Losing Weight: More than Counting Calories

by Food and Drug Administration (FDA)

Americans are getting fatter. We're putting on the pounds at an alarmingly rapid rate. And we're sacrificing our health for the sake of super-sized portions, biggie drinks, and two-for-one value meals, obesity researchers say.

More than 60 percent of U.S. adults are overweight, according to the Centers for Disease Control and Prevention (CDC). And about 15 percent of children and adolescents ages 6 to 19 are overweight.

Poor diet and physical inactivity account for more than 400,000 premature deaths each year in the United States, second only to deaths related to smoking, says the CDC. People who are overweight or obese are more likely to develop heart disease, stroke, high blood pressure, diabetes, gallbladder disease, and joint pain caused by excess uric acid (gout). Excess weight can also cause interrupted breathing during sleep (sleep apnea) and wearing away of the joints (osteoarthritis). Carrying extra weight means carrying an extra risk for certain types of cancer, including endometrial, breast, prostate, and colon cancer.

But there is hope for overweight Americans. They can take small, achievable steps to improve their health and reverse the obesity epidemic. This message is the cornerstone of a national education campaign announced in March 2004 by the Department of Health and Human Services (HHS).

As part of HHS' renewed efforts to combat obesity, the Food and Drug Administration's Obesity Working Group released its Calories Count report in March 2004, highlighting actions that the agency will work toward to help consumers make smart choices about their diet. These actions include strengthening food labeling, educating consumers about maintaining a healthy diet and weight, and encouraging restaurants to provide calorie and nutrition information. Also included are increased enforcement to ensure food labels accurately portray serving size and strengthened scientific research aimed at reducing obesity and developing foods that are healthier and lower in calories.

Are You Overweight?

Overweight refers to an excess of body weight, but not necessarily body fat. Obesity means an excessively high proportion of body fat. Health professionals use a measurement called body mass index (BMI) to classify an adult's weight as healthy, overweight, or obese. BMI describes body weight relative to height and is correlated with total body fat content in most adults.

To get your approximate BMI, multiply your weight in pounds by 703, then divide the result by your height in inches, and divide that result by your height in inches a second time. (Or you can use the interactive BMI calculator at www.nhlbisupport.com/bmi/bmicalc.htm.)

A BMI from 18.5 up to 25 is considered in the healthy range, from 25 up to 30 is overweight, and 30 or higher is obese. Generally, the higher a person's BMI, the greater the risk for health problems, according to the National Heart, Lung and Blood Institute (NHLBI). However, there are some exceptions. For example, very muscular people, like body builders, may have a BMI greater than 25 or even 30, but this reflects increased muscle rather than fat. "It is excess body fat that leads to the health problems such as type 2 diabetes, high blood pressure, and high cholesterol," says Eric Colman, M.D., of the FDA's Division of Metabolic and Endocrine Drug Products.

In addition to a high BMI, having excess abdominal body fat is a health risk. Men with a waist of more than 40 inches around and women with a waist of 35 inches or more are at risk for health problems.

Obesity, once thought by many to be a moral failing, is now often classified as a disease. The NHLBI calls it a complex chronic disease involving social, behavioral, cultural, physiological, metabolic, and genetic factors. Although experts may have different theories on how and why people become overweight, they generally agree that the key to losing weight is a simple message: Eat less and move more. Your body needs to burn more calories than you take in.

Successful 'Losers'

Although many people who lose weight may eventually gain it back, it's a myth that this happens to everyone, says Rena Wing, Ph.D., a professor of psychiatry at Brown Medical School in Providence, R.I. Wing, the co-developer of a research study known as the National Weight Control Registry, has worked to deflate this myth.

Tucked away in the registry's database is information about the weight-control behaviors of more than 3,000 American adults who have lost an average of 60 pounds and have kept it off for an average of six years.

How do they do it?

These successful weight losers report four common behaviors, says Wing. They eat a low-calorie, low-fat diet, they monitor themselves by weighing in frequently, they are very physically active, and they eat breakfast. Eating breakfast every day is contrary to the typical pattern for the average overweight person who is trying to diet, says Wing. "They get up in the morning and say 'I'm going to start my diet today,' and they eat little or no breakfast and a light lunch. Then they get hungry and consume most of their calories late in the day. Successful weight losers have managed to change this pattern."

Six years after their weight loss, most of the registry's successful losers still report eating a low-calorie, low-fat diet. They also exercise for about an hour or more a day, expending about 2,800 calories per week on a variety of activities.

Wing also reports that more than 70 percent of the registry's weight losers became overweight before age 18.

Although Barbara Croft of Columbus, Ohio, was not an overweight child, she gained weight once she left home and started cooking for herself. Replacing the plain and simple meals she had as a child with pizza, sodas, and meat and vegetables laden with sauces, the 5-foot-5-inch Croft worked her way up to 350 pounds. "I always ate from all the food groups — I just ate huge portions and I ate in between meals," says Croft.

When she was diagnosed with type 2 diabetes in February 1999, Croft got scared. "I worried about the health consequences — about going blind. I already have a little numbness in my feet."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.