This past week I met many patients looking to make a change. They had gained 30 or so pounds over a year and weren't happy about it. Few could identify what changes they had made that lead to the added pounds.

So I heard myself repeating my philosophy about starting a weight-loss plan and thought I should write it down.

The primary principle of losing weight: Calories burned need to exceed calories consumed. These 2 sides of the weight loss/gain equation mean that you have 2 ways to slow and reverse the upward trend toward overweight and obesity: Eat less and exercise more. Here are the steps I advise taking.

Step 1: Journal. Write down as you go along all the foods and liquids you consume — along with how much — for an entire week. Journaling is a nuisance, but it's still the best way to identify how all those calories are mysteriously ending up inside you. Also, once you start writing things down, you'll think twice before you eat something regrettable.

At the end of the week, identify any choices you made that could have been smarter and try not to repeat them. For example, skim milk could be swapped for 2-percent milk. Instead of a bagel and cream cheese, try a scrambled or poached egg over half an English muffin, with a fruit salad.

Step 2: Adjust your consumption. Reduce portions, while always making sure you're eating foods that will sustain you — which means having some protein or fat at every meal. Between meals, eat healthy snacks — never let yourself get too hungry or too tired. Eat slowly, chew your meals thoroughly, and stop when you are satisfied, not stuffed. Leftovers make great meals later!

Step 3: Start moving. Avoid escalators and elevators. Add more stairs and steps whenever and wherever you can. If you head to the mall, walk or jog around for a couple of laps before you start shopping. For those who already have an exercise routine, add another 5 minutes per session or an additional session per week.

Make sure you're getting sweaty or feeling the burn: Leisurely walks do not burn calories — normal walking is actually energy-conserving for human beings, meaning that you burn very few calories when walking long distances at a comfortable speed. 

Step 4: Assess your weight-loss goals. First, make sure they are realistic. Don't immediately aim to lose 30+ pounds and don't expect the weight to drop off in the first weeks to months of trying. First, aim to stabilize your weight; stopping the gain is a great achievement in its own right. Losing small amounts of weight is the most achievable and sustainable plan, so start slow. For just about anyone, I suggest aiming to lose 5 pounds in 6 months. (That's right; you heard me. Six months.)

Step 5: Don't weigh yourself more than once a month. Those scales will make you crazy! Besides, scales are pretty useless if you're climbing on and off of them every day. Your weight naturally fluctuates through the course of a single day — never mind the day-to-day swings — so that those changes often merely reflect the ebb and flow of hormones and body fluids, not genuine weight loss or gain.

Instead of trying to assess your goals and progress by using a scale, base your assessment on how you are feeling. More energized? Sleeping better? Better mood? Greater endurance? Gains such as these far exceed the number of pounds lost.

Last, I am often asked by patients for prescription diet aids. If you're hoping to include these pills in your weight-loss plan, I have bad news for you. First, the weight you lose by this method is rarely sustainable. Second, these medications are risky — they can even damage your heart — and are often accompanied by miserable side effects.

Why suffer in this way and risk harming your health when your original purpose for losing weight was to get yourself healthy? Avoid the pills and save yourself some money. You have all the tools you'll need inside.