After diet, exercise and daily physical activity make up the other half of the weight-loss equation.

If you don’t exercise, you will have no way to burn any extra calories, taking all the fun out of eating. Not only will you not be able to afford any food indiscretions, but you forgo the possibility of leaving a life of aches, pains and deconditioning.

Physical activity increases our metabolism, keeps all the chemicals and hormones of daily living in balance, and improves the overall health of our immune system, heart, lungs, bones and muscles.

We also look better in our clothes, have an increased libido, and don’t feel as stiff in the mornings when we exercise regularly.

Increases in physical activity can start modestly with a few more chores, walking farther, taking the stairs, or stretching and lifting small weights whenever you get a chance.

Although, now that I have talked about the need to decrease calories and increase exercise, I should mention that none of this can be done until you have a plan for modifying the old behaviors that created this chronic problem.

Attitude is everything. You must be psyched up, revved, in the groove. You are going to make a commitment to creating new habits that help you lose weight and keep it off. You will be telling yourself constantly that you are a healthy normal weight active person, and this is what healthy normal weight active people do.

There are infinite behavior modification techniques available to dieters in books, on the Internet, in audio media, and through diet counselors. Most people will need to try more than one, and you shouldn’t feel bad if you explore and use several, one right after another.

Some of the most helpful techniques include using food labels and keeping a food journal to increase your awareness of what you eat, how much, when and why. After setting your goals, be prepared to renew those goals frequently.

Few people can kick a habit without a support system of some kind. Finding a support group either in a club of other dieters, with an organized diet group, or with a friendly mentor can make the difference between success and failure.

Can my doctor help me lose weight?

After all the good advice, preventive care and educational handouts, there are medications available to help with the dieting process.

Please note that I did not say they could substitute for the dieting process. In combination with a low-calorie diet and increased exercise, medication may be the additional foot up that some dieters need.

If you decide to use something over the counter, please take the bottle to your primary-care provider and discuss the ingredients and risks before proceeding.

Very few dietary supplements have been proven to help with weight loss, no matter what they claim on the label. Even a placebo (sugar pill) works well when combined with diet and exercise.

Of the medications that doctors prescribe for the short-term treatment of obesity, most are appetite suppressants. These work to increase serotonin and catecholamines to make you feel full and decrease your appetite. They can cause several adverse side effects such as headaches, nausea, increased blood pressure, dependence and tolerance.

Examples of these medications include phendimetrazine (Bontril), phentermine (Adipex, Fastin, Ionamin) and sibutramine (Meridia).

The one medication that is different is Xenical, which came on the market in 1999. It limits the absorption of fat that you eat, but can also cause diarrhea, cramping, and oily orange discharges.

Surgery is a final step for those morbidly obese people (with a BMI over 40) who have failed all the diets and are already dealing with complications like diabetes, high blood pressure, arthritis and heart disease.

This bariatric surgery will either bypass much of your stomach to decrease digestion, or narrow the opening to your stomach to decrease the amount of food you can ingest, depending on what you and your surgeon decide is right for you.

The restrictive surgery, better known as banding, involves a tight band used to make the opening to the stomach smaller, allowing only 1-3 ounces of food in at a time.

Malabsorptive operations involve bypassing part of the stomach and small intestine so that less food is absorbed on its way through to the colon. This leads to better weight loss than the banding procedure, with up to two-thirds of excess pounds lost within two years of the surgery.

Although surgery involves great expense and some scary risks, it can result in weight loss and the subsequent resolution of many obesity-related health problems, eliminating the need for medications to treat them.

With all of the fad diets and short-term medications used in obesity, the NIH brings up an interesting concern not usually noted in articles on obesity. They point out that these treatments may imply that obesity is an acute process and lifestyle choice rather than the chronic disease that we are starting to understand it to be.

With increased public awareness, hopefully perception will change so that patients and their physicians will begin to work with obesity as the complex process it truly is.