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The key to weight management is incorporating three strategies into lifelong practices—eating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the estimated 33 to 40 percent of American women who are trying to lose weight, a minority use this method.

The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.

Eating for Weight Management

Keeping in mind the biological reason we eat—to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it—is a good way to think about food.

Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that "dieting" is not the answer to weight management. The best "diet" is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.

You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.

Your basal metabolic rate is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to www.bmi-calculator.net/bmr-calculator. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.

A more accurate method is to keep a detailed food diary over 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 foods—and use that figure as a starting place for weight maintenance or weight loss.

After you've determined how many calories per day you should eat, plan daily menus. A registered 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 the sensible guidelines set forth by the federal government in its Dietary Guidelines for Americans, which were updated in January 2005. The guidelines, available at http://www.healthierus.gov/dietaryguidelines, recommend reducing calories, moderation and variety in food choices, with an emphasis on consuming more whole grain products, vegetables and fruits.

The best and easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and use low-fat milk products like yogurt as a side dish or a beverage three times each day

These guidelines will help reduce your calories and fat and increase the amount of fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as "off limits," chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:

• Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.

• Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.

• Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.

Health care professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2005 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day. The Dietary Guidelines for Americans are under review, and the new edition will be released in 2010.

Strategies for reducing saturated fat and cholesterol include:

• 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.

You've probably heard of "good" fats and "bad" fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils.

Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.

Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of one type, omega-3, include certain fish, flaxseeds, pumpkin seeds and walnuts. Good sources of the other type, omega-6, include corn oil, sunflower oil and soybean oil.

When an unsaturated fat is solidified—into margarine, for example—the process turns it into partially hydrogenated oils, which contains trans fatty acids.

The Skinny On Fad Diets

Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don't work in the long term because they're impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.

It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn't have sufficient nutrients.

High-protein, low-carbohydrate diets have become popular again. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body's source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables. They may also result in overeating carbohydrate-rich foods.

Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.

Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.

Carbohydrates stored in the body are packed with water. That's why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.

Many people on low-carbohydrate diets actually eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.

Many health care professionals believe that rather than adhere to a low-carbohydrate diet, it's healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.

Choosing A Diet Plan

With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:

• Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.

• Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.

• Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is an absolute minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it's not nutritionally adequate, and you'll be in danger of nutrient deficiencies.

• Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be no more than money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you anything about nutrition and healthy eating habits.

• Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.

• Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.

The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:

• The plan is touted as requiring no sacrifice—no exercise or no change in your eating habits.

• No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective; the promoter has not had the plan properly tested in clinical trials.

• Testimonials and case histories of people who have supposedly been successful on the plan are offered as "proof" of its effectiveness. A few successes don't prove the plan will work for everyone.

• The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.

• The plan is promoted as "cleansing" the body of "toxins" to let the body's "natural" curative powers help in your weight loss efforts.

Today's most popular weight-loss programs vary greatly. No single diet is appropriate for each and every person, so you'll want to weigh factors that vary by plan, such as types of food you can eat, their reliance on supplements or drugs, calorie levels allotted and the amount of support offered.

Popular Weight-Loss Plans

• Mediterranean-Style Diet

  The Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.

  The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.

• Weight Watchers:

  This diet program, one of the most popular among health care professionals, has helped more than 25 million people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthy—long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two options—weekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. They are trained in leadership skills and must pass program tests and take continual training courses to maintain their leader status. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight—what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for cutting calories out of meals. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools, customized sites for men and women and over 1,500 recipes and meal options.

  Exercise is stressed as part of the program as well. In the past, the diet steered members toward a very healthy nutritional balance by outlining how much of specific food groups—fruits, vegetables, dairy products, protein, starches and fats—should make up their daily diets. However, in the past few years, Weight Watchers introduced a system that assigns point values to each food. Dieters are allowed to consume a specific number of points per day based on their weight, and members aren't given as much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, type of food.

  Weight Watchers offers the "10 percent difference" that provides members with a practical framework for focusing their weight-loss efforts. The program begins with assessing your current weight and determining your goal weight. However, rather than defining success as achieving your goal weight, you focus on achieving a 10 percent loss of your total body weight. After losing the 10 percent, the focus shifts to getting you to your goal weight. In this way, you gain the substantial health and self-esteem benefits of a 10-percent weight loss, as well as a motivation boost as you refocus on your overall goal.

• NutriSystem

  This diet is based mostly on NutriSystem's prepackaged foods and involves reducing participants' calorie intake to an average minimum of 1,200 calories per day for women and 1,500 for men. The NutriSystem program is now completely at-home—participants have the option, however, to go online to chat with one of their weight loss counselors about diet and exercise. While the program was developed by registered dietitians and health educators with input from physicians, there have been some complaints in the media that the counselors are not highly trained. If you are concerned about this, you may want to ask about credentials at your center, and always discuss any diet plan with your health care professional.

  Because clients eat prepackaged meals, they have few food decisions to make. Thus they're not learning how to make choices in the real world or change their lifestyles. The program also sells vitamin and mineral supplements.

• Jenny Craig

  This program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides from 1,000 to 2,600 calories daily, depending on your gender and current weight. Clients can attend weekly lifestyle classes and receive one-on-one counseling or choose an at-home program that allows for consultations via phone. As their comfort level grows, clients are given the option to transition to regular foods.

  Jenny Craig emphasizes increased physical activity, changing ingrained eating habits and learning how to balance meals and food choices. The program was developed by registered dietitians and psychologists with input from physicians.

  Relying on prepackaged foods makes dining out and socializing difficult and also de-emphasizes behavior modification and lifestyle change that are pertinent and very important to long-term weight loss. Also, Jenny Craig makes "weight-loss supplements" an integral part of the system. While vitamin and mineral supplements may be helpful to overall health, no herbal or enzymatic supplements should be relied upon for weight loss.

• Liquid Fasting Programs (Optifast, HMR and New Directions)

  These programs consist of a highly structured dieting approach that combines medical, behavioral and nutritional knowledge and skills to support weight loss. The medical team (physician, registered nurse, dietitian or psychologist) provides medical supervision for the dieter in an out-patient medical setting. The diet uses vitamin-fortified liquid-meal replacements or prepackaged foods to achieve a reduced calorie intake of 800, 950 or 1,200 calories per day. Part of the structure includes mandatory weekly group sessions that support the weight-loss efforts and promote positive eating behaviors. In some settings, one-on-one counseling is available.

  The programs emphasize changes in lifestyle behaviors to support weight loss including daily physical activity and menu planning. Once the diet is completed, the patient transitions back to a recommended, healthy eating plan. In many locations, exercise physiologists are available to help design personal exercise plans.

  During the weight-loss phase of the programs, dieters use only the meal replacement products. Because of this, some dieters find it difficult to transition from liquid to regular food. The support of the trained program staff is essential to this transition. Most programs emphasize that the maintenance phase of these programs is the key to success with long-term weight maintenance.

  Due to the close contact with medical professionals, these programs are beneficial for individuals with significant weight to lose or for those with serious health problems associated with their weight. Participation involves the approval of your health care professional.

  Some locations may also offer the opportunity to utilize prescription weight-loss medications.

• Low-Carb Diets

  These trendy diets, including the Atkins, Sugar Busters and Protein Power plans, claim that carbohydrates—and not fat or an overindulgence in calories—are what make people gain weight. They go against the recommendations of the U.S. Department of Agriculture (USDA), the American Heart Association, the American Dietetic Association and the American Diabetes Association.

  Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of the Atkins Diet can provide more fullness with meals and snacks. Foods containing simple carbohydrates are restricted, so blood sugar surges after a high-carbohydrate meal doesn't occur, also helping control appetite. This also prevents blood sugar levels from rapidly plummeting, which contributes to hunger.

  These diets rebel against the past decade's message for healthy eating—moderate fat; increased whole grains, fruits and vegetables; and moderate amounts of protein. These recommendations were—and still are—based on scientific evidence that eating a well-balanced diet will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, diets high in animal protein continue to raise concern of possible increased risks for certain cancers.

  Some nutritionists are willing to accept that the low-fat craze may have gone too far, leading to the consumption of excessive carbohydrates and added sugars. Healthier carbohydrates, like whole grains, should be emphasized over things like bagels and fat-free cookies, they say. However, most of them still agree that the high-protein, low-carbohydrate diets can be dangerous and unhealthy. In fact, an advisory published in the American Heart Association's (AHA) journal Circulation echoes several recent studies that found that high-protein diets have no proven effectiveness in long-term weight reduction and, according to the advisory's authors, may "pose health threats for those who adhere to them for more than a short time."

  Note: Because prolonged ketosis (a side effect of high-protein diets) can lead to kidney damage, people with a family history of renal disease or who have renal problems should avoid high-protein diets.

• The Zone

  This diet relates excess weight to both overeating, and/or to unbalanced consumption of calories from the carbohydrate, fat and protein groups. In the Zone, your diet is exactly one-third lean protein, two-thirds fruits and vegetables, and a dash of monounsaturated fat. The diet consists of one gram of fat for every two grams of protein and three grams of carbohydrates.

  Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods.

  Simply put, this diet is most likely successful because it restricts caloric intake enough to lose weight. The average person eating in the Zone consumes no more than 800 to 1,200 calories a day. Some critics also consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.

• Single-Food Diets

  Diets that push grapefruit or eggs, cabbage soup or oranges have surfaced over the years, some claiming a false connection to the Mayo Clinic or American Heart Association. These diets are dangerous because they're unbalanced nutritionally and rely on too few calories.

• Slim-Fast and Nestle Sweet Success:

  These liquid meal-replacements are milk-based products that have added vitamins and minerals. If "balanced" is defined as containing adequate amounts of the nutrients the government has established as the Reference Daily Intakes (RDIs) then Slim-Fast and Sweet Success meet the requirements. Slim-Fast recommends that users "replace, combine, dine—and snack." Replace breakfast with a Slim-Fast shake or meal bar, combine a shake or meal bar with 200 calories of a healthy food choice at lunch (i.e., half a sandwich, soup and crackers), dine on a sensible meal at dinner (about 500 calories), and snack between meals on fruits and vegetables and calorie-controlled healthy snacks (based on your individualized meal plan).

  Recent research shows that meal replacement diet plans such as Slim-Fast really work. A landmark 10-year study demonstrated that the Slim-Fast Meal Replacement Plan not only helps individuals lose weight, but also helps maintain body weight long term. Participants weighed an average of 33 pounds less after 10 years than a matched group.

  After analyzing studies comparing several types of restricted-calorie diets, the American Dietetic Association issued a practice guideline concluding that structured meal-replacement plans could be at least as effective for losing weight as reduced-calorie diets and sometimes more effective. The guidelines also suggest that for overweight and obese adults who struggle with food selection and portion control, one or two daily meal replacements fortified with vitamins and minerals and supplemented with self-selected meals and snacks may be a successful weight loss and maintenance strategy.

Using Medication to Lose Weight

Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional and 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-Cap, Teramine, Zantryl)

• diethylpropion (Tenuate, Tepanil)

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

• sibutramine (Meridia)

• orlistat (Xenical)

Orlistat also is now available over the counter under the brand name Alli in 60 mg pills, half the strength of the prescription dosage in Xenical. It is the first FDA-approved over-the-counter weight loss drug. Like Xenical, Alli blocks digestion of about 25 percent of the fat eaten at a meal. Orlistat has been found to be safe and effective in combination with a low-fat (less than 30 percent fat), low-calorie diet and can help people lose 50 percent more weight than dieting alone.

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 10 pounds more than what you might lose with nondrug obesity treatments.

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.

Before you take any product for weight loss, be sure to discuss it with your health care professional first. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight. These over-the-counter drugs, except for Alli, and herbs 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 for weight loss. 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. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:

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

• have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)

• 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 several types of bariatric surgery:

• Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes referred to as "stomach stapling," the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.

• Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.

Other less common procedures include:

• Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a "gastric sleeve" that is attached to the small intestine, completely bypassing the duodenum and upper small intestine. In a similar procedure, called biliopancreatic diversion with duodenal switch, a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is so much smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin.

• Gastric sleeve. This procedure is actually the first part of the surgery performed in the BPDS, only the remaining pouch does not bypass the intestine. This procedure seems to be effective on its own and has shown excellent results, although it is still considered investigational.

All procedures can lead to "full and rapid" remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.

While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.

Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.

Most people undergoing bariatric surgery have rapid and extreme weight loss. In one study of 608 patients followed up to 16 years, the average weight loss was 106 pounds. Nearly all the weight is lost by the second year after surgery. An estimated five to 10 percent of patients do not lose much weight, or regain the weight, with higher rates seen in those who undergo the gastric banding procedure.

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 and you will likely need nutritional supplements for the rest of your life.

Trying To Gain Weight?

For the underweight woman who needs to gain weight, either for health reasons or appearance's sake, the journey can be difficult. Weight gain can be more difficult than weight loss. The underweight woman may have a higher metabolism, fewer fat cells or a genetic tendency to be leaner. She may also be taller, or just not care about food.

Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity—like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn't give up exercise because it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:

• Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you'll be more likely to enjoy your meals and snacks without feeling stuffed.

• Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins and minerals, in addition to calories. These include dairy foods, nuts, peanut butter or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid. And watch your use of added sugars and saturated and trans fats.

• Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice, nuts and seeds. Dip crackers, chips and fresh vegetable relishes into high-calorie dips made with low-fat cheese, low-fat sour cream, mashed beans or salad dressings made with mono- or unsaturated oils. Space out snacks during the day so you don't spoil your appetite for later meals.

Physical Activity is Key to Weight Management

Daily physical activity is essential to weight management. 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, or 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. The calories burned per hour are listed for a 140-pound healthy woman.

Moderate intensity activities include:

• hiking (386 calories)

• light gardening/yard work (302 calories)

• dancing (319 calories)

• golf, walking and carrying the clubs (244 calories)

• bicycling, less than 10 mph (370 calories)

• walking, 3.5 mph (370 calories)

• yoga (336 calories)

Vigorous intensity physical activities include:

• aerobics, high-impact (445 calories)

• calisthenics (512 calories)

• running/jogging, 5 mph (580 calories)

• swimming (580 calories)

• bicycling, 12-14 mph (554 calories)

• racquetball, casual (445 calories)

• skiing, downhill (554 calories)

• weight lifting, vigorous (400 calories)

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 while not exceeding caloric intake requirements.

You don't have to do 60 minutes at once; 30 minutes of an aerobics video in the morning and 30 minutes of brisk walking in the evening work just as well as walking for an hour straight.

The best way to keep weight off once it's been lost is with 60 to 90 minutes of moderate-intensity exercise most days, 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 physical activity, 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 or other racquet sports, aerobics classes, ice or roller skating, swimming or cycling.

Because the goal of moderate to vigorous physical activity 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 sustaining an aerobic activity for about five minutes, take your pulse 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 of your maximum heart rate. 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 heart rate counts based on your age. (These are rates per minute; use the instructions above to convert your 10-second count to heart beats per minute.)

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 and stretch when you finish.

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 weight gain.

Some Techniques May Not Live Up to Expectations

Spot exercising, or training particular areas of your body, won't reduce body fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms or thighs have been reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could potentially be dangerous for people with circulation problems.

Liposuction is an increasingly popular technique to reduce fat in specific areas on the body. Liposuction, also called lipoplasty or suction lipectomy, is a surgical procedure that vacuums out fat from beneath the skin's surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck. But depending on how much fat is removed, liposuction may not lead to weight loss, and it definitely won't change any behaviors associated with weight gain. It is also not an appropriate strategy for everyone, as age and skin tone can play a role in how successful the technique will be.

Get Your Mind In Gear

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 other 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 with 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 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 United States, according to 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. You can ask the waiter to box up half of it before you start eating. When eating at home, serve your plate and leave the remaining food in the kitchen; do not place it on the table. Half your plate should be filled with vegetables, one quarter with a protein and one quarter with grain products such as whole-grain bread, pasta, whole-grain rice and cereals. Never, ever, supersize any kind of fast food or takeout meal.