This process involves primarily "white" fat found mainly in the fat cells that lie under our skin. This is our energy, or calorie storage fat. The "brown" fat, or the "good" fat, actually burns calories for body heat. This fat is deeper and surrounds and protects our organs. Normal fatty acid metabolism supports and nourishes the brown fat. The storage, or white, fat is where our body puts the extra calories from dietary sources that we do not utilize. When we diet regularly or our weight goes up and down, our internal weight control system fears starvation and will store more fat as energy for the future. With repeated weight loss and weight gain, the same number of calories in our diet may keep us at a higher weight because we have a higher set point.

When we have developed more fat cells during our growth periods (infancy and adolescence), we will tend to have more fat, a slower metabolism, and a higher set point, and we will be more likely to have a higher weight. Once this pattern develops, such as by being overweight early in life, it is very hard to change. It takes work and a new self-image! Regular exercise and increasing exercise capacity are the main physical ways to improve the set point and lose weight and then to be able to maintain our weight with a reasonable number of calories. This is a far healthier approach than taking thyroid pills or one of the many possible diet stimulants.

Other ideas about individual weight suggest two opposing views. One school says that people are thin because they do not overeat as much as fat people, since they are guided more by internal signals of hunger and the types of food that their bodies want. Overweight people on the other hand respond more to external signals, such as the presence of food or other people and social situations, or they may react more emotionally to the normal internal messages.

Others believe that obese people do not really eat a great deal more than thin people; they just have a different set point and a slower metabolic rate. Heredity and early conditioning play a major role here. Heavier people’s food choices may not be as wholesome as those of thin people, with higher-fat and higher-calorie foods predominating. Malnutrition from nutrient deficiencies and food allergies can also be influential. Obesity is really a combination of these many factors. Of course, most of us know overweight people who eat a lot of food. Then again, we may know overweight people who eat lightly, as well as trim people who can really put it away. Most overweight people, I believe, have overeaten at some point to develop their capacity for obesity, unless there is some hormonal imbalance, which is not very common.

We need to start as early as possible to achieve dietary control. Children need both wholesome, nutritious foods and loving guidance! Only about 10 percent of elementary school children are overweight, yet between 20 and 30 percent of high schoolers are at least moderately obese. To lose weight and maintain it, behavior must change. Behavior modification is a form of therapy that can be effective in helping us change from an overweight person to a trimmer one. This can be practiced by ourselves or with the help of a close friend, spouse, or diet "buddy," but a behavioral or other counselor can often assist with it.

An important beginning is to try to get in touch with our level of hunger. Most "fat" people do not eat from hunger; in fact, many rarely experience this natural guide to eating. Using an eating diary to evaluate what, when, and where we eat, how much, our level of hunger, and what else we are doing at the time can be very revealing. An example of this form is found in Taking Charge of Your Weight and Well-Being by Joyce Nash and Linda Ormiston (Bull Publishing Co., Palo Alto, CA., 1978). Keeping such a diary for several weeks can help us to see more clearly our relationship to eating. We can then make a plan incorporating our new, positive habits and use new rules to change our behavior in weak areas. For example, if we snack while we make dinner or pick at the leftovers in the kitchen, we can make a commitment to eat food only at the dining room table and allow no eating in the kitchen or when standing. It may be difficult at first; constant awareness is needed. Behaviorists claim that it takes three weeks to change a habit and create a new one, so keep at it. Part of our eating behavior is affected by psychological aspects, such as our self-image, relationships to family or partner, sexuality, and general stress. Often, counseling is important to help change behavior to meet our dietary challenge.

Successfully achieving a new weight means changing our diet, not "going on a diet." When we return to our old, "normal" diet, we will create the same body we had before, and likely add another pound or three. First we change our diet by substituting wholesome foods for the more high-calorie and chemical foods in the diet. Next, we work to create good habits. The following list offers some suggestions for behavior patterns, food choices, and activities to help reach and maintain our optimum weight.

Before beginning a new diet plan, a health evaluation may be important, especially for those with recent weight gain or symptoms of medical problems. Before embarking on any low-calorie diets, we should have a complete exam, general biochemistry panel, and, if over 45, an electrocardiogram. A complete thyroid hormone panel is often useful to rule out low thyroid function, which could be a cause of weight gain or difficulty in losing weight. Blood fats, protein, potassium, and calcium levels are also important monitors in the process of weight loss. A positive side effect of diet change and weight loss is reduction of blood cholesterol and triglycerides and high blood pressure, yet also watching for mineral depletions, particularly of potassium, is a good idea.

A food allergy evaluation may be a valuable step on the path to a trim and healthier body. Many people have internal reactions to foods, with increased immune response, cellular irritation, and many possible symptoms. These can cause inflammatory activity and water retention, as well as poor utilization of other foods. Currently, the best way to isolate problem foods is a blood test that measures levels of IgG antibodies to specific food antigens (the protein stimuli of the food). This reveals delayed or "hidden" food allergy or hypersensitivity. Measuring IgE levels can determine foods causing more immediate reactions, such as hives, asthma, or eczema, though these reactions are relatively uncommon, which is why skin tests, which measure the IgE reactions, are not very helpful. Cytotoxic testing, looking at cellular reactions, is no longer used because interpretations of its results were too subjective. Antibody measurement is more reproducible.

Testing food reactions ourselves by trying different foods in the diet and observing how we feel can be very useful for the astute person, but the reactions may involve other variables besides the foods. TV doctor Dean Edell feels that the best method is double-blind testing—giving patients encapsulated dried foods as well as placebos, without the patient or tester knowing which is which, or even what food is being tested. This is a good method, but it is time consuming, and it assumes that food reactions occur so dramatically and immediately that people can be aware of them. Some reactions do happen at once, but many are more subtle and occur 12–24 hours later. Avoiding the causes of these quieter internal reactions contributes to the body’s fine-tuning and makes weight loss easier. Food allergy testing followed by a rotation diet avoiding the reactive foods plays an essential part in reaching and maintaining optimum weight and health (see more in the Allergy program in this chapter).

Several possible diets can be used as long-term plans for people who have problems maintaining their optimum weight. These are all generally healthier diets than those of the general population. There are literally thousands of quick-weight-loss, low-calorie, nutrient-deficient diets available to consumers. That is not what we are looking for to achieve our goals. I do not usually recommend fasting for weight loss, but if someone wants to lose a quick five to ten pounds in a short period of time, I will work with them, after an evaluation, with the overall intention of using that period to create a new eating plan to be used when the fast is over. Fasting is very valuable at increasing food awareness and sensitivity to both bad and good foods and eliminating addictive food and eating patterns, so that people can come back to eating with new enthusiasm and attention. A one-day-a-week fast on water or juices can be a valuable tool for many people who want to lose or maintain weight as it reemphasizes the importance of food choices and food awareness.

• Focus on decreasing caloric intake and increasing calories out (exercise).
• Eat most foods early in the day for best utilization of calories.
• Drink eight to ten glasses of water daily, but not with meals.
• Drink two glasses of water 30 minutes before meals to reduce appetite.
• Eat lots of fruits and vegetables—as snacks, too.
• Walk a lot and exercise regularly.
• Avoid fats in the diet—they are more caloric.
• Use only low-fat or nonfat milk products.
• Minimize salad dressings, cream soup, and meats.
• Lessen or avoid alcohol and caffeine; minimize salt intake.
• Rotate foods—eat a variety; isolate allergenic foods and avoid them.
• Practice food combining.
• See a nutritionist to help with the eating plan or for food-habit counseling.
• Use smaller plate and portions.
• Fill up first on lower calorie foods, such as soups or vegetable.
• Avoid high-calories snacks and desserts.
• Wait 10–15 minutes before taking seconds—hunger will decrease.
• At restaurants, avoid overeating and take any extra food home.
• Take at least 20–30 minutes to eat a meal, even snacks.
• Eat at only one or two places in the home.
• Sit and relax before eating.
• Avoid eating while watching TV, driving, or doing other things.
• Shop for food only after eating, not when hungry.
• Create a schedule for eating.
• Plan meals and food choices ahead, snacks included.
• Carry food with you to work or when going out so that you have the right choices.
• Put snacks and sweet foods away at home.
• Stay out of the kitchen, cupboard, and refrigerator unless preparing food.
• Plan activities to occupy your free time when you might snack.
• Tell family and friends to support you and not push food.
• If you blow it, go right back to your plan, and do not make it an excuse to indulge.
• Weigh yourself only once every week or two.
• Learn about food, fats, calories, and so on , so you know what you are doing.
• Keep a good self-image and positive attitude toward life.
• Allow yourself to indulge (within reason) once weekly without guilt or self-judgement.
• Realize that it is ultimately up to you.

The essential aspects of a healthy weight-loss diet are lean protein (for example, fish and poultry), low fat, and lots of vegetables. High-fiber foods, with some complex carbohydrates, are also helpful, especially with an orientation to vegetables and vegetable-protein combinations such as grains and legumes. Eating a variety of foods and rotating those foods every few days is important. Cold-pressed vegetable oils are the main fats, with some low-fat dairy products if tolerated. Saturated and hydrogenated fats are minimized. Refined sugar and flour foods, including baked goods, candy, sodas, and other sweets, are avoided. Alcohol is out, and caffeine is minimized. We need to drink lots of water instead to support normal weight and healthy skin and internal functions.

Meals are restructured to include a moderate breakfast, great lunch, and light dinner. Snacks are low-calorie foods, such as fruits, vegetables, popcorn, or crackers. Overeating is prohibited. We must take breaks during big meals to let the body balance and let us know whether it needs more food. It usually does not; we really require a lot less food than our overweight mind tells us. Our satiation meter needs to be turned down, and that will take a golden key, which is not always easy to find. It may require going through our past, our emotional and psychological barriers, to find our creative spark and drive to be our best self and not let food interfere with this path of power. It really takes responsibility and a commitment to our new body-to-be, and a knowledge and belief that we can do it. We need to think more about eating to survive and feeding our body with the best possible fuel. Taking the time to eat, chewing each bite thoroughly, is essential to short-term digestion and absorption and the long-term health of the whole digestive tract. Being aware of the process of eating and of what food is eaten is a must.