Oct. 18, 2021 -- Brian Martin Sr. has struggled with weight loss off and on most of his life. He says that struggle kicked into high gear 3 years ago when he needed a hip replacement.
His doctor told the 64-year-old from Woodstock, MD, the good news was the hip replacement was the solution to his problem, but the bad news was he had to bring his body mass index, or BMI, down before he could have the surgery. He weighed just under 400 pounds at the time.
“Having body mass index of at like 55 and having to drop to 40, which entailed dropping about 85 pounds, it was kind of, well shall I say, it was quite an impact on me in many ways. My ego was the first way, but then how to formulate a plan was the next.”
Making that plan is the key, experts say, but no one template will work for everyone. Bouncing from diet plan to diet plan is not unusual, and it’s usually unsuccessful. But some people have found strategies that worked, and the best weight loss plan appears to be the one you find interesting and doable.
The 6-foot-tall Martin says he’s always been a big guy but pretty healthy. He was obese but had none of the conditions that often come with obesity like diabetes and high blood pressure. He was in his 50s when he decided to focus on getting his weight under control.
“That’s when I started trying different things, and everything worked, but nothing stuck, which I’m sure is not only my story,” he recalls. “I always tell people I’m the most disciplined person in the world for the first 21 days, but something happens on that 22nd day I still can’t explain.”
A National Crisis, a Lot of Options
Martin is not alone. According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 70% of American adults are overweight or obese.
And the Boston Medical Center, which houses the Boston Nutrition Obesity Research Center, says about 45 million Americans go on a diet each year and spend a whopping $33 billion annually on weight loss products.
There are dozens of diets and weight loss strategies to choose from.
Katherine Tallmadge, a registered dietitian/nutritionist, designs weight-loss, nutrition, and wellness programs for people, corporations, and restaurants. She says you must change the way a person thinks as well as their behavior. Goals need to be realistic and flexible.
“Each person has to find their unique way of eating and living that is comfortable, enjoyable, satisfying. You have to love what you eat and your lifestyle. It won’t be successful unless everything you eat is delicious, and unless you love the way you feel and you’re happier than ever,” says Tallmadge, the author of Diet Simple and founder of Personalized Nutrition, a wellness coaching business.
If someone feels deprived or miserable, nothing will work, she says.
Keys We Know Work
Tallmadge says a lot of evidence points to the best ways to lose weight.
“There are no mysteries here. It’s amazing how just a few simple changes can create a satisfying, even joyful way of eating and living to achieve you weight loss and health goals,” she says.
Diets like the Mediterranean, the Dash, and the Okinawa, which is a Japanese diet that’s low in calories, fat, and salt but high in carbs and vegetables, are all good, but Tallmadge says many diets don’t teach you how to personalize your dieting. She believes for 90% of people, all that’s needed are small changes and minor tweaks.
“Focus on the positive. What TO do, instead of what NOT to do, is critical to the success of anyone’s ability to lose weight and keep it off,” she says.
Tallmadge says it’s possible to do this without pain. Her advice is to make fruits and vegetables at least 50% of any meal. Monitor your food intake, physical activity, and weight daily. Beware of all the misinformation out there, and never give up.
Kevin Schultze has been focusing on the positive in his weight loss journey. The 52-year-old from Chevy Chase, MD, always worked out but noticed as he was getting older, it was harder to keep the weight off.
At 6-foot-3 and 220 pounds, he was worried about becoming overweight. When clothes started feeling tight, he knew he was not in shape, so he tried a variety of diets -- Weight Watchers, Atkins, and Body for Life.
“All of them worked for me for a certain period of time because it’s exciting, it’s new, and it’s working,” Schultze recalls.
Some diets require too drastic a change, he says, such as the Atkins diet, which emphasizes lots of protein and few if any carbs.
“It’s hard to sustain, and I knew that,” he says. “And I knew that the rigidness of that, and then you know the drastic measures, the changes you have to make just don’t work for me after a while.”
A friend recommended Tallmadge. Schultze credits the individual attention he gets for his success and says she makes losing weight interesting and fun. He now tips the scales at 210 pounds and says 200-205 is his optimum weight.
“What my nutritionist has taught me is that you have a better chance to lose weight if you choose to make small changes such as adding diced fruit to your diet in place of refined sugar, making batches of soup or chili on the weekend so you can eat them throughout the week, by alternating eating red meat and chicken or fish every other night, making sure to get in 10,000 steps per day, and by weighing yourself every day to stay on track.”
These small steps, he says, make it easier to manage his weight long-term.
Grace Guggenheim met Tallmadge over 15 years ago. The 62-year-old from Washington, DC, says her weight has varied since she left college with that extra “freshman 15” pounds. She’s tried several diets over the years; often, she says, with disastrous results.
“The type of diet I understood was just not to eat or a fad diet that made me feel hunger or not well,” she says. “Isn’t that horrible? Looking back, that is a scary way to sustain yourself.”
Guggenheim now weighs 142 pounds and says she has learned to stay away from diet “gimmicks.”
“I believe personalized nutrition is the way to go, and it doesn’t take much. Understanding the basic principles is all you need and to know you can enjoy what you eat and why,” she says.
Her advice to others struggling to lose pounds is don’t get discouraged and take time to educate yourself.
“The misnomer about dieting is that things are being taken away from you forever, and that’s not true. That isn’t how it should be.”
Calories Not the Only Thing
According to Tricia Psota, PhD, managing director of Nutrition on Demand, cutting calories is important, but losing weight is more complicated than that.
“Genetics and metabolism come into play, as well as chronic conditions. While we encourage people to cut back on calories (if they need to lose weight) and eat healthier foods, there’s other factors to consider such as mental health, activity, genetics, and chronic disease risk,” she says.
The U.S. Department of Agriculture’s Dietary Guidelines for Americans says to lose weight, you must reduce the number of calories from food and drinks and increase physical activity. The guidelines, rooted in science, recommend a healthy diet of nutrient-dense foods and beverages.
Nutrient-dense food is high in nutrients and low in calories. It has vitamins, minerals, complex carbohydrates, lean protein, and healthy fats. Fruits and vegetables, seafood, whole grains, eggs, beans, lentils, and nuts are all nutrient-dense. They have little to no added sugar, salt, and saturated fat.
Psota believes science is providing a robust body of evidence.
“We do know a lot about what does work,” she says. “Weight loss strategies shouldn’t focus on just food or nutrients per se.”
Successful programs also focus on other things that affect how you eat, such as food preferences, culture, and which foods you have access to.
“When we’re talking about drivers of weight loss, behavior changes are vital to help people lose weight and then maintain the weight they lose,” she says.
Psota says she does not recommend diets because they set people up to fail.
What We Eat vs. How Much
There are many schools of thought about ways to lose weight. An article by the American Society for Nutrition, published in Science Daily, suggests “focusing on what we eat rather than how much we eat is a better strategy for weight management.”
Both Tallmadge and Psota take issue with that concept.
A recent study in JAMA Network Open looked at whether financial rewards and environmental changes affected weight loss and found that people who got those interventions did not lose significantly more weight than the other participants, leading investigators to suggest individualized weight loss strategies might work better.
Jason Ewoldt is a registered dietitian with the Mayo Clinic Healthy Living Program. He believes that one of the better ways to lose weight is to focus on habit changes you can sustain.
“Emphasis is on small, realistic changes over time to create new healthy habits and break not-so-healthy habits,” he says. “This might take the form of setting a goal around, say, increasing fruit and vegetable servings to five servings daily, or reducing soda consumption from three sodas a day down to one.”
Ewoldt says that if you reach your goal, over time, it will become habit -- just part of your routine. If you don’t reach that goal, tweak it to make it more realistic or change it altogether.
“It’s understood when it comes to not only weight loss, but also weight loss maintenance, the approach should be individualized and sustainable,” he says. “If someone loses weight unsustainably by dieting rather than changing habits, the likelihood of gaining the weight back is high.”
It took Martin almost 3 years to lose the 85 pounds He started with something he knew he could control -- his portion size -- and began eating smaller meals. The last time he stepped on the scale, he weighed 302 pounds. His goal is to get down to 250. He says he knows the frustration of plateauing, of losing ground, and he recommends that when others get to that place, look to whatever motivates you and stick with it.
For him, that motivation was having his first grandchild and wanting to be here for him.
“I’m at 64 now, be 65 in December. The honest report on my life is I’ve got less sunrise ahead of me than I have behind me, but I want as many of those sunrises that I can get,” he says. “So I would just say whatever motivates you, just remember: Keep those things in front of you and let them help bring you through.”