Obesity is a growing epidemic in the United States. We hear about this problem on an almost daily basis. Open up an Internet browser and type in “obesity epidemic in America,” and you get links to numerous articles, graphics, and statistics about this ever-present problem. From my experience as a physician, the worst consequences from this disease are the complications I see in my office every day. These include type 2 diabetes, high blood pressure, heart disease, strokes, obstructive sleep apnea, and many other health conditions(1). I wanted to write this article because I believe weight loss and maintaining a healthy weight are the most beneficial approaches people can use to prevent disease or control the complications of diseases they already have. 

Many people understand that losing weight requires exercise and diet. But, the problem that I see with many failed attempts to lose weight is people putting too much importance on exercise while failing to change their diets. They initially lose weight, but can’t get to their goals because they haven’t changed their eating habits. Exercise is good for many things such as cardiovascular health, endurance, well-being, and staying mentally sharp. But it doesn’t burn as many calories as one might think. Diet is the main predictor of weight. One person may be overweight and fit because he or she exercises, whereas another person may be thin and unfit because he or she eats a better diet but doesn’t exercise. Most of the calories the average person burns each day are consumed by the normal metabolic processes our bodies go through just to keep us alive. 

Let’s challenge the popular adage that states, “Losing weight is simply a matter of calories in vs. calories out.” Is it really true that if you take in fewer calories than you burn, you will lose weight? For years, I believed it was. I believed it when I graduated from college with a degree in chemistry. All through medical school and for most of my residency I believed that this elementary math would help people lose weight; and I taught it to patients all the time. 

Then, in my last year of residency, a faculty member brought up the notion that weight management might not be that simple. Perhaps it also has something to do with the way our bodies process calories. 

In processing fats and proteins your body secretes bile and enzymes into your digestive system to break apart these foods and help absorb them. However, once you absorb the fats and proteins, your body decides what to do with these nutrients by also reacting to your carbohydrate consumption. Eating complex carbohydrates and sugars causes your body to release insulin to bring your blood sugar level down. Insulin is a storage hormone. In addition to regulating blood sugar, it also causes your cells to store fat and take up amino acids to produce proteins. 

So if you eat three high-carbohydrate meals and two or three high-carbohydrate snacks each day, then your body is in a constant state of trying to store calories instead of burn them. 

This principle was shown in an article in the New England Journal of Medicine in May of 2003. It illustrated that severely obese patients, with a body mass index greater than thirty-five percent, lost more weight on a low carb diet than a low-fat, low-calorie diet (2). This changed my perspective. It’s not just the number of calories we take in, but also what type of calories we eat that determine our weight. 

Weight Loss Recommendations: 

1. Diet and exercise are both important in losing weight. Diet is the biggest factor affecting weight. 

2. At every meal, make starches – bread, rice, potatoes, pasta, cereal, etc. - Only one-quarter of your plate. Fill the other three-quarters with lean protein, non-starchy vegetables, and a lesser portion of fruit. 

3. Choose small, balanced snacks that mix some carbohydrate (fruit, dairy, grains) with a lean protein or non-starchy vegetable. 

4. A diet needs to be a lifestyle change, not something you do for three to six months. If your diet is not a lifestyle change you will become a yo-yo dieter. 

5. Your diet will fail if you try to cut out foods you love. Instead, eat everything in moderation, and make the food you love a part of your portioned plate. 

6. Don’t drink your calories. If you are thirsty, drink water.