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上个星期我遇到了许多要做减肥的病人。他们都在一年中体重长了30磅左右，并且对此很不开心。他们之中很少有人能够说出他们体重增长的原因。我对他们反复讲解减肥的起始计划的哲理，感到有必要将此写出来。

减肥的基本原则：燃烧的热量要大于摄入的热量。在减肥/增重的天平两端你有两条路可走，以放缓和逆转天平向体重超重和肥胖方向倾斜：吃得少些，动的多些。以下是我建议要采取的步骤。

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第一步：写饮食记录

写下你整个一周吃下和喝下的所有食物和饮料及数量。写记录很烦人，但这仍然是最好的方法用以发现所有的这些热卡是如何神秘地吃进你的胃里的。一旦你开始将摄入情况写下来，那么你也就会在吃可能使你后悔食物时三思而后行。

在一周之末，要检讨你在饮食中所做的不理智决定，以便尽量不再重犯。比如，你可以用无脂牛奶来取代2%的有脂牛奶，也可吃英式小松糕折包入煎蛋或煮蛋伴吃水果沙拉，而不去吃面包圈抹奶油干酪。

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第二步：调整你的饮食量

在减少餐量的同时，一定要保障你摄入的食物能够保持你的健康，即每餐中要有一些蛋白质和脂肪。在餐与餐之间，要吃些健康的零食，永远不要让自己挨饿或筋疲力尽。吃饭要慢，咀嚼要彻底，见饱就收，不可过饱。剩饭回头也是佳肴。

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第三步：开始运动

要避免乘升降机和电梯。随时随地尽量走楼梯和台阶。如果你去商品中心，先围着商店行走或慢跑两圈然后再去购物。对那些已经做常规锻炼的人来说，每组运动再加上5分钟，每周加做一组运动。

运动中一定要保证出汗和感到发热。悠闲散步不能燃烧热卡，在人类中，正常行走实际上是在储存能量，这就意味着，如果用舒服的速度做长距离的行走只能燃烧很少的热卡。

第四步：评估你的减肥目标

首先要保证减肥目标的可行性。不要一下子就想减30多磅，更不要奢望第一周或第一个月就会明显减肥。要首先稳定住体重，中止体重增加本身就是个巨大的进步。少量减肥是最可行和最可持续的计划，因此减肥要缓慢起步。对所有的减肥者，我的建议是在6个月中减少5磅（是的，你听明白了吗， 6个月）。

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第五步：每月测体重不要超过一次

不断地称体重是会让你疯掉的！此外，如果你每天上去下来地称体重，测试的结果也并没什么用。你的体重可在一天中自然地上下波动，更不要说天与天之间的波动了。因此这些变化仅仅反映了激素和体液的起伏，并非是体重的增减。

根据你减肥的感觉来做评估可能要比磅秤评估减肥目标和进展要来得更好，你是否精力更加充沛？睡眠是否有所改善？心情是否更为开朗？体力耐受力是否增大？在感觉方面的收获要比减少的磅数好的多。

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最后，我常常被病人要求开处方减肥药物。如果你殷切希望在你的减肥计划中包括使用药物，那么我有坏消息要告诉你。首先，药物极少所能取得减肥的持续效果。其二，这些减肥药物有危险性，它们甚至可能有损于心脏，这些药物常常伴有令人非常不愉快的副作用。

倘若你的减肥的初衷是要让自己得到健康，那么为什么要历经这样的痛苦，而甘受有损于健康的危险呢？避免吃这些减肥药也会为你自己节省一些钱。你已经拥有了减肥的各种利器。

How to Start a Weight Loss Program

This past week I met many patients looking to make a change. They had gained 30 or so pounds over a year and weren't happy about it. Few could identify what changes they had made that lead to the added pounds.

So I heard myself repeating my philosophy about starting a weight-loss plan and thought I should write it down.

The primary principle of losing weight: Calories burned need to exceed calories consumed. These 2 sides of the weight loss/gain equation mean that you have 2 ways to slow and reverse the upward trend toward overweight and obesity: Eat less and exercise more. Here are the steps I advise taking.

Step 1: Journal. Write down as you go along all the foods and liquids you consume — along with how much — for an entire week. Journaling is a nuisance, but it's still the best way to identify how all those calories are mysteriously ending up inside you. Also, once you start writing things down, you'll think twice before you eat something regrettable.

At the end of the week, identify any choices you made that could have been smarter and try not to repeat them. For example, skim milk could be swapped for 2-percent milk. Instead of a bagel and cream cheese, try a scrambled or poached egg over half an English muffin, with a fruit salad.

Step 2: Adjust your consumption. Reduce portions, while always making sure you're eating foods that will sustain you — which means having some protein or fat at every meal. Between meals, eat healthy snacks — never let yourself get too hungry or too tired. Eat slowly, chew your meals thoroughly, and stop when you are satisfied, not stuffed. Leftovers make great meals later!

Step 3: Start moving. Avoid escalators and elevators. Add more stairs and steps whenever and wherever you can. If you head to the mall, walk or jog around for a couple of laps before you start shopping. For those who already have an exercise routine, add another 5 minutes per session or an additional session per week.

Make sure you're getting sweaty or feeling the burn: Leisurely walks do not burn calories — normal walking is actually energy-conserving for human beings, meaning that you burn very few calories when walking long distances at a comfortable speed. 

Step 4: Assess your weight-loss goals. First, make sure they are realistic. Don't immediately aim to lose 30+ pounds and don't expect the weight to drop off in the first weeks to months of trying. First, aim to stabilize your weight; stopping the gain is a great achievement in its own right. Losing small amounts of weight is the most achievable and sustainable plan, so start slow. For just about anyone, I suggest aiming to lose 5 pounds in 6 months. (That's right; you heard me. Six months.)

Step 5: Don't weigh yourself more than once a month. Those scales will make you crazy! Besides, scales are pretty useless if you're climbing on and off of them every day. Your weight naturally fluctuates through the course of a single day — never mind the day-to-day swings — so that those changes often merely reflect the ebb and flow of hormones and body fluids, not genuine weight loss or gain.

Instead of trying to assess your goals and progress by using a scale, base your assessment on how you are feeling. More energized? Sleeping better? Better mood? Greater endurance? Gains such as these far exceed the number of pounds lost.

Last, I am often asked by patients for prescription diet aids. If you're hoping to include these pills in your weight-loss plan, I have bad news for you. First, the weight you lose by this method is rarely sustainable. Second, these medications are risky — they can even damage your heart — and are often accompanied by miserable side effects.

Why suffer in this way and risk harming your health when your original purpose for losing weight was to get yourself healthy? Avoid the pills and save yourself some money. You have all the tools you'll need inside.