Weight Loss in America Today
It is no news flash that weight loss is a major focus in the minds of many Americans. From weight-loss programs to exercise videos and low-fat/low calorie foods, losing and gaining weight has become somewhat of a national pastime. Young and old Americans alike have become obsessed with their weight, but all too often the focus is based solely on looks rather than health. Certainly, looking good and feeling good about oneself are important. After all, good health includes not only a healthy body, but also a healthy attitude.
Unfortunately, society has placed more emphasis on body weight than any other component of health or wellness. Granted, excess body fat is a health concern and obesity is associated with many major diseases including heart disease, stroke, hypertension, cancer, and diabetes. However, people too often assume that being thin is equated with good health and likewise, being overweight is associated with poor health. Such assumptions could not be farther from the truth.
Weight Loss versus Weight Management
Lately, the goal of obesity management has been refocused from weight loss to weight management. Weight management focuses on achieving the best possible weight in relationship to overall health.
Traditional weight loss programs based on restrictive diets and unrealistic weight goals have largely been shown to be unsuccessful. The majority of people who lose weight on restrictive diets tend to regain the weight lost. The failure to produce lasting weight loss and the negative effect on self-esteem that often accompanies repeated failures have led health care professionals to focus on optimizing health rather than weight loss.
Everyone can benefit from weight management. For some, weight management may translate into the need to lose weight. If losing weight is the goal, the focus is on a small, maintainable weight loss that can have a significant effect on improving one’s health. A modest weight loss, even if a person is still overweight, can improve diabetes control, and reduce the risks of heart disease by lowering blood pressure and blood cholesterol.
For others, weight gain or stabilizing weight may be the goal of weight management. Maintaining a stable weight can help prevent the upward increase in weight that often occurs with aging or yo-yoing weight that may occur from going on and off restrictive diets. Whatever the goal, the guidelines for weight management can last a lifetime.
Assessing body weight can be somewhat tricky. Although it may seem relatively simple to step on a scale, in reality, body weight in itself is not a good indicator of health risk. A person can be overweight according to the values on height and weight tables and yet their weight may not be a health risk. Body builders who have a great deal of muscle mass are good examples of such individuals. At the same time, some people can get a false sense of security from a height and weight table if their weight falls within the desired range, but a large percent of their body weight is fat. The real issue is the amount of body fat, not the weight itself.
Body mass index (BMI) is a tool commonly used to evaluate health risk. BMI is defined as weight (in kilograms) divided by height (in meters) squared.
BMI = weight (kilograms) / height (meters)2
BMI is used to determine if a person may be at health risk due to excessive weight. A BMI from 18.5 up to 25 is associated with a healthy weight. A BMI from 25 up to 30 is an indication of overweight. A BMI of 30 or higher is an indication of obesity and increased health risks (see Body Mass Index Table).
For persons with a BMI greater than 25, a realistic weight loss goal would be to decrease body weight by 1 or 2 BMI units (10 to 15 pounds) to reduce disease risk and improve health. While this may seem small, a loss of 1 to 2 BMI units can significantly improve health, even if a person is still overweight.
A realistic weight loss goal also needs a realistic time frame. Recommended weight loss is slow, not more than 1/2 to 2 pounds per week. Recommendations are to maintain a decrease of 1 to 2 BMI units for 6 months or more before trying to lose any additional weight.
Basic Weight Management
For “healthy” individuals, weight management is a matter of “calories in” verses “calories out.”
- If "calories in” are the same as “calories out,” then weight remains stable.
- If “calories in” are less than “calories out,” then weight loss occurs.
- If “calories in” are greater than “calories out,” then weight gain occurs.
As one might expect, “calories in” is determined by the amount of calories a person consumes through the foods they eat and the beverages they drink.
“Calories out” is made up primarily of the calories expended by a person’s basal metabolism, physical activity, and the thermic effect of food (calories used for the digestion, absorption, and metabolism of food). People have little control over their basal metabolism. However, when a person gains muscle through a regular physical activity program their basal metabolism will increase because muscle burns more calories than fat. Choices made about physical activity can influence the “calories out” portion of the equation.
Weight management includes a lifelong commitment to a healthy lifestyle, and should be viewed as an on-going process. Weight management redirects attention to achieving and maintaining good health by focusing on:
- Healthy Eating
- Physical Activity
The first component of weight management deals with healthy eating. No food plan is magical and no specific food must be included or avoided. The best dietary recommendation is to follow the guidelines set forth by the USDA MyPlate Plan. The USDA MyPlate Plan encourages eating a variety of foods from the USDA MyPlate Plan food groups.
A modest reduction in calorie intake may be recommended for weight loss. However, severely restricting calories can be counter productive. Calorie intake needs to provide adequate nutrition without being excessive. There are about 3,500 calories in one pound of body fat. Thus, to lose one pound, your calorie intake needs to be 3,500 less than your calorie expenditure. A modest reduction of 500 to 1,000 calories per day from your normal daily calorie needs, but not going below 1,200 calories per day is recommended for weight loss. This would result in about a 1 to 2 pound loss per week. Adequate nutrition is difficult to achieve on fewer than 1200 calories a day and most healthy adults should not consume less than this amount.
Lowering calorie intake does not mean restricting food intake. Calories can be lowered by limiting foods high in fat and added sugars, making lower fat choices from foods in the main USDA MyPlate Plan food groups, and using low-fat preparation methods. Another way to lower calories is to adjust portion size. Try using one teaspoon of margarine instead of two, or having one cookie instead of three.
Although underweight is a less prevalent problem than overweight, for some people the struggle to gain weight is as difficult as weight loss is for others. Some healthy weight gain strategies are to eat regular meals, eat larger portions, eat extra snacks and beverages and increase physical activity to build muscle. A person will gain weight by increasing calories alone, but it will be mostly body fat.
The second component of weight management is to increase physical activity. Regular physical activity is a great way to increase the amount of calories expended, and aerobic activity is one of the best. With aerobic activity you can burn calories and at the same time receive the cardiovascular benefits.
The Physical Activity Guidelines for Adults is at least 150 to 300 minutes of moderate-intensity physical activity a week, or 75 to 150 minutes of vigorous-intensity physical activity, or an equivalent combination of moderate and vigorous-intensity physical activity. Some people may need to consult with a healthcare provider before participating in physical activity. Activities to maximize calorie expenditure should be those that are lower intensity, but performed for a longer period of time. This is one reason that walking is promoted so much for individuals interested in losing weight.
As individuals become active on a regular basis there may be an initial increase in body weight on the scales. This small increase is the result of a slight increase in muscle mass. Individuals who try to lose weight without physical activity may lose weight slightly faster at first; however, such weight loss comes not only from a loss of body fat, but also muscle mass, which is not good for overall health.
Muscles burn more calories than fat. So the more muscle someone has, the more calories they will burn throughout the day. The person who is physically active may see a more gradual change in weight, but it is a more healthy change. Physical activity helps reduce the amount of fat and at the same time tone and strengthen muscles.
Physical activity is also beneficial for persons who want to gain weight. Strength training in particular helps build muscle mass so that weight gain comes from both muscle and body fat.
Physical activity also provides psychological advantages. Physical activity helps you feel and look healthy and thus can improve self-esteem. Feeling good about oneself can help motivate a person to stay with their weight management plan.
Before You Begin
A healthy approach to long-term weight management is based on three key concepts.
- Change should be slow and gradual.
- Look for changes that will last.
- Weight management is an on-going process.
The first concept is that any change that is going to last should be slow and gradual. Rapid weight loss is more likely to lead to a rapid regain of the weight. Losing weight very quickly often involves very low calorie diets with little or no physical activity. These attempts have been repeatedly shown to fail because the very low calorie diets are not practical for long-term health changes.
A second concept to keep in mind is that people get motivated to lose weight, but often their so-called “will power” wears down. For example, a person may be highly motivated to make weight changes because of a New Year’s resolution or an up-and-coming social event, but soon afterwards find they are right back where they started. Such occurrences leave the individual feeling frustrated and defeated. There is nothing wrong with using specific events as incentive to make weight changes, but look for changes that will last.
Weight management should be viewed as a process. The person who has not been doing any regular activity should not decide to go out one day and run 10 miles, but rather should gradually work toward being able to accomplish such a feat. Likewise, the person interested in losing or gaining weight should not expect to suddenly change their weight. Healthy weight management will take time.
Practical Tips for Weight Management
- Patience: Remember slow gradual change will provide the results that last. Recommended weight loss or weight gain is slow, not more than 1 to 2 pounds per week.
- Apply the “90% Rule:” Make the right choices most of the time. Do not expect you will always eat the right foods and do the right amount of physical activity. Give yourself a break and make the healthy choice 90% of the time.
- Avoid going “on” or “off” a diet: Weight management is an on-going process, not one that is started or stopped. Make changes that will fit into your lifestyle.
- Set realistic goals: Be realistic with yourself and set goals you can be happy with on a long-term basis. Your “ideal weight” may or may not be a realistic goal.
- Steer clear: Steer clear of weight loss programs that recommend the use of drugs, excessive vitamin/mineral supplements, fiber, herbs, enzymes, or other products.
- Include favorite foods: Learn how to include favorite foods into a healthy eating plan to avoid feeling deprived and developing cravings that can lead to over eating.
- Never get “too hungry:” It is better to plan a healthy snack than to wait until hunger replaces resolve.
Whitney, E.N. & Rolfes, S.R. (2015). Understanding Nutrition, 14th ed., Wadsworth, Cengage Learning, Belmont, CA.
Brown, J.E. (2014) Nutrition through the Life Cycle, 5th ed., Cengage Learning, Stamford, CT.
United States Department of Agriculture. Dietary Guidelines for Americans 2015-2020.
United States Department of Agriculture. ChooseMyPlate.gov. Accessed at www.choosemyplate.gov
United States Department of Health and Human Services. 2018. Physical Activity Guidelines For Americans. 2nd ed.
Janice R. Hermann, Ph.D., RD/LD
Brenda J. Smith, Ph.D.