Dean (not his real name) was 25 years old, stood 6'2" tall, and weighed 400 pounds. He stated that he had tried every diet, but nothing had worked. He gave me all the usual excuses (I don't eat that much; I exercise regularly; my metabolism is slow; I just can't lose weight). He had many questions about the popular diets and was obsessing on proteins, carbohydrates and fats.
After answering his questions and clearing up his misconceptions - the largest being that it's not carbohydrates or fats that make a person fat, it's too many calories - I stated, "Dean, the reason you are a fat pig is that you won't stop eating and you won't start exercising. I'll bet the farm that you also won't do what I say."
For 10 seconds, he just stared at me with a stunned expression. He then raised his voice and said, "You tell me what to do, and I'll do it!"
I told him to get out pencil and paper and write down this regimen:
A.M. - Drink 20 ounces of water as soon as you wake up.
Breakfast - One standard bowl of high-fiber cereal with nonfat milk, or one standard bowl of hot cereal with one packet of sugar or artificial sweetener; one medium banana; one cup of coffee or tea.
Snack - One orange and 20 ounces of water.
Lunch - Turkey, chicken or tuna sandwich on whole wheat bread, no mayonnaise or cheese; tea, water or one diet soda.
Snack - One apple and 20 ounces of water.
Dinner - A large salad consisting of one cup of any type of beans (black, kidney, white, pinto or garbanzo), leaf lettuce and three or more types of different colored vegetables (i.e., one bean, one green and at least three colors). There are no limits to the amount of vegetables and greens you put in your salad. Dressing: one tablespoon of olive oil, with as much low-calorie, fat-free dressing as you want.
Snack - One cup of nonfat yogurt, or one protein bar, or one protein drink (mixed with water) such as MET-Rx.
Cheat Meals - You may cheat no more than three meals per week. Try to have only one cheat meal per week. On your cheat meal, you can have normal servings of whatever you want, but you cannot have seconds.
- Before breakfast, walk or bike for 10 minutes. Add one minute each day until you are walking or biking at least 45 minutes every morning (preferably 60 minutes every morning). You must do your morning cardio at least five days per week (preferably six days per week).
- Evening exercise: whatever you didn't do in the morning (walking or biking), you should do in the evening. Again, start on day one with 10 minutes, adding one minute each day until you are doing a minimum of 45 minutes (preferably 60 minutes) each afternoon or evening. You should also do your evening workout no less than five days per week.
- Twice a week, you should lift weights for your upper body. This will consist of an exercise for each of these body parts (three sets each): chest, shoulders, upper back, lower back, biceps and triceps - a total of 18 sets. This should take you no longer than 30-40 minutes.
"Dean, if you follow this program," I predicted, "it will be absolutely impossible for you not to lose weight." As I drove home, I thought there wasn't a prayer in the world that this guy would follow my recommendations.
I didn't think about Dean until nine months later when I was asked to do another consultation for the hockey team. When I saw Dean, I was absolutely stunned.
"Hi, Doc," Dean said. "I'm doing everything you told me to do, except that I'm also golfing 18 holes at least once a week and sometimes twice."
He had lost 170 pounds.
I asked Dean if he liked the diet. He appraised the diet as "kind of boring" and that he was often hungry. He reported that he thoroughly enjoyed his "cheat meals," which he had about twice a week: a cheeseburger, fries and a soda, or sometimes a steak and a baked potato ,or some Italian food for the other cheat meal.
I asked him what he thought about the exercise program. He answered that the only thing he liked was the golf, which was not my idea.
"Why did you follow my advice, Dean," I asked.
"Well, at first I was angry at the things you said, and I was going to follow the program for eight weeks to prove to you that I don't eat a lot of food, I do exercise, and I can't lose weight. But after eight weeks I lost 15 pounds, so I stayed on the program. After that, when my exercise was up to 60 minutes two times per day, my rate of weight loss increased to about 20 pounds a month."
In a recent paper, the CDC estimated that Americans eat 100 to 300 calories a day more than then did 10 years ago.1 When you do the math, 100 to 300 calories a day works out to between 36,500-109,500 calories per year.
The moral of this story is that anyone can lose weight with small, sensible meals and regular exercise. Furthermore, if you are not 400 pounds, 45 minutes of brisk walking, jogging or biking five days a week, along with two short weight workouts or some pushups and pull-ups at home, will work wonders if you have the discipline to make it part of your daily routine.
- Mokdad AH, Serdula MK, et al. The spread of the obesity epidemic in the United States, 1991-98. JAMA 1999;282:1519-1522.
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