What You Should Know Before You Start A Weight Loss Plan

The measurements that count

Know your Body Mass Index (BMI)

Over the past twenty years, Americans have become more familiar with specific measurements related to health, such as cholesterol levels and blood pressure readings. When it comes to weight-related health risks, there are three important numbers that you should know. The first is your actual weight in pounds; the second is your Body Mass Index, or BMI; and the third is your waist measurement.

Your BMI is based on your height and weight. Doctors consider BMI to be a better measure of health risk than your actual weight in pounds. In fact, the medical terms "overweight" and "obesity" are based on BMI values. A BMI of between 25 and 30 is defined as overweight, and a BMI of 30 or more is considered obese. The higher your BMI, the greater your risk of developing a weight-related illness, such as type 2 diabetes or heart disease.

What is your BMI? Are you overweight or obese? You can find out by using the BMI Calculator or BMI Chart (PDF file: 1 page / 20 KB; More information about PDF files). The same BMI scale applies to both men and women.

What is your waist circumference?
Body fat that accumulates in the stomach area (described as "abdominal obesity") is more of a health risk than body fat that builds up in the buttocks and thigh areas. For this reason, your waistline provides valuable information about your risk for heart disease, high blood pressure, high cholesterol, and type 2 diabetes. Doctors consider a waist circumference too high if it is 40 inches or more in men, or 35 inches or more in women.

Consulting your doctor about controlling your weight

Talk to your doctor about healthy eating and physical activities that can help you lose weight, improve your fitness and decrease the chances of developing heart disease, high blood pressure or type 2 diabetes. Be sure to set realistic goals. Small changes can make a surprising difference in your health. Your doctor can offer practical suggestions that do not require a complete overhaul of your current way of life. In some cases, your physician may refer you to a nutrition specialist, such as a registered dietitian, for in-depth counseling about food choices. You may want to start the conversation by asking a few questions of your own. For example:

• Ask your doctor for any educational brochures on topics such as eating habits, counting calories or physical activity
• Request to have your BMI measured and ask your doctor what it means with regard to your health status
• Have your waist circumference measured and discuss the significance of the measurement with your doctor
• Be prepared to describe your current diet and activity level and what changes might promote better health
• Think about how much change you're willing to make before you visit your doctor
• Ask if specialists are available on your health plan and in your area, such as dietitians or physical trainers

What is metabolic syndrome?

A high waist circumference can be one sign of a condition called metabolic syndrome. Although most people have never heard of it, this syndrome is quite common; it affects about one out of every four adults in the United States. Metabolic syndrome often progresses to type 2 diabetes—and treating the syndrome can help prevent this form of diabetes.

A person has metabolic syndrome if they have at least 3 of the 5 conditions listed in the table below. If you think you may have metabolic syndrome, it is important to discuss the possibility with your doctor so that you can undergo the appropriate diagnostic tests. Treatments for metabolic syndrome involve basic lifestyle changes, such as losing weight, eating a healthier diet, and increasing your activity level. Your doctor can help you develop a specific plan for making the necessary changes.

More Information on Metabolic Syndrome

Condition	Treatment: Lifestyle Changes	Practical Suggestions
Abdominal obesity (measured by waist circumference) Men: greater than 40 inches Women: greater than 35 inches	Weight loss Increased physical activity	Cut 250 calories a day*; lose 1/2 pound a week; aim for losing 20 pounds in a year 30 minutes of moderate activity 5 days a week
High blood pressure 130/85 mm Hg or greater	Weight loss Reduced salt intake More fruits and vegetables Low-fat dairy products	Aim for 20-pound loss/year Salt shaker off the table; no salt when cooking Get at least 5 servings/day Get 3 glasses of skim milk, low-fat yogurt, cheese/day
Low HDL (good) cholesterol Men: less than 40 mg/dL Women: less than 50 mg/dL	Stop smoking Weight loss Increased physical activity Cut carbohydrates, eat more monounsaturated fats	Aim for 20-pound loss/year 30 minutes of moderate activity 5 days a week Replace cookies, candy, cakes with unsalted almonds, walnuts, peanuts
High triglycerides level 150 mg/dL or greater	Weight loss Reduce simple carbohydrates Limit alcohol	Raise omega-3 fatty acids Aim for 20-pound loss/year Replace soda, juices with seltzer, water, diet soda Limit: 2 drinks/day for men; 1 drink/day for women Eat fish twice/week
High blood sugar after fasting 110 mg/dL or greater	Weight loss Increase soluble fiber	Aim for 20-pound loss/year* Replace white bread with brown bread, whole grains, cereals

*(For example: replacing two 12-ounce cans of sugar-sweetened soda with a beverage sweetened with a sugar substitute can cut over 350 calories per day.

How to get active

Regular physical activity has been shown to help prevent heart disease, type 2 diabetes, osteoporosis and other chronic conditions. It is important for maintaining good health in all adults and children, regardless of whether their weight is a problem or not. Lifestyle changes do not have to be drastic to be effective. Simple measures applied every day can make a significant difference over time. Here are a few examples:

• Increase whatever physical activity you are currently doing by adding 10 minutes a day, or increase the intensity from low to moderate. (See the box below for an idea of different activity intensity levels.)
• Limit time spent online, watching TV and playing video games to less than two hours total per day.
• Take the stairs instead of the elevator.
• Park at the far end of the parking lot and walk to your destination, rather than parking as close as possible. You can also get off the bus one stop earlier and walk the rest of the way.
• Do more household chores (such as dusting, vacuuming or weeding).
• Walk or run with the dog and/or the kids.
• Use an exercise machine (such as a treadmill or bike) while watching TV.
• Take "active" vacations—go hiking or ride bicycles.
• Walk to do errands (such as to the grocery store or post office) instead of driving.
• Buy a pedometer, which measures how many steps you take each day. Gradually increase your daily number of steps. (Pedometers can be purchased at sporting good stores.)
• Don't be embarrassed about exercising!

How Active Are You?

Moderate physical activity	Hard physical activity	Very hard physical activity
Walking a mile in 15-20 min (3-4 mph)	Walking or jogging (12 min/mile)	Jogging (<10 min/mile)
Treading water	Swimming laps (light effort)	Swimming laps (vigorous effort)
Bicycling (10 mph)	Bicycling (12 mph)	Bicycling (> 14 mph)
Dancing or tai chi	High impact aerobics	Step aerobics (6- to 8-in steps)
Yard work/gardening	Mowing lawn with hand mower	Digging a ditch
Hiking	Playing doubles tennis	Playing singles tennis
Vacuuming	Moving furniture	Playing basketball or soccer
Playing actively with children	Weight lifting	In-line skating

Adapted with permission from Blair SN, Dunn AL, Marcus BH, et al. Active living every day: 20 Weeks to lifelong vitality. Champaign, Ill.: Human Kinetics; 2001.

Conditions and medicines that may prevent weight loss

In some people, overweight or obesity may be related to a medical condition or a medicine they are taking, which interferes with their weight loss efforts. If you have, or think you might have, any of the conditions on this list, or you are taking any of the medications listed, speak with your doctor about measures you should take to manage your weight. In some cases, specific treatments for your medical condition or a change in medicines can make a difference in your efforts to manage your weight.

Some Medical Conditions that May Make it Difficult to Lose Weight

Category	Condition
Hormonal Disorders	Hormonal disorders Polycystic ovarian disease Cushing's disease Diabetes Hypothyroidism
Cardiovascular	Congestive heart failure Idiopathic hypertrophic cardiomyopathy Heart valve disorders
Sleep	Obstructive sleep apnea Upper airway resistance syndrome
Eating Disorders	Bulimia Carbohydrate craving syndrome

Medicines that May Cause Weight Gain

Condition	Medication
Allergies	Antihistamines
High blood pressure	Alpha blockers Beta blockers Methyldopa
Contraception	Progestins
Depression	Tricyclic antidepressants
Diabetes	Insulin Sulfonylureas
Epilepsy	Valproate
Manic-depressive illness	Lithium
Schizophrenia	Neuroleptics

Can diet pills and supplements help with weight loss?

Although diet drugs may help you lose weight at first, they usually don't help you keep the weight off and may have damaging side effects. Most diet pills have not been tested by the Food and Drug Administration, which means you can't be sure if the drugs are safe. Taking drugs also does not help you learn how to change your eating and exercise habits. Making lasting changes in these habits is the way to lose weight and keep it off.

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