Without a doubt the most common question I get asked is how best to lose weight. If there was a simple answer I would not be writing this article! Recently, TIME magazine writer Amanda MacMillan offered eight strategies that work best for weight loss. I have covered many of these topics in other articles but here is a quick summary; 

• Eat a big breakfast. Data suggests a big breakfast reduces plaque buildup in arteries and reduces the release of hormones that make you want to eat more later in the day. 
• Drink at least one less soda per week. Sugary beverages increase waist size which in turn causes diabetes and heart disease. 
• Eat  a  Mediterranean-style  diet. This means more fruits, vegetables, nuts, whole grain, olive oil, and lean sources of animal protein. Avoid processed foods and drink alcohol in moderation like a glass of wine with dinner. This diet is rich in phytochemicals that have anti-oxidant and anti-inflammatory properties. As a result you have less heart and stroke disease, less diabetes, cancer and kidney disease 1.    
• Exercise to keep the weight o£. Food choices and portions cause weight loss but exercise helps keep it off by burning excess calories. 150 minutes of moderate or 75 minutes of vigorous exercise a week is considered a minimum.
• Get a good night’s sleep. Sleep has many benefits but increasing sleep time and the quality of sleep actually helps lose weight by reducing subsequent sugar intake and improving food choices. 
• Eat more slowly Chewing food longer allows the body to release stomach hormones that give you a feeling of fullness and satiety. Eating beyond fullness leads to excess calories and weight gain. 
• Dump fake sugar  Artificial sweetners actually increase weight gain. The mechanisms are not clear but these agents can interfere with sugar metabolism. In addition, they create a taste for and craving for real sugar resulting in carbohydrate binge eating.
• Don’t  worry about workout weight gain : Good workouts often shift weight so muscle mass and water weight goes up while fat weight goes down. Waist circumference may be a better measure than the weight scale.

Low fat and low carb diets are equally healthy but low carb diets tend to produce better weight loss. When diet and exercise fail, there are drugs that can help reduce weight. Avoid weight loss supplements that often have stimulants that can cause heart rate and blood pressure to go up. Avoid diuretics and thyroid pills unless you need them for other reasons. Orlistat (Alli and Xenical) is an over-the-counter weight loss aid that prevents absorption of food but often has unpleasant gastrointestinal side effects.

There are three FDA approved prescription oral drugs. Lorcaserin (Belviq) works on serotonin brain receptors and creates a feeling of fullness. The combination of Phenteramine and topiramate (Qsymia) or the naltrexone and buproprion (Contrave) work to control hunger and increase satiety. All three agents appear to level off after an average of 15-20 lb weight loss. The last approved agent in a daily injection is liraglutide (Saxenda), which is also used in lower doses for diabetes management and has favorable effects on the heart. Finally, if all else fails and your BMI (body mass index) is in the morbid obese (>40) category, then a visit to a specialized doctor known as a bariatric surgeon is recommended. They can perform various operations such as a lap band procedure, gastric sleeve procedure or a full gastric bypass surgery. These procedures cause the greatest weight loss and, in well-motivated patients, can reduce diabetes, lower blood pressure, lower bad cholesterol and actually improve survival. 

So what are you weighting for? Lets shed those pounds!