Keeping the pounds off is challenging enough for many women, and for some, the excess weight can be downright dangerous. And if you’ve ever been involved in any kind of diet or workout plan, you know that the paths to weight loss are practically as numerous as the women seeking them. But one thing’s been proven: The most effective approaches involve lifestyle changes, along with professional guidance to reach and stay on goal.

Before getting started, find your motivation, advises weight loss coach Charles D’Angelo of Team Charles Weight Management. “You have to find the desire. You have to be serious,” he says. “Before you can create lasting change, know why change is needed. Ask yourself, If I don’t change, what will happen? Maybe your goal is to fit into clothes better, or maybe it’s about health. But come up with a compelling purpose so you feel motivated.”

For each of his clients, D’Angelo sets up a consistent pattern of healthy eating. “Much of the success is due to being consistent with the kinds of food you’ll consume and the times you’ll eat them,” he explains.

D’Angelo also helps clients shift the way they look at food. “It’s not that sweets and things are going to be your downfall. It’s just that many people associate pleasure with food. And when they reach their weight-loss goal, they celebrate by rewarding themselves with food. Then they go right back to those old habits.”

Pleasurable foods don’t have to be off-limits for the rest of your life, but D’Angelo says we need to learn to take control and keep it in moderation. “Once a week, you can refuel and have things you typically wouldn’t have,” he says. “You can go ahead and have pizza—there are healthy pizza alternatives out there—or have a nice bowl of pasta. Just don’t go out and eat the unhealthiest things.”

Along with nutrition, resistance and cardiovascular training make up another part of the equation. But Nate Palmer, co-owner and head trainer of PerforMax, says results are most effective if you educate yourself about how to best condition your body. “Incorporating a resistance program that works the upper and lower body together is ideal,” he says. “You get more out of the exercise and burn more calories.”

Palmer says a professional trainer can tailor your workout to get results quicker. “There are people who just go from machine to machine at the gym, and wonder why they’re not seeing results,” he says. “That’s why it’s best to get all three—nutrition, resistance and cardio—going at once or the results will be limited.”

For those who have been battling a weight problem for most of their lives and have more than just a few pounds to lose, a surgical option can be the most effective jump-start. At St. Alexius NewStart, these procedures are performed laparoscopically, with several, smaller incisions that allow most patients to recover quickly, according to director Kerrie Warne.

For women with BMIs (body mass index) of 35 or greater with serious co-morbidity conditions such as diabetes, hypertension or sleep apnea, NewStart recommends a couple of procedures for permanent weight loss. The Roux-en-Y gastric bypass is a permanent, non-reversible surgery that reduces the size of the stomach. “The stomach is cut and stapled so that you are left with a golf ball-sized pouch,” Warne explains. “The small intestine is rerouted to the newer pouch, so when food is absorbed, it bypasses the large intestine.” Another permanent weight- loss solution is the laparoscopic gastric sleeve procedure, which creates a tubular or sleeve-shaped stomach pouch. “The procedure removes a portion of the stomach, but there’s no rerouting involved, and the stomach would still hold as much food as a golf ball-sized pouch would,” she notes. “The portion taken out is thought to be responsible for secreting ghrelin, the hormone for appetite or hunger, so that the procedure also acts as an appetite suppressant.”

For those with lower BMIs, Warne says gastric banding, which is reversible, might be an option. “A band is placed on the upper portion of the stomach to restrict the amount of food that can be ingested,” she says. “As a result, patients eat less, and they stay full even four to six hours after eating.”

As with any plans for significant weight loss, maintenance is key to keeping the pounds off. “Losing weight through diet and exercise will only work if the patient is motivated, and surgery can work as a tool,” Warne says. “Any of these procedures will require a lifestyle change and follow-up support to maintain not only physical health but also social and sociological well-being.”