The formula for weight loss — eat fewer calories than you expend — has been known for a long time. If it is that simple, however, why do many people have trouble losing weight — and why do most successful dieters regain their weight? New research has begun to shed light on these questions, but it still leaves the person who just wants to be thinner facing terrible odds.

Fortunately, research also provides direction on how to increase those odds.

For one thing, we’ve discovered that calories are not always equal. We used to believe that if you ate 75 calories, it didn’t matter where they came from. You could eat fat, protein or carbohydrate calories and they would all have the same effect. Now it is known that for many people this is not so.

A great number of people develop what is called metabolic syndrome. In essence, this means that after having consumed too many of the wrong kind of calories — especially simple carbohydrates that are metabolized into sugars — the body develops insulin resistance.

This causes us to want to eat more of the wrong kinds of foods, thus making the problem worse. We crave carbohydrates the same way an alcoholic craves liquor. And as with alcoholics, the longer the problem goes untreated, the harder it becomes to overcome the addiction.

For many, the consequences are very scary: The result can be a heart attack or one of many other serious health problems. For others, it’s the pain of feeling the daily humiliation of being an overweight person in a society in which the majority of the population is clinically overweight and yet is obsessed with thinness.

Another way in which calories are more complex has to do with the question of exercise. I can remember a time when diets books used to advise that it wasn’t worth the effort to exercise. If one hour of walking only burns 200 calories, then why bother? It seemed much easier not to eat the extra 200 calories — the equivalent of two pats of butter.

It is now known that exercise does more than burn calories at a 1-to-1 ratio. It boosts metabolism by causing calories to be burned at a faster rate for a few hours, even after the exercise itself is over. It also can keep your metabolism burning at a higher rate on an ongoing basis by building muscle, which requires more energy to sustain than fat.

How do these findings affect our approach to weight loss? We know that it is possible to sustain weight loss without a lifetime of hunger by accepting two fundamental principles: You can’t eat whatever you want whenever you want, and you must get some exercise. This is true at all ages, but for women facing menopause, this is essential.

Having said that, however, I want to reframe these concepts so that they enter the realm of the possible and you can see how they are within reach. The two keys are retraining the way you think about these ideas — and going slow. If you stick with these principles you can’t fall off the track.

The first cognitive change you must make is to stop thinking about dieting and exercise and rename them “health habits.” These are positive changes you are introducing and adding to your life, not forms of pain and deprivation. People can learn new habits if they are given enough time and if the changes are not too demanding. This is what is meant when you hear “diets don’t work” — but it is possible to change your weight.

A way of thinking about these habits is to examine other health habits you have already mastered. Most adults do not find it hard to perform basic dental hygiene, for example. They might skip flossing once in a while, or perhaps wait too long between dental appointments, but they accept the idea that to keep teeth healthy, they’d better brush twice a day. Children don’t always accept this idea right away, but as they mature, the habit becomes ingrained, and as adults they realize that this need is a reality.

Healthy eating habits can be achieved in a similar way. You accept the idea that doing this is not an unusual form of deprivation but an adaptation to reality and adulthood. By the same token, you accept that new habits develop slowly and may take some discipline until they become second nature.

The analogy to alcohol is useful here as well. Although some people do not drink ever, those that do generally don’t drink every day — certainly not at every meal — and if they do, they are careful to be moderate. On weekends or special occasions they may loosen up a bit, but adults rarely like losing control. They understand the consequences of excessive drinking and do not have to work too hard to keep it in check.

On the other hand, some people are addicted to drinking; they have a physical vulnerability that makes it hard to drink moderately. The rest of the world often doesn’t understand and thinks these people should control themselves, or “pull themselves together.” From this point of view, alcoholism is seen as a psychological or moral failing, and one that is within voluntary control.

The same is true about attitudes towards the overweight and obese. Many people do not understand the complicated interplay between behavioral and physical elements that occurs for a great many people who suffer with weight problems. In addition to the discovery of metabolic syndrome, researchers have begun to see that some people experience hunger more intensely and metabolize and burn calories at different rates.

But just because it’s not your fault doesn’t mean that you can give in. Those who recover from alcoholism know they must change if they are to live a good life — or live at all. Luckily, carbohydrate addiction is not as lethal or as intractable as alcoholism. Usually you are not born with the “disease,” but once you’ve got, it spins out of control. It’s somewhat like smoking: If you stop, you’ll eventually stop craving cigarettes, though it may be harder for some than others.

The difference with food and alcohol or cigarettes is that you cannot give up eating entirely. But if you view yourself as someone who has a chronic tendency to get addicted to certain types of food and ways of eating, you can reframe your thinking and accept that you can’t eat anything you want (even though your sister or husband can) and get away with it.

You can, however, eat anything sometimes, not forgetting who you are. Most people I know who have maintained a normal weight through their adult years approach food the same way as alcohol. During the week, they eat healthy, low-calorie or low-carbohydrate meals. If they do indulge, it is usually rarely and not late at night. On weekends, they relax considerably. At parties they eat dessert, have drinks, appetizers, etc. They keep an eye on portion size and feel satisfied.

Exercise is also a regular habit for people who maintain a healthy weight. On the one hand, it is seen as a priority and an effort is made to fit it in. On the other, in keeping with the reality principle, it has to be something that you can sustain and develop into a lifelong habit.

So, for example, many people begin by vowing to go to the gym daily at 6 a.m. For most people this is a challenging task; it can be achieved for a while, but it is hard to sustain. Once February rolls around, it becomes more difficult to get out of bed in the dark. You must find a way to get started without it requiring superhuman discipline.

My personal philosophy is “never break a sweat.” Though this is not always true, my aim is to never push myself to do something that might seem painful, exhausting or overwhelming. This is a way of remembering that exercise does not need to be hard in order to be useful. And the more you do it, the easier it gets.

Some days, when I don’t feel motivated, I’ll promise myself that I only have to do 10 minutes. If I decide I want to do more, fine. Almost always, this is no problem, because at this point exercising is a pleasurable habit. In the 25 years I have been jogging, I have almost never run for more than two miles, yet I have sustained the habit almost without interruption (possibly because of the moderate distance).

For both long term health and weight control, consistency is the key. It’s true that if you want to lose weight you may have to step up the frequency or intensity for a while, but it’s important to remember that weight lost slowly is more likely to be kept off.

Finally, the psychological benefits of exercise are tremendous. I tell my patients to exercise if they want to do one thing that will automatically lift their mood. Outdoor activity is especially good in this regard, since exposure to fresh air and sunlight can also be mood enhancers.

One last thing to consider when approaching all this: Women in this country are experiencing an epidemic of body image problems. It’s very difficult to accept not being perfect in a society that seems to value beauty so much. And unlike more sophisticated countries such as France, we are subject to the idea that there is only one standard of beauty — and here that is almost always the young kind.

As a woman ages, she may begin to feel overlooked, and the menopausal transition makes many women feel less feminine. While this makes it more important than ever that we try to feel good about our bodies by staying as fit as we can, many women get discouraged.

Often this is tied to a long-standing body image problem summed up by the attitude “why bother, I look terrible anyway.” Others go to opposite extreme, relentless in their pursuit of ageless perfection. Again, engaging in the art of the possible should be the goal, especially at this age.

This is a time of life that has potential for its own brand of healthful beauty and balance, wisdom and maturity, and there’s no reason not to go for it.

Cecilia Ford, Ph.D., is a clinical psychological is Manhattan who specializes in body image, weight control and eating disorders.

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  • Susan May 1, 2009 at 3:36 pm

    Very interesting article, especially the menapausal comments.
    It is all common sense, but sometimes that doesn’t come naturally.

  • Pat Dougherty August 25, 2007 at 5:31 pm

    Most do not know the calorie count of foods – or they assume what they eat has far fewer calories than they really have. More immportantly, even if they do know the calorie count, many will not agree to 1,200 calories a day (what it takes to lost and maintain weight).