Heartburn, Gastroesophageal Reflux (GER), and ... - RTD

Heartburn, Gastroesophageal Reflux 

(GER), and Gastroesophageal Reflux 

Disease (GERD) 

National Digestive Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is GERD? 

Gastroesophageal reflux disease (GERD) 

is a more serious form of gastroesophageal 

reflux (GER), which is common. GER 

occurs when the lower esophageal sphincter 

(LES) opens spontaneously, for varying 

periods of time, or does not close properly 

and stomach contents rise up into the 

esophagus. GER is also called acid reflux 

or acid regurgitation, because digestive 

juices—called acids—rise up with the food. 

The esophagus is the tube that carries food 

from the mouth to the stomach. The LES 

is a ring of muscle at the bottom of the 

esophagus that acts like a valve between 

the esophagus and stomach. 

When acid reflux occurs, food or fluid can 

be tasted in the back of the mouth. When 

refluxed stomach acid touches the lining of 

the esophagus it may cause a burning sensation 

in the chest or throat called heartburn 

or acid indigestion. Occasional GER 

is common and does not necessarily mean 

one has GERD. Persistent reflux that 

occurs more than twice a week is considered 

GERD, and it can eventually lead to 

more serious health problems. People of 

all ages can have GERD. 

What are the symptoms of 

GERD? 

The main symptom of GERD in adults is 

frequent heartburn, also called acid indigestion—burning-type 

pain in the lower 

part of the mid-chest, behind the breast 

bone, and in the mid-abdomen. Most 

children under 12 years with GERD, and 

some adults, have GERD without heartburn. 

Instead, they may experience a 

dry cough, asthma symptoms, or trouble 

swallowing. 

What causes GERD? 

The reason some people develop GERD is 

still unclear. However, research shows that 

in people with GERD, the LES relaxes 

while the rest of the esophagus is working. 

Anatomical abnormalities such as a hiatal 

hernia may also contribute to GERD. A 

hiatal hernia occurs when the upper part of 

the stomach and the LES move above the 

diaphragm, the muscle wall that separates 

the stomach from the chest. Normally, the 

diaphragm helps the LES keep acid from 

rising up into the esophagus. When a hiatal 

hernia is present, acid reflux can occur 

more easily. A hiatal hernia can occur in 

people of any age and is most often a normal 

finding in otherwise healthy people 

over age 50. Most of the time, a hiatal 

hernia produces no symptoms. 

U.S. Department 

of Health and 

Human Services

Other factors that may contribute to GERD 

include 

• obesity 

• pregnancy 

• smoking 

Common foods that can worsen reflux 

symptoms include 

• citrus fruits 

• chocolate 

• drinks with caffeine or alcohol 

• fatty and fried foods 

• garlic and onions 

• mint flavorings 

• spicy foods 

• tomato-based foods, like spaghetti 

sauce, salsa, chili, and pizza 

What is GERD in children? 

Distinguishing between normal, physiologic 

reflux and GERD in children is 

important. Most infants with GER are 

happy and healthy even if they frequently 

spit up or vomit, and babies usually outgrow 

GER by their first birthday. Reflux 

that continues past 1 year of age may be 

GERD. Studies show GERD is common 

and may be overlooked in infants and 

children. For example, GERD can present 

as repeated regurgitation, nausea, 

heartburn, coughing, laryngitis, or 

respiratory problems like wheezing, 

asthma, or pneumonia. Infants and 

young children may demonstrate irritability 

or arching of the back, often during or 

immediately after feedings. Infants with 

GERD may refuse to feed and experience 

poor growth. 

Talk with your child’s health care provider 

if reflux-related symptoms occur regularly 

and cause your child discomfort. Your 

health care provider may recommend 

simple strategies for avoiding reflux, 

such as burping the infant several times 

during feeding or keeping the infant in 

an upright position for 30 minutes after 

feeding. If your child is older, your health 

care provider may recommend that your 

child eat small, frequent meals and avoid 

the following foods: 

• sodas that contain caffeine 

• chocolate 

• peppermint 

• spicy foods 

• acidic foods like oranges, tomatoes, 

and pizza 

• fried and fatty foods 

Avoiding food 2 to 3 hours before bed 

may also help. Your health care provider 

may recommend raising the head of your 

child’s bed with wood blocks secured 

under the bedposts. Just using extra 

pillows will not help. If these changes 

do not work, your health care provider 

may prescribe medicine for your child. 

In rare cases, a child may need surgery. 

For information about GER in infants, 

children, and adolescents, see the 

Gastroesophageal Reflux in Infants and 

Gastroesophageal Reflux in Children and 

Adolescents fact sheets from the National 

Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). 

2 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)

How is GERD treated? 

See your health care provider if you have 

had symptoms of GERD and have been 

using antacids or other over-the-counter 

reflux medications for more than 2 weeks. 

Your health care provider may refer you to 

a gastroenterologist, a doctor who treats 

diseases of the stomach and intestines. 

Depending on the severity of your GERD, 

treatment may involve one or more of the 

following lifestyle changes, medications, 

or surgery. 

Lifestyle Changes 

• If you smoke, stop. 

• Avoid foods and beverages that 

worsen symptoms. 

• Lose weight if needed. 

• Eat small, frequent meals. 

• Wear loose-fitting clothes. 

• Avoid lying down for 3 hours after 

a meal. 

• Raise the head of your bed 6 to 

8 inches by securing wood blocks 

under the bedposts. Just using 

extra pillows will not help. 

Medications 

Your health care provider may recommend 

over-the-counter antacids or medications 

that stop acid production or help the 

muscles that empty your stomach. You can 

buy many of these medications without a 

prescription. However, see your health 

care provider before starting or adding 

a medication. 

Antacids, such as Alka-Seltzer, Maalox, 

Mylanta, Rolaids, and Riopan, are usually 

the first drugs recommended to relieve 

heartburn and other mild GERD symptoms. 

Many brands on the market use 

different combinations of three basic salts— 

magnesium, calcium, and aluminum—with 

hydroxide or bicarbonate ions to neutralize 

the acid in your stomach. Antacids, however, 

can have side effects. Magnesium salt 

can lead to diarrhea, and aluminum salt 

may cause constipation. Aluminum and 

magnesium salts are often combined in a 

single product to balance these effects. 

Calcium carbonate antacids, such as Tums, 

Titralac, and Alka-2, can also be a supplemental 

source of calcium. They can cause 

constipation as well. 

Foaming agents, such as Gaviscon, work by 

covering your stomach contents with foam 

to prevent reflux. 

H2 blockers, such as cimetidine (Tagamet 

HB), famotidine (Pepcid AC), nizatidine 

(Axid AR), and ranitidine (Zantac 75), 

decrease acid production. They are available 

in prescription strength and over-thecounter 

strength. These drugs provide 

short-term relief and are effective for about 

half of those who have GERD symptoms. 

Proton pump inhibitors include omeprazole 

(Prilosec, Zegerid), lansoprazole 

(Prevacid), pantoprazole (Protonix), 

rabeprazole (Aciphex), and esomeprazole 

(Nexium), which are available by prescription. 

Prilosec is also available in over-thecounter 

strength. Proton pump inhibitors 

are more effective than H2 blockers and can 

relieve symptoms and heal the esophageal 

lining in almost everyone who has GERD. 

Prokinetics help strengthen the LES and 

make the stomach empty faster. This group 

includes bethanechol (Urecholine) and 

metoclopramide (Reglan). Metoclopramide 

also improves muscle action in the 

digestive tract. Prokinetics have frequent 

side effects that limit their usefulness— 

fatigue, sleepiness, depression, anxiety, 

and problems with physical movement. 


Because drugs work in different ways, combinations 

of medications may help control 

symptoms. People who get heartburn after 

eating may take both antacids and H2 

blockers. The antacids work first to neutralize 

the acid in the stomach, and then 

the H2 blockers act on acid production. 

By the time the antacid stops working, the 

H2 blocker will have stopped acid production. 

Your health care provider is the best 

source of information about how to use 

medications for GERD. 

What if GERD symptoms 

persist? 

If your symptoms do not improve with 

lifestyle changes or medications, you may 

need additional tests. 

• Barium swallow radiograph uses 

x rays to help spot abnormalities such 

as a hiatal hernia and other structural 

or anatomical problems of the esophagus. 

With this test, you drink a solution 

and then x rays are taken. The 

test will not detect mild irritation, 

although strictures—narrowing of 

the esophagus—and ulcers can be 

observed. 

• Upper endoscopy is more accurate 

than a barium swallow radiograph and 

may be performed in a hospital or a 

doctor’s office. The doctor may spray 

your throat to numb it and then, after 

lightly sedating you, will slide a thin, 

flexible plastic tube with a light and 

lens on the end called an endoscope 

down your throat. Acting as a tiny 

camera, the endoscope allows the doctor 

to see the surface of the esophagus 

and search for abnormalities. If you 

have had moderate to severe symptoms 

and this procedure reveals injury 

to the esophagus, usually no other 

tests are needed to confirm GERD. 

The doctor also may perform a biopsy. 

Tiny tweezers, called forceps, are 

passed through the endoscope and 

allow the doctor to remove small 

pieces of tissue from your esophagus. 

The tissue is then viewed with a microscope 

to look for damage caused by 

acid reflux and to rule out other problems 

if infection or abnormal growths 

are not found. 

• pH monitoring examination involves 

the doctor either inserting a small tube 

into the esophagus or clipping a tiny 

device to the esophagus that will stay 

there for 24 to 48 hours. While you 

go about your normal activities, the 

device measures when and how much 

acid comes up into your esophagus. 

This test can be useful if combined 

with a carefully completed diary— 

recording when, what, and amounts 

the person eats—which allows the 

doctor to see correlations between 

symptoms and reflux episodes. The 

procedure is sometimes helpful in 

detecting whether respiratory symptoms, 

including wheezing and coughing, 

are triggered by reflux. 

A completely accurate diagnostic test for 

GERD does not exist, and tests have not 

consistently shown that acid exposure to 

the lower esophagus directly correlates 

with damage to the lining. 

Surgery 

Surgery is an option when medicine and 

lifestyle changes do not help to manage 

GERD symptoms. Surgery may also be 

a reasonable alternative to a lifetime of 

drugs and discomfort. 


Fundoplication is the standard surgical 

treatment for GERD. Usually a specific 

type of this procedure, called Nissen fundoplication, 

is performed. During the Nissen 

fundoplication, the upper part of the 

stomach is wrapped around the LES to 

strengthen the sphincter, prevent acid 

reflux, and repair a hiatal hernia. 

The Nissen fundoplication may be performed 

using a laparoscope, an instrument 

that is inserted through tiny incisions in 

the abdomen. The doctor then uses small 

instruments that hold a camera to look at 

the abdomen and pelvis. When performed 

by experienced surgeons, laparoscopic fundoplication 

is safe and effective in people 

of all ages, including infants. The procedure 

is reported to have the same results 

as the standard fundoplication, and people 

can leave the hospital in 1 to 3 days and 

return to work in 2 to 3 weeks. 

Endoscopic techniques used to treat 

chronic heartburn include the Bard 

EndoCinch system, NDO Plicator, and the 

Stretta system. These techniques require 

the use of an endoscope to perform the 

anti-reflux operation. The EndoCinch 

and NDO Plicator systems involve putting 

stitches in the LES to create pleats that 

help strengthen the muscle. The Stretta 

system uses electrodes to create tiny burns 

on the LES. When the burns heal, the scar 

tissue helps toughen the muscle. The longterm 

effects of these three procedures are 

unknown. 

What are the long-term 

complications of GERD? 

Chronic GERD that is untreated can cause 

serious complications. Inflammation of the 

esophagus from refluxed stomach acid can 

damage the lining and cause bleeding or 

ulcers—also called esophagitis. Scars 

from tissue damage can lead to strictures— 

narrowing of the esophagus—that make 

swallowing difficult. Some people develop 

Barrett’s esophagus, in which cells in the 

esophageal lining take on an abnormal 

shape and color. Over time, the cells can 

lead to esophageal cancer, which is often 

fatal. Persons with GERD and its complications 

should be monitored closely by a 

physician. 

Studies have shown that GERD may 

worsen or contribute to asthma, chronic 

cough, and pulmonary fibrosis. 

For information about Barrett’s esophagus, 

see the Barrett’s Esophagus fact sheet from 

the NIDDK. 


Points to Remember 

• Frequent heartburn, also called acid 

indigestion, is the most common 

symptom of GERD in adults. Anyone 

experiencing heartburn twice a week 

or more may have GERD. 

• You can have GERD without having 

heartburn. Your symptoms could 

include a dry cough, asthma symptoms, 

or trouble swallowing. 

• If you have been using antacids for 

more than 2 weeks, it is time to see 

your health care provider. Most doctors 

can treat GERD. Your health 

care provider may refer you to a gastroenterologist, 

a doctor who treats 

diseases of the stomach and intestines. 

• Health care providers usually recommend 

lifestyle and dietary changes to 

relieve symptoms of GERD. Many 

people with GERD also need medication. 

Surgery may be considered as a 

treatment option. 

• Most infants with GER are healthy 

even though they may frequently spit 

up or vomit. Most infants outgrow 

GER by their first birthday. Reflux 

that continues past 1 year of age may 

be GERD. 

• The persistence of GER along with 

other symptoms—arching and irritability 

in infants, or abdominal and chest 

pain in older children—is GERD. 

GERD is the outcome of frequent and 

persistent GER in infants and children 

and may cause repeated vomiting, 

coughing, and respiratory problems. 

Hope Through Research 

The reasons certain people develop 

GERD and others do not remain 

unknown. Several factors may be 

involved, and research is under way to 

explore risk factors for developing 

GERD and the role of GERD in other 

conditions such as asthma and 

laryngitis. 


For More Information 

American College of Gastroenterology 

P.O. Box 342260 

Bethesda, MD 20827–2260 

Phone: 301–263–9000 

Internet: www.acg.gi.org 

American Gastroenterological Association 

National Office 

4930 Del Ray Avenue 

Bethesda, MD 20814 

Phone: 301–654–2055 

Fax: 301–654–5920 

Email: member@gastro.org 

Internet: www.gastro.org 

International Foundation for Functional 

Gastrointestinal Disorders 

P.O. Box 170864 

Milwaukee, WI 53217–8076 

Phone: 1–888–964–2001 or 414–964–1799 

Fax: 414–964–7176 

Email: iffgd@iffgd.org 

Internet: www.aboutgerd.org 

You may also find additional information on this topic 

using the following databases: 

The NIDDK Reference Collection is a collection 

of thousands of materials produced for patients and 

health care professionals, including fact sheets, 

brochures, and audiovisual materials. Visit 

www.catalog.niddk.nih.gov/resources. 

MedlinePlus brings together a wealth of information 

from the National Library of Medicine, the National 

Institutes of Health, and other government agencies 

and health-related organizations. MedlinePlus offers 

easy access to medical journal articles, a medical dictionary 

and medical encyclopedia, health information 

in Spanish, hospital and physician directories, drug 

and supplement lists, interactive patient tutorials, 

links to hundreds of clinical trials, and the latest 

health news. Visit www.medlineplus.gov. 

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

North American Society for Pediatric 

Gastroenterology, Hepatology, and 

Nutrition 

P.O. Box 6 

Flourtown, PA 19031 

Phone: 215–233–0808 

Fax: 215–233–3918 

Email: naspghan@naspghan.org 

Internet: www.naspghan.org 

Pediatric/Adolescent Gastroesophageal 

Reflux Association, Inc. 

P.O. Box 486 

Buckeystown, MD 21717–0486 

Phone: 301–601–9541 

Email: gergroup@aol.com 

Internet: www.reflux.org 


National Digestive Diseases 

Information Clearinghouse 

2 Information Way 


Phone: 1–800–891–5389 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). The NIDDK is 

part of the National Institutes of Health of 

the U.S. Department of Health and Human 

Services. Established in 1980, the Clearinghouse 

provides information about digestive 

diseases to people with digestive disorders and 

to their families, health care professionals, and 

the public. The NDDIC answers inquiries, 

develops and distributes publications, and 

works closely with professional and patient 

organizations and Government agencies to 

coordinate resources about digestive diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. This fact sheet was 

reviewed by M. Brian Fennerty, M.D., Oregon 

Health and Science University, and Benjamin 

D. Gold, M.D., Emory University School of 

Medicine. 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 07–0882 

May 2007

NatioNal Digestive Diseases iNformatioN CleariNghouse (NDDiC) 

Irritable Bowel Syndrome 

What You Need to Know 

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Did you know that if you often 

have stomach cramps, bloating, 

gas, diarrhea, or constipation, 

you could have irritable bowel 

syndrome? 

What is irritable bowel syndrome? 

Irritable bowel syndrome (IBS) is a 

functional disorder of the large bowel, 

meaning the bowel doesn’t work, or function, 

correctly. IBS is not a disease, but a group 

of symptoms. 

What are the symptoms of IBS? 

The main symptoms of IBS are 

• pain or discomfort in the abdomen, often 

relieved by a bowel movement 

• chronic diarrhea, constipation, or both 

Other symptoms include 

• whitish mucus in the stool 

• a swollen or bloated abdomen 

• the feeling that you have not finished a 

bowel movement 

Women with IBS often have more symptoms 

during their menstrual periods. 

How will I know if I have IBS? 

Your doctor may diagnose IBS based on 

your symptoms. No specific test for IBS 

exists, but your doctor may do some tests 

to rule out other health problems that can 

cause the same symptoms. 

What can I do about IBS? 

IBS has no cure but you can take some steps 

to relieve symptoms. You might have to try 

a few different things to see what works best 

for you. Your doctor can help you find the 

right treatment plan, which may include 

• avoiding foods that can trigger symptoms, 

such as fatty foods, milk products, and 

carbonated drinks 

• eating foods with fiber 

• eating four or five small meals instead of 

three big meals 

• taking medicines that help relieve 

symptoms 

• reducing emotional stress


Where can I get more information 

about IBS? 





Phone: 1–800–891–5389 

Fax: 703–738–4929 




Clearinghouse is a service of the National 





Services. 


Clearinghouse encourages people to duplicate 

and distribute as many copies as desired. 

The NIDDK Awareness and Prevention Series is 

designed to make you ask yourself, “Could this be 

me or someone I care for?” So take a closer look. 

Additional information on this topic and other 

titles in the series is available through the National 

Digestive Diseases Information Clearinghouse or 

on the Internet at www.digestive.niddk.nih.gov. 





August 2007


Lactose Intolerance 

What You Need to Know 

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Did you know that if you feel 

sick after drinking milk or eating 

foods made with milk, you may 

have lactose intolerance? 

What is lactose intolerance? 

Lactose intolerance means you cannot digest 

foods with lactose in them. Lactose is the 

sugar found in milk and foods made with 

milk. Lactose intolerance is not serious, but 

it can make you very uncomfortable after 

you eat foods with lactose. 

How will I feel if I have lactose 

intolerance? 

After eating foods with lactose in them, you 

may feel sick to your stomach. You may also 

have cramps, bloating, gas, or diarrhea. 

Some illnesses can cause these same 

problems. Your doctor can do tests to 

see if your problems are caused by lactose 

intolerance or by something else. 

What can I do about lactose 

intolerance? 

You will need to avoid or eat less of foods 

that have lactose in them. 

Lactose is in milk and all foods made 

with milk. It is also added to some boxed, 

canned, frozen, and other prepared foods, 

such as 

• breads 

• cereals 

• lunch meats 

• salad dressings 

• mixes for cakes, cookies, pancakes, and 

biscuits 

• frozen dinners 

Learn to read food labels carefully. 

Look for milk and lactose in the list of 

ingredients. Also look for words like whey, 

curds, milk by-products, dried milk, milk 

solids, and powdered milk. If any of these 

words are listed on a label, the product 

contains lactose. 

Do I have to avoid all foods with 

lactose? 

Not necessarily. You may be able to eat a 

small amount of some foods with lactose. 

For example, you may be able to eat cheese 

or yogurt but not drink milk. Try a small 

amount of the food and then see how you 

feel. You can also drink lactose-reduced 

milk. And you can buy lactase enzyme 

caplets or drops that help you digest lactose.


Where can I get more information 

about lactose intolerance? 





Phone: 1–800–891–5389 

Fax: 703–738–4929 




Clearinghouse is a service of the National 





Services. 


Clearinghouse encourages people to duplicate 

and distribute as many copies as desired. 

The NIDDK Awareness and Prevention Series is 

designed to make you ask yourself, “Could this be 

me or someone I care for?” So take a closer look. 

Additional information on this topic and other 

titles in the series is available through the National 

Digestive Diseases Information Clearinghouse or 

on the Internet at www.digestive.niddk.nih.gov. 





June 2007

TIPS FOR ADULTS 

Healthy Eating & Physical 

Activity Across Your Lifespan 

Better Health and You 

WIN 

Weight-control 

Information Network

To request additional brochures, contact the 

Weight-control Information Network at: 

1 WIN Way 


Phone: (202) 828–1025 

FAX: (202) 828–1028 

Toll-free number: 1–877–946–4627 

Email: WIN@info.niddk.nih.gov 

Internet: http://www.win.niddk.nih.gov 

Internet: http://www.win.niddk.nih.gov

Healthy Eating & 

Physical Activity 

Across Your Lifespan 


❑ Eat breakfast every day. People who eat 

breakfast are less likely to overeat later 

in the day. 

❑ Choose whole grains more often. Try whole-wheat 

breads and pastas, oatmeal, brown rice, or bulgur. 

❑ Select a mix of colorful vegetables each day. Vegetables of 

different colors provide different nutrients. 

❑ Eat three meals every day instead of skipping meals 

or eating a snack instead of a meal. 

❑ Have low-fat, low-sugar snacks on hand at home, at work, 

or on the go to combat hunger and prevent overeating. 

❑ At restaurants, eat only half your meal and take the 

rest home. 

❑ Visit museums, the zoo, or an aquarium. You and your 

family can walk for hours and not realize it. 

❑ Take a walk after dinner instead of watching TV. 

❑ Get plenty of sleep. 

WIN 

Weight-control Information Network

Index 

Introduction......................................... 1 

Healthy Eating 

What is a healthy eating plan? .......................... 2 

Tips for Healthy Eating ................................ 2 

Quick Breakfast Ideas................................. 4 

Easy Snack Ideas .................................... 5 

Healthy Weight 

What is a healthy weight?.............................. 6 

What are the health risks of being overweight? ............. 7 

Why do people become overweight?..................... 8 

If You Need to Lose Weight ........................... 10 


Getting Active...................................... 12 

Are you ready to be even more active?. ................. 13 

Be Good to Yourself ................................. 16 

Tips for Adults...................................... 17 

Additional Reading .................................. 18 

Additional Resources ................................ 19 

Better Health and You

Introduction 

A balanced eating plan and regular physical activity are 

the building blocks of good health. Poor eating habits 

and physical inactivity may lead to overweight and related 

health problems. By eating right and being active, you 

may reach or maintain a healthy weight. You may also 

improve your physical health, mental well-being, and set 

an example for others. 

Do it for yourself and your family! 


1


What is a healthy eating plan? 

A healthy eating plan: 

• Emphasizes fruits, vegetables, whole grains, 

and fat-free or low-fat milk and milk products. 

• Includes lean meats, poultry, fish, beans, 

eggs, and nuts. 

• Is low in saturated fats, trans fats, cholesterol, 

salt (sodium), and added sugars. 

For more specific information about food groups and 

nutrition values, visit http://www.healthierus.gov/dietaryguidelines. 

Tips for Healthy Eating 

• Eat breakfast every day. People who eat breakfast are less 

likely to overeat later in the day. Breakfast also gives you 

energy and helps you get your day off to a healthy start. 

• Choose whole grains more often. Try whole-wheat breads 

and pastas, oatmeal, brown rice, or bulgur. 

• Select a mix of colorful vegetables each day. Vegetables 

of different colors provide different nutrients. Choose dark 

leafy greens such as spinach, kale, collards, and mustard 

greens, and reds and oranges such as carrots, sweet 

potatoes, red peppers, and tomatoes. 

2 Better Health and You


• Choose fresh, canned, or frozen fruit more often than 

fruit juice. Fruit juice has little or no fiber, and the calories 

may be high. Fresh, canned, or frozen fruit is often better 

for you. If you eat canned fruit, opt for fruit packed in water 

rather than syrup. 

• Use fats and oils sparingly. Olive, canola, and peanut oils, 

avocados, nuts and nut butters, olives, and fish provide 

heart-healthy fat as well as vitamins and minerals. 

• Eat sweets sparingly. Limit foods and beverages that are 

high in added sugars. 

• Eat three meals every day. If you skip meals or replace 

a meal with a snack, you might overeat later on. 

• Have low-fat, low-sugar snacks on hand. 

Whether you are at home, at work, or 

on the go, healthy snacks may help to 

combat hunger and prevent overeating. 


3


Quick Breakfast Ideas 

• low-fat yogurt sprinkled with 

low-fat granola 

• oatmeal with low-fat or fat-free 

milk, or soy-based beverage 

• a slice of whole-wheat toast with 

a thin spread of peanut butter 

• fruit smoothie made with frozen 

fruit, low-fat yogurt, and juice 

• high-fiber, low-sugar cereal with 

soy-based beverage or low-fat 

milk 



Easy Snack Ideas 

• low-fat or fat-free yogurt 

• rice cakes 

• fresh or canned fruits 

• sliced vegetables or baby carrots 

• dried fruit and nut mix (no more 

than a small handful) 

• air-popped popcorn sprinkled with 

garlic powder or other spices 

• high-fiber, low-sugar cereal 


5


What is a healthy weight? 

Body mass index (BMI) is one way to tell whether you are at a 

healthy weight, overweight, or obese. It measures your weight in 

relation to your height. 

A BMI of 18.5 to 24.9 is in the healthy range. A BMI of 25 to 29.9 is 

overweight, and a BMI of 30 or greater is considered obese. 

In the chart below, find your height in the left-hand column and move 

across the row to find your weight. If you are in the overweight or obese 

range on the chart, you may be at risk for certain health problems. 

BMI (Body Mass Index) 

Sources 

■ George Bray, M.D., 

Pennington Biomedical 

Research Center. 

■ National Heart, Lung, 

and Blood Institute’s 

Clinical Guidelines 

on the Identification, 

Evaluation, and 

Treatment of 

Overweight and 

Obesity in Adults: 

The Evidence Report. 

Weight in Pounds ** 

* Without Shoes **Without Clothes 



Another way to find out if you are at risk for health problems caused 

by overweight and obesity is to measure your waist. If you are a 

woman and your waist is more than 35 inches, or if you are a man 

and your waist is more than 40 inches, your risk of disease is higher. 

What are the health risks 

of being overweight? 

Extra weight may put you at higher risk for: 

• type 2 diabetes (high blood sugar) 

• high blood pressure 

• coronary heart disease and stroke 

• some types of cancer 

• sleep apnea (when breathing stops for 

short periods during sleep) 

• osteoarthritis (wearing away of the joints) 

• gallbladder disease 

• irregular periods 

• problems with pregnancy, such as 

gestational diabetes (high blood sugar 

during pregnancy), high blood pressure, 

or increased risk for cesarean section 

(c-section) 


7


Why do people become overweight? 

Many factors may play a part in why people gain weight. 

• Habits. Eating too many calories may become a habit. You may 

also develop a habit of doing sedentary activities like watching 

TV instead of being physically active. Over time, these habits can 

lead to weight gain. 

• Genes. Overweight and obesity tend to run in families. Although 

families often share diet and physical activity habits that can play 

a role in obesity, their shared genes increase the chance that family 

members will be overweight. 

• Illness. Some diseases may lead to weight gain or 

obesity. These include hypothyroidism, Cushing’s 

syndrome, and depression. Talk to your health 

care provider if you think you have a health problem 

that could be causing you to gain weight. 

• Medicine. Some medicines may lead to weight 

gain. Ask your health care provider or pharmacist 

about the side effects of any medication you are 

taking. 



• The world around you. You can find food and messages about 

food at home, at work, at shopping centers, on TV, and at 

family and social events. People may eat too many foods high 

in fat, sugar, and salt just because they are always there. On top 

of that, our modern world — with its remote controls, drive-in 

banks, and escalators — makes it easy to be physically inactive. 

• Emotions. Many people eat when they are bored, sad, angry, 

or stressed, even when they are not hungry. 

Although you may not be able to control all the factors that lead 

to overweight, you can change your eating and physical activity 

habits. And by changing those habits, you may be able to improve 

your weight and your health. 


9


If You Need to Lose Weight 

A weight loss of as little as 5 to 15 percent of your body weight over 

6 months or longer has been shown to improve health. For example, 

if you weigh 200 pounds, losing 5 percent of your body weight means 

losing 10 pounds. Losing 15 percent of your body weight means losing 

30 pounds. A safe rate of weight loss is 1/2 to 2 pounds per week. 

Try some of these ideas to support your weight-loss efforts: 

• Keep a food diary. To get started, see the sample food diary on 

page 11. 

• Shop from a list and shop when you are not hungry. 

• Store foods out of sight, or do not keep many high-fat, high-sugar 

foods in your home. 

• Dish up smaller servings. At restaurants, eat only half your meal 

and take the rest home. See the Weight-control Information 

Network (WIN) brochure Just Enough for You: About Food 

Portions for more tips on controlling portion size. 

• Eat at the table and turn off the TV. 

• Be realistic about weight-loss goals. Aim for a slow, modest 

weight loss. 

• Seek support from family and friends. 

• Expect setbacks and forgive yourself if you regain a few pounds. 

• Add moderate-to-vigorous intensity physical activity to your 

weight-loss plan. Doing regular physical activity may help you 

control your weight. 



Sample Food Diary 

Time Food Feelings How I Can Improve 

8:00 a.m. Coffee with sugar 

and cream, oatmeal 

with low-fat milk and 

banana 

Hungry. Ate my usual 

breakfast. 

11:00 a.m. Low-fat yogurt Stomach starting to 

rumble. 

12:30 p.m. Roast beef and cheese 

sandwich on wholewheat 

bread, potato 

chips, can of soda 

2:30 p.m. 1/2 chocolate bar from 

coworker, large coffee 

with sugar and cream 

7:30 p.m. Caesar salad, dinner 

roll, ravioli (didn’t finish 

the whole serving), 

1/2 slice of chocolate 

cake 

Probably ate more 

than I was hungry for 

because of the “lunch 

deal” the deli offered 

me. 

Feeling bored, not truly 

hungry. 

Out to dinner with 

friends, so we all ate 

big portions! We split 

dessert, which made 

me feel healthy. 

10:30 p.m. Decaf herbal tea Had trouble falling 

asleep. 

Adding fresh fruit or whole 

grains will help keep me 

from overeating later. 

If I pack my lunch, I won’t 

be tempted in the lunch line. 

A snack like veggie slices 

with salsa is more nutritious. 

Next time, I’ll have a 

salad with low-fat dressing. 

Sweet, fresh fruit is good as 

a refreshing dessert. 

To keep a food diary, write down all the food you eat in a day. Also 

write down the time you eat and your feelings at the time. Writing 

down your feelings may help you identify your eating triggers. For 

example, you may notice that you sometimes overeat when you 

are in a big group, simply because everyone around you is eating. 

The next time you find yourself in this situation, be mindful of that 

eating trigger and try to limit your portion sizes. 


11


Getting Active 

You do not have to be an athlete to benefit from regular physical 

activity. Even modest amounts of physical activity can improve 

your health. Start with small, specific goals, such as walking 

10 minutes a day, 3 days a week, and build up slowly from there. 

Keep an activity log to track your progress. You can refer to the 

sample activity log on page 13. 

Try these activities to add more movement to your daily life: 

• Take the stairs instead of the elevator. Make sure the stairs 

are well lit. 

• Get off the bus one stop early if you are in an area safe 

for walking. 

• Park the car farther away from entrances to stores, movie 

theaters, or your home. 

• Take a short walk around the block with family, friends, 

or coworkers. 

• In bad weather, walk around a mall. 

• Rake the leaves or wash the car. 

• Visit museums, the zoo, or an aquarium. 

You and your family can walk for hours 

and not realize it. 

• Take a walk after dinner instead of 

watching TV. 

12 



Sample Activity Log 

Date Activity Total Time How I Felt 

Mon, 

Mar 1 

Walking 

Free weights at home 

2 x 15 minutes 

20 minutes 

I had more energy after I 

walked than I did before! 

Tues, 

Mar 2 

Walking 

Stretching 

30 minutes 

15 minutes 

Stretching felt great. 

Wed, 

Mar 3 

Extra walking at 

work—used the 

stairs 3 times 

Yoga video at home 

About 20 minutes total 

20-minute video 

I was busy, so I just tried to 

move more all day. 

Yoga helped me relax. 

Thurs, 

Mar 4 

Walking 

15 minutes at lunch and 

15 minutes after work 

Walking with my coworker 

was fun and relaxing. 

Fri, Mar 5 

Walking 

Free weights at home 

30 minutes at lunch 

20 minutes 

My coworker and I picked 

up the pace today! 

Sat, Mar 6 

Water Aerobics Class 

Stretching 

45-minute class 

15 minutes 

This class is fun but 

exhausting. 

Sun, Mar 7 Gardening 60 minutes A surprisingly good workout. 

Are you ready to be even more active? 

As you become more fit, slowly increase your pace, the length of 

time you are active, and how often you are active. Before starting 

a vigorous physical activity program, check with your health care 

provider if you are a man over age 40 or a woman over age 50, 

or if you have chronic health problems. 


13


For a well-rounded workout plan, combine aerobic 

activity, muscle-strengthening exercises, and 

stretching. Do at least 30 minutes a day of moderateintensity 

physical activity on most or all days 

of the week. Add muscle-strengthening activities 

to your aerobic workout two to three times a week. 

If you are trying to lose weight or maintain your 

weight loss, you may need to do more activity. 

Aim for 60 to 90 minutes on most days. 

To reduce the risk of injury, do a slow aerobic 

warm-up, then stretch before aerobic or strengthening 

activities. Follow your workout with a few more 

minutes of stretching. See WIN’s brochure Walking ... 

A Step in the Right Direction for stretching exercises. 

Aerobic activity is any activity that speeds up your heart and breathing 

while moving your body at a moderate or vigorous pace. (See below for 

examples.) If you have been inactive for a while, you may want to start 

with easier activities, such as walking at a gentle pace. This lets you 

build up to more intense activity without hurting your body. 

Regular aerobic activity may help: 

• Control weight. Aerobic activity burns calories, which may help 

you manage your weight. 

• Prevent coronary heart disease and stroke. Regular aerobic 

activity can strengthen your heart muscle and lower your blood 

pressure. It may also help lower “bad” cholesterol and raise 

“good” cholesterol. 

• Maintain strong bones. Weight-bearing aerobic activities that 

involve lifting or pushing your own body weight, such as walking, 

jogging, or dancing, help to maintain strong bones. 

14 



• Improve your outlook. Aerobic exercise relieves tension and 

decreases stress. It may also help build your confidence and 

improve your self-image. 

Choose aerobic activities that are fun. 

People are more likely to be active if they 

like what they are doing. It also helps to get 

support from a friend or a family member. Try 

one of these activities or others you enjoy: 

• brisk walking or jogging 

• bicycling 

• swimming 

• aerobic exercise classes 

• dancing (square dancing, salsa, 

African dance, swing) 

• playing basketball or soccer 

Strengthening activities include lifting weights, using resistance 

bands, and doing push-ups or sit-ups. Besides building stronger 

muscles, strengthening activities may help you: 

• Use more calories. Not only do strengthening exercises burn 

calories, but having more muscle means you will burn 

slightly more calories throughout the day — even when you 

are sitting still. 

• Reduce injury. Stronger muscles improve balance and support 

your joints, lowering the risk of injury. 

• Maintain strong bones. Doing strengthening exercises regularly 

helps build bone and may prevent bone loss as you age. 


15


Strengthening exercises should focus on working the major muscle 

groups of the body, such as the chest, back, abdominals, legs, and 

arms. Do exercises for each muscle group two or three times a 

week. Allow at least 1 day of rest for your muscles to recover and 

rebuild before another strengthening workout. (It is safe to do aerobic 

activity every day.) 

Lifestyle activities are the day-to-day activities that you do. 

These activities can really add up and increase the number of 

calories you burn each day. They may also boost your energy and 

mood by getting your blood and muscles moving. Examples of 

lifestyle activities include: 

• Taking the stairs instead of the elevator. 

• Walking to your coworker’s office instead of using the phone 

or email. 

• Gardening and doing household chores. 

• Walking inside the bank rather than using the drive-through window. 

• Parking farther from store entrances and walking the extra distance. 

• Taking short breaks at work to get up, stretch, and walk. 

• Playing with your children, nieces and nephews, and pets. 

Be Good to Yourself 

Many people feel stress in their daily lives. Stress can cause you 

to overeat, feel tired, and not want to do anything. Regular physical 

activity can give you more energy. Try some of these other ideas 

to help relieve stress and stay on track with your fitness and 

nutrition goals: 

• Get plenty of sleep. 

• Practice deep breathing while relaxing your muscles one at a time. 



• Take a break and go for a walk. 

• Take short stretch breaks throughout the day. 

• Try taking a yoga or tai chi class to energize 

yourself and reduce stress. 

• Try a new hobby, like a pottery class or any 

activity that sparks your interest. 

• Surround yourself with people whose company 

you enjoy. 

A balanced eating plan, regular physical activity, and 

stress relief can help you stay healthy for life. 

Tips for Adults 

• Eat breakfast every day. People who eat breakfast are 

less likely to overeat later in the day. 

• Choose whole grains more often. Try whole-wheat breads 

and pastas, oatmeal, brown rice, or bulgur. 

• Select a mix of colorful vegetables each day. Vegetables of 

different colors provide different nutrients. 

• Have low-fat, low-sugar snacks on hand at home, at work, 

or on the go to combat hunger and prevent overeating. 

• At restaurants, eat only half your meal and take the rest home. 

• Visit museums, the zoo, or an aquarium. You and your family 

can walk for hours and not realize it. 

• Take a walk after dinner instead of watching TV. 

• Get plenty of sleep. 


17

Additional Reading From the National Institutes of 

Health and the Weight-control Information Network 

Aim for a Healthy Weight 

National Heart, Lung, and Blood Institute 

Internet: http://www.nhlbi.nih.gov/health/public/heart/obesity/ 

lose_wt/ 

Diabetes Prevention and Control Publications 

National Diabetes Education Program 

Internet: http://www.ndep.nih.gov/diabetes/pubs/catalog.htm 

Just Enough for You: About Food Portions 

Phone: 1–877–946–4627 

Internet: http://www.win.niddk.nih.gov/publications/just_enough. 

htm 

Tips to Help You Get Active 

Phone: 1–877–946–4627 

Internet: http://www.win.niddk.nih.gov/publications/tips.htm 

Walking … A Step in the Right Direction 

Phone: 1–877–946–4627 

Internet: http://www.win.niddk.nih.gov/publications/walking.htm 

Internet: http://www.win.niddk.nih.gov/publications/caminar.htm 

Additional Reading From Other Organizations 

2005 Dietary Guidelines for Americans 

U.S. Department of Agriculture and U.S. Department 

of Health and Human Services 

Phone: 1–888–878–3256 

Internet: http://www.healthierus.gov/dietaryguidelines 

Exercise and Weight Control 

The President’s Council on Physical Fitness and Sports 

Internet: http://www.fitness.gov 


Additional Resources 

American Dietetic Association 

120 South Riverside Plaza, Suite 2000 

Chicago, IL 60606–6995 

Phone: 1–800–877–1600 

Internet: http://www.eatright.org 

National Heart, Lung, and Blood Institute 

P.O. Box 30105 


Phone: 1–800–575–9355 

Internet: http://www.nhlbi.nih.gov 

National Diabetes Education Program 

1 Diabetes Way 


Phone: 1–800–438–5383 

Internet: http://www.ndep.nih.gov 

The President’s Council on Physical Fitness and Sports 

Department W 

200 Independence Avenue, SW, Room 738–H 

Washington, DC 20201–0004 

Phone: (202) 690–9000 

Internet: http://www.fitness.gov 

Food and Nutrition Information Center 

U.S. Department of Agriculture 

Agricultural Research Service, National Agricultural Library 

10301 Baltimore Avenue, Room 105 

Beltsville, MD 20705–2351 

Phone: (301) 504–5719 

Internet: http://www.nal.usda.gov/fnic 


19

20 Better Health and You 

Weight-control 

Information Network 

1 WIN Way 


Phone: (202) 828–1025 

FAX: (202) 828–1028 

Toll-free number: 1–877–946–4627 

Email: WIN@info.niddk.nih.gov 

Internet: http://www.win.niddk.nih.gov

The Weight-control Information Network (WIN) is a service of the 

National Institute of Diabetes and Digestive and Kidney Diseases 

(NIDDK) of the National Institutes of Health, which is the Federal 

Governement’s lead agency responsible for biomedical research 

on nutrition and obesity. Authorized by Congress (Public Law 

103–43), WIN provides the general public, health professionals, 

the media, and Congress with up-to-date, science-based health 

information on weight control, obesity, physical activity, and 

related nutritional issues. 

Publications produced by WIN are reviewed by both NIDDK scientists 

and outside experts. This publication was also reviewed 

by Rena Wing, Ph.D., Professor of Psychiatry and Human Behavior, 

Brown University, and F. Xavier Pi-Sunyer, M.D., M.P.H., 

Director, Obesity Research Center, St. Luke’s Roosevelt Hospital 

Center. 

This publication is not copyrighted. WIN encourages users of this 

brochure to duplicate and distribute as many copies as desired. 

This publication is also available at http://www.win.niddk.nih.gov. 

http://www.win.niddk.nih.gov. 


21

U.S. Department of 

Health and Human Services 


NIH Publication No. 08-4992 

June 2004 

Updated January 2008

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