# THE SCIENCE OF WEIGHT AND WEIGHT LOSS

Effectively managing weight sounds so easy—eat less and exercise more—but the factors that go into it are tremendously complex, as evidenced by how many people have been gaining weight over the past 40 years in the United States and around the world. This Diet Plan involves making beneficial lifestyle changes in diet and physical activity—eating better and becoming more active. This guide will help you on your journey to better health by teaching you about obesity, its risks, and trends in obesity over time as well as the importance of reaching and maintaining a healthy weight.

## OBESITY

Obesity is defined as an increase in percent body fat, and that can lead to health consequences. Because many people don’t have easy access to a machine that can measure their body fat, the National Institutes of Health (NIH) offers a threefold approach to assess health risks due to increased weight:

1. Calculate your body mass index (BMI).

For most people, weight correlates with percent body fat. Body mass index works well in predicting percent body fat and health consequences of obesity, but it’s not perfect. People who are very muscular, such as body builders, may have high weights and therefore high BMIs, but they are not at increased health risk because their percent body fat is low and their percent muscle—their lean tissue—is higher.

You can determine your BMI in a chart, or you can calculate it yourself. Multiply your weight in pounds by 703 and divide that number by your height in inches. Then divide your answer one more time by your height in inches.

[highlight color=”yellow”]We use BMI to classify obesity and its risks. As BMI increases, so do health risks.[/highlight]

›You’re underweight if you have a BMI of less than 18.5.

› Your BMI is normal if it’s between 18.5 to 24.9.

› You’re classified as overweight if your BMI is between 25 and 29.9.

› Obesity is broken down into two classes: 30 to 34.9 for class 1 obesity and 35 to 39.9 for class 2 obesity.

A BMI that’s greater than 40 is what is classified as class 3, or extreme obesity. There are various terms for a BMI greater than 40, such as extreme obesity, medically complicated obesity, and severe obesity. When BMI is greater than 40, health risks really start to increase.

The second part of the NIH threefold approach is the waist measurement, which is an indicator of how body fat is distributed. The term “apples” describes people who tend to carry their weight around the middle of their body, and the term “pears” describes people who carry their weight around the hips, thighs, and buttocks in a lower-body distribution. In general, men tend to be apples and women tend to be pears.  In general, people who are apple-shaped have higher health risks than those who are pear-shaped. If you carry your weight around the middle, you’re at greater risk of diabetes, high blood pressure, and abnormal blood lipids, as well as heart disease.

The reason why people who are apple-shaped have higher health risks is that they not only have fat just beneath the skin, called subcutaneous fat, but they also carry fat in and around their abdominal organs, called visceral fat.  We’re not exactly sure why visceral fat is so bad, but the prevailing hypothesis is that visceral fat is close to the liver. When visceral fat is broken down into free fatty acids and transported in the blood

DID YOU KNOW? Evidence suggests that how you carry your weight—whether you’re an apple or a pear—may be even more important than your BMI in predicting health risks.

for the body to use for energy, the liver is exposed to a high concentration of these free fatty acids, which appear to be an important factor in causing insulin resistance. This can lead to high glucose values, high blood pressure, and abnormal blood fats—the metabolic syndrome.  Subcutaneous fat is not totally harmless. It appears to increase health risks, too, which is why we measure the total waist measurement when determining obesity.

The waist is measured horizontally at the top of the pelvic bones. While this may not be your natural waist, it is measured this way to standardize results among people. The waist measurement is an indicator of whether you are an apple or a pear. Your waist measurement is considered high if you’re a man and your waist measurement is greater than 40 inches, or if you’re a woman and your waist measurement is greater than 35 inches.

The waist measurement represents a continuous risk, meaning that the higher the waist measurement, the greater the health risks. Within the overweight and obese categories, a high waist measurement increases health risks more than it does in the normal BMI category, where risks are low, and the extreme obese category, where risks are high regardless of the waist measurement.  So, health risks related to weight are both related to increasing BMI and to increasing waist measurement independent of BMI.

In fact, research shows that the highest health risks are associated with a relatively low BMI yet a high waist measurement. The third aspect of weight-related health risks is medical history. Regarding your medical history, ask yourself the following:

› Do you have a family history of obesity, cardiovascular disease, diabetes, high blood pressure, or sleep apnea? This can mean an increased risk for you.

› Have you gained considerable weight since high school? No matter your age or your BMI, gaining more than 10 pounds throughout your adult life puts you at greater risk for weight- related conditions. › Do you already have a health condition that would improve if you lost weight? This includes conditions such as high blood pressure and type 2 diabetes.

› Do you smoke cigarettes? Are you sedentary? Both of these compound your risk of health problems due to excess weight.

While BMI and waist size are a picture of where you are now, your health history gives us a picture of your other health risks and conditions and some hints as to what might happen in the future. For people with other health risks, weight loss is even more important.  If your BMI is in the normal range, your waist circumference is under the described limits, and you were able to honestly answer “no” to all of the health history questions, you may not have anything to gain by losing weight, but that doesn’t mean that some of the nutrition and exercise principles taught in this Best Diet can’t improve your health.

Whether or not you need to lose weight, following the principles of this Best Diet will help improve your health.  If your BMI is between 25 and 30—in the overweight range— if your waist measurement is above the recommended guidelines, and if you answered “yes” to one or more of the medical history questions, then you will most likely benefit from small to moderate weight loss. If your BMI is over 30, putting you in the obese category, some weight loss will almost certainly be beneficial.

## TRENDS IN OBESITY

Since about the 1970s in the United States, the prevalence of obesity has gradually increased in both sexes, in all ages, and in all races. The latest figures show that among all adults, almost 69 percent, or more than two-thirds, are either overweight or obese. Men tend to be more overweight, and women tend to have a higher prevalence within the obese category and the extreme obese categories. Among children, 17 percent are obese.

Caucasian men have the highest prevalence of being overweight, Hispanic men have the highest prevalence of class 1 and class 2 obesity, and black men have the highest prevalence of extreme obesity. Hispanic women have the greatest prevalence of being overweight, and black women have by far the greatest prevalence of being obese and extremely obese.

There are many health complications of obesity. The higher the BMI, the greater the risk of type 2 diabetes mellitus, high blood pressure, and dyslipidemia—all of which are risk factors for heart disease. The risk of these three conditions and heart disease is greater among people who are apple-shaped. The risk of stroke increases with increasing obesity, and overall mortality increases with obesity. This is particularly true in extreme obesity, where there’s a marked increase in the risk of dying. Most cancers are related to increased weight, and the risk of lung disease also increases with increasing weight.

One of the most underdiagnosed conditions related to obesity is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep, particularly when people sleep on their back. There are many cases of obstructive sleep apnea out there; many people have it and don’t know it.

Other health conditions that increase with increasing weight are degenerative arthritis, gallbladder disease, and gastroesophageal reflux disease (heartburn). There’s also a liver condition called nonalcoholic fatty liver disease that’s related to obesity. A small percentage of people who have nonalcoholic fatty liver disease can go on to develop fibrosis, cirrhosis, and even liver failure.

With increasing weight, women can experience gynecologic abnormalities, such as infertility and polycystic ovarian syndrome. Both men and women who are obese also have an increased risk of varicose veins and skin problems, such as intertrigo and cellulitis. There’s also an increased risk of complications during surgery or pregnancy with increasing weight.  Obesity can impact quality of life in many ways, aside from increasing your risk of specific diseases and conditions.

Just as obesity has been increasing over time, some health complications from obesity have also increased, such as diabetes. This increase is largely due to the increase in weight over the years, because there’s such a strong relationship between increased weight and diabetes.

## WEIGHT LOSS

Losing and maintaining weight will help treat and even prevent the conditions associated with increased weight. Weight loss is one of the most effective ways to lower blood pressure. In addition, joint symptoms improve, people can move around more easily— the list goes on and on. Improving habits in diet and physical activity can lead to modest weight loss and decrease your long-term risk of disease.

DID YOU KNOW? When compared to someone with a normal BMI, people who are overweight are three times more likely to have diabetes, and people who are obese are seven times more likely to have diabetes.

Like many things, weight is determined by a combination of genetics and environment. In addition, there are probably many different genes that influence our weight. About 30 to 50 percent of weight is related to genetics; the rest is environment. Then, there are individual factors, such as diet and physical activity habits, that are separate from the environment.

The set-point theory states that it’s difficult to lose and maintain weight loss because the body wants to stay at a certain weight. This may explain why it’s more difficult for some people than others to lose weight, and it may be influenced by genetics. However, it’s difficult to determine how strong this effect may be.

While changes in both diet and activity factors are related to the increasing prevalence of obesity, there is more evidence that the major factor responsible is a decrease in daily physical activity, separate from exercise. The energy balance equation states that the calories we eat minus the calories that we burn wll determine our weight. There are things you can do that influence the equation. For example, if you get too little or too much sleep, you tend to burn fewer calories and weigh more.

DID YOU KNOW? One study reported that Americans burned 130 calories per day less at work in 2010 than they did in 1960.

# GETTING READY FOR THE BEST WEIGHT LOSS DIET

The Best Weight Loss Diet consists of two phases:

Lose It! , a two-week jump-start phase in which you can lose weight relatively quickly by changing a number of habits, and Live It! , in which you take the habits that you changed in Lose It! and turn them into long-term lifestyle changes that will help you continue to lose weight and manage your weight loss over time. The Best Weight Loss Diet is a practical and enjoyable program that will help you not only lose weight, but also improve your health and feel better.

## PREPARING FOR THE BEST WEIGHT LOSS DIET

In preparation for starting The Best Weight Loss Diet, motivation to lose weight is important to consider, both now and in the future. What is your inner burning desire that will help you keep weight off in the long term? There may be several reasons, such as having better health, having more energy, and looking better and feeling better. All of these reasons are valid, but what matters is what is important to you.

Spend a few minutes thinking about what motivates you to lose weight and write down all of your motivators. Post them where you will see them often; this will help you when you’re having a temporary challenge or need a pick-me-up. Add new ones to your list as you go through your weight-loss program.

After you have written down what motivates you to lose weight, pick a start date. It can be helpful and motivating to know exactly when you’ll be off and running. Choosing a start date is also helpful because you’ll need to do a little preparation before then. You’ll want to be as ready and prepared as possible so that you don’t have to take time later to make adjustments while you’re focusing on your plan.

Next, get your kitchen ready, including your cupboard, pantry, and fridge. The idea is to get rid of high-calorie, processed foods and stock up on lower-calorie, unprocessed foods, especially frozen or shelf-stable basics that you can keep on hand. That way, when you need a meal in a hurry, you’ll be ready to go and you won’t be tempted to grab a less healthy option.

The next step in preparing for The Best Weight Loss Diet is exercise. Line up the gear you’ll need for physical activity. Make sure that you have a good pair of walking shoes, comfortable clothes and whatever else you need to be physically active. In addition, you may need some specific items, such as a yoga mat or a bicycle, depending on the types of exercise you choose.

If you’re just starting to exercise, talk to your doctor first about your plans and any concerns you should address. From there, talk to your friends who exercise or the staff at a fitness facility about their ideas on exercise. They can provide helpful tips that can help get you started. Are You Ready to Start a Weight-Loss Program? Managing weight takes time and planning, so how do you know if you’re ready? You don’t want to put off your start date any longer than necessary, but you also don’t want to set yourself up for failure by trying to lose weight at a time when you’re facing a lot of obstacles.

Take this quiz to determine if now is a good time to make big changes to your daily routine.

1 How motivated are you to lose weight?

a. Highly motivated b. Moderately motivated c. Somewhat motivated d. Slightly motivated or not at all motivated

2 Considering the amount of stress affecting your life right now, to what extent can you focus on weight loss and on making lifestyle changes?

a. Easily b. Relatively well c. Uncertain d. Somewhat or not at all

3 Initially, people often lose weight quickly with The Best Weight Loss Diet. But in the long run, it’s best to lose weight at a rate of one to two pounds a week. How realistic are your expectations about how much weight you’d like to lose and how quickly you want to lose it?

a. Very realistic b. Moderately realistic c. Somewhat realistic d. Somewhat or very unrealistic

4 Aside from special celebrations, do you ever eat a lot of food rapidly while feeling that your eating is out of control?

a. No b. Yes

Circle the best answer for each question

You’ll also want to set up a tracking system so that you can track your progress. In the beginning, during the Lose It! phase, it is recommended that you use a habit tracker. If you have a copy of The Best Weight Loss Diet Journal (available separately from this course), you can use the habit tracker there, or you can easily develop your own using paper, an app, a whiteboard, or whatever works for you.

5 If you answered “yes” to the previous question, how often have you eaten like this during the last year?

a. About once a month or less b. A few times a month c. About once a week d. About three times a week or more

6 Do you eat for emotional reasons— for example, when you feel anxious, depressed, angry, or lonely?

a. Never or rarely b. Occasionally c. Frequently d. Always

7 How confident are you that you can make changes in your eating habits and maintain them?

a. Completely confident b. Moderately confident c. Somewhat confident d. Slightly or not at all confident

8 How confident are you that you can exercise several times a week?

a. Completely confident b. Moderately confident c. Somewhat confident d. Slightly or not at all confident

If most of your responses are a, then you’re probably ready to start a weight-loss program. If they’re mostly b and c, consider if you’re ready or if you should wait and take action to prepare yourself. If they’re mostly d, you may want to hold off on your start date. If there is a lot of stress in your life now, investigate ways to better manage the stress. If it’s overwhelming, consider talking to a licensed mental health professional.

If you’re too busy and won’t be able to devote the necessary time to the program, perhaps wait until things settle down and you’re less busy. Take the time you need to address any issues that may prevent your full participation in the program. You may want to talk to your health-care team about what you can do to increase your readiness. Then, when you’re ready to revisit your readiness, ask yourself these questions again.

Later, during the Live It! phase, you’ll need a way to log your daily and weekly goals. Just as with the habit tracker, you can use The Best Weight Loss Diet Journal to log your goals, track servings from the different food groups, and track your activity, or you can use your own activity monitor, app, or tracking system.

## The Best Weight Loss DIET

The Best Weight Loss Diet is much more than a diet—it’s a lifestyle change program. It is broken down into two different phases: Lose It! and Live It! .  In the two-week Lose It! phase, you can lose weight quickly by suddenly changing a number of habits. All of these habits are safe and healthy. You are asked to add five habits, break five habits, and adopt five bonus habits. For example, one of the five habits you can add is to eat breakfast.

Studies have shown that people who eat breakfast have a better time managing weight than people who don’t. Another habit to add is to eat more vegetables and fruits, which are low-energy-density foods that can help you lose weight.

DID YOU KNOW? According to the National Weight Control Registry, 78 percent of registrants who have lost weight and kept it off share the habit of eating breakfast every day.

In The Best Weight Loss Diet pilot program, people lost on average about 6 to 10 pounds in the two weeks of the Lose It! phase. When people started changing their habits, they reported that it seemed challenging at first, but once they got into it, it wasn’t that bad. And they felt empowered; they reported that they did much better than they thought they could.

Live It! is an indefinitely long lifestyle-change phase where you take the habits that you learned in Lose It! and build on them. And you know that you can do it because of the results you achieved in the Lose It! phase. You’ve lost some weight, and the goal is to continue to lose weight at a rate of about one to two pounds a week until you reach your goal weight.

There are various tools that can help people in the Live It! phase. One of these is The Best Weight Loss Healthy Weight Pyramid, which is a guide on how to eat not only to lose weight but also to improve health.  Food pyramids have been around since the U.S. government released its first one in 1992. Unfortunately, that first pyramid was heavily influenced by industry and therefore didn’t give the best advice. The second pyramid that was issued was color-coded without images of food, and this was confusing to many people.

The Best Weight Loss Healthy Weight Pyramid has been around for more than 15 years and has been a helpful tool from the beginning. It’s divided into different food groups. At the bottom of the pyramid are fruits and vegetables. Above that are whole- grain carbohydrates. Above that are lean proteins and dairy, followed by healthy fats and, at the top of the pyramid, a small amount of sweets. At the center of the pyramid is daily physical activity—both because of its effect on weight loss and on improving health.

On the Healthy Dining Table, you’ll see not only a main plate, but also a salad plate; a fruit bowl; a small bowl for healthy fats, such as nuts; a small plate for a sweet, such as dark chocolate; and a glass for fluids, such as water.  Vegetables and fruits should make up the largest portion of your meal. Vegetables should makeup half of your plate, and fruits have their own bowl— you can eat them with the meal, as a snack, or both. An easy way to include more vegetables in your diet is to have a green salad with your meal, which is why there is a separate salad plate.

Other foods should be eaten in moderation. Limit carbohydrates to a quarter of your plate. The same goes for protein and dairy. Fats and sweets should be eaten sparingly, and they may not be a part of every meal. For your fluids, include beverages that are low in calories or calorie-free. Water is best.  To help estimate how much food from each food group you should eat, there are icons, or an object, to help you estimate serving sizes easily. There is no calorie-counting and there are no complicated formulas to use with The Best Weight Loss Diet. You become an expert in estimating serving sizes and how much you’re eating of certain foods.

Pyramid Servings at a Glance

V Vegetables C Carbohydrates Ft Fats

F Fruits PD Protein/Dairy S Sweets

Item Amount Food group servings

Oatmeal, instant, plain (made with water)
1 packet

Chicken, grilled 1 sandwich

Item Amount Food group servings

Vegetable or vegetable beef, canned (broth-based)
1 cup

Spaghetti with marinara sauce 1 cup

Hummus, home-prepared 4 tablespoons

Yogurt, frozen, fat-free ½ cup

Orange, grapefruit or pineapple, unsweetened

4 fluid ounces

A serving of fruit is about the size of a tennis ball. A carbohydrate serving is about the size of a hockey puck. A protein or dairy serving is the size of a deck of cards or smaller. A fat serving is the size of one or two dice.  It is recommended that you track your diet and activity patterns during the Live It! phase because people who track their habits are more successful at weight loss than people who don’t. And as time goes on, it becomes second nature. You’ll make new habits in how you eat, and hopefully the new way you’re eating will be practical and enjoyable, which is critical to making it sustainable as a lifestyle habit.

If you think about what determines how much you eat, it’s not calories; it’s the volume or weight of food that you consume that determines satiety, or feeling full. Some foods have a lot of calories in a small volume and, therefore, are very energy dense, such as butter or sugar. Other foods are bulkier and contain more volume and weight, but not many calories. These foods are low in energy density. These are foods that contain water, fiber, or even air.  Vegetables and fruits have a lot of water and a lot of fiber, which adds bulk and volume but not calories.

You can eat more of these foods, and the weight and volume will fill you up, but you won’t consume a lot of calories. If you’re eating more fruits and vegetables, you’re actually eating more food but getting in fewer calories—and that’s a good thing.

DID YOU KNOW? There are the same number of calories in one and a third sticks of butter as there are in about 20 heads of lettuce or 35 cups of green beans.

Water contained in food has a greater effect on increasing satiety than consuming water separately, probably because the water is absorbed more quickly if it’s consumed separately. So, choosing foods that are high in water content will lower the energy density of a meal and increase your satiety.

DID YOU KNOW? Research has shown that someone will become more satisfied by eating soup than by eating the same amount of dry ingredients and water separately.

A common attitude among people who are trying to lose weight is that they have to deprive themselves. An important benefit of The Best Weight Loss Diet is that you don’t have to live in deprivation. You can eat virtually all the fresh and frozen fruits and vegetables that you want because there will a practical limit—you’re not going to overdose on green beans or broccoli.

Psychologically, you won’t have to feel deprived, which can be liberating and help you stay on the program.  If you’re eating more fruits and vegetables, you’re not eating something else that is higher in calories. You’ll consume fewer calories so that you can lose weight but still achieve satiety. Often, the sauces and other things that you add to vegetables contain more calories than the vegetables, so you will need to be careful about what you put on them.

# STARTING YOUR DIET: THE LOSE IT! PHASE

In the two-week Lose It! phase of The Best Weight Loss Diet, you make changes to your everyday habits. These habits are all lifestyle changes that have some evidence related to weight loss— decreasing calories eaten or increasing calories burned through physical activity. Within this phase, you add five habits, break five habits, and adopt five bonus habits. The habit tracker will help you chart your progress. The habits outlined in this lecture will be what you’ll list in the left column of your table if you’re creating one on your own.

1. Eat a healthy breakfast—but not too much.

Evidence shows that people who consume breakfast tend to have an easier time controlling their calorie intake and managing their weight. One of the theories behind this is that if people eat breakfast, they may be less hungry later on. Conversely, if people don’t eat breakfast, they may be much hungrier later on and snack more or eat more at subsequent meals.

There are a number of things you can do to eat a healthy breakfast, all based on personal preference. These include grabbing some fruit, a whole-grain bagel, a yogurt, or a breakfast wrap as you walk out the door in the morning. To save time, you can prepare breakfast the night before. For example, put the cereal in a bowl on the counter. If you have more time, you can make a smoothie.

2. Eat vegetables and fruits.

Try to shoot for four or more servings a day of vegetables and three or more servings a day of fruits. There’s no limit on the amount of fresh or frozen vegetables and fruits, in their natural form, that people can eat.

There are different things you can do to increase your intake of fruits and vegetables. Make smoothies with fruit. Add fruit to a dish, such as cereal, or even to a salad. Vegetables are good by themselves, or you can prepare them in different ways, such as making soups or adding them to casseroles.

In general, the key is to eat fresh and frozen fruits and vegetables without high-calorie sauces or dips. Frozen fruits and vegetables can be just as healthy, and in some cases healthier, than fresh ones because some vitamins, such as vitamin C, degrade with time. If vegetables sit on a shelf for a long time, the vitamin C content and other nutrients may slightly decrease. Most frozen vegetables are frozen very soon after picking, which can help preserve the nutrients.

Don’t indulge in dried fruits and fruit juice too much. Those are more concentrated sources of calories.

DID YOU KNOW? Studies have shown that people who eat more vegetables and fruits tend to weigh less and gain less weight over time.

3. Eat whole-grain carbohydrates, such as brown rice, oatmeal, whole-wheat bread, or whole-grain pasta.

This habit is both for health and for weight reasons. From a weight standpoint, whole grains contain fiber; therefore, they’re bulkier. This can contribute to satiety, or the feeling of fullness. Whole grains are lower in energy density than refined grains.

You can do many things to increase your intake of whole grains, such as swapping whole-wheat bread or pasta for the regular versions.

DID YOU KNOW? Studies have shown that people who eat a diet that’s higher in fiber tend to weigh a little bit less over time.

4. Eat healthy fats, such as olive oil, vegetable oils, and nuts.

Fat intake doesn’t correlate with weight as much as people think, as long as you’re burning calories through physical activity. The key is to eat healthy fats, such as nuts. Nuts are particularly filling; they cause us to feel satisfied if we listen to our bodies. People are able to have a small amount of nuts, become satisfied, and then eat fewer calories from other foods.

It’s true that you can eat too much fat. However, if you’re reducing your intake of less healthy fats, such as high-fat dairy products or high-fat meats, then there’s room to include some healthy fats in your diet. You can do this in many different ways. You can use nuts as a snack, or you can use them on salads and in other dishes. You can sauté foods in oil, such as canola oil, if you don’t want a strong flavor. If you want the olive oil flavor, olive oil is great for marinades and to use as a dressing.

5. Move.

Try to walk or do some other type of physical activity or exercise for 30 minutes or more each day. If you’re not very active, you may want to build up to this. Start slowly and gradually work up to 30 minutes, and certainly don’t overdo it. Talk to your health-care team before starting a physical activity program.

Don’t do something that is painful or not enjoyable. Instead, try to work regular physical activity into your everyday life. Throughout the day, take the stairs, for example. You can even chunk up the time by walking the stairs for 10 minutes at a time. Or schedule your exercise session if it helps you to do that.

t’s human nature to want to decrease physical activity and take the shortcut. But our environment has markedly changed since the days when those who ate the most and did the least survived. These days, we have to outsmart our inner brain and look for opportunities to get activity.

There are simple ways to do this. Park farther away from your destination. Look for excuses to get more physical activity. Try games and apps that promote physical activity if they interest you.

If you’re going to exercise, choose something you enjoy, make it a priority in your schedule, and focus on continuing it in the long term. Don’t do something that you can’t keep up in the long term or take on too much too fast.

Often in life, something comes along and knocks your exercise off schedule. If this happens, one option is to change the time around: Sometimes exercise in the morning, sometimes at noon, and sometimes in the evening.

## BREAK FIVE HABITS

1. No eating while watching TV—and you can only watch as much TV as the time you spend exercising.

Watching TV is a sedentary activity, so break this habit and get moving. Also, some people tend to mindlessly eat, especially at night in front of the TV or another type of screen. This habit is not only associated with burning fewer calories, but it also can be associated with increasing your calorie intake from eating.

There are various ways to break this habit. For example, put a note on the TV: “No TV while eating” or “TV time equals exercise time.” If you have an exercise area in your house, you can walk on the treadmill or ride a stationary bicycle while you catch up on the news or watch your favorite program.

Another option is to look for alternatives. Many people find that if they turn the TV off, especially while with their family, the conversations around the dinner table are much more enjoyable and can contribute to good family dynamics.

2. No sugar, except what’s found naturally in fruits.

Sugar contributes calories that are very easy to ingest— it’s high in energy density—which can contribute to weight gain. In addition, we need other nutrients to metabolize carbohydrates, such as sugar. Also, there are some direct negative effects of sugar, such as dental cavities. Furthermore, if you’re consuming drinks such as soda that contain sugar, you may not be consuming other healthier drinks, such as milk.

Alcohol counts as a sugar, so avoid it to decrease calorie intake, at least in the Lose It! phase. Also stay away from artificial sweeteners during this phase because they may increase your cravings for sweets. You can reduce your intake of added sugar and artificial sweeteners in many different ways. For example, drink unflavored, carbonated water. In baking, try substituting a fruit puree, applesauce, or something similar for sugar.

DID YOU KNOW? In the United States, a large amount of sugar has been added to the food supply. Sugar has been shown to contribute to increased calorie intake and increased weight.

3. No snacks, except for vegetables and fruits.

The snacks that people often eat are not that healthy, high in calories, and difficult to stop eating. That means the calorie intake from snack foods can be very high. Vegetables and fruits should be the main snacks to consume, but a small amount of nuts could be a good choice if you crave a more traditional snack.

4. Moderate meat intake and use low-fat dairy.

Meat is associated with increased calorie intake, weight gain, and poorer overall health. From a health standpoint, less is better when it comes to red meat, and especially processed meat.

Low-fat dairy contains the same nutrients as full-fat dairy except for the fat content, and the saturated fat in full-fat dairy just adds extra calories and contributes to increased cholesterol levels.

Try to eat just one serving— about the size of a deck of cards—of meat daily. Eating less meat increases the opportunities to eat a wide variety of other foods, such as whole grains, pasta, fish, vegetables, or tofu.

DID YOU KNOW? Studies have shown that both red meat and processed meat are associated with an increased risk of type 2 diabetes and heart disease as well as an earlier death.

5. No eating at restaurants unless the meal fits the program.

When people eat out, they’re not in control of what they’re eating. Many of the dishes served in restaurants may taste good, but they may also be very high in calories. It can be hard to know since you’re not in charge of portion size or cooking techniques.

If you can find things on a restaurant menu that fit the overall program, that’s okay, but be careful when eating at restaurants during the Lose It! phase. Research shows that eating out is one of the factors associated with increased calorie intake and increased weight.

When you do eat out, keep in mind that restaurants are often willing to change recipes or modify them to your needs. Don’t be afraid to ask restaurants to change the way a food is prepared or the amount that’s served.

1. Keep food records.

In the Lose It! phase, you’re using the habit tracker you created as a way to record roughly what you’re doing. At the end of each day, just put a check mark next to all the habits you did. The more check marks you have, the better.

You can do the same thing in more detail with food records, where you write down everything you eat. This can help you to reflect, see your patterns of where your calories are coming from, and adjust as necessary.

2. Keep activity records.

If you keep records with your habit tracker, you know exactly what you’re doing. You can reflect on that, make adjustments, and make sure that you’re getting at least 30 minutes a day of physical activity.

3. Move more.

If you’re able to move for 60 minutes a day—twice as much as the minimum 30 minutes—you can burn more calories and get more health benefits. You don’t want to overdo it, but the more physical activity you’re able to get, the more successful you’ll be in reaching your weight-loss goals.

4. Eat real food.

“Real food” means unprocessed food. When food is processed, often nutrients are removed, and sugar, salt, or other less healthy ingredients are added. So, if you’re eating real food, you’re getting more health benefits and probably consuming fewer calories.

It may take time to prepare real food, but as you get better at preparation, you become more efficient. And although it may take a little more time, preparing good food for your body is more than worth it, even on a busy schedule.

5. Write down your daily goals.

We all have certain things that drive us—not only in terms of weight goals, but in terms of achieving other things in life, such as feeling better and improving the quality of your life. Writing down your goals can help you reflect, embrace change, and keep you motivated to improve your health, as well as your weight.

Once you’ve completed the Lose It! phase, take time to reflect. How did the first two weeks go? Were they harder or easier than you anticipated? The habits in Lose It! are stretch goals; they’re designed to bump you out of your comfort zone in a rather dramatic way and head you in a different direction. So, give yourself a pat on the back for making it through. Equally important, what did you learn from Lose It!? This is key because what you learned about yourself can help you be successful in the next phase of the diet, which is more long-term.

## REFLECTING ON THE LOSE IT! PHASE

Once they’ve gone through the Lose It! phase, it’s pretty common for people to realize certain things. First, it’s important to realize that no one is perfect. No one does all 15 habits for the full two weeks. Give yourself a break from the start; you can’t expect perfection.

You may have realized that the Lose It! phase wasn’t as bad as you anticipated going in. Think about the habits that you changed. Some of the habits are more difficult than others. Typically, the hardest one is no eating while watching TV, and the second hardest habit to break is decreasing sugar intake. But even with these habits, it usually wasn’t as bad as people thought it would be.

You might have realized that watching TV isn’t an essential part of your schedule, and you’re doing fine without it. Or it might take some time to change this behavior. Perhaps for now, you can focus more on the tasty and healthy meal you’re eating and the people you’re with rather than the TV.

As you reflect on the Lose It! phase, what’s realistic for you moving forward? What modifications do you want to make, and what habits become sustainable in the long term? The other thing that people often learn is that going through the Lose It! experience empowered them. You’ve been through it. Hopefully, you’ve experienced some weight loss in the process. Almost all people do, and usually the more habits people follow, the more weight loss they experience.

Before you started Lose It! , you didn’t know what to expect or if you would be able to change these habits. Now that you’ve completed it, hopefully you feel empowered and have more confidence in your ability to continue to do well in the future in Live It! as you turn this into a lifestyle of healthy habits and sustained weight loss.

After the two weeks on the Lose It! program, take a look at the numbers. Look at your weight record, whether you kept it in The Best Weight Loss Diet Journal or in a notebook or on your phone. Check to see how much weight you have lost. You can also re- measure your waist and see if your waist size has decreased.

If you’ve seen improvement, great! If not, keep moving forward. However, don’t get too caught up in the numbers. This is going to turn into a lifestyle program for a long time to come, and you’ll have more opportunities to continue to change and lose weight.

Even if you didn’t lose a single pound, you were successful if you adopted even some of the habits. You ate better, you were more active, and therefore, your health improved. Your health will improve through better habits in diet and physical activity even separate from weight loss.

One of the things you can do to help yourself moving forward is to look back and analyze your habit tracker. You can see patterns in your habits, both looking across and down the habit tracker.  Looking across the habit tracker, which of the habits were more challenging for you? You can total them up on the right side for each week or for the two weeks. Continue to work on the more challenging habits in the future.

You can also look down the columns on the habit tracker. Were there certain days that were more challenging than others? You can use this information as you move forward to try to modify your habits on certain days of the week.

Try to look at what worked for you in Lose It!, what didn’t work overall, and why. Maybe there are some things that you can change. Maybe there are other things that are very challenging—things that you can accept for now and move on.

As you transition to Live It! , think about these habits and try to maintain them as you move forward. But as you maintain them, they should be continued within your own lifestyle in a way that’s not drudgery. They should be practical, hopefully somewhat enjoyable, and fit within your lifestyle so you don’t have to make a heroic effort to keep them going. If you can’t continue one of them perfectly, do what you can in that area— it’s better than doing nothing.

The whole purpose of Lose It! was for you to jump in and change a number of habits that hopefully led to real weight loss. There weren’t many details in Lose It! , such as how many calories you should eat each day, and that was intentional. By changing key habits related to eating and exercise, you were hopefully able to lose weight without getting lost in the details.

Transitioning from Lose It! to Live It! is about staying on track and building on the changes you’ve made. Over time, small, consistent changes can add up to big results.  One of the key goals of Lose It! was to create a mental reset so that you’re no longer tied to your old ways of thinking about eating and moving. Your job now is to start thinking in terms of a lifelong approach. Because this new way of eating and moving is based on a number of general principles, there are endless ways of staying with it without getting bored or overwhelmed.

Some of the habits you’ve worked on so far may have been more challenging than others. While you may not be able to maintain all of the habits perfectly as time goes on, try to maintain as many of them as you can and build on them as you go.

The first five habits are lifestyle strategies you want to keep for life. Maintain these habits as much as possible. Each day, eat a healthy breakfast, plenty of fruits and vegetables, whole grains, and healthy fats. It’s also very important that you continue to make time for physical activity.

Bending the Rules on Breaking Five Habits

The rules for the five habits that you break in the Lose It! phase still need to be followed after you complete the phase, but it’s okay to bend the rules.

For example: Sugar. Will you ever have a piece of dessert or a glass of wine again? Yes, you will. But the distinguishing factor is habitual versus occasional. Can you have cake on your birthday? Yes. Should you have cake or dessert every day? No. Restaurants It’s not that you can never eat at restaurants again.

But try to eat at home more often because you’ll tend to eat healthier when you make your own meals. And when you do eat at restaurants, continue to try to stick with your plan. Snacks. If you can keep processed snacks out of your house and stock your kitchen with fruits and vegetables, eventually you won’t think twice about grabbing a peach or a small handful of nuts to satisfy a craving.

What about the big party at your friend’s house? Go and have some (but not all) of the food, but keep the occasion special and return to your regular routine the next day. Screen time. The habit of eating while in front of a screen is best broken for good. This doesn’t mean that you can’t have some unbuttered popcorn at the movies, but TV dinners should largely remain a thing of the past. already have, go for it! Do this safely, making gradual increases as your fitness increases.

The second set of habits are intended to limit behaviors that add unnecessary calories. People often wonder whether these rules still need to be followed after the Lose It! phase— and they do, as much as possible. But on occasion, it’s okay to bend the rules a bit.

The last batch of habits in Lose It! are bonus habits. With some of these habits, it’s best to try to maintain them for life, such as eating “real” (not processed) food and exercising more. When it comes to keeping records, continue the activity until you feel like you have a handle on the big picture—you’ve learned your weaknesses and the triggers behind them.

Think of this as a journey in which you continue to make changes as time goes on. Soon, you may find yourself eating foods that you never thought you’d eat because you didn’tset up your kitchen for success with the proper cookware and utensils.

Setting Up Your Kitchen for Success

The following items will help you cook healthy and achieve restaurant-quality results:

a hard-anodized sautée pan for scrambling eggs, searing chicken breasts, or a piece of salmon and a deeper sauté pan for sautéing large amounts of vegetables or for making a rice pilaf

good-quality utensils that have a silicon bottom or are made with high- heat rubber good-quality measuring cups and teaspoons (perhaps made of stainless steel) as well as a liquid measuring cup (made of glass or plastic)

a pair of tongs with a nonmetal tip storage containers in various shapes and sizes for portion control (with a good seal)  wire or plastic strainer (which you can rest on top of a pot of boiling pasta to simultaneously steam vegetables)

a good-quality peeler an ice cream scoop for use as a portion scoop

an instant-read thermometer for making sure that you are not over- or undercooking chicken or fish a honing steel for sharpening knives like them—or thought you didn’t.

With the right attitude, you can learn to like new foods, and many wonderful foods exist. If you remain open and curious, the journey will only get better as you move forward.

## TIPS FOR MOVING FORWARD

Change can be challenging, but don’t underestimate yourself. Consider what you accomplished in Lose It!. Even if you only take very small steps in the beginning, as long as you keep moving down the path of healthy weight loss, the journey will become more enjoyable.

Is it really this easy? No, or everyone would be doing it. Is it possible? Absolutely, and you’re on your way. Don’t be surprised if you encounter some roadblocks ahead—everyone does. Although you receive a lot of guidance in this course, keep in mind that this is your journey and your plan. This is you forging your own path toward a healthier lifestyle.

Make the plan yours. Design it and tailor it in a way that fits you. Having a plan that’s individualized to your tastes and lifestyle will make it easier to keep up over time. This individualized approach is much better than continuing to search for the elusive silver (weight-loss) bullet. This doesn’t mean, however, that you can’t or shouldn’t reach out to others for support, including family, friends, and professionals.

As you learn the basic concepts of healthy eating and becoming more active, make sure that the execution fits you, your schedule, priorities, and overall philosophies. Weight loss is a complex process. There are hundreds of factors that affect weight and activity; your job is to determine what you need to do to make your plan work for you. And don’t feel as though you can’t make changes along the way. If something isn’t working, try another approach.

Also, keep it simple. Try not to get hung up on details, such as the precise number of food group servings in your meal or exactly how many calories you burned swimming laps. Sometimes, paying too much attention to the details can make it even more difficult to reach your goals.

Feel free to revisit the two-week Lose It! phase any time you need a refresher course or feel yourself slipping back into old habits. Consider Lose It! your personal reset button that you can use at any time you feel you need to get back on track.

Eventually, as you become comfortable managing your diet and daily activities, you may no longer need to revisit this course. The goal is to get you to a point where you’re fully in control and you have the skills needed to maintain a healthy lifestyle on your own. As your new eating and activity routines—your new habits—become second nature, you’ll make decisions that will automatically default to the healthy option.