Sensible Downsizing - A Guide to Weight Loss

Women have forever been trying to change their size, from diets to corsets, and we are in the midst of an obesity epidemic that is making many of us sick, literally.  The fashion industry hasn't done us any favors either -- the "sizing down" of our bodies has been insidious, and we've been duped into thinking we aren't getting fat.  For example, my lovely daughter was visiting her grandmother not long ago and was given some beautiful vintage dresses from about 1960 which fit her perfectly.  The daughter is a size 6, the dresses from 1960?  Size 12.  The fashion industry knows what we want to hear.

Insurance companies and employers are forever trying to find incentives to encourage their clients and employees to lose weight and to exercise in an effort to become more fit, become more productive, and in the process save them money.  Not all companies are inclined to be nice about it.  Some insurance companies can see the advantage to including weight loss counseling in their list of benefits, but many do not.  Forget incentives.... Arizona was considering a "Fat Tax" for their Medicaid recipients who don't shape up.

To charge the poor for their already poor health without showing them how to change it is just wrong.  There are hundreds of books and articles on the "secret" to losing weight.  Weight loss is big business...everyone wants the snake oil that works, that secret pill that will do the trick, and there are hundreds of products out there.  They all cost money to buy.

I feel strongly that good health starting with weight loss is such a basic part of good health that finding out how to do it should not cost money, so here is my own tried and true method.....for free.  No gimmicks, no special diets or shakes, and you don't have to buy anything from me. 

The Plan

First, some background may be helpful.  This all came about because my husband was told by his doctor that his blood sugar was going up a little and if he didn't lose weight, he would be diabetic like his father was.  I was also seriously overweight, and we decided that enough was enough.  If we didn't want to be sick in our old age, we needed to get our act together.

So we exercised, got a treadmill, followed what we thought was a much healthier diet, and still couldn't lose weight.  I mean, we felt better, but no significant weight loss.  Here I am a doctor, and I can't figure it out either.  So we gave up and decided to go on one of those plans where you purchase the food and then you have to follow their plan, buying your own fruits and vegetables and low fat dairy, etc., and (for about $700 per month) the weight just fell off of us! 

Now, don't get me wrong. The $700 was totally worth it, especially since it was for both of us and we WERE finally losing weight, but "Okay, so what's the trick?", I asked myself, and I started breaking down the protein content, calories, etc. for each meal and realized we were eating about 1300 calories per day.  Duh, I can do that!  We had a vacation coming up and weren't going to be able to take our "happy meals" with us, but didn't want to mess this up, because we had just both lost like 12 lbs in 2 or 3 weeks.  So, at first, we continued to buy things like their desserts, because I LOVE chocolate and I got to eat my chocolate every day.  I also think we were a little afraid of going cold turkey.  But basically we were on our own, with the diet meals in the closet in case we needed them (we didn't), and we continued to lose using the tips below, with both of us each losing an additional 30-35 lbs. My husband's doctor was delighted, by the way, and Steve's blood sugar is normal.  (He even is nearly off his blood pressure meds). 

How It’s Done

1.  Before even dieting, get a little notebook you can slip in your pocket or purse and write down everything you eat and drink.  Make sure you include the calories.  The point is not to say "darn, I wish I hadn't eaten that ice cream!", it's to educate yourself.  Find out how many calories you're eating each day.  Most of us have no idea how many calories are in the foods we eat (See #2).  Do NOT estimate portions.  Take the couple of seconds it takes to pour your cereal into a measuring cup, so you know how much you really ate - Same for the milk. 

2.  Get a calorie book/app.  You can get them at any of the book stores or on line, but the truth is, you need information right now.  The books available now usually have calories listed on the menus of most restaurants and fast food places and we live in the real world.  There are apps available that do the same.  You will probably still stop in for a sandwich with your family, but you might select something on the menu that has 600 calories instead of 1200 calories, if you know.  It's not always the salad that is the best choice.  The one I use also gives calories burned for normal activities, like office work, walking at 2 or 4 mph, or all kinds of different exercise.  Which brings me to #3.

3.  1 lb. = 3,500 calories.  Sounds like a lot, doesn't it?  But if you want to lose a pound a week, that breaks down to 500 calories per day less than you're eating now (if you're maintaining on your present intake).   Now, that's not so bad.   So how many calories are you eating now?  That's why #1 is so important.  You could be eating 3,000 or 4,000 calories per day, in which case, dropping these calories isn't so painful.  A few changes here, a few changes there..... Oh, you want to lose weight faster or you're having trouble?

4.  Many of the big successful diet plans work for quick weight loss by restricting calories to somewhere between 1000 to 1400 calories per day one way or the other.  Even weight loss surgery forces you to restrict your calories.  In the Sixties, we used to wire people's jaws shut so that you had to sip everything through a straw and people lost weight.  Now we do gastric bypass, which also forces people to restrict calories.  Simply put, calories are fuel; whatever you don't use, you store.

5.  Include your favorite foods.  Yes, that's right.  Everything in moderation.  As I said, I love chocolate.  Every day, I know that I will have 150-200 calories of chocolate and the trick is that I don't feel like I'm dieting.  I had a patient who likes to have a beer now and then (as do I....evil beer) and we had a discussion about which light beers taste the best for the least calories.  Love nachos?  Can't live without them?  How about knowing you can have them every day, using a small portion of baked chips, maybe switching to low fat cheese...just count it into your calories.  You make your OWN priorities here!  If you feel deprived, you will not make a diet change and you will not want to do this.  If you feel happy AND are losing weight, it's the best kind of positive reinforcement and you will keep doing it.

6.  Watch portions and remember that snacking between meals if you are hungry is very important.  Be careful what you snack on, however.  50 calories worth of pretzels will fill you up for 30 minutes or so, but leave you craving carbs.  50 calories of low fat string cheese will fill you up and hold you until lunch.  Try to stick with high protein snacks, always counting your calories, especially at first.  Make sure you are getting plenty of vegetables and fruits at each meal, even if it's just a V-8 with lunch.  Limit fruit juices, though, which are high in calories.  Whole fruit is better.  And - really important - stay hydrated.  If your body needs water, you will feel tired, hungry, and dragged out. 

7.  I could write a chapter about portions, but the bottom line is to find ways to make your calories count.  I ate a high protein low calorie cereal, that I didn't like the taste of, for ages before I realized that if I eat a half cup of my favorite yummy cereal and a piece of string cheese at breakfast, I get more protein and actually enjoy breakfast.  I'm not wild about non-fat milk, but the newer fortified ones really do taste like 2%.  I use a yogurt-based margarine that tastes wonderful and has half the calories of my previous spread.  You get the idea.

8.  If you reach a plateau, you have a choice.  You can take a break and just maintain.  Remember that you can lose ten pounds now, then ten more in a couple of months, going on from there.  As long as you aren't losing the same ten pounds, you're doing well.  If you've plateau'd and you want to continue to lose, you need to again make sure you are writing everything down, drop your daily calories by at least 100, and add 30 minutes of exercise daily.  Or if you can't exercise, just drop the calories and be more determined than ever to stick with it.  Give yourself a week or two before you get on the scale again.  You'll be lighter.

9.  Do not worry about counting grams of fat and carbs and protein, or the percentage of this to that.  Stick with calories at first, otherwise it's just too complicated.  That being said, do try to make sure you get protein in every meal, since that will help stabilize your blood sugar and your meals will stick with you longer.

10.  Guess what?  Weekends happen.  If you splurge a little on the weekend, take a deep breath, get on the scale, and go right back to losing weight again on Monday.  No big deal. 

11.  I am a doctor and I am never going to tell you NOT to exercise, but some people can't exercise because of joint problems or cardiovascular issues, or because they are very overweight and it's just difficult to move, or because they're busy driving the kids around.  The plan above, monitoring and decreasing your calories, will work regardless of whether you exercise.  The truth is, once you start to lose weight, you feel more like moving and exercising, not the other way around.

12.  Finally, please note that I am not giving you a specific diet to eat.  YOU know what you eat, you have families, friends, a social life.  Besides, the second I do, someone will have an allergy or be vegetarian or whatever.  You don't need someone to tell you what to eat.  You just need to know how to figure it out.

I know this seems pretty straight forward - like it can't be that easy.  It is.  This is how it's done.  What have YOU got to lose?

Ingrid A. Carlson, MD