Losing Weight: Start By Counting Calories
Americans are getting fatter. We're putting
on the pounds at an alarmingly rapid rate. And we're sacrificing
our health for the sake of super-sized portions, biggie
drinks, and two-for-one value meals, obesity researchers say.
More than 60 percent of U.S. adults are overweight,
according to the Centers for Disease Control and Prevention
(CDC). And about 15 percent of children and adolescents
ages 6 to 19 are overweight.
Poor diet and physical inactivity account
for more than 400,000 premature deaths each year in the
United States, second only to deaths related to smoking,
says the CDC. People who are overweight or obese are more
likely to develop heart disease, stroke, high blood pressure,
diabetes, gallbladder disease, and joint pain caused by
excess uric acid (gout). Excess weight can also cause interrupted
breathing during sleep (sleep apnea) and wearing away of
the joints (osteoarthritis). Carrying extra weight means
carrying an extra risk for certain types of cancer, including
endometrial, breast, prostate, and colon cancer.
But there is hope for overweight Americans.
They can take small, achievable steps to improve their health
and reverse the obesity epidemic. This message is the cornerstone
of a national education campaign announced in March 2004
by the Department of Health and Human Services (HHS).
As part of HHS' renewed efforts to combat
obesity, the Food and Drug Administration's Obesity Working
Group released its Calories Count report in March 2004,
highlighting actions that the agency will work toward to
help consumers make smart choices about their diet. These
actions include strengthening food labeling, educating consumers
about maintaining a healthy diet and weight, and encouraging
restaurants to provide calorie and nutrition information.
Also included are increased enforcement to ensure food labels
accurately portray serving size and strengthened scientific
research aimed at reducing obesity and developing foods
that are healthier and lower in calories.
Are You Overweight?
Overweight refers to an excess of body weight,
but not necessarily body fat. Obesity means an excessively
high proportion of body fat. Health professionals use a
measurement called body mass index (BMI) to classify an
adult's weight as healthy, overweight, or obese. BMI describes
body weight relative to height and is correlated with total
body fat content in most adults.
To get your approximate BMI, multiply your
weight in pounds by 703, then divide the result by your
height in inches, and divide that result by your height
in inches a second time.
A BMI from 18.5 up to 25 is considered in
the healthy range, from 25 up to 30 is overweight, and 30
or higher is obese. Generally, the higher a person's BMI,
the greater the risk for health problems, according to the
National Heart, Lung and Blood Institute (NHLBI). However,
there are some exceptions. For example, very muscular people,
like body builders, may have a BMI greater than 25 or even
30, but this reflects increased muscle rather than fat.
"It is excess body fat that leads to the health problems
such as type 2 diabetes, high blood pressure, and high cholesterol,"
says Eric Colman, M.D., of the FDA's Division of Metabolic
and Endocrine Drug Products.
In addition to a high BMI, having excess abdominal
body fat is a health risk. Men with a waist of more than
40 inches around and women with a waist of 35 inches or
more are at risk for health problems.
Obesity, once thought by many to be a moral
failing, is now often classified as a disease. The NHLBI
calls it a complex chronic disease involving social, behavioral,
cultural, physiological, metabolic, and genetic factors.
Although experts may have different theories on how and
why people become overweight, they generally agree that
the key to losing weight is a simple message: Eat less and
move more. Your body needs to burn more calories than you take in.
The
BMI ranges shown at left are for adults. They are not exact
ranges of healthy and unhealthy weights. However, they show
that health risk increases at higher levels of overweight
and obesity. Even within the healthy BMI range, weight gains
can carry health risks for adults.
Directions: Find your weight
on the bottom of the graph. Go straight up from that point
until you come to the line that matches your height. Then
look to find your weight group.
Healthy Weight: BMI from
18.5 up to 25 refers to healthy weight.
Overweight: BMI from 25 up
to 30 refers to overweight.
Obese: BMI 30 or higher refers
to obesity. Obese persons are also overweight.
Successful 'Losers'
Although many people who lose weight may eventually
gain it back, it's a myth that this happens to everyone,
says Rena Wing, Ph.D., a professor of psychiatry at Brown
Medical School in Providence, R.I. Wing, the co-developer
of a research study known as the National Weight Control
Registry, has worked to deflate this myth.
Tucked away in the registry's database is
information about the weight-control behaviors of more than
3,000 American adults who have lost an average of 60 pounds
and have kept it off for an average of six years.
How do they do it?
These successful weight losers report four
common behaviors, says Wing. They eat a low-calorie, low-fat
diet, they monitor themselves by weighing in frequently,
they are very physically active, and they eat breakfast.
Eating breakfast every day is contrary to the typical pattern
for the average overweight person who is trying to diet,
says Wing. "They get up in the morning and say 'I'm
going to start my diet today,' and they eat little or no
breakfast and a light lunch. Then they get hungry and consume
most of their calories late in the day. Successful weight
losers have managed to change this pattern."
Six years after their weight loss, most of
the registry's successful losers still report eating a low-calorie,
low-fat diet. They also exercise for about an hour or more
a day, expending about 2,800 calories per week on a variety
of activities.
Wing also reports that more than 70 percent
of the registry's weight losers became overweight before
age 18.
Although Barbara Croft of Columbus, Ohio,
was not an overweight child, she gained weight once she
left home and started cooking for herself. Replacing the
plain and simple meals she had as a child with pizza, sodas,
and meat and vegetables laden with sauces, the 5-foot-5-inch
Croft worked her way up to 350 pounds. "I always ate
from all the food groups--I just ate huge portions and I
ate in between meals," says Croft.
When she was diagnosed with type 2 diabetes
in February 1999, Croft got scared. "I worried about
the health consequences--about going blind. I already have
a little numbness in my feet."
Croft went on a diet and lost 200 pounds in
19 months. She has continued to keep it off for more than
three years. "This is the third time I've lost over
100 pounds," says the 52-year-old, 150-pound Croft,
"but this is the longest I've been able to keep the
weight off." In her two previous weight losses, Croft
ate nutritious meals, but didn't exercise. This time, she
started walking for exercise, but could only walk about
a block at first. "My husband went with me because
he was afraid I wouldn't make it," she says. Now, Croft
walks on a treadmill for 50 minutes a day--25 minutes each
morning and night.
She still eats balanced meals, but restricts
her portions. And she always eats breakfast. "I have
Egg Beaters, two pieces of low-calorie bread, fruit, decaf
coffee, and 8 ounces of water." Croft dines out almost
every night, typically eating half her dinner of grilled
chicken or salmon and a vegetable or salad. She sends the
other half back so she isn't tempted to overeat.
"Losing the weight was easy--maintaining
it is much harder," says Croft.
Croft had tried commercial weight-loss programs
in the past, but this last time she did it on her own. "You
have to find out what works for you," she says.
Croft's diabetes is under control now without
medication. And she says her knees don't hurt anymore, she
can buy clothes in a regular store, and she started traveling
again now that she can fit into an airplane seat.
Setting a Goal
The first step to weight loss is setting a
realistic goal. By using a BMI chart and consulting with
your health care provider, you can determine what is a healthy
weight for you.
Studies show that you can improve your health
with just a small amount of weight loss. "We know that
physical activity in combination with reduced calorie consumption
can lead to the 5 to 10 percent weight loss necessary to
achieve remission of the obesity-associated complications,"
says William Dietz, M.D., Ph.D., director of the Division
of Nutrition and Physical Activity at the CDC. "Even
these moderate weight losses can improve blood pressure
and help control diabetes and high cholesterol in obese
or overweight adults."
To reach your goal safely, plan to lose weight
gradually. A weight loss of one-half to two pounds a week
is usually safe, according to the Dietary Guidelines for
Americans 2000. This can be achieved by decreasing the calories
eaten or increasing the calories used by 250 to 1,000 calories
per day, depending on current calorie intake. (Some people
with serious health problems due to obesity may lose weight
more rapidly under a doctor's supervision.) If you plan
to lose more than 15 to 20 pounds, have any health problems,
or take medication on a regular basis, see your health care
professional before you begin a weight-loss program.
Changing Eating Habits
Dieting may conjure up visions of eating little
but lettuce and sprouts--but you can enjoy all foods as
part of a healthy diet as long as you don't overdo it. To
be successful at losing weight, you need to change your
lifestyle--not just go on a diet, experts say. This requires
cutting back on the number of calories you eat by eating
smaller amounts of foods and choosing foods lower in calories.
It also means being more physically active.
Consider limiting portion sizes, especially
of foods high in calories, such as cookies, cakes and other
sweets; fried foods, like fried chicken and french fries;
and fats, oils, and spreads. Reducing dietary fat alone--without
reducing calories--will not produce weight loss, according
to the NHLBI's guidelines on treating overweight and obesity
in adults.
Use the Food Guide Pyramid developed by the
U.S. Department of Agriculture and HHS to help you choose
a healthful assortment of foods. Include bright-colored
(red, yellow, green, and orange) vegetables and fruits,
grains (especially whole grains), low-fat or fat-free milk,
and fish, lean meat, poultry, or beans. Choose foods naturally
high in fiber, such as fruits, vegetables, legumes (such
as beans and lentils), and whole grains. The high fiber
content of many of these foods may help you to feel full
with fewer calories. To be sure that a food is whole grain,
check the ingredient list on the food label--the first ingredient
should be whole wheat or whole grain.
All calorie sources are not created equal.
Carbohydrate and protein have about four calories per gram,
but all fats, including oils like olive and canola oil,
have more than twice that amount (nine calories per gram).
Keep your intake of saturated fat, trans fat,
and cholesterol as low as possible. All of these fats raise
LDL (or "bad
cholesterol"), which increases your risk
for coronary heart disease. Foods high in saturated fats
include high-fat dairy products (like cheese, whole milk,
cream, butter, and regular ice cream), fatty fresh and processed
meats, the skin and fat of poultry, lard, palm oil, and
coconut oil. Trans fat can often be found in processed foods
made with partially hydrogenated vegetable oils such as
vegetable shortenings, some margarines (for example, stick
margarines that are hard), crackers, cookies, candies, snack
foods, fried foods and baked goods.
If you drink alcoholic beverages, do so in
moderation (no more than one drink a day for women, and
no more than two drinks a day for men). Alcoholic beverages
supply calories but few nutrients. A 12-ounce regular beer
contains about 150 calories, a 5-ounce glass of wine about
100 calories, and 1.5 ounces of 80-proof distilled spirits
about 100 calories.
Limit your use of beverages and foods that
are high in added sugars--those added to foods in processing
or preparation, not the naturally occurring sugars in foods
such as fruit or milk. Foods high in added sugars provide
calories, but may have few of the other beneficial nutrients,
such as fiber, vitamins, and minerals, that your body needs.
A food high in added sugars will list a sugar as the first
or second ingredient on the ingredient list. Some examples
of added sugars are corn syrup, high fructose corn syrup,
maltose, dextrose, honey, fruit juice concentrates, and
maple syrup. In the United States, foods high in added sugars
include non-diet soft drinks, sweetened beverages, including
teas, fruit drinks, and fruitades, sweets and candies, and
cakes and cookies.
Using the Food Label
Under regulations from the FDA and the U.
S. Department of Agriculture, the food label, found on almost
all processed foods, offers more complete, useful and accurate
nutrition information than ever before. Even when restricting
calories and portions, you should use the Nutrition Facts
panel on the food label to make sure you get all the essential
nutrients for good health.
When concerned about reducing calories or
controlling your weight, one of the first places you should
look on the Nutrition Facts panel is the serving size and
the number of servings per package, which are listed at
the top. The serving size affects the calories, the amounts
of each nutrient, and the percent Daily Values (%DV) for
the nutrients listed on the panel.
"To be sure you know how many calories
you're consuming, you need to compare what you are actually
eating to the serving size on the label," says Naomi
Kulakow, coordinator for education and outreach in the FDA's
Center for Food Safety and Applied Nutrition. For example,
if there is one cup in a serving and the package contains
two servings, you need to double the calories and other
nutrient numbers if you eat the whole package. Many items
sold as single portions--like a 20-ounce soft drink, a 3-ounce
bag of chips, and a large bagel--actually provide two or
more servings.
In addition to calories and serving sizes,
there are other parts of the Nutrition Facts panel, such
as the list of nutrients, that can help you make healthy
food choices while you lose weight. The nutrients listed
first are the ones that some people eat more of than they
need. Eating too much fat, saturated fat, trans fat, cholesterol,
or sodium may increase your risk for chronic diseases like
heart disease, diabetes, some cancers, or high blood pressure.
"These are nutrients you should try to limit in your
diet," says Kulakow. "The goal is to stay below
100 percent of the Daily Value for each of them for the
day."
The Nutrition Facts panel also shows how much
dietary fiber, vitamin A, vitamin C, calcium, and iron are
contained in a serving. These are the nutrients you want
to get at least 100 percent of the Daily Value every day
for good health.
The %DV is the quickest way to determine how
a serving of food fits in with recommendations for a healthful
diet, says Kulakow. To tell if a food is high or low in
a nutrient, "just glance at the %DV--5 percent of the
Daily Value or less is low, and 20 percent or more is high,"
she says.
You can also use the %DV to compare similar
products or to help you balance food choices throughout
the day. "For example, if you eat a favorite food that's
high in fat at one meal, balance it with low-fat foods at
other times of the day," says Kulakow. Or use the %DV
when comparing foods and claims, for example, to find out
which frozen dinner is lower in saturated fat--particularly
when it involves a comparative nutrient claim, such as reduced-fat.
"You don't need to know the precise definition of 'low'
or 'reduced,'" says Kulakow. "Just look at the
Percent Daily Value and see which product is higher or lower
in the nutrient you are interested in."
The %DVs are based on a 2,000-calorie daily
diet. But even if you eat more or less than 2,000 calories,
the %DV still gives you a frame of reference to gauge your
calorie and nutrient intake.
"Too often, people use the food label
only when they want to restrict calories and fat--but not
as a tool to help them increase the nutrients they need
to get in adequate or greater amounts," says Kulakow.
While restricting calories is important for weight loss,
getting adequate amounts of fiber, calcium, and other key
nutrients is also critical to good health.
Kulakow advises caution when choosing foods
that are labeled "fat-free" and "low-fat."
Fat-free doesn't mean calorie-free. To make a food tastier,
sometimes extra sugars are added, which adds calories. So
dieters should always check the Nutrition Facts panel to
get complete information, says Kulakow.
Increasing Physical Activity
Most health experts recommend a combination
of a reduced-calorie diet and increased physical activity
for weight loss.
In addition to helping to control weight,
physical activity decreases the risk of dying from coronary
heart disease and reduces the risk of developing diabetes,
hypertension, and certain cancers. Researchers also have
found that daily physical activity may help a person lose
weight by partially lessening the slow-down in metabolism
that occurs during weight loss.
Exercise does not have to be strenuous to
be beneficial. And some studies show that short sessions
of exercise several times a day are just as effective at
burning calories and improving health as one long session.
To lose weight and to maintain a healthy weight
after weight loss, many adults will likely need to do more
than 30 minutes of moderate to intensive physical activity
daily.
Prescription Weight-Loss Drugs
For obese people who have difficulty losing
weight through diet and exercise alone, there are a number
of FDA-approved prescription drugs that may help. "On
average, individuals who use weight-loss drugs lose about
5 percent to 10 percent of their original weight, though
some will lose less and some more," says the FDA's
Colman.
All of the prescription weight-loss drugs
work by suppressing the appetite except for Xenical (orlistat).
Approved by the FDA in 1999, Xenical is the first in a new
class of anti-obesity drugs known as lipase inhibitors.
Lipase is the enzyme that breaks down dietary fat for use
by the body. Xenical interferes with lipase function, decreasing
dietary fat absorption by 30 percent. Because the undigested
fats are not absorbed, fewer calories are available to the
body. This may help in controlling weight. The main side
effects of Xenical are cramping, diarrhea, flatulence, intestinal
discomfort, and leakage of oily stool.
Meridia (sibutramine), approved by the FDA
in 1997, increases the levels of certain brain chemicals
that help reduce appetite. Because it may increase blood
pressure and heart rate, Meridia should not be used by people
with uncontrolled high blood pressure, a history of heart
disease, congestive heart failure, irregular heartbeat,
or stroke. Other common side effects of Meridia include
headache, dry mouth, constipation and insomnia.
Other anti-obesity prescription drugs that
were approved by the FDA many years ago based on very short-term,
limited data include: Bontril (phendimetrazine tartrate),
Desoxyn (methamphetamine) and Ionamin and Adipex-P (phentermine).
They are "speed"-like drugs that should not be
used by people with heart disease, high blood pressure,
an overactive thyroid gland, or glaucoma. These drugs are
approved only for short-term use, such as a few weeks.
"There is no magic pill for obesity,"
says David Orloff, M.D., director of the FDA's Division
of Metabolic and Endocrine Drug Products. "The best
effect you're going to get is with a concerted long-term
regimen of diet and exercise. If you choose to take a drug
along with this effort, it may provide additional help."
Prescription weight-loss drugs are approved
only for those with a BMI of 30 and above, or 27 and above
if they have other risk factors, such as high blood pressure
or diabetes.
People should contact a doctor before using
any kind of drug, including a weight-loss drug.
Over-the-Counter Drugs
Until recently, weight-control drugs containing
the active ingredient phenylpropanolamine (also used as
a nasal decongestant) were available over-the-counter (OTC).
However, based on evidence linking this ingredient to an
increased risk of bleeding in the brain (hemorrhagic stroke),
the FDA asked drug manufacturers to discontinue marketing
products containing phenylpropanolamine. In addition, the
FDA issued a public health advisory in November 2000, warning
consumers to stop using products containing this ingredient.
The FDA is proposing to classify phenylpropanolamine
as "not generally recognized as safe" and is proceeding
with regulatory actions that will likely remove this ingredient
from the market. Although cough-cold products were reformulated
using other nasal decongestant ingredients, there is no
currently available active ingredient that is generally
recognized as safe and effective for use in an OTC weight-control
drug product.
Beware of Unproven Claims
Some dietary supplement makers claim their
products work for weight loss. These products are not approved
by the FDA before they are marketed. Under existing laws,
manufacturers have the responsibility for ensuring that
their dietary supplement products are safe and effective.
Many weight-loss products claim to be "natural"
or "herbal," but this does not necessarily mean
that they're safe. These ingredients may interact with drugs
or may be dangerous for people with certain medical conditions.
If you are unsure about a product's claims or the safety
of any weight-loss product, check with your doctor before
using it.
Worth the Effort
"Losing weight requires major lifestyle
changes, including diet and nutrition, exercise, behavior
modification, and--when appropriate--intervention with drug
therapy," says Judith S. Stern, Sc.D., professor of
nutrition and internal medicine at the University of California,
Davis, and vice president of the American Obesity Association.
"But it is always worth making the effort to improve
your health."
Linda Bren is a staff writer for FDA Consumer.
Avoid 'Fad' Diets
The cabbage soup diet, the low-carbohydrate
and high-protein diet, and other so-called "fad"
diets are fundamentally different from federal nutrition
dietary guidelines and are not recommended for losing weight.
Fad diets usually overemphasize one particular
food or type of food, contradicting the guidelines for good
nutrition, which recommend eating a variety of foods from
the Food Guide Pyramid. These diets may work at first because
they cut calories, but they rarely have a permanent effect.
A high-protein diet is one fad diet that has
remained popular over the years. "High-protein items
may also be high in fat," says Robert Eckel, M.D.,
professor of medicine at the University of Colorado Health
Sciences Center in Denver. High-fat diets can raise blood
cholesterol levels, which increases a person's risk for
heart disease and certain cancers.
High-protein diets force the kidneys to try
to get rid of the excess waste products of protein and fat,
called ketones. A buildup of ketones in the blood (called
ketosis) can cause the body to produce high levels of uric
acid, which is a risk factor for gout (a painful swelling
of the joints) and kidney stones. Ketosis can be especially
risky for people with diabetes because it can speed the
progression of diabetic renal disease, says Eckel.
"It's important for the public to understand
that no scientific evidence supports the claim that high-protein
diets enable people to maintain their initial weight loss,"
says Eckel. "In general, quick weight-loss diets don't
work for most people."
Tips for Eating Out
- Ask for nutrition information (for example, calories,
saturated fat, and sodium) before you order when eating
out.
- Choose foods that are steamed, broiled, baked, roasted,
poached, or stir-fried, but not deep-fat fried.
- Share food, such as a main dish or dessert, with your
dining partner.
- Take part of the food home with you and refrigerate
immediately. You may want to ask for a take-home container
when the meal arrives. Spoon half the meal into it,
so you're more likely to eat only what's left on your
plate.
- Request your meal to be served without gravy, sauces,
butter or margarine.
- Ask for salad dressing on the side, and use only small
amounts of full-fat dressings.
