Take it off

New weight loss recommendations clarify what works and why when it comes to achieving a healthy weight

Many people think shedding a few pounds is simple: Change your diet and exercise habits for a while and the weight comes off. But if reaching and maintaining a healthy weight is so simple, why are nearly 69 percent of Americans age 20 and older overweight or obese?

According to the American Heart Association, being overweight or obese makes you more likely to develop conditions that are risk factors for heart disease and stroke, including high blood pressure and high total cholesterol. You are also at greater risk of developing diabetes.

With numbers like these, Michael Jensen, M.D., professor in the Endocrine Research Unit at the Mayo Clinic in Rochester, Minn., says it’s time to consider an unpleasant truth: When it comes to losing weight, we may not know as much as we think we do. "People come in and tell me ‘I know what to do and I’m just not doing it,’ but often they really don’t know what to do," he says. "And many patients who claim to know are actually doing the wrong things. Even with all the public interest in weight loss, there’s still a lot of misinformation out there. It’s a rare person who really knows what to do, is doing it and is still not able to lose weight."

That’s why the National Heart, Lung and Blood Institute, part of the National Institutes of Health, sponsored a task force of leading experts to help primary care providers help patients—that’s most of us, America!—to lose weight and keep it off. The American College of Cardiology/American Heart Association/Obesity Society Guideline, issued in late 2013, evaluated the evidence from dozens of studies. The guideline provides authoritative information to counteract the flood of popular support for fad diets, bogus supplements and quick weight-loss schemes.

Jensen, co-author of the new obesity guideline, says that obesity science has advanced tremendously, and that’s good news for patients. "Over the last 20 years, the science of behavioral change, which is at the heart of weight loss, has become much more rigorous and systematic," he says. "We’re continuously refining our theories to the point where we’re getting good, reproducible results, and that’s what we wanted to highlight in the guideline." Here are some of the findings that had the strongest scientific support.



According to Jensen, the finding that most resonates with patients is that there is no one diet that is superior to others in terms of weight management. "We reviewed all the papers side-by-side and, in the long run, it’s what you can stick with and what works for you," he says, noting that the task force reviewed 17 different weight loss diets. "There isn’t any magic bullet out there."

Nehal Mehta, M.D., M.S.C.E, F.A.H.A., chief of the section of inflammation and cardiometabolic diseases at the National Heart, Lung and Blood Institute, still hears people talk about favoring overly specific ways of eating. "When I hear patients talk about low-carb or low-fat diets, I encourage them to rephrase their outlook as ‘the moderate intake of all food groups’," he says. "The science just doesn’t justify eliminating or severely restricting entire food groups."

But you do need to reduce the number of calories you eat in order to lose weight. "The new guideline shows you can lose weight in different ways as long as you eat fewer calories," says Kristie J. Lancaster, Ph.D., R.D., associate professor of nutrition at New York University in New York City. "We now have scientific proof that not every way of eating works for every person. If one way of eating doesn’t work for you, try another until you succeed."

For tips on finding healthy foods at the grocery store that can help you lose weight, see Shop Right for Weight-Loss Success.



Thanks to a relentless diet of The Biggest Loser and too-good-to-be-true testimonials for weight-loss supplements and fad diets, many people believe that losing a quarter or even a third of their body weight is a realistic goal. In most cases, it’s not, and certainly not in a short amount of time, Jensen says.

Both physicians and patients need to understand that "even modest weight loss can result in clinically meaningful health improvements," says Donna Ryan, M.D., co-author of the new obesity guideline and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge. "Most studies [we reviewed] recommended a goal of weight loss of 5 to 10 percent," but health improvements can be seen even with weight loss in the range of 2 to 5 percent of body weight, she adds.

Jensen often finds himself encouraging patients who have successfully lost weight but also harbor unrealistic expectations. "Say they’ve lost 10 percent of their body weight and reached a plateau, yet they think they’re a failure even though their health is almost certainly better," he says. "I ask them if they’re sleeping better, if they have more energy, if they’re able to play with their kids more, if they’re taking fewer pills. At a 10 percent loss, those answers are going to be yes, but people often get the message from society, friends and even family members: You’re still too fat."

That’s why eating less and exercising more are only two parts of the most effective weight loss programs. According to the guideline, the best results come from adding a third element: behavioral counseling from a qualified therapist. "That’s because most people really do need help with losing weight," Lancaster says. "They need to learn what to do, go out and practice, come back and get help doing it all over again."



If that sounds like a lot of work, it is. According to the guideline, the most effective way for people to lose weight is to participate in a face-to-face, intensive lifestyle intervention program that offers advice on how to increase physical activity and eat fewer calories. "Ideally, that program will be led by a healthcare provider and it will last at least 6 to 12 months, or else the results won’t be as good," Jensen says. "Changing behavior is hard and people do much better when they have ongoing support."

In cognitive therapy, patients learn to recognize their personal overeating triggers and self-defeating thought patterns, and to replace them with more positive thoughts and actions. "You learn to recognize things in your environment that trigger overeating—like the cookie plate at the office—and strategize about ways to change the things you can, and cope with things you can’t," Jensen says. "You don’t want to rely on willpower 24 hours a day, and it takes time to come up with good solutions that will work consistently for you."

Mehta, who also sees patients at the Hospital of the University of Pennsylvania in Philadelphia, sees time as a significant factor in whether his patients are successful in their weight loss attempts. He puts a slightly different spin on it, though. In his opinion, his patients’ biggest problem with weight loss is that they don’t make enough time to exercise. "Exercise is a prioritization issue," he says. "When people get busy, they don’t say ‘I’m not going to go to work today.’ One of the first things they cut back on is going to the gym. People don’t cut going out with friends or hanging out with family. Instead, exercise is always what gets shortchanged, even though it is just as important as everything else in their lives."

Lancaster offers still another perspective on time and weight loss, noting that patients often get impatient at the slow pace of progress. "Everyone wants their bodies to change right now but it’s important to be realistic," she says. "You didn’t put on those pounds in a few weeks, so they’re not coming off in that amount of time, either. If your clothes aren’t fitting differently after a few months of careful eating and exercise, try a different way of eating until you find one that works. This process can take many months, so don’t give up."


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