(MONEY Magazine) – THIS MONTH: -- How one Virginia man spent $12,000 to lose 80 pounds -- High-tech pianos that are truly grand

If that spare tire seems to have taken up permanent and increasingly prominent residence around your waist, you've got plenty of company. Government health figures released late last year revealed that for the first time ever, a majority of Americans are overweight. A $10 billion industry hangs on those millions of love handles--and on their owners' willingness to try everything from Nutri/System memberships (more than $2,000 a year) to the hot new Redux appetite-suppressant pills (about $800 a year) to Suzanne Somers' Eat Great, Lose Weight diet cookbook (Crown, $23) to lose them. As you have no doubt noticed, that industry is competing frantically for your attention; from January to April it draws about 70% of its annual revenues.

--Our advice is simple: Keep one hand on your plump wallet. According to more than two dozen physicians, weight-loss experts and consumer advocates we interviewed, most of the elixirs and programs on the market fail to keep the pounds off for more than a year--and some may even harm you. Among our findings:

--A high price is no guarantee of effectiveness. The cost per pound lost for five popular diet programs ranges from a reasonable $8 with Weight Watchers to a hefty $84 with Optifast (see the table on the opposite page). (Southern Progress Corp., a subsidiary of Time Inc., Money's parent, owns Weight Watchers magazine but has no affiliation with the Weight Watchers diet centers.)

--Even the most expensive programs rarely achieve permanent results, in part because many don't teach dieters how to change their eating habits effectively.

--What's worse, some of the most popular dieting options, including Redux, carry life-threatening health risks.

To be sure, as you stare down at those big numbers on the bathroom scale, it's hard to resist the urge to do something to move the needle the other way. Go ahead if you must; just hold your expectations tightly belted. And keep in mind the following analysis of eight of the most popular ways to banish that bulging belly, starting with the least drastic.

Commercial weight-loss centers. In 1995 an estimated 7.6 million of us spent $1.78 billion at these outfits--a business that's dominated by big national chains such as Diet Center, Jenny Craig, Nutri/ System and Weight Watchers. (Few insurance plans and virtually no managed-care plans cover weight-loss treatments and drugs, so your costs are likely to be entirely out of pocket.) All of the centers charge an enrollment fee that ranges from $30 (Weight Watchers) to $149 for three months (Nutri/System). On top of that are ongoing fees: You must drop in each week for weigh-ins and coaching from a counselor at $10 to $14 (Weight Watchers) on up to $20 to $50 (Diet Center) a week. Additionally, Jenny Craig and Nutri/System require you to buy packaged low-calorie comestibles for at least some meals (cost: $49 to $90 a week). The total for a year's treatment can easily hit four figures.

While these centers can be effective for short-term weight loss, the pounds have a way of creeping back. The National Institutes of Health reported in 1992 that dieters on such programs for several weeks to a few months regain within one year two-thirds of the weight they've lost--and regain in five years almost all of the weight. "The way those centers made most of their money from me," says former customer Brian Steffan, "was by collecting my enrollment fee over again each time I regained weight and rejoined the program." (For Steffan's 16-year weight-loss saga, see the box on page 165.) The best deal: Weight Watchers, which grants you lifetime member status so long as you stay within two pounds of your goal weight for six consecutive weeks.

Nonprofit support groups. The biggest, Overeaters Anonymous (about 7,000 chapters in North America; 505-891-2664), follows a 12-step program similar to that of Alcoholics Anonymous. You typically meet once a week with others who are working to control compulsive overeating. Your family physician or local Yellow Pages may be able to direct you to similar groups near you. Costs are negligible: OA asks only for voluntary donations at each meeting, typically a dollar or two, and local groups often charge nothing. "These groups can be very effective at helping people identify emotional triggers for overeating, and therefore lose weight," says James Merker, executive director of the American Society of Bariatric Physicians. If you're looking for a regimented diet to follow, though, they aren't for you.

Over-the-counter diet pills. Drugstore and supermarket shelves are lined with appetite-suppressing pills such as Acutrim and Dexatrim (about $7 for a 30-day supply) that work in part by stimulating your metabolism. But there's no scientific proof that they produce anything but temporary weight loss, despite the more than $116 million that 1.3 million Americans spend on them each year. More worrisome, those drugs contain an active ingredient called phenylpropanolamine (PPA) that has been associated with reports of elevated blood pressure, seizures and strokes. A pending study commissioned by the U.S. Food and Drug Administration on the link between PPA and such ailments won't be released until next year. In the meantime, the minimal benefits don't justify the potential risks.

Meal-replacement shakes. About 7.6 million dieters consume low-calorie shakes in lieu of some real meals to help lose weight, according to market research firm Marketdata Enterprises. The shakes are sold either in grocery stores (as is big seller Ultra Slim Fast) or, increasingly, through so-called network marketers such as Herbalife, Nu Skin and Shaklee. "Replacing a meal or two a day to lose a few pounds for your high school reunion won't hurt," says Susan Yanovski, director of the Obesity and Eating Disorders Program at the National Institute of Diabetes and Digestive and Kidney Diseases. "But it won't help you control weight over the long term."

If you're tempted, go for Ultra Slim Fast, which costs only about $1 per shake in a can--the most popular form--or about 60[cents] per shake in a powder that you mix with skim milk (calories per serving: 200, vs. 700 or so for the average meal). Monthly cost for replacing two meals a day with Ultra Slim Fast: $36 to $60. The direct-marketed shakes, by contrast, cost much more. Nu Skin's Health Trim Lifestyle 30-day package of shakes, high-fiber bars, vitamin supplements, diet book and video, for example, sets you back $287.

Custom-made weight-loss plans. If you're the type who prefers a bespoke suit to one that's off the rack, consider asking a physician to create a weight-loss program tailored to you. It should incorporate an exercise plan, behavior modification, support groups and menu planning. You'll likely pay $190 to $500, depending on your area, for a complete physical and lab tests, plus an additional $60 to $100 for monthly visits. The success rate is encouraging: A 1992 University of Pennsylvania study found that patients 85% or more over their ideal weight who followed such a program for six months dropped an average of 24 pounds and after one year regained only about one-third of it.

To set up such a program, find a so-called bariatric physician--one who specializes in treating obesity. For referrals, call research hospitals in your area or the American Society of Bariatric Physicians (303-779-4833).

Prescription drugs. Diet drug Redux has been embraced by the overweight with near-religious fervor since hitting the market last June. Already, 65,000 new prescriptions are written for Redux each week (cost for a month's supply of two 15mg capsules per day: $60 to $75). Redux and an older, related drug, fenfluramine (brand name Pondimin), increase the availability in the brain of the neurotransmitter serotonin, which triggers a sense of fullness.

A 12-month study of more than 800 dieters showed that the half taking Redux did lose an average of six pounds more than the half taking a placebo. But people who stop taking it regain the weight, and no studies have determined whether it's effective--or safe--to take the drug for more than one year, says Michael Myers, a bariatric physician in Los Alamitos, Calif. What's scarier, both Redux and fenfluramine can trigger primary pulmonary hypertension, a disease of blood vessels in the lung that kills 50% of those afflicted within four years. A recent New England Journal of Medicine study found that obese people who use such drugs for more than three months raise their odds of developing the disease from about one in 500,000 to about one in 16,667. Says Marc Deitch, a spokesman for Redux maker Wyeth-Ayerst Laboratories: "That risk is still extremely small."

Because obesity-linked health problems can kill too, that risk may be worth it for the morbidly obese--those with a body mass index (BMI) of 30 or more (see the table on page 162 to calculate yours). But "for people seeking cosmetic weight loss, the risk isn't worth it," says Denise Bruner, a bariatric physician in Arlington, Va.

Medically supervised liquid diets. If you have a BMI of 30 or more and don't mind renouncing solid food for a few months, you might consider a very-low-calorie liquid diet such as Medifast or Optifast, the beverage that Oprah Winfrey used to drop 69 pounds back in 1988. For three months you consume only the liquid, made from a protein powder, which supplies you with 400 to 800 calories per day. Then you shift to a three-month diet plan in which you can eat regular food. You must be under a physician's care for the entire six months. The typical patient loses 55 to 70 pounds. Cost: a whopping $3,000 to $3,700.

But as any daytime TV viewer knows, Oprah regained her lost poundage in a few years--and then some. "People tend to have a dramatic rebound in weight unless they learn how to permanently change their eating habits," says Hal Seim, a weight-loss expert at the University of Minnesota.

Surgery. If you are one of the 2% of American men and 4% of women who have a BMI of at least 40 (about 100 pounds of excess weight for men and 80 pounds for women), some doctors recommend surgery as a last resort. Surgeons typically use staples and bands to reduce the stomach's capacity from about 32 ounces to about half an ounce. Average cost: $15,000 to $30,000, usually covered by insurance if the procedure is considered medically necessary. The resulting weight loss averages 50 to 100 pounds within two years after the procedure, and the vast majority of patients keep off at least half that weight after five years. But complications can be serious: between 10% and 20% of patients require follow-up surgery to correct problems such as abdominal hernias.

What really works. Research has found one clearly effective way to lose pounds and keep them off. It is simply to exercise at least three times a week for a minimum of 30 minutes, while eating sensibly. (Your local branch of the American Heart Association can give you a free eating plan to shed pounds; call 800-242-8721.) Best of all is the cost of this regimen: absolutely nothing.