Expert Q&A: Losing a Lot of Weight

An interview with Michael Dansinger, MD.

Medically Reviewed by Louise Chang, MD on November 25, 2008
6 min read

If you’re very overweight or obese right now, you might feel like the odds of ever achieving a healthy weight are pretty remote. But you can do it. And the benefits will be tremendous.

So how do you begin? WebMD asked Michael Dansinger, MD, an assistant professor at Tufts University School of Medicine in Boston. He’s a leading authority on diet and weight loss, and he’s had plenty of experience helping obese people slim down – he’s the nutrition doctor for the TV show The Biggest Loser. Here’s what he had to say.

If you're ready to record your reasons on paper and ready to pick a start date, then you're ready to try again. I think the battle is halfway won once you commit, once you decide that you’re never going to give up trying to control your weight.

Don’t let past failures discourage you from trying again. Almost everyone who loses weight has tried unsuccessfully many times before. Finding the right path to weight loss is like finding the person you eventually marry. You probably have to kiss a few frogs on the way. So don’t look at past weight loss attempts as dead ends. They’re just stages on the path to ultimate success.

There are some practical things to consider. You need to commit to the rules you’re going to follow and figure out some logistics. How will you find time to follow your plan? Do you have a support system that includes your health care professionals, your family, and your friends?

Unless you have a chronic illness or take regular medications, you don’t really need medical supervision when you’re starting a weight loss program, even if you’re obese. There are hundreds of diet books at your local bookstore, and I doubt that following any of them would cause any harm. While a really extreme low-calorie diet – 500 calories or so – could be risky, nobody can really stick to that anyway.

However, I do think you should include your doctor as part of your support system and ideally as a lifestyle coach. Your doctor can help you monitor your progress as well as provide external accountability.

The idea that there's one best plan for successful weight loss is incorrect. It’s like saying there's one best color, or one best type of music. For each individual there very well may be one best dietary approach. But there is a broad spectrum of eating strategies -- dozens of unique approaches -- that all work well for weight loss and overall health improvement. The most important thing is to find an approach you can stick to, because adherence, rather than diet type, is the key to success.

I do think that good plans tend to have some common features. They often include a daily food journal with calorie counting, 90% adherence to a strict eating plan, and about seven hours a week of exercise – cardio and strength training.

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.

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.

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.

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.

Almost all of us eat for comfort sometimes, but some people have a severe problem with emotional eating. Ideally, resolving the underlying causes or stressors is the best idea. Many psychologists specialize in this area. Overeaters Anonymous and similar groups can also be very helpful. For many, finding simple logistical solutions -- like getting the junk food or other trigger foods out of the house -- can work really well.

Almost everybody -- your friends, your family and your doctor -- want you to succeed. But your losing weight can trigger unhelpful responses in some people.

Unhealthy eating is fun – at least at the time – and we don’t like to chow down alone. We do it with friends or family. So if you’ve changed your eating habits, it may be hard for the people around you to accept that you’re not taking part. They may miss how things used to be. They may also get annoyed at all the time you spend at the gym or feel jealous of your success.

So expect some weight loss sabotage. Sometimes, you may need to put some distance between yourself and people who are counterproductive to your efforts. But before you do that, just be firm. They may be testing your limits, just to see how serious you are. It’s like little kids pushing boundaries with their parents to find out which ones can’t be crossed. So if you just stay firm, you may find that a lot of people back off and stop undermining you.

In the end, people may have mixed feelings about what you’re doing. You just have to accept that as a normal downside to achieving weight loss success.

Before I became a nutrition doctor and researcher, I paid much less attention to healthy lifestyle habits. Once I learned about nutrition, I started to find ways to eat less starch and animal fat.

As a busy doctor, husband, and father, it’s been a challenge to figure out how to squeeze enough exercise into my life. Nevertheless, I manage to practice what I preach, which not only allows me to look my patients in the eyes when I advise them -- it also allows me to give specific suggestions in response to each individual patient's unique challenges.