Weight Control

I have some useful things to say about controlling body weight. I have been treating patients with weight problems in my medical practice for over thirty years. In addition, even before my medical training, I was trained in nutrition science and conducted nutrition research studies. With this background, I can give you reliable guidance to effectively evaluate the enormous amount of misinformation currently being published about how to manage excessive body weight. This short summary will focus on what is most important for you to know, as well as strategies that are readily available to help you with this problem.

Realistic goals are absolutely essential to your success

There are two things you must understand if you to have long-lasting success. The first is that rapid weight loss strategies will cause almost everyone who tries them to eventually fail, since their body will prevent them from continuing to lose weight rapidly since rapid weight loss impairs essential body functions. The second is that for almost everyone who is overweight, the tendency to gain too much body fat is a life-long problem. Long term success requires an approach that can comfortably become a part of their lifestyle.

Unfortunately, it is quite common for people to engage in strategies for weight loss that cause rapid decreases in body weight, fail to continue them, and to then gain even more weight than they lost. When this happens repeatedly, it has been called the “yo-yo” dieting syndrome. Short-term, rapid weight loss programs not only don’t work, if you repeatedly use them, they can even damage your health.

Several decades of treating people with weight control problems have given me a pretty reliable idea of what rate of weight loss is sustainable. If someone is within about 50 pounds of their most healthy weight, they can usually lose about 2 pounds a month and keep it going until they reach their target. If they are above this to start, they can probably successfully lose 3 to 4 pounds per month and keep it going. Much faster than this just doesn’t work for 99% of those who try it.

Healthy food guidelines, simplified

For the most part, special diets, calorie counting and popular food fads just do not work. Part of the reason is that they are just too difficult and too much work to be life-long food control strategies. Another part of the reason they fail is that they are usually not very satisfying. What is needed is a way of eating that you can continue for the rest of your life and that will support a healthy body. Then you must stick with it long enough to re-train your body to enjoy healthy fod and unlearn bad habits. I give my patients a few simple rules:

1. If you are not truly hungry — don’t eat.

2. If you are hungry, eat enough to keep youself reasonably satisfied until your next meal.

3. Whether you eat meals or snacks, only eat healthy food.

It is the “only eat healthy food” that is the most difficult part of this for most people who struggle with weight gain, especially in the first few months of making these changes. This may mean avoiding situations where unhealthy food choices are readily available. What follows is a set of directions that will move you toward good food choices. I will list the most important first, (based on my experience with what is most likely to undercut the efforts of the people I treat):

1. Avoid sugars in drinks such as sweet tea, sodas and fruit juice.

2. Avoid red meats and other foods high in animal fat. Substitute fish, fowl or lean cuts of meat.

3. Avoid refined grains and snacks high in sugar or fat.

I say move toward these the food choices since it may take a number of months to several years to re-train your taste buds to be satisfied with a healthier way of eating. If you have very unhealthy food habits, trying to change everything all at once rarely works. Focus on the most important changes first, then added other improvements later.

It is also important to be aware that not only will these food choices help control body weight, we also know that adopting them will help prevent heart attackes, strokes, diabetes, dementia, and a long list of other chronic medical problems. This is true even if a more healthy way of eating fails to control body weight.

Exercise will not counteract poor food choices

There is no doubt that a sedentary life style promotes weight gain, but even a very vigorous exercise program will not allow you you to make poor food choices and still control your weight. Unfortunately, exercise does not burn as much excess food calories as most people think. Since a certain amount of physical activity is needed for your appetite to function properly in controlling your body fat stores, a sedentary lifestyle, by itself, can be a cause of overweight.

Weight loss medications can be sometimes be very helpful, if used effectively

Weight loss medications are almost always a waste of time and money if you do not continue to follow reasonable guidelines for diet and exercise as you begin to use them. Furthermore, even a medication regimen that is working well will be nearly useless for long term weight control if not continued for long enough. This may mean several years or even longer. It takes the expertise and assistance of a clinician with a lot of experience with these medications to use them well.

What causes weight control problems in the first place?

Most people assume that if someone is overweight, it is because of a lack of self control. Based on my experience of having treated many thousands of patients with this problem, it is reltively rare that it is only due to a lack of concern or a lack of effort on their part. For most people struggling with their weight, both eliminating the medical causes of overweight and following healthy food selection and exercise recommendations are not enough to stop the tendency toward continued weight gain. If this was all there was to it, hardly anyone would be overweight.

To give at least a partial answer to the question of what actually causes most weight control problems, I will provide a list of the different outcomes my patients have had over the last three decades or so under my care. This list will include an approximation of how many fall into each category. Please note that only those patients that followed up with me long enough to effectively use all currently effective treatment strategies are included (but this includes just about everyone I have treated).:

5% — Weight control problems that were due to medical problems like hypothyroidism or weight gain as a side effect of a chronic medication. Once the probem was eliminated, the weight problem completely resolved.

5% — Weight gain that was found to be due to a previosly unrecognized or poorly controlled depression. Once the depression was successfully treated, their weight returned to normal.

12% — Patients who just needed knowledgable guidance about diet and exercise. These individuals lost their excessive body fat and kept it off by following good advice and changing poor food habits.

35% — Patients for whom diet and exercise alone were not effective in controlling thier body weight, but who have been very successful after one or more weight loss medications were added to their treatment. These medications usually have needed to be continued to keep the problem from returning.

The remainder (about 40%) — People who have done everything they could do with a well-designed diet and exercise approach, and for whom none of the available weight control medications were effective in stopping weight gain. While their overweight problem was not completely controlled, almost all have been gaining significantly less weight than if they were not being treated.

When I consider this list, it is obvious to me that there is something else going on that is causing so many people to struggle with their weight, even while they are carefully following a well designed food plan and exercise routine. One clue to what else might explain it is that many people overeat when under stress. Another clue is that many medical problems like high blood pressure, diabetes and abnormal cholesterol often cluster together in the same individuals. Looking carefully at the research in this area suggests that there may be one or more causal factors resulting in all these problems. That is, it is likely that the same factors that cause weight control problems are also responsible for chronic medical conditions like hypertension and diabetes.

Although the evidence is limited since there are as yet relatively few research studies evaluating treatments based on these insights, certain new treatment strategies show promise in helping the large number of people for whom food modifications and adequate exercise are not enough to control their body weight. Some of these include controlled breathing sessions, heart rate variability biofeedback, and mindfulness meditation. These and other promising strategies are discussed in other articles on this website, particularly in the Scientific Support for New Testament Teachings series.

This has been a relatively brief introduction to a very complex medical problem. If you are very interested in this topic and would like a much more in-depth education about this topic, the following link will take you to a booklet I wrote a few years back: Weight Control Handbook