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GET THE SCOOP ON ... The doablity of weight loss Measuring fatness Why fat is risky Dieting's new reputation Why Lose weight?
Alright, I tricked you. This book really isn't about dieting, it s about losing weight safely. It's about the state-of-the-art approaches to getting your weight down and keeping it that way. "Dieting" is in the title because people still equate it with weight loss, but as you'll find out in this chapter, dieting and permanent weight loss don't mix. And I'm only interested in helping you lose weight safely, and safely maintain that weight loss.
How much you should weigh, and how to lose it, are among the most controversial, explosive topics in the health field today. Two opposing camps are battling it out: the fat acceptance movement spreading the anti-dieting gospel, and the medical community, alarmed at the epidemic of diabetes and other obesity-related diseases. There may be a compromise position, called "healthy weight." This is a relatively new concept that has emerged from large-scale research studies linking body weight to disease risk. Turns out that you don't have to be skinny to be healthy—great news for many overweight people, for whom "skinny" means fighting an unwinnable battle against powerful genetic forces.
You'll get a pretty good idea of what's a healthy weight for you by the time you finish this chapter. In Chapter 3, you can zero in on it more specifically, if youwant (there's a strong case to be made for not setting a specific goal weight). Also, I'll tell you what the anti-dieting flap is all about and run through the misconceptions that are the legacy of decades of dieting.
Since you may have heard otherwise, let's get something straight: You can lose weight, and you can keep it off. That grim statistic that floats around—that only 5 percent of people ever keep the weight off—appears to be the scientific equivalent of an urban myth: No one knows where it came from. While it's true that studies of very obese people coming out of hospital-based weight loss programs show that most regain the weight, there are no good statistics on what happens to everyone else.
The truth is, no one knows what percent of people who lose weight keep it off over the long haul. But new research, including the Weight Registry Study of 2,000 successful "losers" shows that many people do keep the weight off—tremendous amounts of weight—for 5, 10, 40 years or more. It's certainly not a one-size-fits-all experience. The "success stories" sprinkled throughout this book—people I've interviewed who've kept off 15 to 70 pounds for 1 to 20 years—testify to the many different legitimate approaches. However, as you'll see, there are some basics that most adhere to. You just have to find a way that's right for you.
And for many of you, especially if you've got uncooperative genes, keeping your weight off isn't going to be easy. Sorry, I'm not going to push a fantasy of easy, painless weight loss—you can go to a zillion hokey diet books for that. But I will tell you about the light at the end of the weight loss tunnel: The longer you manage to keep it off, the easier it gets, according to the people I've spoken to who've done it and the nutrition experts who study it.
What's too fat?
Don't get too hung up on definitions of overweight and obesity, since the nutrition community itself hasn't come to a consensus on these terms. What's really important are the body weights and measurements which are related to health and disease. "Overweight" sounds less scary than "obese," but I'll use obese a lot in this chapter because it relates to body fat, while overweight does not, necessarily.
For instance, a muscle-bound body builder might be overweight, but certainly not overfat. We'll use measurements, recognized by much of the scientific community, that rely on percent body fat and the body mass index (BMI), a calculation made from your weight and height measurements.
Body mass index
Until recently, the standard for ideal body weights were the height/weight charts put out in 1959 by the Metropolitan Life Insurance Company (revised in 1983). Twenty percent over the ideal was considered obese. These weights were based on a company study looking at the heights and weights associated with the lowest mortality. Critics of the charts pointed out that the sample population was not representative of society and that the charts were confusing because they were based on frame size, which is hard to measure ("big-boned," "medium-boned," or "small-boned"). Table 1.1 shows what was considered ideal if you're 5'5" or 5'10", according to the 1983 charts:
Compared to the BMI charts (see Table 1.2), the Metropolitan table's high end for the 5'5" male (160 pounds) would be considered a slightly risky BMI of 26 or 27. And the high of 180 pounds for the 5'10" male is also a little over the healthy BMI cutoff of 25.
The BMI chart is rapidly replacing the old ideal weight-for-height charts because it better indicates obesity, not just excess weight. On both the BMI chart and the old ideal height/weight charts, a muscular, heavy (since muscle weighs more than fat) football player could be mistakenly classified as obese. But the BMI chart better adjusts for this.
The real value of the BMI chart is that it relates certain weights-for-heights with disease risk. Basically, after a BMI of 25, the higher your BMI, the greater your risk for heart disease, cancer, and other obesity-related illnesses described later on in this chapter. The risk is just a little higher between 25 and 27 than it is under 25. After a BMI of 27 the risk steadily increases.
Exactly where "overweight" and "obese" fall on the BMI chart is still controversial. A government-sponsored expert panel on obesity recently took a crack at it, defining overweight as a BMI of 25 to 29.9 and obese as a BMI of 30 or above. (A BMI of 25 is about 20 percent over ideal weight by the old height/weight standards.) By these measures, 97 million American adults—55 percent of the population—are considered overweight or obese. Many obesity experts, including Surgeon General C. Everett Koop, who now heads Shape Up America!, criticized the new guidelines, saying that they are unnecessarily stringent and may discourage those who have a hard time making it down to a BMI of under 25. Previous definitions were more generous; the National Center for Health Statistics defined overweight as a BMI of 28 for men and 27 for women. Interviews with the experts I consulted for this book indicate that a BMI of 27 or under is usually a healthy weight; anything over 27 starts getting risky.
Remember, the BMI chart is not infallible. Even with a BMI of 25, 26, or 27 you may not be overfat if you've been working out and much of your weight comes from muscle. Standing naked in front of the mirror still can't be beat for determining whether too much of that weight comes from those rolls of fat padding that bod.
Researchers have linked certain BMIs with increased risk for various diseases. Although BMI gets closer to measuring "overfat" and healthy weight than the old height/weight charts, it's still a fairly crude estimator, and one that is insensitive to individual differences in body fat and muscle. So don't panic if your BMI is in the risky zone, especially if it's around 27 or 28, and especially if the mirror tells you that you've got lots of muscle and little body fat.
Percent body fat
Another way of measuring overweight is to calculate the percentage of body fat. Over 27 percent body fat is considered overweight for a woman, while 32 percent is considered obese. Since men naturally carry less body fat than women, their cutoff point is lower: 23 percent body fat is overweight, and 28 percent indicates obesity. Getting an accurate body fat measure is not that easy; and some of the tools used at health clubs can be pretty useless. Here's what's out there:
Underwater (also called hydrostatic) weighing. Although it's a more accurate measure than some, this procedure probably isn't worth the hassle. And if you're claustrophobic, forget it, unless you need a desensitization shocker! Underwater weighing is just what is sounds like: Clothed only in a thin bathing suit, you get into a little capsule, exhale, and hold your breath for five to 10 seconds while you're completely dunked under water. Those with lots of body fat must be strapped in with heavy, weighted belts to prevent floating. Based on the amount of water that's displaced, and your body weight in water compared to your body weight on land, scientists have come up with a formula that is a good estimator of your body fat percentage. However, as you can imagine, this is a time-consuming and expensive procedure. Not many health clubs or weight loss program offices just happen to have an enormous underwater weighing machine lying around.
Caliper measurement. Don't worry, these plier-like instruments don't hurt. What you should worry about is whether the person doing the measuring is well trained; otherwise your results could be meaningless. Calipers are used to measure the amount of "subcutaneous" fat, the fat right under your skin. Using calipers, the person taking your measurements grabs a fold of skin with the fat underneath and gently pulls it away from the muscle. Still holding the skin, the calipers measure the fold. Typically, this is done on your upper arm (triceps), under the shoulder blade (subscapular), just above the hip bone (suprailiac), at the waist (abdominal), and on the thighs. These numbers are plugged into a formula appropriate for your age and sex category, and body fat is estimated. This method can be very accurate if two situations coexist: The person doing the measuring is well trained (otherwise the measurements can be way off) and if you are under 55 years of age with a regular distribution of body fat. As we age, our subcutaneous body fat thins, and the internal or "visceral" body fat stores grow—and those fat deposits can't be measured by calipers.
Girth measurements. By plugging measurements of the upper arm, abdomen, buttocks, thigh, and calf into a formula, body fat can be estimated. Although this requires just one simple tool—a tape measure—the calculations are pretty involved, differing according to age and gender.
Bioelectrical or electrical impedance. In this method, electrodes are placed on your hands and feet and an electric current is shot through your body. It sounds dreadful, but it's actually painless. Unfortunately, it's also unreliable. The principal behind it is that electric current passes more easily through lean tissue but slows down or is impeded by fat tissue. By measuring the impedance to the flow of an electric current throughout the body this instrument indirectly measures the percentage of body fat. "Problem is, you get different readings depending on which manufacturer made the instrument," according to Ken Ellis, Ph.D., Director of the Body Composition Laboratory at the USDA Children's Nutrition Research Center at Baylor College of Medicine in Houston. Also, says Ellis, the chance for error is high if the person administering the test isn't well trained. "Electrodes placed just half an inch off on the hands or legs can throw the body fat readings off by 10 percent." This test is free at some health clubs and diet programs.
DEXA (Dual Energy X-ray Absorptiometer). This is just the technical name for a bone scan, and it's Ellis's top pick for measuring body fat. As the machine measures bone density it automatically determines the percent of body fat. "You get two tests in one," Ellis points out. Unfortunately, while this procedure is widely used to check out the thickness of your spine or wrist bones, the Food and Drug Administration (FDA) hasn't yet approved it for scanning the whole body. But if you live near a teaching hospital or major weight loss clinic, they may be running a study using the DEXA. Experimental use is kosher with the FDA.
What is a "healthy weight"? "Healthy weight" is the new buzzword, the new goal promoted by nutrition experts. It's the weight range considered to pose the fewest health risks—19 to 25 on the BMI chart. Besides helping you to look and feel better generally, getting down to a healthy weight can greatly reduce your risk of developing big-time killers later on, like heart disease and diabetes. That's because the more body fat you have, the more likely you are to develop health problems. Being slightly overweight may not raise your risk for any disease, but being obese for 10 to 30 years doubles the likelihood of dying prematurely. While there's no clear cutoff point along the BMI chart at which your weight changes from healthy to unhealthy, risk seems to increase gradually after a BMI of 25. A BMI of 28 or greater is linked to a three to four-fold increase in developing stroke, heart disease, or diabetes compared to the general population.
As you can see from the BMI chart, "healthy weight" does not necessarily mean "thin." It's amazing how relatively small weight losses—5 to 10 percent of body weight—can make such huge differences in disease risk. If you're a 5'9" male weighing 189 pounds (and the mirror tells you that way too much of your poundage is body fat), your BMI is an unhealthy 28. Lose 10 percent of your body weight—19 pounds—and you've gone down to a much healthier BMI of 25. Losing 10 percent of your body weight is often enough to bring blood sugar, blood pressure, and blood cholesterol down to normal levels.
What if you fall in between the weights and heights listed in the BMI chart? Plug your measurements into this equation:
Apple-shaped and pear-shaped
Your "love handles" are another way to get a handle on disease risk. You may have heard it before: "apple-shaped" people—those with big bellies—are at higher risk for heart disease, high blood pressure, and diabetes than "pear-shaped" people, who carry more weight in their hips and thighs. You can't control where your body chooses to deposit fat—you're genetically programmed to be more apple-like or pear-like. But you can control how much fat is parked on those hips or that belly. By losing weight you can become a "safe apple," no longer at increased risk for disease.
An unsafe apple is a woman with a waist-to-hip ratio greater than .85 or a man with a waist-to-hip ratio greater than .95. Here's how to calculate your waist-to-hip ratio:
1. With a tape measure, circle your waist—that's the smallest part of your torso between your rib cage and belly button. Write that number down. For this example, let's say you're a man and the number is 41.
2. Now measure your hips, the largest measurement around the widest part of your buttocks. Write it down. For example: 46.
3. Divide your waist measurement by your hip measurement. 41 ( 46 = .89, which is in the safe zone.
Shed pounds, drop risk
Why bother losing weight? Perhaps you shouldn't, if your weight isn't affecting your mental or physical well-being (that is, if you have no weight-related medical conditions such as diabetes or high blood pressure). If your BMI is under 27, you may not be at any increased risk. But if your body weight has moved beyond a medically healthy point, losing just 10 percent of your current weight can make an enormous difference in how you feel, and perhaps, enough of a difference in how you look to satisfy you. Also, a 10 percent loss may be one you can actually sustain.
Successful "losers" in the ongoing National Weight Control Registry overwhelmingly reported that keeping their weight down greatly improved their quality of life, health and well-being, mood, mobility, and energy level. Interestingly, few of these people are thin, but they are maintaining their weight in the healthy range. But if your BMI is past the 27 mark and you're feeling it, getting down to the healthy weight zone will decrease your risk for the following conditions:
Heart disease. Heart disease is the leading cause of death in the U.S. for both women and men, causing 32 percent of men's deaths and 42 percent of women's deaths. The type of heart disease most affected by obesity is "coronary heart disease," in which the coronary arteries, those leading to the heart, start getting clogged up with cholesterol and other gunk. As the arteries narrow, the heart muscle itself can't get enough nutrients and oxygen and starts to falter. A heart attack happens when the arteries are so clogged they finally close off, or a clot that would normally pass through now obstructs the artery. Being overweight increases your chances of developing heart disease because it triggers high blood cholesterol, diabetes, and high blood pressure—all causes of heart disease.
Diabetes. There's an epidemic of Type II diabetes in this country, the type you develop as an adult. Being overweight and sedentary has a lot to do with it. Diabetics have faulty insulin, a hormone responsible for regulating blood sugar and for storing fat. A healthy person's insulin efficiently clears the blood sugar and fat byproducts from the last meal, but diabetics must spew out a large amount of their "inefficient" insulin to clear the blood. Eventually, even high levels of insulin don't work and the resulting high blood sugar wreaks havoc on the organs, causing blindness, foot disease, and other problems. The high volume of circulating fats finds its way to the arteries, clogging them up and causing heart disease and stroke. Plus, all that insulin sends a message to store fat rather than to burn it. Gaining weight can cause Type II diabetes, especially if it runs in your family. Losing weight can usually get rid of this type of diabetes, especially when exercise is part of the weight loss regimen.
Cancer. If we ate a balanced diet, got regular exercise, and stuck to a healthy body weight, about 30 to 40 percent of all cancer cases would be eliminated. Whereas some cancers are caused by unbalanced diets (too much meat and fat, few fruits, vegetables, and whole grains), other cancers—of the colon, rectum, prostate, gallbladder, breast, uterus, cervix, and ovaries—are also related to being overweight. To reduce cancer risk, experts recommend keeping your body mass index between 18.5 and 25.
Gallstones. The gallbladder, a three-inch long organ that lies beneath the liver, helps us digest fat by releasing bile, a detergent-like liquid that breaks up the fat particles in that doughnut, salad dressing, or another fatty food you just swallowed. Being overweight ups your chances of developing gallstones, hard clumps made of cholesterol and other material. Gallstones usually don't bother you, but for the minority of people who have symptoms, the attacks are painful, leading to 500,000 operations yearly. But quick weight loss isn't the answer, in fact, it can bring on gallstones. If you're overweight and have gallstones, the gradual weight loss promoted in this book is your best course of action.
Gout. Gout is a type of arthritis in which painful, needle-like crystals accumulate in the joint spaces, causing inflammation, swelling, and pain, most commonly in the big toe. The crystals are made of uric acid, a naturally occurring substance in the body that rises to too-high levels in people with gout. Uric acid forms from the breakdown of protein, alcohol, and another compound in food called purine. Organ meats, lima beans, certain varieties of seafood, and a few other foods are high in purines. Overeating protein-rich and purine-rich foods contributes to gout in susceptible people. Therefore, the overeating that goes on in obesity is a setup for gout. Also, obesity makes it harder for the body to excrete uric acid. Weight loss, especially on a diet that keeps a lid on protein, alcohol, and purines, helps treat gout.
Osteoarthritis of the spine, hip, or knee. As you get heavier, you place undue stress on these joints and this wears away cartilage, the bone-like substance that makes up joints. This worn-down cartilage is osteoarthritis, which ranges in severity from mild stiffness and aching joints to severe pain and disability. Lose weight through diet and exercise and do your joints a big favor.
Even if your knees are the problem, walking a treadmill seems to be a good thing: In one study, 48 overweight women with osteoarthritis of the knees walked a treadmill three times a week, for up to 45 minutes per session. They also met weekly with a nutritionist who helped them follow a reduced-calorie diet that set a 30 percent limit on fat. The payoff: After six months, the women lost an average of 15.5 pounds, and most had a lot less knee pain. Using something called the Womach pain score, 40 percent of the women reported only half as much pain as they had known before the exercise and diet regimen. A third of the women experienced a 50 percent improvement in functions such as walking up stairs. And compared to when they began the study, on average, the women walked 15 percent farther on a six-minute walking test.
If you're obese, dropping 10 to 15 pounds cuts the risk of getting osteoarthritis by half, according to the research of David Felson, MD, professor of medicine and public health at Boston University School of Medicine, Department of Arthritis. "Besides extra pressure on the joints, obesity may also exert some metabolic influences that affect bone and cartilage," says Felson. Otherwise, why would obese women get more osteoarthritis of the hand, an area that wouldn't be stressed from being overweight?
Additional health problems associated with obesity include:
Breathing problems such as snoring and sleep apnea (brief periods where breathing stops). Excess fat tissue around the neck closes off the airways, causing breathing disorders. Weight loss is by far the most effective treatment for snoring, as shown in a University of Florida study. Nineteen overweight male snorers who went on a weight loss program for six months reduced the number of times they snored per hour. Men who lost over 13 pounds cut snores back to just 12 per hour. Weight loss is explicitly used as part of the treatment for sleep apnea.
Psychological trauma. Since thinness is next to godliness in this culture (especially for women), overweight people often feel unattractive, ashamed, and depressed. It takes a tremendous amount of confidence to feel good about your body when you're overweight. But, as you'll see in Chapter 9, with some help you can feel very differently about your body.
The point is that you don't have to strive for an unrealistic, too-thin weight goal—just losing enough weight to put you in the healthy range can make a tremendous difference in how you feel. For most overweight people, losing 10 percent of their body weight is often enough to normalize the following factors:
Blood cholesterol, reducing risk for heart disease
Blood pressure, reducing risk for heart disease
Blood glucose levels, reducing risk for diabetes
The stress on knees and ankles, reducing the risk and symptoms of osteoarthritis
If exercise is part of your weight loss strategy, you'll really notice a difference in how you feel. Here's what you can look forward to:
Greater body tone (even if you still have more body fat than you'd like)
Stronger bones, thereby decreasing the risk for osteoporosis, a bone-thinning disease
Quicker recovery from illness, and less risk if you have to have an operation
Savings in medical bills and insurance premiums
Is diet just a four-fetter word?
Do you have to diet to keep off the weight? Recently, "diet" has become a dirty word in some nutrition circles. We're in the midst of an anti-diet—or "undieting"—movement, a backlash against all the low-calorie, structured diets ubiquitous in magazines and best-selling diet books over the past 30 years. The year 1998 began with an editorial in the prestigious New England Journal of Medicine that railed against dieting, suggesting that it isn't always medically necessary. The article ended on this dramatic note: "Countless numbers of our daughters and increasingly many of our sons are suffering immeasurable torment in fruitless weight loss schemes and scams, and some are losing their lives." While The 5 Day Miracle Diet is still on the shelves, more and more diet books have anti-dieting titles such as Living Without Dieting or Never Diet Again.
Some of the beliefs of the undieting movement are valid: Dieting can be physically harmful and gaining back the weight does erode self-esteem; overweight people are unfairly discriminated against; and there really is no proof that dieting results in sustained weight loss. But another key premise—that obesity may not be so bad for your health—flies in the face of an impressive collection of solid scientific research. In fact, former Surgeon General C. Everett Koop, who is leading a national campaign (called Shape Up America!) to reduce obesity, was so infuriated by the New England Journal article that he sent out a press release attacking its weak scientific premise and irresponsible message.
So are diets dead? The restrictive low-calorie ones that have you walking around in a hungry daze dreaming about jelly doughnuts are pretty much passé. But some version of a "diet" has its place, especially for the initial weight loss. About half the successful "losers" in the National Weight Registry used some sort of formal diet program to lose the weight—Weight Watchers, liquid meal replacements, or sessions with a dietitian. Some people do better with structure, and a diet plan that tells them what they should eat for breakfast, lunch, and dinner for the next month may really help them take the weight off. For others, this approach doesn't work: They either exercise more; eat less of what they normally eat; eat lower-fat, lower-calorie foods; or use some combination of the three. And face it, whenever you cut back on calories to lose weight, you're doing some type of dieting.
The difference is that there are healthy diets and unhealthy diets—approaches to losing weight that help you maintain your new weight and super-restrictive diets limited to a few foods that practically guarantee a relapse to your old ways and old weight.
What seems to be more important than the terminology—"dieting" vs. "lifestyle eating changes"—is your attitude about eating. The "success stories" I interviewed for this book don't perceive themselves as being "on a diet." They honestly don't feel deprived, at least not enough to be unhappy about it. Ditto for the successful "losers" tracked by other researchers working in this field.
Dieting's legacy: weight loss myths
If you've been through a number of "miracle" diets over the years, you may have gotten some wrongheaded messages. Throw them out along with that stack of old diet books.
Many people think that you have to cut way back on calories, avoid certain foods, and/or feel hungry and deprived to lose weight. But while deprivational techniques may work to take the weight off, even if you can stand it for more than a few weeks or months, they won't help you to keep it off over the long haul. In the 1980s, when Oprah Winfrey lost about 80 pounds on a liquid diet, she gained it all back within a few months. Deprivation dooms dieters to this horrible cycle:
This approach simply doesn't work: While up to 35 percent of Americans say they're on a diet, about half are overweight and a third qualify as obese. Diets in the traditional sense of the word don't work in the long term. Plus, to add insult to injury, they wear down your self-esteem, making you feel like a failure. To break the cycle, you have knock out the restrictive diet part and replace it with a healthy, not-too-low-calorie approach to eating. You won't lose weight as quickly, but you'll have a heck of a better chance at keeping it off.
If you throw in exercise along with the healthy diet, you've just raised your odds of success another few notches. Even if the new way of eating still leaves you feeling a bit deprived, a little fiddling with the diet to include foods you love and a little psychological work can put an end to those feelings. Successful "losers" say that they switched from thinking "Poor me, I can't eat the way I used to" to "I feel in control because I'm choosing to eat well now." And most people who've kept weight off for years say that just changing the way they eat hasn't been enough—some sort of regular exercise was also critical.
The thin myth
This one says that you can, and should, look like a fashion model. The truth is, some of us won't be skinny for life. However, all of you can get down to a healthy weight and, with the right combination of diet, exercise, and attitude, stay there. You see, most bodies just weren't designed to be skinny, and trying to get there and stay there involves such an overwhelming effort (like near starvation) that very few people can achieve it. Because of nature or nurture, or some combination of the two, becoming and staying skinny is just too difficult. However, a healthy weight is much more doable, and that weight will be different for each individual.
Repeated diet failure myth
"You're likely to remain fat if you've lost and gained weight a number of times." Or so goes this fallacy. But who hasn't lost and gained? There's no evidence that a history of yo-yo dieting—cycles of weight loss and gain—necessarily dooms you to remain overweight. In fact, most of the successful "losers" in the National Weight Registry and most of the success stories interviewed for this book had long histories of yo-yoing. The average person totaled a combined loss of 220 pounds over several attempts. The last attempt "took," partly because people made use of strategies they'd learned during previous weight loss efforts.
The genes myth
This myth says that you're doomed to be fat because you have "fat genes." But as you'll find out in Chapter 3, being overweight is usually the result of a complex interaction between genetics and environment. Only a few very rare genetic disorders (and you'd know it if you had one) make excess body fat virtually inevitable.
The gluttony myth
"You're fat because you're a glutton." But it's not clear that overweight people eat more than normal weight people. Instead, it's probable that their bodies just hang on to calories more tightly. Meanwhile everything in our society works against sticking to lower levels of caloric intake. Just look around you: 7-Elevens open all night, McDonald's stands in Wal-Mart, pizza ads on TV just when you thought you were full ... An overabundance of food, food used as stress relief, lack of exercise, and those so-called "fat genes" make gaining weight almost inevitable and keeping it off very tricky.
But keep in mind that lots of people do keep it off. Throughout this book you'll hear their stories, and while you'll see that there's no single "right" way to do it, you will discover that it usually involves some sort of commitment to physical activity (even walking) and a gradual change in dietary habits. Dietary habits, mind you, not diet.
|The Unofficial Guide Reader's Bill of Rights||xiii|
|The Unofficial Guide Panel of Experts||xvii|
|I Getting Started||1|
|1 Healthy Weight, Unhealthy Approaches||3|
|2 Getting Organized||31|
|II Nutrition You Should Know||61|
|3 How Do You Get Fat?||63|
|4 Nutrition Basics to Keep You Basically Healthy||85|
|5 Vital Nutrients||107|
|III Weighing the Options||127|
|6 Getting Good Help||129|
|7 Diets that Deliver, Diets that Deceive||171|
|8 Diet Drugs, Weight Loss Supplements, and Scams||201|
|IV Eating Habits Rx||237|
|9 The Weight Loss Head Trip||239|
|10 What to Eat||273|
|11 Staying Psyched||317|
|12 Eating Disorders Aren't Just for Skinny People||339|
|V Get Moving||375|
|13 You've Got to Keep Moving||377|
|14 Getting Physical||409|
|A Recommended Reading List||445|
|C Menus for You||463|
|D Fast-Food Fat and Calorie Counts||473|
|E Brand Name Calorie, Fat, and Fiber Counts||483|
|F Blank Food Records for You to Use||499|