Experts offer advice for those with lots to lose
By Colette Bouchez
WebMD Weight Loss Clinic - Feature
Reviewed By Louise Chang, MD
When Lisa Goetze tipped the scales at 550 pounds, she wanted to put her fingers in her ears and scream "Stop!" every time a well-meaning friend advised her to start exercising.
"It wasn't that I didn't want to exercise,'" says Goetze, now a svelte size 14 and an American Council on Exercise-certified personal trainer and weight management consultant.
"No one understood that when you are very large, even holding up your body for a three-minute shower is a painful, and sometimes nearly impossible, feat. Walking around the block, it's just impossible."
For the group of people doctors call "morbidly obese" -- those struggling to lose 100 pounds or more -- losing weight is fraught with challenges others may never imagine.
"When you're large, the same weight loss and exercise rules don't apply. They can't apply, but nobody really gets that, not even many doctors," says Goetze, whose company aims to address the needs of what she says is this forgotten group.
From bathroom scales that can't measure your weight, to exercise equipment built for someone half your size, to the health problems associated with being extremely overweight, frustrations abound.
What's more, experts say, the nuts and bolts of dieting -- including caloric intake -- is different for those who need to lose a lot.
"You can't just toss a very overweight person the latest diet book or piece of exercise equipment and expect it to work. There is a whole different mindset to large-scale weight loss, and a whole different approach becomes necessary," says Warren Huberman, PhD, a behavioral consultant for the surgical weight loss program at New York University Medical Center.
That can make finding the right diet plan a challenge. But fortunately for WebMD Weight Loss Clinic members, the WLC eating plan takes current weight and calorie intake into consideration, rather than setting a "one-size-fits-all" calorie limit.
So where do you begin, and how do you stay motivated, when your goal is to lose 100 pounds or more? Three weight loss experts -- including one who shed nearly 400 pounds herself -- offer these 10 strategies to set you on the right path.
1. Seek Supervision.
"The more overweight you are, the more likely you need to be monitored -- and the more you need some type of medical supervision, at least at the start," says Janet Finestein, MS, RD, a nutritionist and dietitian at the Comprehensive Weight Loss Center of NewYork-Presbyterian Hospital.
Because obesity contributes to other health problems, including high blood pressure, high cholesterol, and insulin resistance, Finestein says medical care is a must.
"Sometimes uncovering these health risks and getting treatment can also help you lose weight," says Finestein. "For example, learning how to control your insulin levels may also help you control your hunger, and that can make your weight loss much easier."
2. Join a Support Group.
While it may seem as if no one understands your needs, you are not alone. Experts say one of the best places to find those kindred spirits is in a support group -- like those found on the Weight Loss Clinic message boards.
"If you feel self-conscious about meeting with strangers, the Internet has opened up a whole new world of peer support, with groups and chats and online gatherings of those who share similar goals and similar problems, and I do encourage patients to get involved," Huberman tells WebMD.
By sharing your experiences, or just listening to others share theirs, you may also discover ways to better cope with the challenges you face, Huberman says.
3. Incorporate Movement Into Your Life.
While joining a gym, or even going for an evening walk, may be out of the question at first, Goetze says that getting used to moving your body in small ways is something you can -- and should -- do.
"When you are very large, moving your body is not only physically challenging, it's also emotionally challenging, because with every difficult move comes a reminder of your size," says Goetze.
To counter the problem, she says, make a commitment to doing small movements every chance you get. Walk across the room to change the TV channel instead of using the remote, for example, or bend down to pick up that pencil you dropped.
"Small moves do burn calories, plus they subtly change your mindset about the role of movement in your life," Goetze says.
4. Discover Weight Training.
Experts say one of the most important exercises for very overweight folks is weight training. It builds muscle that can help burn more calories. The best part: Many weight-training exercises can be done sitting down, making them ideal for those with a lot to lose.
"Sitting in a chair and lifting some soup cans, putting on ankle weights and just moving your feet back and forth, lifting your arms over your head and reaching towards the ceiling, all can help build and strengthen muscles, and again, get your body moving," says Goetze.
Finestein agrees: "The more weight you have to move with each movement, the less you have to do to see a reaction, so even small actions can make a big difference."
5. Don't Cut Calories Too Far.
That 1,200-calorie-a-day diet may be just what the doctor ordered for those who need to lose 20 or 30 pounds. But if you're trying to lose 100 pounds or more, you need more calories just to survive.
"The more you weigh, the higher your caloric needs," Finestein says, "so you can eat more than a person who weighs less, and still lose an equal amount of weight."
If you cut just 500 calories out of your diet every day, you could see a one-pound weight loss each week, she says.
6. Focus on How Far You've Come.
To stay motivated for the long haul, experts say, pay attention to how much you accomplish each day.
"Forget where you want to get to," says Finestein. "Realize how far you've come. Remember when you couldn't bend over to tie your shoes, or couldn't walk up a flight of stairs without puffing?" And, she says, never forget that for every pound you lose, your health improves.
"You might still be overweight, but you're definitely healthier," says Finestein.
7. Keep Your Goals Realistic.
Experts say it's also vital not to set the bar too high for your weight loss goals.
"You have to cut yourself a little bit of slack by taking into consideration how long you have been overweight," says Goetze.
When you have lots to lose, it takes longer to reach your goals -- but it's also extra rewarding when you do get there.
"It's a lot easier if you concentrate on your health, rather than each and every pound.," says Goetze.
8. Ditch the "Dieting Mindset."
"The very idea that we go 'on' a diet suggests that at some point we will come 'off' the diet -- and that's where those who are morbidly obese make a wrong turn," says Huberman.
To lose a significant amount of weight and keep it off, a permanent lifestyle change is needed.
"When you are obese, weight control must become a lifetime commitment, and it must involve a decision to completely change the role of food in your life," Huberman says. "And you must make exercise a regular part of your daily living.
"When you can accept that you're not on a diet, but that this is how you are going to live your life for the rest of your life, you will stay motivated and succeed."
9. Consider Medication.
If diet and exercise alone don't seem to do the trick, consider asking your doctor whether medication could be an option for you.
"Don't be afraid, or ashamed, to admit you need some extra help, and talk to your doctor about all your weight loss options, including medication," says Finestein.
Remember that weight loss medication is not a magic bullet. These medications can result in small amounts of weight loss -- as long you eat healthfully and engage in physical activity.
10. Don't Rule Out Weight Loss Surgery.
"For me, weight loss surgery turned out to be the right option -- but I did try every other option first," says Goetze.
She suggests you give yourself room to experiment, but keep in the back of your mind that surgery to reduce the size of the stomach is an option for many people.
"It is dramatic, and not easy, but it can be comforting to remember that there is always hope, no matter what," says Goetze, who lost nearly 400 pounds after she opted for stomach-reducing surgery.
Keep in mind that weight loss surgery requires lifestyle changes -- otherwise, you'll regain the weight over time.
Originally published July 15, 2005.
Medically updated July 2006.
SOURCES: Lisa Goetze, ACE-certified personal trainer, lifestyle and weight management consultant; director, LisaGetsResults.com, Paramus, N.J. Warren Huberman, PhD, behavioral consultant, NYU Surgical Weight Loss Program, NYU Medical Center, New York. Janet Finestein, MS, RD, nutritionist and registered dietitian, Comprehensive Weight Control Center, New York -Presbyterian Hospital, New York.