Losing Weight Safely

Americans trying to lose weight have plenty of company. According to a 1995 report from the Institute of Medicine (IOM), tens of millions of Americans are dieting at any given time, spending more than $33 billion yearly on weight-reduction products, such as diet foods and drinks.

Yet, studies over the last two decades by the National Center for Health Statistics show that obesity in the United States is actually on the rise. Today, approximately 35 percent of women and 31 percent of men age 20 and older are considered obese, up from approximately 30 percent and 25 percent, respectively, in 1980.

The words obesity and overweight are generally used interchangeably. However, according to the IOM report, their technical meanings are not identical. Overweight refers to an excess of body weight that includes all tissues, such as fat, bone and muscle. Obesity refers specifically to an excess of body fat. It is possible to be overweight without being obese, as in the case of a body builder who has a substantial amount of muscle mass. It is possible to be obese without being overweight, as in the case of a very sedentary person who is within the desirable weight range but who nevertheless has an excess of body fat. However, most overweight people are also obese and vice versa. Men with more than 25 percent and women with more than 30 percent body fat are considered obese.

Many people who diet fail to lose weight--or, if they do lose, fail to maintain the lower weight over the long term. As the IOM report, "Weighing The Options: Criteria for Evaluating Weight-Management Programs," points out, obesity is "a complex, multifactorial disease of appetite regulation and energy metabolism."

Because many factors affect how much or how little food a person eats and how that food is metabolized, or processed, by the body, losing weight is not simple. For example, recent studies suggest a role for genetic makeup in obesity. This area is still controversial, and more studies will be needed before scientists can say with certainty that a person's genes may set limits on how much weight can be lost and maintained.

Yet many people persist in seeking simple cures to this complex health problem. Lured by fad diets or pills that promise a quick and easy path to thinness, they end up disappointed when they regain lost weight.

"When it comes to weight loss, if something sounds too good--or too easy, or too delicious--to be true, it probably is," says Victor Herbert, M.D., J.D., professor of medicine and director of the Nutrition Center at the Mount Sinai School of Medicine and Bronx VA Medical Centers in New York City, and member of the board of directors of the National Council Against Health Fraud. "If a weight loss claim is sensational, it is not true; if it is true, it is not sensational."

"There are no shortcuts--no magic pills," adds Lori Love of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. Losing weight sensibly and safely requires a multifaceted approach that includes setting reasonable weight-loss goals, changing eating habits, and getting adequate exercise. Appetite suppressants (diet pills) or other products may help some people over the short term, but they are not a substitute for adopting healthful eating habits over the long term.

The first step in losing weight safely is to determine a realistic weight goal. The table, at right, developed by the U.S. Department of Agriculture and the Department of Health and Human Services, offers a range of suggested weights for adults based on their height.

A physician, dietitian or nutritionist also can help you set a reasonable goal. To reach the goal safely, plan to lose 1 to 2 pounds weekly by consuming approximately 300 to 500 fewer calories daily than usual (women and inactive men generally need to consume approximately 2,000 calories to maintain weight; men and very active women may consume up to 2,500 calories daily).

After determining a reasonable goal weight, devise an eating plan based on the cornerstones of healthful eating--moderation, variety and balance, suggests Herbert.

"Moderation means not eating too much or too little of any particular food or nutrient; variety means eating as wide a variety as possible from each, and within each, of the five basic food groups; and balance refers to the balance achieved by following moderation and variety, as well as the balance of calories consumed versus calories expended," he explains. To lose weight, fewer calories should be consumed than expended; to maintain weight loss, the number of calories consumed and expended should be about the same.

Because fat is the most concentrated source of calories (9 calories per gram compared to 4 calories per gram for carbohydrate and protein), it is usually the focus of weight-maintenance and weight-loss diets. Limiting fat intake alone will likely limit calories, as well. Just as for the general population, weight-conscious consumers should limit fat intake to no more than 30 percent of total calories, according to the Dietary Guidelines for Americans.

Alcoholic beverages also are a source of calories (7 per gram of alcohol). Twelve ounces of regular beer, for example, provides 150 calories; the same amount of "light" beer, 105 calories. Five ounces of wine or 1.5 ounces of 80-proof distilled spirits provide 100 calories. But alcohol provides few, if any, nutrients, so if you drink alcoholic beverages and want to reduce your weight, consider reducing or eliminating your alcohol intake.

In selecting your diet, follow the five basic food groups and the recommended number of servings from each as incorporated into the Food Guide Pyramid developed by USDA and HHS. These groups are (1) bread, cereal, pasta, and rice; (2) vegetables; (3) fruits; (4) milk, yogurt and cheese; and (5) meat, poultry, fish, dry beans, eggs, and nuts. A sixth group (fats, oils and sweets) consists mainly of items that are pleasing to the palate but high in fat and/or calories; these should be eaten in moderation.

Avoid low-calorie fad diets that exclude whole categories of food such as carbohydrates (bread and pasta) or proteins (meat and poultry). These diets may be harmful because they generally do not include all nutrients necessary for good health. "Every fad diet that demands an unusual eating pattern, such as emphasizing only a few types of foods, deviates from one or more of the guidelines of moderation, variety and balance," says Herbert. "The greater the deviation, the more harmful the diet is likely to be."

To help consumers plan a healthful diet, FDA and USDA have revamped food labels. By law, most food labels now must display a Nutrition Facts panel containing information about how the food can fit into an overall daily diet. Nutrition Facts state how much saturated fat, cholesterol, fiber, and certain nutrients are contained in each serving. Serving sizes must now be based on standards set for similar kinds of food, so the nutritional value of similar products may be compared.

On the food label, %Daily Value shows what percentage of a given nutrient is provided in one portion for daily diets of 2,000 calories.

Whether or not a given food fits into a weight-loss diet depends on what other foods you eat that day. For most people, the goal is to select a variety of foods that together add up to approximately 100 percent of the Daily Value for total carbohydrate, dietary fiber, vitamins, and minerals; total fat, cholesterol and sodium each may add up to less than 100 percent.

This system permits a good deal of flexibility. No food is inherently "bad"; it is the total diet for the day that counts. You may compensate fo

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