I am frequently asked if the techniques that we have employed so successfully to lose 40, 50 or 100 pounds can also work for more modest weight loss, such as 10 to 20 pounds. Of course you have guessed the answer is yes.
But just because you only have 10 or 20 pounds to lose does not mean that the challenge is any less difficult. Accomplishing the goal of losing 10 to 20 pounds still requires the same type of mental or psychological change, and the creation of the same kind of healthy habits that are required to lose 50 pounds. The goals can certainly be achieved faster, but maintaining the weight is no less difficult whether you have lost 50 or 20 pounds.

The key is starting with a commitment to losing the weight for yourself, for your health, and for your sense of well-being. It starts with writing down your goal and then identifying the reasons why you wish to achieve that goal. It starts with planning a method to attack the problem in preparation by acquiring some of the items you will need such as healthier alternative snacks and meal preparations, shaker cups, a pedometer and a good scale.

So now to begin. Plan a phase to induce the weight loss or achieve the weight loss over a period of a few weeks, then plan your transition to maintaining the weight loss. In the induction phase you need to lower your calorie consumption while maintaining sufficient protein and multivitamin intake. Drink plenty of water and exercise and use your muscles.

• Protein shakes for breakfast.
• Low carb, 200 calorie snack.
• Light lunch, 400 to 500 calories.
• Low carb afternoon snack, 200 calories.
• Evening walk and protein shake for dinner.
• Six glasses of water.

This regimen will result in a daily calorie intake of around 1300 to 1500 calories, resulting in a significant net daily calorie deficit depending on your basal metabolic expenditure and exercise. In many people with 10 to 20 pounds to lose, this would result in one to two pounds net weight loss per week.

After eight to ten weeks, transition to more regular food with healthy moderate portions.

• Maintain regular exercise.
• Trade habits of healthy meal portions.
• Utilize the suggested tips for weight loss and weight maintenance in everyday life.
• Celebrate your accomplishment with a nonfood award like a massage or a new outfit.
• Continue to remind yourself of your goal and your reasons for maintaining this healthy weight.

You can do it. Put your mind to it.

What if I told you that there was a drug you could take that would result in the following changes, as proven by scientific studies: You would feel better psychologically. You would have greater sense of calm and inner peace. Your blood sugar, blood pressure and cholesterol would be lower. It would result in weight loss and maintenance of a lower, healthier weight.

Would you take that drug? What if I told you there were very few side effects and that these side effects were mostly preventable by you. Now would you take the drug? I think most of us would.

Now if I told you that instead of a drug that it was an activity and it required 30 minutes of your time five days a week and resulted in all those same profound benefits in your life. Would you do it?

When put to us this way, I think most of us would take this drug or do this activity and we’d find time to make sure we did it every week because those benefits are so incredibly profound. What could possibly offer such benefits for such a small time commitment?

The answer, of course, is exercise. And everything that I have described above is true even the “side effects”, namely twisted ankles and so forth, are mostly preventable by being careful. The more serious potential side effects like heart attacks usually come from overdoing it. (Think of shoveling heavy snow in winter or trying to run instead of taking a nice vigorous walk).

So find time, 30 minutes, five days a week, starting today. It does not have to be heroic, gold medal winning exercise. It does have to be regular sustained exercise. I recommend that if you need to lose weight, that you start with walking. Walking is proven to be an important part of weight loss and weight maintenance regimen and it has lots of other benefits including the social benefits of walking with others.

I saw a patient recently who is seeking to lose weight and wanted my advice about the best method for doing so and keeping it off.  After we talked about a range of options including enrollment in the medically supervised weight loss plan, it became clear that there was something psychological holding him back.   After talking about the various program options, the patient confessed to me that really, he just wasn’t psychologically “ready” to lose the weight.

For many people, there clearly is a psychological “readiness factor” and this has to be listened to.

Life is certainly full of a great deal of responsibilities, burdens, chores and struggles.  It takes some psychological organization and energy to effectively put all the pieces together that are necessary to lose weight and keep it off.  It may be part of the reason why most people “try” several times before they finally succeed in losing weight.

The same kind of phenomenon is observed with smoking cessation or any other major change in longstanding habits and behaviors.  It is not easy to change those habits and behaviors, especially of they have some nice positive reinforcement associations like the enjoyment of eating good meals, sweets and treats.  And let’s face it, tackling a major project like serious long-term weight loss, requires hard work and planning.  It takes learning and it takes time to acquire the tools to succeed.  That often means learning better ways of shopping, better lists of ingredients and better understanding of what foods and snacks and produce you should be buying on a regular basis.  And then it can take time to settle into some new routines.

That can mean changing what time you get up, what snacks you take to work, your route in the commute, and a host of changes in life.

So we have to be “ready” to invest in those changes and the time it takes to form new habits. But even before you are totally “ready”, you can begin the planning process.  It is no reason to throw in the towel, just because life is too hectic to think about protein shakes this week.

I say, take advantage of this preparation time. Start listening to audio programs, start purchasing the things you might need, like the protein mix, and the shaker cup. Don’t commit to anything yet. Don’t start beating yourself up over not losing pounds yet. Just start preparing.

Then, once you have done some preparation work, the day will soon come that you feel truly “ready” to begin. Then jump in with both feet – you are on your way.

1. Stay positive.  Focus your friends’ efforts on their goals and successes, their triumphs and hopes.

2. Be persistent.  It is a long road, no matter whether your friend has surgery or pursues a medically supervised program.  Long-term weight loss does not happen overnight.

3. Meet for a walk.  Even the most motivated patient working on their weight loss goals, often finds it hard to find walking partners or people to socialize with as they pursue fitness goals and exercise.  Become a walking partner or fitness partner.  Make specific dates and regular times when you meet with your friend and go on that long walk or head to the gym together.

4. Meet for lunch.  If you have a standing date with somebody, you can make it at a place that will promote very healthy nutritional choices.  You can get in the routine of ordering a satisfying but healthy salad and enjoying some sugar free iced tea with your friend on a regular basis.  The conversation and social interaction will make the meal and experience enjoyable every time.

5. Bring others into the circle.  Losing weight is a long-term project that takes a lot of support and effort.  If you can bring others into the circle and help encourage everyone in the circle of friends to think healthier and educate themselves about long-term healthy nutrition and healthy weight, it will really help your close friend that you are trying to support.  It is a statistical fact that you are more likely to lose weight and stay at a healthy weight if the people around you are also at a healthy weight.

6. Be an example. Are you a little overweight yourself?  Could you stand to lose a few pounds?  Take the messages to heart.  Focus on your own health also and improve your own fitness in support of your friend’s efforts. He or she will admire you for what you are doing, and you will both then be pulling in the same direction.

7. Expand your own food repertoire.  If you are entertaining or hosting a baby shower or going out to dinner or having a group of friends over for book club, you need to expand your repertoire of what is acceptable to serve.  If you are truly going to be a top level support person to your friend who is pursuing long-term serious weight loss, you will help immensely if you can change the menu a bit at these social functions involving food.  Check out some of the recipes from Chef Dave Fouts 90 Ways to Ditch Your Diet (360 Publishing).  This part can require tact and grace, cleverness and great sensibility about how to not draw undue attention to your friend’s weight problem, and yet at the same time offer healthy snacks, meals and hors d’ oeuvres for company.  But you can do it.  Be creative.

8. Avoid singling out your friend.  This can be a challenge if you and perhaps other friends or acquaintances would like to treat you to ice cream or cotton candy or order your favorite fast food cheeseburger.  The name of the game here is to make your weight loss and experience a positive one for your friend.  Avoid singling them out, making them feel unworthy, lonely or separate.  Work hard to try to integrate them into situations where everyone is doing healthy things and doing activities, using muscles, burning fat, consuming healthy calories, or doing totally non-food things altogether.  Try hard to avoid making their weight loss journey a negative experience where they might feel they are missing out on the fun of sharing cotton candy with friends.

9. Run interference.  Here is another delicate one.  You probably realize who in your circle of acquaintances around your friend is likely to become a saboteur or undermine their efforts to become healthier.  Maybe it is another person with a weight problem who refuses to get help.  Maybe it is a person who is always “naturally skinny” and prefers your friend in their role as the overweight one.  Whoever they are, you can probably predict some of the things that are going to happen that will undermine your friend’s chances of success.  Take action.  It is delicate, I know, but there are some things you can do.  The first is to use the knowledge that you have gained by becoming an expert in the health statistics of overweight and obesity and the great health improvements associated with weight loss.  Share these with your would be saboteur friend and acquaintances.  Bring them on board gently through knowledge, insight, education and persuasion.  Don’t be heavy handed but little hints here and there, little facts could really help; and who knows, you might be helping more than one person lose weight and become healthier.

10. Be the lifeline.  Everyone trying to change their life hits weak moments or relapses when they need a life line.  Life’s craziness starts to intervene and throw us off our mission, and we find for reasons seemingly out of our control we are reverting back to old behaviors. In that situation your friend could really use the chance to call you and talk in a moment of crisis.  Your job is to be the life line, be there and listen.  Ask them if they still feel the goals they originally set are worthwhile.  Ask them to enumerate what their goals were and why they wanted to achieve them and reassure them that there is no reason to throw in the towel, no relapse is too great.  Tell them they just have to get right back on that horse.

Bonus Tips:

11. Celebrate milestones with non-food rewards.  If your friend has lost the first 10 pounds or 20 pounds and this feels like a serious accomplishment, then celebrate it for what it is, and offer a reward that does not involve food, like say a new pair of jeans or a massage or an offer to baby sit the kids while your friend goes to the movies.

12. Help with the pantry clean-out.  There will come a time if your friend is really serious about losing weight that he will need to rid the pantry, refrigerator and whole house of the favorite high calorie, high carbohydrate snack foods.  You can help.  Stand shoulder to shoulder with him as he tosses away the favorite orange flavored crunchy chips and the bags of candy treats. Your extra pair of eyes may spot some things that need to go.

I saw a patient in the office this week who brought in a list of diet plans and programs that she had read about or heard about. She wanted my opinion on each one. So we went through the list. And I must say that I was very discouraged to see that of the 12 or 13 diet plans that had piqued her interest, only one of them would qualify as having any sort of scientific validity or underpinning whatsoever.

Yet, weight loss fads and popular diets seem to have become more commercially successful and popular in the public consciousness than ever before. It is big business.

Yet why is there such growth in fad diets which offer very little chance of success?

I think the answers come from many corners. From one thing, scientifically based programs usually lack the sort of commercial push behind them that would allow them to be successful in the public market place. It is very difficult to compete with the commercial plans that can hire celebrity spokespeople and buy huge amounts of media time, create magazine and newspaper placements, and, in short, do all of the things that bring their products to our attention. There are many other factors, of course; for example, the media in general is usually very apt to cover “news items” that seem “timely or hot.” They are often interested in fresh angles and novel stories, and medically-supervised weight loss programs don’t always offer that kind of appeal.

But I would argue there is also a lot of blame to laid at the feet of the medical establishment. For many years, physicians and the medical community in general failed to address obesity as a serious disease. Only now that it is the number one cause of shortened life expectancy and the number one preventable cause of disease in the country, are physicians and medical systems really engaging in a serious way in the process. So in a sense, it can be argued that the medical establishment vacated the playing field and left it to commercial enterprises and fad diet profiteers instead of focusing on the challenges of clinical research and finding cures for this serious health problem.

It would be great if a product existed that allowed us all to “burn fat while we sleep.” And it would be great if a diet plan enabled us to effortlessly lose all the pounds we wanted to lose without any sacrifice on our part. And it would be great if some of our favorite fruits contained the secret mystery ingredient of health and fitness. The truth is that you can succeed in losing weight and keeping it off, but it is not easy. You need serious motivation and you need the right tools and the right information. It takes hard work, persistence, dedication and attention to many small and large things that add up over the course of the year to reduce pounds. It won’t happen overnight, but with a sound medically supervised, or scientifically-based weight loss program, you can do it.

Have you ever noticed that fad diets tend to change every season? If you go back a few years in the fashion magazines and popular press, you will find mention of a mind-boggling number of fad diets over the last years. But every issue and every season the specifics of the diet change. If they are highlighting a particular ingredient, the ingredient usually changes.

It certainly leads to the conclusion that these fad diets live a fairly short life and that the lack of any durable success shoves them off the front pages to be replaced by the next fad diet. And yet why are fad diets so popular?

One reason they are popular is that weight gain and obesity are increasingly serious and increasingly ubiquitous problems. Nearly everyone, it seems, would love to have a simple way to lose pounds after they have built up, and what better way to do it than with a painless diet plan?

The trouble is that fad diets nearly always result in rebound weight gain. Rebound Weight Gain is a phenomenon that occurs after the energy and enthusiasm of the diet wanes. For example, on a very typical fad diet, a person dramatically restricts one’s overall nutrient consumption and eats a narrow range of food choices. The fad diet rarely consists of emphasis on the medically proven, sound building blocks of weight loss, namely that of emphasizing protein and multivitamins along with exercise and increased calorie expenditure. So at the end of the fad diet, a person begins to experience a tremendous amount of hunger.

This hunger stems from the body’s muscles or “lean body mass” which has been depleted as a result of the fad diet. The muscle hunger is powerful and nearly impossible to resist and leads most people to begin voraciously consuming more calories. Usually the calories consumed are not in keeping with the medically sound guidelines that might help facilitate long-term weight loss. As a result of this whole cycle of the fad diet, a person usually yo-yos and ultimately gains more weight than had they not even started on the fad diet.

But it doesn’t stop us from looking for the magic bullet of a fad diet that might one day work. Does it?

1. Be an example to your kids. Be physically active. Promote healthy eating. Strive for and maintain a normal weight.

2. Write a letter to the editor. Let your voice be heard in your local paper or newsletter. Let people know this is one of the most serious and worsening health problems in the country affecting our young people.

3. Joint the Parent Teacher Organization of your local schools. Ask about healthy hot lunches, snacks and meals for all the school children.

4. Write your member of congress. While you are bringing out the pen and paper, send a personal letter to your congressional representative. Let them know what a devastating problem this is in your community and in the nation. Collectively we can do something about it, but it will take change from the highest levels of government. A sample of such a letter is available at www.obesitypreventionfoundation.org.

5. Get outside! Take the neighborhood children outside at least three times a week for some vigorous activity. Take a long walk but bring a Frisbee or a football with you so you can run and catch during the walk. Make it fun and interesting for the kids.

6. Bring it to the Club. The importance of childhood obesity must be brought to the consciousness of everyone. If you belong to Rotary or Elks or a country club, or just your own reading group, bring it up at the club and encourage everyone to get engaged.

7. Support local school extracurricular activities and sports. One of the reasons schools must turn to fast food and soft drink sponsors, is that no one else is stepping up to the plate. Attend the games, encourage your community to take an active interest in sports and extracurricular activities that are “active” for the kids in your area. Then find ways to support them financially.

8. Volunteer. Public school libraries, hospitals and clinics, boys and girls clubs, youth programs: all of these programs, organizations and centers need volunteers. Be a volunteer who also brings awareness about healthy eating and exercise. If you read to toddlers or school children, make it active; between books or chapters stand up, do jumping jacks, go outside, walk, emphasize the importance of physical activity and healthy eating whenever you get a chance.

9. Be a volunteer coach. Today more than ever, the sports and extracurricular activities for youth depend upon coaches and parents who are in short supply and lead busy lives. If you once played soccer or volleyball or anything else, you might make a perfect volunteer assistant coach at a local school. Who knows, you may get tapped to start a new team or a junior varsity or, in some other way, bring in more children into an athletic environment. You could change a life.

10. Join the Obesity Prevention Foundation community today. And tell two friends. This project, to prevent childhood obesity, will take all of us. And together we can make a very important difference in the lives of young people.

In the last few years, I have been approached by a number of people who were not comfortable sharing this health decision with the public. A number of them are famous for one reason or another and wished to undergo weight loss surgery, but they did not wish to disclose this decision publicly. I have also performed weight loss surgery for a number of private citizens who felt that they would prefer to keep their health decisions and weight loss surgery decision private.

It is part of the physician’s code of ethics to honor patient privacy. As a physician and surgeon, I always strive to do the utmost to do so. Bariatric surgery is no different from any other health decision when it comes to privacy.

Or is it? Studies have shown that people wishing to lose weight are more successful when they have the support of friends and family, or others like them who are also striving to lose weight. In addition, many of the best weight loss surgical programs provide not only support groups but also group education events such as seminars and classes on weight loss surgery, weight loss techniques, dieting, exercise, etc.

So how do we respect the privacy wishes of an individual and also offer the very best weight loss solution?

I have spent a lot of time thinking about this question, and ultimately I have crafted what I think is the best solution for the patient who wishes to protect their privacy and not disclose their decision to have weight loss surgery.

What I have done in these cases is make special arrangements to minimize the exposure of the patient to any other patients or bystanders in the office or at the surgery center. We have gone so far as to create an alias under which people schedule their appointments and check in at the surgery center. We have also created a personalized version of the classes and study materials and utilized on-line teaching and training methods.

All of this has worked well, and for the person who wishes to keep their decision to have weight loss surgery private, we can both respect that decision, and provide the best surgical weight loss solution.

There are pros and cons to pursuing weight loss surgery in this private fashion. You may avoid unwanted judgments but miss out on some support from other people. And of course, there is no absolute guarantee to privacy!

In a future blog post, I plan to discuss more aspects of this question:

Should you keep your decision private or should you disclose it?

WHY DIETS LEAD TO REBOUND WEIGHT GAIN AND HOW MEDICALLY SUPERVISED CALORIE RESTRICTION CAN BE BETTER

Rebound Weight Gain causes almost all diets to fail. I have worked to help people avoid this frustrating problem after all the hard work of losing the weight with a diet. And there is a better way!

Successful weight loss does not happen by magic. There are no solutions that take all the burden off your shoulders and eliminate the need for hard work, dedication and perseverance. And yet, clearly some weight loss solutions succeed much more often than others. Diets, by and large, do not work. But what do we mean by “diets”?

Generally, what we mean by diets are temporary changes in one’s nutritional intake that result in a significant calorie intake reduction. There are numerous published diets, fad diets, and many personalized diets that individuals have used before to lose five or ten pounds prior to summer season, for example. By and large, these involve eliminating certain food groups or certain subsets within the diet and, in addition, restricting calories a great deal through certain mechanisms such as simple avoidance or substitution with very narrow list of foods, like raw carrots.

Why don’t diets work? Diets don’t work because they don’t involve a plan to transition to future phases of the diet or to a maintenance program. Diets don’t work because they are not sustainable as eating behaviors beyond a very short term. Diets don’t work because they feel like deprivation and they require a high level of motivation to deprive oneself. This does not last.

And lastly, diets don’t work because they don’t involve creating the right kind of calorie intake that can result in appetite suppression, as well as maintenance of lean body mass. Nearly all diets that people try result in burning of lean body mass or protein mass to an equal or greater degree than burning of the fat mass. When the diet comes to an end, a phenomenon known as rebound weight gain occurs as a result of the hunger and nutrient deprivation experienced by the muscles. So it’s a very powerful biochemical response that leads to an even higher level of hunger and a rapid rebound weight gain.

So if diets don’t work, how can “calorie restriction” work?

Well, calorie restriction can work if it is used properly, if it involves the proper selection of foods, and if it employs the optimal techniques to avoid rebound weight gain. Let’s examine what those are:

First, calorie restriction needs to reduce carbohydrate calories. The most potent stimulus of circulating blood glucose is carbohydrate intake. The carbohydrates stimulate secretion of insulin and leptin into the bloodstream and these surges of hormones cause surges of satiety followed by equally powerful surges of hunger. Protein and fat stimulate these responses to a much less degree. It’s true that protein, and its building blocks, amino acids, do stimulate a rising blood sugar, but it is much less potent in effect than carbohydrate intake. Fats, interestingly, do not stimulate a rise in the blood sugar or insulin. So one of the keys to successful calorie restriction is to limit the carbohydrate intake and try to dampen these surges in circulating blood glucose and the hormones, insulin and leptin. You will then experience less hunger during your calorie restriction. It’s well known, for example, that people on an Atkins type diet that emphasizes protein will feel less hunger and greater satiety over the course of the yearlong dieting attempt than people who attempt to consume a low fat diet that does not restrict carbohydrates. As a result, the diet that restricts carbohydrates and allows more protein, results in somewhat greater weight loss over the course of the year. These findings have been reported in 2007 after a major national trial, and made headline news in the New York Times.

Next principle – protect lean body mass. How do you do this?Two ways:Exercise and protein and vitamin intake. So the key is to try to burn as much fat mass as possible while preserving all the muscle mass that we can. This is best accomplished by adequate intake of protein with a wide variety of amino acids, and an adequate vitamin intake.

Next, you must think of the calorie restriction as a step toward long-term weight loss and this requires developing a transition plan. Ideally, this means setting a number of weeks for the initial calorie restriction component and then having a planned transition to the next phase that is also clearly defined. We are much more likely to comply with the program if the program is clearly defined. That way we know exactly how many days we have to follow one regimen and we know exactly when the transition is to the next regimen.

Next, the calorie restriction program needs to be very well spelled out. This is one reason why meal replacement programs work so well. The “diet” is not open to discussion or debate. It is very clearly laid out for you:Meal replacement shakes and bars through the day at prescribed hours with no substitutions and no variations. Period. Simple.

As a weight reduction program prior to bariatric surgery.

Here is a role that has proven very successful for calorie restriction programs. For successful weight loss surgery to take place, it is best to optimize your condition prior to undergoing surgery. There are numerous studies indicating that if a patient loses weight prior to surgery, their outcome is improved. In addition, there is specific information about calorie restriction resulting in a very advantageous shrinkage of the liver prior to bariatric surgery. The liver shrinkage makes for less cracking and bleeding and less chance of conversion to an open operation. So a four to eight-week program of calorie restriction, ideally using meal replacements, is very helpful for the successful outcomes of weight loss surgery. And the added advantage is that the time frame is very finite. There is a clear transition to the “postsurgical diet” and a clear transition point on the date of surgery after which eating will never be the same again. The vast majority of people who lose weight with a preoperative calorie restriction weight loss program will never see those pounds again in their lifetime.

As a weight reduction “induction” program in a medical weight loss center.

Here, an individual begins his or her weight loss journey with a powerful initial induction program that consists of significant calorie restriction using meal replacements. The choices are eliminated, and a strict regimen of shakes and bars, fluids and vitamins is established. In some centers, prescription appetite suppressants are added. During this phase, the individual loses weight rapidly, usually 2-4 pounds per week. At the end of a 12 week program, a substantial weight loss has occurred. But the only way it will succeed is if the 12 weeks are used learning behaviors that will succeed for the long term. Transition to a plan of slowly introducing real foods occurs next. These real foods contain lower calories and carbohydrates than the individual was consuming under their old bad habits. The best centers teach motivational and will power techniques that enable the person to fight the hunger and stick with the healthier, lower calorie, lower carb meals and snacks. In time, the whole package of induction, behavior techniques, motivational tools, group support, prescription medications, and meal replacements come together for a person to succeed long term. It’s not magic, but it works.

So in summary, calorie restriction does work if used properly. The critical elements are to reduce carbohydrates, maintain protein, amino acid and vitamin intake, exercise is critically important to maintain lean body mass and avoid rebound weight gain. View the calorie restriction as a key step towards a long-term goal of weight loss. Define the calorie restriction time frame very clearly, whether it is four weeks, eight weeks or 24 weeks. Have a clear date on the calendar when the calorie restriction period ends and know what you are transitioning to. This is often a good time for some professional help as it is difficult to craft a healthful and effective long-term maintenance program. Calorie restriction works very well in preoperative weight loss and as a weight loss program to move off of a plateau or to reverse a relapse or period of weight gain. Meal replacements work best as they take away all the choices in the day and the opportunity for cheating or rationalizing extra calorie consumption.

What experiences have you had with calorie restriction?What has worked for you and what has failed for you?