Weight Loss

How do I lose weight without a supportive spouse?

DEAR DOCTOR K: I've gained several pounds since getting married. My husband thinks he is supportive of my weight-loss efforts, but he doesn't exercise or make healthy food choices himself. How can I lose weight without my husband's support?

DEAR READER: Each of us is the person most responsible for living a healthy lifestyle. But we're not islands when it comes to our weight, and family and friends can profoundly influence what we do. That's the message in the important new book "Thinfluence," written by my Harvard colleagues Dr. Walter Willett and Dr. Malissa Wood, with Dan Childs.

What are the best ways to get rid of abdominal fat?

DEAR DOCTOR K: You've written that abdominal fat is particularly bad for your health. What are the best ways to get rid of it?

DEAR READER: When it comes to body fat, location counts. Visceral (abdominal) fat accumulates deep inside the abdomen. It pads the spaces between our abdominal organs. Compared to the fat just beneath the skin -- the kind we can grab with our hands, called subcutaneous fat -- visceral fat appears to be more harmful to health.

How can I tell if I’m a good candidate for weight-loss surgery?

DEAR DOCTOR K: New Jersey Gov. Chris Christie's announcement about his weight-loss surgery got me thinking. Can you tell me more about this surgery and who might be a good candidate for it?

DEAR READER: Governor Christie -- as well-known for his waistline as his politics -- recently confirmed that he had weight-loss surgery. There are several types of weight-loss surgery (also called "bariatric surgery"). They work either by shrinking the size of the stomach, reducing the absorption of calories and nutrients in the intestine, or both.

What’s better for weight loss, diet or exercise?

DEAR DOCTOR K: Please settle a long-running argument between me and my sister. What's more effective for weight loss, diet or exercise?

DEAR READER: Losing weight can be a challenge. The best approach is to eat less and exercise more. But that's not what you asked me. Let's say one person cuts back on calories without exercising and another person increases exercise without cutting back on calories. The first person would probably find it easier to lose weight. That's because it's easier to cut 500 calories a day from your diet than to burn 500 extra calories through exercise.

Why is abdominal fat bad?

DEAR DOCTOR K: Why is abdominal fat worse for your health than fat around the hips and thighs?

DEAR READER: When it comes to body fat, location counts. Fat above the waist (the "apple" shape) is much more dangerous than fat in the butt and thighs (the "pear" shape). In most people, about 90 percent of body fat lies in a layer just beneath the skin. The remaining 10 percent -- called visceral fat -- lies out of reach, deep within your abdomen.

What is metabolic syndrome?

DEAR DOCTOR K: A friend recently told me about a condition called metabolic syndrome. What is it? And what can I do if I have it?

DEAR READER: Metabolic syndrome may be the most common condition you've never heard of. Many of my patients have it; nearly 50 million Americans have it -- and many of them don't know it. Metabolic syndrome is dangerous. If you have it, you have a much higher risk of stroke or a heart attack, and of developing diabetes, kidney and liver disease.

Should I consider weight-loss surgery?

DEAR DOCTOR K: I'm obese. I've tried to lose weight, but nothing has worked. Should I consider weight-loss surgery?

DEAR READER: If you are severely obese, your best chance for long-term weight loss and better health may be weight-loss (bariatric) surgery. You have several options. Some types of bariatric surgery shrink the size of your stomach — you fill up sooner. Other types of surgery route the food you've eaten away from your small intestine, the place where nutrients (and their calories) are absorbed.

How can I help my teen stay healthy while losing weight?

DEAR DOCTOR K: My 15-year-old daughter wants to go on a diet. How can I make sure she stays healthy while losing weight?

DEAR READER: My first question is whether your daughter really needs to go on a diet. Before your teen starts any weight-loss program, talk with her pediatrician, who can help determine an ideal weight for your teen and give her guidance about dieting. Many people (teens and adults) view themselves as overweight when, by medical standards, they are not. They will not get any health benefits from losing weight — though they may think they will look better.

Can eating slowly help with weight loss?

DEAR DOCTOR K: I've read many times that eating slowly can help a person eat less and lose weight. I've tried this approach recently, and I do find it helps keep me satisfied, even when eating smaller portions. What is the mechanism behind this — or is it all in my head?

DEAR READER: It's true ... and it is all in your head (and your gut). Let me explain. Why do we get hungry? And when we eat a meal, why at some point do we feel full? Until recently, we had no idea. We knew that appetite must be lodged in the brain. But how does the brain decide to feel hungry, or to feel full?