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Losing as little as five to 10 percent of your body weight and maintaining that loss can significantly improve your health by increasing glucose tolerance and lowering blood pressure and cholesterol levels. Thus, if you're overweight or obese, you may need to seek medical help to lose weight as well as to maintain it.

Experts recommend losing no more than one to two pounds per week. Maintaining weight loss can be more difficult than losing the weight to begin with, so long-term lifestyle change is key.

The National Weight Control Registry is a self-selected group of 2,800 individuals who have lost at least 30 pounds and maintained the weight loss for more than a year. The individuals who are listed in the registry have reported the following:

• 81 percent reported that they exercised more often and more vigorously than with previous attempts.

• About 55 percent had been involved in a formal weight loss program

• 20 percent lost weight with liquid diets

• 4.3 percent used medications to lose weight

• 1.3 percent had surgery to lose weight

The good news is that burning off more calories than you're taking in will cause you to lose weight. The bad news is that there's no magic formula. Studies find that if you lose the weight slowly, you'll be much more effective at keeping it off, especially if you incorporate exercise into your routine and reduce other sedentary behavior, such as watching TV.

The safest way to lose weight is to eat a nutritionally complete diet that is moderate in calories and fat, add exercise to your daily routine and decrease sedentary activities. In some cases, for example, if your health is being immediately and severely compromised because of your weight, faster weight loss may be appropriate. In these cases, your health care professional may recommend drug therapy or surgery.

Changing Your Diet

The first element of treatment is changing your diet. Your health care professional should provide detailed guidance on the number and types of calories you should eat. As a rule of thumb, however, if you take in about 250 calories per day less than is needed to maintain your current weight, combined with an exercise regime that burns an additional 250 calories a day, you'll lose about a pound a week.

To determine how many calories your body needs to maintain its basic functions—known as your basal metabolic rate—multiply your current weight by 10. For example, a woman who weighs 200 pounds requires 2,000 calories per day to maintain bodily functions such as breathing and digestion.

It's difficult to determine exactly how many calories you need to maintain your weight at your current level of physical activity. You may want to take your basal metabolic rate and add about 20 percent if you're relatively sedentary, 30 percent if you're lightly active, 40 percent if you're moderately active, then subtract 250 calories to arrive at your new recommended daily total.

A slightly more accurate method is to keep a detailed food diary over the course of a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day (several books and Web sites provide calorie counts for thousands of different foods) and use that figure as a starting place from which you then subtract 250 calories.

After you've determined how many calories a day you should eat, you need to plan daily menus. A dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat, which, in most cases, should be based on guidelines developed by the federal government in its Dietary Guidelines. The guidelines emphasize calorie reduction as well as balance, moderation and variety in food choices, with a special emphasis on whole grain products, vegetables and fruits.

To satisfy basic nutritional needs, eat a variety of foods including low-fat dairy, healthy protein sources like chicken, fish, eggs and soy products, vegetables and whole grains, and allow for an occasional treat. While you should try to cut back on excess fats and sugars, all foods and beverages can be consumed in moderation. As soon as you label a food as "off limits," chances are you will crave and perhaps even binge on it.

The 2005 Dietary Guidelines recommend the following (based on a 2,000 calorie-per-day diet) To find the amounts that are right for you, visit the Food Pyramid Web site):

Meat and Beans (Protein)

• Five and-a-half ounces of protein every day (vary your choices of meats, poultry, fish, beans, peas, nuts and seeds)

Fruits, Vegetables and Milk

• Two cups a day of fruit and two-and-a-half cups a day of vegetables

• Eat a variety of fruits and vegetables every day and choose from all of the five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times per week. You may consume fresh, frozen, canned or dried; go light on fruit juices.

• Three cups per day of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese.

Carbohydrates

• Six ounces of grains (cereal, breads, crackers, rice or pasta) a day. At least three ounces should be whole grain, and the other three enriched or whole grain. One ounce equals about one slice of bread, one cup of cereal or one-half cup of cooked rice, cereal or pasta.

• Eat fruits and vegetables that are high in fiber and choose whole grains

• Try to avoid adding sugar or sweeteners to foods and beverages

Sodium and Potassium

• Do not consume more than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day

• Use little or no salt when preparing foods

Eat fruits and vegetables high in potassium such as potatoes, sweet potatoes, soybeans, bananas, and spinach.

Balanced food plans encourage making wise choices about everyday foods so you can maintain a healthy weight throughout your lifetime. Many popular diet plans, however, such as the high protein/low carbohydrate diet, don't include balanced choices. While women can lose weight on these diets, they may find themselves dangerously deficient in certain nutrients or food groups and dangerously high in others. In most cases, women who go on these diets tend to regain any lost weight when the diet ends. That's because these diets don't help you change your lifestyle and your way of handling food and temptation in the long run.

Most successful weight-loss plans call for a reduction in both calories and fat, although fat is probably not a critical component in obesity. Instead, overall calories and lack of physical activity, coupled with a sedentary lifestyle, are most important.

Still, health care professional and dietary guidelines recommend women moderate their fat consumption to 20-35 percent or less of total calorie intake, with saturated fats accounting for less than 10 percent of intake and the rest comprised of equal amounts of monounsaturated fat and polyunsaturated fats. These fats come from vegetable, not animal, sources.

Also, reduce your cholesterol intake to less than 300 mg per day. Strategies for reducing saturated fat and cholesterol include:

• Only eat three servings or less per week of red meats, processed meats, organ meats, eggs and high-fat dairy products.

• Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.

• Use lean cuts of meat and trim excess fat.

• Substitute skim and low-fat milk for high-fat dairy foods.

• Broil, bake or boil foods instead of frying.

• Increase your consumption of fruits, vegetables and whole grains.

Increasing Physical Activity

The second element to losing weight and maintaining a healthy weight is adding exercise to your daily routine and reducing the amount of time you spend sitting. Exercise not only burns calories, it also tempers your appetite, boosts metabolism, improves sleep and provides psychological benefits, such as an increased feeling of control and self esteem, as well as reducing stress.

If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or have a chronic health condition, consult a health care professional before increasing your physical activity. Notify your health care professional about any chest pain, faintness or dizziness, bone or joint pain you're experiencing, and any medications you're taking.

Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. The best kinds of exercises for burning calories are moderate to vigorous intensity physical activities

Moderate intensity activities include:

• Hiking

• Light gardening/yard work

• Dancing

• Golf (walking and carrying the clubs)

• Bicycling (less than 10mph)

• Walking (3.5 mph)

• Weight lifting (general light workout)

• Stretching

Vigorous intensity physical activities include:

• Running/jogging (5 mph)

• Bicycling (more than 10 mph)

• Heavy yard work

• Weight lifting (vigorous effort)

• Basketball (vigorous)

While you and your health care professional should set up a detailed exercise plan based on your individual health status, the 2005 Dietary Guidelines recommend healthy women who want to manage body weight and prevent gradual unhealthy weight gain engage in 60 minutes of moderate-to-vigorous aerobic exercise on most or all days of the week.

You don't have to do 60 minutes at once; Thirty minutes of an aerobics video in the morning and 30 minutes of brisk walking in the evening works just as well as walking for an hour straight. Remember: the longer and more vigorously you work out in a day, the greater the health benefit.

The best way to keep weight off once it's been lost is with 60 to 90 minutes of moderate-intensity exercise per day, being careful not to exceed your specific daily calorie requirement.

If you have been inactive, you need to work up slowly to this amount so you don't get injured or overly fatigued and then become discouraged. Start with five or 10 minutes (or whatever you're comfortable with) every other day, adding one minute every other session. Low- to moderate-intensity exercise, like housework, gardening and walking the dog, provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with more vigorous activities like brisk walking or jogging, singles tennis/racket sports, aerobics classes, ice or roller skating, swimming or cycling.

Because the goal of moderate to vigorous exercise is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and then sustaining an aerobic activity for about five to 10 minutes, take your pulse within five seconds of stopping by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds.

Your heart rate should be about 50 to 85 percent of its maximum, which is your age subtracted from 220.

If you're out of shape or older than 60, aim for an intensity at the lower end of the 50 to 85 percent range. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.5 for the lower end of the range and 0.85 for the higher end. For example, if you're 70:

• 220 - 70 = 150 (this would be your maximum heart rate for one minute)

• 150 ÷ 6 = 25 (this would be your maximum heart rate for 10 seconds)

• 25 x 0.50 = 12.5 (this would be 50 percent of your maximum, or the lower end of where your 10-second heart rate should be when you're exercising)

• 25 x 0.85 = 21.25 (this would be 85 percent of your maximum, or the higher end of where your 10-second heart rate should be when you're exercising).

The following chart illustrates recommended 10-second heart rate counts; the number of beats you count should fall between the two numbers listed beside your age.

An easier way to judge intensity is the "talk test." You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.

Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance, not only improves muscular strength and endurance but raises metabolism, enabling you to burn more calories.

Make sure you take a few minutes to stretch and warm up before doing any kind of exercise.

It's best to incorporate a combination of both types of exercise into your lifestyle—moderate to vigorous physical activities to burn fat and strength training to build muscle. Neither is as effective alone.

At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with obesity.

Medications for Treating Obesity

Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional/exercise regimen.

Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight loss program that includes dietary therapy and physical activity. Currently available prescription medications include:

• Phentermine (Adipex-P, Fastin, Ionamin, Obenix, Oby-trim, Phentercot, Phentride, Pro-Fast, Teramine, Zantryl)

• Diethylpropion (Tenuate, Tepanil )

• Mazindol (Sanorex, Mazanor)

• Phendimetrazine (Adipost, Bontril, Melfiat, Obezine, Phendiet, Plegine, Prelu-2)

• Benzphetamine (Didrex)

• Sibutramine (Meridia)

• Orlistat (Xenical)

Most of these appetite suppressants have been approved for short-term use, meaning a few weeks or months. Sibutramine and orlistat are the only weight-loss medications approved for longer-term use in significantly obese patients, although their safety and effectiveness have not been established for use beyond two years.

Most of these drugs decrease appetite by affecting levels of certain brain neurotransmitters that affect appetite. Orlistat does not act directly on the central nervous system but instead blocks an enzyme essential to fat digestion so your body doesn't absorb fat. In general, combining weight loss medications with an increase in activity level and a decrease in calories can help you lose five to 10 percent of your body weight within a year. If you are, may be or could become pregnant or are nursing, be sure to tell your health care professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.

If you are considering taking drugs for weight loss, remember: NEVER take a drug or herb that hasn't been prescribed or recommended by your health care professional. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight, but they have not been approved by the FDA and may cause significant health complications and even death.

Surgery

For clinically severe obesity, your health care provider may recommend surgery. Many people, including some health care professionals, wrongly believe that obese people merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a health care professional who:

• Have tried other methods of weight loss (changes in eating, behavior, increased physical activity and/or drug therapy) and are still severely obese

• Are unable to physically perform routine daily activities (work-related and family functions) and have a seriously impaired quality of life due to the severity of obesity

• Understand the procedure, risks of surgery and effects after surgery

• Are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve-and maintain-desired results

There are two types of obesity surgery: restrictive and combined restrictive/malabsorptive.

• Restrictive surgery (also called a gastric bypass). This procedure uses surgically placed bands or staples to decrease the size of your stomach, restricting the amount of food you can eat. Possible complications include leaking of stomach juices into the abdomen, injury to the spleen, erosion of the band, breakdown of the staple line, and stretching of the sectioned portion from overeating. Infection or death has been reported in less than one percent of patients.

  After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don't adjust your eating habits, you won't lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your health care professional.

  Equally important, the operation appears to resolve a variety of serious weight-related health problems. Diabetes, common in obese people, often significantly improves or is even cured by the weight loss that occurs after a gastric bypass.

  Patients generally lose about half of their excess body weight in the first year after restrictive surgery. Some patients may regain some of the weight they lost in the first three to five years, and as few as 20 percent of patients keep the weight off after 10 years.

• Combined restrictive and malabsorptive surgery. This procedure is a combination of restrictive surgery as described earlier along with bypass or malabsorptive surgery, in which the stomach is connected to the small intestine, bypassing the duodenum, or beginning portion of the small intestine. The longer the segment of small intestine bypassed, the fewer calories you absorb from food and the more weight you lose.

  This procedure increases the risk of nutritional deficiencies, however, including malabsorption of vitamin B12 and iron deficiency, both which can lead to anemia and. A reduction in vitamin D and calcium absorption can cause osteoporosis and other bone disease. Thus, after surgery you need to take nutritional supplements such as multivitamins, vitamin B12, vitamin D and calcium for the rest of your life, and receive nutritional counseling.

  Other complications include those similar to restrictive surgery complications, and those that result from the stomach pouch that's created. One complication is called "dumping syndrome," in which food moves too quickly through the small intestine. It can cause nausea, weakness, sweating, faintness and sometimes diarrhea after eating. You may also find you can't eat sweets without experiencing severe weakness and sweating. Other side effects include an inability to tolerate dairy products, constipation, headaches, hair loss and depression.

  Most patients who undergo malabsorptive surgery lose weight quickly and continue to lose for 18 to 24 months after the procedure. Most studies report an average weight loss of 60 to 80 percent of excess weight for 10 years or more.

Behavioral Strategies

Another key to successful weight loss is incorporating behavioral strategies into your new eating and exercise activities. These include learning about nutrition, planning what to eat and making sure you eat regularly to end impulsive and thoughtless eating.

Some specific and helpful behavioral strategies include:

• Set the right goals. Your goals should focus on specific dietary and exercise changes, such as "I will eat five servings of fruits and vegetables every day this week," or "I will work up to being able to walk briskly for 30 minutes at a time," rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of regaining the weight.

• Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely such as attending the cinema or taking an hour for yourself. Don't use food as a reward!

• Keep a food and exercise diary. Many behavioral psychologists believe it's necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.

• Monitor your weight sensibly. Keep track of your weight, but don't weigh too often. One day's diet and exercise patterns won't have a measurable effect on the scale the next day and your body's water weight can change from day to day, which may frustrate you and derail your efforts.

• Join a support group. Weekly meetings at a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.

• Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.

• Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate unhealthy eating. In some cases, you can avoid those cues; don't go to that Mexican restaurant where you always eat too many chips, for example. For situations that can't be avoided, however, such as the business lunch or an argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.

• Change the way you go about eating. There are a variety of tricks, from using a smaller plate to eating more slowly, that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu using a meal replacement once or twice a day and other similar efforts can all help.

• When eating out, don't feel compelled to finish your entire meal if portion sizes are too large. The steady growth of food portion sizes served both in restaurants and at home has encouraged the overeating that is fueling the obesity epidemic in the U.S., according to a recent survey by the American Institute for Cancer Research.

• Appropriate portion size is very important. When dining out, for instance, try to take home at least half of your dish. When eating at home, serve your plate and leave the remaining food in the kitchen, do not place it on the table. Half of your plate should be filled with vegetables, one quarter with a protein and one quarter with a starchy vegetable. Never, ever, supersize any kind of fast food or take out meal.