Nutrition and Weight Control - Weight reduction
The treatment of obesity is a complicated problem. In the first place, there is the question of who wants or needs to be treated and how much weight should be lost. Except in unusual situations, anyone who wants to lose weight should be encouraged to do so. Possible exceptions are teenagers who are not overweight but who want to be as thin as they can possibly be—the boy who is involved in an athletic event such as wrestling, or the girl who has decided she wants to look like a fashion model.
Crash dieting is usually unwise if the goal is to lose too much weight too rapidly and should be undertaken only after consulting a doctor about its advisability. As for adolescents who have become slightly overweight during puberty, they may be ill-advised to try to take off the extra pounds that probably relate to a temporary growth pattern.
Losing Weight Must Be Self-Motivated
Unless there are compelling medical reasons for not doing so, anyone weighing 20 percent or more over the normal limit for his age and body build should be helped to slim down. It is extremely important, however, for the motivation to come from the person himself rather than from outside pressure.
Unless an overweight person really wants to reduce, he will not succeed in doing so, certainly not permanently, even though he appears to be trying. He must have convinced himself—intellectually and emotionally—that the goal of weight loss is truly worth the effort.
It is very difficult not only for his friends and family but for the person himself to be absolutely sure about the depth of his motivation. A physician treating an overweight patient has to assume that the desire to reduce is genuine and will try to reinforce it whenever he can. However, if a patient has made a number of attempts to lose weight over a period of years and has either been unable to reduce to any significant degree, or has become overweight again after reducing, it is probably safe to assume that the emotional desire is absent, or that there are emotional conflicts that stand in the way.
It is very possible that such a person could be harmed psychologically by losing weight, since he might need to be overweight for some deep-seated reason. This can be true for both children and adults. Occasionally it is possible for a psychiatrist or psychologist to help the patient remove a psychological block against losing weight, after which weight reduction can occur if the caloric balance is straightened out.
Effective Planning for Weight Loss
The ultimate key to successful weight reduction is proper eating combined with proper physical activity. This balance is extremely difficult for many people to achieve because it involves a marked change in attitudes and behavior patterns that are generally solidly established and of long duration. Furthermore, once the changes are made, they will have to endure for a lifetime if the weight that has been lost is not to be regained.
It is therefore important that the reducing diet should be somewhat similar to the person's usual eating pattern in terms of style and quality. Intake of fat and calories should be reduced and that of fiber increased, and probably the word “dieting” should not be used to describe the process, since most people don't find the idea of permanent dieting congenial.
Similarly, the increased physical activity that must accompany the new eating style should be of a type that the person enjoys. It is virtually impossible for an overeating person to reduce merely by restricting his caloric intake, or merely by increasing his caloric expenditure. The two must go together.
Cutting Down Step by Step
The first thing to determine when planning to lose weight is the number of pounds that have to go. A realistic goal to set is the loss of about one pound a week. This may seem too slow, but remember that at this rate, fifty pounds can be lost in a year.
Start by weighing yourself on arising, and then for two weeks try to eat in your customary manner, but keep a careful record of everything that you eat, the time it is eaten, and the number of calories it contains. During this period, continue to do your usual amount of physical activity.
When the two weeks are over, weigh yourself again at the same time of day as before. If you haven't gained any weight, you are in a basal caloric state. Then check over your food list to see what might be eliminated each day without causing discomfort.
Pay attention to portion size and try to think in terms of eliminating fats and simple carbohydrates first, because it is essential that you continue to get sufficient vitamins and minerals which are largely found in proteins, complex carbohydrates, fruits, and vegetables. The foods described in the “Food Guide Pyramid” should all continue to be included in your daily food consumption. If you are in the habit of having an occasional drink, remember that there are calories in alcohol but no nutrients, and that most alcoholic beverages stimulate the appetite.
When you replan your meals, keep in mind that the items you cut down on must add up to between 300 and 400 calories a day if you are going to lose one pound a week.
Your total daily food intake should be divided among at least three meals a day—more, if you wish. If you need to eat more food or to eat more often, try snacking on low-calorie foods such as cabbage, carrots, celery, cucumber, and cauliflower. All of these can be eaten raw between meals.
It is a good idea to have breakfast every morning, or at least most mornings. This may be psychologically difficult, but try to do it, because it will be easier to control your urge to eat too much later in the day.
At the same time that you begin to cut down on your food intake, start to increase your daily exercise in whatever way you find congenial so that the number of calories expended in increased exercise plus the number of calories eliminated from your diet comes to 500 or more. This is your daily caloric loss compared with your so-called basal caloric state.
Achieving Your Goal
You may wish to double your daily caloric loss so that you lose two pounds a week. Do not try to lose any more than that unless you are under close medical supervision. If you gained weight during your two-week experimental period, you will have to increase your daily caloric loss by 500 for every pound gained per week. Thus, if you gained one pound during the two weeks, you will have to step up your daily caloric loss to 750 to lose a pound a week.
You'll have to keep plugging away to achieve your goal. It will be trying and difficult in many ways. You may get discouraged and be tempted to quit. Don't. You'll probably stray from your eating plan. All this is natural and understandable, so just do the best you can each day.
In many ways it can help, and in some cases it's essential, to have the support and encouragement of family and friends, particularly of those with whom you share meals. You may find it helpful to join a group that has been formed to help its members lose weight and maintain their weight loss. This is a good psychological support.
Maintaining Your Weight Loss
Once you have achieved your desired weight, you can test yourself to see what happens if you increase your caloric intake. Clearly, anyone who can lose weight in the manner described can't stay in a state of negative caloric imbalance indefinitely. But you will have to be careful, or you'll become overweight again. It's a challenge, but people who stick to a disciplined program can be rewarded by success.
If you do not succeed in losing weight in spite of carrying out the program described above, you may need professional help because of some special problem. A qualified physician may try some special diets, or he may even suggest putting you into a hospital so that he can see to it that you have no caloric food at all for as long as three weeks.
Perhaps the situation is complicated by a metabolic abnormality that can be corrected or helped by medication. Although such conditions are rare, they are not unheard of.
Obesity is almost never caused by a “glandular” problem—which usually means an underactive thyroid. Do not take thyroid pills to reduce unless your thyroid has been found to be underactive on the basis of a specific laboratory test.
The indiscriminate use of pills to reduce, even when prescribed, is never helpful in the long run, although it may appear to be at first. The un-supervised use of amphetamines, for example, can be extremely dangerous. See Ch. 29, Substance Abuse , for further information about the dangers of amphetamine abuse.
Because so many people are eager to reduce, and because losing weight isn't easy, there are many unethical professionals who specialize in the problem. Avoid them. All they are likely to do for you is take your money and make your situation no better—and often worse—than it was to begin with.