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Editor’s note:  This is the concluding article in a weight-loss series by Dr. Lauro. The first two articles were addressed to the majority of the population – people who may have put on a few pounds over the years, and who can easily remove those pounds with a little behavior modification.  This article is written to the people who are seriously overweight, and who have tried just about everything to no avail.

So you read parts 1 and 2 of my obesity article and you came away with nothing more than these thoughts:  “This skinny doctor doesn’t know a darn thing about how hard it is to lose weight.  He has provided me with nothing new at all.  I have been on more diets than this doctor has even read about and nothing has worked.  I am going to take his article and put it right next to a package of rice cakes and curse him every time I eat one!”

Believe it or not, I know how you feel.  But please be assured, the advice and information I gave you in the first two articles on obesity is clinically correct and actually quite effective for many people.  But I am afraid it did not do anything to inspire many readers who have faithfully and committedly tried and tried everything that I (and all the other doctors you have ever talked to) have suggested, only to fail, and feel like a failure, and then regain countless pounds of weight.  At some point you have said, for your own sanity, “Enough!”

Part 3 of my series on obesity will specifically talk to those of you who feel that all is lost in the area of weight loss.

But before I begin, I must once again tell you that you can be successful, and it truly is important that you have faith and try once again.  Please, please, please do not take the attitude that you have accepted being overweight and that you stoically accept the risks associated with this frustrating condition and, for better or for worse, you are throwing in the towel.  I just can’t let you do that without hounding you one more time!

Be assured that the scientific conclusions concerning the risks of obesity that I presented in my previous articles are accurate.  We might be inclined to say that science doesn’t have all the answers on obesity, and that the final word on what is good and what is bad to eat has yet to be written.  Please don’t bet your life on it.  Believe me – your health and your chances for a longer life will be positively affected if you will but try again to lose but a few pounds. 

Setting Reasonable Goals

First let me ask you – what is your goal when you decide to undertake a weight loss plan?  Are you possibly setting yourself up for failure by attempting too much right out of the chute? 

I have found that many of my patients have unrealistic goals when starting a weight loss program.  Many of my patients are 30, 40, 50, 100 pounds overweight – and they want to lose 30, 40, 50, 100 pounds.  Not so fast.  For most people it took years to accumulate this extra weight – and it will take a long time to jettison even a portion of that weight, because you are different now – a little older, a little more sedentary, with hormones that may not be up to the levels where they used to be.

The message I want to emphasize today is that losing even five pounds can have a tremendously positive impact on your health.  Now five pounds doesn’t sound like much, and it might not be an amount grand enough to get you excited about starting a new program, but five pounds is a great start! 

Remember, in these articles I am focusing on your good health, not any cosmetic results from dieting.  You might not even notice a weight loss of five pounds when you look in the mirror, but I guarantee you your health will be better.

OK – so you will try again, and you will set a realistic goal as to the amount of weight you feel you can comfortably lose (consider 1 or 2 pounds a week over the next month).  Now, what should you do?  Should you jump into a calorie restricted diet?

Do Not Go on a Diet!

This brings me to my next point – dieting stinks!  Diets, where one counts calories or severely restricts quantities or types of foods, by and large, are a colossal failure!  Do you know why?  Because they are too hard, too strict, too unrealistic, and too difficult to maintain over any length of time.  And one feels like a child as the doctor (or dietician) pats you on the head and tells you never to eat cake again!  That is why I did not mention any type of caloric restriction in my first article.  You should not count calories.  Throw the calorie counter out the window (or better yet use it as a paper weight).

It is far better to understand that you gained your excess weight by eating more calories than your particular body needs, and to try and understand why you continue to do that.  Studies show that normal-weight people usually eat when they are hungry, whereas the overweight individual often eats for reasons other than hunger.  The overweight individuals who eat when they aren’t hungry are instead eating for emotional, cultural, and environmental reasons, whether their body needs fuel or not. 

If this description fits you, the next assignment for you is to go back in time and reestablish hunger as your primary cue for eating.  Even before you put that first bite in your mouth you must stop and consciously ask yourself, “Am I truly hungry?” Or are you just eating because you are bored, emotionally upset, have a craving for a certain food, or because you are at a ward relief society dinner and everyone else is piling it on.

Remember, hunger feels like this:  a growling in your stomach, accompanied by a little lightheadedness and minor irritability from a drop in your blood sugar.  Now it is time to eat!  But a word of caution:  Don’t wait too long to eat because you will then tend to over-eat.

How Much to Eat

A word regarding amounts:  Normal weight people tend to eat until they feel full.  Many overweight people eat beyond feeling full, because the body does not signal fullness until twenty minutes after a person starts eating.  So try one little experiment.  Cut your amounts back just a little (maybe by a fourth or a third).  Wait twenty minutes after eating for your body to realize you have eaten, and then see if you feel satisfied.  You make the decision.  Don’t rely on me or anyone else to count your calories or scold you for eating too much.  You are in control and you get to decide how much enough is.  But remember, moderation in all things! 

Don’t let those big shots in the food industry tell you how much to eat by consuming in total all those big portions they put in packages that they know are too big in the first place!  You tell them who is in charge by only eating half of the package, or only two-thirds of the amount they put on your plate!  You don’t have to listen to them and clean your plate or eat the whole package.  That’s what doggie bags are for.  Besides – if you can turn one meal into two (or even three), think of the money you’ll save!

In the beginning you can eat anything you want, so long as you do not start to eat until you are truly hungry, and you stop when you start to feel full.  As you begin to gain more control, and realize that you are in charge, you can decide on your own if you want to cut out a few high-fat, high-calorie foods on your own. 

Ignoring Environmental Triggers

Next, don’t let Satan tempt you to eat what or when you shouldn’t (I call these the environmental pressures or temptations – i.e. food advertisements, holidays, super-sizing, etc).  The outside environment is always telling you to eat something (preferably what they are selling).   When this happens, stop for a minute and think.  Are you actually hungry, and did you even want that type of food before someone shoved in front of your face?  If the answer is no, then let it pass.  If you are quite hungry, then go ahead and have a bite.  It is your choice.  You are in charge!

You can reduce environmental triggers by putting food out of sight, avoiding the break room at work, switching the channel when they are advertising foods, or by sharing meals with friends (automatically cuts your portions in half, unless you have a good sport like my wife who gives me the bigger portion).

In time you will learn what environmental triggers you need to avoid, and you will break the association between certain activities and places and your habit of overeating in those situations.  We do this same thing with our smokers:  Cut out that cup of coffee, avoid the break room, don’t do anything that makes you feel like you are supposed to smoke.  The same theory works for eating.

Avoid Emotional Eating

Next I want to stress how important it is to develop effective emotional coping skills so that you don’t eat just because you are bored, sad, anxious, angry, and so on.  I am not trying to imply that overweight people are a bunch of emotional cripples, but I do know that many people eat when they are stressed or unhappy.  (It’s called “comfort food” for a reason!)

Again, when you are feeling emotionally upset and your first impulse is to grab food, stop and ask yourself if you are truly hungry, or just eating because you want to settle your nerves.  If you find you can stop at this point and pursue another activity to divert you from food, great!  If you find you cannot stop the temptation to eat when you are upset, you may benefit from psychological counseling.

Increase Your Activity

The final suggestion for helping you lose that first five pounds is to increase your activity.  We physicians glibly tell our patients to put on their athletic shoes and go out and hit the pavement for at least thirty minutes a day.  But that is awfully hard for many overweight people who have issues with pain in their joints, negative feelings or bad past experiences with exercise, extreme deconditioning (out of shape), and other factors.

So once again, you be the boss.  If you can only go for a brisk walk for just 10 minutes (5 minutes out of the house and five minutes back) – good for you.  This is a great place to start.  And you can do this every day, without advancing, for as long as you like.  Then, as you get in a little better condition, you might decide to expand the outbound walk by another 5 minutes (10 out and 10 back).  Look at you – exercising 20 minutes now.  Then, 15 minutes out, 15 back.  Now you’re up to 30 minutes, enough to make any cardiologist proud! 

If you don’t like walking or it hurts your joints, try riding a stationary bike for 5 minutes.  Or try and find a pool to exercise in.  You decide the type and form of exercise, just as long as you feel your pulse increasing a little bit with your activity.  Naturally, if you ever feel chest pain, dizziness, and shortness of breath – stop!

Conclusion

I have been telling people for years to eat better, eat less, and exercise more.  Sometimes it works; many times it doesn’t.  But unfortunately the studies are showing more and more that letting the doctor be the boss just doesn’t work for most people.

I have been slow to learn this.  But with this new approach where you are the boss, where you drive yourself and make your own decisions, I am hopeful that you will be successful.  And remember, you might not lose any weight at all – but if you find yourself eating a little better and exercising a little more, your health will benefit greatly and I will be happy for you.