Losing Weight: Start By Counting Calories

By Linda Bren

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. (Or you can use the interactive BMI calculator at www.nhlbisupport.com/bmi/bmicalc.htm.)

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 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.

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.

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