Aim for a Healthy Weight Patient Booklet

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Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 05-5213). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health National Heart, Lung, and Blood Institute

Aim for a Healthy Weight

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NIH Publication No. 05-5213

National Institutes of Health August 2005 National Heart, Lung, and Blood Institute

Table of Contents

Aim for a Healthy Weight

Why Is a Healthy Weight Important?

eaching and maintaining a healthy weight is good for your overall health and will help you prevent and control many diseases and conditions. We know that an increase in weight also increases a person’s risk for heart disease, high blood cholesterol, high blood pressure, diabetes, gallbladder disease, gynecologic disorders, arthritis, some types of cancer, and even some lung problems (see Box 1). Maintaining a healthy weight has many benefits, including feeling good about yourself and having more energy to enjoy life.

A person’s weight is the result of many things— height, genes, metabolism, behavior, and environment. Maintaining a healthy weight requires keeping a balance . . . a balance of energy. You must balance the calories you get from food and beverages with the calories you use to keep your body going and being physically active.

The same amount of energy IN and energy OUT over time = weight stays the same

More IN than OUT over time = weight gain

More OUT than IN over time = weight loss

Your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that will help you to maintain a healthy weight in the long run.

For many people, this balance means eating fewer calories and increasing their physical activity. Cutting back on calories is a matter of choice. Making healthy food choices that are lower in fats, especially saturated and trans fat, cholesterol, added sugars, and salt can help you cut back on calories, as can paying attention to portion sizes.

This booklet will provide you with information to figure out your body mass index (Box 2) and weightrelated risk for disease. It will also give you information on when and how to lose weight, including tips on healthy eating and physical activity, setting weight loss goals, and rewarding your success.

If you are overweight or obese you are at risk of developing the following diseases:

• High blood pressure
• High blood cholesterol
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Arthritis
• Sleep apnea and breathing problems
• Some cancers
• Endometrial
• Breast
• Prostate
• Colon

Here is a shortcut method for calculating BMI.

(Example: for a person who is 5 feet 5 inches tall weighing 180 lbs.)

1. Multiply weight (in pounds) by 703 180 x 703 = 126,540
2. Divide the answer in step 1 by height (in inches) 126,540/65 = 1,946
3. Divide the answer in step 2 by height (in inches) to get your BMI 1,946/65 = 29.9

BMI = 29.9

What Is Your Risk?

First, let’s gather some information—

Check Your Body Mass Index Your body mass index (BMI) is a good indicator of your risk for a variety of diseases since it gives an accurate estimate of your total body fat.

There are three ways to check your BMI.

• One way is to use the chart on the next page to find your weight and height and then go above that column to find your BMI.
• A second way is to use the BMI calculator on the NHLBI Web site at http://www. nhlbisupport. com/bmi/.
• A third way to check your BMI is to calculate it; one method is shown in Box 2. Another way to do this: Divide your weight in pounds by your height in inches squared and then multiply the total by 703.

Once you know your BMI, check Box 3, which shows the BMI ranges for underweight, normal weight, overweight, and obesity.

While BMI is valid for most men and women, it does have some limitations:

• It may overestimate body fat in athletes and others who have a muscular build.
• It may underestimate body fat in older persons and others who have lost muscle mass.

Appropriate weight gain during pregnancy varies and depends upon initial body weight or BMI level. Pregnant women should contact a health professional to assure appropriate weight gain during pregnancy.

Waist Circumference Measurement Your waist circumference measurement is also important in determining your overall risk. If most of your fat is around your waist, you are at greater chance for developing risk factors for heart disease

BMI

Besides being overweight or obese, here are other risk factors to consider—

• Cigarette smoking
• High blood pressure (hypertension)
• High LDL-cholesterol (“bad” cholesterol)
• Low HDL-cholesterol (“good” cholesterol)
• High triglycerides
• High blood glucose (sugar)
• Family history of premature heart disease
• Physical inactivity

and diabetes. This risk increases with a waist measurement of greater than 35 inches for women or greater than 40 inches for men.

Are You at Risk?

Talk to your doctor to see if you are at an increased risk and if you should lose weight. Your doctor will evaluate your BMI, waist measurement, and other risk factors for heart disease. These risk factors are shown in Box 4.

If you are overweight, do not have a high waist measurement, and have less then two risk factors, it’s important that you not gain any more weight. If you are overweight (BMI 25–29.9), or have a high waist circumference, and have two or more risk factors, or if you are obese (BMI ≥30), it is important for you to lose weight. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing the diseases listed in Box 1.

258 267 276 285 295

53 253 262 271 280 289

244 248252 257261 266269 275

304 314 324 334 344 354 365 376 386 397 408 420 431 443

299 308 318 328 338 348 358 369 379 390 401 412 423 435

287 293296 302306 312315 322325 331335 341345 351355 362365 372375 383386 393396 404407 415418 426 278 284

239 247 255 264 273

234 242 250 259 267

229 237 245 254 262

224 232 240 248 256

Extreme Obesity 220 227 235 243 251

215 222 230 238 246

210 217 225 232 240

205 212 220 227 235

201 208 215 222 229

40 191 196198 203204 209211 217

282 291 300 309 319 328 338 348 358 368 378 389 399 410

278 285 294 303 312 322 331 341 351 361 371 381 391 402

270 279 288 297 306 315 324 334 343 353 363 373 383 394

265 273 282 291 299 308 318 327 338 346 355 365 375 385

259 267 276 284 293 302 311 320 329 338 348 358 367 377

254 262 270 278 287 295 304 313 322 331 340 350 359 369 .

248 256 264 272 280 289 297 306 315 324 333 342 351 361

242 250 258 266 274 282 291 299 308 316 325 334 343 353

237 244 252 260 268 276 284 292 301 309 318 326 335 344

The Evidence Report

225 231232 238240 246247 253255 261262 269270 277278 285286 293294 302302 310311 319319 327328 336 218 224

186 193 199 206 213

177 181183 188189 194195 201

220 227 234 241 249 256 263 271 279 287 295 303 311 320

208 214215 221222 228229 235236 242243 249250 257257 264265 272272 279280 288287 295295 303304 312 202 207

172 178 184 190 196

167 173 179 185 191

Obese34

Body Weight (pounds)162168174180186

158 163 168 174 180

153 158 163 169 175

148 153 158 164 169

143 148 153 158 164

Overweight26

124 129 134 138128 133 138 143

203 209 216 223 230 236 243 250 257 265 272 280 287 295

197 204 210 216 223 230 236 243 250 258 265 272 279 287

191 197 204 210 217 223 230 236 243 250 257 264 272 279

186 192 198 204 211 216 223 229 236 242 250 256 264 271

180 186 192 198 204 210 216 222 229 235 242 249 256 263

175 180 186 192 198 203 209 216 222 228 235 241 248 254

169 174 180 186 191 197 203 209 215 221 227 233 240 246

133 138 143 148137 143 148 153142 147 153 158

119 124 128 132 136

115 119 123 127 131

110 114 118 122 126

105 109 112 116 120

Normal21

100 104 107 111 115

20 96 99 102 106 109

19 91 94 97 100 104

BMI Height(inches)58 59 60 61 62

146 152 158 163151 157 163 169156 162 168 174161 167 173 179166 172 178 185171 177 184 190176 182 189 196181 188 195 202186 193 200 208191 199 206 213197 204 212 219202 210 218 225208 216 224 232213 221 230 238

141 145 150 155 159 164 169 174 179 184 189 194 200 205

135 140 144 148 153 158 162 167 172 177 182 186 192 197

130 134 138 142 146 151 155 160 165 169 174 179 184 189

124 128 132 136 140 144 149 153 157 162 166 171 176 180 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity In Adults: 118 122 126 130 134 138 142 146 150 154 159 163 168 172

113 116 120 124 127 131 135 139 143 147 151 155 160 164

107 110 114 118 121 125 128 132 136 140 144 148 152 156

63 64 65 66 67 68 69 70 71 72 73 74 75 76 Source: Adapted from

How To Lose Weight and Maintain It

Getting Started

We have all heard the facts . . . to lose weight, you have to eat less and move more. But this is often easier said than done. Many people make repeated attempts, often using different fad diets and weight loss gimmicks and are unsuccessful.

This booklet provides you with common sense guidance and tips on ways to eat less and move more, as well as weight loss goals that are attainable.

• Did you know that simply losing as little as 10 percent of your current body weight can make a difference in your health? Achieving this initial weight loss goal will help to lower your risk for heart disease and other conditions, including high blood pressure, type 2 diabetes, osteoporosis, and certain types of cancer.
• Did you know that a reasonable and safe weight loss is 1–2 pounds per week? While it may take as long as 6 months to lose the weight, it will make it easier to keep the weight off. And it will give you the time to make new healthy lifestyle changes such as eating a healthy diet and increasing your physical activity level.
• Did you know that it is better to maintain a moderate weight loss over a longer period of time than it is to lose lots of weight and regain

The following are general goals for weight loss and management:

• Reduce body weight if overweight or obese.
• Maintain a lower body weight over the long term.
• Prevent further weight gain (a minimum goal).

it? You can consider additional weight loss after you have lost 10 percent of your current body weight and have maintained it for 6 months.

To be successful at losing weight, you need to adopt a new lifestyle. This means making changes such as eating healthy foods, being more physically active, and learning how to change behaviors. Over time, these changes will become routine. But there are some people for whom lifestyle changes don’t work no matter how hard they try. Weight loss medications and weight loss surgery can be options for these people if they are at increased risk from overweight or obesity. Each of these approaches are discussed in this booklet.

A Healthy Eating Plan

Calories

To lose weight, most people need to cut down on the number of calories (units of energy) they get from food and beverages and increase their physical activity. For a weight loss of 1–2 pounds per week, daily intake should be reduced by 500 to 1,000 calories. In general:

• Eating plans containing 1,000–1,200 calories will help most women to lose weight safely.
• Eating plans between 1,200 calories and 1,600 calories each day are suitable for men and may also be appropriate for women who weigh 165 pounds or more or who exercise regularly.

If you are on a 1,600-calorie diet but do not lose weight, you may want to try a 1,200-calorie diet. If you are hungry on either diet, you may want to boost your calories by 100 to 200 per day. Very low calorie diets of less than 800 calories each day should not be used routinely because they require special monitoring by your doctor.

What foods make up a healthy eating plan?

A healthy eating plan is one that gives your body the nutrients it needs every day while staying within your daily calorie level. This eating plan will also lower your risk for heart disease and other conditions such as high blood pressure or high blood cholesterol levels.

Foods that can be eaten more often include those that are lower in calories, total fat, saturated and trans fat, cholesterol, and sodium (salt). Examples of these foods include fat-free and low-fat dairy products; lean meat, fish, and poultry; high-fiber foods such as whole grains, breads, and cereals; fruits; and vegetables. Canola or olive oils and soft margarines made from these oils are heart healthy and can be used in moderate amounts. Unsalted nuts can also be built into a healthy diet as long as you watch the amount.

Foods higher in fats are typically higher in calories. Foods that should be limited include those with higher amounts of saturated and trans fats and cholesterol. These particular fats raise blood cholesterol levels, which increases the risk for heart disease. Saturated fat is found mainly in fresh and processed meats; high-fat dairy products (like cheese, whole milk, cream, butter, and ice cream), lard, and in the coconut and palm oils found in many processed foods. Trans fat is found in foods with partially hydrogenated oils such as many hard margarines and shortening, commercially fried foods, and some bakery goods. Cholesterol is found in eggs, organ meats, and dairy fats.

It’s also important to limit foods and beverages with added sugars such as many desserts, canned fruit packed in syrup, fruit drinks, and sweetened beverages (nondiet drinks). Foods and beverages with added sugars will add calories to your diet without giving you needed nutrients.

A healthy eating plan includes foods from all the basic food groups. It is low in saturated fats, trans fat,

A healthy eating plan:

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
• Includes lean meats, poultry, fish, beans, eggs, and nuts.
• Is low in saturated fats, trans fat, cholesterol, salt (sodium), and added sugars.
• Controls portion sizes.

cholesterol, salt (sodium), and added sugars. It contains enough calories for good health but not too many so that you gain weight. A healthy eating plan also emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk and milk products, lean meats, poultry, fish, beans, eggs, and nuts. It also allows for reasonable portion sizes to control calories and prevent unhealthy weight gain.

Grains

Grains such as wheat, rice, oats, cornmeal, and barley are naturally low in fat and provide vitamins, minerals, and carbohydrates—all important for good health. Examples of grain products are breads, pasta, breakfast cereals, grits, tortillas, couscous, and crackers. Whole grain foods such as whole wheat bread, brown rice, and oatmeal also have fiber that helps protect you against certain diseases and keeps your body regular. Fiber can also help you feel full with fewer calories.

Vegetables

Most vegetables are naturally low in calories, fat, and cholesterol, and are filling. They are also important sources of many nutrients, including potassium, fiber, folate (folic acid), vitamin A, vitamin E, and vitamin C. People who eat more vegetables as part of an overall healthy diet are likely to have a lower risk of some chronic diseases such as heart disease and diabetes. Any vegetable or 100 percent-vegetable juice counts as a member of the vegetable group. Vegetables may be raw or cooked; fresh, frozen, canned, or dried/dehydrated; and may be whole, cut up, or mashed. To get the most health benefits, vary the types of vegetables you eat. Eat more dark green and orange vegetables.

Fruits

Most fruits are naturally low in fat, sodium, and calories. None have cholesterol. Fruits are important sources of many nutrients, including potassium, fiber, vitamin C, and folate (folic acid). Whole or cut up fruits also contain fiber which can provide a feeling of fullness with fewer calories. People who eat more fruits as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases such as heart disease and diabetes. Any fruit or 100 percent-fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut up, or pureed. To get the most health benefits, eat a variety of fruits and go easy on fruit juices to avoid getting too many calories.

Milk

Milk and milk products such as yogurt and cheese provide nutrients that are vital for the health and maintenance of your body. These nutrients include calcium, potassium, vitamin D, and protein. People who have a diet rich in milk and milk products can lower their risk of low bone mass (osteoporosis) and maintain healthy bones throughout the life cycle. Whole milk dairy foods contain unhealthy saturated fats, so it’s a good idea to choose low-fat or fat-free milk products such as milk, cheese, and yogurt. If you can’t tolerate milk, try lactose-free milk products.

Meat and Beans

All foods made from meat, poultry, fish, dry beans or peas, eggs, nuts, and seeds are considered part of this group. The foods in this group give you many

nutrients, including protein; B vitamins (niacin, thiamin, riboflavin, and B6); vitamin E; and minerals such as iron, zinc, and magnesium.

Meats, especially high-fat processed meats such as bologna, contain saturated fats and cholesterol, so it’s a good idea to limit these, or to try lower fat varieties. Also choose poultry, fish, beans, and peas more often. Nuts and seeds can be included for variety since they contain healthy fats, however, limit the amount to avoid getting too many calories. Bake, broil, or grill your meats.

Oils (Fats)

Unsaturated oils are necessary for good health in small amounts. Oils and solid fats both contain about 120 calories per tablespoon so the amount of oil you use needs to be limited to balance your total calorie intake. It’s especially important to limit saturated fat, which is found in whole dairy foods, many meats, butter, and lard, and raises blood cholesterol levels and thus the risk for heart disease. Most of your fat should be from fish, nuts, and vegetable oils. Limit solid fats like butter, stick margarine, shortening, and lard.

Daily Food Group Amounts

The table on the next page provides the suggested amounts of food that you should eat from the basic food groups at different calorie levels.

The next section will provide you with information on portion and serving sizes, low calorie menus, food shopping, preparation, and dining out to help you manage your weight.

Calorie Level 1,000 1,200 1,400 1,600 1,800 2,000 2,200

2,400 2,600 2,800

Food group amounts shown in cup (c) or ounce-equivalents (oz-eq), with number of servings (srv) in See note for quantity equivalents for foods in each group. Oils are shown in grams (g).

(2 srv) (2 srv) (3 srv) (3 srv) (3 srv) (4 srv) (4 srv)

Vegetables 1 c 1.5 c 1.5 c 2 c 2.5 c 2.5 c 3 c (2 srv) (3 srv) (3 srv) (4 srv) (5 srv) (5 srv) (6 srv)

Dark green veg. 1 c/wk 1.5 c/wk 1.5 c/wk 2 c/wk 3 c/wk 3 c/wk 3 c/wk

Orange veg. .5 c/wk 1 c/wk 1 c/wk 1.5 c/wk 2 c/wk 2 c/wk 2 c/wk

Legumes .5 c/wk 1 c/wk 1 c/wk 2.5 c/wk 3 c/wk 3 c/wk 3 c/wk

Starchy veg. 1.5 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk 3 c/wk 3 c/wk 6 c/wk

Other veg. 4 c/wk 4.5 c/wk 4.5 c/wk 5.5 c/wk 6.5 c/wk 6.5 c/wk 7 c/wk

Grains 3 oz-eq 4 oz-eq 5 oz-eq 5 oz-eq 6 oz-eq 6 oz-eq 7 oz-eq

Whole grains 1.5 2 2.5 3 3 3 3.5

Other grains 1.5 2 2.5 2 3 3 3.5

Lean meat 2 oz-eq 3 oz-eq 4 oz-eq 5 oz-eq 5 oz-eq 5.5 oz-eq 6 oz-eq and beans

Oils 15 g 17 g 17 g 22 g 24 g 27 g 29 g

Discretionary calorie allowance 165 171 171 132 195 267 290

Quantity equivalents for each food group:

2 c/wk 2.5 c/wk 2.5 c/wk

3 c/wk 3.5 c/wk 3.5 c/wk

6 c/wk 7 c/wk 7 c/wk

7 c/wk 8.5 c/wk 8.5 c/wk

8 oz-eq 9 oz-eq 10 oz-eq

4 4.5 5

4 4.5 5

6.5 oz-eq 6.5 oz-eq 7 oz-eq

31 g 34 g 36 g

362 410 426

fi cup cooked rice, pasta, or cooked cereal; 1 ounce dry pasta or rice; 1 slice bread; 1 small muffin (1 oz); 1 cup ready-to-eat cereal flakes. 1 cup cut-up raw or cooked fruit or vegetable, 1 cup fruit or vegetable juice, 2 cups leafy salad greens. 1 ounce lean meat, poultry, or fish; 1 egg; ⁄ cup cooked dry beans or tofu; 1 tablespoon peanut butter; fi ounce nuts or seeds. 1 cup milk or yogurt, 1fi ounces natural cheese such as cheddar Discretionary calories must be counted for all choices, except fat-free milk.

the remaining number of calories that can be from added sugars and fat in food preparation, sugars added to beverages, canned fruit; higher fat products.

www.healthierus.gov.

A calorie is a calorie is a calorie whether it comes from fat or carbohydrate. Anything eaten in excess can lead to weight gain. You can lose weight by eating less calories and by increasing your physical activity. Reducing the amount of fat and saturated fat that you eat is one easy way to limit your overall calorie intake. However, eating fat-free or reduced

Reduced fat peanut butter, 2 Tbsp

Cookies: Reduced fat chocolate chip cookies, 3 cookies (30 g) Fat-free fig cookies, 2 cookies (30 g)

Ice cream: Fat-free vanilla frozen yogurt (<1% fat), /2 cup Light vanilla ice cream (7% fat), fi cup Fat-free caramel topping, 2 Tbsp

Low-fat granola cereal, approx. /2 cup (55 g)

Low-fat blueberry muffin, 1 small (2 /2 inch)

Baked tortilla chips, 1 oz

Low-fat cereal bar, 1 bar (1.3 oz)

fat foods isn’t always the answer to weight loss. This is especially true when you eat more of the reduced fat food than you would of the regular item. For example, if you eat twice as many fatfree cookies, you have actually increased your overall calorie intake. The following list of foods and their reduced fat varieties will show you that just because a product is fat-free, it doesn’t mean that it is “calorie free.” And, calories do count!

Calories Calories

187 Regular peanut butter, 191 2 Tbsp

Cookies: 118 Regular chocolate chip cookies, 142 3 cookies (30 g) 102 Regular fig cookies, 111 2 cookies (30 g)

Ice cream: 100 Regular whole milk vanilla 104 frozen yogurt (3–4% fat), /2 cup 111 Regular vanilla ice cream 133 (11% fat), /2 cup 103 Caramel topping, homemade 103 with butter, 2 Tbsp

213 Regular granola cereal, 257 approx. /2 cup (55 g)

131 Regular blueberry muffin, 138 1 small (2 /2 inch)

113 Regular tortilla chips, 143 1 oz

130 Regular cereal bar, 140 1 bar (1.3 oz)

Nutrient data taken from Nutrient Data System for Research, Version v4. 02/30, Nutrition Coordinating Center, University of Minnesota.

These low calorie alternatives provide new ideas for old favorites. When making a food choice, remember to consider vitamins and minerals. Some foods

Dairy Products

Evaporated whole milk Whole milk Ice cream

Whipping cream

Sour cream Cream cheese

Cheese (cheddar, American, Swiss, jack)

Regular (4%) cottage cheese Whole milk mozzarella cheese Whole milk ricotta cheese Coffee cream (half and half) or nondairy creamer (liquid, powder)

Cereals, Grains, and Pasta Ramen noodles

Pasta with white sauce (alfredo) Pasta with cheese sauce Granola

Meat, Fish, and Poultry Cold cuts or lunch meats

(bologna, salami, liverwurst, etc.) Hot dogs (regular) Bacon or sausage Regular ground beef

Chicken or turkey with skin, duck, or goose Oil-packed tuna Beef (chuck, rib, brisket)

provide most of their calories from sugar and fat but give you few, if any, vitamins and minerals.

This guide is not meant to be an exhaustive list. We stress reading labels to find out just how many calories are in the specific products you decide to buy.

Evaporated fat-free (skim) or reduced fat (2%) milk Low-fat (1%), reduced fat (2%), or fat-free (skim) milk Sorbet, sherbet, low-fat or fat-free frozen yogurt, or ice milk (check label for calorie content) Imitation whipped cream (made with fat-free [skim] milk) or low-fat vanilla yogurt Plain low-fat yogurt Neufchatel or “light” cream cheese or fat-free cream cheese Reduced calorie cheese, low calorie processed cheeses, etc.; fat-free cheese Low-fat (1%) or reduced fat (2%) cottage cheese Part skim milk, low moisture mozzarella cheese Part skim milk ricotta cheese Low-fat (1%) or reduced fat (2%) milk or fat-free dry milk powder

Rice or noodles (spaghetti, macaroni, etc.) Pasta with red sauce (marinara) Pasta with vegetables (primavera) Bran flakes, crispy rice, etc. Cooked grits or oatmeal Whole grains (e.g., couscous, barley, bulgur, etc.) Reduced fat granola

Low-fat cold cuts (95% to 97% fat-free lunch meats, low-fat pressed meats) Lower fat hot dogs Canadian bacon or lean ham Extra lean ground beef such as ground round or ground turkey (read labels) Chicken or turkey without skin (white meat)

Water-packed tuna (rinse to reduce sodium content) Beef (round, loin) trimmed of external fat (choose select grades)

Continued on next page

Continued from previous page

Pork (spareribs, untrimmed loin) Frozen breaded fish or fried fish (homemade or commercial) Whole eggs Frozen TV dinners (containing more than 13 grams of fat per serving) Chorizo sausage

Baked Goods

Croissants, brioches, etc. Donuts, sweet rolls, muffins, scones, or pastries Party crackers

Cake (pound, chocolate, yellow) Cookies

Snacks and Sweets Nuts

Ice cream, e.g., cones or bars

Custards or puddings (made with whole milk)

Fats, Oils, and Salad Dressings Regular margarine or butter

Regular mayonnaise Regular salad dressings

Butter or margarine on toast or bread Oils, shortening, or lard

Miscellaneous

Canned cream soups Canned beans and franks Gravy (homemade with fat and/or milk)

Fudge sauce Avocado on sandwiches Guacamole dip or refried beans with lard

Pork tenderloin or trimmed, lean smoked ham Fish or shellfish, unbreaded (fresh, frozen, canned in water) Egg whites or egg substitutes Frozen TV dinners (containing less than 13 grams of fat per serving and lower in sodium) Turkey sausage, drained well (read label) Vegetarian sausage (made with tofu)

Hard french rolls or soft “brown ’n serve” rolls English muffins, bagels, reduced fat or fat-free muffins or scones Low-fat crackers (choose lower in sodium) Saltine or soda crackers (choose lower in sodium) Cake (angel food, white, gingerbread) Reduced fat or fat-free cookies (graham crackers, ginger snaps, fig bars) (compare calorie level)

Popcorn (air-popped or light microwave), fruits, vegetables Frozen yogurt, frozen fruit, or chocolate pudding bars Puddings (made with skim milk)

Light-spread margarines, diet margarine, or whipped butter, tub or squeeze bottle Light or diet mayonnaise or mustard Reduced calorie or fat-free salad dressings, lemon juice, or plain, herb-flavored, or wine vinegar Jelly, jam, or honey on bread or toast Nonstick cooking spray for stir-frying or sautéing As a substitute for oil or butter, use applesauce or prune puree in baked goods.

Canned broth-based soups Canned baked beans in tomato sauce Gravy mixes made with water or homemade with the fat skimmed off and fat-free milk included Chocolate syrup Cucumber slices or lettuce leaves Salsa

What’s the Difference Between a Portion and a Recommended Serving Size?

Portion

A “portion” is the amount of a food that you choose to eat for a meal or snack. It can be big or small— you decide.

Serving

A “serving” is a measured amount of food or drink, such as one slice of bread or 1 cup of milk. Some foods that most people consume as a single serving actually contain multiple serving sizes (e.g., a 20-ounce soda, or a 3-ounce bag of chips).

1 Serving Looks Like . . .

Grains

1 cup of cereal flakes = fist

1 pancake = compact disc

1 1

/2 cup of cooked rice, pasta, or potato =/2 baseball

1 slice of bread = cassette tape

1 piece of cornbread = bar of soap

1 Serving Looks Like . . .

Milk

1/2 oz cheese = 4 stacked dice or 2 cheese slices

1 1

/2 cup of ice cream =/2 baseball

Fats/Oils

1 tsp margarine or spreads = 1 dice

Nutrition recommendations use serving sizes to help people know how much of different types of foods they should eat to get the nutrients they need. The Nutrition Facts Label on packaged foods also lists a serving size. The serving sizes on packaged foods are not always the same as those included in nutrition recommendations. However, serving sizes are standardized to make it easier to compare similar foods. To get an idea of how big recommended serving sizes really are, refer to the chart below. For help on using the Nutrition Facts Label, refer to page 17.

Also, check out the NHLBI Portion Distortion Interactive Quiz at http://hin.nhlbi.nih.gov/ portion/ to see how portion sizes have changed in 20 years.

1 Serving Looks Like . . .

Fruits and Vegetables

1 med fruit = baseball

1 1

/2 cup of fresh fruit =/2 baseball

/4 cup of raisins = large egg

1 cup of salad greens = baseball

1 baked potato = fist

1 Serving Looks Like . . .

Lean Meat and Beans

3 oz meat, fish, and poultry = deck of cards

3 oz grilled/baked fish = checkbook

2 Tbsp peanut butter = ping pong ball

Southern, Asian, Mexican-American) at two calorie levels, 1,200 and 1,600. These menus are appropri- The reduced calorie menus illustrate healthy food ate for weight loss in women and men. choices from a variety of cuisines (American,

Breakfast 1,200 Calories

Whole wheat bread 1 med slice Jelly, regular 2 tsp Cereal, shredded wheat /2 cup Milk, 1% 1 cup Orange juice /4 cup Coffee, regular 1 cup

Lunch

Roast beef sandwich:

Dinner

Salmon 2 oz edible Vegetable oil 1/2 tsp Baked potato /4 med Margarine 1 tsp Green beans, seasoned, with margarine /2 cup

Snack

Popcorn 2/2 cup Margarine /4 tsp

Total carbohydrate, % kcals . . . . . . . .58 Total carbohydrate, % kcals . . . . . . . .55

Note: Calories have been rounded. *No salt added in recipe preparation or as seasoning.

1,600 Calories

1 med slice 2 tsp 1 cup 1 cup /4 cup 1 cup with 1 oz of 1% milk

2 med slices 2 oz 1 slice, /4 oz 1 leaf 3 med slices 2 tsp 1 med 1 cup

3 oz edible 1/2 tsp /4 med 1 tsp /2 cup /2 cup 1 med /2 cup 1 cup 2 cup

2/2 cup /2 tsp

Breakfast 1,200 Calories

Orange juice /4 cup Milk 1%, low fat /4 cup

Lunch

Beef noodle soup, canned, low sodium /2 cup Chinese noodle and beef salad:

Carrots /2 cup Zucchini /2 cup Onion /4 cup

Dinner

Pork stir-fry with vegetables:

Broccoli /2 cup Carrots /2 cup Mushrooms /2 cup Steamed white rice /2 cup Tea, unsweetened 1 cup

Snack

Almond cookies — Milk 1%, low fat /4 cup

Total carbohydrate, % kcals . . . . . . . .55 Total carbohydrate, % kcals . . . . . . . .56

Note: Calories have been rounded. *No salt added in recipe preparation or as seasoning.

1,600 Calories

1 small 2 slices 1 tsp /4 cup /4 cup

/2 cup

3 oz 1/2 tsp 1 tsp /2 cup /2 cup /4 cup /4 cup 1 med 1 cup

2 oz 1 tsp 1 tsp /2 cup 1 cup /4 cup 1 cup 1 cup

2 cookies /4 cup

Breakfast 1,200 Calories

Oatmeal, prepared with 1% milk, low fat /2 cup

Lunch

Baked chicken, without skin 2 oz Vegetable oil /2 tsp Salad: Lettuce /2 cup Tomato /2 cup Cucumber /2 cup Oil and vinegar dressing 1 tsp White rice /4 cup Margarine, diet /2 tsp

Dinner

Lean roast beef 2 oz Onion /4 cup Beef gravy, water-based 1 Tbsp Turnip greens /2 cup Margarine, diet /2 tsp Sweet potato, baked 1 small

Corn bread prepared with margarine, diet /2 med slice Honeydew melon /8 med Iced tea, sweetened with sugar 1 cup

Snack

Saltine crackers, unsalted tops 4 crackers Mozzarella cheese, part skim, low sodium 1 oz

Total carbohydrate, % kcals . . . . . . . .50 Total carbohydrate, % kcals . . . . . . . .53

Note: Calories have been rounded. *No salt added in recipe preparation or as seasoning.

1,600 Calories

/2 cup /2 cup 1 med 1 Tbsp /4 cup 1 cup 1 oz

2 oz 1 tsp

/2 cup /2 cup /2 cup 2 tsp /2 cup /2 tsp 1 small 1 tsp 1 cup

3 oz /4 cup 1 Tbsp /2 cup /2 tsp 1 small /2 tsp 1 tsp 1 tsp /2 med slice /4 med 1 cup

4 crackers 1 oz

Breakfast 1,200 Calories

Cantaloupe /2 cup

Orange juice /4 cup Milk, 1%, low fat /2 cup

Lunch

Beef enchilada: Tortilla, corn 2 tortillas Lean roast beef 2 oz

Lettuce /2 cup Chili peppers 2 tsp

Dinner

Chicken taco: Tortilla, corn 1 tortilla Chicken breast, without skin 1 oz Vegetable oil /3 tsp

Corn /2 cup

Spanish rice without meat /2 cup Banana /2 large Coffee /2 cup Milk, 1%, low fat 1 oz

Total carbohydrate, % kcals . . . . . . . .58 Total carbohydrate, % kcals . . . . . . . .56

Note: Calories have been rounded. *No salt added in recipe preparation or as seasoning.

1,600 Calories

1 cup /2 cup 1 slice 1 tsp 1 tsp 1/2 cup /2 cup

2 tortillas 2/2 oz /3 tsp 1 Tbsp 4 Tbsp /2 cup 2 tsp /4 cup 5 sticks 6 sticks /2 cup

1 tortilla 2 oz /3 tsp 1 oz 2 Tbsp 1 Tbsp /2 cup seasoned with /2 tsp margarine /2 cup 1 large 1 cup 1 oz

Foods Lower in Calories and Fat

Use this guide to help you shop for foods that are nutritious and lower in calories and fat to help you achieve your weight goal. Learning how to read a Nutrition Facts food label will help you save time in the store and fill your kitchen with low calorie foods.

Read labels as you shop. Pay attention to the serving size and the servings per container. All labels list total calories and fat in a serving size of the product. Compare the total calories in the product

you choose with others like it; choose one that is lowest in calories and fat. Below is a label that identifies important information.

To achieve your weight goal, you may need to eat much less than the 2,000-calorie reference amount. For example, if you eat 1,600 calories per day, your total daily fat limit should be 53 grams (30 percent calories from fat) and 18 grams of saturated fat (10 percent calories from fat). If you eat 1,200 calories per day, your total daily fat limit should be 40 grams (30 percent calories from fat) and your total daily saturated fat limit would be 13 grams (10 percent calories from fat).

Low Calorie, Low-fat Cooking/Serving Methods

Cooking low calorie, low-fat dishes may not take a long time, but best intentions can be lost with the addition of butter or other added fats at the table. It is important to learn how certain ingredients can add unwanted calories and fat to low-fat dishes— making them no longer lower in calories and lower in fat. The following list provides examples of lower fat cooking methods and tips on how to serve your low-fat dishes.

Low-fat Cooking Methods

These cooking methods tend to be lower in fat:

• Bake
• Broil
• Microwave
• Roast—for vegetables and/or chicken without skin
• Steam
• Lightly stir-fry or sauté in cooking spray, small amounts of vegetable oil, or reduced sodium broth
• Grill seafood, chicken, or vegetables

How To Save Calories and Fat

Look at the following examples for how to save calories and fat when preparing and serving foods. You might be surprised at how easy it is.

• Two tablespoons of butter on a baked potato adds an extra 200 calories and 22 grams of fat. However, /4 cup salsa adds only 18 calories and no fat.
• Two tablespoons of regular clear Italian salad dressing will add an extra 136 calories and 14 grams of fat. Reduced fat Italian dressing adds only 30 calories and 2 grams of fat.

Try These Low-fat Flavorings—Added During Preparation or at the Table:

• Herbs—oregano, basil, cilantro, thyme, parsley, sage, or rosemary
• Spices—cinnamon, nutmeg, pepper, or paprika
• Reduced fat or fat-free salad dressing
• Mustard
• Ketchup
• Fat-free mayonnaise
• Fat-free or reduced fat sour cream
• Fat-free or reduced fat yogurt
• Reduced sodium soy sauce
• Salsa
• Lemon or lime juice
• Vinegar
• Horseradish
• Fresh ginger
• Sprinkled buttered flavor (not made with real butter)
• Red pepper flakes
• Sprinkle of parmesan cheese (stronger flavor than most cheese)
• Sodium free salt substitute
• Jelly or fruit preserves on toast or bagels

General Tips for Healthy Dining Out

Whether or not you’re trying to lose weight, you can eat healthfully when dining out or bringing in food, if you know how. The following tips will help you move toward healthier eating as you limit your calories, as well as fat, saturated fat, cholesterol, and sodium when eating out.

You Are the Customer

• Ask for what you want. Most restaurants will honor your requests.
• Ask questions. Don’t be intimidated by the menu— your server will be able to tell you how foods are prepared or suggest substitutions on the menu.
• To reduce portion sizes, try ordering appetizers as your main meal or share an entree with a friend or family member.
• General tips: Limiting your calories and fat can be easy as long as you know what to order. Try asking these questions when you call ahead or before you order. Ask the restaurant, whether they would, on request, do the following:
• Serve fat-free (skim) milk rather than whole milk or cream
• Reveal the type of cooking oil used
• Trim visible fat off poultry or meat
• Leave all butter, gravy, or sauces off a side dish or entree
• Serve salad dressing on the side
• Accommodate special requests if made in advance by telephone or in person

Above all, don’t get discouraged. There are usually several healthy choices to choose from at most restaurants.

Reading the Menu

• Choose lower calorie, low-fat cooking methods. Look for terms such as, “steamed in its own juice” (au jus), “garden fresh,” “broiled,” “baked,” “roasted,” “poached,” “tomato juice,” “dry boiled” (in wine or lemon juice), or “lightly sautéed.”
• Be aware of foods high in calories, fat, and saturated fat. Watch out for terms such as “butter sauce,”“fried,”“crispy,”“creamed,” “in cream or cheese sauce,”“au gratin,”“au fromage,”“escalloped,”“parmesan,”“hollandaise,”“bearnaise,” “marinated (in oil),”“stewed,”“basted,”“sautéed,” “stir-fried,”“casserole,”“hash,”“prime,”“pot pie,” and “pastry crust.”

Specific Tips for Healthy Choices

Breakfast

• Fresh fruit or small glass of citrus juice
• Whole grain bread, bagel, or English muffin with jelly or honey
• Whole grain cereal with low-fat (1%) or fat-free milk
• Oatmeal with fat-free milk topped with fruit
• Omelet made with egg whites or egg substitute
• Multigrain pancakes without butter on top
• Fat-free yogurt (Try adding cereal or fresh fruit.)

Beverages

• Water with lemon
• Flavored sparkling water (noncaloric)
• Juice spritzer (half fruit juice and half sparkling water)
• Iced tea
• Tomato juice (reduced sodium)

Bread

Most bread and bread sticks are low in calories and low in fat. The calories add up when you add butter, margarine, or olive oil to the bread. Also, eating a lot of bread in addition to your meal will fill you up with extra unwanted calories and not leave enough room for fruits and vegetables.

Appetizers

• Steamed seafood
• Shrimp* cocktail (limit cocktail sauce—it’s high in sodium)
• Melons or fresh fruit
• Bean soups
• Salad with reduced fat dressing (or add lemon juice or vinegar)

Entree

• Poultry, fish, shellfish, and vegetable dishes are healthy choices
• Pasta with red sauce or with vegetables (primavera)
• Look for terms such as “baked,” “broiled,” “steamed,” “poached,” “lightly sauteed,” or “stir-fried”
• Ask for sauces and dressings on the side
• Limit the amount of butter, margarine, and salt you use at the table

Salads/Salad Bars

• Fresh greens, lettuce, and spinach
• Fresh vegetables—tomato, mushroom, carrots, cucumber, peppers, onion, radishes, and broccoli
• Beans, chickpeas, and kidney beans
• Skip the nonvegetable choices: deli meats, bacon, egg, cheese, croutons
• Choose lower calorie, reduced fat, or fat-free dressing; lemon juice; or vinegar

Side Dish

• Vegetables and starches (rice, potato, noodles) make good additions to meals and can also be combined for a lower calorie alternative to higher calorie entrees
• Ask for side dishes without butter or margarine
• Ask for mustard, salsa, or low-fat yogurt instead of sour cream or butter

Dessert/Coffee

• Fresh fruit
• Fat-free frozen yogurt
• Sherbet or fruit sorbet (these are usually fat-free, but check the calorie content)
• Try sharing a dessert
• Ask for low-fat milk for your coffee (instead of cream or half-and-half)
• If you are on a cholesterol-lowering diet, eat shrimp and other shellfish in moderation.

If you’re dining out or bringing in, it is easy to find healthy foods. Knowing about American food terms, as well as other ethnic cuisines, can help make your dining experience healthy and enjoyable. The following list includes healthy food choices (lower in calories and fat) and terms to look for when making your selection.

Chinese

Choose More Often . . .

• Steamed
• Jum (poached)
• Chu (boiled)
• Kow (roasted)
• Shu (barbecued)
• Hoison sauce with assorted Chinese vegetables: broccoli, mushrooms, onion, cabbage, snow peas, scallions, bamboo shoots, water chestnuts, asparagus
• Oyster sauce (made from seafood)
• Lightly stir-fried in mild sauce
• Cooked in light wine sauce
• Hot and spicy tomato sauce
• Sweet and sour sauce
• Hot mustard sauce
• Reduced sodium soy sauce
• Dishes without MSG added
• Garnished with spinach or broccoli
• Fresh fish filets, shrimp, scallops
• Chicken, without skin
• Lean beef
• Bean curd (tofu)
• Moo shu vegetables, chicken, or shrimp
• Steamed rice
• Lychee fruit

French

Choose More Often . . .

• Dinner salad with vinegar or lemon juice dressing (or other reduced fat dressing)
• Crusty bread without butter
• Fresh fish, shrimp, scallops, steamed mussels (without sauces)
• Chicken breast, without skin
• Rice and noodles without cream or added butter or other fat
• Fresh fruit for dessert

Italian

Choose More Often . . .

• Lightly sautéed with onions
• Shallots
• Peppers and mushrooms
• Artichoke hearts
• Sun-dried tomatoes
• Red sauces—spicy marinara sauce (arrabiata), marinara sauce, or cacciatore
• Light red sauce or light red or white wine sauce
• Light mushroom sauce
• Red clam sauce
• Primavera (no cream sauce)
• Lemon sauce
• Capers
• Herbs and spices—garlic and oregano
• Crushed tomatoes and spices
• Florentine (spinach)
• Grilled (often fish or vegetables)
• Piccata (lemon)
• Manzanne (eggplant)

Middle Eastern

Choose More Often . . .

• Lemon dressing, lemon juice
• Blended or seasoned with Middle Eastern spices
• Herbs and spices
• Mashed chickpeas
• Fava beans
• Smoked eggplant
• With tomatoes, onions, green peppers, and cucumbers
• Spiced ground meat
• Special garlic sauce
• Basted with tomato sauce
• Garlic
• Chopped parsley and/or onion
• Couscous (grain)
• Rice or bulgur (cracked wheat)
• Stuffed with rice and imported spices
• Grilled on a skewer
• Marinated and barbecued
• Baked
• Charbroiled or charcoal broiled
• Fresh fruit

Japanese

Choose More Often . . .

• House salad with fresh ginger and cellophane (clear rice) noodles
• Rice
• Nabemono
• Chicken, fish, or shrimp teriyaki, broiled in sauce
• Soba noodles, often used in soups
• Yakimono (broiled)
• Tofu or bean curd
• Grilled vegetables

Indian

Choose More Often . . .

• Tikka (pan roasted)
• Cooked with, or marinated in yogurt
• Cooked with green vegetables, onions, tomatoes, peppers, and mushrooms
• With spinach (saag)
• Baked leavened bread
• Masala
• Tandoori
• Paneer
• Cooked with curry, marinated in spices
• Lentils, chickpeas (garbanzo beans)
• Garnished with dried fruits
• Chickpeas (garbanzo) and potatoes
• Basmati rice (pullao)
• Matta (peas)
• Chicken or shrimp kebab

Mexican

Choose More Often . . .

• Shredded spicy chicken
• Rice and black beans
• Rice
• Ceviche (fish marinated in lime juice and mixed with spices)
• Served with salsa (hot red tomato sauce)
• Served with salsa verde (green chili sauce)
• Covered with enchilada sauce
• Topped with shredded lettuce, diced tomatoes, and onions
• Served with or wrapped in a corn or wheat flour (soft) tortilla
• Grilled
• Marinated
• Picante sauce
• Simmered with chili vegetarian tomato sauce

Thai

Choose More Often . . .

• Barbecued, sautéed, broiled, boiled, steamed, braised, marinated
• Charbroiled
• Basil sauce, basil, or sweet basil leaves
• Lime sauce or lime juice
• Chili sauce or crushed dried chili flakes
• Thai spices
• Served in hollowed-out pineapple
• Fish sauce
• Hot sauce
• Napa, bamboo shoots, black mushrooms, ginger, garlic
• Bed of mixed vegetables
• Scallions, onions

Steak Houses

Choose More Often . . .

• Lean broiled beef (no more than 6 ounces)— London broil, filet mignon, round and flank steaks
• Baked potato without added butter, margarine, or sour cream. Try low-fat yogurt or mustard.
• Green salad with reduced fat dressing
• Steamed vegetables without added butter or margarine. Try lemon juice and herbs.
• Seafood dishes (usually indicated as “surf ” on menus)

Fast Food

Choose More Often . . .

• Grilled chicken breast sandwich without mayonnaise
• Single hamburger without cheese
• Grilled chicken salad with reduced fat dressing
• Garden salad with reduced fat dressing
• Low-fat or fat-free yogurt
• Fat-free muffin
• Cereal with low-fat milk

Deli/Sandwich Shop

Choose More Often . . .

• Fresh sliced vegetables in pita bread with low-fat dressing, yogurt, or mustard
• Cup of bean soup (lentil, minestrone)
• Turkey breast sandwich with mustard, lettuce, and tomato
• Fresh fruit

When you eat in a heart healthy way, you don’t have to give up eating fast foods completely. You can eat right and still eat fast foods if you select carefully. Here are some tips on fast foods to choose:

• Order a small hamburger instead of a larger one. Try the lower fat hamburger. Hold the extra sauce.
• Order roast beef for a leaner choice than most burgers.
• Order a baked potato instead of french fries. Be careful of high fat toppings like sour cream, butter, or cheese.
• Order grilled, broiled, or baked fish and chicken.
• Order skim or 1-percent milk instead of a milkshake. Try the low-fat frozen yogurt or low-fat milkshake.
• Order a salad. Use vinegar and oil or low calorie dressing.
• Create a salad at the salad bar. Choose any raw vegetables, fruits, or beans. Limit high saturated fat toppings of cheese, fried noodles, and bacon bits as well as some salads made with mayonnaise. Also limit salad dressings high in saturated fat and cholesterol.
• For sandwich toppings try lettuce, tomato, onion, mustard, and ketchup instead of toppings high in saturated fat, such as cheese, bacon, special sauces, or butter.
• Order pizza with vegetable toppings such as peppers, mushrooms, or onions instead of extra cheese, pepperoni, or sausage.

Let’s see how small changes can add up to big changes with the following sample fast-food meal:

Typical Meal

Cheeseburger Large french fries 12-ounce cola Vanilla ice milk cone

Lower Fat Choice

Hamburger /2 small french fries 12-ounce cola Low-fat frozen yogurt cone

Saturated fat (g) 6 Dietary cholesterol (mg) 38

Total fat (g) 19 Total calories 649

Physical Activity

Both healthy eating and physical activity are important in weight control. Most successful weight loss involves a combination of eating fewer calories and using more energy through activity. Staying physically active is most helpful in keeping weight off for life. Plus, physical activity has the benefit of lowering the risk of certain diseases such as heart disease and diabetes—beyond the impact of losing weight.

There are many other benefits of regular physical activity listed in the box on page 26.

• For overall health and to reduce the risk of disease, aim for at least 30 minutes of moderate physical activity most days of the week.
• To help manage body weight and prevent gradual weight gain, aim for 60 minutes of moderate-to-vigorous physical activity most days of the week.

Common Chores

Less Vigorous,

More Time Washing and waxing a car for 45 to 60 minutes Washing windows or floors for 45 to 60 minutes Gardening for 30 to 45 minutes Wheeling self in wheelchair 30 to 40 minutes Pushing a stroller 1/2 miles in 30 minutes Raking leaves for 30 minutes Walking 2 miles in 30 minutes (15 minutes/mile) Shoveling snow for 15 minutes Stair-walking for 15 minutes

More Vigorous, Less Time

• To maintain weight loss, aim for at least 60–90 minutes of daily moderate physical activity.

You can do this all at one time, or break it up into shorter bouts of physical activity such as 15 minutes at a time.

Most adults do not need to see their doctor before starting or increasing their activity level. However, you should speak to your doctor before starting a very active (vigorous) program if you are over age 40 (men) or over age 50 (women), or if you have one or more of the conditions below:

• A health problem, such as heart disease, high blood pressure, diabetes, osteoporosis (bone loss), asthma, or obesity
• High risk for heart disease, such as a family history of heart disease or stroke, eating a diet high in saturated fat and cholesterol, smoking, or having an inactive lifestyle

If you have not been physically active in the past, the key to success is to start slowly. Trying too hard at first can lead to injury. Also, taking the time to

Sporting Activities

Playing volleyball for 45 to 60 minutes

Playing touch football for 45 minutes

Walking 1/4 miles in 35 minutes (20 minutes/mile) Basketball (shooting baskets) for 30 minutes

Bicycling 5 miles in 30 minutes

Dancing fast (social) for 30 minutes Water aerobics for 30 minutes

Swimming laps for 20 minutes Basketball (playing game) for 15 to 20 minutes Bicycling 4 miles in 15 minutes Jumping rope for 15 minutes Running 1/2 miles in 15 minutes (10 minutes/mile)

You can have fun and feel healthier by doing any of the following:

• Walk or ride a bike in your neighborhood.
• Join a walking club at a mall or at work.
• Play golf at a local club.
• Join a dance class.
• Work in your garden.
• Use local athletic facilities.
• Join a hiking or biking club.
• Join a softball team or other sports team with coworkers, friends, or family.
• Chase your kids in the park. If you don’t have kids, take your neighbor’s. They will appreciate the break, the kids will enjoy it, and you’ll benefit from getting more activity.
• Walk your dog. If you don’t have a dog, pretend you do.
• Take a walk during your lunch break.

find out what you enjoy doing will help to make physical activity a regular part of your lifestyle.

For the beginner, one way to be more active is to do more “everyday” activities, such as taking the stairs instead of the elevator, stretching or taking a walk during breaks at work, and spending less time watching television and working on the computer. Also, try spending more time doing activities such as gardening, household chores, pushing a stroller or wheelchair, yard work, ironing or cooking, and playing a musical instrument.

The next level would be light activities, such as slow walking, garage work, carpentry, house cleaning, child care, golf, sailing, and recreational table tennis.

Once comfortable with this level, try adding more moderate activities such as faster walking, weeding and hoeing a garden, carrying a load, cycling, skiing, tennis, and dancing.

For example, you can start out walking slowly a total of 20 minutes for 3 days a week and gradually build to 45 minutes or more of faster-paced walking. By doing this, you can use 100 to 200 more calories per day. This plan can be used with other types of physical activity, but walking is popular because it is safe and convenient.

High intensity (vigorous) activities include very fast walking or walking with a load uphill, tree felling, heavy manual digging, basketball, climbing, or soccer/kickball.

You may also want to try:

• Flexibility exercise to improve joints and muscles
• Strength-building or resistance exercises
• Aerobic conditioning

If structured group activities are what you need to help you stay physically active, try joining community recreation programs, the YMCA, or a health club. You can find a variety of activities for all fitness levels and budgets.

The key to success is to choose activities that you enjoy.

• Your weight is much easier to control when you are active.
• Physical activity can be lots of fun.
• You can be with other people when you are active.
• You’ll feel and look better when you’re physically active.
• Physical activity is good for your heart.
• Physical activity is a great way to burn off steam and stress and helps you beat the blues.
• You’ll feel more confident when you are active.
• You’ll have more energy.

Many people are completely inactive, and they all have reasons such as:

I don’t have the time to exercise.

While physical activity does take time, only 30 minutes of moderate activity most days of the week gives benefits to your heart, lungs, and muscles. Although 60 minutes of moderate activity is recommended for weight loss, you don’t have to do it all at once. You can break it up into smaller chunks such as 20 minutes, three times a day. Consider the amount of time you spend watching TV. Also, many forms of physical activity can be done while watching TV, such as riding an exercise bike or using hand weights.

I don’t like to exercise.

You have bad memories of doing situps or running in high school, sweating, puffing, and panting. Now we know that you can get plenty of gain without pain. Activities you already do such as gardening and walking can improve your health, so just do more of the activities you like.

I don’t have the energy to be more active.

Once you become a little more active, you should have more energy. As you progress, daily tasks will seem easier.

Try the sample walking program on page 28 to get you started on a more physically active life.

Examples of moderate and vigorous types of physical activities and the number of calories used (or burned) are shown below.

Approximate Calories/Hr for a

Approximate Calories/Hr for a

From: Dietary Guidelines for Americans 2005. U.S. Department of Health and Human Services; U.S. Department of Agriculture.

Warm-up Exercising Week 1

Session A Walk 5 min Then walk briskly 5 min Session B Repeat above pattern

Session C Repeat above pattern

Cool down Total time

Then walk more 15 min slowly 5 min

Continue with at least three exercise sessions during each week of the program

Week 2

Walk 5 min Walk briskly 7 min

Week 3

Walk 5 min Walk briskly 9 min

Week 4

Walk 5 min Walk briskly 11 min

Week 5

Walk 5 min Walk briskly 13 min

Week 6

Walk 5 min Walk briskly 15 min

Week 7

Walk 5 min Walk briskly 18 min

Week 8

Walk 5 min Walk briskly 20 min

Week 9

Walk 5 min Walk briskly 23 min

Week 10

Walk 5 min Walk briskly 26 min

Week 11

Walk 5 min Walk briskly 28 min

Week 12

Walk 5 min Walk briskly 30 min

Week 13 on:

Gradually increase your brisk walking time to 30–60 minutes, three or four times a week. Remember that your goal is to get the benefits you are seeking and enjoy your activity.

• Hold your head up, and keep your back straight.
• Bend your elbows as you swing your arms.
• Take long, easy strides.

Other Weight Loss Options

Weight loss drugs approved by the Food and Drug Administration (FDA) may be an option for some patients and should be used only as part of a program that includes diet, physical activity, and behavioral changes.

Weight loss drugs may be considered:

• For people with a body mass index (BMI) ≥27 who also have obesity-related risk factors or diseases
• For people with a BMI ≥30 without other obesity-related risk factors or diseases
• If weight loss of 1 pound per week has not occurred after 6 months of a calorie-controlled diet and physical activity

Two weight drugs have been approved by the FDA. They are Sibutramine (Meridia) and Orlistat (Xenical). These drugs have been shown to produce a modest weight loss (between 4.4 and 22 pounds), although some people lose more weight. It is not possible to predict exactly how much weight an individual may lose. Most of the weight loss occurs within the first 6 months of therapy.

The table below provides some information about weight loss drugs.

If you think you’re a candidate for weight loss drugs, you should discuss this option with your doctor. Patients on weight loss drugs need to be monitored for side effects by their doctors. Followup visits are generally recommended within 2–4 weeks after

starting the medication, then monthly for 3 months, then every 3 months for the first year after starting the medication. After the first year, your doctor will advise you on appropriate return visits. The purpose of these visits is to monitor weight, blood pressure, and pulse; discuss side effects; conduct laboratory tests; and answer your questions.

Weight loss surgery may be an option for patients with severe obesity (BMI ≥40 or a BMI ≥35 with high-risk, comorbid conditions such as life threatening severe sleep apnea, obesity-related cardiomyopathy, or severe diabetes). Weight loss surgery may also be considered for people with severe obesity when other methods of treatment have failed.

Two types of operations have proven to be effective: a banded gastroplasty that limits the amount of food and liquids the stomach can hold, and the Roux-en-Y gastric bypass that, in addition to limiting food intake, also alters digestion.

Both of these procedures carry a risk of complications depending on the individual’s weight and overall health. Lifelong medical monitoring is necessary as well as a comprehensive program before and after surgery to provide guidance on diet, physical activity, and psychosocial concerns.

If you feel that you are a candidate for weight loss surgery, talk to your doctor. Ask him/her to assess whether you are a candidate for the surgery and discuss the risks, benefits, and what to expect.

(For more information on weight loss surgery, please refer to Additional Information at the end of this booklet.)

Increase in heart rate and blood pressure

heart failure, arrhythmias, or history of stroke

Decreased absorption of fat-soluble vitamins; oily, loose, and more frequent bowel movements

Moving Forward

Weight management is a long-term challenge influenced by behavioral, emotional, and physical factors. Changing the way you approach weight loss can help you be more successful. Most people who are trying to lose weight focus on one thing: weight loss. However, setting goals and focusing on physical activity changes is much more productive.

Setting the right goals is an important first step. Did you know that the amount of weight loss needed to improve health may be much less than you want to lose to look thinner? If your provider suggests an initial weight loss goal that seems too heavy for you, please understand that your health can be greatly improved by a loss of 5 percent to 10 percent of your starting weight. That doesn’t mean you have to stop there, but it does mean that an initial goal of 5 percent to 10 percent of your starting weight is both realistic and valuable.

It’s important to set diet and/or physical activity goals. People who are successful at managing their weight set only two to three goals at a time.

Effective goals are:

• Specific
• Realistic
• Forgiving (less than perfect)

For example:

“Exercise more” is a fine goal, but it’s not specific enough.

“Walk 5 miles every day” is specific and measurable, but is it achievable 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 on another day?

“Walk 30 minutes, 5 days each week” is specific, achievable, and forgiving. A great goal!

Shaping is a technique where you set some short-term goals that get you closer and closer to the ultimate goal (e.g., reduce fat from 40 percent of calories to 35 percent of calories, and ultimately to 30 percent). It is based on the concept that “nothing succeeds like success.” Shaping uses two important behavioral principles:

• Continuous goals that move you ahead in small steps to reach a distant point
• Continuous rewards to keep you motivated to make changes

Rewards that you control can encourage achievement of your goals, especially ones that have been hard to reach. An effective reward is something that is desirable, timely, and dependent upon meeting your goal. The rewards you choose may be material, (e.g., a movie, music CD, or a payment toward buying a larger item) or an act of selfkindness (e.g., an afternoon off from work, a massage, or personal time). Frequent small rewards earned for meeting smaller goals are more effective than bigger rewards, requiring a long, difficult effort.

Self-monitoring refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables eaten, and 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 of how you are doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually moves you closer to the desired behavior. When you record your behavior, you produce “real time” records for you and your health

care provider to discuss. For example, keeping a record of your activity can let you and your provider know quickly how you are doing. When your record shows that your activity is increasing, you’ll be encouraged to keep it up. Some patients find that standard self-monitoring forms make it easier, while others like their own recording system. Use the form on page 32 to help you keep track of your daily diet and activity levels.

Regular monitoring of your weight is key to keeping it off. Remember these four points if you are keeping a weight chart or graph:

• One day’s diet and activity routine won’t necessarily affect your weight the next day. Your weight will change quite a bit over the course of a few days because of fluctuations in water and body fat.
• Try to weigh yourself at a set time once or twice per week. This can be when you first wake up and before eating and drinking, after exercise, or right before dinner, etc.
• Whatever time you choose, just make sure it is always the same time and use the same scale to help you keep the most accurate records.
• It may also be helpful to create a graph of your weight as a visual reminder of how you’re doing, rather than just listing numbers.

Stimulus (cue) control involves learning what social or environmental cues encourage undesired eating, and then changing those cues. For example, you may learn from your self-monitoring techniques or from sessions with your health care provider that you’re more likely to overeat when

watching TV, when treats are on display by the office coffee pot, or when around a certain friend. Ways to change the situation include:

• 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.)
• Changing the environment (Plan to meet this friend in a nonfood setting.)

In general, visible and reachable food items often lead to unplanned eating.

Changing the way you eat can help you to eat less and not feel deprived.

• Eating slowly will help you to feel satisfied when you’ve eaten the right amount of food for you. It takes 15 or more minutes for your brain to get the message you’ve been fed. Slowing the rate of eating can allow you to feel full sooner and, therefore, help you eat less.
• Eating lots of vegetables and fruit and also starting a meal with a broth-based soup can help you feel fuller.
• Using smaller plates helps to moderate portions so they don’t appear too small.
• Drinking at least eight glasses of noncaloric beverages each day will help you to feel full, possibly eat less, and benefit you in other ways.
• Serving food from the kitchen instead of at the table can help you be less tempted to eat more.
• Pouring food or snacks from large packages into smaller ones and keeping them in your cupboard can prevent overeating.

Once you’ve reached your weight loss goal, maintaining your lower body weight can be a challenge. Successful weight maintenance is defined as a regain of weight that is less than 6–7 pounds in 2 years and a sustained lowered waist circumference reduction of least 2 inches. The key to weight maintenance is to continue the healthy lifestyle changes that you have adopted. Staying on a

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Breakfast

Lunch

Dinner

Activity

healthy diet and aiming for 60–90 minutes of physical activity most days of the week will help you maintain your lower weight. For long-term motivation, continue the strategies you’ve learned from the Moving Forward section of this booklet; ask for encouragement from your health care provider(s) via telephone or e-mail and from friends or family, or join a support group. The longer you can maintain your weight, the better the chances you have for overall long-term success in weight reduction.

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Check It Out Before You Sign Up for Any Weight Loss Program

The best way to reach a healthy weight is to follow a sensible eating plan and engage in regular physical activity. Weight loss programs should encourage healthy behaviors that help you lose weight and that you can maintain over time.

Safe and effective weight loss programs should include:

• Healthy eating plans that reduce calories but do not rule out specific foods or food groups
• Regular physical activity and/or exercise instruction
• Tips on healthy behavior changes that also consider your cultural needs
• Slow and steady weight loss of about 1–2 pounds per week and not more than 3 pounds per week (Weight loss may be faster at the start of a program.)
• Medical care if you are planning to lose weight by following a special formula diet, such as a very low-calorie diet
• A plan to keep the weight off after you have lost it

If you decide to join any kind of weight loss program, here are some questions to ask before you join.

Is the diet safe?

The eating plan should be low in calories but still provide all the nutrients needed to stay healthy, including vitamins and minerals.

Does the program provide counseling to help you change your eating, activity, and personal habits?

The program should teach you how to change permanently those eating habits and lifestyle factors, such as lack of physical activity, that have contributed to weight gain.

Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?

You need to be evaluated by a physician if you have any health problems, are currently taking any medicine, or plan to lose more than 15–20 pounds. If your weight control plan uses a very low-calorie diet (a special liquid formula that replaces all food for 1–4 months), an exam and followup visits by a doctor are also needed.

Is training available on how to deal with times when you may feel stressed and slip back to old habits?

The program should provide long-term strategies to deal with weight problems you may have in the future. These strategies might include things like setting up a support system and establishing a physical activity routine.

Is attention paid to keeping the weight off? How long is this phase?

Choose a program that teaches skills and techniques to make permanent changes in eating habits and levels of physical activity to prevent weight gain.

Are food choices flexible and suitable? Are weight goals set by the client and the health professional?

The program should consider your food likes and dislikes and your lifestyle when your weight loss goals are planned.

There are other questions you can ask about how well a program works. Because many programs don’t gather this information, you may not get answers. But it’s still important to ask them the following:

What percentage of people complete the program?

What is the average weight loss among people who finish the program?

What percentage of people maintain their weight loss after 1, 2, and even 5 years?

What percentage of people have problems or side effects? What are they?

Are there fees or costs for additional items such as dietary supplements?

Remember, quick weight loss methods don’t provide lasting results. Weight loss methods that rely

on diet aids like drinks, prepackaged foods, or diet pills don’t work in the long run. Whether you lose weight on your own or with a group, remember that the most important changes are long term. No matter how much weight you have to lose, modest goals and a slow course will increase your chances of both losing the weight and keeping it off.

Additional Information

American Diabetes Association ATTN: National Call Center 1701 North Beauregard Street Alexandria, VA 22311 800–342–2383 www.diabetes.org

• Information and publications on diabetes, nutrition, and exercise

American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606-6995 800–877–1600 www.eatright.org

• Information and publications on weight control, nutrition, and physical activity
• Find a dietitian

American Heart Association 7272 Greenville Avenue Dallas, TX 75231 800–242–8721 www.americanheart.org

• Information on heart disease; healthy lifestyles, including diet and nutrition; and exercise and fitness

American Society of Bariatric Physicians 2821 South Parker Road, Suite 625 Aurora, CO 80014 303–770–2526 www.asbp.org

• Information on weight loss surgery

American Society for Bariatric Surgery 100 S.W. 75th Street, Suite 201 Gainesville, FL 32607 352–331–4900 www.asbs.org

• Information on weight loss surgery

HealthierUS.gov U.S. Department of Health and Human Services Office of Public Health and Science Office of Disease Prevention and Health Promotion 200 Independence Avenue, S.W. Hubert H. Humphrey Building, Room 738G Washington, DC 20201 202–401–6295 www.healthierus.gov

• Online information on nutrition and physical activity
• Dietary Guidelines for Americans 2005

North American Association for the Study of Obesity 8630 Fenton Street, Suite 918 Silver Spring, MD 20910 301–563–6526 www.naaso.org

• Information on obesity and obesity research

President’s Council on Physical Fitness and Sports 200 Independence Avenue, S.W. Room 738 Washington, DC 20201-0004 202–690–9000 www.fitness.gov

• Information and publications on physical activity

Weight-Control Information Network (WIN) National Institute of Diabetes and Digestive and Kidney Diseases 1 WIN Way Bethesda, MD 20892-3665 877–946–4627 www.niddk.nih.gov/health/nutrit/win.htm

• Information and publications on weight control, nutrition, and physical activity

To Learn More

To find out more about weight management, please visit the NHLBI Aim for a Healthy Weight Web site at: www.nhlbi.nih.gov/health/public/heart/obesity/ lose_wt/index.htm

The Web pages for patients and the public contain many interactive features such as:

• Body mass index (BMI) calculator
• Menu planner
• Portion Distortion Quiz

The Web site also has links to:

• Recipes, including those for African Americans and Latinos
• Tip sheets
• Publications that may be downloaded or ordered on healthy eating in English, Spanish, Vietnamese, and Filipino
• Publications on physical activity that may be downloaded or ordered

Parents looking for information and materials to help prevent overweight and obesity in their children, ages 8–13, should check out the We Can! Web site at: www.wecan.nhlbi.nih.gov for:

• Toolkit for Action
• Parent Handbook
• Poster, print ads, and wristbands

Also, check out these NHLBI heart health Web sites to find out more about heart health:

• NHLBI Web site: www.nhlbi.nih.gov
• Your Guide to Lowering High Blood Pressure: www.nhlbi.nih.gov/hbp/index.html
• Live Healthier, Live Longer (on lowering elevated blood cholesterol): www.nhlbi.nih.gov/chd
• High Blood Cholesterol: What You Need To Know: www.nhlbi.nih.gov/health/public/heart/chol/ hbc_what.htm
• Act in Time to Heart Attack Signs: www.nhlbi.nih.gov/actintime/index.htm
• The Heart Truth: A National Awareness Campaign on Women and Heart Disease: www.nhlbi.nih.gov/health/hearttruth

ISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program and activity) receiving Federal financial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 States that no federally funded contractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health National Heart, Lung, and Blood Institute

NIH Publication No. 05-5213 August 2005