Prepare for Weight Loss

"Hmm . . . Maybe I should do something about this weight. But what?"

So, you’ve finally decided to lose that extra fat weight that has crept up over the last few years, or longer.  Permanent weight loss is not easy and can’t be done on a whim.  Success requires careful forethought.  That’s why I’ve written this eight-part series.

Questions beg for answers.  For example . . .

Which of the myriad weight-loss programs will I follow?  Can I design my own program?  Should I use a diet book?  Sign up for Nutri-System, Weight Watchers, or Jenny Craig?  Should I stop wasting my time dieting and go directly to bariatric surgery?  Can I simply cut back on sodas and chips?  What should I eat?  What should I not eat?  Do I need to start exercising?  What kind?  How much?  Do I need to join a gym?  What methods are proven to increase my odds of success?  How much weight should I lose?  Should I use weight-loss pills or supplements?  Which ones?  What’s the easiest, most effective way to lose weight?  Is there a program that doesn’t require willpower?  Now, what were those “top 10 super-power foods” that melt away the fat?  Am I ready to get serious and stick with it this time.

This series will answer many of these questions and get you teed up for success.  Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course.  Take 10 minutes to read the following articles.  The time invested will pay dividends for years.

Part 1:  Motivation

Immediate, short-term motivation to lose weight may stem from an upcoming high school reunion, swimsuit season, or a wedding. You want to look your best. Maybe you want to attract a mate or keep one interested. Perhaps a boyfriend, co-worker, or relative said something mean about your weight. These motivators may work, but only temporarily. Basing a lifestyle change on them is like building on shifting sands. You need a firmer foundation for a lasting structure. Without a lifestyle change, you are unlikely to vanquish a chronic overweight problem.  Proper long-term motivation may grow from:

  • the discovery that you feel great and have more energy when you are lighter and eating sensibly
  • the sense of accomplishment from steady progress
  • the acknowledgment that you have free will and are responsible for your weight and many aspects    of your health
  • the inspiration from seeing others take charge of their lives successfully
  • the admission that you have some guilt and shame about being fat, and that you like yourself more when you’re not fat  [I’m not laying shame or guilt on you; many of us do it to ourselves.]
  • the awareness of overweight-related adverse health effects and their improvement with even modest weight loss.

Appropriate motivation will support the commitment and willpower that will be needed soon.

PS: I’m thinking of how Dave Ramsay, when he’s counseling people who have gotten way overhead in debt, tells them they have to get mad at the debt.  Then they can attack it.  Maybe you have to get mad at your fat.  It’s your enemy, dragging you down, trying to kill you.  Now attack it!

Part 2:  The Energy Balance Equation

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?”  Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good?  Only one, but…

Where does the fat go when you lose weight dieting?  Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.  Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue.  So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

          minus the energy you burn in metabolism and activity,

               determines your change in body fat.  [read more]

Part 3:  Free Will

The only way to lose excess fat weight is to cut down on the calories you take in, increase your physical activity, or do both.

Oh, sure.  You could get a leg amputated, develop hyperthyroidism or out-of-control diabetes, or have liposuction or bariatric surgery.  But you get my drift.

Although the exercise portion of the energy balance equation is somewhat optional, you must reduce food intake to lose a significant amount of weight.  Once you reach your goal weight you will be able to return to nearly your current calorie consumption, and even higher consumption if you have increased your muscle mass and continue to be active.

Are you be able to reduce calorie intake and increase your physical activity temporarily? It comes down to whether we have free will.  Free will is the power, attributed especially to humans, of making free choices that are unconstrained by external circumstances or by an agency such as divine will.

Will is the mental faculty by which one chooses or decides upon a course of action; volition.

Willpower is the strength of will to carry out one’s decisions, wishes, or plans.

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control.  Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat.  The existence of free will is . . . [read more]

Part 4:  Starting New Habits

You already have a number of good habits that support your health and make your life more enjoyable, productive, and efficient.  For example, you brush your teeth and bathe regularly, put away clean clothes in particular spots, pay bills on time, get up and go to work every day, wear your seat belt, put your keys or purse in one place when you get home, balance your checkbook periodically.

At one point, these habits took much more effort than they do now.  But you decided they were the right thing to do, made them a priority, practiced them at first, made a conscious effort to perform them on schedule, and repeated them over time.  All this required discipline.  That’s how good habits become part of your lifestyle, part of you.  Over time, your habits require much less effort and hardly any thought.  You just do it.

Your decision to lose fat permanently means that you must establish some new habits, such as regular exercise and reasonable food restriction.  You’ve already demonstrated that you have self-discipline.  The application of that discipline to new behaviors will support your commitment and willpower.

Part 5:  Supportive Social System

Success at any major endeavor is easier when you have a supportive social system.  And make no mistake: losing a significant amount of weight and keeping it off long-term is a major endeavor.

As an example of a supportive social system, consider childhood education.  A network of actors play supportive roles.  Parents provide transportation, school supplies, a home study area, help with homework, etc.  Siblings leave the child alone so he can do his homework, and older ones set an example.  Neighbors may participate in carpooling.  Taxpayers provide money for public schools.  Teachers do their part.  The school board oversees the curriculum, supervises teachers, and does long-range planning.

Success is more likely when all the actors work together for their common goal: education of the child.  Similarly, your starring role in a weight-loss program may win an Academy Award if you have a strong cast of supporting actors.  Your mate, friends, co-workers, and relatives may be helpers or hindrances.  It will help if they . . . [read more]

Part 6:  Weight Goals

Despite all the chatter about how to lose weight, few talk about how much should be lost.

If you are overweight, deciding how much weight you should lose is not as simple as it seems at first blush.  I rarely have to tell a patient she’s overweight. She knows it and has an intuitive sense of whether it’s mild, moderate, or severe in degree.  She’s much less clear about how much weight she should lose.  If it’s any consolation, clinicians in the field aren’t always sure either.

Five weight standards have been in common usage over the last quarter-century . . . [read more]

Part 7:  Creative Visualization

How will your life be different after you make a commitment and have the willpower to lose weight permanently?

Odds are, you will be more physically active than you are now.  Exercise will be a habit, four to seven days per week.  Not necessarily vigorous exercise, perhaps just walking for 30 or 45 minutes.  It won’t be a chore.  It will be pleasant, if not fun.  The exercise will make you more energetic, help you sleep better, and improve your self-esteem.

After you achieve your goal weight, you’ll be able to cut back on exercise to three or four days per week, if you want.  If you enjoy eating as much as I do, you may want to keep very active physically so that you can eat more.  I must tell you that I rarely see anyone lose a major amount of weight and keep it off without . . . [read more]

Part 8:  Choosing A Program

I listed most of your weight-loss program options in the introductory comments to this series.  Now it’s time to make a choice.  And it’s not easy sorting through all the options.

Straight away, I must tell you that women over 300 pounds (136 kg) and men over 350 pounds (159 kg) rarely have permanent success with self-help methods such as diet books, meal replacement programs, diet pills or supplements, and meal-delivery systems.  People at those high weights who have tried and failed multiple different weight-loss methods should seriously consider bariatric surgery.

I respect your intelligence and desire to do your “due diligence” and weigh all your options: diet books, diet pills and supplements, bariatric surgery, meal replacement products (e.g., SlimFast), portion-control meal providers (e.g., NutriSystem), Weight Watchers, fad diets, no-diet diets, “just cutting back,” etc.  You have to make the choice; I can’t make it for you.  Here are some well-respected sources of advice to review before you choose . . . [read more]

32 responses to “Prepare for Weight Loss

  1. All and all Maintaining a healthy weight is a lifelong commitment. Fast weight loss programs don’t help people keep weight off for extended periods because they don’t teach them anything.

    Great read, thanks for sharing!

    Your in Health,

  2. Thanks for the complement, Robin.

  3. Leticia Wakely

    I’m getting ready to start the Mediterranean Diet, I had Lupus in 1996 and took cortizone but I quit taking it 1 year later and since then I’ve having problems to lose the weight I gained, right now I’m obese but I’m determined to start this diet and drop that 30 or 40 pounds I have.


  4. I’ll be rooting for you, Leticia!

  5. sam diaz

    looking for the rite diet to loose 50 to 60 lbs i am a diabetic with a kidney transplant i take so many medication. tacrolimus caps, myfortic tabs,prednisone tabs, nifedipine er xl tabs, metoprolol tartrate, clonidine hcl, lisinopri tabs, simbastatin tabs the side affect are tough but i have make it

  6. Patti Nolan

    I’m so glad I found your book! I’m just getting started on the KMDiet and I think this is going to be the right combo for me to lose the weight and get healthy. I’ve gradually put on about 50 lbs over the last 15 years. I have high cholesterol; extremely high triglycerides –on meds for both. I have an underactive thyroid–another pill. I have a family history of diabetes–including a brother on dialysis with blindness and partial foot amputation and 2 of my three sisters are insulin diabetics. I don’t want to follow but I’m fearing I’m getting close to pre-diabetes.
    I also have developed some kind of awful inflammation problem in both hips over the past year. Still running tests to find out what it is. I have some arthritis but my third orthopedic surgeon I’m in the care of tells me my cartilage is not deteriorated and I don’t have AVN. My mom had lupus so I’m going to be tested for that and also for rheumatoid arthritis. I am having difficulty doing everything–walking, stairs, standing…even laying down.
    I am woken up continually through the night with pain. It’s awful.

    How will the Ketogenic Med. Diet help with inflammation? Do you think I should be concerned about osteoporosis?

    Thanks for the feedback and the great book and website!

    • Hi, Patti. I’m sorry you’re having so much trouble.

      Most middle-aged and older women should have some concern about osteoporosis, it’s so common. But it’s rarely if ever the cause of hip inflammation/pain unless there’s a fracture.

      Being significantly overweight is linked to elevated markers of inflammation in the bloodstream. One theory is that adipose (fat) tissue, especially in the abdomen, produces inflammatory molecules that can do damage elsewhere. Losing weight by any reasonable method tends to reduce systemic inflammation. The traditional Mediterranean diet is also associated with improved markers of systemic inflammation, regardless of weight. Whether the Ketogenic Mediterranean Diet is anti-inflammatory remains to be seen. I make no claims about that. I can’t afford to run inflammatory marker labs on my patients: insurance won’t pay for many of them, in my experience. And they’re expensive. I’m talking about tests such as TNF-alpha and interleukin-6. Less expensive and more available are sedimentation rate and high-sensitivity C-reactive protein, which insurance will often cover.

      Keep after your doctors until you get a firm diagnosis. That’s the cornerstone of treatment. In any case, losing 50 lb (23 kg) should take some strain off your hips, improving pain and mobility.

      Best wishes.

  7. Peppy

    Your words are full of wisdom, and I really like what you wrote about beginning a new eating plan. However, I must take issue with your comment about getting mad at our fat. As one, who has metabolic syndrome (along with other medical issues) and who has struggled with my weight, since puberty, I don’t need to dislike my body any more than I do. For me, It “feeds” into the circle of emotional eating, guilt, emotional eating, guilt, etc. I would rather take the stance that I’m going to focus on embracing this worldly body and, in doing so, promise to take better care of it. I know that, at times, I will fall. But, I don’t want to “hate” anything about myself, be it fat or anything else.

    • Hi, Peppy. Thanks for your input.
      That “get mad at your fat” trick sure won’t work for everybody.
      It’s interesting to consider why someone ever makes a voluntary lifestyle change. One paradigm is that we’ll change when it’s more painful to continue in our old ways, than it is to change. That’s sorta what happens when an alcoholic hits rock bottom.

  8. Chelsea Boatman

    My name is chelsea boatman and i was wanting to start this diet in hope of losing 10 pounds a week. even though that may not happen i would still like to try this. My goal weight is 125 at the moment, i need to lose 32 pounds asap because summer is here and yes i have had rude comments on my weight just because im on the verge of obesity and it does motivate me in a way but being a woman, it really brings down your self esteem and ive planned a work out to do for myself in terms of losing weight and i havent lost 1 pound yet and ive been doing the workout for 3 weeks and i walk everyday. nothing is working so im going to give this a shot and hope the best 🙂

  9. susan

    Are you nuts? 10 lbs a week is a dream. I lost 30 over 3 months in 2004, and it’s 2012 and I am within 2 lbs of my original weight loss. It’s about changing habits, exercise daily, giving up diet soda, and watching those bad carbs. You have to think raw or steamed veggies, egg white (add dry onion flakes, black pepper and garlic powder for flavor), and eating nuts (Dollar Tree- affordable) instead of a candy bar. I am 5′ and weight 94 lbs. I need to drop 2 lbs for the summer. No sweat.

    Either you’re not following a good woe, or you need to find out if you have a problem. You can do it, Chelsea. I’m in my 50’s and look good in a bikini 🙂
    Drink LOTS of water. It fills you up, and your skin will love it.

    Weight Loss Cyber Hug to you.

  10. shea

    i’m excited to find this website. i am about 50lbs over weight. i’m only 5’0 so it’s definately time. i’ve been at this weight for just a few months. i was fluctuating w/in 15-20 lbs at different times, but the last 6 months i’ve put on an additional 10 lbs from where i’d been maintaing. i put the majority of my weight on during pregnancy. nursing didn’t help, my age doesn’t help, hormonal changes, and a reduction in activity…. i really believe that i have an addiction to food. especially sugar. i know i need to do something extreme, but honestly, i’m fearful that i won’t see it through. i’m the queen of yo-yo diets. the most unfortunate part is i did hcg injections/diet about 2 years ago. i lost about 30 lbs, and then have since put back on the 30 plus17 additional. i really believe that diet screwed up my metabolism, but i’m determined to loose it because i’m disgusted with myself. many things you’ve said throught out this site have spoke volumes to me. some of the most practical wisdom too. thankyou so much.
    i only have one question. how do i know how much portion wise i’m to eat of the 1st phase low-carb plan? how many nuts? how many servings of veges/protein, etc….
    thank you for your investment in so many of us.

    • shea

      i wanted to say one other thing. i’m very blessed up to this point because besides a sore back and joints, i’m very healthy. i don’t want to loose that. i have children and a life inviting me to come and join in. being overweight just doesn’t allow for that freedom so it’s time to change.

    • Hi, shea. Thanks for the compliments.

      I’m convinced that pregnancy causes long-term metabolic changes that make weight management more difficult. Lucky for men, they don’t have to deal with it. But it’s not insurmountable.

      One of the great things about very-low-carb diets is that you don’t usually have to worry about portion control too much. I usually advise eating from the approved foods list until you’re full, not stuffed. As one finally approaches her weight loss goal, sometimes portion control and active calorie counting is necessary.

      My Ketogenic Mediterranean Diet is an example of a very-low-carb diet. To see it, click here or on the appropriate page under the banner at the top of the blog. Or see this three-page PDF for most of the details and portion sizes.

      As for nuts and seeds on the Ketogenic Mediterranean Diet, I recommend 1 ounce (28 g) daily. This is the “dose” linked to improved cardiac and metabolic health.

      • shea

        wonderful! thank you for responding so quickly. i went ahead and purchased the kindle version of your book. so i’ll be reading it this week, but i’ve begun my journey today. i will plan to do the low carb phase for 2 weeks. i will assess if i can go on with it an additional week or not. if not, i’ll move on to phase two. i’ve always been a higher protein person to function affectively so i know this will work for me. thanks again and blessings!

      • I always take a blessing, shea! Best wishes.

  11. Marilyn

    Any suggestions for less “fishy” fish? I am not a seafood lover, although I have begun to eat more fish. I enjoy tuna, salmon and shrimp, but I only eat them about 1 time a week right now. I have had Panko breaded Tilapia, but I’m sure the breading will be a problem. Do you have a good website with recipes that would follow your plan? I need something quick to prepare or I won’t follow the plan. This is something that many would appreciate assistance with on this plan. Tell us what to eat while we are learning the plan. Meal plans would be great! I appreciate your help! Thanks!

    • “Fishy” fish can be a problem. I’ll confess my wife prefers I eat my canned sardines outdoors! She tolerates the smell of tuna better. Fresher fish should help. I swear sometimes I walk by the fish counter of my local supermarket and the smell is so off-putting, I can’t imaging buying their fish. Our fresh fish markets in Pensacola, Florida, never smelled that bad.

      I hope to post some recipes/eating plans within the next month.


  12. The Mediterranean Diet and regular exercise which includes cardio, yoga and muscle building have been instrumental in a healthy life style and body for me. I really like that you have included Creative Visualization (Part 7) ~ it gives your body and mind a goal or “final picture”.

  13. Marcy

    I will use 1oz of almond flour and an egg to coat fish and sautee’ it in olive oil.

  14. Barbara

    what would 5% carbs equate to?

  15. Barbara

    I am trying to figure out where is the day-to-day Meal Plan on the Ketogenic Mediterranean Diet. My Dr. gave me the 3 page Diet. What food items do you eat with other food items? My Dr. only wants me to consume 5% Carbs, 25% Protein, 70% Good Fats and to Low Cholesterol.
    Help please!

  16. Very Informative!! Thank You for your Tips will definitely give it a try.

  17. leo

    My aunt sent me to this web blog cause I’ve been trying to loose some weight. Your blogs are awesome. You guys should not stop posting. How do i make sure I get notified with the latest blogs?

  18. Thanks doc for this informative post. I recently found your blog and am reading the posts that interest me. I am always interested in weight loss even though I never seem to lose any, LOL. So I was curious on what goal I should shoot for, but that link is broken. Anyway the rest of the post was very useful and thanks for this.

  19. These are the things you need to know before when planning to loose weight. Very helpful and you have shared information that really could up the sustainability and success of loosing weight.

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