I talk a lot about strategies to lose weight in the clinic. To be completely honest, I wish I didn’t have to. I’d rather talk about any other health condition: diabetes, heart disease, fatty liver, gout, kidney disease, cancer, arthritis, food intolerances, irritable bowel syndrome…even constipation lol! Anything but weight loss. But unfortunately excess weight and obesity is not only still increasing (new U.S. stats show almost 42% of the population is obese), it’s a contributor to most of the conditions mentioned above so I have to address it. Carrying too much fat, especially abdominal “belly” fat is inflammatory. I don’t believe it’s as concerning if someone is overweight (as diagnosed by a doctor using body mass index, and yes I know the problems with BMI) but their weight hasn’t changed much over time and they don’t have existing health problems.

The problem is weight gain and accumulation of fat deposits in new areas of the body. When fat cells or adipocytes increase in number and size, immune cells release proteins called cytokines that are pro-inflammatory. Inflammation isn’t necessarily a bad thing, and cytokines are needed to signal problems in the body so that immune cells can be rallied to repair and restore. However, the body interprets excess weight gain as a problem, especially if the weight sticks around, which causes a low-level but persistent type of inflammation called metaflammation. This leads to metabolic irregularities such as high blood pressure, high insulin levels, extra fat stockpiling in the liver…and so on which then leads to any number of health problems.

I don’t prefer counseling on weight loss because there’s confounders that get in the way like stress, poor sleep, and not moving much that change metabolism and the ability to lose weight. People are burned out using apps like Noom and bored of tracking calories. They may be hearing messages about Health At Every Size and how excess weight isn’t a bad thing, which in some cases like I described above may not be, but can be problematic for others if it causes metabolic disturbances that lead to disease or joint inflammation.

So how can one lose weight if there’s a medical necessity? After more than a decade of talking about various strategies, I’ve now come back to one I bypassed at the beginning because I thought it was boring and ineffective⁠—relearning portion sizes. I don’t think it will help everyone, but let’s face it, our eating environment ignores portions. Restaurant portions are large so we can feel we got our money’s worth. At home, we simply fill plates and bowls to the brim. We really don’t know what a portion is anymore. And yet my patients who have lost weight and kept it off all say the same thing: “I ate less” or more importantly “I learned to be satisfied with less.” They changed this behavior permanently.

Filling a plate with an appropriate portion is a convenient tool because it doesn’t require logging onto a website or opening an app on your phone. It’s less likely to become obsessive or triggering than calorie counting, as some of my patients with eating disorders have shared. Intuitively you know this is the right thing to do⁠—to be mindful and aware of what and how much you’re eating. This helps you to appreciate food more.

So what’s the right portion for weight control? The simplest method to get started is using your hand:

• Your palm is the size of protein, such as fish, chicken, tempeh, or beans.
• A fist is the amount of starch, like rice, potatoes, or pasta.
• Two fists is the amount of vegetables or salad.
• A thumb is the size of dressing or nuts or seeds added to the meal.

Here’s a visual:

If you’re a man, your hand will be larger so the method still works. But if this amount leaves you very hungry, try more protein…about the size of your opened hand. You can also increase the vegetables to three fistsfuls.

I also firmly believe in giving the body a break from eating, so in other words, not grazing all day long. In most cases it isn’t natural or healthful to be eating at the top of every hour. So consider setting specific meal times. It’s also normal and entirely natural to allow hunger to build before the next meal. This is a healthy reaction that prepares us to focus on and enjoy the meal to come.

Do you use the portion method? If not, what eating strategies best help you?