We need to start as early as possible to achieve dietary control. Children need both wholesome, nutritious foods and loving guidance! Only about 10 percent of elementary school children are overweight, yet between 20 and 30 percent of high schoolers are at least moderately obese. To lose weight and maintain it, behavior must change. Behavior modification is a form of therapy that can be effective in helping us change from an overweight person to a trimmer one. This can be practiced by ourselves or with the help of a close friend, spouse, or diet "buddy," but a behavioral or other counselor can often assist with it.

An important beginning is to try to get in touch with our level of hunger. Most "fat" people do not eat from hunger; in fact, many rarely experience this natural guide to eating. Using an eating diary to evaluate what, when, and where we eat, how much, our level of hunger, and what else we are doing at the time can be very revealing. An example of this form is found in Taking Charge of Your Weight and Well-Being by Joyce Nash and Linda Ormiston (Bull Publishing Co., Palo Alto, CA., 1978). Keeping such a diary for several weeks can help us to see more clearly our relationship to eating. We can then make a plan incorporating our new, positive habits and use new rules to change our behavior in weak areas. For example, if we snack while we make dinner or pick at the leftovers in the kitchen, we can make a commitment to eat food only at the dining room table and allow no eating in the kitchen or when standing. It may be difficult at first; constant awareness is needed. Behaviorists claim that it takes three weeks to change a habit and create a new one, so keep at it. Part of our eating behavior is affected by psychological aspects, such as our self-image, relationships to family or partner, sexuality, and general stress. Often, counseling is important to help change behavior to meet our dietary challenge.

Successfully achieving a new weight means changing our diet, not "going on a diet." When we return to our old, "normal" diet, we will create the same body we had before, and likely add another pound or three. First we change our diet by substituting wholesome foods for the more high-calorie and chemical foods in the diet. Next, we work to create good habits. The following list offers some suggestions for behavior patterns, food choices, and activities to help reach and maintain our optimum weight.

Before beginning a new diet plan, a health evaluation may be important, especially for those with recent weight gain or symptoms of medical problems. Before embarking on any low-calorie diets, we should have a complete exam, general biochemistry panel, and, if over 45, an electrocardiogram. A complete thyroid hormone panel is often useful to rule out low thyroid function, which could be a cause of weight gain or difficulty in losing weight. Blood fats, protein, potassium, and calcium levels are also important monitors in the process of weight loss. A positive side effect of diet change and weight loss is reduction of blood cholesterol and triglycerides and high blood pressure, yet also watching for mineral depletions, particularly of potassium, is a good idea.

A food allergy evaluation may be a valuable step on the path to a trim and healthier body. Many people have internal reactions to foods, with increased immune response, cellular irritation, and many possible symptoms. These can cause inflammatory activity and water retention, as well as poor utilization of other foods. Currently, the best way to isolate problem foods is a blood test that measures levels of IgG antibodies to specific food antigens (the protein stimuli of the food). This reveals delayed or "hidden" food allergy or hypersensitivity. Measuring IgE levels can determine foods causing more immediate reactions, such as hives, asthma, or eczema, though these reactions are relatively uncommon, which is why skin tests, which measure the IgE reactions, are not very helpful. Cytotoxic testing, looking at cellular reactions, is no longer used because interpretations of its results were too subjective. Antibody measurement is more reproducible.