OVERWEIGHT
WHAT IS IT?
Through most of human history, being fat was good: When food was scarce, anyone with ample body fat had energy reserves stored up for lean times.
Now things are different. We know that if you are obese-that is, if you’re more than 20 percent above the weight most experts agree is healthy for someone of your height because of excess body fat-you have a high risk of many health problems, including heart attack, stroke, type 2 diabetes, and some types of cancer. Even if you’re not obese in the strict sense, some experts think your risk of health problems begins to rise with just a little weight gain, and they think your risk rises steadily as your weight goes up. That’s now the case for more than half the men and women in the United States.
It’s important to know that being overweight isn’t quite the same thing as being overfat. A woman who is 5 foot 6 and weighs 156 pounds is overweight by most standards, but what if she works out every day? Some of her extra weight may be muscle, not fat; she may be very fit and healthy. In general, though, most people who are overweight are overfat.
If you do weigh more than you should for good health, there are ways to lose the extra pounds and do it safely. It isn’t always easy, but the good news is that you can take weight off and keep it off-for a lifetime. The key is to change your eating and exercise habits.
WHAT IS HAPPENING?
A person puts on fat by taking in more calories in food and drink than his or her body needs. A calorie is a measure of energy. Some foods have a lot more calories than others. A 2-ounce chocolate bar has about 300, for instance; a 2-ounce chunk of carrot has only about 20.
How many calories you need for good health depends on how active you are, and your age, height, sex, and build. Most adults need about 2,000 to 2,500 a day. If you take in more than you need day after day, either because you eat too much or you move around too little, your body stores the extra in special cells called adipose (fat) cells. These cells balloon in size as you gain weight-most often in the thighs and over the belt.
Extra fat causes problems in many ways:
Weighing too much makes it harder to get around.
The added pounds put an extra burden on your joints, which can raise your risk of osteoarthritis.
Excess body fat can damage your arteries and raise your blood pressure, which raises your risk of diabetes, heart attack, and stroke.
Excess fat also affects the levels of certain hormones in your body, and that may raise your risk of cancers of the breast, colon, and prostate.
And excess fat raises your risk of sleep apnea, a problem that occurs when soft flesh in your throat sags as you sleep, briefly blocking your airway. When that happens, you snore heavily and stop breathing for short periods. The struggle to take a breath can rouse you from deep, restful slumber. This can cause a host of problems, including daytime drowsiness and an increased risk of accidents, as well as a higher risk of depression, high blood pressure, and heart problems.
WHAT CAUSES IT?
A few people are obese because something in their metabolism-the series of chemical actions that changes food into energy-makes them burn calories too slowly. And scientists are discovering “obesity genes” that appear to regulate body weight, but which may not function properly in some people. For the rest of us, there’s no mystery in how we get fat: It happens when we eat too much and don’t move around enough to use up extra calories.
But it’s not at all clear why so many of us overeat and don’t exercise even when we know these habits are bad for us. It doesn’t help to blame obesity just on a failure of willpower. You have a better chance of dealing with it if you regard it as a chronic ailment like asthma or allergies: If you tend to put on extra weight easily, you’ll want to find ways to keep it under control. And after you’ve come down to the weight you want, you’ll need to keep in mind that your good health depends on continuing to do what got you there.
Many factors can increase your risk of being overweight. Some-such as your sex, age, and family history-are outside your control. But there are others you can do plenty about.
THINGS YOU CAN’T CHANGE
Age
People tend to get fatter as they get older. One reason is that they become less active but go on eating as much as they did when they were younger. On the upside, new research suggests that being overweight, while still bad for a person’s health, isn’t as risky for older adults as it is for younger men and women.
Gender
Women tend to have more body fat than men because physical changes such as menstruation and menopause increase fat storage. And, in fact, women need more fat than men do for good health. But women are also more likely than men to become overweight. One reason may be that they tend to be less active than men, at least in the U.S.
Some experts also think women are more at risk than men of becoming overweight because they diet more. Frequent dieting actually makes losing weight harder because it makes your body behave as if it were starving-the body learns to hang on more tightly to the calories you do take in. Dieting also makes it harder for you to tell when you’re hungry or full-you tend to feel hungry or deprived of food all the time-and that means you’re more likely to have binges of overeating. And once you binge, you may be more likely to get depressed about your weight, which often leads to still more eating. Polls show that 40 percent of women are dieting at any time, so many of them are locked into this pattern of repeated weight loss and weight gain called weight cycling.
Family
Obesity and overweight seem to run in families. If a close relative-your mother, father, brother, or sister-weighs too much for good health, you have a higher risk than someone from a family in which everyone is lean. Some people inherit a slow metabolism, so they tend to store calories as fat instead of burning them for energy. Also, people learn many of their eating and exercise habits from their families. You’ll be less likely to exercise and more likely to overeat, or to eat fattening foods, if others in your family have those same habits.
THINGS YOU CAN CHANGE
Your diet
If you eat too much for the amount of exercise you get, you’ll gain weight. Overeating isn’t the only thing that packs on the pounds, though. What you eat also matters. Many of us eat too much and eat too many foods high in fat, such as meat, buttered toast, ice cream, and processed foods. We’d do better to focus on foods with lots of fiber and complex carbohydrates, along with some protein. Foods high in fiber and carbohydrates are cereals, breads, pasta, fruits, and vegetables. Good sources of protein include eggs, fish, lean meat and poultry, grains, and beans and lentils.
Here’s one problem with fat: It contains more than twice as many calories as an equal amount of carbohydrate (sugar and starch) or protein-one gram of fat has nine calories, in fact; a gram of carbohydrate or protein has only four.
Worse, compared with protein or sugar, the fat we eat is much more easily stored by the body as-you guessed it-fat. In fact, the body has to work extra hard to digest proteins or carbohydrates so they can be used or stored as fat when they’re not needed right away. That means some of the calories in these foods-as many as one calorie in every four-are used to digest them. On the other hand, almost all the fat we eat but don’t need ends up being stored, often in unsightly bulges. There is also evidence that a high-fat diet raises what’s known as the “set point,” an amount of fat that the body naturally tries to maintain.
Exercise habits
People who aren’t active have a high risk of gaining weight and a hard time taking it off and keeping it off. That’s because exercise uses up lots of calories. If you walk briskly for 15 minutes, for instance, you can burn off about 100 calories; if you just sit quietly for the same amount of time, you use up only about 20.
Hormones
Hormones are chemicals that help control many processes in our bodies, including metabolism. A few people-about one in every 100 who are obese-have problems with their hormone levels that make it easy for them to gain weight. One such problem is an underactive thyroid. This gland makes hormones that speed up metabolism. If yours isn’t making enough, you can get the hormones you need in pills.
Medicines
Some medicines, such as antidepressants, may promote weight gain.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to take off weight and keep it off by changing your eating and exercise habits. To lose a pound of fat, you need to use up 3,500 more calories than you take in. That’s because one pound of fat contains 3,500 calories of energy. (A typical fast-food lunch of a burger, fries, and a shake is loaded with about 1,700 calories. By contrast, an apple has only 80.)
Most experts now agree that dieting by itself-simply cutting back on calories-is not a good way to lose weight. When you diet without exercise, you lose muscle along with fat. If you begin to regain the lost weight-which most dieters do-you’ll replace much of that lost muscle with fat. The result: You’ll end up with more body fat than ever.
The best way? Combine smart eating with plenty of physical activity. Exercise builds muscle, so it can help you lose more fat over time. That’s because muscle tissue is “active,” while fat is “passive”-muscles burn lots of calories even when you’re not using them, while fat tissue, remember, stores calories.
If you’re planning to lose more than 20 pounds, if you’re taking any medications, or if you have any health problems such as high blood pressure or diabetes, you should talk with your doctor before going on a weight-loss program.
Here are some tips for a program that works:
Plan to lose weight slowly
Stay away from crash diets. For best results, aim to lose just a pound or two-no more than about 1 percent of your body weight-a week. On a crash diet you might lose lots of weight at first, but studies show that crash dieters almost always gain back weight they’ve lost. And when you go on a crash diet more than once or twice, your body gets better at storing calories. That means that as time goes on, you’ll find it harder to lose weight and keep it off.
Set realistic goals
Don’t aim for a weight you can’t reach or maintain. If you do, you’re likely to end up discouraged. Studies show that a loss of even a few pounds can bring big health benefits, even if you never do get down to your ideal weight.
Ask your doctor to help you set a reasonable weight-loss goal. Set both short-term and long-term goals. For instance, aim to lose four or five pounds a month for a few months, and also decide how much you plan to weigh at the end of a year. See how it goes, and be prepared to revise your goals and your weight-loss plan.
Exercise
Be as active as you can. The idea of exercising if you weigh too much may be a bit scary at first, but exercise is vital. It will strengthen your heart, lower your blood pressure, protect you from osteoporosis, and reduce your risk of weight-related problems such as type 2 diabetes and heart disease. And exercise uses up calories that would otherwise be stored as fat. A brisk daily half-hour walk burns about 180 calories, for instance. If you do it every day for a year, you can burn off about 18 pounds of fat-if you don’t start eating more. Better yet, many people find that for several hours after they exercise, they aren’t as hungry as they are at other times, so they’re less likely to nibble between meals. To make exercise safe and easy:
Start by being a bit more active each day. Anything you do that gets you up and moving around will help. Rake leaves, or play active games with your child-exercise doesn’t have to be a chore. Take the stairs instead of the elevator. Or walk the dog for 10 to 15 minutes each evening; your pooch and your waistline will thank you
If your joints or feet hurt during or after such exercise, try swimming, water aerobics, or cycling instead.
When you’re used to being active, add some activities that are more aerobic to your routine. These should make you breathe harder and sweat a bit, and get your heart pumping. Brisk walking, running, biking, tennis, and swimming are all ideal. Take a couple of months to work up to 20 to 30 minutes-or even longer if you can-most days of the week.
Almost any exercise is better than none, but if you have high blood pressure, avoid pushing or straining, as in weight lifting, until you have your blood pressure under control. If you do move on to lifting weights, don’t hold your breath as you lift.
Find something you enjoy. It’s much easier to keep exercising when you like to do it.
Work out with a friend. It’s a great way to stay motivated.
If you have symptoms of angina or a heart attack-such as chest pain-while exercising, stop and call 911 right away.
Keep track of your eating habits
Keep a food diary for at least a week. List what you eat and when you eat it. Note what’s happening in your life around the time you have the urge to eat. The diary will help you spot triggers, such as stress, that make you overeat. Once you know the triggers, you can work to avoid them, or find healthier ways of reacting to them. If you often respond to stress by eating sweets, for instance, you might try keeping carrots handy instead.
Weigh and measure your food for a while
Many people think they take in fewer calories than they really do. Most people who take weight off and keep it off weigh and measure their foods-at least at first. Try it for a week or two; it can help you learn to judge portion sizes. You can buy a small scale at any hardware store. Also, get one of the little books that tell you what’s in various foods-calories, fats, fiber, and so on-and use it to figure out the number of calories in each item and each meal for a couple of weeks.
Eat the right stuff
Stick to low-fat foods. Remember, fat has many more calories than carbohydrates or protein have. Cutting fat is the simplest way to reduce calories and still eat a satisfying amount of food. The American Heart Association advises keeping your fat intake below 30 percent of your total calories each day. Some experts think you should make it 20 to 25 percent if you’re trying to lose weight. That could mean about 500 calories a day, or even fewer, from fat. (One pat of butter has about 100.)
Also, pay attention to the kinds of fat that you consume. While all fats are fattening, some are worse for your health than others. In fact, new studies show that small amounts of the right kinds of fat are good for you, and especially for your heart.
Saturated fats come from animals and some plants, including palms and coconuts. These fats are solid at room temperature. They raise cholesterol levels in your blood and clog your arteries. (Cholesterol is a waxy substance found only in foods from animals. Your liver makes all you need. Getting extra cholesterol from the foods you eat is one cause of heart disease.) Keep calories from saturated fats to 10 percent or less of your total caloric intake.
Hydrogenated vegetable oils are oils that food manufacturers have turned into saturated fats so they’re solid or semi-solid at room temperature. They’re found in margarine, vegetable shortening, and many packaged foods. They clog your arteries just as saturated fats do. Hydrogenated vegetable oils also contain a form of fat called trans fatty acid, which appears to raise the level of low-density lipoprotein (LDL), the so-called bad cholesterol that clogs arteries, and lower the level of high-density lipoprotein (HDL), the good kind.
Unsaturated fats come from plants and fish, and are liquid at room temperature. They come in two types: polyunsaturated and monounsaturated. Most vegetable oils are a mix of the two. Olive and canola oils are mostly monounsaturated fat. They slightly lower LDL and slightly raise HDL. Sunflower, safflower, and soybean oils are mostly polyunsaturated fat. They lower LDL, but appear to slightly lower HDL as well. Fish oils and flax seed oil contain a special type of fat, Omega-3s, which appears to prevent blood clots and lower the risk of heart attack.
Some simple things you can do to cut the fats from your diet:
Read food labels to know what you’re getting. The important things to look for are calories, calories from fat, total fat, saturated fat, cholesterol, and hydrogenated or partially hydrogenated vegetable oil.
Build your meals around vegetables, fruits, and grains. They have little fat, are low in calories, and they are loaded with vitamins, minerals, and fiber. Fiber is important if you’re trying to lose weight. It will help fill you up without filling you out. That’s because fiber-or roughage-takes up space in your stomach and then passes out of your body without being digested. That means it doesn’t contain calories your body can use or store. Fiber also carries cholesterol out of the body, so it cuts your risk of heart disease. And it seems to play an important role in preventing type 2 diabetes by reducing the sugar spike that comes after you’ve eaten certain foods.
Prepare vegetables the low-fat way. A serving of steamed vegetables gives you zero grams of fat, but sauteing the same vegetables in butter or oil gives you 14 grams (and 126 more calories).
Stay away from fatty snacks such as potato chips and high-fat cheeses. Try low-fat yogurt or fat-free pretzels instead.
If you eat red meat, make it a once-in-a-while treat, not a regular item, and keep it lean. Look for cuts graded “select,” which means they have the least fat. Other low-fat cuts include pork loin, lean ham, venison, veal, and lamb flank.
Before cooking chicken, remove the skin and fat. Don’t use chicken injected with salt and fat-read the package label to make sure.
Eat lean fish such as halibut or sole twice a week, or fatty fish such as salmon or tuna once a week.
Don’t fry foods. Bake, broil, steam, or saute with water or vegetable broth in a nonstick pan.
If you eat dairy foods, go for low-fat or nonfat versions such as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or sherbet instead of ice cream.
For salads, try an oil-free dressing. If you use oil, make it one high in unsaturated fats, such as canola, safflower, sunflower, or olive, and use it sparingly, no more than one to two teaspoons per serving. Or try red wine balsamic vinegar alone as a dressing; it tastes fine without oil.
Try flavoring your dishes with herbs, spices, salsa, or mustard instead of mayonnaise or butter.
Be careful with “low-fat” products. Some of them are loaded with sugar. Though they may not contain much fat, they still pack a lot of calories.
Keep mealtimes special
You’ll find yourself more satisfied with less food when you focus on the food at every meal. Instead of watching television or reading-or worse yet, working-while you eat, pay attention to chewing slowly and savoring each mouthful. Pause now and then to check on whether you’re still hungry. There’s a lag of about 20 minutes between the time you start eating and the time your mind gets the signal that you’ve had enough.
When you’ve finished the food on your plate, take a long pause instead of going for a second helping. Some people even get up and brush their teeth; that sends your body a strong message that the meal is over.
Don’t deprive yourself
Losing weight doesn’t mean you can’t treat yourself. It’s okay to have sweets once in a while. In fact, feeling deprived makes people so unhappy that they’re likely to seek comfort by eating sweets. Just be sure to limit your portion sizes-a few tasty spoonfuls of ice cream or just a couple of cookies, savored slowly, can taste wonderful-and the number of times you indulge each week.
Don’t skip meals
When you skip a meal, you’re likely to become ravenous. Then, when you do eat, you’re apt to overindulge more at your next meal.
Don’t stress out
Your natural response to a demanding or high-pressure event-a problem at work, a wedding, even getting ready for a vacation-causes changes in your body. Your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy. And many people tend to eat more when they’re nervous or tense.
If stress makes you reach for food, set up other ways besides eating to ease the tension. If you have to munch on something, try carrot sticks instead of sweets or crackers. Keep some carrots handy, already cleaned and cut.
Here are some other tips for dealing with the stress in your life:
Exercise. People who exercise often tend to feel less anxious and more relaxed.
Laugh more. Use humor to ease tense moments. Studies show that laughter releases stress-busting hormones.
Don’t try to be perfect. Set goals you can meet, and ask yourself whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is “no,” take a few deep breaths and tell yourself to calm down. If any answer is “yes,” don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do as long as it’s a time-out that changes your tempo. Aim for at least 20 minutes twice a day.
Relax through yoga, deep breathing, stretching exercises, or meditation.
Seek social support
When you have problems in your life, don’t try to escape by eating more. Talk with friends or get support from a therapist. It will also help if your friends and family support your diet plan. Talk with them about any trouble you’re having with it. Also, you might try a group such as Overeaters Anonymous or Weight Watchers. These programs offer clear weight-loss plans. You’ll also meet people who can offer emotional support and perhaps some useful weight-loss tips.
Talk to your doctor
Some medications, such as antidepressants, can cause weight gain. If you’re taking a drug you think is causing problems, talk to your doctor about it. There may be another version that works as well without the side effects.
Don’t get discouraged
When you take steps to lose weight, you may lose it quickly at first. But then your weight loss will slow down, sometimes dropping to one pound or less each week. Don’t lose hope. You will succeed if you stick with your plan.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you’re having trouble losing weight on your own, your doctor can help. He or she can order tests to check for hormone problems such as an underactive thyroid and prescribe medication if that’s the your problem. If it isn’t, here are some other things your doctor might want to discuss:
Diet pills
Doctors tend to advise diet pills only for patients who are very obese and at risk of weight-related health problems but who can’t lose weight any other way. The use of medication to manage obesity is controversial, though. Diet pills can have severe side effects: They may raise blood pressure and increase the risk of heart failure. They may also cause headaches, memory problems, depression, and trouble sleeping.
Several prescription products contain drugs that curb the appetite. Others contain drugs, such as sibutramine, that make you feel full. Some over-the-counter (OTC) diet pills contain a nasal decongestant that also happens to curb the appetite.
Neither prescription nor OTC diet pills will reduce your weight if you don’t also change your eating and exercise habits. These medications usually work only for a while-often for just a few weeks-and then weight loss tends to level off. Many people who take these drugs regain weight after they quit. And the pills don’t work for everyone; some people who take them feel no change in their appetite.
Talk with your doctor before using any diet pills; given their limited benefits and their side effects, they might not be worth the risk.
Antidepressants
Although they are not approved by the FDA for treating obesity, antidepressants such as Prozac may help some people lose weight. Doctors usually prescribe these drugs if an overweight patient is also depressed. These drugs act on chemicals in the brain called neurotransmitters.
Surgery
Surgery such as gastric bypass or stomach banding is an option for people who are very obese and have a life-threatening disease as a result.
In banding, a surgeon cuts into your upper abdomen and puts a small band around the upper section of your stomach, creating a small pouch with a narrow opening into the rest of the stomach. The result is that it becomes harder to eat big meals, and you’ll feel hungry less often. In a gastric bypass, your doctor cuts out a section of small intestine, then reattaches what’s left. The result is that your body can’t absorb as much food as quickly as it did before; the food left over simply passes out of your body.
Both types of surgery have risks, including a risk of tears in the stomach, infection, and food leaking into the abdomen. Ten to 20 percent of patients require follow-up sugery, one-third have problems with gallstones, and nearly 30 percent develop anemia or osteoperosis. Surgery, thus, is a last resort, when nothing else has worked. And even surgery won’t work if you don’t watch your diet and stay active.
Liposuction
In this method of fat reduction, fat is sucked out of the body through a tube attached to a vacuum. It has no proven health benefits, probably because it doesn’t involve lifestyle changes. And it doesn’t help those who are generally overweight; it works only for specific problem areas such as the abdomen, hips, buttocks, thighs, or upper arms. Some people gain fat right next to the site where the fat was removed. The risk of serious complications from liposuction are low, but some patients have died because of excess blood loss, or when blot clots have formed and traveled to the lungs. If you decide to have liposuction, be sure to pick a doctor who has had lots of experience with the procedure.