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The Healthy Heart Handbook for Women

Aim for a Healthy Weight

If you are overweight or obese, taking off pounds can reduce your chances of developing heart disease in several ways. First, losing weight will directly lower your risk. Second, weight loss can help to reduce a number of risk factors for heart disease as well as lower your risk for other serious conditions. Weight loss can help to control diabetes as well as reduce high blood pressure and high blood cholesterol. Reaching a healthy weight can also help you to sleep more soundly, experience less pain from arthritis, and have more energy to take part in activities you enjoy.

Remember, if you need to lose weight, even a small weight loss will help to lower your risks of heart disease and other serious health conditions. At the very least, you should not gain any additional weight. A recent study found that young adults who maintain their weight over time, even if they are overweight, have lower risk factors for heart disease in middle age than those whose weight increases.

When it comes to weight loss, there are no quick fixes. Successful, lasting weight loss requires a change of lifestyle, not a brief effort to drop pounds quickly. Otherwise, you will probably regain the weight. Aim to lose ½ pound to 2 pounds per week—no more. If you have a lot of weight to lose, ask your doctor, a registered dietitian, or a qualified nutritionist to help you develop a sensible plan for gradual weight loss.

To take off pounds and keep them off, you will need to make changes in both your eating and physical activity habits. Weight control is a question of balance. You take in calories from the food you eat. You burn off calories by physical activity. Cutting down on calories, especially calories from fat, is key to losing weight. Combining this change in diet with a regular physical activity program, such as walking or swimming, will help you both shed pounds and stay trim for the long term.


Choose Foods, Not Supplements
Until recently, it was believed that antioxidant vitamins, particularly vitamin E and beta carotene, might protect against heart disease and stroke as well as cancer. But new research shows that taking these vitamins in supplement form can be harmful—even deadly.

In the case of vitamin E supplements, a review of 19 studies showed that daily doses of 400 international units (IUs) or more may significantly increase the risk of death from all causes. Meanwhile, two major studies showed that supplementation with beta carotene (a substance that is converted to vitamin A in the liver) increases the risks of lung cancer and death in smokers. Other recent studies have shown no benefits to taking either vitamin E or beta carotene supplements to prevent cardiovascular diseases or cancer.

But studies do suggest that antioxidants in foods protect heart health. So keep eating plenty of foods that are packed with these vitamins. Foods rich in vitamin E include vegetable oils(especially safflower and sunflower oils), wheat germ, leafy green vegetables, and nuts (almonds and mixed nuts). Foods rich in beta carotene are carrots, yams, peaches, pumpkin, apricots, spinach, and broccoli.

Note: If you are taking vitamin E supplements for protection against medical conditions other than cardiovascular diseases or cancer, talk with your doctor about the risks and benefits of higher dose vitamin E supplements.

Getting Started

Anyone who has ever tried to lose weight—and keep it off—knows that it can be quite a challenge. Here are some tips to help you succeed:

Eat for health. Choose a wide variety of low-calorie, nutritious foods in moderate amounts. Include plenty of vegetables, fruits, whole grains, and low-fat or fat-free milk, as well as fish, lean meat, poultry, or dry beans. Choose foods that are low in fat and added sugars. Choose sensible portion sizes. (See "Portion Distortion".)

Watch calories. To lose weight, most overweight people will need to cut 500 to 1,000 calories per day from their current diet. For tips on choosing low-fat, low-calorie foods, see "The Substitution Solution".

Keep milk on the menu. Don't cut out milk products in trying to reduce calories and fat. Milk and milk products are rich in calcium, a nutrient that helps to prevent osteoporosis, a bone-thinning disease. Instead, choose low-fat or fat-free milk products, which have the same amount of calcium as whole-milk products. Make the switch gradually. If you're used to drinking whole milk, first cut back to 2 percent, then to 1 percent, and finally to fat-free milk.

Keep moving. Physical activity is key to successful, long-term weight loss. It can help you burn calories, trim extra fat from your waist, and control your appetite. It can also tone your muscles and increase aerobic fitness. To lose weight and prevent further weight gain, gradually build up to at least 60minutes of physical activity on most, and preferably all, days of the week. If you've already lost weight, to keep it off you'll need to get 60 to 90 minutes of daily physical activity. That may sound like a lot, but you can get results without running yourself ragged.

A recent study showed that moderate-intensity physical activity, such as brisk walking, helps people lose weight as effectively as more vigorous exercise. For more tips, see "Learn New Moves".

Steer clear of fast food. A single meal from a fast food restaurant may pack as many calories as you need for a whole day! A recent study showed that young adults who eat frequently at fast food restaurants gain more weight and are at higher risk for diabetes in middle age than those who avoid the fast food habit. If you do eat at a fast food place, choose salads and grilled foods, and keep portion sizes small. Ask for salad dressings, mayonnaise, and other high-fat condiments to be served on the side—or not at all.

Forget the fads. Fad diets, including the high-protein, low-carbohydrate diets, are not the answer. As tempting as their promises may be, most quick-fix diets provide poor nutrition and cause many side effects, especially those with less than 800calories per day. Although fad diets can produce fast results, most of the weight loss is due to water loss. The weight returns quickly once you stop dieting.

Know about medicines. If you are very overweight, or if you are overweight and have other weight-related risk factors or diseases, your doctor may advise you to take a medicine to help you take off pounds. You should use a weight-loss drug only after you have tried a low-calorie diet, more moderate-intensity physical activity, and other lifestyle changes for 6 months without successfully losing weight. Because weight-loss medicines have side effects, you should consider all of the risks and benefits before trying one of them. These drugs should be used along with a low-calorie eating plan and regular physical activity, not as a substitute for these lifestyle changes.

Get support. Tell your family and friends about your weight-loss plans, and let them know how they can be most helpful to you. Some women also find it useful to join a structured weight-loss program. The most effective groups provide support and advice for permanently changing eating and physical activity habits. (See "How To Choose a Weight-Loss Program".)

Lock in your losses. After 6 months of gradually losing weight, switch your efforts to keeping the weight off by continuing to eat a nutritious, lower calorie diet and by getting60 to 90 minutes of moderate-intensity physical activity per day. After several months of weight maintenance, talk with your healthcare provider about whether you need to lose additional pounds.

Seven Secrets of Successful Weight Management

If you have ever tried to take off weight, you know that it's more than a matter of promising yourself you'll eat less and move more. You also need to mentally prepare yourself for new behaviors. Here are some tips for getting and staying in a healthy weight mindset:

Start small. Many people set unrealistic goals for the amount of weight they want to lose. But you can greatly improve your health by losing just 5 to 10 percent of your starting weight. Even though you may choose to lose more weight later, keep in mind that this initial goal is both realistic and valuable.

Set smart goals. It's important to set goals that are specific, achievable, and forgiving (allow yourself to be less than perfect).For example, "exercise more" is a fine goal, but it's not very specific. "Walk for 60 minutes every day" is specific and perhaps achievable. But what if you get a bad cold one day, and there's a drenching rainstorm on another? "Walk for 60minutes, 5 days each week" is specific, achievable, and forgiving. A great goal!

Build on success. Rather than select one big goal, choose a series of smaller goals that bring you closer and closer to your larger goal. For example, if one of your big goals is to reduce your daily calories from 2,000 to 1,200, first reduce your calories to 1,700, then move to 1,400, and finally to 1,200. Likewise, with physical activity, first establish a small new habit—such as walking 10 minutes a day—and then gradually increase it. Everyone can find time to walk 10 minutes each day. When you experience success at reaching a small goal, it will motivate you to keep moving toward your larger ones.

Reward yourself! Rewards that you control will encourage you to achieve your goals. For a reward to work well, choose something you really want, don't put off giving it to yourself, and make it dependent on meeting a specific goal. (Examples might be, "When I lose 10 pounds, I'll go to the mall the next day and get a fabulous new nail polish." or "When I've walked 60minutes daily for 3 weeks, I'll take an afternoon off and treat myself to a movie.") Avoid food as a reward. It usually works better to give yourself frequent, small rewards for reaching short-term goals than bigger rewards that require long, difficult effort.

Write it down. Regularly record what you do on your weight-loss program, such as your daily calorie intake and amount of physical activity, as well as changes in your weight. (Try to weigh yourself at the same time of day once or twice a week.)Keeping track this way can help you and your health care provider determine what behaviors you may want to improve. Keeping tabs on your progress can also help you stay motivated.

Know your triggers. To lose weight successfully, you need to be aware of your personal eating "triggers." These are the situations that usually bring on the urge to overeat. For instance, you may get a case of the munchies while watching TV, when you see treats next to the office coffeepot, or when you're with a friend who loves to eat. To "turn off" the trigger, you'll need to make a change in the tempting situation. For example, if the pile of doughnuts near the coffeepot is hard to resist, leave the scene as soon as you pour yourself a cup of coffee.

The fine art of feeling full. Changing the way you eat can help you to eat less without feeling deprived. Eating slowly can help you feel satisfied sooner and therefore avoid second helpings. Eating lots of vegetables and fruits and drinking plenty of noncaloric beverages can also make you feel fuller. Another trick is to use smaller plates so that moderate portions don't seem skimpy. It also helps to set a regular eating schedule, especially if you tend to skip or delay meals.

How To Choose a Weight-Loss Program

Some people lose weight on their own, while others like the support of a structured program. If you decide to participate in a weight-loss program, here are some questions to ask before you join.

  • Does the program provide counseling to help you change your eating and activity habits?
    The program should teach you how to permanently change those eating and lifestyle habits, such as lack of physical activity, that have contributed to weight gain. Research shows that people who successfully keep weight off are those who make changes in their overall lifestyles, rather than simply join a physical activity program.

  • Does the staff include qualified health professionals, such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?
    Qualified professionals can help you lose weight safely and successfully. Before getting started, you'll need to be examined by a doctor if you have any health problems, currently take or plan to take any medicine, or plan to lose more than 15 to 20 pounds.

  • Does the program offer training on how to deal with times when you may feel stressed and slip back into old habits?
    The program should provide long-term strategies for preventing and coping with possible weight problems in the future. These strategies might include setting up a support system and a regular physical activity routine.

  • Do you help make decisions on food choices and weight-loss goals?
    In setting weight-loss goals, the program should consider your personal food likes and dislikes as well as your lifestyle. Avoid a one-strategy-fits-all program.

  • Are there fees or costs for additional items, such as dietary supplements?
    Before you sign up, find out the total costs of participating in the program. If possible, get the costs in writing.

  • How successful is the program?
    Few weight-loss programs gather reliable information on how well they work. Still, it is worthwhile to ask the following questions:
    • What percentage of people who start this program complete it?
    • What percentage of people experience problems or side effects? What are they?
    • What is the average weight loss among those who finish the program?


How To Choose Sensible Servings
It's very easy to "eat with your eyes" and misjudge what equals a serving—and pile on unwanted pounds. This is especially true when you eat out, because restaurant portion sizes have been steadily expanding. Twenty years ago, the average pasta portion size was 2 cups, totaling 280 calories; today, it is 4cups, totaling 560 calories! Use the guidelines below to keep portion sizes sensible:

  • When eating out, choose small portion sizes, share an entrée with a friend, or take some of the food home (if you can chill it right away).

  • Check the Nutrition Facts label on product packages to learn how much food is considered a serving as well as how much fat and how many calories are in the food.

  • Be especially careful to limit portion sizes of high-calorie foods, such as cookies, cakes, other sweets, sodas, french fries, oils, and spreads.

Making the Switch to Low-Calorie Foods

Here are some tasty, low-calorie alternatives to old favorites. Read labels to find out how many calories are in the specific products you buy.

Instead of Replace With
Dairy Products  
Whole milk Low-fat or fat-free milk
Ice cream Sorbet, sherbet, fat-free frozen yogurt, or reduced-fat ice cream
Whipping cream Imitation whipped cream (made with fat-free milk) or low-fat vanilla yogurt
Sour cream Plain, low-fat yogurt or fat-free sour cream
Cream cheese Neufchâtel cheese or light or fat-free cream cheese
Cheese (sandwich types) Reduced-calorie, low-calorie, or fat-free cheeses
Cereals and Pastas  
Ramen noodles Brown rice or whole-grain pasta
Pasta with cheese sauce Whole-grain pasta with red sauce or vegetables
Granola Bran flakes, crispy rice cereals, cooked grits or oatmeal, or reduced-fat granola
Meat, Fish, Poultry  
Cold cuts, hotdogs Low-fat cold cuts and hotdogs (watch sodium content)
Bacon or sausage Canadian bacon or lean ham
Regular ground beef Extra-lean ground beef or ground turkey
Chicken or turkey with skin White-meat chicken or turkey without skin
Oil-packed tuna* Water-packed tuna*
Beef (chuck, rib, brisket) Beef (round, loin) with fat trimmed off; if possible, choose select grades
Pork (spareribs, untrimmed loin) Pork tenderloin, trimmed; lean smoked ham loin
Whole eggs Egg whites
Baked Goods  
Croissants, brioches, etc. Hard French rolls or "brown 'n serve" rolls
Donuts, sweet rolls, or muffins Reduced-fat or fat-free cookies (graham crackers, ginger snaps, fig bars)
Cake (pound, layer) Cake (angel food, gingerbread)
Cookies Reduced-fat or fat-free cookies (graham crackers, ginger snaps, fig bars)
Fats, Oils, Salad Dressings  
Regular margarine or butter Light-spread, reduced-calorie, or diet margarines; look for trans fat-free margarines
Regular mayonnaise Light or diet mayonnaise
Regular salad dressings Reduced-calorie or fat-free dressings, lemon juice, or vinegars
Butter or margarine on toast Jelly, jam, or honey on toast
Oils, shortening, or lard Nonstick cooking spray instead of greasing pans for sauteing

*Women who are pregnant or may become pregnant, nursing mothers, and young children should avoid some types of fish and eat types lower in mercury. See the Web site for more information.

Table of Contents Next: Learn New Moves

Last Updated: February 29, 2012

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