OVERVIEW

Americans are obsessed with both food and dieting. As a nation, we love to eat - eating out more often, where meals are often higher in fat and calories than at home; having larger portions; and partaking of dozens of delicious "new" food products found on our grocery store shelves every year. But we also spend $50 billion a year on commercial weight loss programs, often hoping for a quick fix. And it's no wonder; with all that eating, about 90 million Americans - more than half the nation - are overweight. What's more, dieting is failure-prone, and the statistics are even worse for keeping the weight off.

The answer to this paradox lies in managing your weight on a regular, day-in, day-out basis. Your diet - the way you eat - is ingrained into your lifestyle. To change your weight - whether you want to lose a few pounds, or more, and keep them off - or to ensure you don't succumb to the expanding-waistline syndrome, you must adopt a healthy lifestyle. Experts have come to believe that this approach of weight management is more reasonable and promising than traditional dieting strategies.

Unfortunately, it's not just all that delicious, tempting food that stands in the way of your efforts to achieve and/or maintain a healthy weight. The ways technology has made Americans' lives easier mean we are most frequently sitting - in front of a computer or TV, in a car, at a restaurant. Americans' activity levels have fallen so dramatically that 25 percent of adults - and an even greater percentage of women - report they are sedentary and engage in no physical activity during leisure time. After age 44, upwards of 30 percent of woman are sedentary, and by age 65, the proportion increases to almost 35 percent. And by the time they reach age 75, about 50 percent of all women are sedentary. Despite the fact that it is absolutely essential to weight management and health, only about 22 percent of American adults engage in regular, sustained physical activity for at least 30 minutes five times a week; and only 15 percent exercise both regularly and vigorously.

Being overweight increases your risk for many diseases. If you are overweight, you are more likely to develop health problems, such as heart disease and stroke, the leading causes of death for both men and women in the United States. Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, which is also a risk factor. Overweight people are twice as likely to develop Type 2 diabetes - a major cause of death, heart disease, kidney disease, stroke and blindness - as people who are not overweight. Several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Being overweight can also cause problems such as gout - a joint disease caused by excess uric acid; gallbladder disease or gallstones; sleep apnea - interrupted breathing during sleep; and osteoarthritis - wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.

It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds and fewer still - about 5 percent of the 50 million Americans on diets every year - are successful at maintaining the weight loss. Many factors other than overeating can play a part: Your genetic makeup, cultural influences, and natural hormonal and neurologic regulators can all make it hard to control body fat by diet alone.

Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Weight loss should not be your only or even your primary goal if you are concerned about your health. The success of your weight management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors - for example, lowered blood pressure or cholesterol - and symptoms like blood sugar levels, as well as by your new healthy lifestyle habits. In fact, some experts believe that it is not weight that causes the diseases associated with being overweight, but the accompanying unhealthy foods and sedentary lifestyles themselves.

On the flip side, some women are underweight despite having tried to achieve or maintain a "normal" weight. Having a metabolism that burns too many calories can be as dangerous as being overweight. Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.

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A Word About Teens

Teenage girls today feel a lot of pressure from friends - and sometimes parents - to be very slim. This pressure can create a distorted body image, making them see themselves fatter than they really are. A national survey of 11,631 high school students conducted by the national Centers for Disease Control and Prevention found that more than a third of the girls considered themselves overweight, compared with fewer than 15 percent of the boys. More than 43 percent of the girls reported that they were on a diet - and a quarter of these dieters didn't think they were overweight. The most common dieting methods used were skipping meals, taking diet pills, and inducing vomiting after eating.

Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent boys from developing muscles. If the diet doesn't provide enough calcium, phosphorus and vitamin D, bones may not lay down enough calcium, which may increase the risk of osteoporosis later in life.

The flip side to feeling pressured to be thin is having legitimate concerns about your weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a doctor or nutritionist whether you are carrying too much body fat for your age and height. If you find out you need to lose weight, you should, for the most part, follow the sensible guidelines laid out here. Depending on your age, your healthcare professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.

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DIAGNOSIS

The weight management techniques discussed here are straightforward. But if you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or suffer from a chronic condition, you should consult a physician before you begin any effort to reduce your weight or increase your activity level.

If you are healthy, you may not need to consult a physician before launching a weight management program, but you might want to talk to a professional who specializes in this area. These include:

• A dietician or nutritionist - both evaluate the diets of clients suffering from medical disorders and suggest ways of fighting various health problems by modifying the intake of certain food items. They usually have a bachelor's degree with a major in dietetics, food and nutrition, or a related subject.
• A registered dietitian (RD) - An RD after someone's name indicates he or she is a dietician who has completed academic and experience requirements established by the American Dietetic Association, including a bachelor's degree, an accredited preprofessional experience program, successful completion of a national credentialing exam, and ongoing continuing professional development.
• An endocrinologist - Endocrinology is the field of medicine involving the body's chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity as well as diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions, and growth and gonadal disorders.
• A personal trainer - Trainers provide one-on-one exercise - and sometimes diet-related goal-setting help, motivation, professional expertise, and personalized attention - all key components of reaching your personal health and fitness goals. A personal trainer should be certified by an accredited professional organization such as the American Council on Exercise, the American College of Sports Medicine, or the American Aerobics and Fitness Association. However, keep in mind that personal trainers vary greatly, not only in educational background and costs, but also in personal philosophy, training and consulting practices.

Lose, Maintain or Gain?

To determine if you are overweight, of normal weight, or underweight, you or your healthcare professional can calculate your body mass index (BMI), which describes body weight relative to height and is strongly correlated with total body fat content in adults. Your BMI equals your weight in kilograms divided by your height in meters squared. Or you can divide your weight in pounds by your height in inches squared, and then multiply by 705.

The table below has already done the math and metric conversions. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.

A woman or man with a BMI between 18.5 and 24.9 is considered within the normal, healthy range; 25 to 29.9 is considered overweight; 30 or more is considered obese, and 40 and greater is considered severely obese. An exception would be athletes, who have more muscle mass and less body fat than normal. They might have a BMI as high as 30 and yet not be obese. If your BMI falls under 18.5, you may be underweight; if so, you may want to ask your healthcare professional to assess your health. If he or see suggests gaining weight, there are some helpful hints in the Treatment section.

Charts using the same mathematical principles as BMI can show you your ideal weight based on your height. An excellent height-weight chart that shows lower and upper limits of overweight, obese and severely obese can be found at http://www.niddk.nih.gov/health/nutrit/pubs/health.htm.

Your healthcare professional might also measure your body composition, which is the percentage of lean muscle to fat. The most common test for this is the use of a caliper-like device to measure skin fold thickness and subcutaneous fat, which lays just under the skin, at targeted sites such as the back of your upper arm, waist or thigh. Measurements of skin fold thickness depend on the skill of the examiner, and may vary widely when measured by different examiners. Or, your healthcare professional may conduct a bioelectrical impedance test. A handheld instrument called an impedance analyzer transmits a non-invasive low frequency electrical current through electrodes placed on your hand and/or foot using a gel. Sophisticated software analyzes your body composition in seconds.

In addition, because abdominal fat is an independent predictor of disease risk, you or your healthcare professional should measure your waist and measure to determine your waist-to-hip ratio. Divide your waist measurement in inches by your hip measurement in inches. A ratio of 0.8 or greater for women (1.0 or greater for men) indicates that you tend to store your body fat around your middle (making you an "apple" vs. a "pear" shape.) Women with a waist circumference over 35 inches (and men over 40 inches) are at the greatest risk. Higher proportions of this visceral fat are associated with higher risks of insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and strokes).

Your healthcare professional may also ask you about chest pain, faintness or dizziness, bone or joint pain, and any medications you may be taking, and will probably check the health of your heart and joints, measure your blood pressure, and determine if you have a hernia or diabetes. These issues may effect how vigorously you exercise or which types of exercises you should not do. If you have heart disease or risk factors for it, you may be asked to take an electrocardiography test, commonly called a stress test. During this test, you walk on a treadmill while the healthcare professional monitors your heart's activity.

In other cases, it may be your healthcare professional who first brings up the idea of your starting a weight management program. He or she may make this recommendation if you have high blood pressure, blood sugar or cholesterol, and/or are overweight or have a high percentage of body fat.

Your healthcare professional can give you advice about a program suited to your weight and health goals. He or she also may refer you to a nutritionist and/or fitness professional or a hospital-based weight-management or fitness class to provide guidance while you're getting started.

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TREATMENT

The key to weight management is incorporating three strategies - eating healthfully, exercising regularly, and using behavioral techniques (changing the way you react to things) - into a single, lifelong way of living. Unfortunately, of the 43 percent of all women who are trying to lose weight, only 19 percent are using this method. The most important key to success is to approach any changes in diet and exercise not as punishment but to plan and implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.

Drug therapy and surgery are more appropriate for obese women than those who simply want to lose a few pounds. Prescription appetite suppressant drugs can have side effects, and they don't help you learn new eating habits, resulting in weight gain after you stop taking the medication. Nutritional supplements and herbal weight loss treatments are controversial and additional research is needed to determine their potential side effects, interactions with other medications, long-term effectiveness and general safety. For example, the herb guarana has effects similar to caffeine and may produce similar adverse effects. Another herb, ephedra sinica, commonly known as ma huang and touted as promoting weight loss, also can have dangerous side effects, especially when it's combined with caffeine as it is in many compounds. In general, remember that herbs and supplements are not regulated, and manufacturers are not required by law to back claims with thorough testing or clinical trials.

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Eating for Weight Management

Keeping in mind the biological reason we eat - to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it - is a good way to think about food.

The fact that 90 percent of dieters who lose weight regain all or part of it within five years indicates that "dieting" is not the answer to weight management. The best "diet" is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.

Your can ask a nutritionist or dietician for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, for weight loss, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day. This way, you will safely lose about a pound per week.

To determine how many calories your body needs to maintain its basic functions - known as your basal metabolic rate - multiply your current weight by 10. (Men should multiply their weight by 11.) For example, a woman who weighs 135 pounds requires 1,350 calories per day just to maintain bodily functions like breathing and digestion. You need additional calories to provide energy for daily activities like walking, vacuuming, even sitting at the computer. It's difficult to determine exactly how many calories you need to maintain your weight at your current level of physical activity. You may want to take your basal metabolic rate and add about 10 percent if you're relatively sedentary, 20 percent if you're lightly active, and 30 percent if you're moderately active. So the 135-pound woman who is lightly active needs about 1,680 calories a day to maintain her weight. If she needs to lose weight based on her height or body composition, she should then subtract the 250 calories to arrive at her new recommended daily total of 1,430 (assuming she plans to add exercise).

A more accurate method is to keep a detailed food diary over the course of a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day - several books and web sites provide calorie counts for thousands of different foods - and use that figure as a starting place for weight maintenance or weight loss.

After you've determined how many calories per day you should eat, you need to plan daily menus. A dietician or nutritionist can help you plan menus that include the types and amounts of food you should eat, which, in most cases, should be based on the sensible guidelines set forth by the federal government in its Dietary Guidelines and Food Pyramid. The guidelines emphasize balance, moderation and variety in food choices, with a special emphasis on whole grain products, vegetables and fruits.

The best advice - and the easiest to follow - is to plan your meals so that your main dishes are made mostly from vegetables, dried beans and peas, and grain products like whole-grain bread, pasta, rice and cereals. Also, eat plenty of fruits. Meat and milk products should be eaten as smaller side dishes. These proportions will help lower your fat intake and increase the amount of fiber in your diet, both of which have been shown to decrease risk for many types of conditions, including heart disease, and breast and colon cancer. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as "off limits," chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:

• Hold the sauce. Don't eat dishes that include high fat sauces, mayonnaise and regular salad dressings.
• Drink more water. And steer clear of calories hidden in drinks like fruit juices, alcoholic beverages, fancy coffee concoctions, and smoothies. Water itself is a weight-loss aid, and you should drink at least eight 8-ounce glasses a day.
• Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on the fats, oils, and sweets.
• Healthcare professionals recommend women cut fat consumption to 30 percent or less of your total calorie intake, with saturated fats accounting for only about 10 percent of intake, and the rest comprised of equal amounts of monounsaturated fats and polyunsaturated fats - that is, more vegetable-source fats. Also, reduce cholesterol intake to about 300 mg per day. Strategies for reducing fat and cholesterol intake include:
• reduce your consumption of red meats, organ meats, eggs, and dairy products
• choose low-fat protein sources, such as fish, turkey, chicken, and legumes (dried peas and beans)
• when consuming meats, use lean cuts and trim excess fats
• substitute skim and low-fat milk products for whole-fat dairy foods
• broil, bake, or boil foods instead of frying
• increase your consumption of fruits, vegetables, and whole grains

An understanding of dietary fat may simplify your meal planning. Fat is an organic compound consisting of fatty acids, hydrocarbons, and other compounds. All humans need to eat some amount of dietary fats as found in seeds, nuts, some vegetables and fruits, meats, and dairy foods. Different combinations of hydrogen and carbon make a fat either saturated or unsaturated.

You have probably heard of "good" fats and "bad" fats. These labels refer to various types of fats' impact on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. This fat is considered unhealthy because it can cause fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils.

Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of one type, omega-3, include certain fish, flax and pumpkin seeds, and walnuts. Good sources of the other type, omega-6, include corn oil, sunflower oil and soybean oil.

When an unsaturated fat is solidified - into margarine, for example - the process, which uses high heat and hydrogen, causes it to act like a saturated fat and clog arteries. These partially hydrogenated oils also contain trans fatty acids, which can lead to difficulty processing essential fatty acids.

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The Skinny On Fad Diets

Despite numerous unsubstantiated advertising claims to the contrary, there simply is no magic formula for losing weight. Fad diets, like those centered around cabbage soup, grapefruit or all-protein, may help you lose some pounds - often water weight - in the short run; but, long term, they don't work because they are temporary measures that are impossible and unhealthy to maintain. The truth is, permanent weight loss takes time and requires a change in eating and exercise habits.

Extreme diets of less than 1,100 calories carry health risks and are often followed by unhealthy bingeing or overeating. Such diets usually have insufficient vitamins and minerals as well. Severe dieting has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation, and menstrual irregularities. Most of the initial weight loss is in fluids and minerals; later, fat is lost, but so is muscle, which can account for more than 30 percent of the weight loss. It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas did not have sufficient nutrients. Those whose diets include a high intake of fluids and much reduced protein and sodium are at risk for hyponatremia, which can cause fatigue, confusion, dizziness, and in extreme cases, coma.

High-protein low-carbohydrate diets have become popular again. Although a high-protein diet will lead to quick weight loss, its health benefits are dubious. One byproduct of this diet is the release of substances called ketones, which can cause nausea, lightheadedness, and bad breath. Such high-protein diets may also be high in fat and low in fiber-rich and healthful whole grains, fresh fruits, and vegetables. Such high-protein diets also often result in carbohydrate binges.

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Choosing A Diet Plan

With all the crazy fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:

• Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may also be harmful to your overall health. A weight- loss goal of one to two pounds per week is an effective rate for long-lasting results.
• Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy, or protein, you risk missing out on essential vitamins and minerals.
• Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is an absolute minimum, and most people actually need more. If a weight-loss plan restricts calories below this level, it's not nutritionally adequate and you'll be in danger of nutrient deficiencies.
• Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be no more than moneymaking schemes to benefit the seller. These types of programs will drain your wallet without teaching you anything about nutrition and healthy eating habits.
• Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain, not just on short-term losses, but on long-term lifestyle changes.
• Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely, to maintain that weight.

The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:

• The plan is touted as requiring no sacrifice - no exercise or no change in your eating habits.
• No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective; the promoter has not had the plan properly tested in clinical trials.
• Testimonials and case histories of people who have supposedly been successful on the plan are offered as "proof" of its effectiveness. A few successes don't prove the plan will work for everyone.
• The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.
• The plan is promoted as "cleansing" the body of "toxins" to let the body's "natural" curative powers help in your weight loss efforts.

Today's most popular weight-loss programs vary greatly. No single diet is appropriate for each and every person, so you'll want to weigh factors that vary by plan, such as types of food you can eat, their reliance on supplements or drugs, calorie levels allotted, and the amount of support they offer.

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Popular Weight-Loss Plans

Weight Watchers: This diet program has helped more than 23 million people lose unwanted pounds since it was founded in 1963. In general, the plan is healthy - long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides members support through weekly weigh-in meetings. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. They are trained in leadership skills and must pass program tests and take continual training courses to maintain their leader status. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight - what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for cutting calories out of meals.

Exercise is stressed as part of the program as well. In the past, the diet steered members toward a very healthy nutritional balance by outlining how much of specific food groups - fruits, vegetables, dairy products, protein, starches and fats - should make up their daily diets. However, in the past few years, Weight Watchers introduced a system that assigns point values to each food. Dieters are allowed to consume a specific number of points per day based on their weight and members aren't given as much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, food.

A recent addition to the program is the "10 percent difference" that offers members a practical framework for focusing their weight-loss efforts. The program begins with assessing your current weight and determining your goal weight. However, rather than defining success as achieving your goal weight, you focus on achieving a 10 percent loss of your total body weight. After losing the 10 percent, the focus shifts to getting you to your goal weight. In this way, you gain the substantial health and self-esteem benefits of a 10 percent weight loss, as well as a motivation boost as you refocus on your overall goal. Weight Watchers does have a line of signature foods that can go along with the program, but the diet does not depend on these foods, and you can follow it with regular supermarket items.

Nutri/System: This diet is based mostly on Nutri/System's prepackaged foods and reducing participants' diet to an average minimum of 1,200 calories per day for women and 1,500 for men. Participants go into the center (or more recently can participate over the Internet) for weekly weigh-ins and one-on-one counseling for 15 to 20 minutes. Clients determine weekly goals with the "diet technicians," often focusing on exercise. While the program was developed by registered dieticians and health educators, with input from medical doctors, there have been some complaints in the media that the diet technicians are not highly trained; if this is of concern to you, you may want to ask at your center.

Because clients eat prepackaged meals, they have few food decisions to make, but they also aren't learning how to make choices in the real world or change their lifestyles. The program also sells vitamin/mineral supplements, or even "herbal phen-fen," which can be dangerous. Sometimes clients, after a brief consultation with a physician, are prescribed the weight-loss drug Meridia or phen-pro, a prescription drug made from a combination of phentermine and Prozac and touted as an alternative to fen-phen, which was removed from the market for safety reasons. The safety of phen-pro has not been determined.

Jenny Craig: This program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides from 1,000 to 2,600 calories daily depending on your gender and current weight. Clients can attend weekly lifestyle classes and one-on-one counseling. After losing half of goal weight, clients are given the option to transition to regular foods.

Jenny Craig emphasizes increased physical activity, changing ingrained habits, and balanced eating. The program was developed by registered dietitians and psychologists with input from medical doctors.

Relying on prepackaged foods makes dining out and socializing difficult and also de-emphasizes behavior modification and lifestyle change that are pertinent to long term weight loss. Also, Jenny Craig makes "weight-loss supplements" an integral part of the system.

Optifast: A medically supervised program of fortified liquid-meal replacements or prepackaged foods, Optifast does eventually include regular foods. Dieters are assigned either 800, 950, or 1,200 calories daily and are seen regularly by a physician, a registered nurse, a registered dietician and/or a psychologist, often in a hospital setting. Mandatory weekly sessions promote positive eating behaviors and one-on-one counseling is available.

While the program itself discourages the use of diet drugs, some sites offer phentermine based on the discretion of the individual physician. The program emphasizes changes in behavior and diet planning for "real" foods in group and individual counseling sessions, and exercise physiologists are available to help design personal exercise plans. But dieters must rely on Optifast products during the reducing phase, and it can be difficult to transition from liquid to regular food.

Because of the close contact with health professionals, this program is beneficial for people with serious health problems who need a low-calorie plan to promote quick weight loss.

Dr. Atkins New Diet Revolution, Quick Weight-Loss Center, Sugar Busters Diet, Protein Power, the Carbohydrate Addict's Program, and other very low-carbohydrate diets: These trendy new diets claim that carbohydrates - and not fat or an overindulgence in calories - are what makes people gain weight. They tell you to ignore the dietary recommendations from the USDA, the American Heart Association, the American Dietetic Association, and the American Diabetes Association.

Dr. Atkins' diet is a high-protein, low-carbohydrate plan that begins with a 14-day Induction Diet in which daily carbohydrate intake cannot exceed 20 grams, about as much as is in one corn muffin. Breads, pastas, and even many fruits and some vegetables are to be avoided. This first phase is designed to induce ketosis, a state where fat is burned for part of the body's energy requirements. After the initial Induction phase, you have to choose your Critical Carbohydrate Level for Losing based on your "metabolic resistance." Finally, you determine your Critical Carbohydrate Level for Maintenance once at your goal weight. The Carbohydrate Addicts Diet is even simpler - you can only eat carbohydrate-rich foods for a one-hour window each day.

Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of The Atkins Diet can provide more satiety with meals and snacks. High carbohydrate food portions and sweets are restricted, so blood sugar surges after a high carbohydrate meal or sweet do not occur, also helping control appetite.

These diets rebel against the past decade's message for healthy eating - decrease fat, increase complex carbohydrates, and eat moderate amounts of protein. These recommendations were -and still are - based on scientific evidence that eating so will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, high-beef diets continue to raise concern of possible increased cancer risks.

Some nutritionists are willing to accept that the low-fat craze may have gone too far, leading to the consumption of too much carbohydrates and added sugars. Healthier carbohydrates, like whole grains and natural wheats, should be emphasized over things like bagels and fat-free cookies, they say. However, most of them still agree that the high- protein, low-carbohydrate diets can be dangerous and unhealthy. Nevertheless, high-protein diets sweep the country and have done so for the past 30-plus years. Why? Because they do indeed decrease body weight, which seems to be the primary goal of Americans. So, despite repeated warnings of potential long-term health risks from many institutions, desperate weight-loss hopefuls will continue to flock to whatever works. But once they lose the weight, they revert back to old eating habits, as sticking to a very low-carb diet is not an easy lifestyle.

Note: Because prolonged ketosis can lead to kidney damage, people with a family history of renal disease or that have renal problems should avoid high-protein diets.

The Zone: This diet relates excess weight to both overeating, and/or to unbalanced consumption of calories from the carbohydrate, fat, and protein groups. In the Zone, your diet is exactly 40 percent carbohydrate, 30 percent fat, and 30 percent protein. You must keep this ratio for all meals and snacks.

Protein requirements are established by assessing your lean muscle mass and physical activity level. Your protein needs are then divided into blocks, with each block representing 7 grams of protein. Having established the required number of protein blocks, you assign one carbohydrate block (7 grams) and one fat block (1-1/2 grams) for each protein block. Meals and snacks consist of an equal number of carbohydrate, protein, and fat blocks. Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods.

Simply put, this diet is most likely successful because it restricts caloric intake to a level where one loses weight. The average person eating in the Zone will consume no more than 800 to 1,200 calories a day. However, as with all low- carbohydrate regimens, this diet is criticized for being unbalanced with respect to USDA standard dietary recommendations that emphasize carbohydrate-rich foods as the bulk of daily intake. Some critics also consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.

The Mayo Clinic diets: Several of these diets that push grapefruit or eggs, cabbage soup or oranges, have surfaced over the years, none of which originated at or are approved by Mayo Clinic. (Some of them have also been attributed to the American Heart Association, which also did not originate or approve these diets.) These diets can also be dangerous because they are unbalanced and rely on too few calories.

Slim Fast and Nestle Sweet Success: These liquid meal-replacements are milk-based products that have added vitamins and minerals. If "balanced" is defined as containing adequate amounts of the nutrients the government has set Recommended Dietary Allowances (RDAs) for, then Slim Fast and Sweet Success meet the requirements. Slim Fast commercials state, "a shake for breakfast and lunch and a sensible dinner" is the road to weight loss. So, what happens if one starts following the Slim Fast plan? If the two Slim Fast shakes and whatever is consumed for the sensible dinner add up to less calories than the body needs, weight will be lost. How much weight you actually lose will depend on how long you follow the plan and what your calorie deficit is.

One thing that might stand in your way is hunger. Another drawback: nutritionists recommend you divide your caloric intake evenly throughout the day; on the Slim Fast plan, you may end up loading up on calories in the evening. In addition, if you stops following the Slim Fast or Sweet Success plan and return to old habits, the weight that was lost will be regained - the same problem with any program that gives a person a diet and does not teach her anything about the eating habits that caused her to gain weight in the first place.

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Trying To Gain Weight?

For the underweight woman who needs to gain weight, either for health reasons or appearance's sake, the journey can be a difficult one. Weight gain for women who are underweight is much more difficult that for women who are already overweight. The underweight woman may have a higher metabolism, fewer fat cells or "lean genes," be taller, or just not care about food. Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity - like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn't give up exercise, as it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:

• Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you'll be more likely to enjoy your meals and snacks without feeling overstuffed.
• Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins, and minerals, in addition to calories, such as dairy foods, nuts, peanut butter, or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid.
• Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins, and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice. Dip crackers, chips, and fresh vegetable relishes into high-calorie dips made with cheese, sour cream (either regular or reduced-fat), mashed beans, or fat-free salad dressings. Space out snacks during the day so you don't spoil your appetite for later meals.

Physical Activity Is Key To Weight Management

Daily physical activity is essential to weight management. Exercise not only burns calories, it also tempers the appetite. Exercise boosts metabolism, which dieting can impair, and has psychological benefits including an increased feeling of control and reduction in stress. Women who exercise tend to translate those psychological benefits into a better ability to control the eating part of the equation.

If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or suffer from a chronic condition, you should consult a physician before you begin your effort to increase your physical activity. Be sure to notify your physician about any chest pain, faintness or dizziness, bone or joint pain, and any medications you may be taking.

The best kinds of exercises for burning calories are aerobic activities - which involve using the large muscles of your body in a rhythmical, continuous activity - and not only help reduce body fat but also improve cardiovascular conditioning. Low- to moderate-intensity aerobic exercise, like housework, gardening, and walking the dog, provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with vigorous activities like brisk walking or jogging, singles tennis, aerobics classes, or cycling.

The Centers for Disease Control and Prevention and other professional groups recommend healthy women do some sort of aerobic exercise on most or all days of the week for 30 to 45 minutes. These minutes can be accumulated - 15 minutes of an aerobics video in the morning and 15 minutes of brisk walking in the evening, for example. However, a single sustained exercise session may be more effective at helping lose weight. If you have been inactive, you need to work up slowly to this amount so you don't get injured or overly fatigued and then discouraged.

Because the goal of aerobic exercise is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and then sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jawline and about one to two inches in front of your ear. Count the beats for 10 seconds. Your heart rate should be about 70 percent to 85 percent of its maximum, which is your age subtracted from 220. The following chart illustrates recommended 10-second heart rate counts; the number of beats you count should fall between the two numbers listed beside your age. (Age) 70 % of maximum 85 % of maximum :

20 23 28
30 22 27
40 21 26
50 20 24
60 18 23

If you are out of shape or older than 60, you should aim for an intensity at 50 percent to 70 percent of your maximum heart rate.

To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.6 for the lower end of the range and 0.73 for the higher end. For example, if you're 70:

• 220 - 70 = 150 (this would be your maximum heart rate for one minute)
• 150 divided by 6 = 25 (this would be your maximum heart rate for 10 seconds)
• 25 x 0.60 = 15 (this would be 60% of your maximum, or the lower end of where your 10-second heart rate should be when you're exercising)
• 25 x 0.73 = 18 (this would be 73% of your maximum, or the higher end of where your 10-second heart rate should be when you're exercising).

An easier way to judge intensity is the "talk test." You shouldn't exercise so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.

Another type of exercise has received much attention over the past several years for its health benefits and contribution to weight loss efforts. Strength training - which includes weight lifting and isometrics, or using your own body weight as resistance such as in push ups - not only improves muscular strength and endurance, it also raises metabolism, causing you to burn more calories. As you work on building muscle, remember that in a resting state, muscle burns more calories than fat. You can do strength training at a gym with a personal trainer or at home using videos or printed materials. Start slowly, with lighter weights, and work up to heavier weights and more repetitions or sets of repetitions. You don't need to strength train more than three days per week; and always wait at least a day or two before exercising the same muscle group to give those muscles adequate time to recover between sessions.

It's best to incorporate a combination of both types of exercise into your lifestyle - aerobics to burn fat and strength training to build muscle - because neither type is as effective alone. One hundred sit ups a night will not rid a woman of abdominal fat if she isn't also burning calories through aerobic exercise and a reduced-calorie diet. But the sit ups will help build strong muscles that make her body's metabolic state more active, as well as make her middle section more toned once the fat is gone.

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Some Techniques May Not Live Up To Expectations

Spot exercising, or training particular areas of your body, is ineffective in reducing fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants, and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms, or thighs were reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could be dangerous for people with circulation problems. Another popular spot reducer, liposuction, does get rid of fat cells in specific areas, such as the thighs, buttocks, or knees, but the pain after the operation can be severe and often the skin does not contract, resulting in a flabby look. It doesn't result in much weight loss or positive health effects.

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Get Your Mind In Gear

Another key to successful weight management is incorporating into your new eating and exercise habits behavioral strategies designed to improve daily patterns associated with eating and physical activity. Learning about nutrition, planning what to eat, and making sure you eat regularly help put an end to impulsive and thoughtless eating. To increase your awareness of your eating patterns and help you find habits that need to be changed, you should keep a dairy of all activity related to eating patterns, including the times of day, length of meal, emotional states, companions, and, of course, the kind and amounts of food eaten. For instance, if you find your overeat while watching TV, you might want to restrict your eating to another room or watch less TV.

Some other specific and helpful behavioral strategies include:

• Set the right goals. Your goals should focus on specific dietary and exercise changes, such as "I will eat five servings of fruits and vegetables every day this week," or "I will work up to being able to walk briskly for 30 minutes at a time," rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in your goal setting, that losing more than one to two pounds per week can be unhealthy and greatly improves your chances of gaining the weight back.
• Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely. Do not use food as a reward.
• Monitor your weight sensibly. Keep track of your weight, but don't weigh too often. One day's diet and exercise patterns won't have a measurable effect on the scale the next day, and your body's water weight can change from day to day, which may frustrate you and derail your efforts. Weigh yourself once a week.
• Join a support group. Weekly meetings at a nearby support group - or even over the Internet - can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations, and a variety of other psychological benefits.
• Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.
• Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to attending a party, may stimulate you to eat in an unhealthy way. In some cases, you can avoid those cues; don't go to that Mexican restaurant where you always eat too many chips, for example. But for situations that can't be avoided, from the business lunch to the argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.
• Change the way you go about eating. There are a variety of tricks, from using a smaller plate to eating more slowly, that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu, and other tricks can all be helpful.

PREVENTION

If you have 10 or more pounds to lose, it's probably a sign you've been letting your eating habits get out of control for six months to a year. Of course, it's best to use weight management techniques before you become overweight, to prevent weight gain in the first place. The sensible eating and exercise guidelines above can not only help you lose weight, they can also prevent weight gain.

Additional helpful dietary guidelines spelling out how much and which foods you should eat and how much you should exercise to stay healthy are issued by the federal government and found on the Internet at www.usda.gov/cnpp/. The guidelines, which are revised every five years, are widely used by physicians, foodmakers and educators, and also form the basis of the well-known U.S. Department of Agriculture (USDA) Food Pyramid used to teach healthy eating habits based on food groups such as grains, vegetables and fats.

The 10 guidelines in the latest dietary guidelines, issued in May 2000, are to:

1. aim for a healthy weight
2. be physically active each day
3. let the Food Guide Pyramid guide your food choices
4. eat a variety of grains daily, especially whole grains
5. eat a variety of fruits and vegetables daily
6. keep food safe to eat
7. choose beverages and foods that limit intake of sugars
8. choose and prepare foods with less salt
9. if you drink alcoholic beverages, do so in moderation
10. choose a diet low in saturated fat and cholesterol, and moderate in total fat

The Food Pyramid recommends healthy women eat the following each day:

• 6 servings of grain, such as bread, cereal, rice or pasta. Whole grains are best. A serving equals one slice of bread, about 1 cup of cereal or about 1/2 cup of rice or pasta.
• 3 servings of vegetables. A serving equals about 1 cup raw leafy vegetables, 1/2 cup of other vegetables, or 3/4 cup vegetable juice.
• 2 servings of fruit. A serving equals 1 medium-sized apple, orange, banana or pear; 1/2 cup of chopped, cooked or canned fruit; or 3/4 cup fruit juice.
• 2 servings of dairy foods, such as low- or non-fat milk, yogurt or cheese. Women over age 50 and children and teenagers ages 9 to 18 need 3 servings. A serving equals 1 cup milk or yogurt, 1.5 ounces of natural cheese or 2 ounces of processed cheese.
• 2 servings, for a total of five ounces of preferably low-fat meat, poultry, fish, dry beans, eggs or nuts. A serving equals 2-3 ounces cooked lean meat, 1 cup cooked dry beans, 1 cup tofu, 2.5 ounce soy burger, 2 eggs, 4 tablespoons of peanut butter, or 2/3 cup of nuts.

Following the nutritional strategies and suggestions for physical activity as laid out in guidelines will help you remain at a healthy weight. Don't forget to exercise at least 30 to 40 minutes on most days of the week.

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FACTS TO KNOW

1. About 90 million Americans - more than half the nation - are overweight.
2. Sixty percent of Americans don't meet basic activity level recommendations, and 25 percent are completely sedentary.
3. More than 300,000 lives could be saved each year if everyone maintained a healthy weight.
4. More than a third of teenagers in a national survey considered themselves overweight. More than 43 percent said they were on a diet, even though a quarter of them didn't think they were overweight. Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly.
5. Children and teens who are overweight often have a lifelong struggle with their weight and are at high risk for developing diabetes, high blood pressure, diseased arteries, damaged hearts, and liver damage.
6. If a woman's waist circumference divided by her hip measurement is greater than 0.8, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This is especially true if her waist measurement is more than 35 inches. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.
7. If you eat 250 calories per day fewer than needed to maintain your weight, and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.
8. Your basal metabolic rate, or the number of calories your body needs just to maintain its basic functions, is determined by multiplying your current weight by 10. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.
9. Ninety percent of "dieters" who lose weight regain all or part of it within five years.
10. Of the 43 percent of women who are trying to lose weight, only 19 percent are using the "sensible" method of eating healthfully and exercising regularly.