Weight Loss and Medical
Weight Loss Education

The Center for Medical Weight Loss of Seguin, Texas

Expert, Physician Supervised, Medical Weight Loss

Part 1: Assessing Your Risk

According to the NHLBI guidelines, assessment of overweight involves using three key measures:

• body mass index (BMI)
  
• waist circumference, and
  
• risk factors for diseases and conditions associated with obesity.

The BMI is a measure of your weight relative to your height and waist circumference measures abdominal fat. Combining these with information about your additional risk factors yields your risk for developing obesity-associated diseases.

What is Your Risk?

1.  Body Mass Index (BMI)

BMI is a reliable indicator of total body fat, which is related to the risk of disease and death. The score is valid for both men and women but it does have some limits. The limits are:

Use the BMI calculator or tables to estimate your total body fat. The BMI score means the following:

2.  Waist Circumference

Determine your waist circumference by placing a measuring tape snugly around your waist. It is a good indicator of your abdominal fat which is another predictor of your risk for developing risk factors for heart disease and other diseases. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women

The table, Risks of Obesity-Associated Diseases by BMI and Waist Circumference, provides you with an idea of whether your BMI combined with your waist circumference increases your risk for developing obesity associated diseases or conditions.

3.  Other Risk Factors

Besides being overweight or obese, there are additional risk factors to consider.

4.  Assessment

For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, the guidelines recommend weight loss. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing diseases associated with obesity. Patients who are overweight, do not have a high waist measurement, and have less than 2 risk factors may need to prevent further weight gain rather than lose weight.

Talk to your doctor to see if you are at an increased risk and if you should lose weight. Your doctor will evaluate your BMI, waist measurement, and others risk factors for heart disease. People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers, and even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing those diseases.

Guide to Physical Activity

An increase in physical activity is an important part of your weight management program. Most weight loss occurs because of decreased caloric intake. Sustained physical activity is most helpful in the prevention of weight regain. In addition, exercise has a benefit of reducing risks of cardiovascular disease and diabetes, beyond that produced by weight reduction alone. Start exercising slowly, and gradually increase the intensity. Trying too hard at first can lead to injury.

Your exercise can be done all at one time, or intermittently over the day. Initial activities may be walking or swimming at a slow pace. You can start out by walking 30 minutes for three days a week and can build to 45 minutes of more intense walking, at least five days a week. With this regimen, you can burn 100 to 200 calories more per day. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week. This regimen can be adapted to other forms of physical activity, but walking is particularly attractive because of its safety and accessibility. Also, try to increase "every day" activity such as taking the stairs instead of the elevator. Reducing sedentary time is a good strategy to increase activity by undertaking frequent, less strenuous activities. With time, you may be able to engage in more strenuous activities. Competitive sports, such as tennis and volleyball, can provide an enjoyable form of exercise for many, but care must be taken to avoid injury.

Activity Progression

For the beginner, activity level can begin at very light and would include an increase in standing activities, special chores like room painting, pushing a wheelchair, yard work, ironing, cooking, and playing a musical instrument.

The next level would be light activity such as slow walking of 24 min/mile, garage work, carpentry, house cleaning, child care, golf, sailing, and recreational table tennis.

The next level would be moderate activity such as walking 15 minute/mile, weeding and hoeing a garden, carrying a load, cycling, skiing, tennis, and dancing.

High activity would include walking 10 minute/mile or walking with load uphill, tree felling, heavy manual digging, basketball, climbing, or soccer/kick ball.

You may also want to try:

Guide to Behavior Change

Your Weight Is As Important To Us As It Is To You!

Over the past few years it has become clear that weight is an important health issue. Being overweight is a risk factor for health problems such as diabetes, high blood pressure, high cholesterol and triglycerides, arthritis, gall bladder disease, gynecologic problems, some cancers, and even lung problems. Some people who need to lose weight for their health don't recognize it, while others who don't need to lose weight, want to get thinner for cosmetic reasons. We understand that in some ways your weight is different from, for example, your cholesterol level or your blood pressure, because you can't see what these are by looking at someone. Many patients have had health-care providers who approached their weight in a less-than-sensitive or helpful manner. Some patients may have had health-care encounters in which they felt blamed, but not helped. Please be assured that when we bring up your weight, it's because we know that this is an important aspect of your overall health care. We understand, though, that successful weight management is a long-term challenge.

By the same token, we may discuss weight goals that are different from those you select. Weight can affect a person's self-esteem. Excess weight is highly visible and evokes some powerful reactions, however unfairly, from other people and from the people who possess the excess weight. The amount of weight needed to improve your health may be much less than you wish to lose when you consider how you evaluate your weight. If we suggest an initial weight goal that seems too heavy for you, please understand that our major emphasis is on your health and that your health can be greatly improved by a loss of 5-10 percent of your starting weight. That doesn't mean you have to stop there, but it does mean that an initial goal of losing 5-10 percent of your starting weight is both realistic and valuable.

Behaviors That Will Help You Lose Weight and Maintain It

Set The Right Goals
Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. However, the most productive areas to focus on are the dietary and exercise changes that will lead to that long-term weight change. Successful weight managers are those who select two or three goals at a time that they are willing to take on, that meet the following criteria of useful goals:

Effective goals are 1) specific; 2) attainable; and 3) forgiving (less than perfect). "Exercise more" is a commendable ideal, but it's not specific. "Walk five miles everyday" is specific and measurable, but is it attainable if you 're just starting out?" Walk 30 minutes every day" is more attainable, but what happens if you're held up at work one day and there's a thunderstorm during your walking time another day? "Walk 30 minutes, five days each week" is specific, attainable, and forgiving. In short, a great goal!

Nothing Succeeds Like Success

Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e. g., an initial reduction of fat intake from 40% of calories to 35% of calories, and later to 30%). It is based on the concept that "nothing succeeds like success." Shaping uses two important behavioral principles: 1) consecutive goals that move you ahead in small steps are the best way to reach a distant point; and 2) consecutive rewards keep the overall effort invigorated.

Success (But Not With Food)

Rewards that you control can be used to encourage attainment of behavioral goals, especially those that have been difficult to reach. An effective reward is something that is desirable, timely, and contingent on meeting your goal. The rewards you administer may be tangible (e. g., a movie or music CD or a payment toward buying a more costly item) or intangible (e. g., an afternoon off from work or just an hour of quiet time away from family). Numerous small rewards, delivered for meeting smaller goals, are more effective than bigger rewards, requiring a long, difficult effort.

Balance Your (Food) Checkbook

Self-monitoring refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables, exercise sessions, medication usage, etc., or an outcome of these behaviors, such as weight. Self-monitoring of a behavior can be used at times when you're not sure how you're doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually changes the behavior in the desired direction and can produce " real-time" records for review by you and your health care provider. For example, keeping a record of your exercise can let you and your provider know quickly how you're doing, and when the record shows that your exercise is increasing, you'll be encouraged to keep it up. Some patients find that specific self-monitoring forms make it easier, while others prefer to use their own recording system.

While you may or may not wish to weigh yourself frequently while losing weight, regular monitoring of your weight will be essential to help you maintain your lower weight. When keeping a record of your weight, a graph may be more informative than a list of your weights. When weighing yourself and keeping a weight graph or table, however, remember that one day's diet and exercise patterns won't have a measurable effect on your fat weight the next day. Today's weight is not a true measure of how well you followed your program yesterday, because your body's water weight will change much more from day to day than will your fat weight, and water changes are often the result of things that have nothing to do with your weight-management efforts.

Avoid A Chain Reaction

Stimulus (cue) control involves learning what social or environmental cues seem to encourage undesired eating, and then changing those cues. For example, you may learn from reflection or from self-monitoring records that you're more likely to overeat while watching television, or whenever treats are on display by the office coffee pot, or when around a certain friend. You might then try to sever the association of eating with the cue (don't eat while watching television), avoid or eliminate the cue (leave coffee room immediately after pouring coffee), or change the circumstances surrounding the cue (plan to meet with friend in non-food settings). In general, visible and accessible food items are often cues for unplanned eating.

Get The (Fullness) Message

Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message you've been fed. Slowing the rate of eating can allow satiety (fullness) signals to begin to develop by the end of the meal. Eating lots of vegetables can also make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear meager. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.

Fat Free Versus Regular Calorie Comparison

A calorie is a calorie is a calorie whether it comes from fat or carbohydrate. Anything eaten in excess can lead to weight gain. You can lose weight by eating less calories and by increasing your physical activity. Reducing the amount of fat and saturated fat that you eat is one easy way to limit your overall calorie intake. However, eating fat-free or reduced-fat foods isn't always the answer to weight loss. This is especially true when you eat more of the reduced fat food than you would of the regular item. For example, if you eat twice as many fat-free cookies you have actually increased your overall calorie intake. The following list of foods and their reduced fat varieties will show you that just because a product is fat-free, it doesn't mean that it is "calorie-free." And, calories do count!

Nutrient data taken from Nutrient Data System for Research, Version v4.02/30, Nutrition Coordinating Center, University of Minnesota.

Low Calorie, Lower Fat Alternative Foods

These low-calorie alternatives provide new ideas for old favorites. When making a food choice, remember to consider vitamins and minerals. Some foods provide most of their calories from sugar and fat but give you few, if any, vitamins and minerals.

This guide is not meant to be an exhaustive list. We stress reading labels to find out just how many calories are in the specific products you decide to buy.

Food Exchange List

Within each group, these foods can be exchanged for each other. You can use this list to give yourself more choices.

Fat-Free and Very Lowfat Milk contain 90 calories per serving. One serving equals:

Very Lean Protein choices have 35 calories and 1 gram of fat per serving. One serving equals:

Fruits contain 15 grams of carbohydrate and 60 calories. One serving equals:

Lean Protein choices have 55 calories and 2-3 grams of fat per serving. One serving equals:

Medium Fat Proteins have 75 calories and 5 grams of fat per serving. One serving equals:

Starches contain 15 grams of carbohydrate and 80 calories per serving. One serving equals:

Fats contain 45 calories and 5 grams of fat per serving. One serving equals: