I am a 39-year-old female and I weigh 245 pounds. I have arthritis in both ankles, and osteoarthritis in the lower back. I need a workout program and a diet program to help me lose weight. Thank you very much for your help.

--dorsey

Well, it sounds like you're ready to go for it, dorsey. That's good because I've got plans for you. Too much weight can exacerbate the pain you experience from arthritis, and speed the development of osteoarthritis in other joints. We'll focus on losing as much as is reasonably possible, because any extra weight -- even lean muscle mass -- places extra stress on your joints; it might be better for you to weigh 200 or 190 with 18% body fat, rather than be a solid 220 with 10% body fat.

Start counting your calories. Right now, you need almost 3,000 calories per day to maintain a weight of 245 lbs. Cut 500 calories a day from your total intake; 2,400-2,500 calories will give you plenty of nourishment as you begin exercising, and you can start to lose some weight. Try to cut most of the calories from excess fat, since a gram of fat has nine calories while a gram of protein or carbs only has four calories. Hold your daily fat intake to no more than 20 percent of your daily calories. Get the rest from carbohydrates and protein (about 60 percent carbs and 20 percent protein).

Get started exercising with non-impact activities that give you a cardiovascular workout and keep your joints moving through their normal range of motion. This will deliver the fluid that lubricates the cartilage in your joints.

Start with cycling and swimming. Both employ big muscle groups for an aerobic workout with little or no stress on your joints. You should have an initial goal of 30 minutes of cardio 3-5 times per week. If you're out of shape, even 10 or 15 minutes is fine until you build your endurance. You can even do a couple of 10-minute sessions a day and begin to get the benefits, if you can't do 15-20 minutes non-stop.

At a maximum weight loss of two pounds per week (anything more is unrealistic and won't be permanent), you can lose about 20 pounds in three months. Then add some weight training. You don't want to carry too much muscle on your frame, but you do want to be as lean as possible. Increasing lean body mass will help keep weight off by raising your resting metabolism. A full body resistance program will also help maintain joint lubrication and help keep your bones strong. Strengthening your muscles will also give your joints more support as well. Ask your doctor or physical therapist which strengthening exercises are recommended for your problem joints.

In four months, you should be lighter and leaner. Re-calculate your calorie requirement. (Basically the formula is 11 times your body weight plus 10 percent.)

If you can, add low impact exercises like walking (if it's OK for your ankles and back), using a stepper, or cross-country ski machine for variety. Your ultimate goal is to be as light as possible while maintaining a healthy diet that can sustain 5-6 days of cardiovascular exercise and 2-3 weight workouts per week. Daily stretching will alleviate the tightness in your muscles and help relieve stiffness in your joints, as well as helping you maintain the greatest range of motion possible in all of your limbs.

Good luck, I know you can do it!

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