Weight loss on a sliding scale

IF YOU are one of the millions of people who are dieting right this minute, or even thinking about it, here's some good news: you don't have to throw a lot of money at the problem to see results. In fact, you may not have to spend much at all.

Every year consumers spend billions of dollars on supplements, diet foods, books and meal replacements. But the truth is that success depends not so much on what diet plan you choose or what program you join.

"What matters most is your level of motivation and your willingness to change," says Kelly Brownell, a psychologist and director of the Rudd Centre for Food Policy and Obesity at Yale.

A study published in the February 26 issue of The New England Journal of Medicine, for instance, compared four popular diets and found they all produced similar results. After two years, the dieters in each group lost an average of nine pounds. Notably, the dieters who attended more counselling sessions lost a little bit more, which may support the notion that behaviour is more important than diet alone.

Motivation, though, is not always easy to come by, especially when it involves changing habits. Some people may need a little help to kick-start a weight-loss regimen, whether that means following a popular diet or enrolling in an organised programme. Your goal, though, should not be short term.

"Keeping weight off permanently is a lifelong process," says James Hill, a psychologist and a founder of the National Weight Control Registry (www.nwcr.ws), a database of 6,000 people who have lost weight and kept it off.

How ready are you? The more committed you are, the less you will need to spend. Try the no-money down, do-it-yourself approach first. If that doesn't work, or you know you need more structure, move on down the list below.

$0.00 DIY. If you're highly motivated but low on cash, this approach is for you. You will need to reduce the calories you consume, increase the amount you exercise and learn new eating habits.

Your primary care physician can give you basic guidelines for a healthy, low-calorie diet. You can also look at the dietary advice on the Weight-Control Information Network, a site developed by the National Institutes of Health (win.niddk.nih.gov), Brownell suggests.

Your new diet should include as much fresh food as possible, especially items high in fiber and low in fat. If you already eat well, you can just reduce your portion sizes. Weigh yourself regularly to keep track of your progress and try to get 30 to 40 minutes of exercise a day.

Hard? Yes. Possible? Of course. About half of the members of the National Weight Control Registry lost weight on their own, says Hill, who is also the director of the Centre for Human Nutrition at the University of Colorado, Denver.

$ Buy a guide book. For just US$20 or so, a book can give you some inspiration and wise advice. If you want a plan to follow, try The South Beach Diet (St Martin's Griffin, 2005) or The Best Life Diet (Simon & Schuster, 2006). Both provide realistic, healthy programmes.

Another good book is The Volumetrics Weight-Control Plan (HarperTorch, 2002), which explains how to build a diet around foods that make you feel full.

Chronic dieters should read the new book by a former chief of the Food and Drug Administration, David Kessler, called The End of Overeating: Taking Control of the Insatiable American Appetite (Rodale, 2009). In it, Dr Kessler explains why and how we get hooked on unhealthy food.

"When I was a kid, we ate three meals a day," he said in an interview. "Now fat, sugar and salt are on every corner 24/7. It's become socially acceptable to eat bad food all day long." In his book Dr Kessler explains how our brains become wired to crave unhealthy food and provides tips to help control your impulses.

Hill's book, The Step Diet (Workman, 2004), is ideal if you're determined to keep weight off.

$$ Join a group. Formal organisations like Weight Watchers and Jenny Craig can provide support, education and a healthy dose of peer pressure.

Weight Watchers is a good place to start, because it's relatively inexpensive. You'll pay an initial fee of US$15 to US$20, and then US$13 to US$15 for each weekly meeting. In exchange, Weight Watchers will teach you how to use its points system and provide you with that all-important weekly weigh-in.

Jenny Craig is more expensive, but may suit those who need one-on-one guidance. A yearly membership costs US$399, and an additional US$83 a week, on average, for Jenny's Cuisine meals. "There's not much evidence, though," Brownell says, "that programmes that provide meal replacements are more effective than those that don't."

$$$ Try a hospital programme. If you need to lose a substantial amount of weight and have a condition like diabetes, you might want to invest in a hospital-sponsored weight-loss programme.

"You'll get individualised help from people who are quite knowledgeable," Brownell said.

At Johns Hopkins Weight Management Center in Baltimore, for instance, you pay US$250 for an initial four-hour assessment with a medical doctor, a registered dietitian, a psychologist and a trainer. Follow-up visits are US$125 a week, but that includes food.

Most people stay with the programme for several months or longer. It's costly, but a medically monitored programme may be more effective for those who are obese and who have related health conditions, says the program's director, Dr Lawrence Cheskin.

Priceless: Keep it off. If you become one of the lucky losers, you'll need to fight hard to protect your losses. One way is to exercise a lot.

"Diet is a key for losing weight," Hill said. "But physical activity is the key for keeping it off."

To maintain their weight, members of the National Weight Control Registry ideally exercise 30 to 60 minutes a day. Another key is to enlist the support of family and friends. If your buddies are mocking you for eating a salad while they're inhaling beer and pizza, Hill said, it's going to be tough to succeed. New York Times