e're not the same people we were 5, 10, or 15 years ago. That's because for more than a few of us, we're tipping the scales at 5, 10, or 15 pounds more than we did back then.

It's not surprising; most of us live in lands of plenty. We can eat what we want when we want. And often what we want is not all that good for us: fast foods, highly processed and refined foods, and foods loaded with "hidden" sugar, salt, and preservatives. All these-and many others-can conspire to add inches to our physiques in ways that are not at all complimentary.

In most industrialized countries obesity is a fitting symbol of the excesses of our twenty-first-century lifestyles. Never before in recorded history have so many been so seriously overweight. In fact, only during the past 200 years has the industrialized world had the necessary abundance of food to make obesity a possibility.

The truth is that most of us carry around more pounds than we need for optimum health. Today the average American adult is 18 percent overweight,¹ with 24 percent of males and 27 percent of females weighing 20 percent or more above medically recommended weight (the standard definition of obesity).² In industrialized and developing countries obesity currently ranks among the top five global health problems.³

It would be a mistake to assume, however, that the overindulgence that characterizes obesity is totally voluntary. This is a problem that goes far beyond simple self-control. Highly motivated people can see significant progress in losing weight in the short term. But within three to five years about 95 percent of them will be at or above their previous weights. Dieting has become a national pastime, but unfortunately it is often no more than a temporary fix as long as we're held by old habits and careless lifestyles.

Get With the Program
Anyone interested in losing weight needs to do more than just restrict calories. The following suggestions for weight loss and maintenance are based on current research. Some of these recommendations are more strongly supported than others, but for each there is sufficient scientific evidence to warrant its inclusion in the list.

Experience has shown that behavior change is more likely to be successful when multiple strategies are employed. Those who employ all or most of these strategies will be more likely to succeed than those who try only one or two. Likewise, these strategies must never be regarded as temporary, to be discarded as soon as a desired weight or dress size is achieved. Instead, they are intended as permanent lifestyle changes that must become part of one's daily routine.

1. Limit fat intake. It's a sad fact of nature that the body is far more efficient in storing dietary fat than it is in converting the fat already stored into energy. Fat contains more than twice as many calories per gram as proteins and carbohydrates. This makes it very easy to overeat foods that contain high levels of fat.

This is further complicated by the fact that foods high in fat provide the least satiety value-it takes more high-fat foods to feel full.⁴ These two factors-high caloric density and low satiation response-make it almost inevitable that overeating will occur when high-fat foods are available.

The biggest culprit by far is fast food. When an average meal at a fast- food restaurant (double cheeseburger, large fries, and a milk shake) contains nearly as many calories as one person requires in a day (most of them from fat), more than one fast-food meal a week is bound to result in more fat stored around one's middle.

Once an acceptable weight has been achieved, the amount of fat should be increased to between 20 percent and 25 percent of total calories eaten during the day (40 to 60 grams). When fat intake is held to the required level it will be necessary, by default, to increase markedly the intake of carbohydrates that come from complex carbohydrate sources (such as fruits, whole grains, and vegetables), rather than from highly processed foods.

2. No foods are off-limits. Beyond the distinctions between clean and unclean foods outlined in the Bible (Lev. 11), it is important to counter the concept that some foods are always "good" while others are always "bad." A judicious use of the guideline of a maximum of 20 grams of fat per day for weight loss and 20 to 25 percent of total calories from fat for weight maintenance will allow the eating of virtually any food-as long as it is eaten in moderation. Low-fat and low-calorie foods are neither if multiple servings are consumed.

3. Eat at least 10 grams of dietary fiber with each meal. Eating an apple is more helpful in losing weight than drinking a glass of apple juice. Why? Because the apple has fewer calories than the juice, and the fruit itself adds more to the feeling of fullness. And research has shown that fiber delays the release of glucose into the circulatory system, thus blunting the glycemic response.⁵ This in turn reduces the likelihood of fat storage.⁶

4. Drink eight ounces of fruit juice 30 minutes before each meal. Research indicates that a glass of juice-orange, apple, cranberry, anything containing fructose-results in eating fewer calories and less fat at mealtimes.⁷ But only real fruit juice works. Many fruit-flavored drinks (Tang, Kool-Aid, Sunny Delight, etc.) contain very little fructose.

5. Eat a significant breakfast. Breakfast is just what its name implies, the breaking of an overnight fast. After 10 to 12 hours without food, breakfast fills the important role of providing the body with its initial source of energy for the day. In a study of moderately obese women Vanderbilt University researchers found that women who ate breakfast ate less fat, more carbohydrates, and had a better, balanced diet throughout the day. In the study they also ate fewer unplanned, impulsive snacks.⁸

6. Establish regular mealtimes. Regular mealtimes allow the body to anticipate incoming calories and adjust its metabolism accordingly. Dividing the daily caloric content among at least three meals seems to be important in maintaining a proper weight.⁹ If too long a time elapses between meals (as when a meal is skipped), binge eating is often the sad result.¹⁰

7. Avoid drinking fluids with meals. Researchers have noticed that when water or other fluids are taken with a meal, the amount of food eaten tends to increase.¹¹ The moistening effect of the fluid seems to make the food more palatable, thus increasing the likelihood of overeating.

8. Abstain from alcoholic beverages. Alcohol contains seven calories per gram, making it considerably more dense than carbohydrates and proteins (4 calories per gram) and only slightly less dense than fat (9 calories per gram). And studies show that alcohol makes fat calories more likely to be stored as fat tissue.¹² In controlled settings individuals burned about one third fewer fat calories when they consumed alcohol.¹³ In addition, those who use alcohol most often seem to store it where most of us want it least: around our waist, the place where obesity carries the greatest health risks.¹⁴

9. Do not eat after 6:00 p.m. Our normal circadian body rhythms slow our metabolic rates during the nighttime hours. Food ingested just prior to, or during, this period is more likely to be stored as fat since it is not needed immediately for energy. When obese subjects were fed a single low-calorie meal either as an 8:00 a.m. "breakfast" or as a 5:00 p.m. "dinner," the breakfast eaters lost substantially more weight.¹⁵ For purposes of losing weight and maintaining an ideal one, a light evening meal (fruit, crackers, popcorn, bread, etc.) is preferred over a heavy one (entr�e, vegetable, salad, dessert, etc.).

10. Do 30 minutes of aerobic exercise each day. While mild aerobic exercise has only a minimal effect in terms of the actual number of additional calories utilized during the day,¹⁶ it is an important component of a healthy lifestyle. It keeps muscles and joints toned and pain-free. In addition, the calories burned during and after exercise tend to use more fat, helping to keep weight off once it has been lost. Exercise has the additional advantage of being a stress reducer, and it can take the place of snacking.¹⁷ To be beneficial, exercise can be as simple as taking the stairs instead of the elevator, parking the car away from the store or office and walking to the building, using a push mower instead of a self-propelled one, etc. A short walk after a meal can double the thermic effect of the meal, meaning that the body uses about twice as many calories to process the food as when you sit or lie down after a meal.

11. Do weight training each day, alternating upper and lower body workouts. Our basic rate of metabolism depends primarily on the amount of lean (muscle) tissue present. While a certain amount of lean tissue is inevitably lost during weight reduction, weight training reduces the amount of muscle loss, and skeletal muscle may actually be increased.¹⁸ When weight training is added to a low-calorie diet and aerobic exercise, weight and fat loss increase.

12. Spend at least 30 minutes a day in meditation and/or quiet relaxation. Stress elevates cortisol and insulin levels,¹⁹ which in turn have been shown to increase the rate at which fat is stored in the body.²⁰ Elevated levels of cortisol reduce the mobilization of lipid from fat cells, which makes weight loss more difficult.²¹ Chronic stress has been shown to cause increases in concentrations of both corticosteroids and insulin. These increases result in the body using energy stores to build fat rather than muscle (and more often than not the fat makes its home around the middle). A period of relaxation or meditation tends to reduce stress levels and may keep cortisol levels down, thus keeping fat from being stored around the waist and increasing the movement of lipids out of the body.

13. Get at least seven to eight hours of sleep each night. Too little sleep seems to increase the appetite. Researchers at Tufts University found that sleep-deprived people increase their caloric consumption by as much as 15 percent.²²

The human body is a remarkable mechanism, designed for years of useful activity. Just like we care for anything of value-our relationships, our cars, our homes-our health is worth the extra effort it might take to cultivate wholesome habits and seek common sense solutions for the lifestyle choices we face from day to day.

After all, this is not a dress rehearsal; this is the real deal.

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¹ A. J. Jordan, "Obesity Treatment: State of the Art," Evaluation and Treatment of Obesity (Champaign, Ill.: Life Enhancement Publications, 1984).
² The Lancet 350 (1997): 423-426.
³ J. Johnston, "Doctors Warn About an Epidemic of Obesity," Health Scout, Oct. 20, 1998.
⁴ S. H. Holt, J. C. Miller, P. Petocz, and E. Farmakalidis, "A Satiety Index of Common Foods," European Journal of Clinical Nutrition 49, No. 9 (September 1995): 675-690; B. J. Rolls, "Carbohydrates, Fats, and Satiety," American Journal of Clinical Nutrition 61, no. 4, supplement (April 1995): 960S-967S.
⁵ D. J. Jenkins and A. L. Jenkins, "Dietary Fiber and the Glycemic Response," Proceedings of the Society for Experimental Biology and Medicine 180, no. 3 (December 1985): 422, 431.
⁶ S. Y. Kimm, "The Role of Dietary Fiber in the Development and Treatment of Childhood Obesity," Pediatrics 96, no. 5, part 2 (November 1995): 1010-1014.
⁷ J. Rodin, "Comparative Effects of Fructose, Aspartame, Glucose, and Water Preloads on Calorie and Macronutrient Intake," American Journal of Clinical Nutrition 51, no. 3 (March 1990): 428-435.
⁸ D. G. Schlundt, J. O. Hill, T. Sbrocco, J. Pope-Cordle, and T. Sharp, "The Role of Breakfast in the Treatment of Obesity: A Randomized Clinical Trial," American Journal of Clinical Nutrition 55, no. 3 (March 1992): 645-652.
⁹ J. LeBlanc, I. Mercier, and A. Nadeau, "Components of Postprandial Thermogenesis in Relation to Meal Frequency in Humans," Canadian Journal of Physiology and Pharmacology 71, no. 12 (December 1993): 879-883.
¹⁰ S. Ledoux, M. Choquet, and R. Manfredi, "Associated Factors for Self-reported Binge Eating Among Male and Female Adolescents," Journal of Adolescence 16, no. 1 (March 1993): 75-91.
¹¹ I. Ramirez, "Feeding a Liquid Diet Increases Energy Intake, Weight Gain, and Body Fat in Rats," Journal of Nutrition 1, no. 17, (1987): 2127-2134.
¹² J. P. Flatt, "Body Weight, Fat Storage, and Alcohol Metabolism," Nutritional Review 50. no. 9 (September 1992): 267-270.
¹³ P. M. Suter, Y. Schutz, and E. Jequier, "The Effect of Ethanol on Fat Storage in Healthy Subjects," New England Journal of Medicine 326, no. 15 (Apr. 9, 1992): 983-987.
¹⁴ F. M. Berg, "Alcohol Promotes Fat Storage," Obesity and Health, November/December 1993, pp. 107, 108.
¹⁵ J. C. Chan and F. C. Bartter, "Weight Reduction: Renal Mineral and Hormonal Excretion During Semistarvation in Obese Patients," Journal of the American Medical Association 245, no. 4 (1981): 371-373.
¹⁶ G. G. Blix and A. G. Blix, "The Role of Exercise in Weight Loss," Behavioral Medicine 21 (1995): 31-39.
¹⁷ J. S. Raglin, "Exercise and Mental Health: Beneficial and Detrimental Effects," Sports Medicine 9, no. 6 (1990): 323-329; J. B. Dyer and J. G. Crouch, "Effects of running and Other Activities on Moods," Perceptual and Motor Skills 67 (1998): 43-50.
¹⁸ J. E. Donnelly, T. Sharp, J. Houmard, M. G. Carlson, J. O. Hill, J. E. Whatlet, and R. G. Israel, "Muscle Hypertrophy With Large Scale Weight Loss and Resistance Training," American Journal of Clinical Nutrition 58 (1993): 561-565.
¹⁹ A. Hart, Adrenalin and Stress (Waco, Tex.: Word Books, 1986), p. 38.
²⁰ F. M. Berg, "Risks Focus on Visceral Obesity May Be Stress-linked," Obesity and Health, September/October 1993.
²¹ M. Ottosson, P. Lonnoth, S. Eden, and P. Bjorntorp, "Differential Effects of Cortisol and Growth Hormone on Lipolysis in Human Adipose Tissue," International Journal of Obesity, supplement 5, abstract P92 (1995).
²² Tufts University Diet and Nutrition Letter 12, no. 9 (1994): 1, 2.

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Glen Blix is an associate professor of health promotion and education at the School of Public Health, Loma Linda University.