Maintaining a healthy weight, and not smoking, are the two most vital things a person can do to enjoy a long and active life.  Becoming overweight strongly increases your risk of developing heart disease, stroke, high blood pressure, diabetes, many cancers, sleep apnea, degenerative arthritis, heartburn, and other respiratory illnesses. In fact being over one’s ideal weight is statistically linked to all causes of premature death. Today 60 percent of Americans are overweight and 30 percent are obese (defined as thirty pounds above ideal weight). This growing weight problem in society is not due to a genetic change- it is due to the intake of more calories and less exercise than our forbears enjoyed. Genetic shifts occur over many generations. America’s weight problem has been accelerating within a generation. Overweight has become America’s #1 health concern.

Excess weight is such a personal issue that it is difficult for doctors and patients to address. It would be simple if people lived in self contained laboratories or if we could even be treated like we do our pets- if your dog is overweight we reduce the amount of dog chow, walk him more, and then his weight drops to normal. But there is no such thing as people chow, and no one is there to force us to exercise! Every person is different, with unique tastes, appetites, and grows up with different cultural expectations. We are all surrounding by quick and super-sized meals. Food is everywhere and plentiful. U.S. farmers produce twice the calories that are needed to feed every American, and so there is competition to produce, market, and sell foods in excess of what we actually need. It is a strong willed person who can "say no" to such temptations, but that is what is so necessary today. When we combine this incredible availability of food with too little physical activity the result is what we have witnessed in this short period of time.

There has been an explosion of quick weight loss plans/diets/pills/schemes. The one thing that all experts agree on is that "a calorie is a calorie" and that regardless of where the calorie comes from (carbohydrate, protein, fat) the result is the same. The calorie is the "currency" of weight management- if one deposits (consumes) more calories into the bank (their body) than one withdraws (exercises off) then the account (weight) will go up- regardless of whether the extra calories came from a streak, pasta, or vegetables.

Almost any kind of diet, no matter how weird, can obtain some weight loss success at least in the short term- because that diet makes a person pay attention, be mindful, of what they eat! Given that, let’s review a few of the popular diets and look at their attributes and failings.

1.Very low fat diets (the Ornish Diet is a 10% fat, vegetarian diet) are difficult for people to stay on. Recent short-term studies suggest that moderately low fat diets don’t produce much weight loss. Charlie deligently stayed on the Ornish diet for a year (not for weight loss, but in the belief that this diet is very healthful) and found it to be a challenging diet to maintain long term. People with a history of depression must be careful about starting a very low fat diet because may be associated with an exacerbation or recurrence of depression. Also, a very low fat diet is counterproductive if one adds significant salt, sugar, or food additives to make the diet palatable.

2. The Zone and the Glucose Revolution diets suggest that people should eat foods with a lower glycemic index (GI). This is a measure of how a food affects your blood sugar level. Foods made from refined grains (white rice/bread/pasta/potatoes,etc) have high GI’s while legumes/fruits/vegetables have lower GI’s. A high glycemic index food causes a rapid rise in blood sugar, a quick matching release of insulin from our pancreas, and then a sudden drop/return to normal sugar levels which appears to generate new hunger signals! Most of us have experienced the truth in this. By avoiding high GI foods a person could cut calories with less of a hunger response. A Mediterranean diet, given the use of fruits, vegetables, nuts, and legumes is an example of a relatively low glycemic index diet.  While the glycemic index may not be "the main factor" in determining a diet's worth, there does seem to be benifit here. 

3. The high protein, low carbohydrate diets (Atkin’s diet) do have the benefit of keeping blood sugar levels low and steady, curbing hunger. However there are no long term studies to show that weight can be kept off, and in our own practice experience no patient has tolerated this type of diet for long. A diet should not have a beginning and an end, but represent one's lifelong way of eating.  The optimal diet can't just be a tool to reduce weight, but should be one to support health.  There is a long term risk that these low carbohydrate diets may cause early osteoporosis as calcium can be leached from bones due to the high protein intake. Additionally these diets are high in harmful saturated fat and cholesterol, and low in the fruits/vegetables that are so healthful. The dietary kernel of truth is that by paying attention to what you consume, and reducing white, nothingness carbohydrates you can lose weight.

No diet will allow weight loss unless your calorie intake is less than your calorie expenditure! You need to find the diet that appeals to your palate and appropriately calorie restrict it. The present medical literature would suggest the Mediterranean diet is optimally healthful. It is a diet that is high in fruits and vegetables, contains nuts and legumes, and is rich in whole grains (pasta/rice/breads). The Mediterranean diet allows for olive oil, fish, and some skinless chicken- so it is only moderately low in fat. If you refer to the "Foods to Avoid" and "Foods to Embrace" sections you will see that this diet fits well.

Exercise daily as much as you can- at least 30 minutes. Staying fit improves your chances of living longer and healthier. Without exercise muscle is slowly replaced by fat which then slows your resting metabolism (unlike muscle, fat has very little metabolic burning potential). It is a vicious cycle- if your resting metabolism slows you are increasingly dependent on formal exercise in order to burn calories. Exercise daily, do what is fun, go out of your way to walk at work/during your day, and just be active.

Exercise alone will not generate much weight loss. Appropriate dietary calorie restriction is vital. A "happy meal" at McDonald’s gives us 750 calories (super-sized adult hamburger 1800 calories) and jogging an hour burns 700 calories. Diet is important! Here are some tips- some might work for you: