Calories in, energy out: Lutheran Weight Management Center.

According to the Centers for Disease Control, costs attributed to both overweight and obesity medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion.

Being overweight carries multiple health risks. For women, obesity doubles the risk of heart failure. Men who are 22 pounds over their ideal weight face a 75 percent increase in the risk of a heart attack. Diabetes, stroke, arthritis, gall bladder disease, sleep apnea and an increased risk for a number of cancers are all associated with being overweight.

Our response to the fat is to diet. We cut out fat, and the pounds melt away. We eat fat and cut out carbs, and the pounds disappear. We shun sugar, and we slim down. What almost any former dieter can tell you is that it's not losing weight that's so difficult, it's keeping it off for any significant period.

The alluring before and after photos advertising the latest diet may hold a grain of truth, but the real truth lies in the National Weight Registry, a database of dieters who have lost 30 pounds or more and have successfully maintained that loss for at least a year. Weight Registry participants used a wide range of diets to lose weight, but to maintain their weight loss they use a number of common strategies.

Most follow a low-fat, high-carbohydrate food plan.

They are very active, averaging 60 to 90 minutes of exercise per day.

They monitor the food they eat and their weight regularly.

Ninety percent eat breakfast regularly.

It's ultimately about energy balance or the old equation: calories in, energy out. If you eat more calories than your body burns, the excess is stored as fat. And if you're serious about weight control, you can't ignore exercise.

The solution is not to diet, but to use strategies based on sound nutritional principles that will help you develop a delicious but healthier eating style.

Substitute healthy monounsaturated fats such as olive, canola and safflower oils for less healthy choices such as butter and saturated fats.

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