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A dietitian can help design a healthful weight-loss program and also teach how to judge portion sizes.

When should I see my doctor?
A doctor should be consulted before changing eating and exercise habits if a person:

• Wants to lose more than 15 pounds, or is over the age of 35.
• Is considering using diet drugs, a liquid diet, or any regimen of less than 800 calories per day.
• Develops symptoms such as sudden chest pains or fainting while dieting.
• Has diabetes or another chronic health disorder.
• Has a lifelong history of being overweight.
• Is pregnant.
• Is still growing.

What will the doctor do?
The doctor should evaluate general health and check weight and blood pressure and do an ECG.

After assessing the scope of the weight problem, the doctor may recommend a weight-loss regimen or refer the patient to a registered dietitian. The person will probably need to keep a food diary for at least a week (see sample), so the dietitian can spot faulty habits.

Many people who lose weight successfully participate in organized weight-control programs. The doctor may suggest one.

If the patient has a medical condition that makes weight loss imperative, diet drugs may be prescribed. In the past, such drugs were discouraged because many were addictive. New medications such as flenfluramine and phentermine are similar to amphetamines but are less addictive. Fluoxetine (Prozac), a widely used anti­depressant, suppresses appetite and has been used experimentally as a weight-loss drug.

Long-term approach

After a person carefully analyzes eating habits and identifies those that contribute to the weight problem, he or she can make a concerted effort to change them. Many people, for example, starve themselves all day, only to overindulge in the evening. Therefore, make it a rule to eat a sensible breakfast, lunch, and dinner, which reduces the temptation to overeat at night.

Some weight-loss programs have formal maintenance plans for participants to follow for the first several months after they reach their goal weights. Alternatively, groups such as Overeaters Anonymous provide needed support.

Finally, don't be overly discouraged if you regain the lost weight. Studies show that 90 percent of dieters regain their previous weight within 5 years — a phenomenon called "yo-yo-dieting." Until recently, this up-and-down weight problem was considered a health risk, but new studies indicate that even temporary weight loss is less harmful than long-term obesity.