Accountants are sometimes disparagingly called "bean counters," but the truth is that counting beans is much like counting money. Body weight is the result of calories consumed minus calories burned just as net income is revenue less expenses. The calories we put in our mouth are used up by both our basal metabolism and physical activity. Any excess gets stored as fat while a deficit burns up the stores, resulting in weight loss. The bottom line is that 3,500 calories equals 1 pound. Accountants and health care providers will argue that it’s not so simple. Fair enough; consider this a "bare bones" explanation.

To employ a lifestyle that ensures a healthy weight, it is essential to drill down and understand the details of a caloric profit and loss statement. Countless patients complain to their health care providers that they watch what they eat and get plenty of exercise but can’t seem to take off the extra pounds. Once the provider determines through laboratory testing that there is no medical reason for weight gain, such as an underactive thyroid, the therapeutic relationship can reach an uncomfortable impasse.

Failure to lose excess weight in the face of a reasonably healthy diet and regular exercise often comes from overestimating how many calories are burned by physical activity and underestimating how many calories are in those little tasty rewards for good behavior. To lose 1 pound per week, one simply needs to reduce their steady-state intake by 500 calories per day. Here are some foods that can be left off the table to get there: two Spam musubi (506 calories), 1 cup of macaroni/ potato salad (509 calories), 1 cup of oxtail soup (458 calories), one lau lau (414 calories) or one Big Mac (550 calories).

In contrast, calories burned during a given activity depend on one’s current weight, height, age, gender and other individual characteristics. Still, the average person burns about the same amount of energy while watching television as when sleeping and only slightly more when sitting at a desk. Roughly 500 calories are burned during a decent night’s sleep. On the other end of the spectrum, scuba diving can burn as much as 900 calories per hour depending on how cold the water is, while moving along on a stand-up paddleboard will average roughly 500 per hour. Swimming draws roughly the same as does mountain biking or a strong-paced hike up Koko Head. Yoga can also burn up to 500 calories per hour when practiced full tilt.

While diet and physical activity are both essential to maintaining a healthy weight, to pay for one slip of the tongue can take a huge physical effort. Unless you are fully ready to hustle up Koko Head right after lunch, don’t eat that second lau lau. Let it slide only a few times and be ready to carry around an extra pound next time you take the hike. Call my CPA if you don’t believe me.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.