Echoing Monica's advice here, but "lifestyle changes" is not very well defined. Maybe it would help to give you some of my story: About fifteen years ago my waist size was 38 and I knew I was headed to 40, tipping the scales at almost 200 pounds. I don't remember what I weighed back in HS and college, but I suppose it was in the mid-150s. My doctor was increasingly concerned, starting having "The Talk" with me about possible diabetes, and I got suitably scared. The good news is that I was able to reduce. I used the Atkins approach, pretty religiously, along with bicycle riding for exercise. I got down to about 36 waist size and 165-170 pounds, and thought I was pretty much done for about ten years. But then it seemed my glucose levels were still staying higher than the doctor wanted to see. So, I got religion again, counting calories and carbs, and am now at about 155#, 34" waist (comfortable), and my blood tests look great. It is hard to do at times. But I do enjoy desserts from time to time, and I really enjoy a glass of wine or a beer. Nothing to excess. When we go out to eat which isn't very often, I do enjoy some bread and butter. At home we often have a nice big salad topped with chicken that I BBQ, and with olive oil and balsamic vinegar for dressing. Oh, and did I mention a glass of wine? The other thing I found necessary for me is to every single day... weigh myself. Yes, it sounds extreme, but only then do I see if my weight is staying about where I want it, or if it's trending up. It never goes down without my attention. My weight tends to fluctuate about a pound up and down, anyway, so if I didn't monitor it, then I would not know where I am in that cycle. Lastly, turn it into a game. Don't make it into a "I'll never be able to have cake (or pick your poison) again! Woe is me!" If you do that then it's so hard to stay motivated because you feel like your starving yourself and life's just too short. Give yourself credit and a pat on the back when you lose a pound. And look forward to buying new (smaller) clothes! Okay, I'll get off my soap box. Send me a PM if you'd like more thoughts... Good luck, Emma