International Nutrition Consultant Association

Ever larger portion size expectations are increasingly part of the problem. Americans have embraced restaurant food (sit-down and take-out both) as offering convenient solutions for meal-preparation. Restaurants, in turn, have taken to offering large and 'super sized' portions of high-calorie food at inexpensive prices as a means of attracting customers. Over time larger portions have come to be considered normal and expected and the overall amount of food being consumed has risen. Weight gain has been the result.

Exercise. Exercise is an essential component of a healthy weight management program. Where a person's genetics are more or less set at conception, the amount of energy a person expends in physical activity is under voluntary control. People can choose to be more active, and becoming more active will help people to lose weight. Exercise builds lean muscle mass and burns up fat reserves. Muscles are very metabolically active. Adding muscle mass through strength training raises metabolism (the rate at which the body burns calories) which makes it easier to lose weight. A significant loss of muscle mass, on the other hand, which is what happens when people are sedentary, reduces resting metabolic rate and makes it harder to lose weight. Adding muscle mass helps people to look firmer and slimmer because muscle takes up less space than fat. Careful strength training reduces the risk of accidental injury, improves bone density, helps with digestion and assists in lowering blood pressure, cholesterol and triglyceride levels (all predictors of disease when elevated). Nutrition
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Most weight loss programs begin with a reducing diet (designed to promote weight loss) which creates its effect by limiting how much of different types of foods one can eat. There are a bewildering number of reducing diet styles, however. Some recommend a simple reduction in the total amount of food consumed, while others recommend specific reductions of particular types of foods consumed (breads and pastas, for instance). A knowledge of basic nutrition concepts helps us to understand why the variety of recommendations exist.

The six groups are then arranged into a pyramid shape to indicate the relative proportions of each food that people should eat each day. For example, the Grains (bread, cereals, rice and pasta) group takes up a larger percentage of the pyramid's area than other groups to indicate that proportionally more servings of bread, cereals, rice and pasta are appropriate to eat each day versus other groups. Importantly, not just any grain is recommended. At least half of the grains eaten in a given day should be 'whole' grains, which contain the grain germ (fertile seed part), and the bran (hard outer seed coating). Look for whole wheat breads and pastas when making food choices, if possible.

The Fruits and Vegetables groups's area is smaller than the Grains group, but larger than the Milk and Meat & Beans groups, suggesting that more fruits and vegetables are to be consumed than milk, meat or beans for balanced nutrition. The types of fruit and vegetable choices made are important as well. Whole, fresh fruit is much better for you than fruit juice. Dark green and orange vegetables such as spinach and carrots are in general better for you than vegetables that do not have these colors, and fresh vegetables are in general better for you than canned vegetables. When choosing dairy or meats to eat, the pyramid suggests that you choose lower fat varietys. When chosing oils and fats to use for cooking and eating, the pyramid indicates that liquid choices (such as olive oil) are better than solid choices (such as butter, margerine, or shortening). The Oils group is the smallest of all the groups, indicating that as a percentage of your total diet, relatively few oils should be consumed.

For the first time ever, the pyramid now includes a physical exercise componant as part of the essential food groups, to indicate that regular physical exercise for at least 30 minutes a day, most days of the week (60 minutes a day for children and teens!), is vital for everyone's health.

The six food groups recognized in the food pyramid may be each very different in origin, composition and taste, but they all contain nutrients necessary for building and maintaining bodily health. There are six classes of necessary nutrients found in foods: carbohydrates, fats, protein, vitamins, minerals and water. Working together, these nutrients perform three vital life functions: they provide energy, they promote body growth and maintainance, and they assist in regulating bodily processes. Carbohydrates, fats and proteins work together to provide us with energy. Proteins, fats, vitamins, minerals and water promote growth and maintainance and are necessary for appropriate body process regulation. All six nutrient classes must be present in sufficient amounts at all times or the body will not function properly.

Different nutrient classes contain different amounts of calories. For instance, carbohydrates and proteins provide only 4 calories per gram while fat provides 9 calories per gram. This is why high fat foods are more 'fattening' than lower fat foods; they are more calorically dense.

With the exception of water, each nutrient class contains a variety of different subtypes of that nutrient. Some of these nutrient subtypes can be better for health than others. For example, within the fats class, there are saturated fats, mono-unsaturated fats and poly-unsaturated fats. Eating a diet high in saturated fats (such as are found in butter, lard, and shortening) is known to increase LDL (bad) cholesterol levels and increase the risk for cardiovascular disease. Trans-fatty acids (man-made saturated fats produced via a process called hydrogenation), found in most margarines and store-bought baked goods, are now thought to pose similar health risks. On the other hand, mono-unsaturated and poly-unsaturated fats (such as occur in olive oil) help to lower LDL cholesterol.

Like fats, carbohydrate subtypes are not all equally nutritious. Foods rich in refined sugar and flour (white bread, cakes, cookies, etc.) provide 'empty' calories as they are mostly devoid of nutritional value. In contrast, complex unrefined carbohydrates such as those found in whole grain products (brown rice, bran, whole wheat bread, etc.) and fruits and vegetables provide essential nutrients as well as fiber in addition to providing energy. Fiber comes in two helpful varieties. Insoluble fibers helps to keep the digestive and eliminatory tract functioning regularly, while soluble fiber helps to keep the arteries clean by reducing LDL cholesterol in the bloodstream.

All nutrients, including carbohydrates, fats and proteins, are essential for life and should be present in a healthy diet. Since all classes of nutrients are necessary the wisdom of severely limiting or eliminating any category is questionable. Rather than attempting to eliminate nutrient classes as some reducing diets seem to suggest, the wisest course is to select a diet based heavily on the healthier types of nutrients from each nutrient class. Such a diet includes fresh fruits and vegetables, whole grain breads and cereals, lean meats, fish and poultry, low fat or nonfat dairy products, and the sparing use of healthy fats such as olive oil. Refined sugars, white flour, and partially-hydrogenated oils should be avoided. Less nutritious (but still delicious) foods, including steaks, hot dogs and sausages, cream and butter, and cake and ice cream can be eaten on an occassional basis but should not become staples of an everyday diet.

The body needs both calories and nutrients to function properly. Unfortunately, not all foods provide quality nutrients. So-called 'junk foods' (e.g., candy bars, sodas, fast-food hamburgers, etc.) are high in calories and in refined sugars and/or saturated fats, but do not provide other worthwhile nutrients. While junk foods can be sources of quick energy, they are bad for health overall. If empty calories replace more important nutrient-dense foods such as fruits, vegetables and low-fat dairy products, the end result is a poorer quality diet. A steady diet of junk food can actually contribute to malnutrition and disease. In children and adolescents a steady diet of junk food might negatively effect growth and development.

In the last century, food producers have taken to refining foods so that they will last longer on supermarket shelves. The process of refining food, however, often damages its nutritional value. The white flour used to make white bread provides a good example. Wheat berries that get ground to make flour have several parts - the bran, or outer protective layer, the germ, or living seed, and the endosperm, which is the starchy food source the germ will consume while growing. White flour is made by removing the germ (which contains oil that would go rancid) and bran parts (which contain fiber) of the wheat berry and grinding what is left. As much of the nutritional value of wheat is found in the germ and bran parts of the wheat berry, white flour ends up having very little nutritional value. Whole wheat bread made from whole wheat flour (so-called because it is made by grinding the whole of the wheat berry including the bran and germ) contains far more nutritional value than white bread.

The best, most nutritional foods to eat tend to be 'whole' foods; minimally processed and arriving at the supermarket with much the same composition they had while growing. Whole grains such as whole wheat, whole oats and beans which retain their beneficial fiber provide more nutrients than highly processed foods and may also reduce the risk for cardiovascular disease and certain cancers. Minimally processed foods containing fiber also help moderate blood glucose levels, aid elimination, assist in lowering blood cholesterol, and make weight management easier.

Most of the foods and meats found in a regular supermarket are produced on factory farms with the aid of chemical pesticides, hormones and antibiotics. Though most of these chemicals wash away, trace levels remain in foods and get eaten by people. This is of particular concern with regard to meat animals which get raised on pesticide dosed vegetation and concentrate pesticides in their tissues. Many people feel that having such chemicals in their foods is a bad idea that can lead to health problems. The alternative to conventional foods are organic foods, which are often produced on smaller scale 'family' farms and always without using pesticides, hormones or antibiotics. Though they generally cost more, organic foods are less likely to contribute to disease, and more likely to be nutritious than their conventional counterparts. Some people claim organic foods taste better too, but this may be a matter of opinion.

From both nutritional and weight-loss standpoints, it is smarter to eat a balanced nutritional diet all of the time than to eat as one likes (without regard for nutrition) most of the time only to go on a special reducing diet when one feels overweight. The latter option is unsustainable, and sometimes even unhealthy. Though reducing diets work when properly followed, they are not necessarily well balanced nutritionally. Reducing diets also have a fatal flaw which is that they always end. Returning to a poorly-balanced regular diet after going 'off' a reducing diet will all but certainly result in new weight gain.

The sheer number of reducing diets and "miracle" weight-loss products is mind-boggling. We survey some of this variety below. No matter how you approach it, permanent weight loss requires effort, may require substantial changes in eating and exercise habits, and is never accomplished overnight.

Almost any reducing diet that reduces caloric intake will result in weight loss if it is rigidly followed. However, such diets are hard to sustain, and serious weight maintainance problems immediately appear when the diet is abandoned and no new healthy eating patterns have been established to replace ones that resulted in weight gain in the first place. In order to be recommendable, a reducing diet should encourage sensible weight loss, and encourage healthy eating and exercise habits both during and after 'dieting' is complete.

As dietary fats carry almost twice as many calories as carbohydrates and proteins, reducing dietary fat intake seems a natural approach to weight loss. In fact, the current USDA Food Pyramid recommends a low fat diet for healthy living. As the name implies, a low fat diet involves careful regulation of the amounts of dietary fats one may eat, reducing fat intake to 30% of one's total intake with only 10% of total calories in saturated fat form. Both obvious (butter and spreads, fried foods, mayonnaise, etc.) and subtle sources of dietary fat (many restaurant-prepared foods are surprisingly high in fat)must be identified and restricted for this dietary approach to work.

A common misconception dieters have regarding low fat diets is that they can eat as much low fat food as they want and still lose weight. There is nothing magical about eating a low fat diet, however. Such a diet can help with weight loss only when it succeeds in reducing the total amount of calories a person eats. Dieters who increase portions of low fat foods end up eating as many calories as they did before and fail to lose weight. All calories count.

It is a good idea to use judgment and to keep nutritional principles in mind while selecting foods to eat for a low fat diet. Some so-called low fat foods are really only low fat versions of high fat foods. Low fat ice cream, for example, may be low fat in comparison to premium ice cream, but it is still essentially a high fat item that shouldn't be eaten while on a low fat diet. Also, some packaged low fat foods are made with all sorts of unpronounceable chemicals. As always, the best low fat food choices will be unprocessed, naturally low fat foods, such as fresh fruits and vegetables.

Low fat diets are one thing, and very low fat diets are another. Recommended by some medical doctors (including Dean Ornish and John McDougal) as a part of a balanced plan for heart disease rehabilitation, very low fat diets require limiting fat intake to 5% or 10% of total calories. Diets this low in fat tend to be high in starches and carbohydrates. While not harmful for most adults, this type of diet may not be suitable for those with diabetes or insulin resistance. A very low fat diet is difficult to follow over the long term as it requires people to avoid tasty foods they like to eat. Some dieters give into cravings for higher fat or protein foods and lapse off their diet, sometimes abandoning it all together. Suggestions for managing cravings and dietary lapses are described below.

Low or restricted carbohydrate diets such as the Atkins Diet have become popular because they can produce rapid weight loss. Such diets work as do any reducing diets, by severely reducing calorie intake. Unlike other restrictive diets, low carbohydrate diets encourage a blatantly unbalanced approach to caloric restriction, reducing not only carbohydrate intake but also intake of fruits, vegetables, legumes and grains. By restricting carbohydrates and encouraging meat eating, low carb diets end up encouraging people to eat far more saturated fat than is healthy. Such a diet is not sustainable over the long term.

The South Beach Diet takes a different approach to carbohydrate restriction than the Atkins diet. Like the Atkins diet, the South Beach Diet's first phase restricts eating of carbohydrates, producing rapid weight loss. However, the diet's second and third phases reintroduces 'good' carbohydrates and promote moderate consumption of a wide variety of nutritional foods. The South Beach diet thus combines the weight loss benefits of the unsustainable low carbohydrate diet with the healthy and nutritional diet necessary for sustained weight maintainance and health.