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Expert Q&A: Losing a Lot of Weight

An interview with Michael Dansinger, MD.

What are some safe, painless ways I can exercise?

Almost all people are physically capable of walking. So if you’re in poor physical shape, start with that. Aim for seven hours a week, regardless of your current health status. You start with seven hours a week of slow walking and gradually increase it to seven hours a week of moderate walking. Eventually, you can work up to running.

If you have problems with your hips or feet, upper body exercises can be useful. Almost anybody can use 1- to 3-pound dumbbells to achieve beneficial levels of exercise.

Some obese people find exercise painful, and they get stuck in a bind: You can’t exercise because you’re too heavy, but you’re too heavy because you can’t exercise. Try to push through. In many cases, exercise becomes less uncomfortable as you shed the weight.

How quickly can I expect to lose?

If you’re really sticking to it, a good plan will produce 10% weight loss in three to four months and up to 20% weight loss at one year. A less ambitious effort will typically produce 5% weight loss in three to four months and 10% weight loss at a year.

People often say that losing 1 to 2 pounds a week should be your goal. But I typically see more than that in the short term and less than that in the long term. It doesn’t really worry me if someone’s losing 3 to 4 pounds a week at the outset.

How can I keep up my motivation over the long term?

Maintaining motivation is crucial for long-term success. Initially, you might be rewarded all the time, as you see the scale moving daily or weekly, start fitting into smaller-sized clothes, and get compliments on how you look. But the rate of weight loss inevitably slows, so then the motivation must come from within.

You must keep reminding yourself of your reasons for taking care of your body and putting in the effort. Keep a written list of reasons and refer to them often. A photo of yourself at your start weight can be a helpful reminder of how far you’ve come.

It also helps to rely on others who will help you stick to your plan. This could be a personal trainer, or your health care provider, or a support group. The more authority you give them and the more accountable you feel to them, the more likely you are to maintain your weight loss. You may want to find someone who isn’t so polite -- often, the drill sergeant approach is the most effective.

How do I know if weight loss surgery is right for me?

I’m a big advocate of weight loss surgery for people who qualify – they either have a BMI over 40 or a BMI over 35 with a related medical problem. It’s a last resort, but it’s very effective. Still, I think most people would rather try a strategy focused on healthier eating and increased exercise first.

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