By Howard Eisenson, MD

Fighting the battle of the bulge is a familiar story to millions of overweight and obese Americans. But while disappointment and failure is all too common for a majority of people, it should not overshadow the benefits of leading a healthy and active life.

In his own words, Howard Eisenson, MD, director of the Duke Diet & Fitness Center and co-author of The Duke Diet, addresses some common issues which can set back weight loss goals and provides encouraging words of wisdom that are the principles behind the weight loss programs at Duke.

What we emphasize in our program is helping people accomplish healthier “weight management.” I use that phrase advisedly, as I think there tends to be overemphasis on loss and not enough on maintenance of a healthier weight.

Howard Eisenson, MDAlso, there is too much emphasis on weight loss as the entire goal and not enough on adoption of a more physically active lifestyle, or on the practice of healthy behaviors as important end goals themselves.

If someone is serious about improved weight management, they need to own the problem -- and the solution. It is too easy and too common to find excuses.

It's never too late to start working on this issue: the sooner, the better. Adults should model healthy behaviors for their children.

“All or nothing thinking” is a simple, almost trite, phrase, but so many of our successful patients tell us that they only achieved their success once they internalized the notion that their new behaviors are for life, not for a time-limited goal -- that all progress in the right direction is meaningful, that "slips" are inevitable, and that there is no giving up.

Willpower and self-discipline are important attributes, but often not enough to accomplish our goals. We talk with patients about trying to outsmart the problem -- that is, to honestly assess those behaviors or situations that seem to trip them up, to brainstorm practical solutions, and to apply the solutions in new behavior.

People need to expand their repertoire of ways to respond to hunger cues -- which are so often driven by habit, emotions, advertising, social pressure, and not by physical need -- other than by eating.

We need to really work at reducing our portion sizes, our consumption of between-meal snacks, and our consumption of sugared beverages and calorie-dense treats.

Regular physical activity is key. Even in the absence of weight loss, physical activity improves our health. Since living in the modern world no longer requires us to be active, we need to look for opportunities to insert more physical activity into the day. And the opportunities are there if we look for them, no matter how busy we are.

We need to accept the fact that there are no simple solutions. It is a chronic problem and an insidious one. Most of us have a biological predisposition to gain weight if we find ourselves in an obesity-promoting environment -- and that is indeed where we find ourselves. If we are to accomplish improved weight management and a more physically active lifestyle, we will have to work at it...for life.

While we can't change the world, we can exert some control over our own micro-environment: how we stock the kitchen, how we prioritize our tasks, how we spend our leisure time, with whom we socialize. I never cease to be amazed at how, even in the “artificial” setting of the Duke residential program, almost everyone -- even those whose eating is chronically out of control -- are able to get a handle on things to be satisfied with substantially fewer calories than usual and to be enjoying daily exercise.

It's difficult to maintain healthy habits even when folks have minimal stress -- good health, good social support, plenty of time, no money worries. It's even harder when people have other issues, including physical conditions such as shortness of breath, chronic pain, chronic fatigue, and social and emotional problems. We believe one's chances of success is improved when they “get their house in order” by working with a dedicated and skilled multidisciplinary team of professionals to address the big picture.

It's important to keep a sense of humor and perspective, and to be kind to ourselves. Medical science simply does not have all the answers for this problem, and many people tend to beat themselves up too much over it. Weight control is important, but it's not all that's important. We are (or ought to be!) so much more than our scale reading or our clothing size.

Learn more about The Duke Diet, available online and in stores.