26: Watch How I Create a Weight Loss Plan for My Patients (Real Example) [ASK DR. ANNA]

What does a real Mediterranean weight loss plan actually look like in practice? In this episode of ASK DR. ANNA, I walk through the exact steps used to build a personalized plan for a 58-year-old patient looking to lose fat while also addressing prediabetes risk and concern about fatty liver.

You'll get my real clinical thinking behind every decision — from setting calories based on actual activity level to building meals that protect muscle, control blood sugar, and prevent "healthy" foods like olive oil from stalling progress.

Listen in to learn:

• Why assessing the full health picture always comes before targeting fat loss
• How to calculate calorie needs based on age and real activity level — not a one-size-fits-all formula
• Why setting different calories for exercise days versus lighter days makes a meaningful difference
• How the 50-30-20 macro framework works in practice for adults over 50
• Why building every meal around protein first is essential for protecting muscle after 50
• The simple math for converting calories to grams so the numbers actually make sense
• Why fat needs to stay in check even on a Mediterranean plan — because olive oil is extremely calorie dense
• How to measure olive oil and spot hidden calories that are easy to overlook
• Which cooking method changes make the biggest difference in reducing added oil
• Why tracking — even short term — stops the guessing and helps troubleshoot stalls before they derail progress

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Transcript

Why Generic Plans Fail

SPEAKER_00 0:00

Ever wonder how a medical doctor makes a targeted weight loss plan for their patients? Well, today I'm going to walk you through a real example so you can see exactly how this works. If we haven't met yet, hey, I'm Dr. Anna. I'm a medical doctor, and I've helped thousands of adults over 50 lose weight, keep it off, and reverse chronic diseases using the fastest approach to permanent weight loss there is: simple Mediterranean strategies. So I'd like to tell you today about one of my patients. She was 58 years old when she came to me and she wanted to lose weight, but it wasn't just about the weight for her. She had prediabetes, which meant her blood sugar was starting to creep up and she was at risk of getting type 2 diabetes later. She also had high blood pressure, and she was really concerned about her liver numbers on her labs. Now, her husband had just been diagnosed with fatty liver himself, and she told me she really didn't want to go down that path. That was a condition that really scared her, and rightly so. So we needed to be extremely specific about making her diet really balanced and healthy to support her current health situation, on top of the fact that we were trying to target weight loss, which meant fat loss. Now, we obviously had to think about the total calories she was eating, because that is required for somebody to truly burn fat. But we also had to think about being smart with exercise so that when she was losing weight, she wasn't losing the important tissues of her body, like her muscle tissue, which tends to happen when people do a weight loss approach. When they do weight loss and they cut calories, if they're not clever with exercise, they risk losing muscle and lean tissue. So the overall approach had to be strategic. Today, what I'm gonna do now is walk us through exactly what I did with this patient of mine. Because this is really how I approach weight loss for my patients, and this is going to be a big showcase, kind of opening the kimono, and you're gonna see how I think about this. And you're probably going to realize that this is not how you've heard doctors typically think about stuff like this. And yes, that is because I teach and I practice medicine in a way that is very comprehensive and incorporates lifestyle approaches.

One Patient’s Health And Goals

SPEAKER_00 2:15

So by the end of this, you're gonna understand how you could think about this for your own path and maybe talk to your own doctor about adopting a strategy like this. Now, quick heads up before we dive in. I am not gonna hold anything back in this episode, but of course, since I'm gonna be talking technicalities, it might sound like it's medical speak and medical jargon. This video is not medical advice. You have your own situation, and what I talk about with this patient of mine does not guarantee your own results. So make sure you keep that in mind. This is just an example of what this could look like for somebody. Let's jump right in. So, step number one, when I'm approaching weight loss with somebody, and first I have to look at their whole health picture. We start with determining the total calories somebody needs. So, for this patient of mine, we calculated based off of her age and her activity level, how many calories her body really needed to function. So, this is where most people I think get it wrong. They start to just do weight loss with picking a random number of calories that maybe they think I can't I need to eat 1200 calories a day or 1500 calories a day, or they sign up for some random meal plan that's not personalized at all to them. And it says this is a weight loss meal plan. It's only 1500 calories a day, and they're frustrated why that's not working for them. But that plan wasn't designed for them specifically, it was just generic. So I work with patients by being specific for them. And the other thing that we need to keep in mind is that the body does not have identical needs every single day if every single day for you doesn't look the same. Now, if you're somebody who lifts weights, and for example, this patient of mine, she is somebody who is lifting weights, you're probably not gonna do that every single day. That's actually not a safe approach to weight lifting or weight training. So you have to think about which days are you doing lifting, which days are you taking rest days or taking a break. Some days you might just be sitting on the couch, like was true for my patient. And you have to understand that that's going to change your body's calorie needs on those different types of days. So here's what I did with this patient of mine. She was exercising three times a week with weight lifting with a gym trainer. We had gotten her to doing some of that activity. She had tried it before, but I got her in a regimen that was really working well for her. On her lift days, meaning the days she lifted weights, we determined that she needed about 1,800 calories or 1,800 calories. Now, on her lighter days, when she was not lifting weights, she was still getting in activity. She would walk. Sometimes she would walk at an incline

Step One Calculate Real Calories

SPEAKER_00 4:50

on a treadmill, sometimes she would walk outside, depending on the type of weather. And once a week she liked to do a water aerobics class. So she needed fewer calories on the days she didn't lift weights. For her, it was about 1,500 to 1,600 calories. Okay. Her calories, as you can see, adjusted based on her activity. It was not a random number that we picked. It wasn't based on what worked for someone else. It was what her body needed for her specific experience. So that was the step one. Now, step two, what did we do? Well, we used a very simple macronutrient framework to keep it sustainable. Now, a lot of you might hear that and off the bat just say, I hear this word macros all the time. I don't really understand what that means, Dr. Anna, and I feel like it's really complicated. Well, it's not complicated. I'm going to teach you right now. So macros is a short version of the word macronutrients. What is a macronutrient? Well, it's not the micronutrients that we typically hear about, which are vitamins and minerals. Instead, these are nutrients that provide us with calories. So the main categories of macronutrients are carbohydrates, fats, and proteins. Now, some people throw on their alcohol. It's kind of a misnomer because it's absolutely not nutritious for our body, but it does provide calories. So it's sort of the anti-nutrient macronutrient. And then some people put in there the concept of fiber. But again, fiber does not provide us calories, but it is nutritious. It's a little bit of an outlier on this topic. So the main three that you need to keep in mind are carbs, fats, and proteins, right? That's what usual macro approaches to dietary eating are going to include. With this patient of mine, I used a simple framework that I like to use a lot of the time when I'm first starting out designing a weight loss protocol for someone by the 50-30-20 protocol. What does this look like? 50% of her calories were going to come from carbohydrates, 30% were going to come from protein, and 20% were going to come from fat. This wasn't random. It fit her other health goals. She was concerned about fatty liver. She needed to target fat loss. She was already doing a good amount of weight lifting. This also supported her blood sugar goals because, again, she had pre-diabetes. This overall fit her lifestyle and the types of meals she enjoyed eating. So it really

Step Two The 50 30 20 Macros

SPEAKER_00 7:10

was a good approach for her. Now here's the key. The framework of 5030-20 is actually quite flexible. It sounds rigid, but it doesn't have to be. It's a generic guideline that will make meal planning really simple for you if you're just getting started. So for her, we went with 50-30-20. Now, step three of our strategy is we always designed her meals, and I had her selecting what she wanted to eat, starting from the protein. So protein first approach. Why? At age 58, our muscle mass will already naturally be declining. After the age of about 40s and 50s, we are losing muscle mass every single year. And that process can only get slowed down with a smart strategy, meaning weightlifting and eating enough protein. Now, as well, at her age, 58, she was in a situation where she already went through menopause, which meant her insulin sensitivity had worsened. A lot of her hormones shifted things in her body. And it just made it really important for us to get her enough protein because we know protein protects metabolism and it helps make people feel full and satisfied after their meal. So what we did was on her light days, again, she was eating about 1,500 calories on those days. We took 30% of her calories being from protein, again, from the 50, 30, 20 protocol, equaled about 450 calories from her whole day needing to come from protein. So we basically worked our way backwards. We thought, how much protein does she need? In order to answer that question, we need to start from how many calories she can have, what is the percentage of protein that's going to come from the total calories, and then how many calories of her diet were provided by protein. So here's where the math comes in. All you math wizards out there, people who like numbers, you're gonna enjoy this part. And for people who don't, I'm sorry, just bear with me. This is the math. You take 450, the calories that needed to come from protein, divided by four, because there are four calories per gram of protein. That gives you about 112 grams of protein per day that she needed to eat. Now, why am I dividing by four? Because protein has four calories per gram. The different macronutrients have different caloric densities. That is what this means. Protein and carbohydrates both provide four calories per gram, whereas fat or oil provides nine calories per gram. And small caveat, alcohol provides seven calories per gram. So yeah, alcohol as a molecule provides calories and is more calorie dense than carbs and protein. So again, if this patient of mine needed 450 calories from her protein, we again divided 450 by the number four, and that gave us 112 grams of protein she needed per day. That became the anchor of how we designed the rest of the meals. So we built the rest of her day and her meals around that number. So every meal, every snack, we made sure she was at least hitting her protein target. Now remember, this was

Step Three Protein First Planning

SPEAKER_00 10:15

for her non-lift days. So when she was lifting weights, the math changes just when you're using the number 1800 total calories instead of 1500. Okay. Now we're on step number four. And this is where we figure out how much fat to include. So on her light days, from 1500 calories on a light day, again, we were using the 50, 30, 20 principle. 20% of her calories were gonna come from fat. What is the math on that? Well, that's 300 calories in her day that come from fat. How did we get that number? Again, 1,500 times 20% is 300. Then we take 300 and now we have to divide that number by 9, not 4. 4 was the amount of calories per gram for protein. 9 is the amount of calories per gram for fats. So 300 divided by 9 is about 33 grams of fat per day. Now, this is where it gets interesting. And this is where I classically see people who are even doing healthy food choices and making sure their meals are balanced with nutrition, are not quite getting the calories correct. And usually it comes down to this fat is very calorie dense. We often are overdoing it in our diet. For example, olive oil, this can be about 15 to 20 grams of fat. How do we get that number? So one or one and a half tablespoons of olive oil, which is not a lot, is going to be already very calorie dense, about 150 calories, maybe even 180 calories. Remember, we are only trying to get 300 calories of the day from fat. So what that ends up meaning is that even at just two tablespoons of olive oil, you're basically done for the day. Really tricky to stay in that margin if you're not being careful. But we can also get fat from other sources. It's not just the added oil, it's the avocado, the nuts, the cheese, the fatty milk, the yogurt, the fatty fish, fatty red meat, even fatty turkey, other sources of fat in our diet. It comes up all over the place. So with this patient of mine, we had to be very strategic about what ingredients she was going to use in her meals. We didn't just say eat as much olive oil as possible, even though olive oil is a classic Mediterranean selection and it's obviously a super healthy food for us. Instead, for this patient of mine, we had her measuring it. We made sure it fit into her fat budget for the whole day so that she could still target weight loss. Now, real quick, if you're listening to this and you're thinking, gosh, Dr. Anna, I really want to learn how to create a plan like this for myself. I can't do math. I would need a lot of help. Don't worry. I have a free Mediterranean weight loss webinar just for you, where you can learn my whole system for effortless weight loss and permanent results so that you can stop guessing, stop stressing, and

Step Four Fat Budget Reality

SPEAKER_00 13:05

finally lose weight in a way that works for your body. Not some pre-made plan that other people are trying to sell you, your body, something targeted. You can register for that free webinar by clicking the link in the description below this episode. Or if you're watching this on a TV, I have a QR code on screen that you can scan. Okay, now we're ready for step number five, which I kind of alluded to earlier, but we adjusted her plan for weight loss based off of her activity level. So remember, I told you on her resting days she was eating about 1500 calories, and on her lift days, she was about 1800 calories. That meant that we increased her calories by 300 on those days. But we really didn't do this very dramatically in all of the macronutrients because for her, it was easiest for her to just increase those calories by adding some more carbs. We still made sure she was eating enough protein, but again, we don't have to be so precise to the exact number of grams of protein every single day. You can give or take 20, 30 grams, and you're pretty much still gonna be on target most of the time if you go for your ideal amount, okay? So remember the protein and the fat that we calculated, it if it was roughly the same, she still gets about 112, maybe 115. Maybe on these lift days, she would even go up to 120, 125 grams of protein, but she still tried to keep the fat in check. 33, maybe 35 grams of fat, not too much higher than that. So her extra 300 calories coming from carbs was really what helped her fuel her workout and give her enough energy to do her workouts. That meant eating a little bit more rice,

Free Webinar Invitation

SPEAKER_00 14:45

a little bit more vegetables, more fruits, more sweet potatoes, healthy sources of carbs. Because her body really needed that fuel to lift the weights and recover properly. Notice what we did here. We didn't start with how much olive oil should I eat, or how many carbs can I have today? Instead, we started with what is the total amount of calories across the entire day, and what is the activity level we're going to get today. With her, what I did was thinking about her health conditions, her overall goals and her weight, and her overall activity level, we worked our way backwards. Olive oil was then placed into the system. The healthy foods, the healthy sources of protein, the healthy sources of fat, and all the fruits and vegetables that she needed were all placed into the system almost after the fact. First we calculated the needs, then we plugged and chugged with the food selection. That is how I like to actually approach it. A lot of people, when they're trying to do weight loss, they start from the food. They start from thinking about the food and making swaps and doing random things and they're not being targeted. I can tell you, you can do that, but it's going to take you longer. It is going to be a faster approach if you're measuring and tracking and being precise. And the other thing I always like to remind people is that what doesn't get measured doesn't get improved. If we don't know exactly what we're doing, it's really hard to make shifts to improve it when we find we're stuck or it's not working. So again, we're not picking random numbers of tablespoons of this or that ingredient or a number of servings of carbs. We start with the calorie needs. We think about your body, your age, your activity level. We work our way backwards with the right framework that works for us. Could be 50, 30, 20, could be something else. We prioritize the most pivotal ingredients or rather nutrients first for preserving our metabolism and helping save our muscle mass, protein. Then we think about how much fat we can allot, and then we can add in the carbs and we can adjust our activity levels and goals. Now, that is structure, that is personalization, and that is strategy. This is why I like to call it health freedom. We're not guessing, instead, we're understanding how the system works. And the system works for everyone. You don't always have to have the same approach as everybody else, but if you have a system, that is how it's going to work

Step Five Fuel Lift Days

SPEAKER_00 17:05

the best for you. So again, with this particular patient of mine, that meant she could have about two tablespoons of olive oil across her day. So that meant, yeah, she obviously wasn't using olive oil every single time she ate. She was eating different kinds of things. For you, this could look completely different. Maybe you don't even like olive oil and you're like, I don't even use oil, but you like having a lot of nuts in your diet. No problem. That's going to be your source of healthy fat. So if you're more active, you may need more calories than this. If you're less active, you need fewer, etc. Realize, and I hope I have made this painfully clear in this episode, there is no one size fits all when it comes to this stuff. Instead, we have to adopt a smart strategy that is targeting what our personal needs are. Okay. Now, this approach, creating a personalized plan that's based on your body, your activity, your specific goals. Again, it is exactly what I start to teach you in my free weight loss webinar. And this is so you can lose weight effortlessly, you can keep it off permanently, and finally understand how to make it work for you long term. That is the goal. Now we have to talk about something really essential. Here's the problem most people run into when they start to do this themselves. Even when they think they're using the right amount of olive oil, they end up using way more than they realize. Let me tell you what happened with me. When I actually started weight training seriously, I decided to challenge myself and track everything I was eating. I'll be honest with you, I don't love tracking. It actually stresses me out. But my husband, who is a certified personal trainer, he always has been tracking things and he's taught his clients to do this for years. He used to tell me, you know, Anna, you really have to track. If you don't track, you don't really know. And of course, I was eating healthy meals because I love nutrition, but he was right. I needed to track.

Tracking Reveals Hidden Calories

SPEAKER_00 18:55

So I actually did it. I challenged myself and I said, I'm going full Monty or doing the whole tracking thing. I needed to see exactly where each of my calories was coming from. Now, I'll be honest, I thought I had a pretty good handle on it because of I'm a doctor, I studied nutrition, and this is kind of my thing. But I'll tell you, I was shocked when I actually started measuring. What was the most shocking thing of all was how many tablespoons of olive oil I was actually eating that dramatically changed the amount of calories in my meals. And that's why I like to use that as such a classic example, because it happened to be too. So I would cook my vegetables, usually sauteing them in a pan. And how would I do that? Well, I'd pour some olive oil and I'd kind of just eyeball it. I'd say, hey, it's not that much. Throw it in there. Maybe it was one tablespoon. But when I actually started measuring it, I was pouring about three or four tablespoons on my food every time. And that was just the oil being added to my vegetables. Now, three or four tablespoons of oil, yeah, that's up to like 480, even 500 calories just from that. I had no idea that I was adding that many calories to my food. So what did I do? I changed my approach. I started using water-based cooking methods, steaming, boiling, sauteing with a little bit of water at the bottom. So it's almost like you're steaming it in a pan. Then what I would do is I would actually add the amount of olive oil I wanted after the thing was cooked for getting maximum flavor. So that meant I was steaming my broccoli and then measuring one tablespoon of olive oil and drizzling it over at the end. Now, to be fair, it's not like I invented this. This is something that I've seen so often when I was living in Italy. People pour olive oil on the food after it's cooked all the time. They even put it on a big piece of steak. So this is an easy approach to measuring the amount of oil in your diet if that's something that you need help with. Overall, you drizzle it on top and the flavor's really gonna pop. I didn't actually mean to make that rhyme, but that sounded pretty good. Okay, so this trick, as we mentioned, will cut back on so many calories. And when you cook with oil, remember you need a lot to coat the pan to prevent sticking and to cover all the food. So if this is you and you cook this way, you might want to change up your cooking method.

Cook With Water Then Drizzle

SPEAKER_00 21:10

When you add oil instead after, because you used a different method to cook your food, like cooking your vegetables and used vapor or water, you're gonna end up using way less oil and you might still get all the flavor and all the health benefits. Yeah, I know that some of you buy those spray bottles for olive oil. Now, I'm gonna tell you, honestly, I'm not a fan. My dad likes to do this, so it works for him, it doesn't work for me. I worry that it makes the oil oxidize and it can go rancid a little bit faster. But if you buy the right bottle and you're storing it in a dark place away from heat, you're probably not gonna have that issue. Now, here's another patient story that I want to share just because it shows how this plays out in real life. Once I had a woman working with me who was eating a very classic Mediterranean approach. She thought she was doing everything right, but she wasn't losing the weight. And she couldn't figure out why. Now, caveat, I hear this all the time. This is one person's experience, but I'm telling you, it's many people's experience. I asked her to show me how she cooked or describe it for me, because we were in the office. She told me she liked to cook her vegetables on the stovetop and she would usually cook with olive oil or butter. And I said, I want you to describe for me and like show me with the motion how do you do it? And she literally said, Well, I grabbed the bottle and I just do this. And I knew right away what the problem was. Easily she was using like four or five tablespoons of olive oil or whatever oil she was using in her meal just to cook it. So again, that added like 600 calories just from the one meal and from the preparation method. She had no idea because again, she knew olive oil was healthy or even butter. Sometimes she wanted the flavor of butter. She said, this should be fine, right? Sort of. It's not that it's bad, it's just not going to target fat loss. I had her instead start measuring things. One tablespoon to cook with, maybe one more to drizzle after. Stop it too. Easily from this one move, she was cutting 300 or even 400 calories a day by being intentional with the amount of oil she used. What then happened

The Olive Oil Mistake Case Study

SPEAKER_00 23:10

to her? She lost eight pounds in the first month, and we changed nothing else. Now, here's the lesson. As mentioned, of course, olive oil is super healthy. And I know if you're watching this video, you've probably seen other videos on my channel. I hope. Of course, Mediterranean eating is very plentiful with lots of olive oil and it's super nutrient dense. It's fantastic for our bodies, but it's calorie dense. So we have to be realistic as well. You can absolutely include it in a weight loss approach if you enjoy the flavor of olive oil. But you also need to be aware of how much you're actually using. And this is true of all oils, not just olive oil. Most people pour freely, they eyeball it, they don't measure, and they end up using three to four times the amount they actually think they are. Because when you think back, you say, yeah, I just did a really small amount, must have been like a tablespoon. But I guarantee you, when you start measuring it for real, you're gonna be surprised. You may unintentionally be adding hundreds of calories that are sneaking into your day without you even realizing it. Okay, so let's recap for a second before we move forward. There is no magic tablespoon number of olive oil to target weight loss. You may need to figure this out for yourself and do a little bit of the math, but I hope I walked you through how to do that so you can at least start experimenting. The goal is to be in the ballpark. We don't need to be overly precise, but by measuring and tracking at least for a little bit the calorie amount we need for the day based on our activity level, figuring out what is our framework, maybe 50, 30,

Recap And Next Steps

SPEAKER_00 24:45

20, figuring out how much of our calories should come from protein, then work towards the fat, then think about how many carbs. For example, an approach like that may really help you speed up your weight loss results. And this again is what I like to teach. I like to teach you guys how to actually apply this stuff in a flexible way. So you're not feeling like you're following a diet for the rest of your life. Because quite honestly, everything I just described to you and the entire Mediterranean approach that I teach, it's really not a diet. It's an approach, it's a system. It's a system that you can apply and individualize it to your own health. And remember, if you need help learning this, and by watching this video, this is really just a stepping stone to learning my full system of Mediterranean weight loss. Don't forget to join my free webinar that is linked below. This is how you can find a plan that works for your body and your lifestyle. Okay. So when you're ready to keep going, jump into all my other episodes up here. I have so much more for you to learn about healthy, targeted weight loss approaches that are going to boost up your health and make you feel fabulous. I'll see you in those other episodes.