What doctors from the nation's top weight loss clinics want you to know as you start eating right, working out, and losing weight for good
By: Hollis Templeton
Going at weight loss alone is like independent study. Yes, it can be done, but it’s much easier—and more enjoyable—when there’s someone standing right in front of you, providing knowledge, guidance, and feedback on your performance.
For some, the ultimate ally is a weight loss clinic. There, teams of medical doctors, psychologists, nutritionists, and fitness instructors coach you through the process, helping you select an individualized approach to weight loss and adopt healthy eating and exercise habits, and strategizing on ways to keep the weight off once you start to see results. (Search: Weight loss success stories)
Unfortunately, not everybody has access to one of these comprehensive, state-of-the-art programs, which often take place at clinics located in large metropolitan areas. Plus the programs are pricey—they range in cost from several hundred to several thousand dollars per month. And fees vary widely, depending on program type, length of treatment, and whether or not there is a residential or rehabilitation component. Some health insurance providers will chip in, but don’t assume they will pick up the tab.
To give you the inside scoop on what works when it comes to taking off the weight for good, we spoke with physicians and coaches at weight loss centers across the country and rounded up 21 tips that can help you start—or finish—your weight loss journey and maintain your ideal weight.
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You know the old saying “A journey begins with a single step,” but sometimes that first foot on the ground—or into a sneaker—can be the hardest one you take. Still, wanting to lose weight and being ready to make healthy lifestyle changes are parts of the equation too. “A healthier life begins the day you decide that you are going to align your actions with your intentions,” says Aruni Nan Futuronsky, who leads the Integrated Weight Loss program at the Kripalu Center for Yoga & Health in Stockbridge, MA. “Weight loss starts not when you lose 1 pound, but when you make a decision to go to bed earlier or eat a healthier meal.”
Try these five strategies when embarking on a new weight loss goal:
Devise your own plan. At the Johns Hopkins Weight Management Center at Johns Hopkins University in Baltimore, MD, lead dietitian Katrina Seidman, RD, uses a technique called “motivational interviewing” to help clients formulate weight loss plans and healthy habits that they can—and will want to—stick to. “You’re not so much telling people what to do or teaching people what to do,” she ways. “You’re getting a person to formulate and create and decide what changes he or she wants to make and how to proceed.”
Seidman and her staff ask questions like, “What do you think you could do to avoid grabbing a bag of chips for your nighttime snack?” A patient’s response is used as a guide toward making a healthy change (e.g., "I always eat chips when I watch television, so I’m going to try taking a walk after dinner instead of sitting down with the remote.”) “If the suggestion comes from the patient, it has much more value and it is more likely to be followed,” says Seidman.Share your goals. “When we talk to others, we get perspective,” says Futuronsky. “When left to our own devices, it’s kind of difficult to get a realistic sense of what is true.” She advises talking to a friend, family member, or coworker, or writing in a journal. Start with broad statements, like “What I want in my life is…” and “My commitment to myself is…” Then boil things down to what you can do now: Jot down “What I’m willing to do today is…” and fill in the blank with a healthy habit that you can stick with for the entire day, she suggests.
Immerse yourself. Jumping into a healthier lifestyle feet first can be very motivating, says Futuronsky, noting that when participants in Kripalu’s 5-day retreat-style weight loss program arrive on Sunday and start eating a whole-food diet and participating in outdoor exercise and yoga that they typically feel better by Tuesday or Wednesday. By Thursday they are beaming and by Friday they are profoundly motivated because they are not clogged with processed foods, caffeine, and sugar and have spent the past week participating in daily physical activity, she explains. Still, it’s important to bear in mind that achieving your ultimate goal will take time and that small changes made over time will pay off (more on that below).
Acknowledge intermediate achievements. When setting a weight loss goal, there’s often a disconnect between how much weight someone wants to lose and what amount of weight loss could improve that person’s health, says Lawrence Cheskin, MD, director of the Johns Hopkins Weight Management Center. The CDC states that even modest weight loss of 5 to 10% of your total body weight (a 200-pound individual would need to drop 10 to 20 pounds) can produce lower blood pressure, blood cholesterol, and blood sugar. Still, many patients are not satisfied with losing only 10 pounds. “When setting goals, keep in mind that you can get benefits from intermediate weight loss too,” says Cheskin.
Don’t make promises you can’t keep. Adopting an all-or-nothing attitude can put you on the fast track to failing a weight loss strategy. It’s important to talk yourself down from overpromising (e.g., hitting the gym 7 days a week), says Futuronsky. Instead, take one day at a time, deciding what you’ll do today and acknowledging that even small bouts of activity (like 10 minutes of yoga or stretching) are better than no activity at all, she says.
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“Behavior modification involves a lot of different steps toward changing your environment and your mindset,” says Seidman, whose program kicks off with a 1-hour behavioral assessment that includes questions about one’s relationship with food, stressors, coping mechanisms, childhood weight, history of dieting, and general feelings about change. “It’s a lot of self-reflection and it’s a lot of opening up and finding out what your motivations are,” she says.
Here are tips for performing your own self-evaluation:
Examine life from every angle. Perform a brief assessment of recent life changes, suggests Cheskin. Ask yourself questions such as: Did I recently switch jobs or take on a second job? Am I under more stress? Do I have less time to prepare healthy meals and am I opting for takeout more often? Have I been ill? Am I taking a new medication that increases my appetite?
Identify food triggers, and find nonfood substitutions. “Many people with weight problems have nothing wrong with their appetite control system,” says Cheskin, explaining that emotional eating—reaching for food when you’re bored, happy, sad, and so on— is often to blame for overeating.
“If you feel hungry again at 9 p.m., ask yourself if you are actually hungry. Or is what you really want, perhaps, to talk to someone, take a bath, or sit quietly and read?” says Futuronsky. “Become aware of habitual patterns and relax around them, realigning your attention in another direction.” When nighttime hunger hits, call a friend, do stretches, or take a bath, she suggests. You’ll be practicing what Futuronsky calls “yoga off the mat”—acknowledging an emotion, like stress or loneliness (just as you take note of how your body feels in a particular yoga pose). Instead of trying to conquer it or make it instantly go away, breathe and then find a practical substitution, she instructs.Keep a food journal. Pinpoint destructive eating behaviors by documenting everything you eat either on paper or by using an online tracking tool, suggests Seidman. You’ll gain insight into why you are eating (hunger, sleepiness, stress, boredom) and become more aware of what’s in your food in terms of fat, calories, protein, sugar, and so on, she says.
Enlist the help of a therapist. “We see a lot of [people who use food to manage] anxiety, even more often than depression,” says Domenica Rubino, MD, director of the Washington Center for Weight Management and Research in Arlington, VA. If you are overeating as a result of extreme stress, anxiety, or depression, work with a therapist before starting a weight loss program, she suggests. “It’s more complicated than meets the eye, because an individual really has to figure out what the different pieces are—why he or she chooses to eat when stressed and what those stressors are, for example. When you work toward those things, sometimes weight loss naturally follows,” she says.
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Experts agree that sustainable weight loss comes from making permanent lifestyle changes, not putting yourself on a never-ending diet. “A diet is an external thing that people check off their list and then go back to their old life,” says Futuronsky. Instead of treating a diet like a temporary achievement, use these tips to make lasting changes to your eating and exercise regime:
Diet only in the beginning. If someone has a lot of weight to lose, that person may start out on a very low-calorie diet, and portion control and medical monitoring can result in weight loss of 3 to 5 pounds within 1 week, says Seidman. “This helps someone feel more motivated and ready to make changes,” she says.
Transition from a diet to a lifestyle-based approach. After a low-calorie diet, patients at the Johns Hopkins Weight Management Center transition to meal replacements and then to a food-based approach, integrating the healthy eating habits they have learned throughout the program. These include meal planning, grocery shopping, controlling portion sizes, meeting nutrition requirements, getting adequate fiber and water, cooking food at home versus eating out, selecting sensible meals when dining out, and fueling for and recovering from exercise.
Experiment with what works—and what doesn’t. Make weight loss “a conscious and mindful experiment,” says Futuronsky. Figure out what you want to do for 1 week (e.g., give up sweets, get 30 minutes of exercise each day), evaluate your success and how you feel after 7 days, and then recalibrate, recommitting to the same goal for next week or tweaking it as necessary.
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Be realistic. “Identify who you are and what’s going on with your lifestyle,” says Rubino. “Do you cook? If you don’t cook, you’re not likely to start. Look at the places you eat out and maybe pick a different one,” she says. For example, if every time you go out for Italian, you end up with a bottle of wine and dessert on the table, choose a restaurant that lets you opt for soup, salad, or steamed veggies. “The nice part is that now there’s a lot of dining information online, so you can plan your meal in advance,” Rubino says.
If you eat take-out food regularly, look for lower-calorie frozen meals instead. If you don’t mind some cooking, prepare large quantities of one dish at the beginning of the week so you’ll be less tempted to call for delivery when you have to think fast about what’s for dinner.
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Use medication only as backup. Cheskin says he turns to medication for patients only when they’ve started to go off track with a food-based plan and experience too much hunger. “We rarely start day 1 with an appetite suppressant,” he says. “People are usually pretty motivated during the honeymoon period, and we like to have something to fall back on if the initial approach falters.”
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You know breaking a sweat is essential to shedding pounds, but perhaps your idea of exercise involves a gym membership and hours of Spinning. Here are some ways to make physical activity feel less daunting:
Don’t feel like you have to run a marathon. “Incorporate physical activity every single day, even if it’s just walking,” says Seidman. Choose activities that are enjoyable, like golf, and don’t forget that activities that you don’t do at the gym or with a set of weights, like cleaning or gardening, count too. Find any way to be more active than you are now, she says.
Rubino suggests starting with two 10-minute walks each day, using them as stress relief from your work day. Typically, what happens when you integrate this into your day is that you’ll move up to two 15-minutes walks or three 10-minute walks daily, she adds.
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Roll out the mat. “You can’t lose weight if your body is flooded with cortisol and adrenaline,” says Futuronsky. “Yoga is a way to get out of being in constant fight-or-flight mode.” Research suggests that yoga lowers levels of cortisol, a hormone that increases your appetite especially for carbohydrates and sugary foods. At chronically high levels, the hormone can switch your body into fat storage mode, especially in your belly region.
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“Maintenance is a lot harder than weight loss because you don’t have the same motivation,” says Seidman. Without the reward—watching the numbers on the scale go down, receiving compliments from your friends, sliding into your “skinny jeans”—sticking to an eating and exercise plan can be tough. Follow these five tips to stay on track:
Learn to enjoy food again. If you’re transitioning from strict diet to a higher-calorie diet, try to enjoy what you are eating, advises Seidman. “In the maintenance phase, you can add a few calories here and there and indulge once in awhile,” she says. “It’s not one meal or snack that’s going to cause the weight to come back.” Just be careful not to give up when you make a mistake, she warns. Eating two pieces of birthday cake is not an excuse to give up on your diet.
Get comfortable with making healthy choices in front of friends. “You can’t lose weight and then go back to hanging out with your friends at the sports bar and drinking beer all the time, but you can do it once in awhile,” says Rubino, explaining that weight maintenance can be especially hard for young people, who may be accustomed to consuming several drinks per night when they go out. Stick to one drink and don’t be embarrassed about it, she advises.
Schedule quality sleep. “If you go to bed at 1:00 a.m., you’re not getting up at 4:00 a.m. to exercise,” says Rubino, who suggests shooting for 7 to 8 hours of slumber each night. Skimping on sleep stimulates the endocrine system and makes you eat more, she explains.
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Stay active. Data from the National Weight Control Registry, a tracking database of more than 10,000 adults who have maintained a 30-pound weight loss for at least one year, shows that if you exercise, you’re more likely to maintain weight loss, says Rubino. It’s not just about burning calories, she adds. The endocrine system signals the brain that this is the body’s new state of existence. If you maintain that state, your body composition will change, she explains.
Don’t stop self-monitoring. The key to keeping weight off is continuing to weigh yourself frequently and track what you eat, says Cheskin. “Those who have been successful in the long-term can tell you at any point in the day whether they are behind or ahead of schedule in terms of daily calories,” he says. “It’s just like budgeting your salary, except you’re not putting extra calories on a credit card. If you overspend, you’re going to gain weight.”
Experts suggest weighing yourself either daily or weekly. “You need to be somewhat obsessive, but not so much so that it creates anxiety and stress by itself,” says Rubino.
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