).
The FDA is currently seeking product recalls from a num-
ber of the companies that produce these supplements. If the
companies don’t comply, warning letters, seizures, injunctions,
or criminal charges are the next step. Considering the risks
associated with these products (not to mention their limited
or questionable efficacy), most experts advise people to avoid
all weight-loss supplements. If you do choose to try one, con-
sult your health care professional.
their weight, compared with less than 2% in people
taking placebos.
■ Antiseizure drugs. Two medications used to
treat seizure disorders, topiramate (Topamax) and
zonisamide (Zonegran), are being studied as possible
treatments for obesity. But topiramate’s side effects
(confusion and other thinking problems) make it
unacceptable for most people. Zonisamide caused a
6% loss of body weight, compared with 1% in a con-
trol group, in one study. The main side effect was
fatigue. But further, longer studies are needed before
this medi­cation is widely recommended.
■ Diabetes drugs. Most medications used to treat
people with type 2 diabetes tend to cause weight gain,
but some, namely metformin (Glucophage and oth-
ers), exenatide (Byetta), and liraglutide (Victoza), have
the opposite effect for some people. In the Diabetes
Prevention Program study, people taking metformin
lost an average of 4% of their body weight over one to
two years. Exenatide and liraglutide both have similar
effects, although they must be injected and may cause
gastrointestinal problems. All of these drugs should
be taken only by people who have type 2 diabetes (or
are at high risk for developing it) and are being closely
monitored by a doctor.
Who should take them?
One way to minimize the risks of these drugs is to
prescribe them only for people who need them for
health reasons: those who have obesity-related condi-
tions such as type 2 diabetes or hypertension, or those
at high risk for developing such disorders. Guidelines
issued by the National Institutes of Health (NIH)
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
advise that weight-loss drugs be given only to people
with a BMI of 30 or more, or—in the case of those
with weight-related health problems—a BMI of 27 or
more. The use of diet drugs by people with lower BMIs
is likely to pose more risks than benefits.
Be aware that weight-loss drugs aren’t effective for
everyone. Clinical guidelines suggest that if a person
hasn’t lost at least a pound a week in the first month
on a weight-loss medication, she or he is unlikely to
benefit from the drug. A drug that helps one person
may be no better than a placebo for someone else. For
example, people who overeat because of stress, bad
habits, or emotional issues may benefit less from appe-
tite suppressants than do people who overeat because
of hunger. For them, psychotherapy or behavioral
therapy may be a more appropriate first step.
How should they be taken?
The NIH guidelines make clear that weight-loss drugs
should be used only in combination with diet and
physical activity. To lose weight over the long term,
you need to recognize and change the behaviors that
led to the weight gain. Otherwise, any weight you lose
is likely to return.
The idea behind using weight-loss medications is to
improve health and reduce disease risk, not to achieve
an ideal body weight. A 5% to 10% reduction in weight
over time is one common goal. But even more mod-
est weight loss helps. One study of women with obe-
sity demonstrated that those who intentionally lost any
amount of weight experienced a 40% to 50% decrease
in death from obesity-related cancers and a 30% to
40% decline in death from type 2 diabetes.
41
 Weight-loss surgery
I f you are severely obese, diet and medications may
have little effect on your weight. Your best chance
for long-term weight loss and better health may be
surgery to promote weight loss, called bariatric sur-
gery. The results can be dramatic: within the first
two years after surgery, people typically achieve
a maximum weight loss of around 20% to 35% of
their initial body weight, depending on the tech-
nique. Weight loss tends to decline over time, but is
often kept within a range that results in significant
health improvements. Type 2 diabetes, high blood
pressure, high cholesterol, and sleep apnea com-
pletely disappear in roughly 60% to 80% of people
who have bariatric surgery, according to pooled
data from a number of studies. These health benefits
translate into a nearly 30% lower risk of early death.
A range of other health problems also improve fol-
lowing surgery, including arthritis, asthma, gastro­
esophageal reflux, infertility, sexual dysfunction,
and urinary incontinence.
Figure 6 Gastric bypass
Stomach pouch
Small intestine
rerouted to
stomach pouch
Small intestine
reattached in Y shape
42 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
Bypasses, bands, and sleeves:
How they work
The two most common types of bariatric surgery are
gastric bypass and gastric banding. A third procedure,
sleeve gastrectomy, is emerging as an alternative tech-
nique, as it combines the best features of bypass and
banding. If you are an appropriate candidate for bariat-
ric surgery (see Table 6), you and your surgeon should
discuss the various risks and benefits of each technique
to decide which surgery, if any, is right for you.
Gastric bypass surgery
Gastric bypass surgery (see Figure 6) shrinks the size
of your stomach by more than 90%, which makes you
feel full after eating very small amounts of food. Your
body will absorb fewer calories, because food bypasses
most of the stomach and upper small intestine. Your
appetite will shrink as well, probably because the
internal rearrangement affects the release of hormones
Gastric bypass was developed in the late 1960s after surgeons noticed that
overweight patients who underwent similar gastric surgery for stomach
ulcers lost weight. The upper part of the stomach is converted into a small
pouch about the size of an egg. The small intestine is cut and one end is
connected to the stomach pouch; the other end is reattached to the small
intestine, creating a Y shape. This allows food to bypass most of the stomach
and the upper part of the small intestine, although both continue to produce
the gastric juices, enzymes, and other secretions needed for digestion. These
drain into the intestine and mix with food at the crook of the Y.
Advantages: Patients lose weight rapidly for up to two years after surgery.
Many maintain a loss of 60% to 70% of excess weight for 10 years or more.
Gastric bypass is more effective in curing or improving obesity-related health
problems than banding procedures, particularly for people with diabetes. About
80% of people with type 2 diabetes who undergo the procedure are cured.
Disadvantages: Gastric bypass is more difficult to perform (whether
done as open surgery or laparoscopically) than gastric banding and has a
somewhat higher complication rate. It’s also associated with a higher risk of
vitamin and mineral deficiencies, which may require lifelong supplementation.
Figure 7 Gastric banding (adjustable)
Upper stomach Adjustable band
Small intestine
Lower
stomach
To port
such as ghrelin, a hormone that makes you feel hun-
gry. However, the egg-sized pouch that remains may
stretch over time. The procedure can be done through
a large incision (open surgery) or though smaller inci-
sions with smaller instruments (laparoscopically).
Gastric banding
This procedure is often called a “Lap-Band,” the name
of the commercial system used in the surgery, which
is done laparoscopically. It also restricts the amount of
food you can eat by placing an adjustable band around
the opening of the stomach (see Figure 7). Compared
with gastric bypass, the surgery is simpler and has
a lower risk of complications immediately follow-
ing the operation. But the amount of weight you lose
depends on how well you’re able to follow a nutritious
diet afterward. If you indulge often in high-calorie
food that is soft or liquid, such as ice cream or sugary
drinks, for example, the band won’t help you feel full
and prevent you from overeating.
Sleeve gastrectomy
Sleeve gastrectomy transforms the stomach into a nar-
row tube by removing the curved side of the organ
(see Figure 8) instead of the lower part, as is done
with gastric bypass. This strategy has several benefits.
First, the stomach shrinks and is less likely to stretch
out again. Second, the tube-shaped stomach has fewer
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
A silicone band about two inches around restricts stomach size to a small
upper chamber, with an opening at the bottom to the rest of the stomach
and digestive tract. The size of the band can be adjusted by injecting or with-
drawing saline through a port implanted just under the skin.
Advantages: Gastric banding surgery is usually done laparoscopically with
camera-guided instruments inserted through tiny incisions. Compared with
more complicated procedures, such as gastric bypass, it has some advantages.
It requires less time in the operating room and a shorter hospital stay. There are
fewer postsurgical complications. And the band can be removed if necessary.
Disadvantages: Vomiting may occur if food intake is too rapid or the open-
ing into the lower stomach is too narrow. The silicone band may wear, slip, or
leak, necessitating another surgery. Compared with gastric bypass, there is
generally less weight loss, and weight loss is slower. There is less information
on its long-term effectiveness.
ghrelin-producing cells, which helps you feel satis-
fied with less food. Finally, the operation is less risky
than bypass because the intestines are not rearranged,
and also may be safer than banding because it doesn’t
require putting foreign materials into the body. Still,
the overall weight loss isn’t as dramatic with a sleeve
compared with bypass or a band procedure.
Criteria for weight-loss surgery
National Institutes of Health (NIH) guidelines recom-
mend bariatric surgery only for highly motivated peo-
ple with a BMI of 40 or more and no success or only
temporary success with other approaches to weight loss
(see Table 6). This therapy may also be appropriate for
people with moderate obesity (with BMIs of 35 to 40)
if they have an obesity-related health problem, such as
type 2 diabetes, heart disease, or sleep apnea. In 2011,
the FDA approved the use of the “Lap-Band” system in
people with milder obesity (BMIs starting at 30) and
an obesity-related health problem. The lowering of this
weight requirement, down from a BMI of 35, means
that millions more people will be eligible to receive
the banding procedure. However, Medicare and other
health insurance providers may or may not change their
coverage guidelines for this procedure in the future.
The study supporting the expanded use of the
band relied on data from 151 people with BMIs of 30
43
to 40, most of whom were women, with an average of
63 pounds of excess weight. About two-thirds of the
participants lost at least half of their excess weight
within a year. An earlier study in Annals of Internal
Medicine compared gastric banding against nonsur-
gical treatment (which involved a very low-calorie
diet, weight-loss drugs, and behavioral change to
improve diet and exercise habits) in 80 people with
mild obesity. After two years, members of the sur-
gery group had lost nearly 22% of their body weight,
compared with 5.5% in the nonsurgical group. And
those who had undergone surgery reported a better
quality of life.
Choosing a surgeon, and other
considerations
If you are considering bariatric surgery, choose a cen-
ter certified by the American College of Surgeons that
specializes in bariatric procedures, where you’ll be
evaluated by clinicians specializing in medicine, nutri-
tion, and psychology. The purpose is to make sure you
are physically and mentally prepared for surgery (and
the accompanying changes), are willing and able to
participate in follow-up care and diet, and understand
all the potential risks and benefits.
Only experienced bariatric surgeons should per-
form the surgery (research suggests it’s best to choose
one who has performed at least 100 procedures), and
you should receive extensive medical, nutritional, and
counseling services before and after surgery.
The risks of bariatric surgery have dropped in
recent years and are now no greater than those asso-
ciated with gallbladder or hip replacement surgery,
according a 2009 study in The New England Journal
of Medicine. The study followed 4,776 bariatric sur-
gery patients (most of whom had gastric bypass) for a
month after surgery. Complications were more com-
mon among people with a history of blood clotting
problems and those with sleep apnea.
Two earlier studies from the same journal docu-
mented the long-term benefits of bariatric surgery.
One, which compared surgical to conventional ther-
apy for obesity, showed a 30% lower risk of death
in those who had surgery over an average follow-up
period of nearly 11 years. The other study compared
nearly 10,000 people who had surgery with a simi­
lar number of severely obese control subjects and
found a 40% lower risk of death among those who
had bariatric surgery during an average follow-up of
7.1 years.
According to the American Society for Meta-
bolic and Bariatric Surgery, 220,000 people had
weight loss surgery in 2009. Bariatric surgery costs
about $17,000 to $35,000; insurance coverage varies
by provider.

Figure 8 Gastric sleeve

Portion of
stomach Sleeve gastrectomy was originally used as the first step in surgery for people
removed with super severe obesity (BMIs of 55 or higher). The second step involved
re­arranging the small intestine to separate the passage of food from the flow
Stomach of bile and pancreatic juices. This led to severe malabsorption, which is why the
pouch two-step procedure is rarely performed today.
Advantages: This surgery is technically easier than gastric bypass because it
doesn’t require the surgeon to reattach parts of the intestine to new locations in the
gut. The vertical pouch the sleeve procedure creates is less prone to stretching com-
pared to the pouch left by a gastric bypass. Studies suggest the sleeve procedure
Small intestine may lead to more weight loss and better hunger control than the gastric band.
Disadvantages: You may not lose as much weight from this surgery compared
to a bypass procedure, but accurate comparisons aren’t yet available as there are
less long-term data available for the sleeve procedure. Like bypass, it is irrevers-
ible. Also, because this procedure is still considered experimental, not all insurance
providers will pay for it.

44 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

After surgery
For the first few months after surgery, your appetite
will decrease dramatically and you’ll eat substan-
tially less food. If you eat too quickly or too much,
your stomach pouch can overfill, and you may vomit
or feel pain in the chest and upper abdomen. You
may need to take supplementary vitamins (espe-
cially vitamins B₁₂ and D) and minerals (especially
calcium and iron). After about a year, most people
increase their food intake to 1,200 calories per day.
You will need to be closely monitored by a physi-
cian, who can help address the common complica-
tions of bariatric surgery, such as gallstones, kidney
stones, and ulcers. Some people develop other com-
plications, such as a hernia at the incision site or ste-
nosis (narrowing) where the stomach is attached to
the small intestine. After a high-carbohydrate meal,
a person who has had gastric bypass surgery may
suffer from “dumping syndrome,” a reaction that
causes flushing, sweating, severe fatigue, nausea,
vomiting, diarrhea, and intestinal gas. People who
lose 100 pounds or more sometimes need additional
surgery to remove sagging skin that won’t return to
normal.

Table 6 Are you a candidate for bariatric surgery?

Bariatric surgery may be appropriate for people with BMIs of 40 or higher, along with people whose BMIs fall between 35 and 40 who also
have an obesity-related health problem such as type 2 diabetes, heart disease, or sleep apnea.
Height 5' 2" 5' 6" 6' Category
Body weight in 136–158 155–179 184–213 Overweight (25–29 BMI): People in this category generally are
pounds not candidates for bariatric surgery.
164–213 186–241 221–287 Obesity (30–39 BMI): People with a BMI of 35 or over can be
candidates if they also have an obesity-related health problem
such as diabetes, heart disease, or sleep apnea.*
218 or more 247 or more 294 or more Severe obesity (40 BMI and over): People in this category can be
good candidates.
*Gastric banding has been approved by the FDA for people with BMIs of at least 30 who have obesity-related health problems.

www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off 45

 Keeping the weight off
A s veteran dieters know all too well, losing weight
is only half the battle. Keeping it off over the long
run can be equally challenging. Conventional wisdom
states that most people who lose weight will regain
it within a few years. Yet relatively little research has
explored this phenomenon until quite recently—and
the findings suggest that adults in the United States are
more successful at sustaining weight loss than experts
previously thought.
In one such study, researchers looked at weight data
from more than 14,000 people ages 20 to 84 who par-
ticipated in the 1999–2006 National Health and Nutri-
tion Examination Survey (NHANES). About 17% of
people reported that they had kept off an average of
42 pounds for a year or longer. That means more than
one in six U.S. adults who has ever been overweight or
obese has maintained a weight loss of 10% for at least a
year, according to the authors, whose findings appeared
in the International Journal of Obesity in 2010.
Keys to lasting weight loss
Much of the original research on weight-loss mainte-
nance comes from a long-term project known as the
National Weight Control Registry (NWCR). The proj-
ect has uncovered clues to successful weight loss by
Longtime losers: Who’s in the NWCR?
A few facts about the National Weight Control Registry:
• Most (80%) are women.
• The average woman is 45 years old and currently weighs
145 pounds.
• The average man is 49 years old and currently weighs
190 pounds.
• They’ve lost an average of 66 pounds and have kept it
off for 5.5 years.
• Weight loss ranges from 30 to 300 pounds.
46 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu
tracking some 6,000 people who have lost weight and
successfully kept it off for many years. However, these
people are self-selected (that is, they chose to partici-
pate) and therefore represent only successful “losers,”
not the entire population of people who have tried to
lose weight. There is no evidence that the techniques
and approaches these people use are the key to suc-
cess, because many other people have used similar
approaches without success. Nonetheless, their hab-
its jibe with many recognized weight-loss or weight-
maintenance strategies and may prove helpful for
some people. The participants (see “Longtime losers:
Who’s in the NWCR?” at left) receive detailed ques-
tionnaires and annual follow-up surveys to examine
their behavioral and psychological characteristics, as
well as the strategies they use to keep weight off.
Some of the people in the registry are motivated
by an experience that frightened them—for example,
finding out that they were at high risk for a serious
illness. Others say they were extremely unhappy with
the way they looked and felt.
Their diet plans and physical activities differ
widely, but one thing that these individuals have in
common is that they chose strategies that they liked
that fulfilled some personal goal and that they could
stick with. The six strategies gleaned from NWCR par-
ticipants who have kept off at least 30 pounds for at
least one year include many of those listed in the spe-
cial section, “10 habits to help you lose weight” (see
page 31); namely, getting lots of exercise, eating break-
fast, watching little television, and keeping a food
diary. Of note, most participants weigh themselves at
least once a week, and just over a third make weigh-
ing a daily practice. Over time, people who weighed
themselves less often tended to regain more weight
than those who increased their weight-monitoring
frequency. Researchers speculate that this habit allows
people to detect a small weight gain and take action
before the problem escalates.
 Research has also shown that the more freedom
people have in planning their weight-loss programs,
the greater their prospects for success. A study in BMJ
compared the outcomes of women following two main-
tenance diet plans, having lost weight through a medi-
cally supervised weight-loss plan. Over a yearlong
period, the women in one group selected meals and
snacks from a menu of foods that added up to a set
number of calories per day. Those in the other group
could eat whatever they wanted within certain gen-
eral guidelines. The guidelines involved avoiding fried
foods, cutting back or eliminating the use of butter or
margarine on bread, eating lean meats, and eating more
complex carbohydrates, such as brown rice or whole-
wheat bread. After one year, the women on the calorie-­
restricted diet regained an average of 9 pounds, but
those who ate what they wanted—within the healthy
eating guidelines—regained less than half that amount.
Two additional behaviors appear to help: making
a conscious effort to control eating habits and curb-
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
ing out-of-control eating episodes—formally known
as increasing dietary restraint and reducing disinhibi-
tion (see “Emotional backlash,” page 7), as described
in a 2010 study in Annals of Behavioral Medicine. The
study compared two groups of people: those who had
lost at least 10% of their weight and kept it off for
five years and who were now at a normal weight, and
those who were overweight and who had a history of
dieting. What might explain why the first group had
more restraint and less disinhibition than the second
group? Differences in their home environments, say
the authors, who found that people in the first group
had fewer televisions and fewer high-fat foods at
home compared with the second group. The weight-
loss maintainers also exercised more, perhaps because
they were more likely to have exercise equipment in
their homes. Taking control of cues that trigger over-
eating in your immediate environment is also a good
strategy for weight loss (see “10 habits to help you lose
weight,” page 30).
47
 Resources
Organizations The Obesity Society
8757 Georgia Ave., Suite 1320
America on the Move
Silver Spring, MD 20910
4455 E. 12th Ave., Office 315 301-563-6526
Denver, CO 80220 www.obesity.org
800-807-0077 (toll-free)
www.americaonthemove.org A professional society that focuses on understanding of the causes,
consequences, prevention, and treatment of obesity in order to
A national nonprofit organization that promotes healthful eating improve the lives of those affected by obesity.
and active living, via small steps and small changes.
Weight-Control Information Network
American Diabetes Association
1 WIN Way
1701 N. Beauregard St. Bethesda, MD 20892
Alexandria, VA 22311 877-946-4627 (toll-free)
800-342-2383 (toll-free) http://win.niddk.nih.gov
www.diabetes.org
An information service of the National Institute of Diabetes and
The leading professional organization devoted to research and Digestive and Kidney Diseases, which is part of the National Insti-
treatment of diabetes, a common complication of overweight and tutes of Health. Provides health professionals and consumers with
obesity. Provides extensive information on nutrition and weight science-based information on obesity, weight control, and nutrition.
loss for people with diabetes.

American Dietetic Association Books

120 S. Riverside Plaza, Suite 2000
Chicago, IL 60606 Eat, Drink, & Weigh Less: A Flexible and Delicious Way to
800-877-1600 (toll-free) Shrink Your Waist Without Going Hungry
www.eatright.org Mollie Katzen and Walter C. Willett, M.D.
(Hyperion, 2006)
A professional organization of registered dietitians. Provides
information on nutrition and a list of dietitians in your area. Written by a well-known cookbook author along with the head
of Harvard School of Public Health’s Department of Nutrition,
American Society for Metabolic and Bariatric Surgery this book describes a flexible and medically sound weight-loss
100 75th St. SW, Suite 201 program that uses a “Body Score,” a number that reflects your
Gainesville, FL 32607 eating and exercise habits. The book provides diet and behavioral
352-331-4900 steps to boost your score and lose weight, as well as healthy,
www.asmbs.org easy-to-prepare recipes.
The leading professional organization for the study and support The LEARN Program for Weight Management, 10th Edition
of surgical therapies for obesity. Provides public education and
Kelly D. Brownell, Ph.D.
patient support programs.
(American Health Publishing Company, 2004)
American Society of Bariatric Physicians The LEARN program (which stands for Lifestyle, Exercise, Atti-
2821 S. Parker Road, Suite 625 tudes, Relationships, and Nutrition) was developed by a weight-
Aurora, CO 80014 loss researcher at Yale University. The program describes more
303-770-2526 than 200 lifestyle changes intended to help people adopt new,
www.asbp.org healthier habits to lose weight.
A professional organization of surgeons who perform bariatric The No Sweat Exercise Plan: Lose Weight, Get Healthy,
surgery for weight loss. Provides names of surgeons in your area. and Live Longer
Shape Up America! Harvey B. Simon, M.D.
www.shapeup.org (McGraw-Hill, 2006)

A not-for-profit organization committed to raising awareness of
obesity as a health issue. Provides evidence-based information
and guidance on weight management.
Written by a leading Harvard Medical School physician, this book
introduces an innovative exercise plan that shows how to be
healthy and lose weight through day-to-day activities and without
working up a sweat. The book is based on sound scientific data and
written for people who know they need to exercise to look better
and improve their health, but just aren’t into heavy workouts.

48 Healthy Solutions to Lose Weight and Keep it Off www.health.har vard.edu

 Glossary
bariatric surgery: Any of several gastrointestinal operations
that cause therapeutic weight loss.
body mass index (BMI): An estimate of an individual’s rela-
tive body fat calculated from his or her height and weight.
calorie: The unit for measuring the amount of energy in food.
carbohydrate: The major component in fruits, milk, and
starches such as bread, pasta, rice, and potatoes. Carbo­
hydrates are one of the three primary nutrients (along with
fats and proteins) and provide most of your body’s fuel.
diabetes: A chronic metabolic disorder in which levels of
blood glucose, or sugar, are elevated. Excess body weight
raises the risk of developing this condition.
fat: One of the three major nutrients (along with carbo­
hydrates and proteins). Fat is found in both animal and
plant foods; however, fats from different sources have
differing chemical compositions and health effects.
fiber: An indigestible substance found in plant foods.
glucose: The body’s chief source of energy; a simple sugar
that passes easily from the digestive tract into the blood-
stream when you consume carbohydrates.
hypertension: High blood pressure. Individuals who are
overweight or have obesity are at greater risk of developing
hypertension.
metabolism: The rate at which your body uses energy,
measured in calories.
www.h e a l t h . h a r v a r d . e d u Healthy Solutions to Lose Weight and Keep it Off
monounsaturated fat: A type of fat found in peanut oil,
canola oil, olive oil, cashews, peanuts, many other nuts,
and avocados.
polyunsaturated fat: A type of fat found in corn, soybean,
and other vegetable oils. It’s also found in seeds, legumes,
whole grains, and fatty fish, such as salmon and tuna.
protein: One of the three major nutrients (along with carbo­
hydrates and fats). It is used by the body for building and
repairing tissues. Protein is derived primarily from animal
sources but can be found in some vegetables as well.
resting energy expenditure: The rate at which you burn
calories while at rest. Resting energy expenditure accounts
for 60% to 75% of daily energy expenditure.
saturated fat: A type of fat found in animal foods, such as
meat, poultry skin, butter, and whole-milk dairy products.
Also found in palm and coconut oils.
trans fats: Processed fats that are solid at room temperature
and include partially hydrogenated or hydrogenated vegetable
oils and shortening. These fats are often found in commercial
baked goods.
very low-calorie diet: A weight-loss diet that allows
800 or fewer calories per day (usually followed under
medical supervision).
49
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