Place A Bet On Your Weight-Loss Goal, And You May Win Twice

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Money is a big motivator. And the prospect of a cash payoff in any sort of gamble is alluring — just think of the Powerball buzz this week.

So, what happens when financial incentives are tied to weight-loss goals? A growing body of evidence suggests that it's not necessarily a slam dunk.

Just last week, our sister blog, Shots, reported on a workplace initiative that promised to cut workers' health insurance premiums if they lost weight. Turns out, the initiative failed. Workers, on average, lost less than two pounds.

Why? Well, for starters: "People are motivated by immediate awards," explains Mitesh Patel of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, one of the study authors.

Telling people to look for a few extra bucks in a future paycheck due to a discounted health insurance premium, it turns out, just isn't very sexy, or motivating.

So, here's an alternative that's gaining traction: a good old-fashioned wager. Through programs such as HealthyWage, people are betting on their own weight loss.

Another company called StickK uses a similar approach. Participants set up personal contracts for weight loss and other types of goals. As I reported in 2008, when the company was launching, if you don't live up to your end of the contract, StickK will give your money to charity or a person you designate.

And one strategy to motivate people: have them pick an organization or charity they don't agree with (or whose views they oppose). For instance, a bird-watching pacifist who would be in favor of stricter gun control would pledge money to the National Rifle Association if they didn't meet their goal. Or a Republican would pledge money to the Democratic National Committee.

Ben Carnes on Jan. 14, 2016, after losing 100 pounds with the help of the HealthyWage program.Courtesy of Ben Carnes

HealthyWage as a concept appealed to Ben Carnes, a schoolteacher and football coach in Westfield, Ind., whose weight had crept up to 370 pounds.

"I knew that if I put money on the line, it [would be] a double-motivating thing," Carnes tells us. He signed up with HealthyWage in 2014. The idea behind the program is to use both carrot (the opportunity to win a cash prize) and stick (the threat of loss) to motivate people.

"I didn't want to lose the money I was putting in," Carnes says. "[And] my wife and I agreed that if I won, I got to spend it on anything I wanted." So, this was the motivation to get started.

Ben Places His Bet

Here's how his wager worked: He put down about $60 a month, aiming to lose close to 100 pounds. If he achieved his goal, he'd double his money. And if he failed to meet his weight-loss goal, he'd lose his money. (Over a yearlong wager, he'd put in $720.)

In the early months, the weight fell off. But then things got tough.

At one point midway through the wager, Carnes says, his weight had hit a plateau. "I was feeling sorry for myself. I hadn't lost any weight for like a three- or four-week span," he says. He wanted to go eat burgers and fries — and bail.

"My wife actually at one point called me out. ... She kinda yelled at me and said, 'We're paying way too much money for you to just bail on this now.' "

Carnes' — and his wife's — aversion to losing the more than $700 they'd put into the bet turned out to be a powerful motivator to stick with it.

And this "loss aversion" is part of what makes this model successful. "We know from studies that people [can be] more motivated by losses than gains," says Patel. "People don't want to lose something they already have."

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In the end, Carnes won his bet. He reached his goal in December 2015. He lost 100.2 pounds. And he cashed a check for about $1,500.

He's currently training for a triathlon and says he no longer needs to take high-blood pressure or cholesterol medicine. "I feel much better," he tells us.

So, how many people who bet on their own weight loss succeed? And how often doesthe house win?

I put that question to the founder of HealthyWage, David Roddenberry, a former health care consultant. "About 30 to 40 percent of participants win [their] challenge," he told me.

The others? Yep, they fail to reach their goal weight. And they lose the bet.

But Roddenberry says the model is sound. He points to a study published in JAMAthat found dieters with a financial incentive to lose weight were significantly more likely to reach their target compared with those who had no money at stake.

So, good odds? You be the judge.

Diet and Weight Loss: The Best Ways to Eat

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Low carb, or low fat? Should you go Atkins, Zone or Paleo? Or does it even matter which diet you choose when you want to lose weight? Most weight loss experts say that shedding pounds comes down to a simple formula: calories in versus calories out. In other words, if you burn more calories than you take in, you'll lose weight.

However, the question of exactly how to cut calories — in a healthy, sustainable way — has often perplexed dieters. To find the best diets for weight loss, Live Science conducted a months-long search for information. We spoke with many weight loss experts and dove deep into the most well-regarded studies on the topic done to date. We wanted to know what these studies found and, ultimately, determine the best approaches to healthy eating for weight loss.

We found that the calorie equation reigns supreme as the most important aspect of losing weight, but also that there's still plenty of room to choose a diet that fits your personal preferences. For example, Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard University T.H. Chan School of Public Health, told Live Science that "the No. 1 factor is still a calorie deficit, so the question is, what kind of styles or what kind of foods can help people achieve a calorie deficit, and what can sustain the calorie deficit?" [What Are Calories?]

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So, what should you eat if you're trying to slim down?

Read on for the best foods to choose for weight loss.

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(What all experts did not agree on, however, was the calorie question: Is a calorie really a calorie?) [The Great Calorie Debate]

"The best food someone on a diet should eat? The same foods they should eat when they're not on a diet, but just less of them," said Dr. Frank Sacks, a professor of cardiovascular disease prevention, also at Harvard's School of Public Health. All of the experts we spoke with agreed that those foods should include the staples of a "healthy" diet — fruits, vegetables, whole grains and healthy fats. These foods are important not only for achieving or maintaining a healthy body weight but also for good health in general.

In this article, we'll highlight some of the most popular diets people turn to in order to lose weight, and explain what the science really says about how well they work. But before we delve into the diets, it's important to break down the macronutrients of the foods we eat — carbohydrates, fats and protein — and the roles they play in the body. Of course, individual food can contain more than one more macronutrient.

Back to basics

Carbohydrates

Carbohydrates are your body's go-to source of energy, and they're digested quickly. Glucose — the most basic unit of a carbohydrate — is the only type of carb your cells can use directly to make energy. But the carbs we eat come in three forms — sugars, starches and fiber — and when it comes to weight loss, these three are not equal. [What Are Carbohydrates?]

Sugars (found in fruit, vegetables and dairy) and starches (found in grains, vegetables and beans) ultimately suffer the same fate: They're broken down into glucose and are used by the body for energy. But your body can use only so much energy at once, so not all of the glucose you eat is immediately used for fuel. Some of the extra glucose can be stored in your liver or muscles and be used later.

As for the rest? It gets converted to fat.

The difference between sugars and starches — which are sometimes referred to as "simple" and "complex" carbohydrates, respectively — is the complexity of their structure. Sugarscontain only one or two molecules, so it's very easy for the body to digest sugars and absorb them into the blood. Starches, in contrast, contain many simple carbohydrate molecules linked together. Because of their size and complexity, starches take longer to be digested into single molecules.

Is it okay to eat carbs if you're trying to lose weight?

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Fiber is an entirely different ball game. Fiber is found alongside sugars and starches in fruits, vegetables, whole grains and legumes. Like starch, it's a complex carbohydrate, meaning it contains many carbohydrate molecules linked together. However, your body can't digest fiber, so this carbohydrate doesn't get absorbed by the gut. It never enters the bloodstream, and it is never broken down for energy. The stuff passes through your body relatively untouched.

The benefit of eating starches, and especially fiber, rather than sugars is that they can help you feel fuller for a longer time because they are either broken down slowly or aren't broken down at all. And the idea is, if you're feeling full, you'll eat less. Of course, keep in mind that complex carbs aren't a free pass to eat as much as you like — extra calories consumed will still be stored as fat.

Compared with fat, carbohydrates are less calorie-dense: 1 gram of carbohydrates contains 4 calories, whereas a gram of fat contains 9 calories. However, because carbohydrates are broken down and absorbed quickly, they can lead to a quicker burst of sugar into the bloodstream than fat does. Therefore, carbs may raise blood sugar levels more than fat does (when compared in equal amounts).

Proteins

Protein-rich foods are important for everyone, not just bodybuilders. Protein serves as the building blocks for our bodies, from the tiniest structures inside our cells, to the largest parts of our anatomy. Unlike carbs or fat, excess protein isn't readily stored by the body, so it's essential to eat enough of this macronutrient every day. Of course, just because your body doesn't store the protein doesn't mean you have free rein to eat as much as you'd like without gaining weight. The body can convert excess protein into glucose, or store it as fat. [What is Protein?]

When you eat protein, the large protein molecules are broken down into their basic components, which are known as amino acids. There are 20 amino acids that are important in the body, and some can be converted from one type of amino acid to another as needed. However, there are also several amino acids that cannot be produced in the body by converting other amino acids, meaning you must get these amino acids from your diet. These are known as essential amino acids.

Both animal-based proteins (such as those found in meat, fish, dairy and eggs) and plant-based proteins (found in soy, legumes, nuts and some grains) contain essential amino acids. However, whereas all animal-based proteins contain all of the essential amino acids your body needs, plant-based proteins generally contain a smaller set of amino acids. That means that if you eat a vegan diet, you need to eat a variety of plant types to get all of your essential amino acids.

As with carbohydrates, 1 gram of protein contains 4 calories.

Fats

Fat does more than pad your waistline — in fact, your body needs some fat to function. For example, in addition to being a reserve source of energy that can be taken out of storage and converted into glucose if needed, fat can help your body absorb certain vitamins. And because fat is broken down more slowly than carbs, it can also help you feel full longer than carbs can.

But there's no doubt that fat is high in calories. In fact, it's the most calorie-dense of the macronutrients, weighing in at 9 calories per gram.

Of course, like carbs, not all fats are created equal. Unsaturated fats are typically found in fats that are liquids at room temperature — oils such as olive oil and canola oil — as well as foods such as nuts and fish. These fats are considered heart healthy, and can certainly be considered a part of a healthy diet for weight loss.

But saturated fats (such as butter), which are usually solid at room temperature, and trans fats (such as hydrogenated oils) are largely considered unhealthy, mainly because of their effects on heart health.

Fat that goes unused by the body ultimately has the same fate as carbs and protein: It's stored as fat.

The macronutrient wars

Though all three macronutrients — carbs, protein and fat — are essential to your diet, there's debate about exactly how much of each you should eat. Should carbs be the star of your diet, and fat be consumed sparingly? Or should fat be fronted-loaded? Or do the relative amounts of macronutrients in your diet even matter at all?

There's an abundance of advice in books, magazines and online sources about the best way to diet, and there are anecdotes about the diet "trick" that worked miraculously for someone's mom's best friend's former next-door neighbor to be found everywhere. But how do we know if they actually work?

Enter clinical trials, which allow researchers to directly compare the effects of different diets. And even among these trials, some are better designed than others. Researchers consider many factors when looking at the quality of a trial, including the size of the trial (the more participants, the better) and the length of the study period (the longer, the better), when deciding how much stock to put into the results.

Are veggies important for weight loss?

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The largest clinical trial that compared different diets was the Women's Health Initiative (WHI) Dietary Modification Trial, which included more than 48,000 postmenopausal women and had a follow-up period of seven years. However, the trial was not designed to look at weight loss. Rather, the goal of the trial was to see how fat in the diet affected thewomen's risk of cancer and heart disease. (Because the trial was only in women, it's unclear if the results also apply to men.)

The WHI Dietary Modification Trial was designed in 1990, when researchers were asking many questions about whether high-fat diets or low-fat diets were better for people's health, said Barbara Howard, a senior scientist at the Georgetown University Medical Center in Washington D.C. In a study published in the Journal of the American Medical Association (JAMA) in 2006, Howard took data from the original WHI Dietary Modification Trial and looked to see whether the two diets had different effects on weight loss.

In the WHI, 40 percent of the participants were encouraged to reduce their fat intake so that only 20 percent of their total daily calories came from fat. (At the study's start, all of the participants had reported that at least 32 percent of their daily calories had come from fat.) The women were encouraged to increase their daily servings of fruits, vegetablesand whole grains, and attended group sessions where they got advice about cutting fat. However, because the trial wasn't designed with weight loss in mind, these women were not encouraged to cut calories.

The other 60 percent of the women went into the control group. They were given a copy of the U.S. government's Dietary Guidelines for Americans and some additional educational material, but that was it. [Low-Fat Diet: Facts, Benefits & Risks]

The researchers monitored the diets of all of the participants during the study through questionnaires, and measured the women's height and weight at annual checkups.

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It turned out that the women in the low-fat-diet group lost a little bit of weight over the course of the study period, and they maintained their weight loss, said Howard, who is also a scientist at the MedStar Research Institute, a non-profit healthcare system of hospitals and clinics in the Washington D.C. area.

The researchers found that the women in the low-fat-diet group lost about 5 lbs. (2.2 kilograms) during the first year of the study, and then maintained a lower average weight than the control group over the rest of the study period.

The researchers concluded that there was a "clear relationship" between the change in the women's fat intake and their weight, they wrote in their study. The questionnaires showed that the women in the low-fat-diet group increased their daily intake of fiber, fruits, vegetables and whole grains, and decreased their daily intake of total fat, saturated fat and unsaturated fat. [Which States Are Eating Their Fruits and Veggies?]

In particular, the women who cut the most fat lost the most weight, the researchers found.

Also, the women in the low-fat-diet group who ate more fruits and vegetables also lost more weight than those whoate smaller amounts of fruits and vegetables, the researchers found. The same went for fiber: The women who ate more fiber lost more weight than the women who ate less fiber.

Another long-running clinical trial designed to compare the effects of different diets on weight loss was carried out in Israel: the Dietary Intervention Randomized Controlled Trial, or DIRECT, study.

But although that large, high-quality study found a relationship between a low-fat diet and weight loss, other studies conducted since have found that a low-fat diet is no more effective than other types of diets in helping people lose weight. It's important to note that the women in the study who switched to a low-fat diet didn't replace the fat in their diet with white bread and other refined carbohydrates, Howard said. In other observational studies, researchers have shown that when "high-carb" means sugar and refined carbohydrates, people don't lose weight, she noted.

The trial included 322 people, ages 40 to 65, all of whom were overweight and worked at the same research center. The participants were randomly assigned to different diets — a low-fat diet, a Mediterranean diet or a low-carb diet — for a two-year period. The researchers also conducted a follow-up four years after that, so the total study period was six years. The participants in the low-fat diet group and the Mediterranean-diet group were instructed to cut their calories, while those on the low-carb diet were given no calorie restrictions.

As in the WHI study, the participants received diet guidance in small group sessions. (One key difference between the two studies, however, was that in the DIRECT study, everyone was assigned to a group session.) In addition, because all of the participants worked at the same place, the researchers provided lunch each day. Each diet group was given a lunch that fit their diet, according to the report of the study,published in 2008 in The New England Journal of Medicine.

But unlike in the WHI study, the low-fat diet in the DIRECT study didn't result in the most weight loss. Rather, weight loss was the highest in the low-carb group — the participants in this group lost an average of 12.1 lbs. (5.5 kg) after two years. The participants in the Mediterranean-diet group lost, on average, 10.1 lbs. (4.6 kg), and the participants in the low-fat group lost, on average, 7.3 lbs. (3.3 kg) after two years. [Low-Carb Diet: Facts, Benefits & Risks]

Additionally, there was a difference in which diets were the most effective for each sex. The women in the study who were on the Mediterranean diet lost more weight than the women on the low-fat diet. In comparison, the men on the low-carb diet lost more weight than the men on the low-fat diet, the researchers found. (However, only 45 women completed the study, compared with 277 men.) In other words, both women and men lost more weight on a diet other than the low-fat diet.

The DIRECT study showed that one diet doesn't fit all, said Iris Shai, a professor of nutrition and epidemiology at Ben-Gurion University of the Negev in Israel and the lead author of the study. In other words, the researchers learned that there are some alternatives to a low-fat diet that also work for weight loss, Shai told Live Science. These alternatives (the low-carb diet and the Mediterranean diet) also have more health advantages in the long run, such as improved cholesterol and blood sugar levels, respectively, she said.

However, Shai noted that even though the people on the low-carb diet were not given a calorie restriction, they ended up eating a similar number of calories as the people in the calorie-restricted groups, Shai said. Ultimately, all of the groups cut their calories by about 400 to 500 calories a day, she said. In other words, the study suggested that calories do matter for weight loss.

In the follow-up four years later, the researchers found that all of the participants had regained some of the weight. Over the entire six-year period, the average total weight loss was 6.8 lbs. (3.1 kg) for the Mediterranean-diet group and 3.7 lbs. (1.7 kg) for the low-carbohydrate group. The average weight loss of 1.3 lbs. (0.6 kg) for the low-fat group was not statistically significant, meaning that the finding could have been due to chance, the researchers wrote.

One reason the Mediterranean diet appeared to be the most effective for weight maintenance is that, simply put, in real life, a more "balanced" diet that offers many options may work best in the long term, Shai said. [Mediterranean Diet: Foods, Benefits & Risks]

Dr. George Bray, a professor emeritus at Pennington Biomedical Research Center at Louisiana State University and the founder of The Obesity Society, agreed.

"I'm a fan of using a high-quality, good-pattern diet with lower amounts of food, and one way of doing that is with portion control," Bray said. Plenty of evidence suggests the Mediterranean diet is highly beneficial for people's health and, combined with portion control, is a good strategy for weight loss, Bray told Live Science. The DASH diet, which was developed to lower blood pressure, also has shown weight loss benefits, he said. The DASH diet is a low-sodium diet that's rich in fruits, vegetables, low-fat dairy, nuts, beans and seeds.

"As far as I can see, nothing else is of value," Bray told Live Science. "It comes down to calories — pure and simple." [Best Calorie Counter App]

Bray was one of the authors on another major weight loss study, called the Preventing Overweight Using Novel Dietary Strategies study, or the POUNDS Lost study. The results of that study were published in 2009 in The New England Journal of Medicine.

In that study, two teams of researchers — one in Boston and one in Baton Rouge, Louisiana — carried out the randomized trial, which was — and still is — the largest clinical trial designed to compare the weight loss effects of different diets. (The study had more participants than the DIRECT study, although the study period for the POUNDS Lost study was shorter.)

The POUNDS Lost study began with more than 800 participants (400 in Boston, and 400 in Baton Rouge) who were randomly assigned to one of four diets: low-fat with average protein, low-fat with high protein, high-fat with average protein and high-fat with high protein. A total of 645 people completed the study.

The people in the study were assigned to counseling sessions to learn about their diets, and there were group sessions held throughout the course of the study. The researchers provided the participants with daily meal plans, and the plans were largely similar across the four diets, with only small tweaks — for example, to include a bit of extra olive oil, or a bit less meat. All of the diets in the study were healthy — they all contained healthy fats, whole grains, fruits and vegetables, said Sacks, who was the lead author of the study. And all of the diets contained an equal number of calories — fewer than the number of calories the people in the study were normally eating, he said. [2016 Best Food Scales]

So, how did the different diets stack up for weight loss?

The main takeaway of the study is that all of the diets produced the same amount of weight loss, Sacks said. "There was no advantage of one diet type over another," he said. The researchers observed that, at six months, the participants in each diet had lost, on average, 13.2 lbs. (6 kg). After the one-year mark, on average, the participants began to regain some of their weight. By the end of the study, the average weight loss for all of the diets was 8.8 lbs. (4 kg).

Bray, who ran the Baton Rouge arm of the study, noted that there was certainly a range for the weight loss observed among the people on each diet. However, the range was similar in all of the groups, he said. Some people on each diet lost as much as 33.1 lbs. (15 kg), and some people on each diet gained a bit of weight, Bray told Live Science. But even the proportions of people losing a lot of weight or gaining a little weight were similar in all four diets, he said.

The biggest factor for weight loss? Undoubtedly, it was adherence to the diet, Bray said. "If you stuck to [the diet] well, you should lose more, and if you didn't stick to [the diet], you shouldn't," Bray said.

Putting it all together: Meta-analyses

Of course, it's important to keep in mind that, while these three trials have revealed some of the best evidence yet about weight loss strategies, countless smaller or shorter clinical trials have focused on diet and weight loss. To truly get a sense of the state of the field of research, scientists look at many studies together, in a type of study called a meta-analysis. This type of research can be especially valuable when looking at a number of smaller clinical trials because it reveals what the studies show when they are combined as a whole.

High fat or low fat? Read on to see what the science says.

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A meta-analysis lets researchers examine a large number of smaller studies to see if, collectively, there's been an impact, Bray said. And when you do that with weight loss trials, you don't come out with any notable differences between diets, he said.

A 2014 meta-analysis, published in JAMA, looked specifically at named diets — for example, the Atkins diet, the Ornish diet and others — and found that both low-fat and low-carbohydrate diets resulted in weight loss. There were 48 studies included in the meta-analysis, and between the individual named diets, the differences in weight loss were small, according to the researchers.

Both low-fat diets and low-carb diets resulted in about 18 lbs. (8 kg) of weight loss after six months, according to the study.

And while there were some statistically significant differences in weight loss between some of the diets (for example, after six months, the Atkins diet was associated with a 3.7-lb. (1.7 kg) greater weight loss than the Zone diet), "these differences are small and likely to be unimportant to many seeking to lose weight," the researchers wrote in their study. [2016 Best Online Diet Services]

"The main takeaway [of the meta-analysis] is that there's really no important differences between any of the diets," said Bradley Johnston, the director of Systematic Overviews through advancing Research Technology at the SickKids Research Institute in Toronto and lead author of the meta-analysis.

Indeed, most of the diets that Johnston looked at seemed to come back to calories.

Whether people did low-carb or some other type of diet, most of them were calorie-restricted, Johnston told Live Science. "If you actually follow the diet, it's highly likely that you're going to lose weight," he said.

What's important is that people choose a diet that they can stick with.

"Adherence is crucial," Johnston told Live Science. Because different people have an easier time sticking to different diets, the ideal diet is the one that the individual can adhere to best, so that they can stay on the diet as long as possible, the researchers wrote in their study. And in smaller studies, healthy eating habits have been linked with not only weight loss but also improved health, such as lower blood pressure, lower cholesterol levels, lower blood sugar levels and even improved cognitive function.

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In another meta-analysis, published in October 2015 in the journal The Lancet, researchers concluded that low-fat diets were no better than other types of diets evaulated for long-term weight loss. The researchers looked at 53 studies that had weight loss as a goal, as well as other studies for which weight loss was not the primary goal (think back to the Women's Health Initiative study, for example).

When comparing weight loss trials specifically to one another, the researchers found that low-carbohydrate diets resulted in greater weight loss than low-fat diets. For both the weight loss trials and the other trials, the researchers found that higher-fat diets resulted in greater weight loss than low-fat diets. And low-fat diets only resulted in greater weight loss when compared with a person's usual diet, according to the study.

But none of the diets blew the others out of the water. The big picture that people can take away from this meta-analysis is that a low-fat, high-carb diet is not more effective than any other weight-loss diet, said Hu, who was the senior author of the study.

And the amount of weight loss induced by any of the diets was not very impressive, Hu added. Most people regained the weight they lost in six months to a year, he said. Studies have shown that many people tend to regain lost weight over time, and experts think that more research is needed on how to keep weight off successfully. "A low-carb diet may be a little bit more effective than a low-fat diet, but in the long run, both diets are not significantly different from each other in terms of weight loss," Hu told Live Science.

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Because many diets produce similar results for weight loss, it's time to go beyond looking at macronutrients for weight loss, Hu said. Now, the focus should be on the quality of the foods that are eaten, he said. The majority of studies focus on macronutrient composition without paying attention to the quality of foods, he said.

And quality counts — people who eat a lot of refined starches and added sugars are more likely to feel hungry and regain their weight because these foods aren't satiating, Hu said. "On the other hand, if you eat a healthy diet with high-quality foods like fruits and vegetables, high-fiber whole grains and [healthy fats such as] avocados and nuts," you may be able to lose more weight and also sustain your weight loss with that kind of diet, he said. [Best Diet and Nutrition Apps]

Of course, if you really want to lose a lot of weight in a short amount of time, you can cut one-third or one-half of your total calories. But although that can be a very quick fix, the problem is that a quick fix usually doesn't last very long, Hu said.

For longer-term weight loss, people need to think about their overall diet patterns and gradually adapt to these patterns so they can stick with them, he said

.

The Best Way to Lose Weight Safely

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The formula for losing weight is simple: Eat fewer calories than you burn. But the methods of doing this can vary. In truth, there is no one "best" way to lose weight — what works for you might not work for someone else. To get the lowdown on the latest science on weight loss, Live Science conducted a months-long search for the best information. We contacted nearly a dozen experts who have researched weight loss, and looked at the most well-regarded studies of weight loss done to date.

We wanted to know what these studies found and, most importantly, when all the science and evidence were boiled down, what experts recommend for people who would like to shed pounds in a safe, healthy manner. All of the experts emphasized one thing: A person's approach to weight loss should be one that is enjoyable and can be maintained over the long term. Weight loss shouldn't be about deprivation, because diets that deprive people of their favorite foods tend to be short-lived, said Dr. Pieter Cohen, an assistant professor of medicine at Harvard Medical School and general internist at Cambridge Health Alliance.

"If you make this commitment to lifestyle changes, then maybe five years from now, you're 10 pounds [4.5 kilograms] lighter," Cohen said. "If you're doing crash diets, you would probably be 10 pounds more."

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People should focus on making lifestyle changes — sometimes even small ones, like cutting down on the sugar in coffee — to reduce their overall calorie intake. While these changes might not lead to drastic amounts of weight loss in short periods, they can produce healthy, gradual weight loss that will counter the natural tendency for people to gain weight as they age, Cohen said.

As we'll describe in detail below, a successful weight loss program usually involves cutting back on your calories, increasing your physical activity and making behavioral changes to help you stick with a diet and exercise regimen over the long term. [How to Get Started on a Weight Loss Program]

Should you lose weight? Find out below how to calculate your BMI.

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Who should lose weight?

Obesity is a growing problem in the United States. Over the past 15 years, the nation's obesity rate rose by 24 percent (7.2 percentage points) among adults, from 30.5 percent in the years 1999-2000 to 37.7 percent in 2013-2014, according to a report from the Centers for Disease Control and Prevention published in November 2015. The adult obesity rate in 2013-2014 was the highest ever for the nation, and equates to more than 78 million people.

The extra pounds come with baggage; they increase the likelihood of many health conditions, including the following:

heart disease

high blood pressure

stroke

Type 2 diabetes

high cholesterol levels

cancer

osteoarthritis

sleep apnea

gallstones

Though science has yet to establish a surefire link between obesity and each health risk, the extra fat tissue seems to be the biggest culprit. More fat in the neck has been tied to sleep apnea, while compounds released by fat cells may increase the chances of developing type 2 diabetes. In addition, the more body fat a person carries, the more blood is needed to provide the tissue with oxygen and nutrients, resulting in higher blood pressure. (On the other hand, losing weight can relieve such burdens on the body, leading to health benefits, including reduced blood pressure, cholesterol and blood sugar.)

Chart shows relationship of healthy weight and height.

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That's why one of the most widely used gauges of whether a person needs to shed pounds isbody mass index (BMI) — an indicator of body fatness developed by Belgian statistician Adolphe Quetelet in 1832 that's based on the ratio of height to weight. For example, a person who is 5 feet 7 inches (1.7 meters) and weighs 172 lbs. (78 kg) would have a BMI of 27. [BMI Calculator: What's My BMI]

The goal with BMI is to be what the National Institutes of Health considers "normal." The lowest risk for health conditions related to weight has been tied to a BMI between 18.5 and 24.9 (labeled "normal weight"). Risks go up as a person climbs this BMI ladder, with numbers between 25 and 29.9 considered overweight, and BMIs of 30 or greater considered obese, according to the NIH.

Although BMI is easy to calculate, it is not a perfect measure of body fatness. For example, people with a high amount of muscle mass can have a high BMI without being overweight or obese.

If your BMI places you in the obese category, it's time to lose weight, according to the most recent (2013) weight management guidelinesfrom the American Heart Association and other professional organizations. Weight loss is also recommended if you're overweight and have other risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol levels, or a waist circumference greater than 35 inches (88 centimeters) for women and 40 inches (102 centimeters) for men.

The 2013 guidelines were put together by an expert panel from the American Heart Association, the American College of Cardiology, and the Obesity Society, and were reviewed by the National Heart, Lung, and Blood Institute. The guidelines are based on a rigorous review of recent scientific studies.

People who are normal weight, or overweight and do not have any additional risk factors for heart disease, should focus on avoiding weight gain, rather than losing weight, the guidelines say, because there is no strong evidence that weight loss provides health benefits for these people. However, additional weight gain could lead to problems, experts said.

"It's common to gain weight with age, and weight maintenance is much easier than weight loss, so the best plan for these patients is to maintain their weight, eat healthier and exercise more — but not to focus on weight loss," Cohen said.

How much weight should you aim to lose?

Obese people who lose as little as 3 to 5 percent of their body weight improve their health. Research suggests that losing 5 percent of body weight results in a 3-mmHg drop in systolic blood pressure (the top number in a blood pressure reading, which is a measure of the pressure in the arteries when the heart beats) and a 2-mmHg drop in diastolic blood pressure (the bottom number in a blood pressure reading, which is a measure of the pressure in the arteries between heartbeats), according to the 2013 guidelines. Losing even more weight is associated with greater health benefits, so the guidelines recommend that people start out with a goal of losing 5 to 10 percent of their body weight over six months.

To accomplish this weight loss, most experts interviewed by Live Science recommended that you shed 0.5 to 2 lbs. (0.23 to 0.9 kg) every week. This usually means cutting 250 to 1,000 calories out of your daily diet. (If you cut 500 daily calories, you'll lose about a pound per week.)

For women, that means consuming about 1,200 to 1,500 calories a day. For men, it means a daily intake of about 1,500 to 1,800 calories. However, the number of calories you should consume can vary depending on your current weight and activity level.

Chart shows daily calorie range for a 40-year-old woman.

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To figure out how many calories to consume, you may want to use a calculator, such as the National Institutes of Health Body Weight Planner, which takes into account your current weight and activity level to determine how many calories a day are needed to maintain your current weight and how many are needed to achieve your desired weight loss.

You'll lose more weight if you cut even more calories. However, trimming too many calories will likely backfire and can even kill you.

Experts warn that severely restrictive diets — which cut more than 1,000 calories per day — tend to be unsustainable. You might see a rapid weight loss at first, but you'll likely regain much of the weight. For example, Oprah Winfrey famously lost 67 lbs. (30 kg) on a diet that allowed her to consume just 420 calories a day, only to later regain the weight.

Over the long term, severely restrictive diets tend to result in about the same amount of weight loss as diets that are less restrictive, said Robert Jeffery, director of the University of Minnesota Obesity Prevention Center.

For example, researchers reviewed data from six trials of very-low-calorie diets (fewer than 800 calories a day) and found that, after about 26 weeks, participants lost 16 percent of their initial body weight, whereas participants on a typical low-calorie diet (1,000 to 1,800 calories a day) lost about 10 percent of their body weight. But after about two years, both groups retained about the same amount of weight loss — around 5 to 6 percent of their initial body weight, according to the 2012 study.

The study is notable because it looked at data from clinical trials that directly compared very-low-calorie diets with typical low-calorie diets, which is a better method than looking at studies that do not involve a comparison, and instead include only a single diet.

Even the weight you lose on these restrictive diets may not be the right kind of weight, as cutting too many calories can cause you to lose muscle instead of fat, said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill-Cornell Medical College in New York.

"If you lose weight very rapidly, on a diet like a cleanse, then you're going to lose excess muscle," Aronne said. Muscle loss can be detrimental, because muscle tissue burns more calories than fat tissue; therefore, keeping muscle tissue can help with weight loss and maintenance, said Aronne, who is the author of the upcoming book "The Change Your Biology Diet" (Houghton Mifflin Harcourt, 2016).

Finally, any adult diet that allows fewer than 800 calories per day can be harmful and should only be undertaken under the supervision of a medical professional, according to the 2013 guidelines. People who follow such a diet may experience dehydration, irregular periods (for women), kidney infections and even sudden death, among other health problems, according to the Michigan Department of Health and Human Services. Such diets also increase the risk of developing gallstones.

It's important to have realistic expectations for weight loss with a reduced-calorie diet over the long term. Studies suggest that people can lose about 9 to 26 lbs. (4 to 12 kg) after six months of a typical reduced-calorie diet. Afterward, people usually gain back some of that weight, so they end up with a total of 9 to 22 lbs. (4 to 10 kg) of weight loss after one year, and 6 to 9 lbs. (3 to 4 kg) of weight loss after two years, according to the 2013 guidelines. [2016 Best Bathroom Scales]

Is there a "best" diet for weight loss?

People can lose weight on a number of different diets, as long as they consume fewer calories than they burn. "There's no one diet that's superior to other diets for long-term weight loss and maintenance," said Kathy McManus, director of the Department of Nutrition at Brigham and Women's Hospital in Boston.

A successful plan for weight loss is often one that is tailored to an individual's lifestyle and other personal factors. McManus and her colleagues found that the breakdown of calories from protein, fat and carbohydrates doesn't matter for weight loss. They followed 800 people assigned to different calorie amounts from these food categories. After two years, the participants had dropped about 9 lbs. (4 kg), on average. Few diet studies have followed such a diverse group — the McManus study involved people ages 30 to 70 with a wide range of incomes, from cities in the northern and southern United States — for more than a year.

Often, even small changes in your diet can help you lose weight. For instance, just replacing an unhealthy snack every day with fruits and vegetables, or eliminating an evening snack, can result in weight loss, said Katherine Tallmadge, a registered dietitian and an op-ed contributor to Live Science. "If people make minor changes that they can live with, it's more likely that they can lose the weight and keep it off," Tallmadge said. [ 4 Calorie-Cutting Tips That Won't Leave You Hungry]

Moreover, nothing magical happens when you cut fat — it doesn't result in extra weight loss, studies have shown. A recent study, published in October 2015, found that people on a low-fat diet lost about the same amount of weight as people on diets with more of their calories from fat.

Which foods keep you full for longer? Find out below.

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But what if you're the type of person who "cheats" because you feel hungry? That's where the type of calories and a few other tricks come in.

Though not foolproof, a low-glycemic diet that's chock-full of protein, fiber and healthy oils, and low in starches and other sugars, may help combat feelings of hunger. Researchers think that nutrients like protein and fiber help to create the "I'm full" feeling, while sugars and refined carbohydrates cause spikes in blood sugar that may increase hunger later, Aronne said. In that way, people on a low-glycemic diet may feel more satisfied while cutting back on overall calories and thus may be more likely to stick with the diet.

Liz Applegate, director of sports nutrition at the University of California, Davis, said she recommends a diet that is about 20 percent protein (about 60 to 70 grams, or 2 to 2.5 ounces, per day), spread across all three meals. This recommendation agrees with findings from a study of people in the National Weight Control Registry who have lost at least 30 lbs. (13.6 kg) and kept it off for at least a year. An analysis of 900 people in this registry showed that about 18 to 20 percent of their daily calories came from protein. This would be the equivalent of eating 6 ounces of Greek yogurt at breakfast (17 grams of protein), 3 ounces of salmon for lunch (21 grams of protein) 1 ounce of nuts for a snack (7 grams of protein) and 3 ounces of chicken for dinner (19 grams of protein).

Applegate also encourages people not to skip meals, because that deprivation often causes people to overeat later in the day. In particular, studies show that people who skip breakfast tend to weigh more than people who eat a healthy morning meal, according to the NIH.

According to a 2015 report from the Dietary Guidelines Advisory Committee, which advises on the nation's diet recommendations, people tend to have a healthy body weight if they eat a diet high in fruits, vegetables and whole grains; moderate in dairy products; and low in meats and sugar-sweetened foods and beverages.

In addition, since alcoholic drinks are essentially "empty" calories — they don't contribute towards you're daily nutrition — cutting back on alcohol may be one way to help you lose weight, experts said.

Surprise! Alcohol contains calories.

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As an alternative to eating a reduced-calorie diet every day, some people try to do "intermittent fasting." This means they significantly cut their calories on a few days per week and eat normally the other days. This diet is generally not recommended, but early research suggests that some people may find it easier to follow this diet than a traditional one, Tallmadge said. A review study published in April 2015 found that people on intermittent-fasting diets lost about 9 percent of their body weight over six months, and about 80 percent of the participants were able to stick with the diet.

Still, studies on this type of dieting are limited, and more research is needed to confirm the findings, the researchers said.

As for commercial weight loss programs, the most effective programs are in-person ones, where people regularly meet with a trained health professional, according to the 2013 guidelines. People should look for a program that lets them meet with a registered dietitian, psychologist, exercise specialist or health counselor at least 14 times over a six-month period, the guidelines say. If you can't attend an in-person program, some studies show that programs that use telephone calls, email or text messages to provide feedback on your progress can also help with weight loss.

How much exercise do you need?

You've worked on the calorie intake part of the equation. Now what about the "calories out?" Studies show that people who exercise while dieting lose more weight, and are better able to keep it off, than people who diet and do not exercise, said Wayne Miller, programs director at West Virginia School of Osteopathic Medicine's Center for Rural and Community Health.

Miller and his colleagues reviewed 25 years' worth of weight loss research and found that, during a typical 15-week weight loss program, people lost, on average, 23 lbs. (10.4 kg) by only dieting and 24 lbs. (10.9 kg) by dieting and exercising, they reported in 1997. That difference may seem small, but after one year, the people who only dieted kept off 14 lbs. (6.4 kg), on average, whereas those who dieted and exercised kept off 19 lbs. (8.6 kg). [2016 Best Heart Rate Monitor Watches]

As for how strenuous the exercise has to be, experts recommend that people who want to lose weight meet the government's guidelines of at least 150 minutes of moderate physical activity (such as brisk walking) every week, or about 30 minutes a day for five days a week.

But those who want to maintain weight loss over the long term may need to do more exercise. A 2008 study of the National Weight Control Registry involving 3,600 people who lost at least 30 lbs. (13.6 kg) and kept it off for a year or longer found that they reported at least 60 minutes of moderate physical activity per day. [Best GPS Watches]

The National Institutes of Health also recommends resistance training to strengthen muscles at least twice a week. These activities include lifting weights and doing push-ups and crunches, which can help build muscle. Resistance training exercises are important for weight loss maintenance because muscle tissue requires more calories to maintain itself, meaning you will burn more calories just by having more muscle. [ 4 Easy Ways to Get More Exercise]

Do diet pills and supplements work?

If weight loss sounds like a lot of physical and mental work, that's because it is. And there's no magic pill: Dietary supplements that claim to help people lose weight have not been proven to work, and they have the potential to be dangerous, Cohen said. Many nutritionists and researchers agree that such supplements can do more harm than good. Supplements can contain drugs that are not listed on the label, and may have harmful side effects. In 2014, the Food and Drug Administration identified more than 30 weight loss supplements that contained hidden drugs, but only seven of these were recalled by their manufacturers.

Weight loss supplements send more than 4,600 people to the emergency room every year, often due to heart symptoms, such as chest pain and a rapid heart rate, according to an estimate by a study published in October 2015.

The bottom line, many experts told Live Science, is that there is often no scientific evidence supporting a supplement's claims. The makers of diet supplements do not need to prove that their supplements actually help people lose weight in order to sell them in stores.

In contrast, makers of prescription and over-the-counter weight loss drugs, such as orlistat (brand names: Alli and Xenical) and lorcaserin (brand name: Belviq), must conduct studies showing that the drugs can lead to weight loss before the pills are approved by the FDA for use in obese individuals and those considered overweight (BMI of 27 or greater) who also have obesity-related risk factors.

Generally, people who take weight loss drugs — which often work by decreasing appetite and increasing feelings of satiety — can lose an average of 5 to 10 percent of their body weight in a year, according to the Mayo Clinic. However, these drugs still need to be used along with diet and exercise for people to achieve this level of weight loss. (Studies of these drugs involve people who have also made changes to their diet and activity level.)

According to the 2013 guidelines, the drugs might be helpful for people who aren't able to lose weight with diet and exercise alone, but people should consider discontinuing the drugs if they don't lose at least 5 percent of their body weight within 12 weeks of starting them.

However, Cohen cautioned that the long-term safety of weight loss drugs hasn't been studied. Most of the studies look at these drugs' safety after just one year, he said, and some earlier drugs that were approved by the FDA were later taken off the market because of their side effects. For example, in 2010, the weight loss drug sibutramine(sold under the brand name Meridia) was removed from the market — even though it had originally been approved — because it was later linked with an increased risk of heart attack and stroke.

In any case, weight loss drugs may not be a long-term method for keeping weight off, because people may regain the weight when they stop taking the drugs, Cohen said.

Lack of sleep increases the odds you’ll gain weight. Find out below how much shuteye you need.

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Can a lack of sleep cause weight gain?

Here's a bit of advice that may make a dieter smile, or yawn: Get more sleep. A growing body of evidence suggests that getting insufficient sleep increases the risk of obesity. However, most of these studies have been conducted at a single point in time, which makes it hard to determine whether a small amount of sleep was a cause or an effect of weight gain.

The longest-running study on the link between short sleep and weight gain followed about 68,000 women for 16 years. It found that women who slept 5 hours or less per night gained about 2.5 lbs. (1.1 kg) more, on average, than those who slept at least 7 hours per night, over 16 years. In addition, those who got 5 hours or less were 15 percent more likely to become obese during the study period than those who got at least 7 hours of sleep.

Getting too little sleep, which most experts define as less than 7 hours of shut-eye per night, may increase levels of an appetite-stimulating hormone called ghrelin, and decrease levels of the hormone leptin, which makes you feel full, according to the NIH. This may lead to an increase in hunger. In addition, people who sleep less could have more time to eat. In a small study of 11 people who stayed in a sleep lab, participants ate more snacks when they slept for just 5.5 hours than when they slept for 8.5 hours. This increase in snacking occurred mostly during the late-night hours.

Still, it's not clear if getting more sleep actually helps people lose weight. However, studies are now being conducted to answer that question. Inone study, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases will look at whether obese people who usually sleep less than 6.5 hours a night see changes in their weight if they increase their sleep by an hour per night. [Best Fitness Trackers]

Should you consider bariatric surgery?

Bariatric surgery, an operation on the stomach and intestine used to treat obesity, may be an option for people who are still severely obese after attempting to lose weight through other methods, such as diet and exercise. People with a BMI of 40 or greater, or those with a BMI of 35 or greater who also have obesity-related health conditions (such as type 2 diabetes), are candidates for this invasive surgery, according to the NIH.

People who have bariatric surgery will still need to make lifestyle changes, including following a healthy diet and engaging in regular exercise, to lose weight and keep it off.

A 2009 study that reviewed outcomes for more than 11,000 bariatric surgery patients found that patients typically lost about 56 percent of their excess body weight, or nearly 85 lbs. (38.5 kg), and maintained it for at least two years. Scientists who reviewed 89 studies on weight loss after bariatric surgery found that patients with a BMI of 40 or higher benefited most from the surgery, losing 44 to 66 lbs. (20 to 30 kg), on average, and maintained that weight loss for up to 10 years, they reported in 2005 in the Annals of Internal Medicine.

The operation has the following side effects:

The surgery alters the gut's ability to absorb nutrients, so you may need to take vitamins and minerals, to prevent malnutrition.

You will not be able to eat large meals.

You will need to eat liquid or pureed foods for several weeks following the surgery, according to the Mayo Clinic.

How can you keep weight off?

It's typically harder to keep weight off than it is to lose it, the experts agreed. Many studies show that people usually experience their maximum weight loss after about six months of a diet-and-exercise program. After that, the pounds come creeping back, although most people don't regain all of the weight. For example, a 2007 review of 80 diet studies involving more than 26,000 people found that dieters lost about 11 to 19 lbs. (5 to 8.5 kg) after six months, but then their weight loss plateaued, and after four years, they maintained about 6.5 to 13 lbs. (3 to 6 kg) of weight loss.

Chart of the habits of those who successfully keep weight off.

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Participating in a program that focuses on maintaining weight loss — one that meets at least once per month for a year or more — can increase the chances that you'll keep the weight off. A 2008 study of more than 1,000 people who lost about 19 lbs. found that people who participated in a weight loss maintenance program that met in-person once a month kept off about 3 lbs. (1.4 kg) more over a 2.5-year period than people who didn't participate in the program.

To assist any weight loss effort, weigh yourself twice a week, continue the lower-calorie approach indefinitely and exercise at least 200 minutes per week, according to the 2013 guidelines. The Centers for Disease Control and Prevention recommends that you make a plan for how to keep up your healthy eating pattern, even on weekends, vacations and special occasions. [2016 Best Pedometers]

Eating breakfast may also stave off hunger later in the day. In a 2002 National Weight Control Registry study of nearly 3,000 people who kept off 30 lbs. (13.6 kg) for at least a year, researchers concluded that one habit that stood out was eating a morning meal: 78 percent of the participants ate breakfast every day.

Once you've lost weight, keeping it off can seem like a never-ending battle. But it's a battle worth fighting, even if you slip sometimes. Trying, even if you don't always succeed, is better than not doing so, scientists say. There's no clear evidence that "yo-yo dieting" — or weight cycling, as researchers call it — is linked with an increased risk of early death or disease, compared with remaining obese, McManus noted. And very few studies report harmful effects of yo-yo dieting.

"Weight loss intervention should not be discouraged because of a person's tendency to be a weight cycler," McManus said.

In a nutshell, the bulk of the evidence says that maintaining your weight loss is achievable if you do the following: keep up your healthy diet, continue to exercise and monitor your weight so you notice when your regimen needs adjusting.

This article is part of a Live Science Special Report on the Science of Weight Loss. It will be updated whenever significant new research warrants. Note that any significant change in diet should be undertaken only after consultation with a physician.

How to lose weight for baby???

For one Ohio mom-to-be, a years-long struggle to lose weight has become even more urgent.

Jeneen Bufford, 32, had bounced from one fad diet to another, never dropping as many pounds as she wanted. She lost 80 of her 320 pounds through a boot camp program, but later gained back 35. Now expecting a baby in December, Bufford worries about all the extra pounds.

“With me being very overweight, I definitely want to make sure I have a healthy pregnancy,” Bufford told NBC News. “I really don’t want to cause any harm to my child because of any choices that I’ve made.”

Bufford has a reason to be concerned. A recent study published in JAMA found the risk of extremely premature birth -- babies born between 22 and 27 weeks -- rose rapidly with increasing maternal weight.

Women with a body-mass index between 30 and 35 were 58 percent more likely than those at a healthy weight to deliver an extremely premature baby, a team of U.S. and Swedish researchers found after examining the medical and delivery records of 1,599, 551 Swedish moms. Pregnant women with a BMI between 35 and 40 were twice as likely as normal-weight moms to have an extremely premature baby, while those with BMIs of 40 or greater were nearly three times as likely to deliver an extremely premature baby.

“When a baby is born earlier than it should be born, the potential for all the organs not being fully developed is increased,” said Karen Cooper, director of Healthy Expectations, a program at the Cleveland Clinic that helps women lose weight before they become pregnant. The program also helps obese pregnant women such as Bufford make healthier lifestyle choices so they might minimize the risks to their babies.

“When it comes to being obese and being pregnant, the risk factors for things going wrong multiply very quickly,” Cooper told NBC News. “Along with that comes gestational diabetes, hypertension, and preeclampsia, which can eventually lead to eclampsia, which is a condition where seizures occur.”

A premature baby may need a ventilator to help with breathing and nutrients fed through an IV tube, said Dr. Sandra McCalla, director of obstetrics at the Maimonides Medical Center. Further, prematurity can put a baby at risk for future problems, McCalla said.


More than half of American women of reproductive age are overweight or obese, said Cooper. But dieting during pregnancy is not the solution to maternal obesity.

“We just really encourage them to have a healthy lifestyle,” Cooper said. “We put together exercise activities per the individual mom and a calorie plan specific to the mom to have them gain an appropriate amount of weight.”

That’s where the surprise may come in for some women.

“Someone who has a body mass index between 19 and 24.9 has been encouraged to gain between 25 and maybe 35 pounds,” Cooper said. “When someone is overweight or obese, though, the amount of weight gain that is recommended is reduced. With a body mass index of 30 or higher the recommendation is a weight gain of 11 to 20 pounds.”

For Bufford, the changes have gone further than just counting calories.

“During my pregnancy my goal is to make sure that I eat enough fruits and vegetables and limit my grains,” she told NBC News. “And also to incorporate some protein as well and dairy.”

Ultimately, Bufford hopes the changes will pay off with a healthy baby.“Now that I’m pregnant it’s no longer about me, it’s about my child,” she said. “I want my baby to be 100 percent healthy, 10 fingers, 10 toes and no internal problems whatsoever.