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Lose weight, stay active

Six small changes can help keep off pounds

Last updated: January 2011

Illustration: Tracy Walker

Trying to reverse the 1-to-2-pounds-a-year weight gain that is the fate of the average middle-aged American? Overwhelmed at the thought of changing your lifestyle enough to reach a healthful weight?

Fortunately, there is an alternative approach to the drastic diet and exercise revisions that Americans find so difficult to embark on and sustain. The idea is to start with smaller, easier changes that will, at the very least, halt the weight-creep and give encouraging results.

"We find that people who make small changes will often lose a few pounds," said James O. Hill, Ph.D., director of the Anschutz Health and Wellness Center at the University of Colorado at Denver. "Those who start with small changes often end up able to make more and bigger changes and lose more weight."

Here are a half-dozen small changes you can make right now:

1. Stop drinking calories
In the late 1970s the average American consumed about 70 calories a day in the form of sugar-sweetened beverages. By 2000 we were guzzling an average of 190 calories. Numerous studies have left little doubt about the connection between increased consumption of sugar-sweetened drinks and the soaring rates of weight gain and obesity that occurred during that same time period.

"When we consume energy in beverage form, we don't get the same fullness as when we consume solids," said Richard D. Mattes, Ph.D., professor of foods and nutrition at Purdue University. "Those calories tend to add to the diet rather than displacing another energy source."

Fruit juice is not a replacement for soda. It might have a few vitamins and minerals, but it's just as damaging to your waistline. "If you drink 300 calories of apple cider, you'll feel less full than if you ate 300 calories of apples," Mattes said. And you'd have a lot to eat: You'd get to chew about three 3-inch apples for 300 calories.

What about replacing your favorite full-sugar drink with an artificially sweetened version? The evidence is mixed. Some studies suggest that though diet sodas don't add calories, they still activate your sweet tooth. But other studies show no such effect. "It's very difficult for my patients to stop drinking soda," said Caroline Apovian, M.D., director of the Nutrition and Weight Management Center at Boston Medical Center. "I always tell them to switch to diet soda."

As for milk, Mattes thinks it fools our internal calorie-counting mechanism the same way soft drinks do. Other experts doubt that, but they all agree that milk provides some useful nutrients in exchange for its calories. Similarly, the health benefits of moderate alcohol consumption might justify the calorie penalty, but that form of liquid calories is unlikely to make you feel full.

2. Eat more protein
Remember when experts thought the high-protein, low-carb Atkins diet didn't work and was dangerous? It's been more than seven years since the first studies started overturning that idea. Low-carb, high-protein diets have proved surprisingly effective, especially in the short term. And it turns out that people who eat a higher proportion of their calories from protein end up consuming fewer calories overall.

"There's currently a fair amount of evidence that protein is a more satiating nutrient than others, at least in a solid food," Mattes said.

But don't expect miracles from that approach. "It's really difficult to manipulate your protein intake markedly while eating normal foods," Mattes said.

In a major clinical trial that looked at high-protein diets, published Feb. 26, 2009, in The New England Journal of Medicine, participants didn't get their protein intake to the target level of 25 percent of total calories. But they did increase it from a baseline of 18 percent to about 21 percent.

The bottom line is that it can't hurt to substitute a bit more lean protein for some of the fat and starches in your diet.

3. Eat more fiber
Fiber is the good guy of food. It may help protect against colon cancer and heart disease, and it is your weight-control friend. It slows digestion, helping you to feel fuller longer, and displaces other caloric foods. Best of all, it comes in fruits, vegetables, and whole grains that are loaded with beneficial vitamins and minerals.

But as with protein, don't set your expectations too high, Mattes cautioned.

"Most of the studies showing beneficial effects are based on very large intakes that just aren't realistic for the general population," he said. "The typical American consumes 10 to 14 grams a day. The recommendation is for 25 or more grams, which is a huge departure from one's customary intake."

You might not make it to that goal, but you can boost your fiber-rich vegetable intake fairly painlessly, said Barbara Rolls, Ph.D., professor of nutritional sciences at Pennsylvania State University.

"Grow the amount of vegetables on your plate and shrink everything else," Rolls said. "Toss them in oil and roast them in the oven. Add your favorite veggies to sandwiches, pizza toppings, stews, wherever you can."

4. Lead yourself not into temptation
Can't eat just one Dorito or chocolate kiss? That is no accident, as former Food and Drug Administration Commissioner David Kessler, M.D., documented in his book, "The End of Overeating" (Rodale, 2009). The food industry works hard to create high-calorie foods with the most addictive possible combination of intense flavor and "mouthfeel."

"A century ago, to consume 400 calories, you had to go buy the meat, vegetables, and rice, and come home and cook it," Apovian said. "Now you can consume the same amount of calories just by downing a bag of Cheetos."

You obviously can't avoid encountering those foods in your daily life and probably eating them on occasion. But never have them at home, Apovian advised.

5. Add 2,000 steps a day
That's 20 to 25 minutes of walking, covers about a mile, and will burn about 100 calories a day—enough, Hill said, to prevent gradual weight gain in most people.

"It doesn't matter how you get there," Hill said. "It can be all at once or spread out. Once you do get there, do more."

Some of Hill's suggestions for sneaking in extra steps: When you step outside to get your mail, walk around the block before going back inside; do some errands on foot; at work, park at the far end of the office lot and use a distant rest room.

6. Cut your screen time
"When we're sitting, we are burning almost as few calories as we do when we're sleeping," said Marc T. Hamilton, Ph.D., a professor at the Pennington Biomedical Research Center in Baton Rouge, La. "Sitting too much is hazardous to your health in a different way than exercising too little."

Hamilton is a researcher in the new field of inactivity physiology, the study of what happens when we're, well, just sitting there. Research shows that the more you sit, the higher your risk of weight gain, type 2 diabetes, and cardiovascular disease. That seems to be true even for people who get the prescribed 150 minutes a week of moderate-to-vigorous physical activity.

"Standing upright washing dishes, getting dressed, or filing papers isn't exercise by anybody's standard," Hamilton said. "Yet these activities double your metabolic rate compared to sitting. If you can find 6 or 7 more hours a week to spend standing instead of sitting, you've done something good for yourself."

Sitting in front of a computer or television is one of the least active things most of us do. Research has shown that the more screen time we indulge in, the fatter we tend to be. And when we cut down our screen time, we tend to stand up and move around. A November 2010 Consumer Reports survey of 1,234 Americans found that those who spend 5 or more hours sitting during a typical weekday log less time in everyday activity.

So look for chances to stand up and move around in the course of your day. And see whether you can cut back your daily screen time.

Safe, effective long-term weight-loss pill remains elusive

The Food and Drug Administration turned down two applications for new anti-obesity drugs in recent months, in part because of safety concerns.

But on Dec. 7, 2010, an FDA advisory committee recommended approval of a new weight-loss drug. Called Contrave, it is a combination of two older medications: naltrexone, used to treat alcohol and drug addiction, and bupropion, an antidepressant. In a 56-week clinical trial, obese patients on Contrave lost an average of 5 to 6 percent of their starting weight, compared with a little more than 1 percent for patients on placebo. A significant number reported side effects from Contrave, including nausea, constipation, and dizziness. A final FDA decision on Contrave was expected in January 2011*.

With the October 2010 removal of Meridia (sibutramine) from the market because of the risk of major cardiovascular side effects, there's only one prescription weight-loss medication currently approved for long-term use in the U.S. It's Xenical (orlistat), which blocks your body from absorbing 30 percent of the fat you ingest. Also available in a lower over-the-counter dose under the Alli brand name, Xenical has never achieved the widespread popularity once expected.

That might be because of intestinal side effects, caused by the undigested fat, that could result in oily spotting. And in clinical trials of orlistat, severely overweight patients on a reduced-calorie diet lost only about 7 pounds more after a year of treatment than subjects who took placebos.

* Clarification:

On Jan. 31, 2011, the FDA declined to approve Contrave for sale. According to a statement from the drug's manufacturer, Orexigen Therapeutics, the agency was concerned about the cardiovascular safety of the drug.

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