Body Mass Index

The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual. The body mass index (BMI) is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m², resulting from mass in kilograms and height in meters.

BMI is considered an important measure for understanding population trends. For individuals, it is one of many factors that should be considered in evaluating healthy weight, along with waist size, body fat composition, waist circumference, blood pressure, cholesterol level and blood sugar.

The World Health Organization defines overweight as a body mass index equal to or more than 25 – 29.9 kg/m² and obesity as a BMI equal to or more than 30.

Adults with a body mass index of 35 or higher and an obesity-related condition (e.g., diabetes) and adults with a BMI of 40 kg/m² or higher are considered severely obese.

Moreover, your Body Mass Index (BMI) does not take into account your age, gender or muscle mass. Nor does it distinguish between lean body mass and fat mass. As a result, some people, such as heavily muscled athletes, may have a high BMI even though they don’t have a high percentage of body fat. In others, such as elderly people, body mass index may appear normal even though muscle has been lost with aging.

To calculate your body mass index, you divide your body weight in kilograms by your height in meter squared (commonly expressed as kg/m²), see the body mass index formula below.

Figure 1. Body Mass Index formula

To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) :

Adults

For children and adolescents (younger than 20 years of age), overweight and obesity are based on the Centers for Disease Control and Prevention’s (CDC’s) BMI-for-age growth charts, which are available at (https://www.cdc.gov/growthcharts/clinical_charts.htm).

BMI calculator for children and teens

Body Mass Index for Men and Women Adults

The body mass index is an attempt to quantify the amount of tissue mass (muscle, fat, and bone) in an individual, and then categorize that person as underweight, normal weight, overweight, or obese based on that value. Commonly accepted body mass index ranges are:

• Underweight: under 18.5 kg/m²,
• Normal weight: 18.5 to 25 kg/m²,
• Overweight: 25 to 30 kg/m²,
• Obese: over 30 to 39.9 kg/m².
• Severely Obese: over 40 kg/m².

Two thirds of the adult population in the United States and at least half the populations of many other developed countries are currently overweight or obese ¹. Although it is well established that obese people — defined as having a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 kg/m² or more — have increased death rates from heart disease, stroke, and many specific cancers ². In this large, pooled analysis of prospective studies, both overweight and obesity (and possibly underweight BMI below 22·5 kg/m²) were associated with increased all-cause mortality in analyses restricted to participants who never smoked and did not have diagnosed cancer or heart disease ³. Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to the body-mass index (BMI), and BMI to them, body-mass index (BMI) is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is reduced by 8–10 years (which is comparable with the effects of smoking) ⁴.

People of Asian descent have different associations between body mass index, percentage of body fat, and health risks than those of European descent, with a higher risk of type 2 diabetes and cardiovascular disease at body mass index lower than the WHO cut-off point for overweight, 25 kg/m², although the cutoff for observed risk varies among different Asian populations.

Essentially, body mass index is a simple mathematical formula, based on height and weight, that is used to measure fatness. You should be aware of your BMI because of the health risks of being overweight (that is, having a BMI of 25 or over). According to a report in the August 2006 New England Journal of Medicine, excess body weight during midlife is associated with an increased risk of death.

While BMI is a simple, inexpensive method of screening for weight categories, it is not a diagnostic tool. BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals. Measuring BMI while it is a simple, inexpensive method of screening for weight categories, it is not a diagnostic tool. Health professionals use other tools to do further assessments to fully evaluate health risks. These additional tools would include measurements of waist hip ratio, body fat percentage, diet history, exercise patterns, and family history. One thing that experts agree on is that weight is only one factor in our risk for disease. When it comes to evaluating weight and its impact on health, your percentage of body fat, waist circumference, BMI, and physical activity patterns are all important.

Furthermore, BMI does not take into account your age, gender or muscle mass. Nor does it distinguish between lean body mass and fat mass. As a result, some people, such as heavily muscled athletes, may have a high BMI even though they don’t have a high percentage of body fat. In others, such as elderly people, BMI may appear normal even though muscle has been lost with aging.

Fat around your waist is more biologically active and can do more damage to your body than weight around your hips. The research data show that waist circumference is more reliable and more closely correlated with diseases associated with obesity.

In people who are not overweight, waist size may be an even more telling warning sign of increased health risks than BMI ⁵. An expert panel convened by the National Institutes of Health identified these useful benchmarks: Men should aim for a waist size below 40 inches (102 cm) and women should aim for a waist size below 35 inches (88 cm) ⁶.

According to the National Institutes of Health, a bigger waist circumference (greater than 40 inches for men and 35 inches for women) is linked to a higher risk of type 2 diabetes, high blood pressure, abnormal cholesterol levels, and heart disease when BMI is 25 to 34.9 kg/m^{2 6}.

• Although BMI can be used for most men and women, it does have some limitations. It may overestimate body fat in athletes and others who have a muscular build. BMI also may underestimate body fat in older people and others who have lost muscle.

Furthermore, the fat around your waist is more biologically active and can do more damage to your body than weight around your hips. The research data show that waist circumference is more reliable and more closely correlated with diseases associated with obesity.

Many health care experts think BMI is a useful tool to measure weight and health risks, but others question its accuracy. Some believe a better way might be to take out the tape measure and check your waist circumference (the waist hip ratio). This is because your health is not only affected by excess body fat, but also by where the fat is located. Some people gain weight in their abdominal regions (the so-called ”apple” body shape.) Others are ”pear-shaped,” with excess weight around the hips and buttocks. People with apple shapes are at higher risk for health problems associated with being overweight.

According to the National Institutes of Health, a bigger waist circumference (greater than 40 inches for men and 35 inches for women) is linked to a higher risk of type 2 diabetes, high blood pressure, abnormal cholesterol levels, and heart disease when BMI is 25 to 34.9 kg/m².

One thing that experts agree on is that weight is only one factor in your risk for disease. When it comes to evaluating weight and its impact on health, your percentage of body fat, waist circumference, BMI, and physical activity patterns are all important.

The National Heart, Lung, and Blood Institute recommends that health care providers assess BMI, waist circumference, and any other risk factors for obesity-related conditions. Combining all of the information provides the best assessment.

Figure 2. Body Mass Index chart

Footnote: A graph of body mass index (BMI) as a function of body mass and body height. The dashed lines represent subdivisions within a major class. The Body mass index scale show all people with high level of muscles also overweight or obese. This is because the BMI scale is designed in accordance to the body fat levels not body muscles mass levels. Therefore, BMI measure is not an accurate measure for muscular individual.

Body Mass Index for Children and Teens

Overweight are obesity are defined differently for children and teens than for adults. Children are still growing, and boys and girls mature at different rates.

BMIs for children and teens compare their heights and weights against growth charts that take age and sex into account. This is called BMI-for-age percentile. A child or teen’s BMI-for-age percentile shows how his or her BMI compares with other boys and girls of the same age.

For children, age needs to be considered when defining overweight and obesity.

For children under 5 years of age:

• overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
• obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.

Children aged between 5–19 years

Overweight and obesity are defined as follows for children aged between 5–19 years:

• overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
• obesity is greater than 2 standard deviations above the WHO Growth Reference median.

What Does the BMI-for-Age Percentile Mean ?

BMI-for-Age Percentile     

Less than 5th percentile = Underweight
5th percentile to less than the 85th percentile = Healthy weight
85th percentile to less than the 95th percentile = Risk of overweight
95th percentile or greater =Overweight

For more information about BMI-for-age and growth charts for children, go to the Centers for Disease Control and Prevention’s BMI-for-age calculator.

How to lose belly fat

To lose weight you’ll need to start with finding a way to eat fewer calories than you need. A calorie is a unit of energy, which is in the foods and drinks you consume. Scientifically, the calorie (a unit of energy) was originally defined as the amount of heat required at a pressure of 1 standard atmosphere to raise the temperature of 1 gram of water 1° Celsius. When you hear something contains 100 calories, it’s a way of describing how much energy your body could get from eating or drinking it. However, since calories are too small of a measurement to use when discussing nutrition and exercise, kilocalorie (kcal) measurements are used instead and the term is interchangeable with calories. Kilocalorie (kcal) is a unit of measurement for energy that is equivalent to 1,000 calories. Also,1 kcal or 1 kilocalorie is equivalent to 1 large Calorie (with an uppercase C) or 1,000 calories.

Some countries use kilojoules (kJ) to measure how much energy people get from consuming a food or drink.

• 1 calorie = 4.184 joule
• 1 kilocalorie (kcal) = 4.184 kilojoules (kJ)
• 1 Calorie (1,000 calories) = 4.184 kilojoules (kJ)

Here’s how many calories are in your foods and drinks ⁷:

• 1 gram of carbohydrate = 4 calories
• 1 gram of protein = 4 calories
• 1 gram of fat = 9 calories
• 1 gram of water = 0 calorie

Most foods and drinks contain calories. You can find out how many calories are in a food by looking at the nutrition facts label. The label also will describe the components of the food such as how many grams of carbohydrate, protein, and fat it contains.

That means if you know how many grams of each one are in a food, you can calculate the total calories. You would multiply the number of grams by the number of calories in a gram of that food component. For example, if a serving of potato chips (about 20 chips) has 10 grams of fat, 90 calories are from fat. That’s 10 grams x 9 calories per gram. Some foods, such as lettuce, contain few calories (1 cup of shredded lettuce has less than 10 calories). Other foods, like peanuts, contain a lot of calories (½ cup of peanuts has 427 calories).

There are many unhealthy misconceptions about weight loss. There are no magical foods or ways to combine foods that melt away excess body fat. To reduce your weight, you’ll have to reduce your calorie intake.

Calories aren’t bad for you. Your body needs calories for energy. Your body uses energy (calorie) for everything you do from breathing and sleeping to exercising. Some people mistakenly believe they have to burn off all the calories they eat or they will gain weight. This isn’t true. Your body needs some calories just to operate — to keep your heart beating and your lungs breathing. When you eat, you’re replacing the energy (calorie) you’ve used, which helps you to maintain a healthy weight. But eating more calories than your body needs and not burning enough of them off through activity can lead to weight gain and other health problems such as type 2 diabetes, heart disease, high blood pressure, certain cancers (e.g., uterine, gallbladder, kidney, liver, and colon cancers) and death ⁸, ⁹, ¹⁰, ¹¹.

Being overweight or obese is the result of an energy imbalance between your daily energy intake and your energy expenditure resulting in excessive weight gain ¹². The amount of energy or calories you get from food and drinks (energy IN) is balanced with the energy your body uses for things like breathing, digesting, and being physically active (energy OUT):

• The same amount of energy IN and energy OUT over time = weight stays the same (Energy Balance)
• More energy IN than OUT over time = Weight Gain
• More energy OUT than IN over time = Weight Loss

In order to lose weight, energy expenditures must exceed energy intake. To lose weight, most people need to reduce the number of calories they get from food and beverages (energy IN) and increase their physical activity (energy OUT). To achieve this imbalance, you can decrease energy intake, increase energy expenditures or combine a decrease in intake with an increase in expenditures. Being physically active and eating fewer calories will help you lose weight and keep the weight off over time. As a result, most weight loss recommendations advise combining a low caloric diet with an exercise program in order to achieve a significant energy deficit ¹³. A long-standing consistent observation is that regular exercise by itself is prescribed in small to moderate amounts resulting in modest weight loss or in some cases weight gain ¹⁴.

Weight loss of about 1 to 1 ½ pounds per week is considered reasonable and more likely to be maintained. For a weight loss of 1 to 1 ½ pounds per week, daily intake should be reduced by 500 to 750 calories. In general ¹⁵:

• Eating plans that contain 1,200–1,500 calories each day will help most women lose weight safely.
• Eating plans that contain 1,500–1,800 calories each day are suitable for men and for women who weigh more or who exercise regularly.

Very low calorie diets of fewer than 800 calories per day should not be used unless you are being monitored by your doctor. Because dieting can be harmful because your body responds to these periods of semi-starvation by lowering its metabolic rate. When you lose weight too quickly, you lose fat and muscle. Muscle burns kilojoules, but fat doesn’t. So, when you stop dieting and return to your usual habits, your body will burn even fewer calories than before because the relative amount of muscle in your body has decreased and your metabolic rate is slower. This kind of eating pattern can also affect your general health – just one cycle of weight loss and weight gain can contribute to an increased risk of coronary heart disease (regardless of your body fat levels). That’s why it’s more important to be able to maintain weight loss.

Energy balance is also important for maintaining a healthy weight. To maintain a healthy weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that helps you maintain a healthy weight.

You can reach and maintain a healthy weight if you:

• Follow a healthy diet, and if you are overweight or obese, reduce your daily intake by 500 calories for weight loss
• Are physically active
• Limit the time you spend being physically inactive

While people vary quite a bit in the amount of physical activity (exercise) they need for weight control, many can maintain their weight by doing 150 to 300 minutes (2 ½ to 5 hours) a week of moderate-intensity activity such as brisk walking. People who want to lose a large amount of weight (more than 5 percent of their body weight) and people who want to keep off the weight that they’ve lost may need to be physically active for more than 300 minutes of moderate-intensity activity each week.

You now know the basics about calories – the key to weight loss for most people is simply finding the right combination of exercise, healthy foods and cutting back on portions will help you lose those extra pounds. No fad diet required. In other words, eat healthily, watch your portions and get moving more. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. To prevent the weight creeping back on, you need to keep going with the healthy habits you’ve formed.

How many calories do I need per day?

The total number of calories you need each day varies depends on a number of factors, namely your age, sex, height, weight, level of physical activity, and pregnancy or lactation status. According to the Dietary Guidelines for Americans, American female adult estimated calorie needs range from 1,600 to 2,400 calories per day and for males 2,000 to 3,000 calories per day ¹⁶. The average, healthy, adult, American male consumes approximately 2,800 calories per day, and the average female about 1,800 calories ¹⁰. But most people need different amounts of calories based on how their bodies work, how active they are and any weight management goals. And if you want to lose weight you’ll have to reduce your calorie intake.

Here is a general estimate of calories you need each day:

• Sedentary lifestyle (little to no exercise)
  • Women: 1,800 to 2,400 calories
  • Men: 2,200 to 3,000 calories
• Moderately active lifestyle (engages in moderate exercise/physical activity like walking or light yard work:
  • Women: 2,000 to 2,600 calories
  • Men: 2,400 to 2,800 calories
• Very active lifestyle (engages in hard exercise/physical activity, or has a physically demanding job):
  • Women: 2,200 to 2,800 calories
  • Men: 2,800 to 3,200 calories

These are just general guidelines. It’s essential to consult with a nutritionist or a doctor who can give personalized advice based on your specific situation. Remember, it’s not just the quantity but also the quality of calories that matters for overall health.

Obesity results from the accumulation of excessive body fat, which is stored as adipose tissue. An energy deficit of approximately 3,500 calories is required to lose one pound of fat. However, there are several factors that can influence this particular number. These include compensatory changes in your resting metabolism (basal metabolic rate [BMR]), the energy cost of work, and discretionary physical activity, which can sometimes alter this figure by 100 to 200 calories. Your basal metabolic rate (BMR) also known as resting metabolic rate (RMR) is the number of calories your body burns while performing basic life-sustaining functions, such as breathing and keeping your heart beating. Your basal metabolic rate (BMR) is typically between 1,000 and 2,000 calories per day.

How to calculate calories you need for weight loss

You can calculate your basal metabolic rate (BMR) or resting metabolic rate (RMR) using the Mifflin-St Jeor equation ¹⁷, which is considered more accurate than the Harris-Benedict equation, especially for lean people. According to the Academy of Nutrition and Dietetics Evidence Analysis Library (EAL), the Mifflin-St. Jeor equation accurately predicted resting metabolic rate (RMR) using actual body weight within +/- 10% of measured RMR in 70% of obese individuals ¹⁸. Of the remaining 30%, 9% were overestimations and 21% were underestimations. The individual error range was a maximum overestimate of 15% to a maximum underestimate of 20%” ¹⁹. While the Harris-Benedict and WHO equations are often used in clinical practice with reasonable accuracy, results have been mixed regarding their applications to individuals who are overweight or obese ¹⁰.

The Mifflin-St Jeor formula for calculating your basal metabolic rate (BMR) or resting metabolic rate (RMR):

• Males Basal metabolic rate [BMR] (kcal/day) = (10 X weight in kilograms) + (6.25 X height in centimeters) – (5 X age in years) + 5 (kcal/day)
• Females Basal metabolic rate [BMR] (kcal/day) = (10 X weight in kilograms) + (6.25 X height in centimeters) – (5 X age in years) – 161 (kcal/day)

You can also use the free online Basal Metabolic Rate (BMR) calculator here: https://www.nasm.org/resources/calorie-calculator

Or the Body Weight Planner (https://www.niddk.nih.gov/health-information/weight-management/body-weight-planner).

The Body Weight Planner allows you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards.

The Basal Metabolic Rate (BMR) calculator factor in your activity levels, overall goals, and calorie usage to help you craft a weight-loss plan.

Once you have found your basal metabolic rate (BMR), multiply your BMR by your Physical Activity Levels to provide a baseline daily caloric level for weight maintenance:

• Sedentary (light physical activity associated with typical day-to-day life) = 1
• Low Active (walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life), For males = 1.11 and females = 1.20
• Active (walking more than 3 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate intensity physical activity). For males = 1.25 and females = 1.27
• Very Active (walking more than 7.5 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate to vigorous intensity physical activity). For males = 1.48 and females = 1.45

Your Total Daily Energy Expenditure (TDEE) gives you the estimated number of calories you need to maintain your current weight based on your activity level.

To find your Total Daily Energy Expenditure (TDEE) multiply your Basal Metabolic Rate (BMR) by your Physical Activity Levels

For example:

• Sedentary (little to no exercise): BMR x 1
• Lightly active (walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life): BMR x For males = 1.11 and females = 1.20
• Moderately active (moderate exercise/sports 3-5 days/week): BMR x 1.55
• Very active (walking more than 7.5 miles per day at 3 to 4 miles per hour, in addition to light physical activity associated with typical day-to-day life: 60 minutes of at least moderate to vigorous intensity physical activity): BMR x For males = 1.48 and females = 1.45
• Super active (very hard exercise & physical job or 2x training): BMR x 1.9

You can increase your basal metabolic rate (BMR) by:

• Exercising more, especially interval training
• Weight training to build muscle mass
• Eating fat-burning foods
• Getting enough sleep

After calculating your basal metabolic rate (BMR) or resting metabolic rate (RMR), your RMR should be multiplied by an appropriate physical activity factor to provide your baseline daily caloric level for weight maintenance. Once your baseline caloric level is known, your recommended calorie intake should be reduced to facilitate your weight loss.

If you want to lose weight, subtract 500 to 1000 calories from your Total Daily Energy Expenditure (TDEE) to get a daily intake goal. For weight gain, add extra calories. Reducing your calorie intake by 500 calories is a common strategy to yield a weight loss of approximately one pound per week, although reductions of up to 750 calories per day are sometimes used ²⁰.
Another approach is to reduce your current caloric intake by 30% ²⁰. Diets that reduce caloric intake relative to energy expenditure result in weight loss, regardless of macronutrient composition ²⁰.

Here’s how to estimate how long it will take to reach your goal:

Jessie’s current weight is 150 lbs. She wants to lose 20 lbs.

• 150lbs – 20lbs = 130lbs.
• 20lbs loss at 2lbs/week = 10 weeks.
• It will take Jessie about 10 week to lose the weight.

Remember, these are general guidelines only. It’s crucial to monitor your progress and adjust as necessary. Consulting with a nutritionist or health professional is always recommended for personalized advice.

How many calories should I eat to lose weight?

For a healthy and sustainable weight loss journey, it’s typically recommended you not to shed more than 2 pounds of fat weekly. This translates to a daily calorie deficit of 1,000 calories. It’s essential to note that when weight loss surpasses 2lbs within a week, it’s often water weight being lost, not just fat.

For those leading a more sedentary lifestyle, aiming to lose 1lb per week is a good starting point. This means creating a daily calorie deficit of 500 calories.

On the other hand, those who are more active naturally have higher daily calorie needs. So, when they’re trying to lose weight, they can afford to eat a bit more since their maintenance calories are already elevated.

For such individuals, aiming for a daily calorie deficit of 500-1,000 calories is realistic, potentially leading to a weight loss rate of up to 2lbs weekly.

What happens when your calories are too low?

Consuming calories below your body’s needs for an extended period can lead to various physiological and psychological consequences. Here’s what can happen when your caloric intake is too low:

• Slower metabolism: Your body might slow down its metabolic rate as a defense mechanism to conserve energy. This can make weight loss harder over time and weight regain more likely once normal eating resumes.
• Nutrient deficiencies: Low calorie intake can lead to inadequate intake of essential vitamins and minerals. Over time, this can result in conditions like anemia, osteoporosis, and impaired immune function.
• Loss of muscle mass: Your body might start breaking down muscle tissue for energy, especially if protein intake is inadequate. This can further slow down metabolism and lead to weakness.
• Hormonal changes: Reduced calorie intake can affect hormone levels, leading to disruptions in menstrual cycles for women, reduced bone density, and other hormonal imbalances.
• Reduced energy and fatigue: You might feel constantly tired or find it difficult to concentrate.
• Mood changes: Low caloric intake can influence mood. This can result in irritability, depression, or anxiety.
• Impaired Immune Function: Your body might become more susceptible to infections due to a weakened immune system.
• Hair and skin problems: You might experience hair loss, dry skin, or brittle nails due to inadequate nutrient intake.
• Digestive problems: Constipation or other digestive issues can occur as a result of reduced fiber and fluid intake.
• Fertility issues: Low calorie and nutrient intake can lead to fertility problems in both men and women.
• Cardiovascular problems: Chronic low calorie intake can affect heart health, leading to low blood pressure, irregular heart rhythms, or other cardiovascular issues.
• Increased risk of gallstones: Rapid weight loss from very low-calorie diets can lead to the development of gallstones.

Setting Realistic Goals

Realistic goals are achievable and manageable within your current circumstances. To set realistic goals, you can use the SMART method, which stands for Specific, Measurable, Attainable, Relevant, and Time-bound:

• Specific: Define exactly what you want to accomplish
• Measurable: Make your goal quantifiable so you can track your progress
• Attainable: Ensure your goal is something you can do with your current resources
• Relevant: Consider how your goal will improve your life or career
• Time-bound: Set a deadline for when you want to achieve your goal

Here are some other tips for setting realistic goals:

• Write it down: Make your goal feel more tangible by writing it down
• Plan your steps: Think of one or two things you are ready, willing and able to change about the way you eat and exercise. Then set a goal for each. Consider three things:
  • What is the behavior that you will change? Be specific.
  • How often will you do this?
  • Don’t try to change too much at once. Be realistic.
• Share your goal: Tell someone you trust about your goal to help you stay accountable and motivated
• Focus on one or two goals at a time: Working on too many goals at once can make it difficult to complete any of them
• Set a range: Set a range of what’s good, great, and excellent to help you stretch your goals

Here are some examples of goals that include the SMART method:

• Eating goal: Four days each week (How Often) I will eat an apple instead of ice cream as my evening snack (Realistic and Specific).
• Physical activity goal: Five days each week (How Often) I will take a 30 minute walk during my lunch hour since I don’t really need the whole hour to eat (Realistic and Specific).

Notice that the eating goal is not “I will eat more fruit” or “I will eat healthier.” The activity goal is not “I’ll walk more.” Goals like that are not specific enough.

There is no single target weight that will meet every one’s goals ¹⁰. Optimal weight reduction targets vary depending on your sex, height, weight, health, level of physical activity and medical conditions. Progress toward healthier weight goals should involve a gradual approach that minimizes health risks and is timed to your level of readiness. With time, greater weight loss may be possible if realistic goals are adopted, met, and sustained.

Most people may have unrealistic ideas of how much better they will look with even modest weight loss (i.e. a half-pound per week) ²¹. You need to have a realistic weight loss target set for yourself, which you have developed during consultation with your healthcare professionals (e.g., your doctor and dietitian). Most people’s weight loss targets are often unrealistically high and their time frames unrealistically short (e.g., targets of 25% or more of body weight in a few weeks rather than many months) ¹⁰. Numerous studies have shown that obese individuals hope to lose 25 to 35% of their initial weight within a year or less after beginning obesity treatment ¹⁰. Realistically, people only lose 5 to 15% of their initial weight over a year after beginning any kind of obesity treatment ¹⁰. Unfortunately, many dieters still maintain unrealistic standards even when they are repeatedly informed that their goals may be unrealistic ²², ²³, ²⁴.

A healthy weight-loss target is usually to achieve a weight loss of one-half to two pounds of body weight each week over six months (24 weeks), leading to a decrease of 5 to 10% in body weight from baseline ¹⁰. For example a 250 pound, 5’6’’ woman with a BMI of 40 that lost 12.5 pounds over six months, would have a 5% weight loss, and an ending BMI of 38.5. A 10% weight loss would result in a BMI of 36.3. The goal is to maintain this weight loss over time, and that is never easy. A weight loss of 5 to 10% is achievable and moderate enough to decrease some obesity-related risk factors, such as type 2 diabetes, high blood pressure, heart and blood vessel disease, and sleep apnea ²⁵.

Once you set your goals, start setting up a plan to help you achieve them. After that it is vital to begin a weight maintenance program that includes the same three components used for initial weight loss such as dieting, physical activity, and behavior change to help prevent weight regain and maintain your new, healthier lifestyle ¹⁸.

Behaviors that will help you lose weight and keep it off

Set the Right Goals

Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. However, the most productive areas to focus on are the dietary and physical activity changes that will lead to long-term weight change. Successful weight managers are those who select two or three goals at a time that are manageable.

Useful goals should be:

1. Specific;
2. Attainable (doable); and
3. Forgiving (less than perfect).

For example, “exercise more” is a great goal, but it’s not specific. “Walk 5 miles every day” is specific and measurable, but is it doable if you’re just starting out? “Walk 30 minutes every day” is more attainable, but what happens if you’re held up at work one day and there’s a thunderstorm during your walking time another day? “Walk 30 minutes, 5 days each week” is specific, doable, and forgiving. In short, a great goal!

Be prepared for setbacks

Setbacks are normal. After a setback, like overeating at a family or workplace gathering, try to regroup and focus on getting back to your healthy eating plan as soon as you can. Try to eat only when you’re sitting at your dining room or kitchen table. At work, avoid areas where treats may be available. Track your progress using online food or physical activity trackers, such as the Body Weight Planner (https://www.niddk.nih.gov/bwp), that can help you keep track of the foods you eat, your physical activity, and your weight. The Body Weight Planner allows users to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards. These tools may help you stick with it and stay motivated.

Overcome roadblocks

Remind yourself why you want to be healthier. Perhaps you want the energy to play with your nieces and nephews or to be able to carry your own grocery bags. Recall your reasons for making changes when slip-ups occur. Decide to take the first step to get back on track.

Problem-solve to “outsmart” roadblocks. For example, plan to walk indoors, such as at a mall, on days when bad weather keeps you from walking outside.

Ask a friend or family member for help when you need it, and always try to plan ahead. For example, if you know that you will not have time to be physically active after work, go walking with a coworker at lunch or start your day with an exercise video.

Nothing Succeeds Like Success

Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e.g., an initial reduction of fat intake from 40 percent of calories to 35 percent of calories, and later to 30 percent). It is based on the concept that “nothing succeeds like success.”

Shaping uses two important behavioral principles:

1. Consecutive goals that move you ahead in small steps are the best way to reach a distant point; and
2. Consecutive rewards keep the overall effort invigorated.

Reward Success (But Not With Food)

An effective reward is something that is desirable, timely, and dependent on meeting your goal. The rewards you choose may be material (e.g., a movie or music CD, or a payment toward buying a more costly item) or an act of self-kindness (e.g., an afternoon off from work or just an hour of quiet time away from family). Frequent small rewards, earned for meeting smaller goals, are more effective than bigger rewards that require a long, difficult effort.

Balance Your Food Checkbook

“Self-monitoring” refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables, amount of physical activity, etc., or an outcome of these behaviors, such as weight. Self-monitoring of a behavior can be used at times when you’re not sure how you’re doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually moves you closer to the desired direction and can produce “real-time” records for review by you and your health care provider. For example, keeping a record of your physical activity can let you and your provider know quickly how you’re doing. When the record shows that your activity is increasing, you’ll be encouraged to keep it up. Some patients find that specific self-monitoring forms make it easier, while others prefer to use their own recording system.

While you may or may not wish to weigh yourself frequently while losing weight, regular monitoring of your weight will be essential to help you maintain your lower weight. When keeping a record of your weight, a graph may be more informative than a list of your weights. When weighing yourself and keeping a weight graph or table, however, remember that one day’s diet and exercise patterns won’t have a measurable effect on your weight the next day. Today’s weight is not a true measure of how well you followed your program yesterday, because your body’s water weight will change from day to day, and water changes are often the result of things that have nothing to do with your weight-management efforts.

Avoid a Chain Reaction

Stimulus (cue) control involves learning what social or environmental cues seem to encourage undesired eating, and then changing those cues. For example, you may learn from reflection or from self-monitoring records that you’re more likely to overeat while watching television, or whenever treats are on display by the office coffee pot, or when around a certain friend. You might then try to change the situation, such as by separating the association of eating from the cue (don’t eat while watching television), avoiding or eliminating the cue (leave the coffee room immediately after pouring coffee), or changing the circumstances surrounding the cue (plan to meet your friend in a nonfood setting). In general, visible and reachable food items are often cues for unplanned eating.

Get the Fullness Message

Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message that you’ve been fed. Eating slowly will help you feel satisfied. Eating lots of vegetables and fruits can make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear too small. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.

Seek support

Ask for help or encouragement from your family, friends, or health care professionals. You can get support in person, through email or texting, or by talking on the phone. You can also join a support group. Specially trained health professionals can help you change your lifestyle.

Eating behavior

Emotional eating can quickly sabotage weight loss efforts. For example, you have probably heard that some people eat to cope with stress. Others eat to preoccupy themselves when they feel bored. If you can pinpoint the emotions that cause you to reach for food, you can stay on track.

If you have recently eaten and find yourself craving food again, do a quick emotional check. Do you want food because you are hungry or to fill an emotional need?

Here are some tips to keep your eating in check:

• Remember which emotions and situations trigger you to eat.
• Write a list of other things to do to fulfill that emotional need, for example, call a friend, take a walk, drink some water or another zero-calorie beverage, send an email to a pal or do a few yoga stretches.
• Track the food you eat, how hungry you are when you eat and how you feel at the time. You may get a better idea of which emotions trigger eating when you are not physically hungry.

If you are having a hard time, reach out for help. Involve family members and friends to help support your weight loss efforts. Support groups, therapy and members of your health care team can also help.

What is the best way to lose weight?

There is no one best way to lose weight, which is why doctors and dietitians work to understand your personal circumstances when making recommendations. There is no quick fix. Improving your diet and increasing activity can be key to losing weight, although are not the only factors that need to be considered. When aiming to lose weight it is important to have realistic goals that are achievable. Success boosts confidence in your ability to lose weight. A weight loss of between 0.5 to 2 pounds (0.5-1kg) a week is a safe and realistic target. Experts recommend losing 5 to 10 percent of your body weight within the first 6 months of treatment ²⁶. If you weigh 200 pounds, this means losing as little as 10 pounds. Moreover, it’s not just about your weight on the scales, losing inches from your waist helps to lower your risk of conditions like type 2 diabetes and high blood pressure. To reach and stay at a healthy weight over the long term, you must focus on your overall health and lifestyle habits, not just on what you eat. Successful weight-loss programs should promote healthy behaviors that help you lose weight safely, that you can stick with every day, and that help you keep the weight off. People who successfully lose weight and keep it off develop techniques to make their new lifestyle and activity habits an enjoyable way of life and also make them life long.

You weight loss programs and weight loss maintenance programs should focus on changing your behavior to reduce energy intake by cutting unhealthy foods, decreasing sugar‐sweetened beverage consumption and fat intake, portion control, increasing fruit and vegetable intake, and adhering to a diet ²⁷. Additionally, energy expenditure should be promoted through increasing physical activity.

American College of Sports Medicine recommendations for physical activity for Weight Loss and Prevention of Weight Regain for Adults ²⁸:

• Maintain and improving health: 150 minutes/week
• Prevention of weight gain: 150 – 250 minutes/week
• Promote clinically significant weight loss: 225 – 420 minutes/week
• Prevention of weight gain after weight loss: 200 – 300 minutes/week

Strong evidence exists that exercise (physical activity) can reduce weight gain in those at risk for obesity, and many exercise training programs are capable of producing at least modest weight loss (~2 kg) ²⁸. A question often encountered in the clinical setting from patients is how much exercise is needed to lose weight and what type of exercise training should be performed. Overall, the changes in weight in response to exercise training without caloric restriction are highly heterogeneous and individual differences can span weight gain to clinically significant weight loss ²⁹. Patients should should consult their clinicians or dietitians on what are reasonable expectations based on their specific weight loss program. However, research data suggest that physical activity has an important role in the amount of weight regain following successful weight loss ³⁰. Therefore, patients attempting to reduce recidivism after weight loss should engage in physical activity levels above 200 minutes/week ²⁸.

Furthermore, high levels of physical activity and cardiorespiratory fitness (fitness) are inversely associated with cardiovascular disease, type 2 diabetes and all-cause mortality ³¹. Several epidemiological studies even suggest that high levels of physical activity or cardiorespiratory fitness reduces the health risk of obesity ³², ³³. Moreover, cardiorespiratory fitness levels have been shown to alter the relationship of the obesity paradox, where high cardiorespiratory fitness level is associated with greater survival in all body mass index (BMI) categories ³⁴. In summary, patients are encourage to adhere to exercise programs or engage in regular physical activity regardless of the weight loss achieved.

Another question that is often encountered in the clinical setting is if there is a difference between weight loss achieved through dietary means or through exercise training in terms of cardiovascular and type 2 diabetes mellitus risk factors. In an elegantly designed study, Ross et al. ³⁵ randomized obese men (n= 52) to diet-induced weight loss, exercise induced weight loss, exercise without weight loss, or a control group for 3 months. The diet-induced and exercise-induced weight loss groups lost approximately 7 kg of weight (8% weight reduction), and had significant reductions in total fat mass, visceral fat and increased glucose disposal ³⁵. However, the exercise-induced weight loss group had a greater reduction in total fat mass compared to the diet induced weight loss group ³⁵. Importantly, the exercise-induced weight loss improved cardiorespiratory fitness (fitness) whereas the dietary group did not. In the group who performed exercise training without weight loss, the participants still experienced reductions in visceral fat and increased cardiorespiratory fitness.

The observations by Ross et al. ³⁵ reaffirm that an exercise training program still confers health benefits to obese patients even in the absence of weight loss. Although dieting without exercise training has potential cardiovascular benefits, exercise training should be encouraged by to help patients improve cardiorespiratory fitness levels, which is an independent risk factor for cardiovascular diseases, type 2 diabetes mellitus and mortality 10, and may further augment the negative energy balance created by caloric restriction. Lastly, Ross’ observations suggest that there is a rationale for exercise training to be a part of weight loss programs as the authors observed greater changes in visceral fat, oral glucose tolerance, and glucose disposal in the exercise training group with clinically significant weight loss compared to the group with exercise without weight loss group ³⁵.

Healthy Weight-Loss

Healthy weight loss is key for long-term weight maintenance. A variety of weight loss methods are available, from minimally structured self-guided methods to medically supervised very low calorie diet (VLCD; e.g., 400–800 kcal/day) regimens ³⁶. Intensive, very low-calorie diets (VLCDs; e.g., ≤800 calories per day and especially <500 calories) produce significantly greater initial weight loss; however, these results are often not maintained over time ³⁶. In a study done in 2008, participants were enrolled in a program designed to help maintain weight loss ³⁶. Participants all initially lost weight using one of three methods, very low calorie diet (VLCD; e.g., 400–800 kcal/day), commercial programs or a self-guided approach ³⁶. At the start of the study, those who had used a very low calorie diet (VLCD; e.g., 400–800 kcal/day) lost up to 24% of highest body weight in the last two year compared to those in the commercial programs and self-guided approaches who lost 17% ³⁶. Results showed that those who used a very low calorie diet (VLCD; e.g., 400–800 kcal/day) regained significantly more weight than the other two groups by six months in the weight maintenance program ³⁶. However, those who had lost weight using a self-guided method were able to maintain their initial weight loss with great success ³⁶. It should be emphasized that the primary reason for losing weight is for better health outcomes; therefore, weight loss should occur by using healthy methods that can be maintained throughout your life ¹⁰. Concentrating on improving health outcomes and other risk factors rather than simply on weight loss is vital ¹⁰.

In most people, a 10% weight loss target can be achieved with a calorie deficit of 500 to 1,000 calories per day, leading to weight losses of one pound to two pounds per week (i.e. total calories deficit of 3,500 to 7,000 per week) ¹⁰. Cutting down on alcohol, dietary fats and sugary carbohydrates is a practical way to produce this calorie deficit ³⁷. A comprehensive analysis of data that focuses on dieting and weight loss found that increased lean tissue (muscle tissue) is lost if the energy deficit of the diet is too large in combination with rapid weight loss ³⁸. In contrast, inclusion of exercise (both cardio workout and weightlifting) and adequate dietary protein (60 grams per day, ranging from 0.8 g to 1.5 g per kg of body weight) helps to minimize muscle tissue loss ³⁸. These dietary strategies should be incorporated into dietary treatment plans to minimize muscle mass reduction and maximize fat loss ¹⁰.

For women, a weight reduction plan of eating approximately 1,000 to 1,200 calories per day is suitable. According to the National Institutes of Health and the National Heart, Lung, and Blood Institute, a 1,200 – 1,600 calorie allowance for men or women who weigh 165 pounds, or more, and who exercise regularly is recommended ¹⁰. These calorie amounts along with increased physical activity and behavioral modification will likely produce a caloric deficit to achieve the targeted weight loss plan of one to two pounds per week ³⁹. With a caloric deficit of 500 to 1000 calories per day, if followed with perfect adherence, after six months, weight loss of 26 to 52 pounds would be expected. However, in reality, losses are usually between 20 to 25 pounds, since adherence is never perfect ⁴⁰.

It is recommended that you dieting should last for 6 months or less, because according to research after about six months, most people have great difficulty sticking to any diet, especially if it is very strict ¹⁰. Furthermore, your weight will plateau as your energy intake fluctuates and as your resting metabolic rate and energy output decrease. After six months of weight loss, you should focus on maintenance of the weight loss through a combination of diet therapy, physical activity, and behavior modification. If successful, after several months you can start a new weight loss cycle again ¹⁰. If further weight reduction is necessary after 10% of initial body weight is lost, it can be attempted with an increased calorie deficit after prior weight loss has been maintained for several months.

When you do not engage in a weight management program that includes all three components (i.e., diet therapy, physical activity, and behavior modification) you’re risking regaining all or extra weight increase ¹⁸, ⁴⁰. Most people regain one-third of their lost weight in one year, and nearly half return to their original weight within five years ²³. The more frequently you have has contact with your healthcare provider (doctor and dietitian), the weight loss and maintenance outcomes tend to be more successful ¹⁸.

Now you know the basics about calories and healthy weight loss, the key to weight loss for most people is simply finding the right combination of exercise, healthy foods and cutting back on portions will help you lose those extra pounds. No fad diet required. In other words, eat healthily, watch your portions and get moving more. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. To prevent the weight creeping back on, you need to keep going with the healthy habits you’ve formed.

Low-Calorie Diets (LCDs)

Low-Calorie Diets (LCDs) are eating plans or meal plans that reduce your caloric intake to about 1,200 to 1,500 calories in women, and 1,500 to 1,800 calories in men ¹⁰. Low-Calorie Diets (LCDs) will result in weight loss if they are adhered to perfectly, regardless of their macronutrient composition ²⁰, ⁴¹. This is because these low caloric levels will result in a caloric deficit for most overweight and obese adults. The National Institutes of Health have recommended low calorie diets (LCDs) of 1,000 to 1200 calories for women, and 1,200 to 1,600 calories per day for men, although adherence may be difficult with lower caloric intake ⁴⁰. Either way, the rationale is that on such eating plans, a deficit of approximately 500 to 1,000 calories per day will be created, which should result in a slow progressive weight loss of one to two pounds per week ¹⁰. The MyPlate.gov website (https://www.myplate.gov/) that can be accessed by consumers provides a simple visual reminder to choose a variety of foods throughout the day and throughout the week. It represents what and how much to eat from each of the food groups over the course of the day, whether you eat on a plate, from a bowl, or another way.

It is important to recognize that when using fixed calorie diet plans, that even with perfect adherence, individuals will vary greatly in their weight loss. This is because their resting energy needs and physical activity, and thus energy outputs, often differ markedly, and may fluctuate even within an individual.

1200 Calories eating plan

Over the next 12 weeks you’re going to make healthier choices to help you lose weight and keep it off. From today, you’ll stick to a daily calorie intake of 1200 Calories.

Table 1. 1200 Calories Traditional American Cuisine

Breakfast	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Whole-wheat bread, 1 med. slice	70	1.2	15	(1 Bread/Starch)
Jelly, regular, 2 tsp	30	0	0	(½ Fruit)
Cereal, shredded wheat, ½ Cup	104	1	4	(1 Bread/Starch)
Milk, 1%, 1 Cup	102	3	23	(1 Milk)
Orange juice, ¾ Cup	78	0	0	(1½ Fruit)
Coffee, regular, 1 Cup	5	0	0	(Free)
Breakfast Total	389	5.2	10
Lunch	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Roast beef sandwich
Whole-wheat bread, 2 medium slices	139	2.4	15	(2 Bread/Starch)
Lean roast beef, unseasoned, 2oz	60	1.5	23	(2 Lean Protein)
Lettuce, 1 leaf	1	0	0
Tomato, 3 med. slices	10	0	0	(1 Vegetable)
Mayonnaise, low-calorie, 1 tsp	15	1.7	96	(1⁄3 Fat)
Apple, 1 medium	80	0	0	(1 Fruit)
Water	0	0	0	(Free)
Lunch Total	305	5.6	16
Dinner	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Salmon, 2 oz edible	103	5	40	(2 Lean Protein)
Vegetable oil, 1½ tsp	60	7	100	(1½ Fat)
Baked potato, ¾ medium	100	0	0	(1 Bread/Starch)
Margarine, 1 tsp	34	4	100	(1 Fat)
Green beans ½ Cup, seasoned with margarine	52	2	4	(1 Vegetable) (½ Fat)
Carrots, seasoned	35	2	0	(1 Vegetable)
White dinner roll, 1 small	70	2	26	(1 Bread/Starch)
Iced tea, unsweetened	0	0	0	(Free)
Water	0	0	0	(Free)
Dinner Total	454	20	39
Snack	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Popcorn, 2½ Cups	69	0	0	(1 Bread/Starch)
Margarine, ¾ tsp	30	3	100	(¾ Fat)
Grand Total	1247	34	24

Footnotes:  Total Calories = 1,247; Total Carb = 58% kcals; Total Fat = 26% kcals; Saturated Fat = 7% kcals; Cholesterol = 96 mg; Protein = 19% kcals; Sodium (salt) = 1,043 mg (No salt added in recipe preparation or as seasoning). Consume at least 32 oz (950 ml) water. Recommended Dietary Allowance (RDA) is average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people. 100% RDA met for all nutrients except: vitamin E 80%, vitamin B2 96%, vitamin B6 94%, Calcium 68%, Iron 63% and Zinc 73%.

[Source ⁴² ]

1600 Calories eating plan

Table 2. 1600 Calories Traditional American Cuisine

Breakfast	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Whole-wheat bread, 1 medium slice	70	1.2	15	(1 Bread/Starch)
Jelly, regular, 2 tsp	30	0	0	(½ Fruit)
Cereal, shredded wheat, ½ Cup	104	1	4	(1 Bread/Starch)
Milk, 1%, 1 Cup	102	3	23	(1 Milk)
Orange juice, ¾ Cup	78	0	0	(1½ Fruit)
Coffee, regular, 1 Cup	5	0	0	(Free)
Milk, 1%, 1 oz	13	0.03	23	(1⁄8 Milk)
Breakfast Total	402	5.23	12
Lunch	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Roast beef sandwich
Whole-wheat bread, 2 medium slices	139	2.4	15	(2 Bread/Starch)
Lean roast beef, unseasoned, 2 oz	60	1.5	23	(2 Lean Protein)
American cheese, low-fat and low-sodium, 1 slice (¾ oz)	46	1.8	36	(1 Lean Protein)
Lettuce, 1 leaf	1	0	0
Tomato, 3 medium slices	10	0	0	(1 Vegetable)
Mayonnaise, low-calorie, 2 tsp	30	3.3	99	(2⁄3 Fat)
Apple, 1 medium	80	0	0	(1 Fruit)
Water	0	0	0	(Free)
Lunch Total	366	9	22
Dinner	Energy (Kcal)	Fat (gram)	% Fat	Exchange for:
Salmon, 3 oz edible	155	7	40	(3 Lean Protein)
Vegetable oil, 1½ tsp	60	7	100	(1½ Fat)
Baked potato, ¾ medium	100	0	0	(1 Bread/Starch)
Margarine, 1 tsp	34	4	100	(1 Fat)
Green beans ½ Cup, seasoned with margarine	52	2	4	(1 Vegetable) (½ Fat)
Carrots ½ Cup, seasoned with margarine	52	2	4	(1 Vegetable) (½ Fat)
White dinner roll, 1 medium	80	3	33	(1 Bread/Starch)
Ice milk, ½ Cup	92	3	28	(½ Fat)
Iced tea, unsweetened, 1 Cup	0	0	0	(Free)
Water	0	0	0	(Free)
Dinner Total	625	28	40
Snack	Energy (Kcal)	Fat (gram)	%Fat	Exchange for:
Popcorn, 2½ Cups	69	0	0	(1 Bread/Starch)
Margarine, 1½ tsp	51	6	100	(1½ Fat)
Grand Total	1490	48	29

Footnotes:  Total Calories = 1,490; Total Carb = 52% kcals; Total Fat = 29% kcals; Saturated Fat = 8% kcals; Cholesterol = 142 mg; Protein = 19% kcals; Sodium (salt) = 1,341 mg (No salt added in recipe preparation or as seasoning). Consume at least 32 oz (950 ml) water. Recommended Dietary Allowance (RDA) is average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people. 100% RDA met for all nutrients except: vitamin E 99%, Iron 73% and Zinc 91%.

[Source ⁴³ ]

Very-Low-Calorie Diets (VLCDs)

Very-Low-Calorie Diets (VLCDs) are eating plans or meal plans that reduce your caloric intake to about 800 calories or less per day with a total of 50 to 80 grams of protein and 100% of the Reference Daily Intake (RDI) for vitamins and minerals per day, and are designed to produce very rapid weight loss while still preserving lean muscle mass ¹⁸. Very-Low-Calorie Diets (VLCDs) are reserved for special uses and for people at high obesity-related health risks where it is imperative to lose weight because of their potential for greater adverse metabolic effects and the consequent need for more extensive medical monitoring. Possible side effects of very-low-calorie diets (VLCDs) are fatigue, constipation, nausea, or diarrhea to more serious risks such as ketoacidosis and gallstones ¹⁰. Very-Low-Calorie Diets (VLCDs) contraindications include recent heart attack (myocardial infarction), heart conduction disorders, history of cardiovascular disease, kidney or liver disease, cancer, type 1 diabetes, and pregnancy ¹⁰. Behavioral contraindications to their use include bulimia nervosa, major depression, bipolar disorder, substance abuse, and acute psychiatric illness ¹⁰.

Very-Low-Calorie Diets (VLCDs) are often prescribed by your doctor as a form of intensive diet therapy, which require close medical supervision by a physician specializing in obesity care and should not be used long-term ¹⁰. Very-Low-Calorie Diets (VLCDs) are intended to induce quick and significant weight loss of about 3 to 5 pounds per week or 14 to 21 kilograms over 11 to 14 weeks ¹⁰. Very-Low-Calorie Diets (VLCDs) are sometimes used to provide a jump-start to further obesity treatment. This is typically done through meal-replacement liquid diets ⁴⁴. Any diet, regardless of its caloric level, that provides less than half of an individual’s energy needs can be considered a Very-Low-Calorie Diet (VLCD) for that individual. However, virtually all adults have energy needs that exceed 1,000 calories per day, and therefore any diet below 500 calories, and for most individuals, diets below 800 calories, are Very-Low-Calorie Diets (VLCDs) ¹⁰. Depending on your caloric requirements, other dieting regimens that are higher in calories may also be VLCD for some people with very high energy needs using this same rule of thumb; for example, a 1,200 calorie diet prescribed to a man whose usual intake is 3,000 calories would also qualify as a VLCD ¹⁰.

According to the National Task Force on the Prevention and Treatment of Obesity, Very-Low-Calorie Diets (VLCDs) in patients with BMI >30 are usually effective in promoting significant short-term weight loss, in addition to improving coexisting obesity-related conditions (e.g., obstructive sleep apnea, poorly-controlled type 2 diabetes, hypertriglyceridemia) ⁴⁵. However, Very-Low-Calorie Diets (VLCDs) require close metabolic monitoring with at least every 2 weeks doctor visits, and should only be prescribed and adjusted under the supervision of a physician specializing in obesity care ¹⁰.

The main advantages of the VLCD for patients include a rapid improvement in blood pressure, blood glucose, serum lipids and often-psychological status. For those who require surgery, the rapid loss of weight may reduce some of the surgical risks associated with obesity ¹⁰.

There are 2 major types of very-low-calorie diets (VLCDs) currently in use; commercial and “home-made” preparations. The commercial very-low-calorie diets (VLCDs) preparations include powdered products that are rich in egg- or milk-based proteins, are mixed with water, and consumed four to five times per day ¹⁰. The commercial products must provide at least 70 grams of protein by law, and often contain much higher amounts of high quality protein (70 to 100 grams), 50 to 100 grams carbohydrate, and up to 15 grams fat per day, plus vitamins and minerals in amounts to meet the Recommended Dietary Allowances (RDA) ¹⁰. These products are formulated under U.S. Food and Drug Administration (FDA) regulatory specifications. They are convenient and have a predictable and adequate composition when used as directed. Their major disadvantage compared to home preparations is their higher cost. The formulas or prepackaged meals are relatively choice-free and help dieters avoid contact with conventional foods, which in some cases may facilitate dietary adherence and remove temptation.

Several commercial weight loss programs are available that provide an entire program of commercially prepared very-low-calorie diets (VLCDs) plus the other essential aspects of a sound weight control program, including dietetic advice, exercise, behavioral modification, and supervision during the VLCD and post VLCD phases. The choices include the programs of HMRTM (Health Management Resources), OptifastTM (Novartis Nutrition), and MedifastTM. These programs employ health professionals who are trained in weight management, and a structured program that encourages adherence. The major disadvantage is that they are expensive ($3,000 to $34,000 for 26 to 28 weeks), and costs may not be covered by health insurance ⁴⁶. Also, there is the uncertainty that the weight that is lost will remain so over the long run. Therefore a serious psychological as well as economic investment of effort in long-term weight management is also mandatory.

“Home made” VLCD regimens are sometimes referred to as “protein-sparing fasts” or “protein sparing modified fasts” (PSMF) ¹⁰. This is a misnomer since they do not “spare” protein except in contrast to a total fast. “Home made” very-low-calorie diets (VLCDs) are usually based on lean meat, fish or poultry and a few other foods plus supplements of two to three grams of potassium chloride and a multivitamin or multimineral supplement in amounts approximating the Recommended Dietary Allowances (RDA) ¹⁰. Without such supplementation, they may be nutritionally inadequate ¹⁰. When dieters are provided with appropriate dietetic counseling and health supervision by a physician who is experienced in the use of very-low-calorie diets (VLCDs) and other aspects of a complete weight reduction program, these formulations are also safe and generate rapid weight loss ¹⁰. The extremely low caloric versions of VLCDs (e.g., less than or equal to 800 calories per day), which are low in carbohydrate and sodium, promote a mild ketosis that gradually leads to diuresis and rapid weight loss in the first several days on the diet.

There seems to be little difference in outcomes between commercial and properly formulated homemade very-low-calorie diets (VLCDs). The National Institute of Health expert panel review of existing studies found that preservation of weight loss over the long-term (e.g., >1 year) was not different on Very-Low-Calorie Diets (VLCDs) from that of Low-Calorie Diets (LCDs) since most patients gained back 30 to 50% of the lost weight ¹⁰. Studies of VLCDs vary in their long-term results, but weight regain is common (3.1 to 3.7 kg during 21-38 weeks afterwards) ²⁰. Combining a VLCD with behavior therapy, physical activity, and active physician follow-up may help to prevent this weight regain, and lend to greater weight loss ⁴⁷. As such, the long-term advantages of VLCDs in weight control are unclear. Although weight gain is common after cessation of VLCDs, individual clinicians may decide that the expense and quick initial weight loss are worth it for their patient ¹⁸.

Patients on VLCDs should drink at least two liters of water per day to make up for decreased food intake and to prevent dehydration ¹⁰. Avoidance of caffeinated beverages is sometimes recommended, as they can further the risk of dehydration, although moderate use is not prohibited ¹⁰. Electrolyte imbalances may occur, and so may nutrient deficiencies if measures are not taken to prevent them on “home-made” VLCD, by use of appropriate supplements. Minor side effects that occur, even with appropriate physician monitoring of heart and general health status, include fatigue, dizziness due to orthostatic hypotension, muscle cramps, gastrointestinal distress (constipation and/or diarrhea), and cold intolerance ¹⁰. The risk of cholelithiasis (gallstones) is increased, and seems to be particularly high when weight loss is very rapid (e.g., >1.5 kilograms/week) ¹⁰. The risk of cholelithiasis (gallstones) can be decreased by administering ursodeoxycholic acid, including a moderate amount of fat in the diet, and limiting the amount of weight loss to 1.5 kilograms per week ⁴⁶.

Alternate-day fasting

On typical alternate-day fasting diets, dieters consume 25% of their energy needs on the fast day, and food intake as necessary or desired (ad libitum) the next day ¹⁰. Many of the alternate-day fasting studies do not include control groups that undertake other dietary approaches to weight loss, plus the sample sizes have been small (15 to 64 subjects) and the durations short (8 to 12 weeks) ⁴⁸, ⁴⁹, ⁵⁰, ⁵¹, ⁵². However, results to date show similar weight loss and improvements in metabolic factors as compared to studies using other dietary approaches to weight loss, as well as good adherence. For example, Varady et al ⁴⁸ found that alternate-day fasting was a viable diet option, helping obese patients not only to lose weight, but to also decrease their risk of coronary artery disease (coronary heart disease). Emerging evidence suggests that the relative contribution of fat and carbohydrate in alternate-day fasting diets does not have an impact on weight and blood lipid profiles ⁵³. An alternative fasting regimen that has become popular among some dieters is two days of fasting followed by five days of usual eating. Further research is needed with larger samples, dietary control groups, and longer durations before alternate-day fasting’s widespread use for weight loss purposes ¹⁰.

An alternative intermittent fasting regimen that has become popular among some dieters is two non-consecutive days of fasting and five unrestrictive days of usual eating each week ¹⁰. This “5:2 Diet”, developed by Dr. Michael Mosley in the United Kingdom, has spread widely throughout Europe, and now the United States. For the two fast days, men are to eat no more than 600 kcals, and women 500 kcals. Usually this consists of a very light breakfast and dinner with little or no lunch ¹⁰. Anecdotally, weight loss has been similar to other dietary approaches to weight loss (2 pounds/week) for short terms (6 weeks) ¹⁰. However, research is lacking on the “5:2 Diet”, so its long-term safety and efficacy has not been tested, and its appropriateness in varying populations is currently unknown ¹⁰.

Intermittent fasting

Intermittent fasting also known as “periodic fasting”, “time‐restricted feeding”, “alternate-day fasting” or “reduced meal frequency”, is when people restrict the time (e.g., 16–48 hours) during the day when they can eat ⁵⁴, is another way of reducing food intake that is gaining attention as a strategy for weight loss and health benefits. Alternate-day fasting is one type of intermittent fasting that consists of a “fast day” (eating no calories to one-fourth of caloric needs) alternating with a “fed day,” or a day of unrestricted eating. Intermittent fasting focuses on the timing of when you can consume meals either within a day or a week. For example, someone may eat only during a 12-hour time period, such as 7 a.m. to 7 p.m. Skipping meals commonly consists of a daily fast for 16 hours, a 24-hour fast on alternate days, or a fast 2 days per week on non-consecutive days ⁵⁵. Intermittent fasting is not a diet plan. While it may have some of the same health benefits as a diet, it’s really an eating pattern. It means you fast (don’t eat) during a certain period of time each day (usually an extended period of time). You then eat during another period of time each day (usually a smaller period of time). While you’re fasting, you can drink beverages that don’t contain calories, including water, black coffee, and unsweetened tea. There is still much for scientists and doctors to learn about intermittent fasting. Researchers have conducted only a few studies of intermittent fasting as a strategy for weight loss. They have no long-term data on the safety, how it affects the body and its systems and effectiveness of intermittent fasting for long-term weight maintenance.

Some popular approaches to intermittent fasting include:

• Alternate-day fasting. Eat a normal diet one day and either completely fast or have one small meal (less than 500 calories) the next day.
• 5:2 fasting. Eat a normal diet five days a week and fast two days a week.
• Daily time-restricted fasting. Eat normally but only within an eight-hour window each day. For example, skip breakfast but eat lunch around noon and dinner by 8 p.m.

How fasting and eating is divided each day is called an eating schedule. One of the most common, easy-to-follow schedules is 16:8. This means you fast for a 16-hour period of time and eat your daily meals during an 8-hour period of time. For example, you may want to fast from 7 p.m. until 11 a.m. the next day. You would then eat a healthy lunch and dinner between 11 a.m. and 7 p.m. You wouldn’t eat anything after 7 p.m. until 11 a.m. the next day. This is just an example of times. You can select any 16-hour and 8-hour block of time that works best for your schedule. But it’s important to keep your eating window at the same every day.

Other intermittent fasting schedules include 18:6 (when you fast for 18 hours and eat for 6 hours) or alternating days. With alternating days, you fast for 24 hours, then eat a healthy diet for the next 24 hours, then fast again for the following 24 hours. This schedule continues using the every-other-day format. Another schedule option is 5:2. This is when you fast for two days a week, and eat a normal, healthy diet the other five days. This is a little different, though, as this schedule allows you eat one small meal of 500 to 600 calories on your fasting days.

The time you’re allowed to eat is called your eating window. During your eating window, focus on eating a healthy diet and maintaining portion control. Don’t eat too many calories and avoid junk food and fast food. While you don’t need to eat anything in particular, you do need to make sure you’re getting the nutrition you need. Some people choose to use the Mediterranean diet as a guideline for what to eat. This plan focuses on fruits, vegetables, beans, whole grains, and fish. You can also choose lean proteins and healthy fats.

During fasting, caloric consumption often ranges from zero to 25% of caloric needs ⁵⁴. Alternative day fasting may consist of 24-hour fasts followed by a 24-hour eating period that can be done several times a week such as a 5:2 strategy when there are 2 fast days mixed into 5 nonrestrictive days ⁵⁶. For time restricted fast programs, variations include 16-hour fasts with 8 hour feeding times, 20-hour fasts with 4-hour feed times or other similar versions ⁵⁶. While both caloric restriction and intermittent fasting may result in overall decreased caloric intake, this is not integral to intermittent fasting. Intermittent fasting has been linked to better glucose control in both humans and animals ⁵⁷. However, long-term adherence to caloric restriction is low while adherence to intermittent fasting may be more promising.

While researchers are still studying intermittent fasting, some research has shown it offers some health benefits. For starters, it’s common to lose weight when following intermittent fasting. That’s because your body is using fat—not glucose—as its energy source. Additionally, if you make wise food choices when you do eat, you’re likely eating fewer calories than before you started intermittent fasting. If you add exercise to the mix, it’s a great combination for not only weight loss, but also improved health benefits. Intermittent fasting may help people who have cardiovascular disease, neurological disorders, and some cancers. Intermittent fasting may also help lower your bad cholesterol and improve symptoms of arthritis.

The majority of studies of intermittent fasting in humans have considered whether intermittent fasting can be a potential strategy to reduce weight and correct adverse metabolic parameters amongst obese and overweight subjects ⁵⁸. This is important since the problems of long term adherence to continuous calorie restriction for weight management are well known ⁵⁹. Losing weight and being physically active help lower your risk of obesity-related diseases, such as diabetes, sleep apnea and some types of cancer. For these diseases, intermittent fasting seems to be about as beneficial as any other type of diet that reduces overall calories. Johnson et al. ⁶⁰ undertook the first trial of intermittent fasting for weight loss amongst 10 obese subjects with asthma which tested alternate days of an 85% energy restricted low carbohydrate diet regimen. This study reported beneficial reductions in serum cholesterol and triglycerides, markers of oxidative stress (8-isoprostane, nitrotyrosine, protein carbonyls, and 4-hydroxynonenal adducts) and inflammation (serum tumor necrosis factor-α) ⁶⁰. Circulating ketone levels were also elevated on the fasting days ⁶⁰. In more recent 27 clinical trials, intermittent fasting resulted in weight loss, ranging from 0.8% to 13.0% of baseline body weight ⁵⁴. Weight loss occurred regardless of changes in overall caloric intake. In the studies of 2 to 12 weeks’ duration, body mass index (BMI) decreased, on average, by 4.3% to a median of 33.2 kg/m². Therefore intermittent fasting shows promise as a primary care intervention for obesity, but little is known about long-term sustainability and health effects. Longer-duration studies are needed to understand how intermittent fasting might contribute to effective weight-loss strategies. Symptoms such as hunger remained stable or decreased, and no adverse events were reported. While intermittent fasting is a moderately successful strategy for weight loss, it shows promise for improving glycemic control, although it does pose a potential risk of hypoglycemia. However, to lose weight and keep it off, the best strategy is to adopt healthy eating and exercise habits that you enjoy so you can stick with them over time.

To get the benefits of intermittent fasting, you need to fast for at least 12 hours. That’s how long it takes your body to switch from using glucose for energy to using fat for energy. Additionally, it will take your body a while to get used to this new eating schedule. So don’t expect results right away. You may need to wait between 2 and 4 weeks to see or feel any results.

It may take 2 to 4 weeks for your body to get used to eating on an intermittent fasting schedule. During those first few weeks, you may have headaches and feel hungry, grouchy, or tired. Know you may feel this way before you start and make a plan to push through these feelings. After a few weeks, your body will get used to this eating pattern and those symptoms should go away. In the end, many people say that feel better following an intermittent fasting lifestyle.

High Protein Weight Loss Diets

High protein weight-loss diets are those that provide more than 1.6 grams per kilogram of desirable weight per day ¹⁰. Self-prescribed high protein weight-loss diets vary in their composition from about 28 to 65% of energy, providing 71 to 163 grams of protein per day. High protein weight-loss diets are currently popular as a new strategy for losing weight, and are usually quite low in their carbohydrate content. Some are clearly ketogenic, and severely limit carbohydrates to below 50 grams per day. Examples include the Doctor’s Quick Weight Loss Diet, The Dukan Diet, Dr. Atkins Diet Revolution, The 17 Day Diet and various iterations of the Paleo Diet ¹⁰. Diets that are extremely high in protein should not be undertaken for long periods of time, since their long-term safety has not been sufficiently studied.

Other diets are extremely high in protein, very low in carbohydrate and ketogenic, but also very high in fat, is Protein Power ⁶¹. Two other high protein diets with enough carbohydrate so that they are not likely to be ketogenic are The Zone and Sugar Busters ¹⁰.

Many high protein diets include elaborate instructions that prescribe strict, structured eating schedules, and involve limited food variety and dietary flexibility. The high protein diets that are ketogenic also induce quick initial weight loss because of their low caloric level, and their diuretic effect owing to glycogen depletion, and sodium and water loss ¹⁰. They may also be associated with decreased appetite due to the high protein intake, since protein may show to be particularly satiating ⁶², ⁶³. Ketosis has long been said to reduce appetite, although little data supports this. Nonetheless, for some patients these constraints may help them to achieve and maintain low calorie intakes over the short run.

However, popular high protein weight-loss diets are not risk-free. Many of these high protein weight-loss diets advocate very high intakes of protein from meat and other foods that are also often high in saturated fat, cholesterol and sodium while they are low in dietary fiber, antioxidants, potassium, calcium, magnesium, and some vitamins ¹⁰. The purine content of meat, poultry, seafood, eggs, seeds, and nuts is high, and can increases uric acid levels and risk of gout in susceptible individuals ¹⁰. The high protein load may also increase urinary calcium loss if it is not buffered ⁶⁴. In patients with diabetic kidney disease (diabetic nephropathy), very high protein diets may speed progression, although the data are not definitive ⁶⁵. Because many high protein diets are often by default low in carbohydrate, they also can cause an increase in ketosis. Finally, high protein weight-loss diets do not necessarily promote greater long-term weight loss as compared to other healthier eating options ⁶⁶, ⁶⁷, ⁶⁸.

Weight-loss programs to avoid

A fad weight loss diet is any diet that promises fast weight loss without a scientific basis. These diets often eliminate entire food groups and as a result do not provide a wide range of important nutrients. Fad diets may provide short-term results but they are difficult to sustain and can cause serious health problems. The best approach to weight loss is to follow a long-term, healthy and balanced eating plan and to exercise regularly.

Avoid weight-loss programs that make any of the following promises:

• Lose weight without diet or exercise!
• Lose weight while eating as much as you want of all your favorite foods!
• Lose 30 pounds in 30 days!
• Lose weight in specific problem areas of your body!

Other warning signs to look out for include:

• very small print, asterisks, and footnotes, which may make it easy to miss important information
• before-and-after photos that seem too good to be true
• personal endorsements that may be made up

You can report false claims or scams by weight-loss programs to the Federal Trade Commission (https://www.ftc.gov).

Fad diets often lead to fast weight loss at first. But most of this weight loss is water and lean muscle, rather than fat. When you eat very little, your body begins to break down muscle to meet energy (kilojoule) needs. Unfortunately, this occurs much more easily than the breakdown of fat stores.

Breaking down muscle leads to:

• Water loss, making it seem like you’re losing weight quickly
• A reduced metabolic rate, so when the diet is stopped, it is much easier for your body to gain fat than it was prior to going on the diet.

As a result, over time, people can diet themselves fatter.

Fad diets often encourage a short-term change in eating behavior, rather than encouraging long-term, sustainable changes. It is essential that any diet meets nutritional needs, is practical and suitable for individual lifestyles.

Regular physical activity is important for those wanting to lose weight to help maintain muscle mass.

How to Make Healthy Eating Choices

Here are some tips for making healthy eating choices:

• Eat a variety of foods. Eat a variety of foods from each of the five food groups daily. Healthy choices include fruits, vegetables, whole grains, protein foods, and fat-free or low-fat dairy. Foods are grouped together because they provide similar amounts of key nutrients. For example, key nutrients of the milk, yoghurt, cheese and alternatives group include calcium and protein, while the fruit group is a good source of vitamins, minerals, antioxidants. As a bonus, choosing a variety of foods will help to make your meals interesting, so that you don’t get bored with your diet.
• Eat fruit instead of drinking it. Eating fruit is linked to a reduced risk of several health conditions, but fruit juices are more likely to spike blood sugar levels.
• Add healthy fats. Healthy fats like monounsaturated and polyunsaturated fats can help lower cholesterol and protect your heart. You can find healthy fats in foods like olive oil, nuts, avocados, and some types of fish.
• Drink water. Sipping water throughout the day can help keep you full and hydrated. Sometimes thirst is mistaken for hunger.
• Reduce added sugar. Too much added sugar in your diet can contribute to weight gain, obesity, type 2 diabetes, and heart disease.
• Chew your food well. Chewing your food well can help you make healthier food choices.
• Sit at the table to eat. Sitting at the table to eat can help you focus on your food and internal cues for hunger or fullness.

Carbohydrates

Carbohydrates are your body’s fuel. Carbohydrates also play roles in gut health and immune function ⁶⁹. For healthy children and adults, carbohydrates should make up approximately 45 to 65% of energy intake based on the minimum required glucose for brain function ⁶⁹. However, some carbohydrates are more nutritious than others.

Foods that contain the most carbohydrates include:

• Fruit.
• Vegetables, especially potatoes and corn.
• Legumes, including dried beans, peas and lentils.
• Grains.
• Bread.
• Breakfast cereal.
• Rice, pasta and noodles.
• Low-fat milk and yoghurt.

These foods are rich in vitamins, minerals and antioxidants and are generally low in fat. This makes them well suited to a healthy eating plan. Some are excellent sources of dietary fibre, including wholegrain varieties, legumes, fruit and vegetables.

Foods with lots of added sugar like soft drinks, alcohol and sweets are another source of carbohydrates, but these contribute extra kilojoules with few vitamins and minerals.

Optimal carbohydrate intake should consist of high fiber, nutrient-dense whole grains, fruits, vegetables and legumes, without the added sugar ⁷.

The Dietary Guidelines for Americans recommends that carbohydrates should make up 45 to 65% of one’s daily calories ⁷⁰. To calculate how many grams of carbohydrates you need, multiply your daily calorie requirements by 0.45 and 0.65 to obtain calories from carbohydrates.

• (A) 0.45 x 2000 = 900 calories
• (B) 0.65 x 2000 = 1300 calories

Divide answers in step 1 by 4 since there are 4 calories per 1 gram of carbohydrate

• (A) 900/4 = 225g of carbohydrate
• (B) 1300/4 = 325g of carbohydrate

Carbohydrates are eaten in the form of simple carbohydrates, like monosaccharides and disaccharides, or complex carbohydrates, like oligosaccharides and polysaccharides ⁶⁹. Monosaccharides are the basic building blocks of all carbohydrates and include glucose, fructose, and galactose. Glucose is the simplest type of carbohydrates and is the major source of energy for your body’s cells ⁶⁹. Glycogen is the storage form of glucose in animals and is present in the liver and muscle, but there is little to none in the diet.

Disaccharides contain two sugar units and include lactose, sucrose, and maltose. Lactose is a carbohydrate found in milk, and sucrose is basic table sugar.

Oligosaccharides consist of 3 to 10 sugar units and include raffinose and stachyose, which are in legumes.

Polysaccharides include greater than ten sugar units and consist of starches, glycogen, and fibers, like pectin and cellulose. Starches like amylose are in grains, starchy vegetables, and legumes and consist of glucose monomers.

Fibers are plant polysaccharides like pectin and cellulose found in whole grains, fruits, vegetables, and legumes but are not digestible by humans. However, fibers play a major role in gut health and function and can be digested by microbiota (microorganisms) in the large intestine ⁷¹. The recommended fiber intake is greater than 38 g for men and 25 g for women, which is the intake that research has observed to lower the risk of coronary artery disease (a heart disease that affects the main blood vessels that supply blood to the heart).

Does eating more carbohydrates cause body fat?

If carbohydrates control body fat, then you would expect that low-carb diets are less “fattening” than higher carbohydrate diets. This means that low carb diets should add less body fat to people than higher carbohydrate diets do. This is true in the most basic sense in that when you overconsume calories (Calorie IN more than Calorie OUT). You do store at least some of the excess calories as body fat. But studies don’t support that view that low-carb diets are less “fattening” than higher carbohydrate diets. It turns out that excess carbohydrates are relatively difficult to store as body fat, at least compared to fats.

In one study where people were overfed carbohydrates and fats, fats were stored ~20% more efficiently than carbs ⁷². In another study where people were overfed carbohydrates, there was a very minimal conversion of carbohydrates to stored body fat, indicating that it is very inefficient to turn carbohydrates into body fat ⁷³.

Furthermore, low-carb diets are not necessary for weight loss, nor are they alone sufficient for weight loss. Carbs don’t necessarily control body fat after all. Over the last several decades there have been dozens of scientific studies comparing low-carb diets to other diets to examine their efficacy ⁷⁴. There are plenty of studies whose results do not support the idea that carbohydrates per se control body fat. For example, in one study of 4,451 people, there was a lower risk of being obese or overweight if you consumed a moderate to high carbohydrate diet when compared to a lower carbohydrate diet ⁷⁵. That study found consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults ⁷⁵.

Another study found that there was no real association between BMI and daily carbohydrate intake, suggesting that if carbohydrates did control body fat, it would be a relatively minor effect ⁷⁶.

Ultimately, science tells us that carbohydrates are not more fattening than fats; in fact, it would make more sense to eat a few too many carbohydrates than a few too many fats. Indeed, this is what you see when you follow people who over-consume carbohydrates versus fats – they tend to gain a little less body fat ⁷⁷.

Are low-carb diets are better for weight loss than other diets?

The majority of the clinical trials that have examined whether low-carb diets are better than other diets for fat loss show that low-carb diets result in the same amount of weight loss as other diets ⁷⁸.

When you tightly control people’s diets and measure virtually every part of their metabolism, it is apparent that low-carb diets are not better for weight loss ⁷⁹. They might be slightly worse for body fat loss than low-fat diets. This holds true even if you go to very low levels of carbohydrate intake ⁸⁰.

Furthermore, when people adopt a low-carb diet in the real world and over more extended periods, they still see very similar results for weight-loss.

The primary findings from these studies have been:

1. Low-carb diets are not necessary for weight loss. Virtually all types of diets can and do result in weight loss when there is a negative energy balance (i.e. an energy deficit).
2. From a body fat mass perspective, low-carb diets may result in inferior fat mass reductions in shorter term diets.
3. Adherence to low-carb diets is no better or worse compared to most other forms of dieting.
4. Low-carb diets often result in more immediate water weight loss and glycogen depletion than moderate-carb diets.

In conclusion, although the idea that carbohydrates control body fat has been popular in the media, there is little scientific evidence to support it. Unless you have extreme levels of carbohydrate intake (Calorie IN more than Calorie OUT), there is no real link between carbohydrates and body fat. From scientific studies, it turns out that carbohydrates are less fattening than dietary fat. When followed in the real-world, low-carb diets can be useful for weight loss, but they are not any more effective than other low calorie diets.

Very low-carb diets can often result in a state called ketosis. This occurs when dietary carbohydrates are low enough, or fat is high enough, such that the body begins producing ketones at a level that allows them to accumulate.

It is often touted that being in a state of ketosis increases fat loss, but there is no good evidence to suggest that is true. In fact, one recent study showed that fat loss is similar, if not inferior, in a state of ketosis ⁸¹. If you choose to adopt a low-carb diet, ketosis may be a result of that process, but should not be the primary focus.

Furthermore, there is some evidence that if someone is an athlete engaging in higher intensity, higher volume exercise, ketogenic diets should be avoided as they can impair performance ⁸², ⁸³.

Very low carbohydrate diets can come with unwanted and potentially dangerous side effects when followed for extended periods. For example, cardiac dysfunction, impairment of physical activity, hair loss, nausea, digestive issues, and lipid abnormalities are all common side effects.

How many carbs should you eat a day to lose weight?

For otherwise healthy individuals with no underlying medical conditions, there does not appear to be a truly minimal amount of carbohydrates that need to be consumed daily.

Your daily recommendations for carb intake are based on two primary criteria:

1. Your total daily calorie requirements (your basal metabolic rate [BMR] or resting metabolic rate [RMR])
2. Your intensity or volume of physical activity.

Higher total daily calorie needs come with higher recommendations for total daily carb intake, while lower total daily calorie needs come with lower recommendations. Furthermore, as your body relies heavily on carbohydrate intake for moderate to higher intensity physical activity, carb recommendations will increase as your total volume and intensity of activity increase.

Your total daily calorie intake can be estimated using the Mifflin-St Jeor formula above. However, there are also online tools that can be used that can help you determine how many calories you should consume daily. Such as the free online Basal Metabolic Rate (BMR) calculator here: https://www.nasm.org/resources/calorie-calculator

Or the Body Weight Planner (https://www.niddk.nih.gov/health-information/weight-management/body-weight-planner).

The Body Weight Planner allows you to make personalized calorie and physical activity plans to reach a goal weight within a specific time period and to maintain it afterwards.

After that, the number of carbs grams per unit of body weight can be estimated based on current guidelines from the American College of Sports Medicine and the Academy of Nutrition and Dietetics. These recommendations are generalized as follows ⁸⁴:

• Light Activity: 3-5 g carb/kg/day
• Moderate Activity (1 hour of moderate exercise): 5-7 g carb/kg/day
• High Activity (1-3 hours of intense, endurance exercise): 6-10 g carb/kg/day
• Very High (4-5 hours of intense, endurance exercise): 8-12 g carb/kg/day

It is often recommended that more moderate carbohydrate intakes (1 to 3 g/kg/day) are consumed even in the context of weight loss.

Your muscles need carbs to fuel and recover from your workouts. At least 40% of your total daily calories should come from good carbs. Eat carbs 60 to 90 minutes prior to your workout, and then eat a combo of carbs and protein (2:1 ratio) within an hour after you finish.

Although many nutrition labels count all carbohydrates toward calorie intake, the truth is not all carbohydrates provide a meaningful number of calories as the human body does not digest and extract energy from all forms of carbohydrates.

In most situations, dietary fiber is considered a non-digestible carb and does not contribute to the total carbohydrate intake. As such, in many cases, fiber is subtracted from total carb intake. The grams of fiber is often subtracted from the total carbs grams to yield a total of usable carbs grams. For example, a food label may list 34 g total carbohydrate consisting of 4 g fiber and 6 g added sugar. By subtracting dietary fiber (4 grams of fiber) from total carbohydrates (34 grams) = 30 grams of usable carbs.

Protein

Protein is an essential nutrient that you need throughout life. Proteins are the building blocks of life. Protein is in every cell in your body. The basic structure of protein is a chain of amino acids ⁸⁵. A protein is a chain of amino acids bound to one another via peptide bonds (chemical bond linking amino acids together to form a protein). When someone eats protein, it is broken down into its amino acids.

Your body needs protein to make, maintain, repair and renew bones, muscles, cartilage, hormones, enzymes, neurotransmitters, vitamins, blood and skin cells ⁶⁹, ⁸⁶, ⁸⁷. Proteins provide energy (calories) if necessary, the others are fat and carbohydrates. Proteins do everything from fighting infections to helping cells divide. Protein is also important for growth and development in children, teens, and pregnant women.

Excess or deficiency of protein can lead to disease, resulting in nervous system defects, metabolic problems, organ failure, and even death ⁸⁵. Clinical symptoms of inadequate intake of essential amino acids may include depression, anxiety, insomnia, fatigue, weakness, and growth stunting in the young. These symptoms are mostly caused by a lack of protein synthesis in the body because of the lack of essential amino acids ⁸⁷. Kwashiorkor and marasmus are examples of more severe clinical disorders caused by malnutrition and inadequate intake of essential amino acids as a macronutrient ⁸⁷.

High protein diets can promote weight loss via increased insulin sensitivity, fatty acid oxidation, appetite suppression, and feeling full. However, caution is necessary for people with diabetes who have gout because protein can elevate niacin levels, which may exacerbate gout-related symptoms.

The protein in your food is broken down into parts called amino acids during digestion. Your body needs a number of amino acids in large enough amounts to maintain good health. While there are hundreds of amino acids, humans use only 20 amino acids ⁸⁵, ⁸⁷.

Amino acids are classified into three groups ⁸⁵:

1. Essential amino acids. Essential amino acids cannot be made by your body, and must be supplied by food. Essential amino acids do not need to be eaten at every meal. The balance over the whole day is more important. There are 9 essential amino acids:
   • Histidine
   • Isoleucine
   • Leucine
   • Lysine
   • Methionine
   • Phenylalanine
   • Threonine
   • Tryptophan
   • Valine
2. Nonessential amino acids. Nonessential amino acids are made by your body from essential amino acids or in the normal breakdown of proteins. There are 5 amino acids that are termed non-essential amino acids:
   • Alanine
   • Asparagine
   • Aspartic acid
   • Glutamic acid
   • Serine
3. Conditionally Essential amino acids. Conditionally Essential amino acids are needed in times of illness, stress, starvation or inborn errors of metabolism. A healthy body can make conditionally essential amino acids under normal physiologic conditions. There are 6 amino acids that are called conditionally essential amino acids:
   • Arginine
   • Cysteine
   • Glutamine
   • Glycine
   • Proline
   • Tyrosine

You get protein (amino acids) in your diet from animal and plant-based foods such as meat, fish, eggs, dairy products, nuts, and certain grains, beans, peas, and lentils ⁸⁸. Proteins from meat and other animal products are complete proteins. This means they supply all of the amino acids your body can’t make on its own. Most plant proteins are incomplete. So you should eat different types of plant proteins every day to get all nine essential amino acids your body needs. For example, pairing protein sources like rice and beans, hummus, pita bread, or oatmeal topped with almond butter. Regarding volume, it may be necessary to eat more plant-based foods to get a similar amount of protein and amino acid profile provided by animal-based proteins ⁸⁹.

• Animal protein – protein-containing foods from animals are meat, chicken, fish, eggs and dairy products. Meat and poultry foods should be lean or low-fat, like 93% lean ground beef, pork loin, and skinless chicken breasts. Choose seafood options that are higher in healthy fatty acids called omega-3s fatty acid and lower in methylmercury, such as salmon, anchovies, and trout. And stay away from processed meats or artificial (fake) meat.
• Vegetable protein – protein-containing foods from plants include tofu, nuts, seeds, lentils, dried beans and peas, and soy milk.
  Good protein choices include:
  • Soy protein
  • Beans
  • Nuts
  • Fish
  • Lean chicken with no skin
  • Lean beef
  • Pork
  • Salmon
  • Anchovies
  • Trout
  • Low-fat dairy products

It is important to get enough dietary protein. You need to eat protein every day, because your body doesn’t store it the way it stores fats or carbohydrates. Furthermore, protein foods provide nutrients important for maintaining your health and body. How much protein you need depends on your age, sex, height, weight, health, and level of physical activity. The amount can also depend on whether or not you are pregnant or breastfeeding.

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ⁹⁰. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ⁹¹, ⁹², ⁹³, ⁹⁴.

For healthy children ages 1 to 3 approximately 5 to 20% and children ages 4 to 18 approximately 10 to 30% of daily energy intake should come from protein. The daily recommended intake of protein for healthy adults is 10% to 35% of your daily energy intake based on the adequate amount needed for nitrogen equilibrium ⁷. One gram of protein supplies 4 calories. Therefore, if you consume 2,000 calories per day, this would work out to be between 200 to 700 calories of protein per day, you could eat 100 grams of protein, or 400 calories from protein, which would supply 20% of your total daily calories.

The recommended daily intakes (RDIs) can also be calculated by your body weight. The Academy of Nutrition and Dietetics recommends that the average individual should consume 0.8 grams of protein per kilogram or 0.35 grams per pound of body weight per day for general health. So a person that weighs 75 kg (165 pounds) should consume an average of 60 grams of protein per day. Since there are approximately four calories per gram of protein, 60 grams of protein would result in the intake of 240 calories.

How much protein do I need?

How much protein you need depends on your age, sex, height, weight, health, and level of physical activity. The amount can also depend on whether or not you are pregnant or breastfeeding. The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ⁹⁰. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ⁹¹, ⁹², ⁹³, ⁹⁴.

How to calculate your daily protein needs:

Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by the range that best fits your activity levels.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day

• 68.2kg (0.8g grams of protein per kilogram) = 54.6g
• 68.2kg (1g grams of protein per kilogram) = 68.2g

For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day.

• 68.2kg (1.2g grams of protein per kilogram) = 81.8g
• 68.2kg (1.7g grams of protein per kilogram) = 115.9g

Here are some practical protein equivalents in common foods. One ounce (30 grams) of most protein-rich foods contains 7 grams of protein. An ounce (30 grams) equals:

• 1 oz (30 g) of meat fish or poultry
• 1 large egg has six grams of protein
• ¼ cup (60 milliliters) tofu
• ½ cup (65 grams) cooked beans or lentils
• 1 cup of dry beans has about 16 grams of protein
• 1 cup of milk has eight grams of protein
• 1 cup of soy milk has about seven grams of protein

Low fat dairy is also a good source of protein. An eight ounce container of yogurt has about 11 grams of protein

Most Americans eat enough protein in their diet but need to select leaner varieties of meat and poultry. Americans may also need to increase the variety of protein foods selected and choose meats less often. However, if you are vegetarian or vegan, the advice to eat meat, poultry, and seafood does not apply to you. Vegetarian protein options include beans, peas, lentils, nuts, seeds, and soy products.

What counts as an ounce-equivalent in the protein foods group?

The following examples count as 1 ounce-equivalent from the protein foods group ⁸⁶:

• 1 ounce of meat, poultry, or fish
• ¼ cup cooked beans
• 1 egg
• 1 tablespoon of peanut butter
• ½ ounce of nuts or seeds
• ¼ cup (about 2 ounces) of tofu
• 1 ounce tempeh, cooked

The table below lists amounts that count as 1 ounce-equivalent in the protein foods group towards your daily recommended amount.

Table 3. Daily protein foods general recommendations by age

Daily Protein Recommendation* in Ounce-Equivalents
Toddlers	12 to 23 months	2 ounce-equivalent
Children	2-3  yrs 4-8 yrs	2 to 4  ounce-equivalent 3 to  5½ ounce-equivalent
Girls	9-13 yrs 14-18 yrs	4 to 6  ounce-equivalent 5 to 6½ ounce-equivalent
Boys	9-13 yrs 14-18 yrs	5 to 6½ ounce-equivalent 5½ to 7 ounce-equivalent
Women	19-30 yrs 31-59  yrs 60+ yrs	5 to 6½ ounce-equivalent 5 to 6 ounce-equivalent 5 to 6 ounce-equivalent
Men	19-30 yrs 31-59  yrs 60+ yrs	6½ to 7 ounce-equivalent 6 to 7 ounce-equivalent 5½ to 6½ ounce-equivalent

How much protein do you need for optimal muscle maintenance?

How much protein you need depends on your age, sex, height, weight, health, and level of physical activity. The amount can also depend on whether or not you are pregnant or breastfeeding. The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day ⁹⁰. For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day or 0.5 to 0.8 grams per pound of body weight ⁹¹, ⁹², ⁹³, ⁹⁴.

How to calculate your daily protein needs:

Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by the range that best fits your activity levels.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day

• 68.2kg (0.8g grams of protein per kilogram) = 54.6g
• 68.2kg (1g grams of protein per kilogram) = 68.2g

For strength training athletes adequate protein intake should range between 1.2 and 1.7 grams of protein per kilogram of body weight per day.

• 68.2kg (1.2g grams of protein per kilogram) = 81.8g
• 68.2kg (1.7g grams of protein per kilogram) = 115.9g

Muscle mass is built when the net protein balance is positive: that is muscle protein synthesis exceeds muscle protein breakdown. Research shows muscle protein turnover is the greatest after working out. Additionally, it has been shown that muscle mass increases over time when resistance exercise (i.e. weight lifting, body weight exercises, etc) is combined with nutrient intake.

However, as you age, you need to increase your protein intake ⁹¹. Around 50 years of age, you need to increase the protein in your diets to 1 gram per kilogram of your body weight to maintain muscle mass ⁹¹. People that exercise regularly also need to eat more protein than the recommended daily intake ⁹¹.

Several studies performed by the group of Philip and others showed that protein supplementation did not further increase muscle strength among individuals who consumed adequate amounts of dietary protein ⁹⁴, ⁹⁵, ⁹², ⁹⁶. However, with the aim of maximizing performance, individuals seeking to gain muscle mass are likely to consume more protein with the misconceived belief that large quantities of protein consumption might generate more muscle protein ⁹⁷.

To increase muscle mass in combination with physical activity, it is recommended that a person that lifts weights regularly or is training for a running or cycling event eat a range of 1.2 to 1.7 grams of protein per kilogram of body weight per day, or 0.5 to 0.8 grams per pound of body weight ⁹¹. Consequently, the same 75
kilogram individual should increase their protein intake to 75 grams (300 calories) to 128 grams (512 calories) in order to gain muscle mass. This level of intake can generally be met through diet alone and without additional protein and amino acid supplementation ⁹¹.

When should I consume protein?

The process of protein turnover is increased with resistance training and can remain elevated for up to 48 hours in people beginning a new resistance training program ⁹¹. Therefore it is important to provide enough energy including protein so there is a sufficient pool of amino acids available to repair and build new muscle. You do not want to exercise on an empty stomach. In fact, exercising in an unfed state leads to an increase in protein loss making it more difficult for your body to both repair and build muscle ⁹¹. Your body can only use approximately 20–40 g of protein per meal. For best results, eat around this much protein every 3 to 4 hours.

Research suggests there are several benefits to pre-exercise protein supplementation ⁹¹. Pre-exercise protein supplementation helps to improve body composition by increasing resting energy expenditure up to 48 hours after exercise ⁹¹. This is important because it suggests that pre-exercise protein ingestion will not only help increase lean muscle mass and strength, but will also simultaneously reduce fat mass ⁹¹. However, the most scientifically supported and most significant benefits of consuming protein prior to exercise may be improved recovery and hypertrophy. This is thought to occur because of improved amino acid delivery ⁹¹.

Make sure you have a healthy diet that meets the current protein intake recommendations and then use supplements to add anything else you might need. A good diet will not make a mediocre athlete into a champion, but poor food choices can turn a champion into a mediocre athlete. The International Olympic Committee (IOC) position stand is that “the use of supplements does not compensate for poor food choices and an inadequate diet”. Reinforcing this importance of food, researchers have found that athletes eating a diet rich in nitrates from vegetables (not supplements) for just 10 days were able to enhance their exercise performance, compared to when they were eating their usual diet ⁹⁸.

Protein supplement

Protein supplementation has been shown to improve muscle building with regular exercise training. Protein supplementation should contain a high amount of the amino acid leucine, which is responsible for muscle protein synthesis. Whey protein is a great option for leucine. Eating less protein may not be enough to rebuild muscles, and eating more doesn’t usually give you more benefits.

Whey protein is beneficial in supporting muscle adaptations due to its rapid absorption rate in addition to casein that has a slower and more sustained rate of amino acid absorption over a few hours ⁹¹. Branched chain amino acids are similarly beneficial and have been shown to aid in recovery from exercise with respect to not only protein synthesis but also aiding in replacing our muscle glycogen and delaying fatigue associated with exercise.

Protein supplementation after exercise may have a more profound impact on skeletal muscle hypertrophy. Several studies have demonstrated that protein ingestion following an acute bout of resistance training stimulates muscle protein synthesis for up to three hours ⁹¹. In contrast, failing to eat after exercise
may limit protein synthesis and therefore limit potential progress in lean muscle tissue development. Research actually suggests there may be an “anabolic window” such that protein intake within an hour of exercise has the greatest influence on resistance training adaptations ⁹¹.

Generally, naturally occurring animal proteins contain 2:1:1 ratio of leucine, isoleucine and valine. These proteins have been identified as providing optimal support of muscle adaptations with exercise training. In order to meet the recommended RDA a consumption of approximately 45 mg/kg/day of leucine and 22.5 mg/kg/day of isoleucine and valine is suggested ⁹¹.

What is the best protein powder supplement?

Creatine monohydrate is generally safe and can help you build more muscle mass ⁹⁹, ¹⁰⁰, ¹⁰¹, ¹⁰², ¹⁰³, ¹⁰⁴. Always check with your doctor before starting any supplement.

Creatine (N-[aminoiminomethyl]-N-methyl glycine) is an amino acid–like compound that is produced in your liver, kidney, pancreas, and possibly the brain from the biosynthesis of the essential amino acids methionine, glycine, and arginine, or obtained from dietary sources ¹⁰⁵. The primary dietary sources are high-protein foods including meat, fish, and poultry. Once synthesized or ingested, creatine is transferred from the plasma through the intestinal wall into other tissues by specific creatine transporters located in skeletal muscles, the kidney, heart, liver, and brain.

Creatine as a dietary supplement is a tasteless, crystalline powder that readily dissolves in liquids and is marketed as creatine monohydrate or as a combination with phosphorous ¹⁰⁶. The majority of creatine (95%) is stored in skeletal muscle (fast twitch, type 2): two-thirds in a phosphorylated form and one-third as free creatine ¹⁰⁷. Creatine serves as an energy substrate for the contraction of skeletal muscle. The intention of creatine supplementation is to increase resting phosphocreatine levels in muscles, as well as free creatine, with the goal of postponing fatigue, even briefly, for sports-enhancing results ⁹⁹.

Creatine is one of the most widely used dietary supplements. Athletes, body builders, and military personnel use creatine to enhance muscle mass and increase strength. Creatine is also used as an ergogenic aid to improve performance of high-intensity exercise of short duration ¹⁰⁸, ¹⁰⁹, ¹¹⁰. Creatine’s popularity as a dietary supplement was further increased by a 2006 study demonstrating its positive effect on cognitive and psychomotor performance ¹¹¹.

Experiments among athletes and military personnel indicate that creatine taken at levels commonly available in supplements produces minimal, if any, side effects ¹¹⁰, ¹¹². Using evidence from well-designed, randomized controlled human clinical trials of creatine, Shao and Hathcock ¹¹² concluded that chronic intake of 5 g/ day of creatine was safe and posed no significant health risks.

Muscle creatine concentrations are increased by 20% with creatine monohydrate supplementation ¹⁰⁷. Creatine monohydrate supplements increase lean body mass, as well as strength, power and effectiveness in short-duration, high-intensity exercises ¹¹³. The increase in body mass may be a result of the increase in intracellular water related to the osmotic properties of creatine ¹¹⁴. Studies on creatine monohydrate supplementation have shown short-duration improvements in sports performance and strength: specifically, in maximum-intensity exercises, muscle power, number of repetitions, muscle endurance, speed and total strength ¹¹⁵.

The use of creatine monohydrate can yield increases in power during short sprints of maximum intensity, which can be even more evident when repeated sprints are accompanied by short recovery periods ¹⁰⁴. Furthermore, with creatine monohydrate supplementation, effects are also observed in muscle glycogen stores ¹¹⁴. This is important because the availability of muscle glycogen is the main determinant of sports performance in resistance exercises, and its depletion can lead to muscle fatigue ¹¹⁶. In addition, creatine monohydrate is one of the few sports foods supplements or ergogenic aids (substance used for the purpose of enhancing performance) with health claims authorised by the EFSA and the European Commission (EC), due to its evident effects on the health and sports performance of athletes ¹¹⁷, ¹¹⁸.

The approved health claims are ‘Creatine increases physical performance in repeated bursts of high-intensity exercise in the short term’ and ‘Daily creatine consumption can enhance the effect of resistance training on muscle strength in adults over the age of 55’. These health claims refer to the 3-g dose of creatine monohydrate ¹¹⁸. Resistance training should be performed at least three times per week for several weeks, at an intensity of at least 65–75% of one repetition maximum (1RM). The target population is adults over the age of 55, who are engaged in regular resistance training ¹¹⁸. Creatine in combination with resistance training and improvement in muscle strength ¹¹⁸.

Fat

You need to eat some fat even when you are trying to lose weight. The human body needs small amounts (3 to 6 grams) of essential fatty acids (Omega-6 and Omega-3 fatty acids). Fat is important for many body processes. Fat helps your body absorb nutrients and move nutrients around your body. Some fat is necessary as a carrier for the fat-soluble vitamins A, D, E, and K. Fat is the main source of energy storage in your body, fat contributes to cellular structure and function, fat keeps you warm, and protects your organs ¹¹⁹, ¹²⁰, ¹²¹. Fat also helps with hormone production. Therefore your diet should not be devoid of fat. However, because fat is calorically dense (1 gram of fat has 9 calories of energy), it is often decreased on weight-loss diets to reduce energy intake.

Fat needs will vary by individual and will depend largely on your body composition goals and body types. For example, dietary fat recommendations are slightly higher in competitive athletes than non-athletes to promote health, maintain healthy hormone function, and maintain energy balance. Typical recommendations for athletes are 30 to 50% of total energy intake.

There are 4 main types of fats:

1. Unsaturated fats are those that are liquid at room temperature. Examples include olive, peanut, and canola oils. We want to include as many unsaturated fats in our diet because they can decrease bad cholesterol, contain high amounts of antioxidants such as Vitamin E, and contain essential omega-3 and omega-6 fatty acids. Unsaturated fats are typically classified by how many hydrogen bonds they have in their structure: either 1 (mono) or two or more (poly).
2. Monounsaturated fats. Monounsaturated fat is a type of unsaturated fat. Monounsaturated fats are liquid at room temperature but start to harden when chilled. Monounsaturated fats is one of the healthy fats, along with polyunsaturated fat. Monounsaturated fats are good for your health in several ways:
   • Monounsaturated fats can help lower your LDL (bad) cholesterol level. Cholesterol is a soft, waxy substance that can cause clogged, or blocked, arteries (blood vessels). Keeping your LDL level low reduces your risk for heart disease and stroke.
   • Eating plant foods high in monounsaturated fats, particularly extra virgin olive oil and tree nuts, may benefit heart health and blood sugar regulation. Monounsaturated fats from plants may lower bad cholesterol and raise good cholesterol. They also may improve the control of blood sugar levels. Replacing saturated fats with monounsaturated fats in your diet may lower the level of bad cholesterol and triglycerides in your blood. Triglycerides are fat cells that circulate in the bloodstream and are stored in the body’s fat cells. A high level of triglycerides in the blood increases the risk of diseases of the heart and blood vessels.
   • Monounsaturated fats help develop and maintain your cells.
   • Monounsaturated fats are found in plant foods, such as nuts, avocados, and vegetable oils. Monounsaturated fats are found in red meats and dairy products. About half the fats in these foods are saturated and half monounsaturated. Many plants and plant oils are high in monounsaturated fats but low in saturated fats. These include:
     • Oils from olives, peanuts, canola seeds, safflower seeds, and sunflower seeds.
     • Avocadoes.
     • Pumpkin seeds.
     • Sesame seeds.
     • Almonds.
     • Cashews.
     • Peanuts and peanut butter.
     • Pecans.
3. Polyunsaturated fats. Polyunsaturated fat is a type of unsaturated fat. Polyunsaturated fats are liquid at room temperature but start to harden when chilled. Polyunsaturated fats include omega-3 and omega-6 fats. These are essential fatty acids that your body needs for brain function and cell growth. Your body does not make essential fatty acids, so you must get them from food. Polyunsaturated fats can help lower your LDL (bad) cholesterol. Cholesterol is a soft, waxy substance that can cause clogged or blocked arteries (blood vessels). Having low LDL cholesterol reduces your risk for heart disease. Polyunsaturated fats is one of the healthy fats, along with monunsaturated fat. Polyunsaturated fat is found in plant and animal foods, such as salmon, vegetable oils, and some nuts and seeds.
   1. Omega-3 fatty acids are good for your heart in several ways. They help:
      • Reduce triglycerides, a type of fat in your blood
      • Reduce the risk of developing an irregular heartbeat (arrhythmia)
      • Slow the buildup of plaque, a substance comprising fat, cholesterol, and calcium, which can harden and clog your arteries
      • Slightly lower your blood pressure
   2. Sources of omega-3 fatty acids include:
      • Fish such as salmon, anchovies, mackerel, herring, sardines and tuna.
      • Oils from canola seeds, soybeans, walnuts and flaxseed.
      • Soybeans.
      • Chia seeds.
      • Flaxseed.
      • Walnuts.
   3. Omega-6 fatty acids may help:
      • Control your blood sugar
      • Reduce your risk for diabetes
      • Lower your blood pressure
   4. Sources of omega-6 fatty acids include:
      • Corn oil.
      • Cottonseed oil.
      • Peanut oil.
      • Soybean oil.
      • Sunflower oil.
4. Saturated fats. Saturated fats are those that are solid at room temperature. Examples include margarine, butter, whole fat dairy products, the fat marbling in meats, and coconut oil. Saturated fats don’t need to be avoided entirely, but diets high in saturated fats can increase bad cholesterol and triglycerides, increasing the risk for heart disease. The Dietary Guidelines for Americans suggest that less than 10% of calories a day should be from saturated fats. The American Heart Association recommends that saturated fats only make up 5 to 6% of your daily calories. For a 2,000 calorie diet, that is a total of 100 calories, or 11 grams a day. Foods high in saturated fats include:
   • Foods baked or fried using saturated fats.
   • Meats, including beef, lamb, pork as well as poultry, especially with skin.
   • Lard.
   • Dairy products like butter and cream.
   • Whole or 2% milk.
   • Whole-milk cheese or yogurt.
   • Oils from coconuts, palm fruits, or palm kernels.
5. Trans fats. Trans fatty acids are unhealthy fats that form when vegetable oil goes through a process called hydrogenation. This leads the fat to harden and become solid at room temperature. Hydrogenated fats, partially hydrogenated oils (PHOs) or “trans fats,” are often used to keep some foods fresh for a long time. Trans fats are unsaturated fats that are artificially turned into saturated fats and increase heart disease and stroke risk by raising bad LDL cholesterol and decreasing good HDL cholesterol levels. High LDL (bad) cholesterol along with low HDL (good) cholesterol levels can cause cholesterol to build up in your arteries (blood vessels). This increases your risk for heart disease and stroke. Trans fats have also been known to increase the risk of developing type 2 diabetes. Trans fats are most commonly found in fried foods, frozen baked products such as pizza, non-dairy coffee creamers, vegetable shortenings, some margarines, crackers, cookies, snack foods, and other foods made with or fried in partially hydrogenated oils (PHOs). Because of the health risks from trans fats, the United States Food and Drug Administration (FDA) has banned food manufacturers from adding partially hydrogenated oils (PHOs) to foods. Although the food industry has greatly reduced the use of trans fat in recent years, trans fat may still be found in many fried, packaged, or processed foods. There are very small amounts of naturally occurring trans fat in meats and dairy from grazing animals, such as cows, sheep and goats. You should avoid foods made with hydrogenated and partially hydrogenated oils (such as hard butter and margarine). They may contain high levels of trans fatty acids. It is important to read nutrition labels on foods. This will help you know what kinds of fats, and how much, your food contains.

How much fat do I need?

To prevent any fatty acid deficiencies it is recommended that you consume at minimum 1g of fat per kg of body weight per day. According to the Dietary Guidelines for Americans ⁷⁰, fats should make up 20 to 35% of your total daily calorie intake. For those attempting to lose body fat, 0.5 to 1 fat per kg of body weight per day should be consumed per day to avoid essential fatty acid deficiency. For healthy children ages 1 to 3, ages 4 to 18, and adults, approximately 30 to 40%, 25 to 15%, and 20 to 35% of daily energy intake should come from fat, respectively ⁶⁹. Approximately 5 to 10% of your daily fat energy intake should consist of Omega−6 fatty acids (linoleic acid) and 0.6 to 1.2% of Omega−3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) ⁷. Both omega−6 fatty acids (linoleic acid) and omega−3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) are considered essential fatty acids, meaning that they must be obtained from your diet ¹²². Apha-linolenic acid can be converted into eicosapentaenoic acid (EPA) and then to docosahexaenoic acid (DHA), but the conversion (which occurs primarily in your liver) is very limited, with reported rates of less than 15% ¹²³, ¹²⁴. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential fatty acids, meaning the body can’t produce them and they must come from your diet ¹²⁵. Therefore, consuming eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in your body.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids found in varying amounts in seafood such as cold-water fish like salmon, tuna, herring, and mackerel, as well as in fish oil supplements and seaweed. Eating 8 ounces per week of seafood may help reduce the risk for heart disease.

Some researchers propose that the relative intakes of omega-6s and omega-3s, the omega-6/omega-3 ratio, may have important implications for the cause of many chronic diseases, such as heart and blood vessels disease (cardiovascular disease) and cancer ¹²⁶, but the optimal ratio, if any, has not been defined ¹²⁷. Others have concluded that the omega-6/omega-3 ratios are too nonspecific and are insensitive to individual fatty acid levels ¹²⁸, ¹²⁹, ¹³⁰.. Most agree that raising EPA and DHA blood levels is far more important than lowering linoleic acid or arachidonic acid levels ¹²⁴.

For someone who weighs 150lbs (68kg), this would equate to 34-68g fat per day. Using both of these references you can calculate your daily fat needs:

To calculate your daily fat needs:

• Convert body weight in pounds to kilograms (round to the nearest 10th).
 Multiply weight in kilograms by 1.

Let’s look at an example:

• Convert pounds into kilograms 150lbs / 2.2 = 68.2kg

The recommended fat intake is 1 gram per kilogram of body weight per day

• 68.2kg (1g grams of fat per kilogram) = 68.2g of fat per day

Weight loss diets that are moderate to low in fat (20 to 30% of calories) are called “balanced deficit” diets because they maintain a reasonable balance among macronutrients similar to that recommended in MyPlate, DASH, and the Dietary Guidelines for Americans ⁷⁰, ⁴⁷. They tend to achieve most of the caloric deficit by reducing fat from the typical level in North American Diets of about 34% or more of calories to 20 to 30% fat, 15% protein, and 55 to 65% of calories from carbohydrates. Some examples of low fat diets are the Weight Watchers Diet (25% fat, 20% protein, and 55% carbohydrate, with 26 grams of dietary fiber), Jenny Craig, the National Cholesterol Education Program Step 1 diet (25% fat), diets based on the MyPlate, the DASH diet, the Shape up and Drop 10 diet of Shape Up! America and the Nutrisystem diet ¹⁰. Popular diet books using this approach include The Biggest Loser Diet, The Mayo Clinic Diet and The Engine 2 Die ¹⁰. These dietary patterns have been extensively reviewed and appear to be effective for weight reduction on low calorie diets for most individuals ¹⁰.

Very low-fat diets such as the Pritikin Diet ¹³¹, the Ornish Diet ¹³² and The Spark Solution Diet ¹³³ have been advocated not only for weight reduction, but also for improving cardiovascular risk profiles. The Ornish Diet ¹³², which is very low in fat (13% of calories) and saturated fat, very high in carbohydrate (81% of calories) and very high in fiber (38 grams), is part of a program that includes nonsmoking, exercise and behavior modification. The Ornish Diet ¹³² was shown to reduce some cardiovascular risk factors in a limited long term study. For those who can adhere to the Ornish regime it may be helpful. However, it may not be appropriate for all populations, such as diabetics.

What are Healthy fats?

Healthy fats include:

• Monounsaturated fats
• Polyunsaturated fats (omega-3 and omega-6).

The healthier fats are unsaturated fats. They can be found in sunflower oil, safflower oil, peanut and olive oils, poly- and mono-unsaturated margarine spreads, nuts, seeds and avocado. These are much better for you than the saturated fat found in butter, cream, fatty meats, sausages, biscuits, cakes and fried foods.

Foods that contain healthy monounsaturated fats include:

• Avocados and their oils/spreads
• Unsalted nuts such as almonds, cashews and peanuts and their butters/spreads
• Olives and their oils/spreads
• Cooking oils made from plants or seeds, including: olive, canola, peanut, sunflower, soybean, sesame and safflower.

Foods that contain healthy polyunsaturated fats (omega-3 and omega-6) include:

• Oily fish like salmon, mackerel and sardines
• Tahini (sesame seed spread)
• Linseed (flaxseed) and chia seeds
• Soybean, sunflower, safflower, canola oil and margarine spreads made from these oils
• Pine nuts, walnuts and brazil nuts.

It is important to choose foods with the healthiest type of fat such as avocados, olives, nuts and seeds, and use healthy oils for cooking, for example, olive, canola, sunflower, peanut and soybean oil.

Reduce the amount of highly processed food you eat such as baked goods including cakes, biscuits and pastries, along with processed meat, and fried and takeaway foods. These foods are high in saturated and trans fats, added sugar and salt, and are not part of a heart-healthy eating pattern. Try to have these foods only sometimes and in small amounts.

Many Americans eat more fat than they need, which can lead to weight gain and heart disease.

What are Unhealthy fats?

Unhealthy fats include:

• Saturated fat
• Trans fat

Foods rich in unhealthy fats include:

• Animal fats including butter, ghee and lard along with the visible fat/skin on meat
• Hydrogenated plant oils like copha, vegetable shortening and some margarines
• Coconut oil
• Processed foods such as baked goods (cakes, biscuits and pastries), processed meat ( bacon, sausages, salami) and fried and takeaway foods.

Replace foods rich in saturated and trans fats with foods rich in healthy unsaturated fats as part of a healthy diet.

It is important to choose foods with the healthiest type of fat such as avocados, olives, nuts and seeds, and use healthy oils for cooking, for example, olive, canola, sunflower, peanut and soybean oil.

Reduce the amount of highly processed food you eat such as baked goods including cakes, biscuits and pastries, along with processed meat, and fried and takeaway foods. These foods are high in saturated and trans fats, added sugar and salt, and are not part of a heart-healthy eating pattern. Try to have these foods only sometimes and in small amounts.

Many Americans eat more fat than they need, which can lead to weight gain and heart disease.

Weight loss exercise

Regular physical activity is one of the most important things you can do to improve your health. Being active may help you live longer and protect you from developing serious health problems, such as type 2 diabetes, heart disease, stroke, and certain types of cancer.

Regular physical activity is linked to many health benefits, such as ¹³⁴:

• lower blood pressure and blood glucose, or blood sugar
• healthy bones, muscles, and joints
• a strong heart and lungs
• better sleep at night and improved mood.

A 2013 report estimated that 18.2% of deaths annually in the United States (approximately 465,000 deaths) could be attributable to overweight and obesity ¹³⁵. Another 2013 article asserted that there is no such thing as “healthy obesity” ¹³⁶.

Moving more and sitting less have tremendous benefits for everyone, regardless of age, sex, race, ethnicity, or current fitness level ¹³⁷. Individuals with a chronic disease or a disability benefit from regular physical activity, as do women who are pregnant ¹³⁷. The scientific evidence showed physical activity is linked with even more positive health outcomes than previously thought with benefits even with small amounts physical activity. The Physical Activity Guidelines for Americans, 2nd edition ¹³⁷, define regular physical activity as at least 150 minutes a week of moderate-intensity aerobic activity, such as brisk walking. Brisk walking is a pace of 3 miles per hour or faster. A moderate-intensity activity makes you breathe harder but does not overwork or overheat you. You should also do muscle-strengthening activities at least 2 days a week.You may reach this goal by starting with 5 minutes of physical activity several times a day, 5 to 6 days a week. You could then gradually work up to 10 minutes per session, 3 times a day. If you do even more activity, you may gain even more health benefits ¹³⁸.

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines:

• Aerobic activity. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week. Greater amounts of exercise will provide even greater health benefits. But even small amounts of physical activity are helpful. Being active for short periods of time throughout the day can add up to provide health benefits.
• Strength training. Do strength training exercises for all major muscle groups at least two times a week. Aim to do a single set of each exercise, using a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

When combined with healthy eating, regular physical activity may also help you control your weight. However, research shows that even if you can’t lose weight or maintain your weight loss, you still can enjoy important health benefits from regular physical activity ¹³⁹, ¹³⁴.

Physical activity also can be a lot of fun if you do activities you enjoy and are active with other people. Being active with others may give you a chance to meet new people or spend more time with family and friends. You also may inspire and motivate one another to get and stay active.

How much physical activity should I do to lose weight?

Physical activity is important in weight loss and all weight loss programs should include physical activity. If left on their own, most dieters become more sedentary during weight loss, especially if their diets are very low in calories ¹⁰. This is because a markedly negative energy balance reduces your exercise tolerance, your body’s maximal power output and increases your body’s sense of perceived exertion ¹⁴⁰. Therefore, conscious efforts to increase physical activity while dieting should be attempted.

According to the 2008 Physical Activity Guidelines for Americans, recommendations for weight loss include engaging in 45 to 75 minutes of moderate-intensity activity per day ¹⁴¹. This can include activities such as walking at least three miles per hour, participating in water aerobics, ballroom dancing, or gardening. Alternatively, individuals could instead participate in 22 minutes of vigorous activity per day, such as swimming, jogging, jumping rope, or hiking. However, physical activity alone, without a reduction of calories, only induces modest reductions in body weight ¹⁰. Few studies to date have incorporated enough physical activity to achieve even a 5% weight loss using a physical activity intervention alone ¹⁰. When physical activity is paired with calorie restriction, it has a synergistic effect on weight loss ¹⁰. Despite physical activity modest effects on weight loss, physical activity is also essential for improving health-related outcomes relevant to many obesity related medical conditions (e.g., heart disease, type 2 diabetes, and possibly some cancers) ¹⁴². Physical activity is also vital in preventing weight regain and may enhance quality of life ¹⁴². There is a strong association between physical activity at follow-up and maintenance of weight loss. Data from the National Weight Control Registry, a registry of more than 3,000 individuals who have successfully maintained at least a 30-pound weight loss for a minimum of one year, shows that 90% of the individuals report that physical activity is crucial to their long-term weight maintenance. They report expending, on average, 2,700 calories per week in exercise, the energy equivalent of walking four miles seven days a week ³⁷.

Once you lose weight, physical activity and exercise are still important for maintaining weight loss. For weight maintenance, 60 minutes of moderate activity per day or 30 minutes of vigorous activity per day is recommended ¹⁰. In addition, weight resistance activities, which involve all the major muscle groups, are recommended for two or more days per week ¹⁰. Resistance training increases muscle strength by making your muscles work against a weight or force. Different forms of resistance training include using free weights, weight machines, resistance bands, your own body weight or any other object that causes your muscles to contract.

Recent evidence supports the benefits of resistance training in increasing and/or maintaining lean body mass and bone mineral density ¹⁴³, ¹⁴⁴ and highlights their effects on muscular strength and muscle building ¹⁴⁵, ¹⁴⁶. Muscle building occurs when the size and/or number of myofibrils (actin and myosin) within a muscle fiber increases. It’s more common in fast-twitch muscles than slow-twitch muscles, and Type 2A fibers grow the most. Muscle building is a slow process. When you lift heavy weights, your muscles tear and your body experiences metabolic stress. In response, your body tells the proteins to increase, and your muscles slowly grow ¹⁴⁷.

Exercise and weight maintenance

The American College of Sports Medicine position stand on physical activity intervention strategies to promote weight loss and weight regain emphasize the distinction between the minimum levels of physical activity to maintain health (150 minutes per week) and higher levels of physical activity to prevent weight regain (200 minutes per week) ²⁸. Therefore, obese individuals who have successfully lost weight require a substantial amount of physical activity to maintain this weight loss ²⁸. As indicated in the American College of Sports Medicine position, several major limitations to research of physical activity on weight regain exist including the observational and the retrospective nature of the existing literature from randomized trials ²⁸. However, several studies in this area deserve mentioning. Using data from a physical activity weight loss study, Jakicic et al. ¹⁴⁸ observed a dose response between the amount of self-reported physical activity per week and long-term success with weight loss at 18 months of intervention (composed of caloric restriction and exercise training). Adults who exercised greater than 200 minutes per week (−13.1 kg) lost more weight compared to those who exercised between 150-199 min per week (−8.5 kg), and those that exercised less than 150 minutes week (−3.5 kg) ¹⁴⁸. A different study by Jakicic et al. ¹⁴⁹ observed similar findings in post hoc analyses of a weight loss intervention composed of both caloric restriction and exercise training in women. After 12 months of intervention, women with greater than 200 min/week (13.6%) had maintained significantly greater percentage of weight loss compared to those who had exercised at 150-199 min/week (9.5%), and less than 150 min/week (4.7%). Lastly, Andersen et al. ¹⁵⁰ evaluated the effect of low-fat diet (1200 kcals/day) in combination with either structured aerobic exercise training or lifestyle activity (patients were advised to increase their physical activity to recommended levels), and both groups lost approximately 8 kg of weight following 16 weeks of intervention. Weight maintenance was monitored for 1 year after the intervention, and those who were the most active lost additional weight (1.9 kg) whereas the group that was the least active regained a substantial amount of weight (4.9 kg). These data suggest that physical activity has an important role in the amount of weight regain following successful weight loss. Therefore patients attempting to reduce recidivism after weight loss are encouraged to engage in physical activity levels above 200 minutes/week ²⁸.

What kinds of physical activities can I do?

You don’t need to be an athlete or have special skills or equipment to make physical activity part of your life. Many types of activities you do every day, such as walking your dog or going up and down steps at home or at work, may help improve your health. Try different activities you enjoy. If you like an activity, you’re more likely to stick with it. Anything that gets you moving around, even for a few minutes at a time, is a healthy start to getting fit.

The four main types of physical activity are aerobic, muscle-strengthening, bone-strengthening, and stretching. Aerobic activity is the type that benefits your heart and lungs the most. Table 4 summarizes the expected weight change from different exercise training programs in obese patients and describe the overall likelihood for clinically significant weight loss.

A well-known physiologic effect of exercise or physical activity is that it expends energy. A metabolic equivalent of task or MET, is a unit useful for describing the energy expenditure of a specific physical activity. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. For example, 1 MET is the rate of energy expenditure while at rest. A 4 MET activity expends 4 times the energy used by the body at rest. If a person does a 4 MET activity for 30 minutes, they have done 4 x 30 = 120 MET-minutes (or 2.0 MET-hours) of physical activity. A person could also achieve 120 MET-minutes by doing an 8 MET activity for 15 minutes.

Table 4. Expected weight loss from different modalities of exercise training

Exercise modality	Weight Loss	Clinically significant weight loss
Pedometer-based step goal	Range: 0 to 1 kg of weight loss	Unlikely
Aerobic Exercise Training only	Range: 0 to 2kg of weight loss	Possible, but only with extremely high exercise volumes
Resistance Training only	None	Unlikely
Aerobic and Resistance training only	Range: 0 to 2kg of weight loss	Possible, but only with extremely high volumes of aerobic exercise training
Caloric restriction combined with aerobic exercise training	Range: −9 kg to −13 kg	Possible

[Source ³⁰ ]

Walking

Walking is free and easy to do—and you can do it almost anywhere. Walking will help you:

• burn calories
• improve your fitness
• lift your mood
• strengthen your bones and muscles

You can download fitness apps that let you enter information to track your progress using a computer or smart phone or other mobile device.

Devices you can wear, such as pedometers and fitness trackers, may help you count steps, calories, and minutes of physical activity. Trackers can help you set goals and monitor progress. You wear most of these devices on your wrist like a watch, or clipped to your clothing.

Keeping an activity journal is another good way to help you stay motivated and on track to reach your fitness goals.

If you are concerned about safety, try walking in a shopping mall or park where it is well lit and other people are around. Many malls and parks have benches where you can take a quick break. Walking with a friend or family member is safer than walking alone and may provide the social support you need to meet your activity goals.

If you don’t have time for a long walk, take several short walks instead. For example, instead of a 30-minute walk, add three 10-minute walks to your day. Shorter spurts of activity are easier to fit into a busy schedule.

Aerobic exercise

Aerobic exercise is also called endurance activity, moves your large muscles, such as those in your arms and legs. Running, swimming, walking, bicycling, dancing, and doing jumping jacks are examples of aerobic activity. Aerobic exercise makes your heart beat faster than usual. You also breathe harder during this type of activity. Over time, regular aerobic activity makes your heart and lungs stronger and able to work better.

Below are examples of aerobic activities. Depending on your level of fitness, they can be light, moderate, or vigorous in intensity:

• Pushing a grocery cart around a store
• Gardening, such as digging or hoeing that causes your heart rate to go up
• Walking, hiking, jogging, running
• Water aerobics or swimming laps
• Bicycling, skateboarding, rollerblading, and jumping rope
• Ballroom dancing and aerobic dancing
• Tennis, soccer, hockey, and basketball

You can do aerobic activity with light, moderate, or vigorous intensity. Moderate- and vigorous-intensity aerobic exercises are better for your heart than light-intensity activities. However, even light-intensity activities are better than no activity at all.

The level of intensity depends on how hard you have to work to do the activity. To do the same activity, people who are less fit usually have to work harder than people who are more fit. So, for example, what is light-intensity activity for one person may be moderate-intensity for another.

Absolute rates of energy expenditure during physical activity are commonly described as light, moderate, or vigorous intensity. Energy expenditure is expressed by multiples of the metabolic equivalent of task (MET), where 1 MET is the rate of energy expenditure while sitting at rest.

• Light-intensity activity
  • Light-intensity activities are common daily activities that don’t require much effort.
  • Light-intensity activity is non-sedentary waking behavior that requires less than 3.0 METs; examples include walking at a slow or leisurely pace (2 miles per hour [mph] or less), cooking activities, or light household chores.
• Moderate-Intensity activity
  • Moderate-intensity activities make your heart, lungs, and muscles work harder than light-intensity activities do.
  • On a scale of 0 to 10, moderate-intensity activity is a 5 or 6 and produces noticeable increases in breathing and heart rate. A person doing moderate-intensity activity can talk but not sing.
  • Moderate-intensity activity requires 3.0 to less than 6.0 METs; examples include walking briskly (2.5 to 4 mph), playing doubles tennis, or raking the yard.
• Vigorous-Intensity activity
  • Vigorous-intensity activities make your heart, lungs, and muscles work hard. On a scale of 0 to 10, vigorous-intensity activity is a 7 or 8. A person doing vigorous-intensity activity can’t say more than a few words without stopping for a breath. Vigorous-intensity activity examples include jogging, running, carrying heavy groceries or other loads upstairs, shoveling snow, or participating in a strenuous fitness class. Many adults do no vigorous-intensity physical activity.
  • Vigorous-intensity activity requires 6.0 or more METs.

Bicycling

Riding a bicycle spreads your weight among your arms, back, and hips. For outdoor biking, you may want to try a mountain bike. Mountain bikes have wider tires and are sturdier than road bikes with thinner tires. You can buy a larger gel padded seat to make biking more comfortable.

For indoor biking, you may want to try a recumbent bike. On this type of bike, you sit lower to the ground with your legs reaching forward to the pedals. Your body is in more of a reclining position, which may feel better than sitting straight up. The seat on a recumbent bike is also wider than the seat on a regular bike.

Water workouts

Swimming and water workouts put less stress on your joints than walking, biking, or dancing. If your feet, back, or joints hurt when you stand, water activities may be best for you. If you feel self-conscious about wearing a bathing suit, you can wear shorts and a T-shirt while you swim.

You don’t need to know how to swim to work out in water. You can do shallow- or deep-water exercises at either end of the pool without swimming. For instance, you can do laps while holding onto a kickboard and kicking your feet. You also can walk or jog across the width of the pool while moving your arms.

For shallow-water workouts, the water level should be between your waist and chest. During deep-water workouts, most of your body is underwater. For safety and comfort, wear a foam belt or life jacket.

Exercising in water

lets you be more flexible. You can move your body in water in ways you may not be able to on land.
reduces your risk of hurting yourself. Water provides a natural cushion, which keeps you from pounding or jarring your joints.
helps prevent sore muscles.
keeps you cool, even when you are working hard.

Dancing

Dancing can be a lot of fun while it tones your muscles, strengthens your heart and lungs, and boosts your mood. You can dance at a health club, dance studio, or even at home. Just turn on some lively music and start moving. You also can dance to a video on your TV or phone.

If you have trouble standing on your feet for a long time, try dancing while sitting down. Chair dancing lets you move your arms and legs to music while taking the weight off your feet.

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