How To Lose Weight
Mark Sandoval, M.D.
Notes
Body Mass Index
When contemplating overweight and obesity, one term we need to understand is Body Mass Index (BMI). BMI is how much you weigh (in kilograms) divided by the square of how tall you are (in meters2). This allows us assess whether someone is overweight or obese. Naturally, someone who is taller should weigh more than one who is shorter, and BMI helps us to keep that perspective. There are six generally recognized classifications of weight:
| Underweight | BMI less than 18.5 |
| Normal | BMI 18.5 – 24.9 |
| Overweight | BMI 25-29.9 |
| Obesity Class 1 | BMI 30-34.9 |
| Obesity Class 2 | BMI 35-39.9 |
| Obesity Class 3 (morbid obesity) | BMI 40 or greater |
For a person who is 5 feet 5 inches tall:
| Underweight | <_ 110 pounds |
| Normal | 111 – 149 pounds |
| Overweight | 150 – 180 pounds |
| Obesity Class 1 | 181 – 210 pounds |
| Obesity Class 2 | 211 – 240 pounds |
| Obesity Class 3 | > 240 pounds |
Overweight & Obesity Health Consequences
| Cardiovascular | Cancer | Other |
| Coronary heart disease | Endometrial | Diabetes |
| Diabetes | Breast | Liver/Gall Bladder |
| High Cholesterol | Colon | Sleep Apnea |
| Osteoarthritis | ||
| Abnormal Menses / Infertility | ||
| Varicose Veins |
The Cause?
Overweight & Obesity have been increasing rapidly across the population. Stephen O’Rahilly, professor of clinical biochemistry and medicine at Cambridge University says, “Nothing genetic explains the rise in obesity. We can’t change our genes over 30 years.“ This leaves us with environmental (lifestyle) causes
- Eating too much
- Eating the wrong foods
- Eating at the wrong times
- Sedentary Lifestyle
- Energy in > energy out = weight gain
Weight is determined by calorie intake vs. energy expenditure. Weight loss involves decreased caloric intake and/or increased energy expenditure, ie: Diet and Exercise!
Advice
Avoid FAD diets – rapid weight loss is water loss
Avoid starvation diets – lost muscle more than fat.
Plan on losing ½ to 1 pound per week
You can gain weight to lose weight – exercise can increase muscle mass, muscle is more dense than fat, so while gaining muscle mass you can
Avoid starvation diets – lost muscle more than fat.
Plan on losing ½ to 1 pound per week
You can gain weight to lose weight – exercise can increase muscle mass, muscle is more dense than fat, so while gaining muscle mass you can
Energy Expenditure (Exercise)
2 Areas of Exercise: Cardiovascular, Strength, Flexibility
FIT: Frequency, Intensity, Time
Poor Man’s Intensity Guide:
FIT: Frequency, Intensity, Time
Poor Man’s Intensity Guide:
| Low Intensity | Can sing |
| Medium Intensity | Can talk, but not sing |
| High Intensity | Can talk, but short of breath |
| Very High Intensity | Cannot talk, gasping for air |
Cardiovascular Exercise
| Frequency: | At least 5 times weekly |
| Intensity: | If heart problems, start low intensity, work up over 1-3 months |
| If no heart problems, medium | |
| If your weight loss plateaus, increase intensity or time | |
| Time: | 1 hour/day for weight loss, 30 minutes/day for general health |
Resistance Exercise
| Frequency: | At least 2 times weekly |
| Intensity: | Begin with a weight you can lift 10-15 times, rest, and repeat another 10-15 times |
| When it becomes easy, increase the weight | |
| Time: | 2 sets per exercise, each major muscle group |
Diet For Weight Loss
Calorie Density
Understanding and using calorie density is important in weight loss. Foods that are high in fat, sugar, and processed carbohydrates are calorie dense. If you only want to eat 200 Calories of these foods, you cannot eat much of them, because they have lots of calories in a small amount. Foods that are high in water and fiber and low in fat are not calorie dense. If you only want to eat 200 Calories of these foods, you can eat a lot of them, because they don’t have many calories in the same amount. For example, for 200 Calories, you can only eat 28g of butter, 41g of Dorito’s chips, 41g of Snickers, 50g of saltine crackers, 51g of cheddar cheese, 52g glazed donuts, and 75g of cheeseburger. But, for 200 Calories, you can eat 90g flax bread, 290g grapes, 308g cooked corn, 385g apples, 553g of honeydew, 570g carrots, 588g broccoli, and 1425g celery.
Understanding and using calorie density is important in weight loss. Foods that are high in fat, sugar, and processed carbohydrates are calorie dense. If you only want to eat 200 Calories of these foods, you cannot eat much of them, because they have lots of calories in a small amount. Foods that are high in water and fiber and low in fat are not calorie dense. If you only want to eat 200 Calories of these foods, you can eat a lot of them, because they don’t have many calories in the same amount. For example, for 200 Calories, you can only eat 28g of butter, 41g of Dorito’s chips, 41g of Snickers, 50g of saltine crackers, 51g of cheddar cheese, 52g glazed donuts, and 75g of cheeseburger. But, for 200 Calories, you can eat 90g flax bread, 290g grapes, 308g cooked corn, 385g apples, 553g of honeydew, 570g carrots, 588g broccoli, and 1425g celery.
| Foods | Calories per Pound |
| Oils | 3,900 |
| Potato Chips / French Fries | 2,600 |
| Meat | 2,000 |
| Cheese | 1,600 |
| White Bread | 1,300 |
| Chicken & Turkey (white meat) | 900 |
| Fish | 800 |
| Eggs | 700 |
| Whole Grains (wheat & rice) | 600 |
| Starchy Vegetables (potatoes & corn) | 350 |
| Beans | 350 |
| Fruits | 250 |
| Green Vegetables | 100 |
You can eat more food and lose weight if you switch to eating foods that have a low calorie density. The feeling of satiety (feeing like you have consumed a sufficient amount of food) after you eat is highly dependent upon stretch receptors in the stomach. As you eat food and the stomach is stretched by that food, it signals to the brain that you have had enough. If you eat low calorie dense foods (like salad), you can fill the stomach, trigger the stretch receptors, feel satisfied, but you have only eaten a few calories. However, you can eat the same “amount” of calorie dense food (like French Fries, pizza, and meat), fill the stomach, trigger the stretch receptors, feel satisfied, but you have eaten lots of calories.
Simple Advice For Weight Loss
- Ask yourself the following 3 questions. If you can answer yes to all 3, go ahead and eat.
- Is it the right time to eat?
- Is it healthy for me?
- Is it the right amount?
- Maintain a regular schedule for meals
- Eat a large breakfast, medium lunch, and very small supper (if at all)
- Space meals at least 5 hours apart
- Don’t eat within 3 hours of bedtime
- Eat nothing between meals
- Eat slowly
- Chew your food thoroughly
- Eat only until satisfied, not full or stuffed
- Put the amount on your plate that you need, and don’t go back for seconds
- Eat plant foods, but limit nuts/seeds
- Never go shopping on an empty stomach
- Only drink water between meals and cut out the juice and soft drinks
- If you are hungry and it’s not meal time, drink water. It will calm your hunger and not give you any calories
- Fast 1-2 days each week
- Set a goal for how much weight you want to lose
- Tell several people that you are losing weight and keep them informed about how it is going
- Get an exercise partner and/or eating partner to keep you accountable
Avoid:
- Flesh foods
- Dairy products
- Refined carbohydrates / sugars
- Fried / high fat foods
- Artificial sweeteners
- Calorie-containing drinks
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