Making Calories Count

Dieting is as American as the apple pie that puts the pounds on in the first place. At any one time, 45 percent of women (and 25 percent of men) are on a diet, according to the American Dietetic Association. Most of them probably should be: the government's most recent survey, using a strict new definition of desirable weight, found that 50.7 percent of women (and 59.4 percent of men) are overweight. Losing those extra pounds is critical, since obesity contributes to heart disease, diabetes, infertility, gallstones and breast and uterine cancer. "It's not just an issue of vanity," says Robert Kushner, head of the nutrition, fitness and weight-management program at Northwestern Memorial Hospital in Chicago. Our battle of the bulge produces fat profits for the companies that sell $33 billion worth of weight-control products and services each year. From popular diets to drugs, here is a guide to what works and what doesn't.

The proportion of elderly obese people in this country has grown from 14 percent in the 1960s to nearly 23 percent today. Women are slightly more susceptible than men, say researchers, with the trend holding true for all racial and ethnic groups. Popular diets: Today's best-selling diet books--"The Zone," "Sugar Busters," "Dr. Atkins' New Diet Revolution"--extol the virtues of protein and rightly condemn nutritionally worthless foods made with highly processed grains and sugars. Yet low-calorie, high-protein diets may result in nutrient deficiencies and can be deceptive because much of the weight loss is water.

"Sugar Busters" urges women to shun not only refined sugar but also insulin-producing starches, such as carrots and baked potatoes. "It's so alarmist--'sugar is toxic'," says Chris Rosenbloom, a nutrition professor at Georgia State University. Coauthor Morrison Bethea, a heart surgeon, argues that he simply prefers dieters to choose higher-fiber broccoli and sweet potatoes. "The flesh of the potato is a pure starch," he says. And though many people think "Sugar Busters" advocates unlimited protein and fat, it does not. Dieters can eat cheese, but just a thin slice, and nuts, but only 12, he says.

Women who live by "The Zone"--which advocates getting 30 percent of calories from fat, 30 percent from protein and 40 percent from carbs--buy into biochemist Barry Sears's notion that keeping insulin levels in check is the secret to weight loss. Yet dietitian Rosenbloom says women who faithfully follow the menus in "The Zone" can fail to get even half of the government's recommended intakes of thiamine, iron, magnesium, zinc and copper. Sears denies that his diet causes deficiencies. In fact, he says, his diet is so laden with fruits and vegetables that people can feel too full to finish their meals. (He suggests starting the day with a six-egg-white omelet, along with oatmeal and a cup of strawberries, then moving on to a lunch of two heads of lettuce, four ounces of tuna fish, a cup of mushrooms, two cups of chopped peppers, a cucumber and a quarter cup of chick peas.) Nutritionists also criticize the omission of calcium-rich dairy products from The Zone Food Pyramid. But Sears says he allows consumption of low-fat cheese.

Some 27 years after "Dr. Atkins' Diet Revolution" first appeared, the extremely low-carb regimen is enjoying a resurgence in popularity. Always controversial, it can cause ketosis (a depletion of stored carbohydrates, the body's preferred energy source) and can rob the body of sodium and potassium. Cardiologist Robert Atkins rails against the government's food pyramid, which puts grains at the base of the diet. Some 99 percent of the grains Americans consume are refined and not healthful, he says. "My diet is nothing but nutrient-dense foods ... People need supplements because they spend too much darn time on the food pyramid."

Another best seller adopts regimens based on blood type. Naturopath Peter D'Adamo, author of "Eat Right for Your Type," admits that no one has conducted a large study that says he's right. But he claims that people with type-O blood thrive on meat-filled diets, whereas people with type-A blood fare better on a diet of plants, fish and grains. Celebrities such as Elizabeth Hurley and Cheryl Ladd follow "Eat Right for Your Type," but nutritionists don't.

At the other extreme, followers of Dean Ornish and the Pritikin diet espouse high-carb diets with no more than 10 percent of calories from fat. Their aim is weight loss not just for its own sake, but also to help prevent heart disease. Dietitians say most people can't follow such a low-fat diet. And groups such as the American Heart Association say it is all right to get 30 percent of calories from fat.

Obesity drugs: Prescription weight-loss drugs got a bad name from fen-phen in 1997, when Mayo Clinic researchers linked fenfluramine (the fen) to heart-valve abnormalities. Fen-phen is no longer on the market, but some doctors prescribe "phen-Pro"--a combination of phentermine and Prozac. Hoffmann-La Roche hopes for FDA approval later this year for orlistat (Xenical), which reduces intestinal absorption of dietary fat by 30 percent. Unfortunately, it can cause potentially embarrassing gastrointestinal problems, such as loose stools. Knoll Pharmaceuticals sells sibutramine (Meridia), which works on brain chemicals to reduce appetite and make people feel full. It can also raise blood pressure and heart rates. Dieters who use Xenical or Meridia lose only 10 percent of their initial body weight in a year and regain it when they go off the drug. Drug companies have not conducted clinical studies of the two drugs in combination.

Diet supplements: The most popular diet pill today is the widely advertised over-the-counter supplement Metabolife, which contains the stimulants caffeine and ephedrine (from the Chinese plant ma huang). A proposed FDA rule would require labels to state that no more than 24 milligrams of ephedrine alkaloids a day or 8 milligrams per serving should be taken. They can cause an increased heart rate, nervousness, headaches, insomnia, heart attacks, strokes, seizures and even death, says Bill Gurley, professor of pharmaceutics at the University of Arkansas. A single tablet of Metabolife, designed to be taken two to four times a day, contains 12 milligrams of ephedrine alkaloids (and as much caffeine as a half cup of coffee). "A child's dosage of cold tablets has 30 milligrams per dosage," says Metabolife president Mike Ellis.

Most other weight-loss supplements also include caffeine or ephedrine. Unlike prescription drugs, these so-called nutritional supplements are not subjected to rigorous safety, efficacy and strength standards. "Even if they do work, you also run the risk that they could be contaminated. People can produce this stuff in their garage," says Linda Van Horn, professor of preventive medicine at Northwestern University. "[And] any of these products are only good as far as weight loss or weight control while you're taking them."

Some things to keep in mind:

Shun useless foods: Life's not fair. Most women need only 1,800 to 2,200 calories a day to maintain body weight, whereas men get an extra 600 or so. Women "have less room for two martinis and the basket of chips," says Rosenbloom. Skip the empty-calorie rice cakes and bagels that many fat-conscious women live on. Those foods don't contain the vitamins and minerals that the U.S. Department of Agriculture says women are deficient in: calcium (in yogurt, milk, cheese, molasses, broccoli), vitamin E (in nuts, seeds, wheat germ), vitamin B6 (in chicken, peanut butter, almonds), magnesium (in spinach, peanut butter, pecans) and zinc (in ground beef, tofu, sunflower seeds, almonds). Eat high-fiber fruits and vegetables. And avoid excess calories from nutritionally worthless beverages such as alcohol and sweetened soft drinks. Skip french fries and spend your fat calories more wisely on avocados, salmon or nuts.

Eat less, weigh less: Reduce calories--but remember that women who go on crash diets are in danger of not getting adequate vitamins, minerals, protein and calcium. Very-low-calorie diets increase the risk of gout, gallstones, cardiac complications and later weight gain.

Exercise more, weigh less: Walk or run a mile and burn 100 calories. And lift a weight or two: strength training builds muscle mass and boosts metabolism.

Be realistic: Bodies weren't meant to carry 300 pounds. But women who are bigger than a size 6 can still be healthy and happy. Too often they think they're obese "if they're not like the cast of 'Friends'," says Rosenbloom. Despite the old adage, you can be too thin--but never too healthy.