Medical Nutrition Therapy

By Elyse Sosin, RD

Lose Weight.” “Eat Less.” “Exercise More.” “Get Motivated.” You hear it from your doctor, people on television, and even government spokespeople, and you read it in magazines. There are endless so-called solutions to the issue of excess weight, but almost all are short-lived. Regardless of the push to lose weight, the percentage of overweight and obese people continues to climb in the United States. There are those who still look for the magic bullet. There are also those who are willing to work hard to lose weight but do not know what to do or whom to believe. It can all seem so overwhelming.

Even people who know how to eat with good health in mind may have trouble losing weight. There are many reasons for weight gain: genetics, environment, socioeconomic level, career obligations, peer pressure, social obligations, certain medications, and habits developed over a long period. Some approaches to weight loss seem obvious and practical but in fact are often overlooked or not attempted. So, rule number 1 is to start with a single change and then add to it. Let’s consider some possible changes.


From muffins, steak, hamburgers, pizza, pasta, bagels, and even fruit, the size of food portions has increased over the years. And our eyes are now accustomed to big, bigger, and biggest, and that is what we eat. What can you do?

  • Check out to determine whether you have been underestimating your food portions.
  • Don’t forget the condiments – mayonnaise, butter, oil, salad dressing, pesto, and ketchup. The condiments that are added to food to enhance taste count too, and sometimes contain more fat, calories, and sodium than the food to which these are added.
  • Don’t assume that a drinking glass contains 4 or 8 ounces. You may be surprised to find that your glass holds 12 or 16 ounces.
  • Most people have no idea how much rice, pasta, or dry cereal they consume. Measure these foods once, and you may be surprised at the amount you eat.
  • Check out the size of a steak or chicken or even fish. Many people tend to consume two or even three times the amount of protein they really need, especially at the dinner meal.


Dining out is a way to socialize, conduct business, or simply eat a meal. Most people eat more food at restaurants compared with home-cooked meals. What can you do?

  • Choose a restaurant with reasonable choices and moderate portions.
  • Try to order first; that way you won’t change your food selection if you see or hear someone order another option that is less healthy.
  • As annoying as it may be, when you order a salad, insist on having the dressing on the side. And you can save hundreds of calories by adding less dressing yourself.
  • Entrees are often the equivalent of two portions (see above). Order two appetizers instead. Share an entrée or order the entrée you want and before it is brought to the table request that ½ is placed in a “doggy bag.”
  • Some restaurants have menus with calorie counts. Take a look at the counts and consider the amount of calories you will be consuming.
  • Ask the server how the food is prepared so that you can make the best decision. “Fried,” “scalloped,” or “crispy” should be a red flag that means more calories and fat.
  • Ask the server not to bring bread, or take the amount you want to eat and then ask to have the basket removed. Ifthis is not possible, at least move the basket away from you. If extra food is within reach, chances are you will eat more than you need to.
  • People spend a much longer time dining at a restaurant than at home, and will eat more food over time. When you are finished with your meal, ask the server to remove your plate. That way you will avoid eating more while waiting for others to finish.
  • Free food? Whether someone else is picking up the bill or you know the owner of the restaurant, the calories still count!
  • Drinks? If you need a drink, stick with one, or a wine spritzer, or club soda.


A person, place, or thing may encourage people to eat more than they want or need. Some people encourage you to eat a lot, order dessert, or have drinks (alcohol). Popcorn and a soda are almost a must in a movie theater. What can you do?

  • Recognize your own triggers and have a strategy.
  • If someone at your table wants to order dessert, remember that you do not have to have dessert too.
  • Decide that you will have a dessert on occasion, but not every day.

Physical Activity

Everyone should have physical activity every day, regardless of his or her weight. The many benefits of daily physical activity include physical and emotional changes that improve your health and lifestyle. What can you do?

  • If you have been sedentary, start slowly with any physical activity routine (check with your physician to make sure that you are ready to start a program or routine).
  • Do not choose something you dislike, as you will not stay with it very long.
  • Try to eventually have a few different types of physical activity you can perform. You will reduce the boredom factor and have a more versatile physical activity program.
  • Find a friend or relative to be physically active with you. Even your dog can be your physical activity buddy.


Alcohol, Vitamin Water, Gatorade, juice, smoothies, Starbucks coffee drinks with milk and sweeteners, and Jamba Juice may contain a lot of calories. What can you do?

  • Check the portion size of these fluids because they can range from 8 to 32 ounces, adding hundreds of calories.
  • “Natural,” “pure,” and “organic” juices or drinks still contain a lot of sugar and calories.


Stress and the damage it causes are facts of life and contribute to overeating. What can you do?

  • Get a support system in place and use it as you go through the weight loss process. It can include your doctor, nutritionist, trainer, sister, or friend.


Measuring success can be very tricky. Some people weigh themselves daily but some people do better with weekly weigh-ins. Success is not just the number on the scale but also the new habits that are created along the way. And remember that fluid retention can contribute to the weight seen on the scale. What can you do?

  • Decide where you are going to weigh yourself. If you think a scale at home will be difficult in that you weigh yourself too much, try the scale at the gym, doctor’s office, or best friend’s or relative’s house.
  • Decide how often you will weigh yourself and stick with it.

Realistic Food Plan

It took a while to gain the weight and it will take a while to lose it. Some food plans are too strict or restrictive and can set you up to fail because you get too hungry and the lack of calories is too drastic. What can you do?

  • Subtracting 500 calories from your daily intake (from less food or from less food plus physical activity) will result in a 1-pound weight loss in 1 week (3500 calories = 1 pound). One pound per week is a reasonable rate of weight loss for most people.
  • Eating three meals daily tends to curb overeating.
  • Include foods you enjoy. If you eliminate all the foods you love you will become bored and eventually you won’t follow your food plan.
  • Low-fat food is helpful for some people, but for others it isn’t satisfying and hunger returns too quickly. And for some, such food is a green light to eat large quantities.

Grazing / eating off other peoples’ plates / clearing plates / cooking

This may sound funny, but hundreds of calories are consumed this way, and often the person is not even aware that he or she is eating. What can you do?

  • Eat only when sitting at a table.
  • Do not eat while you are on the phone, reading, on the computer, or watching television.
  • Eat only from your own plate.

Food Logs

This is a key to weight loss. What can you do?

  • Recognize your eating patterns. For example, how does the food intake change on the weekend compared to during the week? How much food do you eat when you are not really hungry? These pieces of information are keys to changing behavior. Accountability works!
  • Purchase a notebook and record the time of eating, food, and approximate portion size. Other categories may include mood, hunger level, physical activity, location where the food was eaten (home, office, restaurant).
  • Recording the food log can be done as the day goes on or, if time does not allow you to do it throughout the day make sure you write in the log at the end of the day. Try not to wait until the next morning. You will probably forget some of the food.
  • Using the log to tally up daily calorie intake can also be helpful for some people to manage their food intake or to explain why someone may not be losing weight.

Short- and Long-Term Goals

Both are important. You must be able to achieve a short-term goal and continue to the next short-term goal and feel a sense of accomplishment along the way to the long-term goal. What can you do?

  • Goals must be realistic and allow for plateaus and sometimes even setbacks.
  • Realize that success in losing weight is about lifestyle changes over time. Your food intake and physical activity level will not always be what you planned, so strive for improvement.
  • Losing weight takes time and effort. But there is nothing better than feeling good and improving your health.
  • Write down everything you eat and the quantity so you can identify the relationship of your eating history with your short-term weight change.

To conclude, losing weight is complex. You have developed certain habits over the years and are now trying to change them. Just starting the process should allow you to feel better and eventually will enhance your health. Make time for yourself, because no one can lose weight for you.

During her twenty-year career as a nutritionist in private practice, Elyse Sosin, RD, has counseled children, adolescents, and adults on weight management, wellness, eating issues, pregnancy, gestational diabetes, and hyperlipidemia. Previously, Ms. Sosin was on the staff of Mount Sinai Medical Center as a Nutritionist at the Medical Center as well as the Adolescent Health Center and the Women’s Center. Ms. Sosin has lectured at public and private schools, colleges, organizations and medical facilities and has been a consultant to several food and publishing companies. She has appeared on television, and has been quoted in The Daily News, The New York Times, The Post, and other publications.