Last month I explained why the body weights currently defined as “ideal” are too stringent for approximately two-thirds of the population. (See Ideal Weight:  A Case of Myth-Information.)  I recommended that you determine your own ideal body weight by considering what you weighed one or two years after settling into marriage or a career. I suggested that you use the ratio of your waist measurement to your hip measurement to determine whether the amount of body fat you are carrying is placing you at an increased risk of developing health challenges.

Men should have a waist to hip ratio of 0.941 or less. The ratio in women should be 0.841 or less. If you are a man whose waist hip ratio exceeds 0.973 or a woman who has a waist to hip ratio greater than 0.878 you are almost certainly at increased risk for developing high blood pressure and type 2 diabetes. You are also more likely to have a heart attack or stroke in the future.

Studies demonstrate that the body weight associated with the best health outcome increases as people age. It is not uncommon for a sixty year old to weigh more than he or she did at twenty-five or thirty. If your weight has increased more than 3 percent per decade, however, you are probably carrying more body fat than you should for optimum health.

If your current weight is too high relative to your young adult weight or your waist to hip ratio indicates that your health is at risk you should develop a long-term strategy to achieve and maintain a weight that is right for you. Fifty percent of people who institute a weight loss program regain all of the lost pounds within a year. Ninety-seven percent have returned to or exceeded their original weight within five years. It is therefore imperative that any weight reduction strategy address long-term weight maintenance as well as short-term weight loss.

Restrictive diets, diet foods and beverages, and diet pills are not the answer. I have been a physician long enough to have seen the ultimate failure of restrictive diets. Most are based upon false assumptions. In many circles it is believed that the lower the carbohydrate content the healthier the diet. While low carbohydrate diets can result in weight loss, they tend to be acidifying. When the body tissues are overly acidic the individual is more likely to develop osteoporosis and other degenerative conditions. A person who includes starches in his or her diet is actually less likely to become fat than someone who does not. That is because carbohydrates, including starches, tend to be burned quickly to produce energy rather than being stored as fat for later use.

For a time our nation was obsessed with limiting the amount of fat in the diet. It is not true that the amount of fat in the diet determines the amount of fat in the body. It has been shown that people who eat low fat diets tend to consume more calories because they do not experience a feeling of fullness as quickly.

Diet sodas are not effective weight loss aids. They contain substances that tend to elevate sugar and insulin levels, resulting in greater fat accumulation over time. It is also a myth that “fat-burning” foods exist. Subsisting on grapefruit or cabbage will result in weight loss because of a low calorie intake, but the foods do not require more energy for digestion than they provide.

Although many diet pills have been introduced and have at times enjoyed great popularity, I know of none that have brought lasting success to those using them. The most successful diet pills over the years have been stimulants that increase the body’s metabolic rate. Amphetamines are the prototype. When they were first introduced they were prescribed freely. Only after they had been in general use for a period of time did the dangers associated with their use become clear. Amphetamines are rarely prescribed to support weight loss today.

Physicians and non-physicians alike have discovered that combining stimulants can produce amphetamine-like results. Unfortunately, those combinations are inevitably linked to amphetamine-like side effects. This is true whether the product is a drug combination such as the ill-fated Fen/phen or whether it is a combination of caffeine with stimulant herbs like ephedra, zhi shi, and yerba mate. In my opinion stimulant weight loss products should by avoided.

The same is true for the “fat blocking” drug orlistat, which is sold as Xenical and Alli. The embarrassing side effect of unexpected fecal incontinence is the most obvious consequence of using the drug, but its interference with the absorption of fat-soluble nutrients is a greater concern.

If restrictive diets, diet products, and diet pills are ineffective tools in the quest to achieve and maintain an ideal body weight, what strategies are effective? How can you win the “battle of the bulge”?

A current radio advertisement states, “If everyone would simply eat one meal a day of less than 100 calories our nation wouldn’t have a weight problem.” Right. If pigs would simply sprout wings they could fly. Losing weight is not as simple as is often suggested, but it can be done.

It is important to understand that the key to successful weight management resides not in the body, but in the soul – comprised of the mind, the will, and the emotions. If one does not make a decision in the mind, which becomes settled in the will and is not subject to changing emotions, a healthy weight will never be maintained. Unfortunately, emotions usually carry the most weight. I have seen many attractive young women gain over fifty or even one hundred pounds after being sexually molested.

John Candy is a prime example of a person whose weight was determined by his emotions. John’s father had died of a heart attack at age 35, when John was only 5 years old. John responded with a life characterized by the consumption of excess food, alcohol, drugs, and cigarettes. At times his weight exceeded 250 pounds. He died of a massive heart attack at age 43.

The basic formula for weight control consists of two Es: Eat less; Exercise more. In regard to eating less, the Talmud says this, “In eating, a third of the stomach should be filled with food, a third with drink and the rest left empty.” When it comes to the importance of being physically active Winnie the Pooh said it well, “A bear, however hard he tries, grows tubby without exercise.”

It is clear, however, that the often quoted mathematical formula that 3500 calories taken in through food and beverages or expended in the performance of physical activity equals to one pound of body fat gained or lost is an overly simplistic view of weight control. We have learned that many factors play a role in determining one’s body fat content.

Impediments to weight control include crash dieting, drugs, vitamin and mineral deficiencies, insulin resistance, thyroid challenges, sleep disturbances, chronic stress, and addiction. Other factors undoubtedly affect one’s ability to achieve and maintain a healthy physique, but these are significant and can be addressed with our current understanding of how the body functions.

Crash dieting is defined as limiting caloric intake to less than 1,200 to 1,500 calories a day. This is often achieved by what is called a protein-sparing modified fast. The Cambridge liquid diet is an example.

When a person goes on a crash diet the body interprets the low food intake as a famine. In response, steps are taken to lower the metabolic rate, the pace at which calories are burned. As a result, once crash dieters resume a normal eating pattern they often end up weighing more than they did before they began the diet. People who repetitively crash diet become heavier and heavier over time.

A number of drugs can adversely affect the body’s metabolism. Categories that are most likely to trigger weight gain include antidepressants, antipsychotics, anticonvulsants and corticosteroids, such as prednisone. Diabetic drugs, including insulin, can cause weight gain. Metformin is an exception, as it tends to lower insulin resistance and facilitate weight loss. Beta blockers, which are used to treat high blood pressure, control rapid heart beats, and prevent migraine headaches, can also increase body weight.

While medical studies do not generally support the idea that contraceptives promote weight gain, many women do gain weight while on the drugs. I believe the explanation is that contraceptive weight gain is generally seen after six or more months on a drug, while studies designed to study a drug’s effect on weight have almost always been three months or less in duration.

Pica is an abnormal appetite for certain substances. An example is a craving for ice during pregnancy. This is due to iron deficiency. Many people have trouble maintaining a healthy weight because they crave carbohydrates. I believe that carbohydrate craving is closely related to pica. Refined carbohydrates (white sugars, flours, & grains) are commonly eaten in our society. Refining strips away nutrients the body needs to process the foods, including minerals and B vitamins. Knowing that it did not receive the required nutrients the body seeks to obtain them from other refined carbohydrates. This creates a vicious cycle of craving, intake, deficiency, greater craving, higher intake and greater deficiency. The most common nutritional deficiencies contributing to carbohydrate craving are chromium, magnesium, vanadium, and B vitamins.

Iodine deficiencies have also become common in our society. The most likely reason is that since 1980 bromine has been used instead of iodine in the commercial bread making process. Iodine is critical for thyroid function. Since thyroid hormone is a key regulator of metabolic rate, iodine deficiencies make maintaining a healthy weight more difficult.

Insulin is required by the body to utilize sugar. It is also instrumental in the body’s ability to store energy as fat. Many in our society have lost their ability to utilize insulin effectively. When insulin resistance develops blood insulin levels rise. This causes more fat to be stored in the body. Insulin resistance develops largely as a result of physical inactivity and a diet high in refined foods, which creates vitamin and mineral deficiencies.

A family history of type 2 diabetes predisposes an individual to insulin resistance. A blood pressure greater than 130/85), an enlarging waist size, the presence of hypoglycemic episodes, a low HDL cholesterol level (less than 40 in a man or 50 in a woman), and a triglyceride level greater than 150 are signs of insulin resistance.

Thyroid challenges caused by pituitary or thyroid failure, the presence of thyroid antibodies, or failure to convert thyroid hormone to its most active form cause the body’s metabolic rate to fall. When this occurs it is nearly impossible to lose and maintain weight. Clues that a thyroid challenge exists are a temperature less than 97.8 upon awakening in the morning, feeling colder than others, having dry skin and thin or brittle hair and nails, experiencing constipation, feeling sluggish and tired, having difficulty getting thoughts to flow well, noticing unexplained weight gain, and snoring excessively.

Sleep disorders can trigger weight gain. It is now known that lack of sufficient sleep triggers an increase in appetite. Production of ghrelin, a hormone that is produced by the stomach and increases the desire for food, rises as the amount of sleep decreases. On the contrary, the production of leptin, a substance that is produced by fat cells and which decreases the desire for food, falls as sleep decreases.

Sleep apnea, a condition in which an individual repeatedly stops breathing during sleep, commonly causes substantial weight gain. This creates a vicious cycle as weight gain worsens sleep apnea.

Cortisol is a hormone that is produced in response to ongoing stress. As cortisol levels rise more fat is stored in the trunk of the body. Chronic stress can therefore cause weight gain and make weight loss more difficult.

I have become convinced that addiction prevents many people from achieving and maintaining a healthy weight. Signs of addiction include an intense craving for the substance, using the substance more than intended, an inability to cut back or stop use of the substance, continuing to use the substance in the face of physical problems created by its use, hiding consumption of the substance from others, practicing poor eating habits as a result of the substance, and a lack of concern over one’s physical appearance.

While people generally view addiction as a phenomenon limited to drugs such as nicotine, alcohol, or narcotics, many people exhibit most or even all of the signs of substance abuse in relation to “sweets” or chocolate. Long-term weight control will not be accomplished if the addiction factor is unaddressed.

An effective weight control action plan should involve making wise food and beverage choices, eating less, exercising more, avoiding crash or fad diets, eliminating drugs that can trigger weight gain, correcting vitamin and mineral deficiencies, and, if they are present, addressing insulin resistance, thyroid challenges, and sleep disturbances. Steps should be taken to effectively manage stress and foods that are associated with addictive behavior should be avoided.

The wisest beverage choice is purified water. The diet should be colorful and comprised of foods that would remain palatable at room temperature. Refined sugars, flours, and grains should be limited. Whole grains and legumes, which are high in fiber, should be included, as should oils. Meat portions should be limited to four ounces per meal and the foods eaten should be varied from day to day.

A number of strategies have been used to lessen the amount of food eaten. Some include using smaller dishes, chewing food thoroughly before swallowing, and keeping food out of sight when not preparing a meal. Dishing up food away from the table and discarding rather than eating any that remains at the end of the meal is often helpful. The tendency to “clean it up” because there is not enough left over to save for later must be avoided. Throwing it into the trash is a much wiser and healthier approach than throwing it into your body.

It is often helpful to develop the habit of eating only when you are hungry. Eating at specific times even if you are not hungry only promotes weight gain. Societies in which people nibble when hungry tend to be thinner than those in which people habitually sit down to large meals. Since what is considered a standard portion size has increased significantly over the past few decades consider splitting a meal or planning in advance to take home part of your meal when eating out.

When making dietary changes it is important to consider only those that you believe you can maintain indefinitely. This means that you should not resort to fad diets or crash diet programs. Short (one to three day) fasts can be helpful to get back on track if you feel that a weight reduction program has stalled. An approach that has worked well for many is a lemonade fast. The recipe is the juice of one lemon in twenty ounces of water sweetened to taste with pure maple syrup (typically 1 to 2 tablespoons). The lemonade tends to prevent fatigue or sinking spells during the fast.

Getting your body moving for twenty to thirty minutes each day is important not because you will burn a specific number of calories but because doing so will improve your metabolism over the next 24 hours. It has been shown performing physical activity for five hours a week provides the maximum benefit in controlling weight.

Building muscle is also beneficial as energy is expended in the process of muscle repair and growth. Evidence now suggests than lifting weights once or at most twice weekly produces the best results. Up to six muscle groups can be worked per session, so up to twelve muscle groups may be worked per week. Using a weight that brings about complete muscle fatigue within 8 to 10 repetitions brings about the greatest gain in muscle strength over time.

Giving your body comprehensive nutritional support is critical to weight maintenance. When your body is receiving optimum amounts of vitamins, minerals, and amino acids you will not experience the pica-like cravings. The two products I recommend in my practice are Lifetime and New Generation.

Specific fats support weight loss and maintenance of an optimum body weight. These are omega-3 oils, such as those extracted from cold water fish, and medium chain triglycerides, which are found in food products such as coconut oil. Two fish oil capsules (Marine Lipids) should be taken twice daily. Coconut oil may be used in frying or used in the place of butter or margarine in many recipes.

Finally, I strongly encourage you to address addiction as addiction. An ex-smoker can almost never “have just one”. He or she will return to the habit after the first nicotine hit. It is nearly impossible for someone with a history of alcohol abuse to become a casual “social drinker”. Drug abusers cannot stop with one snort of cocaine or one shot of heroin. Why, then, should we assume that a person with a history of addiction to sweets will be able to have an occasional treat?

It is possible to win the Battle of the Bulge. It must, however, be viewed as a prolonged battle rather than a brief skirmish. “Victory,” said Napoleon, “belongs to the most persevering.” Winston Churchill put it like this: “Never, never, never give up!”