Here are specific recommendations for losing weight and keeping it off. If you haven’t already done so, first look at the general principles of weight loss. As I say there, scientific studies looking at large groups of patients shows that no single diet or regimen works better than another. But we’re all unique, and you’ll find some things are best for you. Rather than a magic bullet, the best strategy is to investigate what has worked for others. Try out various approaches and see what works for you.

The critical first principle is don’t gain more weight. Weight is a lot easier to put on than take off. One you have it, your body resists losing weight with every force available.

Second, figure out if you are overweight and, if so, by how much. If your body mass index (BMI) exceeds 25, you are overweight and should certainly not gain more. A BMI over 30 means obesity. If your BMI is under 25, you don’t need to lose weight unless your waist exceeds 35 inches (women) or 40 inches (men). BMI isn’t perfect: being really muscular can raise it even if you’re not fat. Truth be told, waist size matters more than BMI. So if you lose fat and get fit, your clothes will fit better but the scale might not change much.

Given that you do intend to lose weight, let’s begin.

Initial tips

I discuss exercise here. If you have the time to gradually increase the amount you exercise up to two hours a day, you will almost certainly lose a substantial amount of weight, along with significant other health benefits. Because finding time to exercise for even half an hour a day is a struggle for so many, suffice it to say that not exercising at all makes shedding pounds much more difficult. Up to a point, more exercise is better, assuming you do it properly. Alas, exercise alone is usually not enough.

Keep a log of what you eat and how you feel immediately after the meal and an hour later. Writing down your food (including portion size and calories) is a proven weight-loss strategy, and recording your reactions to food may help you make better choices. Also, record your emotional state if you get a sudden craving. Diet-logging software and web sites make recording food intake much simpler. (To find these sites, google “food log”.)

Weigh yourself regularly, at least once a week. Daily fluctuations of 3-4 pounds are normal and rarely reflect true weight gain or loss.

Unless you’re on a special kidney diet, eat a high-protein breakfast every day. This will increase your energy and alertness, and you’re less apt to crave snacks later in the morning. Breakfast cereal with fruit and nonfat or soy milk is a good choice. Another is the meal-replacement shake I describe below.

Many of my patients have lost weight without changing their diet at all. They shrink the portion size of what they eat: less of the same foods they usually consume.

Diet strategies

Let’s start with the stuff to avoid:
  • Avoid comfort food: what you eat when you’re not hungry but anxious or upset. Closely related are snacks, fast food, and convenience foods.
  • Avoid “frankenfoods”: manufactured “products” full of artificial ingredients. How you can tell? Read the label. Artificial food has a dozen ingredients, many of which you can’t pronounce. Your grandmother wouldn’t recognize it. It will never spoil. It makes nutritional claims (“no cholesterol!” or “low fat!” or “high in vitamin C!”). It sounds like you’re getting something for nothing. No one you know could make it in their kitchen.
  • Avoid foods sweetened with high-fructose corn syrup.
Next are foods you should eat in moderation: some, but not often or a lot:
  • Don’t each much red meat (beef or pork) except on occasion or as flavor, like pasta sauce that contains meat. People who consume the most red meat have a 30% higher mortality rate than those who eat the least, and most meat is high in fat and calories.
  • Minimize your intake of white starch: white bread, white rice, potatoes, and pasta (unless the pasta is cooked firm or “al dente,” which slows digestion). These high-glycemic-index foods raise blood sugar and insulin levels in many people.
  • Eat tiny amounts of sweet and fatty foods, just enough to satisfy your craving without adding significant calories.
  • It isn’t fair, but diet soft drinks aren’t any better for you than sodas containing sugar or corn syrup. Recent studies show an association between obesity and drinking even one soda a day, even if it’s diet.
Here are the foods to eat more of:
  • Have 5-10 servings a day of fresh fruits and vegetables, preferably more vegetables. With each meal, at least half of your plate should be fresh produce. Note: one serving of vegetables is the usual handful of food you’d have on your plate at a meal. It’s about 6 fluid ounces (180 mL) by volume. If you’re still not sure, check out
  • Select carbohydrates made with whole grains, brown rice, yams, and beans.
  • Lean turkey, chicken, and fish are good protein sources. Soy is excellent. One caution: most ocean-caught fish contain mercury, so limit your intake to 2-3 servings a week. Some farmed fish are contaminated with industrial pollutants like PCBs. But people who eat 1-2 servings of fish a week are healthier than those who never eat fish.
  • Nonfat dairy products are ideal so long as you’re not lactose intolerant.
  • Green tea is actually really good for you and has proven health benefits. (Green tea pills or capsules, not so much.) Black tea and coffee are also all right in moderation. Too much coffee in particular can raise blood pressure and make your heart race. Avoid caffeinated beverages within 6-8 hours of bedtime: the caffeine hangs around for hours and can keep you awake.
Meal-replacement shake

Some people do well if they replace one or two meals a day with a dietary shake. I personally use this approach. Many people like the SlimFast line of products. I make my shakes in the blender. Here is my current formula, which you should modify to meet your needs:

  1. Eight ounces of plain soy milk (not flavored or sweetened)
  2. Two ounces of plain kefir (unflavored and unsweetened), a source of probiotic bacteria
  3. A heaping teaspoon of ground flax seed, for fiber and omega-3 fatty acids
  4. One tablespoon of nonfat cottage cheese
  5. Four to six ounces of chunks of fresh fruit. What I use depends upon the season but variably includes banana, melon, strawberries, blueberries, mango, kiwi fruit, grapes, etc.
  6. A handful of mixed nuts; Costco has a great source.

Avoid the kefir and cottage cheese if you’re lactose intolerant.

I buy everything at Costco, except I get the kefir and flax seed at the supermarket. I put the first five ingredients into the blender jar and turn it on at low speed, covering with the lid to prevent splashes. After a few seconds I lift the lid and add the scoop of protein powder, blending until everything is mixed. Banana, mango, and blueberries may thicken the mixture, so sometimes I eat it with a spoon. The total volume is just under a quart.

This shake makes a good breakfast. If you put it in a sturdy plastic to-go container with a few ice cubes, then in an insulated bag, it lasts without refrigeration until lunch.

The flax seed sticks to the side of the blender jar and is hard to clean out, even with a good dish brush. But letting the blender jar sit full of water for a few minutes loosens the flax, and then it’s a breeze.