Excerpt: 'The Skinny: On Losing Weight Without Being Hungry'

May 18, 2009 — -- Dr. Louis Aronne, founder and director of the Comprehensive Weight Control Program at New York/Presbyterian Hospital/Weill Cornell Medical Center has a new weight loss guide.

In his new book, "The Skinny," Aronne shares his secrets to losing weight without being hungry and tackles the challenge of how to keep the weight off. Free of fads, "The Skinny" offers healthy methods for controlling cravings and eating smart without counting calories.

"The Skinny" gives extensive advice on how to achieve healthy, long-term weight loss and includes recipes and tips for eating out, along with an easy-to-stick-to exercise guide.

Read an excerpt from the book below and then head to the "GMA" Library for some more good reads.

The Solution for Lasting Weight Loss

Some surveys indicate that roughly 80 percent of people who lose weight regain most or all of it within a year. I want you to fall into the other category, the category of people we rarely hear about. I want you to be a part of the 20 percent who keep it off. To stay successful, use this plan for maintaining your weight loss.

Your first step in achieving lasting weight loss lies in determining when to stop losing and start maintaining. Many dieters pick an arbitrary finish line.They want to get down to a specific clothing size or see a specific number on the scale, but you just can't bully your body into losing the perfect amount of weight. Will you shed enough fat to fit into a size four, six, or eight, or into the jeans you wore in high school? I can't make that promise. At some point, as you lose weight, your body will fight back. It will defend your weight, and if you try to battle your body at this point, you'll end up feeling extremely hungry despite choosing the most filling foods and plateau anyway because your metabolism will slow.Trying to fight against this biology is like trying to push a car uphill. You may manage to go a few steps, but, eventually, biology wins, and your weight-like that car-goes in the other direction.

I know this isn't what you want to hear, and I wish I could tell you the magical secret that would allow you to get your body to that pre-determined perfect place, but I just can't. I'd much rather be honest, and I'd much rather give you the tools to help you get to a healthy weight and then stay there. If you have a lot of weight to lose and can't consider some of the options such as medication and surgery discussed in chapter 10, I'd rather you lost a little weight and kept it off than lost a lot of weight and then gained a lot of it right back.

For this reason, I'd like you to forget about any preconceived notions you once had about your maintenance weight. Forget about that coveted number or clothing size. Instead, focus on your behavior on successfully following this book's nutrition and lifestyle principles and let your maintenance weight find you.To do so, follow the Phase 1 menus and exercise as directed in Part 2 for as long as you can. Once you feel deprived or bored with the Phase 1 choices, slowly transition to Phase 2 eating as described in chapter 3. Increase exercise as directed in chap-ter 9. Eventually, no matter how closely you monitor your eating or how diligently you exercise, you'll stop losing weight. This is your mainte-nance weight.

Expect to Gain a Little BackI've got some more news that you probably won't like. Most people gain back about 10 percent of their total weight loss. In other words, if you lost 20 pounds, you can expect to regain 2 to 3 pounds. If you lost 100, you may regain 10. Although few if any diet authors will admit it, everyone who loses weight regains a little. It's normal and it happens to almost everyone no matter how closely they follow their dietary and fitness regimens.

Why does it happen? You've transformed your body from one with chronically high levels of the fullness hormone leptin and low levels of the hunger hormone ghrelin to the opposite. Now leptin is low and ghrelin is high. These low leptin levels are, in part, what caused your plateau. As leptin levels drop, so does thyroid hormone, reducing metabolism so you burn fewer calories. Low leptin levels also allow hunger hormones to enter the brain unchecked.

We don't yet know all of the physical reasons why this happens, but regaining just a few pounds seems to increase leptin levels above some threshold level we haven't been able to identify, and brain chemicals stop sending out so many "eat more" and "burn less" signals.Your appetite and your metabolism reach a "truce," and your weight plateaus. Your body reaches an equilibrium that it can maintain.

Skinny Secrets for Staying Skinny To maintain your weight loss after you gain that initial 10 percent, do the following.

Keep moving. Continually look for ways to add more lifestyle walking to your daily repertoire. It's the best way I know of for overcoming plateaus and for maintaining weight loss. It's one of the few strategies that seem to help prevent low leptin levels from making your muscles more efficient. As a result, your metabolism can no longer act as such a brake on your weight loss. Some of my patients have plateaued, started a regular exercise program, and then experienced a new onset of weight loss to a lower plateau.

Exercise also helps overcome occasional overeating. Whenever you overdo it, your body has to decide what to do with the extra calories. If your muscles are "metabolically active" from exercising, calories will be sent to your muscles to be burned rather than to your fat cells to be stored. When researchers from Brown University and the University of Colorado studied longtime weight maintainers, they discovered that people who tended to regain weight got lax on their exercise hab-its.Those who kept the weight off tended to increase exercise as they maintained, with the average maintainer moving for sixty minutes a day, mostly through walking and light- intensity activities such as housework and gardening.

Weigh yourself regularly. Researchers from Cornell University asked a group of freshmen women to weigh themselves daily. They asked another group of women to weigh themselves just twice at the beginning of the semester and at the end. At the end of the semester, the women who weighed daily gained no weight, whereas the women who didn't weigh gained between 4 and 8 pounds.

Why did daily weighing help? Even though the researchers provided the students with no information about dietary and exercise habits, the women who stepped on the scale each day naturally found ways to control their weight. If they saw an increase, they either ate less or moved more.They skipped snacks, skipped dessert, shrank portions, or stepped up their exercise efforts. They didn't count calories, but the feedback of the scale gave them constant nudges in the right direction.

You'll need to strike a careful balance between denial (it's just water weight, I don't need to do anything differently) and negativity (I gained weight, I may as well eat whatever I want). Many factors affect your weight beyond the size of your fat cells. You can expect your weight to fluctuate by about 5 pounds based on the amount of fluid your body is retaining, the regularity or irregularity of your bowel habits, and the amount of carbohydrate stored in your liver and muscles. In the study I just mentioned, the college freshmen plotted their weight on a graph such as the one on page 158. A slight up- and- down line was nothing to worry about. A steady upward line, however, meant they needed to take corrective action.

What types of corrective actions should you take? Your first action should be to see if you've strayed from your Phase 2 menus or cut back on exercise. If so, reestablish those habits. If you're gaining despite carefully following the Skinny menus and tips described in the rest of this chapter, then see your doctor.You may have a health problem that's affecting your weight. Read chapter 10 to see if a sleep problem, a weight-gaining medication, or something else is affecting your weight. And try to make small dietary or lifestyle changes. Can you add five or ten additional minutes of movement a day? Can you fill up on fewer calories by eating even leaner, sneaking more veggies into a meat dish, or shrinking your starch portions?

Fight hunger with lean protein plus vegetables. As you maintain, you may ?nd that at times, you feel hungrier than usual. During these times, increase your lean protein and your vegetable portions. By eating more of the right foods, you'll be able to more easily eat less of the wrong foods, and you'll more easily maintain your weight, too. But remember, just cutting back on calories is often not productive and can lead to overwhelming hunger because the counterbalancing systems get activated.To maintain your weight, it's always better to add than to subtract. Eat more filling foods, so they naturally displace the fattening ones.

Turn off the tube. People who regain weight tend to watch more TV than people who don't. The average American watches four hours a day, and more than 60 percent of average Americans are overweight or obese. Research completed at Brown University and a number of other institutions, however, shows that successful weight maintainers watch far less. More than a third of people who have maintained a 30- pound weight loss for a year or longer watch fewer than five hours a week and another third fewer than ten hours.The more TV study participants watched, the less they exercised and the more weight they regained.

Be vigilant when life gets more stressful. When patients come to see me after regaining weight, I always ask,"What changed?" Inevitably, something has. They take on more responsibility at work, move, have a baby, have a sick family member, or twist an ankle and can't walk as much.Whenever something changes in your life, it's time to be more vigilant.That's when you're most likely to backslide.

Be consistent. Use The Skinny to guide your eating during the week, on the weekends, and during vacations and holidays. Don't use it on some days and not on others. For example, many dieters like to have cheat days and cheat meals. They follow an eating approach flawlessly during the week and then go hog wild on weekends.That may be okay for some people, but this type of eating could damage your fuel gauge, causing you to start each week feeling excessively hungry from your weekend dessert-and- starch binge. Research shows that the most successful maintainers eat consistently every day, no matter the occasion.

In particular, always:Eat protein for breakfast. Although some people can get away with cereals, oatmeal, toast, juice, or another starchy breakfast once or twice a week, most maintainers can't eat these foods every day without noticing an increase in hunger. Most maintainers find that they must consume protein foods (from their Phase 1 breakfast options) most days of the week. The protein controls hunger and cravings for the rest of the day, so they naturally eat less for lunch and dinner. If you feel you have to have a starch for breakfast, have it with protein. For example, have a whole- grain English muffin with peanut butter, an egg, or turkey sausage.

Eat starch and dessert last. Always consume starch or dessert at the end of the meal, after you've consumed your vegetables, salad, soup, and lean protein.This is when you'll have most control, so one reasonable serving of pasta does not turn into one gargantuan serving. For the same reason, never consume alcohol as an appetizer or just before your meal.Always have it with the main course or after dinner.

Use the three- bites rule. I'm a weight- loss doctor. Does that mean I never eat cake or cookies? No way. As long as most of what you eat is rich in lean protein, fiber, and nutrients, you can occasionally eat sweets in moderation. The two important keys here are occasionally and in moderation. A few bites of dessert once or twice a week is probably okay for most people. A large serving every day probably isn't. Once you fix your fullness resistance, you can eat the small serving.

When you have dessert, hold yourself to three or four bites, or about 100 calories. Most desserts served at restaurants contain 400 to 500 calories, or even more.This excess sugar and fat causes long- lasting rebound hunger.You'll find that you wake feeling hungrier the day after eating a huge dessert, and feel hungrier for a few days. Is that amount of hunger worth a huge piece of cake, pie, or cheesecake? It's not for me. Split desserts with two or three dining companions, and try to hold yourself to just a few bites. Pay careful attention to how the dessert tastes.You'll probably find that the first bite tastes the best, with each progressive bite tasting less intense than the first. By the fourth bite, the flavor has probably declined substantially. Once that happens, stop eating. If you keep on eating past that point, you may lose your sense of fullness and feel that you have to eat the whole piece, or another. Sound familiar?

Keep protein lean. This allows you to eat a greater volume of food, so you fill up on fewer calories. Research on successful maintainers shows that most consume about half as much fat as the general population. Hold red meat to two to three times a week, opting mostly for skinless poultry or fish on the other days of the week.

End the Yo-Yo Cycle Have you ever wondered what causes yo- yo dieting, the phenomenon in which people get to their lowest weight and then regain everything right back? I can explain it to you. It involves two parts, one physical and the other psychological. First, your body resists weight loss because of changes I described earlier.Then you regain a few pounds to get your leptin levels back in equilibrium and you're a little nervous.Then you eat a big dessert, step on the scale the next day, see that you've gained weight, and get demoralized. Now you're hungry every day because fullness resistance is back.You feel as if nothing you try works, and you've stopped finding the point of trying so hard. So you give up.

To stop the yo-yo cycle, you first must understand and expect it. No matter how dedicated you are when you start maintaining, you'll eventually eat more than just a few bites of dessert. Everyone does. Expect that you will do this, so you can prepare yourself for the aftermath.You'll most likely do it on a holiday or at a birthday party. I've heard this story probably a hundred times.You're going to a birthday party and you want to eat some cake. You hardly eat anything all day long, banking your calories for the cake.You eat the biggest slice of cake that you can find, and perhaps a second slice as well. The sugar and starch in the cake spikes your blood sugar and insulin. With insulin this high, the brain wants to store these cake calories quickly, so a lot of the sugar goes straight to your liver, where it gets stored along with a generous amount of water. The liver converts some of it into fat, which settles in your fat cells.

You wake the next morning with a food hangover. It's very real, just like a hangover from alcohol. You're thirsty, because your body needs water to store the excess sugar. You're tired, hungry, and fuzzy-headed because the excessive release of insulin and other hormones has driven you into a low-blood-sugar state.The fastest way to feel better? Some hair of the dog, which is why you're craving sugar in the form of a breakfast pastry, a soft drink, juice, or a doughnut. Have those choices, however, and things will only get worse.

This is where you must stop the cycle. Don't reach for the doughnut. Don't have the soft drink. Don't berate yourself. Don't get demoralized. Instead, do the following.

Get on the scale. Doing so will help you recommit, but don't pay too much attention to the actual number. It's wildly exaggerated. I don't care how much overeating was involved. Even if you ate an entire cake along with a gallon of soda, it's physically impossible to gain 5 pounds of fat overnight. Each pound of fat adds up to more than 4,000 calories. You may have gained a fraction of a pound of fat, but you certainly did not gain 5.

Most of that 5- pound gain is from extra glycogen and water.You've gained liver weight, not fat weight.Your liver is the first reserve gas tank for your body. Whenever you overeat, your body stores most of the excess here, along with a lot of water. If you recommit to The Skinny, most of this liver weight will be gone within a few days.

The problem is that most people don't know this. So when they get on the scale and see the 5 extra pounds, they have a series of thoughts that do little to keep them motivated. They think things like "I really screwed up," "Now look what I've done," and "I worked so hard to get it off. How can it come back so quickly?" They are plagued with self- doubt. They question their judgment. They question their willpower. They question whether they have what it takes to keep the weight off.

You have what it takes.You won't gain anything if you recommit right now. It bears repeating: this is not fat weight. It's liver weight. If you get back on track now, it'll be gone in a few days.

Be prepared for withdrawal symptoms. You're going to feel as crummy as you did when you first started The Skinny. You're going to go through withdrawal, and this withdrawal will last longer because your hunger hormones will not drop as quickly now that you've reduced your body size. It may take as long as a week for you to completely recover.

Eat more protein for breakfast. Keep a meal-replacement shake in the fridge, just for these mornings. You'll want a doughnut, which is why it's so important to have easy access to a shake. If you really, really, really are craving starch and a shake or an omelet just won't do, then have high-?ber cereal. The breakfast that usually fills you up will probably leave you feeling hungry that morning after eating a big dessert.You may even feel hungrier all day long. Eat a larger- than- usual breakfast, if needed, to squelch hunger. If needed, have another shake midmorning. Increase your protein portions all day. If you usually eat 5 ounces, increase them to 8.

Continue to eat more protein for about a week. It may take as long as a week for the hunger to subside and the fullness to set back in. It may also take this long for the liver to shed the glycogen and water and for you to see that sudden 5- pound gain reverse itself into a sudden 5- pound drop.

Lose What You Gain This is another one of those dirty little secrets about dieting that no one will tell you. Nearly everyone who loses weight gains and reloses many times. They don't lose 60 pounds and keep that 60 pounds off for life. Rather, their weight maintenance resembles the up- and- down rhythm of an EKG readout. They gain 3 pounds, take steps to address it, and then lose 3 pounds. They gain 2 pounds, make another change, and then lose it.They gain 5, and then they lose 5.

They do this over and over again. If you gain, do the following to turn the numbers around.

Keep a food log. One big mistake every day can easily cause weight regain and stoke up your appetite. Many of my patients, during maintenance, ate nearly perfectly all day, but they gained because of one really bad food choice. They reverted to eating bread before dinner instead of after, for example, or they reverted to drinking juice with breakfast. They didn't even realize they had made the change, but they did realize they were hungrier, and didn't know why. They were not eating massive quantities of any one food, but they were eating one fattening food every single day and increasing their overall appetite as a result.

The following foods can be "fattening" because they increase your appetite, making it harder to maintain your weight loss. If you find yourself gaining, write down everything you eat, and look over your records daily and weekly. Look for patterns. What fattening foods have returned to your daily repertoire? Here's a list of common offenders: Bread Sweets Soft drinks Juice Large servings of pasta Large servings of any type of starch, even a whole- grain starch Wine or beer before dinner Starch before dinner Artificial sweeteners Fatty foods

Add more exercise. Find more ways to sneak in more activity. Can you take a short walk before or after meals? Consider straightening up the house in the evenings instead of reading or watching TV. Ride a bike short distances instead of taking your car.

Add more vegetables. Vegetables are the most filling foods on the planet and the best way to reduce your overall calorie intake without feeling as if you are eating less. Look for ways to sneak vegetables into your favorite recipes. Can you add more chopped veggies to your omelet, mushrooms to that burger, or shredded carrots to your meat loaf ?

Get a checkup.You may be developing diabetes or another health condition, which makes controlling your weight more difficult.You also may have started taking a medicine that is increasing your appetite or slowing your metabolism.

You may slip up, regain, and then recommit and lose many times before your weight stays within an even fluctuation. Rather than seeing each small gain as a personal failure, think of small gains as success builders. The more often you get yourself back on track, the stronger you will become.The longer you maintain, the better you will become at maintaining your weight. Research shows that the longer people keep off lost weight, the easier it is for them to maintain. All of their new eating and exercise habits become part of their lives. These habits become so automatic that they rarely think about their food choices.

They eat Skinny for life.

Some surveys indicate that roughly 80 percent of people who lose weight regain most or all of it within a year. I want you to fall into the other category, the category of people we rarely hear about. I want you to be a part of the 20 percent who keep it off. To stay successful, use this plan for maintaining your weight loss.

Your first step in achieving lasting weight loss lies in determining when to stop losing and start maintaining. Many dieters pick an arbitrary finish line.They want to get down to a specific clothing size or see a specific number on the scale, but you just can't bully your body into losing the perfect amount of weight. Will you shed enough fat to fit into a size four, six, or eight, or into the jeans you wore in high school? I can't make that promise. At some point, as you lose weight, your body will fight back. It will defend your weight, and if you try to battle your body at this point, you'll end up feeling extremely hungry despite choosing the most filling foods and plateau anyway because your metabolism will slow.Trying to fight against this biology is like trying to push a car uphill. You may manage to go a few steps, but, eventually, biology wins, and your weight-like that car-goes in the other direction.

I know this isn't what you want to hear, and I wish I could tell you the magical secret that would allow you to get your body to that pre-determined perfect place, but I just can't. I'd much rather be honest, and I'd much rather give you the tools to help you get to a healthy weight and then stay there. If you have a lot of weight to lose and can't consider some of the options such as medication and surgery discussed in chapter 10, I'd rather you lost a little weight and kept it off than lost a lot of weight and then gained a lot of it right back.

For this reason, I'd like you to forget about any preconceived notions you once had about your maintenance weight. Forget about that coveted number or clothing size. Instead, focus on your behavior on successfully following this book's nutrition and lifestyle principles and let your maintenance weight find you.To do so, follow the Phase 1 menus and exercise as directed in Part 2 for as long as you can. Once you feel deprived or bored with the Phase 1 choices, slowly transition to Phase 2 eating as described in chapter 3. Increase exercise as directed in chap-ter 9. Eventually, no matter how closely you monitor your eating or how diligently you exercise, you'll stop losing weight. This is your mainte-nance weight.

Expect to Gain a Little BackI've got some more news that you probably won't like. Most people gain back about 10 percent of their total weight loss. In other words, if you lost 20 pounds, you can expect to regain 2 to 3 pounds. If you lost 100, you may regain 10. Although few if any diet authors will admit it, everyone who loses weight regains a little. It's normal and it happens to almost everyone no matter how closely they follow their dietary and fitness regimens.

Why does it happen? You've transformed your body from one with chronically high levels of the fullness hormone leptin and low levels of the hunger hormone ghrelin to the opposite. Now leptin is low and ghrelin is high. These low leptin levels are, in part, what caused your plateau. As leptin levels drop, so does thyroid hormone, reducing metabolism so you burn fewer calories. Low leptin levels also allow hunger hormones to enter the brain unchecked.

We don't yet know all of the physical reasons why this happens, but regaining just a few pounds seems to increase leptin levels above some threshold level we haven't been able to identify, and brain chemicals stop sending out so many "eat more" and "burn less" signals.Your appetite and your metabolism reach a "truce," and your weight plateaus. Your body reaches an equilibrium that it can maintain.

Skinny Secrets for Staying Skinny To maintain your weight loss after you gain that initial 10 percent, do the following.

Keep moving. Continually look for ways to add more lifestyle walking to your daily repertoire. It's the best way I know of for overcoming plateaus and for maintaining weight loss. It's one of the few strategies that seem to help prevent low leptin levels from making your muscles more efficient. As a result, your metabolism can no longer act as such a brake on your weight loss. Some of my patients have plateaued, started a regular exercise program, and then experienced a new onset of weight loss to a lower plateau.

Exercise also helps overcome occasional overeating. Whenever you overdo it, your body has to decide what to do with the extra calories. If your muscles are "metabolically active" from exercising, calories will be sent to your muscles to be burned rather than to your fat cells to be stored. When researchers from Brown University and the University of Colorado studied longtime weight maintainers, they discovered that people who tended to regain weight got lax on their exercise hab-its.Those who kept the weight off tended to increase exercise as they maintained, with the average maintainer moving for sixty minutes a day, mostly through walking and light- intensity activities such as housework and gardening.

Weigh yourself regularly. Researchers from Cornell University asked a group of freshmen women to weigh themselves daily. They asked another group of women to weigh themselves just twice at the beginning of the semester and at the end. At the end of the semester, the women who weighed daily gained no weight, whereas the women who didn't weigh gained between 4 and 8 pounds.

Why did daily weighing help? Even though the researchers provided the students with no information about dietary and exercise habits, the women who stepped on the scale each day naturally found ways to control their weight. If they saw an increase, they either ate less or moved more.They skipped snacks, skipped dessert, shrank portions, or stepped up their exercise efforts. They didn't count calories, but the feedback of the scale gave them constant nudges in the right direction.

You'll need to strike a careful balance between denial (it's just water weight, I don't need to do anything differently) and negativity (I gained weight, I may as well eat whatever I want). Many factors affect your weight beyond the size of your fat cells. You can expect your weight to fluctuate by about 5 pounds based on the amount of fluid your body is retaining, the regularity or irregularity of your bowel habits, and the amount of carbohydrate stored in your liver and muscles. In the study I just mentioned, the college freshmen plotted their weight on a graph such as the one on page 158. A slight up- and- down line was nothing to worry about. A steady upward line, however, meant they needed to take corrective action.

What types of corrective actions should you take? Your first action should be to see if you've strayed from your Phase 2 menus or cut back on exercise. If so, reestablish those habits. If you're gaining despite carefully following the Skinny menus and tips described in the rest of this chapter, then see your doctor.You may have a health problem that's affecting your weight. Read chapter 10 to see if a sleep problem, a weight-gaining medication, or something else is affecting your weight. And try to make small dietary or lifestyle changes. Can you add five or ten additional minutes of movement a day? Can you fill up on fewer calories by eating even leaner, sneaking more veggies into a meat dish, or shrinking your starch portions?

Fight hunger with lean protein plus vegetables. As you maintain, you may ?nd that at times, you feel hungrier than usual. During these times, increase your lean protein and your vegetable portions. By eating more of the right foods, you'll be able to more easily eat less of the wrong foods, and you'll more easily maintain your weight, too. But remember, just cutting back on calories is often not productive and can lead to overwhelming hunger because the counterbalancing systems get activated.To maintain your weight, it's always better to add than to subtract. Eat more filling foods, so they naturally displace the fattening ones.

Turn off the tube. People who regain weight tend to watch more TV than people who don't. The average American watches four hours a day, and more than 60 percent of average Americans are overweight or obese. Research completed at Brown University and a number of other institutions, however, shows that successful weight maintainers watch far less. More than a third of people who have maintained a 30- pound weight loss for a year or longer watch fewer than five hours a week and another third fewer than ten hours.The more TV study participants watched, the less they exercised and the more weight they regained.

Be vigilant when life gets more stressful. When patients come to see me after regaining weight, I always ask,"What changed?" Inevitably, something has. They take on more responsibility at work, move, have a baby, have a sick family member, or twist an ankle and can't walk as much.Whenever something changes in your life, it's time to be more vigilant.That's when you're most likely to backslide.

Be consistent. Use The Skinny to guide your eating during the week, on the weekends, and during vacations and holidays. Don't use it on some days and not on others. For example, many dieters like to have cheat days and cheat meals. They follow an eating approach flawlessly during the week and then go hog wild on weekends.That may be okay for some people, but this type of eating could damage your fuel gauge, causing you to start each week feeling excessively hungry from your weekend dessert-and- starch binge. Research shows that the most successful maintainers eat consistently every day, no matter the occasion.

In particular, always:Eat protein for breakfast. Although some people can get away with cereals, oatmeal, toast, juice, or another starchy breakfast once or twice a week, most maintainers can't eat these foods every day without noticing an increase in hunger. Most maintainers find that they must consume protein foods (from their Phase 1 breakfast options) most days of the week. The protein controls hunger and cravings for the rest of the day, so they naturally eat less for lunch and dinner. If you feel you have to have a starch for breakfast, have it with protein. For example, have a whole- grain English muffin with peanut butter, an egg, or turkey sausage.

Eat starch and dessert last. Always consume starch or dessert at the end of the meal, after you've consumed your vegetables, salad, soup, and lean protein.This is when you'll have most control, so one reasonable serving of pasta does not turn into one gargantuan serving. For the same reason, never consume alcohol as an appetizer or just before your meal.Always have it with the main course or after dinner.

Use the three- bites rule. I'm a weight- loss doctor. Does that mean I never eat cake or cookies? No way. As long as most of what you eat is rich in lean protein, fiber, and nutrients, you can occasionally eat sweets in moderation. The two important keys here are occasionally and in moderation. A few bites of dessert once or twice a week is probably okay for most people. A large serving every day probably isn't. Once you fix your fullness resistance, you can eat the small serving.

When you have dessert, hold yourself to three or four bites, or about 100 calories. Most desserts served at restaurants contain 400 to 500 calories, or even more.This excess sugar and fat causes long- lasting rebound hunger.You'll find that you wake feeling hungrier the day after eating a huge dessert, and feel hungrier for a few days. Is that amount of hunger worth a huge piece of cake, pie, or cheesecake? It's not for me. Split desserts with two or three dining companions, and try to hold yourself to just a few bites. Pay careful attention to how the dessert tastes.You'll probably find that the first bite tastes the best, with each progressive bite tasting less intense than the first. By the fourth bite, the flavor has probably declined substantially. Once that happens, stop eating. If you keep on eating past that point, you may lose your sense of fullness and feel that you have to eat the whole piece, or another. Sound familiar?

Keep protein lean. This allows you to eat a greater volume of food, so you fill up on fewer calories. Research on successful maintainers shows that most consume about half as much fat as the general population. Hold red meat to two to three times a week, opting mostly for skinless poultry or fish on the other days of the week.

End the Yo-Yo Cycle Have you ever wondered what causes yo- yo dieting, the phenomenon in which people get to their lowest weight and then regain everything right back? I can explain it to you. It involves two parts, one physical and the other psychological. First, your body resists weight loss because of changes I described earlier.Then you regain a few pounds to get your leptin levels back in equilibrium and you're a little nervous.Then you eat a big dessert, step on the scale the next day, see that you've gained weight, and get demoralized. Now you're hungry every day because fullness resistance is back.You feel as if nothing you try works, and you've stopped finding the point of trying so hard. So you give up.

To stop the yo-yo cycle, you first must understand and expect it. No matter how dedicated you are when you start maintaining, you'll eventually eat more than just a few bites of dessert. Everyone does. Expect that you will do this, so you can prepare yourself for the aftermath.You'll most likely do it on a holiday or at a birthday party. I've heard this story probably a hundred times.You're going to a birthday party and you want to eat some cake. You hardly eat anything all day long, banking your calories for the cake.You eat the biggest slice of cake that you can find, and perhaps a second slice as well. The sugar and starch in the cake spikes your blood sugar and insulin. With insulin this high, the brain wants to store these cake calories quickly, so a lot of the sugar goes straight to your liver, where it gets stored along with a generous amount of water. The liver converts some of it into fat, which settles in your fat cells.

You wake the next morning with a food hangover. It's very real, just like a hangover from alcohol. You're thirsty, because your body needs water to store the excess sugar. You're tired, hungry, and fuzzy-headed because the excessive release of insulin and other hormones has driven you into a low-blood-sugar state.The fastest way to feel better? Some hair of the dog, which is why you're craving sugar in the form of a breakfast pastry, a soft drink, juice, or a doughnut. Have those choices, however, and things will only get worse.

This is where you must stop the cycle. Don't reach for the doughnut. Don't have the soft drink. Don't berate yourself. Don't get demoralized. Instead, do the following.

Get on the scale. Doing so will help you recommit, but don't pay too much attention to the actual number. It's wildly exaggerated. I don't care how much overeating was involved. Even if you ate an entire cake along with a gallon of soda, it's physically impossible to gain 5 pounds of fat overnight. Each pound of fat adds up to more than 4,000 calories. You may have gained a fraction of a pound of fat, but you certainly did not gain 5.

Most of that 5- pound gain is from extra glycogen and water.You've gained liver weight, not fat weight.Your liver is the first reserve gas tank for your body. Whenever you overeat, your body stores most of the excess here, along with a lot of water. If you recommit to The Skinny, most of this liver weight will be gone within a few days.

The problem is that most people don't know this. So when they get on the scale and see the 5 extra pounds, they have a series of thoughts that do little to keep them motivated. They think things like "I really screwed up," "Now look what I've done," and "I worked so hard to get it off. How can it come back so quickly?" They are plagued with self- doubt. They question their judgment. They question their willpower. They question whether they have what it takes to keep the weight off.

You have what it takes.You won't gain anything if you recommit right now. It bears repeating: this is not fat weight. It's liver weight. If you get back on track now, it'll be gone in a few days.

Be prepared for withdrawal symptoms. You're going to feel as crummy as you did when you first started The Skinny. You're going to go through withdrawal, and this withdrawal will last longer because your hunger hormones will not drop as quickly now that you've reduced your body size. It may take as long as a week for you to completely recover.

Eat more protein for breakfast. Keep a meal-replacement shake in the fridge, just for these mornings. You'll want a doughnut, which is why it's so important to have easy access to a shake. If you really, really, really are craving starch and a shake or an omelet just won't do, then have high-?ber cereal. The breakfast that usually fills you up will probably leave you feeling hungry that morning after eating a big dessert.You may even feel hungrier all day long. Eat a larger- than- usual breakfast, if needed, to squelch hunger. If needed, have another shake midmorning. Increase your protein portions all day. If you usually eat 5 ounces, increase them to 8.

Continue to eat more protein for about a week. It may take as long as a week for the hunger to subside and the fullness to set back in. It may also take this long for the liver to shed the glycogen and water and for you to see that sudden 5- pound gain reverse itself into a sudden 5- pound drop.

Lose What You Gain This is another one of those dirty little secrets about dieting that no one will tell you. Nearly everyone who loses weight gains and reloses many times. They don't lose 60 pounds and keep that 60 pounds off for life. Rather, their weight maintenance resembles the up- and- down rhythm of an EKG readout. They gain 3 pounds, take steps to address it, and then lose 3 pounds. They gain 2 pounds, make another change, and then lose it.They gain 5, and then they lose 5.

They do this over and over again. If you gain, do the following to turn the numbers around.

Keep a food log. One big mistake every day can easily cause weight regain and stoke up your appetite. Many of my patients, during maintenance, ate nearly perfectly all day, but they gained because of one really bad food choice. They reverted to eating bread before dinner instead of after, for example, or they reverted to drinking juice with breakfast. They didn't even realize they had made the change, but they did realize they were hungrier, and didn't know why. They were not eating massive quantities of any one food, but they were eating one fattening food every single day and increasing their overall appetite as a result.

The following foods can be "fattening" because they increase your appetite, making it harder to maintain your weight loss. If you find yourself gaining, write down everything you eat, and look over your records daily and weekly. Look for patterns. What fattening foods have returned to your daily repertoire? Here's a list of common offenders: Bread Sweets Soft drinks Juice Large servings of pasta Large servings of any type of starch, even a whole- grain starch Wine or beer before dinner Starch before dinner Artificial sweeteners Fatty foods

Add more exercise. Find more ways to sneak in more activity. Can you take a short walk before or after meals? Consider straightening up the house in the evenings instead of reading or watching TV. Ride a bike short distances instead of taking your car.

Add more vegetables. Vegetables are the most filling foods on the planet and the best way to reduce your overall calorie intake without feeling as if you are eating less. Look for ways to sneak vegetables into your favorite recipes. Can you add more chopped veggies to your omelet, mushrooms to that burger, or shredded carrots to your meat loaf ?

Get a checkup.You may be developing diabetes or another health condition, which makes controlling your weight more difficult.You also may have started taking a medicine that is increasing your appetite or slowing your metabolism.

You may slip up, regain, and then recommit and lose many times before your weight stays within an even fluctuation. Rather than seeing each small gain as a personal failure, think of small gains as success builders. The more often you get yourself back on track, the stronger you will become.The longer you maintain, the better you will become at maintaining your weight. Research shows that the longer people keep off lost weight, the easier it is for them to maintain. All of their new eating and exercise habits become part of their lives. These habits become so automatic that they rarely think about their food choices.

They eat Skinny for life.