Excess Weight Management

Hover over the images to the right to view the evidence-based health consequences that an individual with obesity is at an elevated risk of developing

Social Awareness & Compassion

 Critical’ Social Theory and the sub-’discipline’ of Fat Studies need to be addressed for their contributions to the weight management discussion. One social movement that has emerged from this field is Body Positivity. Importantly, this movement calls attention to removing bodyweight from the collective/individual social evaluation of ourselves/others. This message encourages greater compassion, which our culture undoubtedly needs. 

However, we must also address the common elements of science denialism pervasive within critical social theory. A typical theme within the movements associated with Fat Studies is that bodyweight has no valid health implications. This opinion is a direct rejection of decades of evidence that illustrate a clear association between excess body weight and elevated risk of adverse health consequences and can contribute to the spread of misinformation with life-threatening effects. 

These movements are imbued with the human impulse to be kind and promote greater social inclusion but should be subject to higher academic and social scrutiny. The most recent estimates of adult obesity predict a national prevalence of about 42%. Sadly the prevalence of childhood obesity is also rising with the most recent evidence predicting about 18%. With knowledge of the associated consequences, we should continue to explore how our society can promote the adoption of healthier lifestyles. The social concern for weight management needs to be rooted in health & wellbeing rather than appearance.  

Preparing for Success

Often, people set themselves up for “failure” during the planning stage of weight loss. An effective strategy should include the establishment of reasonable and achievable goals. Typically, a realistic goal would be weight loss in the realm of 5-15% over six months. A healthcare professional may consider a recommendation of 20% for individuals with a BMI of 35 or greater. Healthy and sustainable weight loss is a product of long-term lifestyle improvement. Therefore, your goals should reflect that timeframe. Weight cycling may carry adverse health effects and is associated with psychological distress, emphasizing the importance of a realistic plan that attends to all the dimensions of wellness. 

The critical requirement for losing weight is that you routinely burn more energy than you consume through your diet in a day. This concept is what is known as an energy or calorie deficit. However, when people consciously attempt to eat fewer calories through portion size reduction alone, many psychological and hormonal factors can make losing weight very difficult. By practicing healthy eating patterns (which incorporate more nutrient-dense foods), and enjoyable exercise, you can significantly increase your chances of adopting a more healthful lifestyle that leads to sustainable weight loss. 

Nutrition and physical activity are the two areas of lifestyle that are most often considered for weight management. This is because these factors are much more readily modified than other contributors to excess body weight (e.g., genetics and environment). However, it is always important to consider the entire wellness picture, especially when working towards weight loss. Factors such as social support, stress management, and quality sleep play a significant role in sustaining a healthier body weight. We intend to explore these additional factors in future posts. 

For a well-rounded approach to weight loss, physical activity is a necessary component of any strategy. When dietary interventions are the only strategy utilized, the body tends to lose both fat and lean body mass. A loss of lean body mass implies a loss of muscle, which is essential for physical functioning and general wellness. The importance of lean muscle mass also highlights some rationale behind tracking health progress with waist circumference-based measurements rather than BMI alone (see above). 

This section will take a look at physical activity as it applies to the topic of weight management, but explore our related pages for a broader look at the topic of physical activity and to view options for virtual exercise instruction that you can engage in from the comfort of your home or anywhere on the go. 

When you increase your levels of physical activity, your energy expenditure increases, which often helps to maintain a calorie deficit. Physical activity exists in many forms (e.g., structured exercise, leisure activities, walking, and other forms of physical transportation), which help increase your energy expenditure to different degrees based on physical intensity and duration of the activity. Exercise can be a worrisome topic for some based on concerns related to physical strain amongst social and psychological factors. However, when approached tactfully, exercise can be tailored to be a rewarding experience for any individual and minimize unnecessary discomfort. Exercise is a wonderful stimulus for physical health improvement but should be appropriately planned to ensure safety. Daily physical activity is highly beneficial and safe for most people. Still, the questionnaire linked below can help you determine if you should speak with your physician before increasing your physical activity levels. 

The Physical Activity Guidelines for Americans are a vital resource for planning for or assessing your current physical activity regardless of your age or current physical fitness. The guidelines recommend at least 150 minutes of moderate-intensity aerobic exercise per week and at least 2 days of muscle-strengthening activities. Remember the guidelines are a goal to work towards, but if you do not currently exercise regularly, begin small, and make incremental progress. Start by reviewing the guidelines before continuing to explore some specifics about exercise for weight loss. 

Aerobic vs. Anaerobic

The term aerobic exercise can be a source of confusion for some. It is often referred to as “cardio” and typically associated with an activity such as brisk walking, jogging, swimming, or running. However, the term aerobic refers to the body’s primary method of energy production. The anaerobic systems are integrated during short bouts of very high-intensity exertion (e.g., a sprint) in which the aerobic system alone cannot produce all of the body’s energy needs. With these factors considered, any sustained physical activity is appropriately classified as aerobic. 

This understanding generates a lot of freedom for you to engage in activities that you enjoy for aerobic exercise. When mindfully engaging in aerobic exercise, you should aim to maintain moderate-vigorous intensity for an extended time to build your endurance over time. Aerobic exercise does not need to be traditional or occur in the stereotypical public or home gym setting. A frantic 45-minute cleaning session before a family gathering can easily elevate your heart rate to a similar degree as a jog. Furthermore, exercise can easily be both aerobic and muscle-strengthening at the same time (e.g., HIIT, kettlebell training, power yoga, or vigorous yard work). With this mindset, your daily life begins to present many aerobic exercise opportunities should you allow yourself to be creative and engage at a challenging intensity. 

Every Minute Counts

With a goal of weight loss, engaging in exercise with limited rest intervals during the session is useful because it increases the calories burned in a given period. However, long duration, continuous exercise may not be feasible for those whose bodies are not accustomed to this physical demand. For these individuals, breaking up activity into multiple small training sessions throughout the day can be an effective and manageable way to burn calories while slowly building the physical fitness required for continuous exercise. 

Breaking up exercise into multiple sessions appears to be as productive for weight loss as completing the same exercise volume in a single session. The “every minute counts” slogan sheds light on the value of a lifestyle of regular physical activity in addition to structured exercise. Our culture has grown increasingly sedentary, but every day presents physical activity opportunities should you allow yourself to assess situations with this mindset. 

There’s never a competition for the parking spot furthest from a storefront entrance. The stairs are often less trafficked than the escalator. A brief walk in nature can soothe the mind, and a mid-workday movement routine can alleviate a stiff-achy body. Additionally, each of these activities can play a role in contributing to your calorie deficit each day. 

• High-Intensity Interval Training (HIIT)

  • Shown to be feasible and well-tolerated by people with obesity

  • Similar weight loss effect to moderate-intensity continuous training (e.g., light jogging) with ~40% less time commitment 

  • May not be an appropriate starting point for those with minimal exercise history (see PAR-Q)

  • Certain health conditions may restrict high-intensity training (consult with your physician or physical therapist) 

  • Concerns regarding joint overload depending on the specifics of the individual and exercise (aim for low-impact options)

• Moderate-Intensity Continuous Training

  • Well-established as an effective means of promoting weight loss

  • Can occur in many different forms (brisk walking, light jogging, swimming, cycling, etc.) 

  • Longer-duration (relative to HIIT) but less physical strain

• Resistance Training

  • Aids in the development of muscle and lean body mass

  • Traditionally, utilizes relatively long rest intervals, leading to lesser burned calories in a given duration 

  • Can be planned with limited rest intervals (e.g., kettlebell training)

Commitment to Change

Weight regain is a substantial obstacle to overcome for those who succeed in losing weight. Unfortunately, only an estimated 20% of people with excess weight succeed in maintaining 10% weight loss for over one year. This statistic highlights the importance of adopting the mindset of lifestyle change over temporary weight-loss strategies. We continue to emphasize wellness dimensions because they all influence success with weight loss, yet we often focus only on the physical aspect. Establishing a positive social support system, cultivating positive mental health, and honoring the values imposed by your life’s meaning all have a positive influence on your ability to commit to change. 

Remaining injury-free is another vital component of moving forward on the path of wellness. Be sure to familiarize yourself with the importance of a warm-up and cool-down by reviewing the Physical Activity Guidelines for Americans. 

Arguably, the most crucial concept in the discussion of dieting for weight management is the energy density of your diet. The components of the food we eat each provide a certain amount of energy (calories) relative to their weight/mass as follows: water (0 calories per gram), fiber (2 calories per gram), carbohydrate (4 calories per gram), protein (4 calories per gram), alcohol (7 calories per gram), and fat (9 calories per gram). Foods with relatively lower energy density can be consumed in higher quantities than their higher density counterparts for the same total amount of calories. By lower the overall energy density of the food you consume, you can reduce your total energy intake without feeling hungry. This concept is the foundation of most diets. 

More guidance on managing energy density for weight management from the CDC 

Typical processed foods (e.g., soda, candy, potato chips) are very high in energy density but relatively lower in nutrient density than whole foods. When substituting out processed foods for whole foods, a diet becomes less energy-dense and more nutrient-dense. Often, the pleasure and convenience of processed foods pose a barrier to converting to a diet with more fruits and vegetables. A commitment to practicing the art and skill of cooking can lead to a much more enjoyable diet while rewarding you with the benefits of healthful meals. 

Hover for basic tips on reducing energy density of your diet

Macronutrient Focused Dieting

Many dietary strategies use macronutrients as the foundation for planning daily meals. In particular, these nutritional strategies require the dieter to begin to consider the foods they consume with respect to their relative percentage of carbohydrates, fats, and protein. Each macronutrient focused diet will typically recommend macronutrient ranges for the participant to maintain daily. It is essential to recognize that the cumulative evidence does not support any specific macronutrient strategy as superior to another. Each diet can be useful for weight loss when a calorie deficit is maintained. We will now take a more in-depth look at low-carbohydrate diets because they have demonstrated additional health benefits for some conditions (see Harvard’s Evidence Summary and Chris Kresser’s Guide to Low-Carb). Remember, a low-carb diet may not be ideal for everyone. 

Low-Carbohydrate Diets

• General Low-Carb

  In the broadest sense, low-carbohydrate diets aim to significantly reduce the proportion of carbs that compose your daily energy intake. The typical American diet includes about 50% carbohydrates, whereas a low-carb diet will generally restrict carbohydrate intake below 15%. Low-carb diets have been effectively used to treat many adverse health states, but individual responses to the diet vary. Quality of carbohydrates is another critical consideration alongside quantity, as whole foods typically have higher nutritional value than processed foods. Remember, low-carb diets are one of the many effective options for weight loss.

• Ketogenic Diets:

  A ketogenic diet aims to put your body into a state of ketosis in which the primary fuel source is transitioned to fat as opposed to carbohydrates. Maintenance of this state requires carbohydrate intake to be very low (5-10%). The classic ketogenic diet, developed as a treatment for epilepsy, entails fat intake in a range of 75-90% with limited intake of protein (5-20%). There are individual differences between people in their ability to maintain ketosis within different macronutrient ranges. Confirmation of ketosis can be tested at home to help fine-tune the diet for you. 

  Chris Kresser’s Complete Guide to Keto

Keto Cookbook

• The Atkins Diet:

  Dr. Robert Atkins (cardiologist) began developing this dietary strategy in 1963 in response to his concern about medicating patients in an attempt to control appetite. His method has evolved to support varying degrees of carbohydrate restriction. The Atkins website hosts an extensive library of free tools and resources related to the diet.

  The Akins Website

  Atkins Diet Comparisons

Get the free eBook here

Food Pattern Focused Dieting

Although macronutrient ranges may be discussed within these eating patterns, the focus is more on the type and quality of foods consumed. Diets that focus on healthy eating patterns generally encourage foods with lower energy density than those within the typical American diet. Again, each of these diets can be very effective for weight loss when an appropriate calorie deficit is maintained. You may find that experimenting with several types of eating patterns over an extended time gives you a lot of insight into which diet you can successfully support. 

View the 2020 Dietary Guidelines for Americans for a broad look at healthy eating patterns

Dietary Approaches to Stop Hypertension - DASH

This eating pattern was developed as a treatment for high blood pressure. The emphasis of this eating pattern is reducing sodium and increasing mineral-rich foods such as fruits and vegetables. DASH encourages a traditional food-pyramid approach to eating, with high consumption of grains and limited animal product consumption.

Mayo Clinic’s Overview of DASH

National Institute of Health’s Guide to DASH

Cookbook

The Mediterranean Diet

The ‘Mediterranean diet’ emerged in the U.S. based on the presence of fewer heart disease-related deaths in Mediterranean countries. In general, this eating pattern emphasizes plant-based foods, healthy fats, fish, and poultry with the moderation of red meat and dairy consumption.

Mayo Clinic’s Overview of the Mediterranean Diet

Healthline’s Mediterranean Guide for Beginners with Sample Menu

Cookbook

Vegetarian

Vegetarian diets represent a broad category of eating patterns that are often pursued for a variety of health, cultural, and value-based factors. Vegetarian diets can be very healthful, but require planning to prevent nutrient deficiencies. There are varying degrees of restrictedness within vegetarianism. Some variations include consumption of dairy (lacto-vegetarian), eggs (ovo-vegetarian), dairy & eggs (lacto-ovo vegetarian), or fish (pescatarian). By decreasing the diet's restrictiveness, participants can balance ease of nutritional completeness with personal and cultural values.

Mayo Clinic’s Overview of Vegetarian Diets

Healthline’s Vegetarian Guide for Beginners with Sample Menu

Cookbook

Chris Kresser’s Concerns with Vegetarian Diets

Vegan

Veganism is a highly restrictive form of a vegetarian diet in which no animal products are consumed (or used in daily life). Followers of the diet are often highly motivated by value-based decisions. A vegan diet can assist in weight loss and other health benefits, but it is vital to recognize the prevalence of nutrient deficiency in vegan practitioners. It is possible to prevent deficiency on a vegan diet with proper planning and supplementation.

Healthline’s Guide for Beginners with Sample Menu

Chris Kresser’s Concerns with Vegan Diets

G-rated Cookbook

Not so G-rated Cookbook

Paleo

A paleo diet focuses on eating whole foods that were present in the diets of our hunter-gatherer ancestors. It is founded on the idea that the modern diet contributes to many chronic diseases because it contains many foods that our bodies’ are not adapted to processing. The diet’s specifics can vary based on your reference, but generally, the eating pattern includes lean meats, fish, vegetables, nuts, and seeds while excluding most dairy, legumes, and grains.

Mayo Clinic’s Overview of Paleo Diets

Healthline’s Beginner’s Guide to Paleo with Sample Menu

Free Paleo Recipes

Chris Kresser’s free eBook: Effortless Paleo Weight Loss

Chris Kresser’s Book: The Paleo Cure

Cookbook

Intuitive Eating

Intuitive eating is a nutritional strategy that calls attention to the flaws of temporary (“on and off”) dieting. In summary, this strategy uses ten principles to gradually move the participant in the direction of healthful eating without promoting the shame associated with diets that have rules (that are often inevitably broken). These teachings may provide significant insights that can be combined with future learning (especially for those who have a history of mental struggle with diets).

Health’s Overview of the 10 Intuitive Eating Principles

Intuitive Eating Website

The Intuitive Eating Book

Intuitive Eating Workbook with Healthful Recipes

The Nordic Diet

The Nordic Diet is an eating pattern traditionally observed in Nordic countries (Finland, Norway, Sweden, Denmark, and Iceland). It was popularized in response to the observation of the above-average health of people from this region compared to those consuming the typical American/Western diet. The eating pattern sheds light on the value of eating a diversity of whole foods from one’s local environment.

Healthline’s Overview of the Nordic Diet

Chris Kresser’s: Health Lessons from Nordic Cuisine

Using Local and Organic Food to Promote Healthy Lifestyle

The Nordic Cookbook

Weight Watchers

Weight Watchers is a subscription-based program that creates a customized plan for you based on your goals. Through the use of a mobile application, participants log their food consumption daily. Each food item is assigned a point value allowing you to track your intake relative to your daily allotment of points. This program’s point system focuses on the development of healthier eating patterns rather than counting calories.

Weight Watchers Website

Jenny Craig

The Jenny Craig program is a subscription-based service that utilizes virtual health coaching paired with catered meals delivered to your door. Participants receive a customized meal plan for daily meals and snacks based on their current health status and weight loss goals. This program removes you from the food sourcing and meal preparation process, so be sure to learn and establish a plan for when you transition off the program to avoid weight gain.

Jenny Craig Website

Nutrisystem (Similar Program Structure)