It's all about portions

"When you're trying to lose, it's actually the decrease in calories that's more effective," says Helen Thompson, a registered dietitian with the Center for Human Nutrition at the University of Colorado, and director of America on the Move in Colorado. However, exercise can help with weight loss. She notes, "Maintaining weight loss is tied to exercise." Why does fasting not work? Your body is a very efficient machine, and when you fast, it actually wants to conserve energy so it can function with less calories. You really tend to lose fluids, even if you are drinking water. The pounds tend to reappear on the scale once you stop the fast.

Personal success stories like one of my professors at work make it clear that dieting indiscriminately or exercising aggressively never succeeds 100% in reducing that pot-belly. 'It is all about portion-size and addiction control', he said. No matter how much he ran, he didn't see his pant-size drop till he practiced reduction of his daily portion sizes. And mind you, he is one who runs 20 miles a week and even trains for the Ironman Triathlon. Some say eliminating the whites in your food, or at least minimizing it helps: the white bread, pastas, rice, potatoes.

One of my patients with a BMI (body mass index) of 42 wanted to know if she could be given alli (Orlistat) to help her reduce her weight. This woman has other co-morbidities like fibromyalgia and arthritis that prevent active participation in physiotherapy. Add to that, her reluctance to watch her diet. And then, the holiday season, which everyone thinks is the perfect excuse to not think about one's health. Anyway, alli works by reducing the absorption of fat in the body, and one can reportedly reduce about 5% of initial body weight. But alli alone won't cure obesity. Ditto for those considering bariatric surgery for their excess pounds. Diet and exercise remain the foundation stones of weight loss, and healthy living.

People, take a moment to go to the CDC website and watch how the obesity pandemic has spread its tentacles over the entire US. Watch the color coding of the states change from 1985 (when obesity information was first analyzed) to 2006. It is fascinating how the human race is becoming dangerously fatter with every passing year. FYI, let me inform you that West Virginia (where I work) is ranked No. 2, second only to Mississippi, both with >30% prevalence.