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Q: My husband, an octogenarian, is overweight and a sugar lover. He’s having significant back pain. His physician recently encouraged him to lose weight by following the South Beach Diet and to quit drinking sugar-sweetened sodas. It’s hard for my husband to change his food choices and eating behaviors. What are some guidelines for him?

A: Your husband is hardly alone finding it a challenge to change his food habits. After all, he’s been fine-tuning these now for 80-plus years!

In my experience, when physicians give advice to follow a specific diet, be it South Beach or another, they’re succumbing to the pressure to provide you with quick, tangible advice. They and you would be better served with a referral to a registered dietitian nutritionist.

The fact is, regardless of which diet your husband’s physician suggested, it’s unlikely your husband, or most adults, will successfully make wholesale changes in long-held eating habits and behavior based on cultural traditions. Our habits, especially by the time we reach senior-citizen status, are close to our hearts.

One diet after another comes into the public arena like a knight in shining armor, promising to be the next savior for weight control.

But studies show that people don’t dramatically alter the calories they consume from carbohydrates, protein and fat — our major sources of calories, other than alcohol.

The results of a study published in 2009 by researchers at the Harvard School of Public Health and Pennington Biomedical Research Center reinforce this point. The Pounds Lost study, begun at the height of yet another lower-carbohydrate, higher-protein diet craze, set out to see whether 800 participants would lose more weight on one of four diets. They ranged from a diet with a very low proportion of carbohydrates (35 percent) and high proportion of protein to a diet with a higher proportion of carbohydrates (65 percent) and less protein. Participants were offered group and individual counseling and support. The weight loss and slow regain reported were similar to other weight-loss studies, with maximum weight loss (13 pounds or 7 percent from the initial weight) by six months. At two years, the net weight loss was 9 pounds from starting weight.

Here’s what’s relevant: People who attended at least two-thirds of the counseling sessions over the two years lost about 20 pounds, far more than the average noted above. Yes, stick-to-it-ness matters! That’s been shown repeatedly. Regarding the diet composition for weight loss, no one eating pattern (that is, mix of carbohydrates, protein and fat) produced more weight loss than another. Participants modified their food intake toward the goal of the diet they were assigned but didn’t quite get to the goal. Bottom line: The reduction in total calories mattered more than how much of the calories were from carbohydrates, protein and/or fat. The Pounds Lost study teaches us that rather than focusing on the rigidity of the latest, greatest diet and forcing dramatic eating-habit changes, save yourself a few bucks and possibly a series of spousal spats.

Aim instead to make small and steady changes. “Many of us have unrealistic expectations about the changes we want to see in our bodies,” says Rebecca Scritchfield, registered dietitian and owner of Capitol Nutrition Group (, a private nutrition practice in Washington. “The real secret to a healthy body is balance. Design a realistic plan that works for you and avoid drastic, quick fixes,” Scritchfield says.

Some realistic actions for you and your husband:

Pour fewer sugar-sweetened beverages. Your husband’s physician is absolutely right about skipping regular soda. The calories add up quickly and your husband isn’t burning many due to his age and limited activity. One 20-ounce bottle of nearly every regularly sweetened beverage contains about 250 calories — calorie-dense with nearly nil nutrition. If he craves that bubbly sweet taste of soda, try diet soda. Don’t get caught up in the frenzy about diet sodas and weight gain. A randomized clinical trial (RCT) published last week from the University of Colorado and Temple University showed people who regularly drank diet beverages rather than water as part of a weight-loss program lost more weight and reported significantly less hunger. This trial echoes the results of the Choice Study, another RCT published in 2012. Also, quench thirst with water or sparkling water. Make it tasty with a squirt or splash of lemon, lime or fruit juice.

Enjoy sweets, but cut down on the sources and sizes. You mention your husband is a sugar lover. Scritchfield’s advice: “Avoid cutting out foods that you like; instead set boundaries around how often you eat them.” Help your husband identify his favorite sweets — those he can’t live without. Next, ask him how many times a week he feels he needs to satisfy his sweet tooth to not feel deprived. With this target in mind — and in petite amounts — he can feel good about every bite of sweets he eats.

Opt for fruit for sweet satisfaction. Enjoy a small bowl of berries, a slice of watermelon or honeydew, a handful of raisins or couple of dates. Use these options to end a meal, for an afternoon snack or late-night treat.

Gain volume with vegetables. We hear the message “eat less,” but in fact most people need to eat more when it comes to  vegetables. For dinners, think beyond what protein will occupy the center of the plate. Fill your plate with cooked and raw vegetables. Or make meals that limit the protein and maximize vegetables, such as stir-fries or fajitas. Having a sandwich for lunch? Make it a wrap stuffed with lettuce, sliced cucumbers, shredded carrots and sprouts or half of a sandwich with raw vegetables or a salad on the side.

Practice portion control. Continue to prepare the majority of foods your husband enjoys, but prepare less of them. If you make enough for a few meals, serve out smaller-than-usual portions. Serve foods at the stove. Don’t place large amounts of food on the table within arm’s reach. This promotes overeating and ensures you won’t have those precious leftovers for another meal.

Perhaps you’ve heard a few of these suggestions. Most of us know what to skimp on and what to fill our plates with. But, it’s hard to do in our food-obsessed world. Take a different tack. Tweak your husband’s eating habits and food choices rather than setting unrealistic goals or holding out hope that a new fad diet holds the power to help him finally achieve a healthy weight.

Warshaw, a registered dietitian and certified diabetes educator, is the author of numerous books published by American Diabetes Association and the blog EatHealthyLiveWell found on her Web site,

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