Making the decision to lose weight is one of the most positive, empowering decisions you'll ever make in your life. If you're serious about losing weight, consider this decision the first step in a lifelong journey, one with no easy shortcuts, solutions, and no sure path to success. This is not meant to discourage you, but rather encourage you to approach your decision to lose weight from a long-term, life-affirming perspective. In the end, the creation of a balanced, healthy life that you can feel good about is the ultimate goal of your journey, no matter how much weight you lose. Consider us a useful guide in helping you along your chosen path to a healthy life.

Arming yourself with as much knowledge as possible into your weight-loss journey is the best way to get started, and you will find a wealth of helpful information available here. Find out all there is to know about dietary information, exercise & activity, medical management and weight-loss procedures. Inform yourself about all the weight-loss options available to you.

Based on your research, look at where you are and where you want to be. From there, create manageable goals for yourself , baby steps if you will, in order to give yourself the potential to produce tangible results. When one of these small steps is achieved, you'll feel a sense of accomplishment in realizing a goal, and hopefully an eagerness to move forward and achieve the next step in your journey to better health.

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In very simple terms, creating a diet means decreasing the amount of calories you consume every day. Reducing calories moderately is essential to achieving a slow, steady weight loss. Maintaining this lowered calorie level over time is the goal of your diet strategy, and the healthiest way to begin tackling your weight-loss goals. Please note that you should avoid drastic changes to your diet, because they can have serious and harmful effects on your health.

Learning about food is a simple but necessary step in taking ownership of your diet plan. Educate yourself about the calorie content of different foods, food composition (fats, carbohydrates, and proteins), nutrition labels, the most healthful types of foods to buy, and how to prepare foods the healthy way. Include all food groups in your diet. Supplement your calorie reduction with vitamin and mineral supplements if you're consuming less than 1,600 calories/day.

Armed with these types of specific diet knowledge will propel you towards becoming your own expert on diet and weight loss, and getting your weight under control.

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Get moving! You must increase your level of physical activity if you want to lose weight and keep it off. Physical exercise is perhaps the single most integral part of losing weight, keeping it off, and in doing so, creating a better body image for yourself and creating a happier you.

You don't have to join a gym or start training for a marathon to begin the process of incorporating exercise into your life routine. Small, tangible goals are again the best way to begin thinking about how you will make room for exercise in your life, because even a little exercise done around your home is a great way to start an exercise program, and in the process avoid many obesity-related health consequences.

You may be asking yourself questions like, where do I begin? What exercises are safe? Do I need special equipment? What if I'm embarrassed to exercise in front of other people? These are all legitimate concerns for any person getting serious about weight loss. If you take things step by step, and set realistic expectations, you will be on your way to a healthier, happier life before you know it. We recommend the following steps to ensure the best strategy for you, no matter what stage of the weight-loss journey you find yourself.

• Talk to your doctor.

  Before you begin any weight-loss program, you should see your doctor if you:
  1) have more than a few pounds to lose
  2) have chronic health problems like diabetes, heart disease, asthma, arthritis, high blood pressure, or a personal or family history of heart disease
  3) are a woman over age 50, or a man over 40

• Start slowly.

  This isn't a race - it's your health. Allow your body time to get used to your new level of activity.

• Set realistic goals.

  Just like dieting, it's easy to give up exercise if you aren't seeing the results you want. Start with short-term goals, like going for a five to 10-minute walk three to four times a week in your first week. With each subsequent week, walk for a little longer, a little more frequently. Feel good about what you can do, and don't worry about what you can't do , because if you stick to it, you'll get there! This is your life, your health, and your goals are yours! get there. This is your life, your health, and your goals are yours.

• Always warm up...and cool down.

  A good warm-up lets your body know you're getting ready to exercise. March in place, swing your arms, rotate your ankles, roll your shoulders forward and backward...get the blood pumping! All of these things help get your body heated up, and will help loosen your muscles and joints for activity. Just as important is a cool-down period, which protects your heart and helps relax your muscles. Don't just stop when you're done, slow down, little by little, and stretch for at least 10 minutes.

• Don't go it alone.

  It has been proven that exercising with a buddy makes it easier to stay motivated, so bring along a friend or family member. It's good for both of you!

• Keep an exercise journal.

  This is the best way to track your progress. It's also a good way to motivate yourself, and it shows you just how far you've come. You won't forget where you started, or where you want to get to, and most importantly, it documents the journey of how you're getting there!

• Look the part.

  The right exercise apparel is comfortable, makes it easy to move, and gives you confidence that you look the part. Wear supportive athletic shoes, clothes that you can move around in with ease, and be sure to wear sunscreen and a hat if you exercise outdoors.All these things will help you feel confident and also positive about your exercise experience.

Even folks with a lot of weight to lose can take part in some kind of physical activity. You don't need to go to a gym or buy any special equipment to get started (although you can do those things later!) Here we'll show three main exercise categories:

• Weight-bearing activities: walking involves lifting + pushing your own body weight.
• Non-weight bearing activities: swimming puts little or no stress on your joints.
• Lifestyle activities: cleaning + gardening are good ways to move around the house.

Weight-bearing activities:
Walking - Its the easiest way to start your exercise routine. Even a leisurely stroll is great, but try steady walking that makes you breathe a little heavier , works up a little sweat and gets your heart rate up.
Weight training - Think of healthy, strong muscles, and how your muscles will help you burn calories. If you can lift your arms, you can train with weights. Small hand weights or even soup cans are all you need to start. You don't have to join a gym to use weights, but if you've never used weights before, it is a good idea to start with some supervision or a spotter that can provide an extra measure of safety.
Dancing - What better way to have fun, get your blood pumping, and listen to your favorite tunes? Dancing is a weight-bearing activity that can be done anywhere, with any music, alone or with anyone. If you can't move on your feet for very long, try sitting down and move your arms and legs to the music to get started.

Non-weight bearing activities:
Swimming or water workouts - Exercising in water is a fantastic way to get a safe and effective workout. There is very little stress on your joints, it works out your whole body, it increases your heart rate, and you get to splash around too!
Bicycling - Whether its outdoors on a road bike or indoors on a stationary bike, bicycling is a really great way to get exercise and it doesn't put much stress on your joints. For those of you just getting started, a recumbent bike may be the way to go. It let's you sit back, with your legs in front of you, without hunching over the handlebars and stressing out your lower back, and you still get a great workout.

Lifestyle activities:
Household chores - Improve your health while working in and around your home. Raking leaves, gardening and vacuuming are all great ways to get your body moving, and you don't have to make extra time in your day for them.
Take the stairs instead of the elevator - If you're going up one or two floors in an office building or when you're shopping, take the stairs at a slow but steady pace. Make the decision to exert yourself more than usual. Every little bit helps and builds your confidence!
Regardless of what kinds of exercise you do, drink lots of water, and keep moving. Any exercise at all is better than nothing, and it's good for your body, your attitude and your journey to better health.

When you're overweight, you have to pay special attention to the signals your body is sending you. Sweating and feeling a little out of breath is OK. In fact, that's how you know you're challenging your body. But, if you feel any of the following, stop immediately:

• Dizziness or nausea
• Pain, tightness, or pressure in your chest or left neck, shoulder, or arm
• Muscle cramps
• Breaking out in a cold sweat
• Pain in your joints, feet, ankles or legs
• So out of breath that you cant talk or you're gasping

Remember, there's a difference between soreness and pain. It's natural to feel a little sore after a workout, but pain shouldn't be ignored under any circumstances. If the pain doesn't go away on its own, or if it comes back the next time you exercise, see your doctor right away.

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Whenever any of us thinks about losing weight, the first thing that usually comes to mind is going on a diet. And with good reason: changing the way we eat is critical to losing weight. For that reason, its often the first step in any weight-loss program.

Advantages: When its done right, dieting is one of the safest approaches to losing weight.

Disadvantages: Even people who manage to reach their weight goals through dieting alone often gain some or all of that weight back within one year. In fact, National Institutes of Health studies show that 90% of people who participate in diets and weight-loss programs dont lose much weight, and usually gain back what they do lose. Finally, unsupervised diets, crash diets (drastic and sudden decreases in calorie intake), or yo-yo dieting (losing weight and gaining it back over and over again) can lead to potentially serious health issues.

That said, while just going on a diet may not help you reach your goals, it is still necessary for successful weight loss, and it's safer than most other methods. Whether you're dieting on your own, under the supervision of your doctor, or through a non-clinical program (like Weight Watchers), a weight-loss plan should always include the following:

• Slow but steady weight loss. While your weight loss may be faster at the beginning of a program, the calorie level of your eating plan should let you lose about 1/2 to 2 pounds per week, with no more than 3 pounds per week. This usually means eating about 300 to 500 fewer calories per day.
• Healthy eating plans. Dieting requires a reduction in calories, but this does not mean cutting out entire food groups. Depriving yourself of certain kinds of foods not only makes it harder to stick to a diet, it puts you at risk of creating a nutritional imbalance that could negatively affect your health. Creative and tasty recipes make it easier to stay motivated, and help ensure you get the nutrition you need. A healthy diet should include the following:
  • Vitamins and minerals. When you reduce your calorie intake, it can be difficult to get all the vitamins and minerals you need. If you're eating less than 1,600 calories per day, consider adding nutritional supplements to your meal plan.
  • Carbohydrates. No matter what the latest diet fads may say, about 55% of your daily calories should come from good carbs like whole grains, fruits, and vegetables. You need at least 130 grams of carbs a day to prevent fatigue and nausea.
  • Protein. Protein is critical for making repairs to the body and preventing muscle breakdown. Women 19 years of age and older should get about 46 grams a day; for men, its about 56 grams a day.
  • Fats. Limiting fats may help you limit calories, which may help you lose weight. Fats should make up no more than 30 percent of your daily calories. For a 1,500 calorie-a-day diet, that means about 50 grams of fat.
• Regular physical activity. Helping you lose weight is just one of the many benefits of exercise. It also helps you keep it off. Learn more about exercise and take a look at some physical activities appropriate for folks who are overweight.

Maybe some day in the future there will be a medication or diet pill that will make losing weight easy. But for now, it just doesn't exist. Here is some information about the main types of diet pills, and a few of the many reasons why you should avoid them or consider other alternatives:

• Over-the-counter diet pills: Simply put, most of those miracle diet pills you see advertised on T.V. or sold in your grocery store just dont work. And more importantly, they're not regulated by the Food and Drug Administration, so you really have no idea what you're getting yourself into when you take them. Quite often, they contain combinations of vitamins, minerals, and herbs that can be toxic. Sometimes they even contain harmful chemicals. Many diet pills contain laxatives, and you can even become addicted to some of them.

  But wait, theres more! Not convinced diet pills are a bad thing? Then take a look at this list of potential side effects:

  Nervousness, restlessness, insomnia, high blood pressure, fatigue and hyperactivity, heart arrhythmias and palpitations, congestive heart failure or heart attack, stroke, headaches, dry mouth, vomiting and diarrhea or constipation, intestinal disturbances, tightness in chest, tingling in extremities, excessive perspiration, dizziness, disruption in menstrual cycle, change in sex drive, hair loss, blurred vision, fever and urinary tract problems. Overdoses can cause tremors, confusion, hallucinations, shallow breathing, renal failure, heart attack and convulsions.

• Prescription Diet Pills: Right now, there are only two prescription drugs approved for long-term use in a doctor-supervised weight-loss program:
  • Xenical (also known by its generic name, Orlistat) is part of a class of drugs known as fat blockers, which prevent a certain amount of the fat you consume from being absorbed into your body. Side effects include cramping, intestinal discomfort, and diarrhea.
  • Meridia (also known as Sibutramine) is an appetite suppressant, the most commonly-known kind of diet pill. Side effects include increases in blood pressure and heart rate.

While the side effects for Xenical and Meridia aren't common, neither of these drugs are a guaranteed way to lose weight; and even if you do, neither has been proven to help keep weight off. Furthermore, most people who take these drugs lose less than 10% of their original body weight, so they are not particularly effective for people with excessive body weight.

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Weight-loss surgery (also known as gastrointestinal or bariatric surgery) helps you lose weight by:

• Restricting food intake by surgically decreasing the size of the stomach, or
• Both restricting intake & surgically bypassing a portion of the intestine so that fewer calories and nutrients can be absorbed

Advantages: Bariatric surgery usually leads to long-term weight loss of 60-85% of excess weight in patients who undergo the procedure. It improves or resolves most weight-related medical problems, including high blood pressure, diabetes, arthritis, high cholesterol and sleep apnea. Risk of death is decreased by 89%. Improved mood, self-esteem and sense of well being occur with weight loss. You will also be able to participate in more social and physical activities that you may have shied away from in the past.

Disadvantages: Like any surgical procedure, it has potential complications, costs, and requires lifelong management and medical supervision.

There is a perception that people who undergo weight-loss surgery just haven't tried hard enough to lose weight through dieting or exercise. This is flat-out wrong. First of all, not just anyone can have weight-loss surgery. As we said above, only those who are considered morbidly obese are candidates, and even they must go through a strict qualification process. Secondly, those that do qualify are usually folks who have tried numerous weight-loss techniques, with little or no success. Finally, weight-loss surgery candidates often have health complications brought on by their weight that are serious, and their lives may be in danger. In other words, the decision to have weight-loss surgery is not a step patients or doctors take lightly!

Losing weight is challenging for everyone, with the National Institutes of Health (NIH) reporting that 90% of people who participate in diets and weight-loss programs do not lose or keep off significant amounts of weight. For people who are considered morbidly obese, though, excessive weight (usually combined with other physical and hereditary issues) makes it even more difficult to lose weight and keep it off. Worse yet, they often suffer from weight-related health problems that can endanger their lives.
Morbid obesity is defined as:
(use our calculator to define your BMI)

1) Being 100 pounds or more over your ideal body weight or having a body mass index (BMI) of 40 or more
2) having a BMI of 35 or more, plus significant health-related issues like diabetes, sleep apnea, high blood pressure, cardiovascular disease, etc.
3)having a BMI of 35 or more plus major weight-related physical problems like difficulty walking, working, caring for your family, etc.

For morbidly obese people, weight-loss surgery is often their best chance to lead a healthier, longer life. In fact, the NIH and numerous other medical organizations have endorsed weight-loss surgery as an effective treatment for people considered morbidly obese (Read the NIH report).

The most commonly performed weight-loss surgeries use a restrictive (limiting food intake) technique or a combination of restrictive and malabsorptive (limiting nutrient absorption) techniques. Below is a description of four of these procedures:

Usually called "gastric bypass", this procedure has been performed in the United States for more than 30 years and is the most commonly performed weight-loss surgery. There are minimal complications, and most insurance companies authorize this procedure.

How it works: A very small pouch is created at the top part of the stomach, which reduces the size of the stomach by about 95%. Then, about 4 feet of intestine is bypassed to reduce the amount of calories absorbed. This operation works primarily by using restriction and, to a lesser degree, malabsorption.

Results: Most people lose 50-100 lbs in the first six months after surgery, with long-term weight loss of about 70% of excess weight.

Also called "the vertical gastrectomy with duodenal switch", this procedure is performed by only about 40 surgeons around the world. Compared to other types of surgery, the Duodenal Switch seems to offer the most success in terms of weight loss. However, it relies to a greater degree on malabsorption, which makes it somewhat controversial in the medical community, and it may also have more complications. For these reasons, some insurance companies consider it investigational and will not authorize it.

How it works: Unlike the Roux-en-Y procedure, where the stomach is divided horizontally to form a small pouch at the top, the Duodenal Switch divides the stomach vertically. This is the restrictive part of the surgery, making the stomach about 85% smaller. The malabsorptive part of the surgery bypasses greater lengths of the intestine than the Roux-en-Y.

Results: Patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. Average weight loss is 75-80% of excess weight.

A purely restrictive procedure, the LAP-BAND system was approved by the FDA in 2001, but has been performed around the world since 1990. It is generally performed in an outpatient setting, and only requires an overnight stay in the hospital. LAP-BAND is considered very safe and effective, and is ideal for patients who do not want to permanently alter their gastrointestinal tract, or for those patients who are higher risk. However, because it is a newer procedure, some insurance companies will not authorize it.

How it works: A hollow plastic band is wrapped around the top of the stomach and secured in place, creating a smaller, pouch-like stomach. The band is then inflated with saline solution, which works to cinch the band in place like a belt. Over time, the band can be tightened or loosened as needed through a tube that connects the band to an access port placed just under the skin. This makes the LAP-BAND procedure very customizable for the patient's needs.

Results: The LAP-BAND system tends to have slower weight loss and overall less weight loss than other procedures. Because LAP-BAND does not depend on malabsorption, successful results are very dependent on the patient's willingness to change his/her eating habits and engage in regular physical activity.

Usually called just "Vertical Gastrectomy", this is a relatively new procedure that was developed to minimize complications and risks after surgery. This surgery appears to be especially well suited for older (50+) patients or those who have a BMI of 50 or more. And because it only involves the stomach, Vertical Gastrectomy is a good choice for lower BMI patients who are concerned about the long-term risks of an intestinal bypass.

How it works: About 90-95% of the stomach is removed, leaving a small and thin tube-like stomach that remains connected directly to the intestine. Because there is no rearrangement of the intestinal tract, and therefore no malabsorption, vitamin deficiencies and nutritional problems are almost non-existent.

Results: Patients who undergo this procedure lose at least as much weight as those who undergo a Gastric Bypass or Duodenal Switch. Weight loss is significant and rapid, with few complications. Because this is a new procedure, weight-loss statistics are only available for about 2 years after surgery.

All of these surgeries can usually be done laparoscopically, with minimal pain and scarring. "Laparoscopic" means the doctors operate through several small incisions, using a telescope with a camera mounted on it. This results in a faster recovery, fewer pulmonary complications, a better cosmetic result, and less pain. However, laparoscopic surgery is technically very demanding, so you should only entrust yourself to surgeons who have done at least 150 procedures.

No matter how you are trying to lose weight, you'll go further with a little help from your friends. That's why the Obesity Resource Center offers several resources designed to answer your questions, address your concerns, and help you stay motivated.

A great place to begin is our Ask a Doctor section, where you can get answers to your questions and concerns about weight-loss surgery from a certified Weight-Loss Physician. Another good resource is the Web site for the Laparoscopic Associates of San Francisco, a leading weight-loss surgery practice and a Center of Excellence, based on criteria set forth by the American Society of Bariatric Surgery and by Blue Cross of California.

Sometimes, it feels like the toughest part of trying to lose weight is knowing what to eat. That's where our Recipe Boards come in handy, with tasty and nutritious recipes submitted by doctors, dieticians, and people just like you.

Finally, there's our comprehensive Obesity Directory, where you'll find links to other helpful weight-loss related Web sites, nutritionists, sleep specialists, clothing designers, doctors, personal trainers, and more. If you'd like to add your own resource to our Obesity Directory, please click here.

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