"We've all heard it a million times: In order to lose weight, just burn more calories than you consume. Simple math, right? Yeah, unless you live in the real world—the one with deadlines and cronuts. Only one in five dieters are successful at losing—and keeping off—10 percent of their body weight, according to the National Weight Control Registry (NWCR). "You're battling your biology—your body reacts to dieting by burning fewer calories—as well as your emotions and your environment, where there are way too many temptations," explains Robert Kushner, MD, director of the Center for Lifestyle Medicine at Northwestern's Feinberg School of Medicine."
But getting help can make all the difference. Brand-new obesity-treatment guidelines from the American Heart Association, the Obesity Society and the American College of Cardiology say that the best way to lose weight is to work with a trained health-care professional. And just over half of the successful losers tracked by the NWCR sought outside help.
In fact, with the right tools and support, anyone can achieve weight-loss success. "People who have maintained long-term weight loss had many failed diets in their past," points out James Hill, PhD, co-founder of the NWCR and director of the Colorado Nutrition Obesity Research Center. "Just because you haven't succeeded yet doesn't mean you can't do it." It may simply be a sign that it's time to call in reinforcements. Here's where to turn if you're having trouble losing on your own.
Consult a dietitian
What it is: Think of a dietitian as your personal food coach. After taking a thorough look at your eating habits, daily schedule, stressors and snack triggers, she will help you come up with an overall nutrition plan. "We can help women with budget and time constraints find ways to eat healthy, give advice on how to lighten up favorite recipes and provide suggestions for dealing with emotional eating or getting more exercise," explains Jessica Crandall, RD, general manager at Denver Wellness and Nutrition. Bonus: Meeting with a specialist provides accountability, so it's easier to stay focused on your goals.
What the research shows: Nutrition education can improve overall diet quality and aid in weight loss. A 2013 study in the Journal of the Academy of Nutrition and Dietetics found that people who received eight nutrition-coaching sessions over six months lost on average 5 percent of their body weight.
Who should consider it: Anyone who's committed to cleaning up her diet but isn't sure where to start. A dietitian can also work with you to strategize around a specific food challenge, whether you're eating off your kids' plates or struggling with a health problem like diabetes.
How to find one: Look for someone with the initials RD, for "registered dietitian," or RDN, for "registered dietitian nutritionist." Both indicate that she has earned at least a bachelor's degree with requirements to study the science of nutrition and the psychology of eating, complete a supervised practice program and pass an exam given by the Academy of Nutrition and Dietetics (AND). Search for an RD in your area at the AND website (eatright.org).
Cost: Usually from $100 to $250 an hour; most people do three to six sessions over the course of four to six months. Insurance coverage varies, but it's more likely if you have a weight-related health problem.
See a cognitive-behavioral therapist
What it is: Cognitive-behavioral therapy (CBT), a short-term, results-oriented form of counseling, focuses on changing unhelpful behaviors and thoughts—like I deserve to eat a piece of cake because I've had a hard day. "A cognitive-behavioral therapist can help you identify your triggers for overeating, teach you strategies for managing stress and give you insight into how psychological issues, like depression, anxiety or low self-esteem, might be affecting your diet," says Sherry Pagoto, PhD, associate professor of medicine at the University of Massachusetts Medical School's Division of Preventive and Behavioral Medicine.
What the research shows: "Studies that have looked at using CBT in people with binge-eating disorder have found that about 50 percent are able to get it under control," says Marney White, PhD, associate professor of psychiatry at Yale University School of Medicine. "And binge eating is notoriously difficult to treat." In 2012, one study found that women who had CBT alone over the course of six months, without being encouraged to exercise or eat less, lost on average about 5 pounds.
Who should consider it: "If you struggle with emotional eating or have other issues, like depression, anxiety or a history of disordered eating, a mental health professional is a good choice," Dr. Kushner says.
How to find one: Go to the Association for Behavioral and Cognitive Therapies site (abct.org) and click on Find a Therapist, where you can look for practitioners who specialize in weight management or obesity.
Cost: Anywhere from $100 to $200 or more an hour. According to the new obesity treatment guidelines, the most effective plans involve two or three visits a month for at least six months. Under the Affordable Care Act, insurers are required to cover mental health care, though your plan may have some restrictions. Many therapists offer a sliding fee scale to make it more affordable, and teaching institutions tend to have reasonable rates.
Visit a weight-loss spa
What it is: A retreat with body-transforming benefits. The options range from spa resorts that offer light, fresh food and a few seminars on nutrition to more specialized diet destinations. In general, programs with a stronger weight-loss emphasis will give you the biggest bang for your buck. "Good spa programs have a daily exercise component, healthy food and lots of education about diet and exercise, so you learn strategies to use once you leave," Hill says.
What the research shows: Most spas don't invest in peer-reviewed research, but one study of the Hilton Head Health program in Hilton Head, S.C., found that 68 percent of guests kept off the weight they lost for at least a year.
Who should consider it: "People who are ready for a long-term change but would like a jump-start to push them in the right direction," Dr. Kushner notes. "That said, most people are going to need some ongoing support after they leave."
How to find one: Spafinder.com and destinationspavacations.com provide lists of weight-loss spas. You can also get suggestions from friends and doctors. "Look for a place that uses a solid medical approach, with at least a few RDs and exercise physiologists on staff," Dr. Kushner advises. And you'll want a philosophy that suits your style and needs. For example, The Ranch at Live Oak in Malibu and The Biggest Loser Resorts emphasize exercise and fitness, while Pritikin Longevity Center & Spa in Miami and Canyon Ranch resorts are more medical, with blood tests and MDs on hand. Green Mountain at Fox Run in Ludlow, Vt., teaches women a sustainable "nondiet" approach to eating.
Cost: Expect to pay $3,000 to $4,000 or more a week for the basic program; add-ons, like individual consultations with nutritionists, typically cost extra.
Next Page: Talk to your doctor about a diet drug
Talk to your doctor about a diet drug
What it is: Alas, there's no pill that instantly melts off fat, but there are several prescription drugs that can help in combination with a healthy diet and exercise. Xenical—a higher dose of the active ingredient in the over-the-counter drug Alli—works by preventing the body from digesting fat from food. (It can cause side effects such as changes in bowel movements.) Two new meds were approved in 2012: Belviq activates a serotonin receptor in the brain, which may help you eat less and feel full after eating smaller amounts. Qsymia is a combination of the stimulant phentermine, an appetite suppressant, and the anti-seizure medication topiramate, which helps you feel full.
What the research shows: A new review in The Journal of the American Medical Association showed that compared with a placebo, people who took Qsymia lost up to 9.3 percent of their body weight in a year; those on Belviq lost on average about 3.2 percent over placebo, while folks on Xenical lost slightly less than that. Keep in mind, though, that "people respond differently to all these meds," says Ronald Sha, MD, medical director at the Duke Diet and Fitness Center.
Who should consider it: These drugs are for those with severe weight problems—a BMI of 30 or higher, or 27 or higher if you have type 2 diabetes, high blood pressure or cholesterol or another weight-related health issue.
How to find it: Ask your primary care doc or endocrinologist if you'd be a good candidate for a medication.
Cost: $150 to $250 per month; insurers might cover the cost.
Enroll in a medical weight-loss program
What it is: Less cushy and more intensive than a spa, these programs last from a week to a month or more. Many are affiliated with a university (for example, Duke, Northwestern, UCLA and Johns Hopkins all have centers), and the best ones out there keep knowledgeable weight-loss experts on staff. You'll find MDs who specialize in weight-related medical problems as well as dietitians, exercise physiologists, psychotherapists and often even acupuncturists. The longer commitment allows you more time to form new habits, Dr. Sha notes.
What the research shows: "We see average weight loss of more than 10 percent in those who do our six-month programs," says Hill, who is also executive director at the University of Colorado's Anschutz Health and Wellness Center. But even university-based centers don't have long-term data on how well patients do once they're on their own.
Who should consider it: People with serious weight-related health issues, like diabetes, are particularly well-suited, but anyone struggling with weight loss could benefit.
How to find one: Consult your doctor, or go to health.com/weight-loss-programs for our top picks. "Look for a place that has a variety of experts who specialize in obesity and that offers a good follow-up program," Hill suggests. If it has prepackaged meal plans, for instance, make sure it also provides support when you're transitioning to a more varied diet.
Cost: From as low as $400 for a 12-week group program to $7,500 or more for an immersive four-week individualized program; insurance may cover the cost if a doctor recommends it to treat an obesity-related medical problem. The catch: Most centers don't have on-site accommodations, so you'll need to pay for lodging if the program isn't local.
Consider surgery
What it is: There are three main approaches to bariatric surgery—gastric banding, sleeve gastrectomy and gastric bypass. They all work by decreasing the capacity of the stomach, reducing the amount you can eat before you feel full. "Each approach has its benefits and drawbacks," says Daniel Jones, MD, director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center in Boston. "Gastric bypass has been the gold standard, but it's also the most invasive and is the riskiest."
What the research shows: Within two to three years, weight-loss surgery usually helps people lose 40 to 80 percent of their excess weight—and often eliminate their weight-related health problems as well.
Who should consider it: Surgery used to be reserved for people with a BMI of 40 or higher, but new research has found that the benefits may outweigh the risks even for those with a lower BMI—30 or higher—if they have medical issues that could get better with weight loss.
How to find a surgeon: Your doc will undoubtedly make a referral, but before you commit, be sure the facility is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, and ask how many procedures the surgeon does every year. One study found that surgeries performed by doctors with less experience in them tend to have more complications; look for a surgeon who performs 50 or more a year.
Cost: Many insurers cover some or all of the procedures—they cost $25,000 to $30,000—but getting approval can be tricky. Some require a six-month waiting period, during which you try to adopt healthy diet and exercise habits so the postsurgical weight loss will be more likely to stick.
"We tend to see people who are at their wit's end—they've tried a number of diets and are severely overweight," Dr. Sha says.
BE SMART WHEN YOU SHOP
You've seen the ads for weight-loss supplements and heard their pitches ("Boost metabolism!" "Burn fat!"). It's enough to make even the most sensible woman wonder, Should I try it?
Unfortunately, many of these products are ineffective. Indeed, a 2012 research review in the International Journal of Sport Nutrition and Exercise Metabolism found no strong research evidence that any supplement will help you lose more than a few pounds over the long term.
But beyond that, some diet supplements pose a threat to your health, says Pieter Cohen, MD, assistant professor of medicine at Harvard Medical School. Most recently, in November, several OxyElite Pro products were pulled from the market after the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration (FDA) began investigating cases of serious liver illness linked to the products.
What's more, the FDA has identified dozens of weight-loss supplements that contain potentially dangerous prescription meds, like sibutramine, a drug taken off the market in 2010 because of increased risk of heart attack and stroke. Because regulators are on the lookout for sibutramine, some companies are altering the drug's molecules so it's undetectable in tests. "That's particularly reckless because once you change the chemical formula, you no longer know exactly what the chemical is or what it does," Dr. Cohen warns. Another problem: Companies are creating stimulants in the lab and marketing them as "natural." One of those ingredients, DMAA, aka geranium extract, could elevate blood pressure and lead to a heart attack.
As of last April, the FDA had sent warning letters to 11 companies producing supplements that contain DMAA, telling them to take the products off the market. All of them complied, but the ingredient is likely still out there. Bottom line: Use caution before you buy.