Weight Control: Eating Right and Keeping Fit

The body mass index (BMI) is a tool that often is used to measure body fat. It is based on height and weight. To find out your BMI, you can use the online calculator at www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.

A person with a BMI of

• 18.5 to 24.9 is a normal weight
•  25–29.9 is overweight
• 30 or higher is obese

About 4 in 10 women in the United States are obese.

If you are overweight or obese, you also should measure your waist size. Extra fat in the abdomen (an "apple" shape) is a greater health risk than extra fat in the hips and thighs (a "pear" shape).

To measure your waist, stand up and place a tape measure around your middle, just above your hip bones. Take the measurement just after you breathe out. If your waist size is 35 inches or greater, your risk of certain health issues associated with being overweight is increased.

Every function of the body—from building cells to moving muscles—needs energy. Energy is measured in calories. Calories also measure how much fuel is in a certain food.

The body uses only as many calories as it needs for energy. Any calories that are left over are stored as fat in the body. Taking in more calories than you use up is the most important factor that leads to weight gain.

It is normal to gain a little weight as you grow older. You may not be as active as you were when you were younger. If you do not adjust your food intake, you may put on extra weight. Even as little as 100 extra calories a day can add up to an unhealthy weight.

Genes may affect a person’s weight directly or indirectly. Some people have genetic disorders that lead to obesity. Others are at increased risk because being overweight or obese runs in their families.

After having a baby, a woman might not lose all of the weight she gained during pregnancy. If this happens with each pregnancy, the weight can add up.

Many serious health problems are linked to being overweight or obese:

• Cardiovascular disease—The name given to a variety of conditions that involve the heart and blood vessels.
• Diabetes mellitus—A disease in which the level of glucose (sugar) in the blood is too high. In the most common type of diabetes (type 2 diabetes), the body’s cells are resistant to the effects of a hormone called insulin. Insulin is the chemical in the body that carries glucose to the body’s cells. 
• Metabolic syndrome—Both cardiovascular disease and diabetes are related to this condition. Metabolic syndrome is a combination of factors that includes high blood pressure, low levels of “good” cholesterol, a waist measurement of at least 35 inches (for women), and higher-than-normal levels of glucose and triglycerides in the blood. You have metabolic syndrome if you have at least three of these factors.
• Gallbladder disease
• Certain types of cancer, such as cancer of the endometrium, breast, colon, and gallbladder; obesity also may increase the risk of ovarian cancer.
• Sleep apnea
• Joint disease
• Infertility

Women who are overweight or obese have a higher risk of developing diabetes and high blood pressure during pregnancy than women of normal weight. Overweight or obese women also are more likely to have a cesarean birth.

If you are overweight or obese, losing weight can have many benefits for your health and well-being. Even a modest weight loss of 5 to 10 percent of your body weight can have a positive effect.

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise combined with a program of healthy eating.

Losing weight this way usually is gradual. Think of losing weight as a lifestyle change. Once you lose weight, you need to be able to keep it off. You may lose weight more quickly with a "crash" diet, but these diets are not meant to be permanent. You are more likely to gain back the weight you lost if you go on a crash diet rather than make long-term lifestyle changes.

Healthy eating should be the first step in weight loss. It is important to get the nutrients your body needs to replace worn-out tissue and to provide energy.

The MyPlate website from the U.S. Department of Agriculture (myplate.gov) can help you plan a balanced diet. It offers a diet-tracking program called MyPlate Plan that takes into account your age, sex, height, weight, and physical activity. MyPlate Plan gives you the amount you should have each day from each of these five food groups: grains, vegetables, fruits, dairy foods, and protein foods.

MyPlate makes it easy to remember what to eat at each meal. One half of your plate should be fruits and vegetables. The other half should be grains and protein foods.

Try to make at least one half of the grains you eat whole grains, such as whole-wheat bread, brown rice, or oatmeal. Eat more foods that are naturally low in fat, such as low-fat or non-fat milk, many types of fish, and leafy vegetables.

Limit your intake of processed low-fat foods. Often, low-fat cookies and chips are high in sugar and salt to make them taste good. Read food labels carefully (see below).

Eat fewer foods that are high in sugar and fat. An easy way to cut calories and to reduce the amount of sugar you eat is to avoid sugary drinks, such as soft drinks and sweetened tea.

Weight loss is not only about what you eat, but how much you eat. Portion control is key. When trying to lose weight, pay attention to the total number of calories you consume. Eat smaller amounts of all foods. For example, a 3-ounce serving of meat or poultry is the size of a deck of cards. A tablespoon of butter is about the size of a poker chip.

All packaged foods and drinks must be clearly labeled with nutrition facts. Reading all food and drink labels can help you make smart choices. The labels will tell you how many calories and the amount of nutrients that are in each serving. It helps to understand these facts on a label:

• Serving Size: The amount of the food in one serving. The information on the label refers to this amount of food.

• Calories: The amount of energy the food supplies.

• Nutrients: A list of the nutrients the product contains. Nutrients often listed here are fat (saturated and trans), cholesterol, sodium, carbohydrate (dietary fiber and sugar), and protein.

• Total Fat: The amount of fat in one serving.

• Saturated Fat: This type of fat comes mainly from meat and milk products. It tends to be solid when chilled—like butter and lard, for instance. Shortening, palm oil, and coconut oil also are saturated fats.

• Trans Fat: This is a kind of saturated fat. Trans fat is made when liquid oil is turned into solid fat like shortening and hard margarine. This is done to make foods last longer and give them better flavor. Vegetable shortenings, some margarines, crackers, cookies, and snack foods like potato chips contain trans fat.

• Total Sugars: The amount of sugars in one serving. This includes sugars found naturally in foods and drinks, such as sugar in fruit or milk, and any sugars added to the product.

• Added Sugars: Added sugars are put into food or drinks when they are made. Added sugars include table sugar, syrups, honey, sucrose, dextrose, and sugars from concentrated fruit or vegetable juices.

• Percent Daily Values: The percentage of nutrients this product provides based on a total daily diet. Daily values are the recommended amounts of nutrients to consume or not to exceed each day. These values are based on a diet of 2,000 calories.

Find more tips from the U.S. Food and Drug Administration (FDA) on how to understand and use food labels.

Regular exercise has many benefits. It promotes general health, increases mental well-being, and helps you maintain a healthy weight. Your endurance increases, as does your flexibility and muscle strength. Exercise can help reduce symptoms of depression and anxiety in some people. Your risk of heart disease, colon cancer, and diabetes decreases with regular physical activity.

People who have lost weight and kept it off generally get 60 to 90 minutes of moderate intensity activity on most days of the week. You do not have to do this all at once. For instance, you can exercise for 20 to 30 minutes three times a day.

It may be a good idea to talk with a health care professional before starting an exercise program. If you are obese, pregnant, older than 50, or have a medical condition and have not exercised for a while, you definitely should discuss how to ease into a safe exercise program.

Getting enough physical activity does not mean that you have to join a gym or play a sport. Brisk walking is an easy and inexpensive way to be physically active. It also is a good way to lose weight. According to a large study of people who have lost weight and kept it off, walking was the most frequently reported exercise.

Moderate activities are those in which your breathing and heart rate are faster than normal but you can still have a conversation:

• Walking briskly (a 15-minute mile) or hiking

• Light yard work (raking or bagging leaves or using a lawn mower)

• Actively playing with children

• Biking (less than 10 mph)

Vigorous activities are those in which your heart rate is even higher and you are breathing too hard to have a conversation:

• Jogging or running

• Swimming laps

• Most competitive sports (football, basketball, or soccer)

Read Staying Active: Physical Activity and Exercise for more advice.

Many women report that it is hard for them to lose weight. No matter how much they cut down on their food intake and how much they exercise, they still cannot seem to shed the extra pounds. What is going on? Experts looking into this problem have proposed several different reasons for why weight loss may be difficult for some women:

• Lack of sleep. Getting less than 6 to 8 hours of sleep a night may be linked to higher levels of body fat.

• Your body’s set point. Some research suggests that the body regulates the amount of fat that is stored to stay within a certain weight range—the so-called "set point." When you eat fewer calories than you usually do, you lose weight. However, once you stop eating fewer calories, you regain the lost pounds and return to your original weight. The set-point idea often is used to explain why dieting is not a good strategy for permanent weight loss.

• Loss of muscle. As we age, we tend to lose muscle. Muscle burns calories at a faster rate than fat. As muscle is lost, calories are burned more slowly. If you do not take in fewer calories as you approach midlife, you may gain weight.

• Hormones. The female hormones estrogen and progesterone may influence how fat is stored and distributed in the body. Hormones that control appetite also have been discovered. Levels of these hormones may be influenced by the type of food that is eaten and at what time of day it is eaten.

Talk with your health care professional if you are having trouble losing weight and keeping it off. You also can try one or more of the following strategies:

• Do not start a diet that you cannot realistically stick with for the rest of your life. If you plan only to follow a certain plan until you lose weight and then return to your "normal" way of eating, you may find yourself regaining all of the weight that you lost.

• Vary your fitness routine. Alternate exercise that builds endurance, like fast walking or cycling, with exercise that builds muscle mass, such as weight training.

• Get at least 8 to 9 hours of sleep a night.

• Instead of reducing portions of all foods, eat larger portions of foods that are low in calories, such as vegetables, salads, and broth-based soups, and smaller portions of high-fat, high-sugar, and high-calorie foods, such as french fries, desserts, and fatty meats. Eating a salad before a meal can help satisfy your hunger and reduce the number of calories that you take in. Using MyPlate can help you identify where you could add more low-calorie foods and where you could cut back on high-fat and high-sugar options.

Keeping the lost weight off may be harder than losing it. Maintaining a healthy weight requires a lifelong commitment to good nutrition and exercise. You need to make healthy food choices, eat moderate portions, and build physical activity into your daily life.

Most people who lose weight and keep it off stick to a low-fat, low-calorie diet. They also keep up a high level of physical activity. The following strategies also may help you maintain your weight loss:

• Eat breakfast every day.

• Weigh yourself at least once a week.

• Watch fewer than 10 hours of television per week.

• Exercise on average 1 hour per day.

For some people, it may be hard to lose weight through diet and exercise alone. If you have a BMI greater than 30, or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, medications may be able to help you lose weight. These medications should be combined with a healthy eating plan and regular physical activity.

There are several types of government-approved weight-loss medications available by prescription. They each work in different ways in the body and have different side effects. Talk with your health care professional about the type of medication that is best for you and how to manage side effects.

If diet and exercise do not work, a special type of surgery, bariatric surgery, may be an option for people who are very obese (a BMI of 40 or greater) or who have a BMI between 35 and 39 and also have major health problems caused by obesity. Bariatric surgery can result in significant weight loss. This may decrease the risk of the serious health problems associated with obesity.

Bariatric surgery can be divided into two main types:

1. Restrictive surgeries—Surgeries that reduce the amount of food the stomach can hold

2. Malabsorptive surgeries—Surgeries that change the way food is absorbed through the intestines

Each type of surgery has different benefits, risks, and success rates, which you should discuss in detail with your health care professional. Weight loss with restrictive surgery tends to be slow and steady, while weight loss with malabsorptive surgery may be more rapid and significant.

The risks of bariatric surgery may include the following:

• Leaking of stomach juices into the abdomen

• Injury to other organs, such as the spleen

• Wearing away of the band or staples used in the surgery

• Infection

• Complications from anesthesia

• Death

This surgery may have long-term effects on your body, such as changes in bowel habits and eating patterns. You should not have this surgery unless you are committed to making lifestyle changes, including restricting your diet and exercising regularly. You may need to take vitamin and mineral supplements, such as vitamin B12 and iron, for the rest of your life.

You should delay getting pregnant for 12 to 24 months after having bariatric surgery, when you will have the most rapid weight loss.

Anesthesia: Relief of pain by loss of sensation.

Bariatric Surgery: Surgical procedures that cause weight loss. These procedures are used to treat obesity.

Body Mass Index (BMI): A number calculated from height and weight. BMI is used to determine whether a person is underweight, normal weight, overweight, or obese.

Calories: Units of heat used to express the fuel or energy value of food.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.

Cholesterol: A natural substance that is a building block for cells and hormones. This substance helps carry fat through the blood vessels for use or storage in other parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. The gene is the basic unit of heredity and can be passed from parent to child.

Glucose: A sugar in the blood that is the body’s main source of fuel.

High Blood Pressure: Blood pressure above the normal level. Also called hypertension.

Hormone: A substance made in the body that controls the function of cells or organs.

Infertility: The inability to get pregnant after 1 year of having regular sexual intercourse without the use of birth control.

Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.

Metabolic Syndrome: A combination of problems that can lead to diabetes and heart disease. These problems include high blood pressure, waist size of 35 inches or more (in women), higher-than-normal blood sugar level, lower-than-normal levels of "good" cholesterol, and high levels of fats in the blood (triglycerides).

Nutrients: Nourishing substances found in food, such as vitamins and minerals.

Ovarian Cancer: Cancer that affects one or both of the ovaries.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

Sleep Apnea: A disorder that causes interruptions of breathing during sleep.

Triglycerides: A form of body fat found in the blood and tissues. High levels can cause heart disease.