Please see COVER STORY next page The average weight of Americans will continue to climb for the next decade before the obesity epidemic levels off, the nation's top registered dietitians predict.
And there is no quick fix in sight.
Among the pitfalls: People don't limit portions, and they follow fad diets instead of sensible ones, the nutritionists say. Seeing a turnaround in poor diet and exercise habits could take years, they say.
USA TODAY surveyed 126 nutrition professionals with the American Dietetic Association, including sports nutritionists, cookbook and nutrition book authors, heads of hospital wellness programs, university weight-loss researchers and many dietitians in private practice.
From their responses, it is clear that they care passionately about helping Americans get control of their weight; they consider obesity a major threat to public health.
National obesity researchers agree. ''We cannot afford to allow the weight of the population to increase over the next 20 years,'' says James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver. ''We must begin now to prevent the 1 to 2 pounds that the average American gains each year, so that over time we can gradually reduce the percentage of Americans who are overweight or obese.''
About 65% of adults in the USA weigh too much, putting them at an increased risk of diabetes, heart disease and many types of cancer. Some health experts predict that obesity will overtake smoking as the leading preventable cause of death by 2005.
The major obstacles
The survey findings point to a number of reasons that people don't lose weight:
* They don't have a realistic idea of portion sizes. Restaurants often contribute to the problem with portions that are at least twice the recommended serving size.
* They don't change their eating habits for good. Instead, they choose fad diets that they can't adhere to over the long term.
* They aren't exercising. People consider exercise drudgery, the dietitians say, and they feel they don't have time to do it.
* People don't want to try to change their eating habits because they're afraid they'll have to give up their favorite foods.
Many of the dietitians have worked for 20 or more years with clients, and they know all too well what's tripping people up.
Americans are ''too gullible,'' says Bonnie Taub-Dix, a registered dietitian in New York and a spokeswoman for ADA. ''People have not realized or don't want to realize that there is no miracle diet. They go from one craze to another ---- the cabbage soup diet, high-fat diet, low-fat, high-carb, low-carb, high-protein, no-protein.
What people want to hear is that losing weight is quick, easy and miraculous, she says. ''They'd like to hear something like, 'I stand on one foot and eat and lose weight.' But the only way that's going to work is if you chew and don't swallow, which I don't recommend.''
People can enjoy food and still lose weight, but they have to do it properly. It has to be balanced, and it has to make sense, she says.
Another big problem: Activity has been squeezed out of people's lives by modern technology. ''The everyday lives of most people are almost as if they were in a coma,'' says Robyn Flipse, a nutritionist in Ocean, N.J. ''They are in their cars, at their desks, in front of computers, in front of TV screens. They push a button to microwave their food, to wash the dishes, to do the laundry, to turn on the TV.''
Most people have to work to make the time to do the minimum amount of 30 minutes of exercise a day, but even that isn't going to offset obesity or the calories consumed by moderate eating for sedentary people, she says.
Studies show that people can lose weight by cutting calories, but the dietitians overwhelmingly agree that activity is a crucial component of weight loss.
They tell clients that the more they move, the more they'll lose. They encourage people to find something they enjoy doing and do it regularly. Some recommend buying a pedometer and working up to walking 10,000 steps a day.
When enough is enough
The people who are most successful at losing weight have a ''wow'' or ''light bulb'' moment when something clicks and they decide they don't want to live this way anymore.
''They've had enough of their own procrastination, enough of their own hypocrisy of saying one thing and doing another,'' Flipse says.
They have a very clear motivation, agrees Dawn Jackson, a dietitian at Northwestern Memorial Hospital Wellness Institute in Chicago. She sees 100 weight-loss patients a month. ''If you ask them why they are trying to lose weight, they don't pause. It's on the tip of their tongue.''
They may be going to a class reunion, attending a wedding or approaching a hallmark birthday such as their 40th or 50th.
Or they may have daily aggravations that are weighing them down, such as difficulty fitting into airline or movie-theater seats, not being able to wear most of their clothing or breathlessness when they walk up a flight of stairs.
Or they may have medical fears such as high blood pressure, diabetes or fear of having heart attack.
Some are prompted by specific incidents to turn their lives around.
Jackson had one patient who lost 130 pounds because she became frustrated on a hike with her teenage daughter. The woman was so winded after walking a short distance that she had to sit down on a bench. An elderly man with a cane passed her by. So did a person in a wheelchair.
''This was the straw that broke the camel's back, and it was that image she kept in her mind every time she was tempted by things like a plate of cookies that someone brought into work,'' Jackson says. ''She would repeat to herself, 'If this is going to stop my chances to hike with my daughter, it's not worth it.' ''
Taub-Dix had a patient who was motivated to lose after she went to buy a pair of pantyhose for a wedding. The sales clerk told her she would never fit into the ones she planned to buy and she needed a bigger size. ''She felt like someone had shot her.''
Favorite foods have a place
In the survey, the nutritionists say many people don't even try to revamp their eating habits because they think they'll have to give up their favorite foods.
''Everything can fit into a diet, but you may not be able to have it every day,'' Taub-Dix says. She recommended that one patient who loved pie declare one day a week ''pie day'' and eat a piece only on that day.
If you crave a high-calorie food like chicken nuggets, she suggests you ''turn the lights down, turn the soft music on and enjoy them, but only have them once a week.''
Too many people go through the weight-loss process as if they are ''walking through a tunnel with blinders on,'' she says. They say ''no thank you'' to this food and that food, so when they quit dieting, all those foods are so tempting that they gorge on them.
But if they had eaten some of their favorite treats when they were losing weight, nothing would ''glitter'' as much when they were finished, she says.
Deprivation works two ways, Taub-Dix says. She tells her clients that by overeating, they may not be denying themselves food, but ''they are depriving themselves of a smaller size clothing, better self-image, better agility, better health.''
Invoking the 80-20 rule
Many overweight people have a diet mentality when what they really need is an eat-right-daily mind-set. They consider themselves either on or off a diet, Jackson says. ''They think they can eat everything they want or nothing they want, and both of those attitudes equal failure.''
She tells patients to consider themselves a ''B'' student and follow the 80-20 rule: About 80% of the foods they eat need to be lean protein such as poultry, fish and beans; fruits and vegetables; low-fat dairy such as yogurt and skim milk; high-fiber grain products; and healthier fats such as olive oil. The other 20% of the time they can eat foods that are not as healthful.
She also tells people to forget willpower. A better strategy is environmental control. If you want to lose weight, do not bring a gallon of ice cream into the house, she says, because it's too hard to resist. Instead, buy small prepackaged portions of ice cream bars for occasional treats.
No one is saying weight loss is easy. It takes a lot of work, especially since dieters are fighting against the tide in a society that has food available 24/7.
It's hard to change habits, Flipse says. ''You have to buy different foods, fix them in different ways, sometimes pay more money for them and not eat all of it. I tell people it would probably be easier to learn to speak Japanese or play the violin than change eating habits.''
Please see COVER STORY, 11BCover story
To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com
© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.