Weight loss hard to maintain

REVIEW-JOURNAL

Atkins, South Beach, Weight Watchers, carb watching, fat watching, diet pills, you name it, there are no shortage of ways to shake off excess weight. For the obesity epidemic there is equal balance of weight loss success stories, some argue. But the problem is that most of those success stories are temporary.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 68 percent of the adults in the U.S. are considered overweight, or have a body mass index of 25 or greater. People considered obese, or with a BMI topping 30, on average pay $1,429 more in health care costs annually, according to the group. The dire statistics tied to our bulging waistlines are nothing new to most Americans. And many are willing to do something about it.

As of 2008, the weight loss industry was estimated to be a greater than $60 billion affair, according to Marketdata Enterprises, a research firm that tracks the diet and weight loss industry. On any given day, some 71 million Americans are dieting, the research firm adds.

That’s a lot of people unhappy with what they see in the mirror.

With so much attention focused on losing weight, one would think that keeping it off would be just as important. But that’s not the case.

Dr. James Atkinson, a valley bariatric surgeon whose practice also helps patients lose weight naturally, says the national statistics still show that only about 5 percent of those who have had considerable weight loss don’t gain it all back.

“For most of America, it’s really all mental and behavioral. When 70 percent of us are overweight, that’s not genetic. That’s lifestyle and behavior,” he adds.

THE LOSER REGISTRY

For those successful losers who have kept weight off, researchers want to know just what this growing minority has done right. The National Weight Control Registry (www.nwcr.ws) was created in 1994 by Brown University professors Rena Wing and James Hill. The pair was looking specifically for the stories of people who could document weight loss of at least 30 pounds and show that they kept it off for at least a year. The goal was to gatheras much information as possible on these winners of their losing battle and find their similarities.

While the minimum requirement to join the registry is to have maintained weight loss for at least one year, most entrants sign on after keeping the weight off for five or six years, says John Thomas, a Brown University professor of behavioral medicine and researcher for the registry.

Thomas adds that while minimum weight loss needs to be 30 pounds in for registry consideration, many have lost more than 100 pounds and the average is 70 pounds for the 10,000 that are currently enrolled.

“Back then (in 1994) a lot of researchers were saying ‘why bother losing weight? People always gain it back,'” says Thomas. “When we founded the registry it was a way to determine if there even were any people out there that were successful at maintaining a substantial weight loss. Those people broke that assumption and we wanted to find out how they did it.”

THE NOT SO SEXY TRUTH

Through the years, several common characteristics of successful losers have emerged. And Thomas admits that many of them are a bit old school. Like the most obvious one: on average, most of the 10,000 who keep their weight off on the registry, say they do about an hour a day of physical activity.

“Often we ask, ‘how do you find the time?’ and many say they find it by reducing their screen time, watching less TV, particularly. And the added benefit to that is that TV can be a cue for eating and eating the wrong things,” Thomas adds.

Another not so sexy finding is that most of the successful losers and maintainers do eat a low-calorie, low fat diet. During the peak of the Atkins diet craze, people criticized the registry for this finding. As the low-carb craze crested the composition of the registry didn’t change, Thomas notes. Still, a majority reported using a low fat diet.

“We’re not saying you can’t be successful on a low-carb diet. … You have to sort of make your own inferences from that,” he adds.

But in a unique twist, successful maintainers also tend to eat what Thomas refers to as “the same set of face foods.” It seems those who maintain their weight loss know what foods and their amounts that work for their body composition and tend to eat the same foods over and over.

“There tends to not be a whole lot of variety in their diet and they don’t tend to splurge,” he adds. “Keeping it boring seems to work really well for a lot of people.”

Thomas admits that this detail goes against America’s food culture.

“The problem we have with weight in this country can largely be attributed to the food environment we live in. … There are very delicious but calorie-dense foods available cheaply and in large quantities. … Avoiding the negative consequences by limiting yourself to a smaller section of very safe foods presumably is helpful,” he notes.

SCALE WORSHIP

When losing weight the scale is your friend who brings good news frequently. But once the big goals are already met, it is the enemy. Even the slightest up-tick can lead to sabotage. But those who keep weight off make sure to weigh themselves at least once a week. Scale vigilance can also help one take immediate action when a small amount of weight gain occurs, the researcher says.

Jim White, an American Dietetic Association spokesman and owner of Jim White Fitness and Nutrition Studios in Virginia Beach, VA, says he encourages clients to weigh-in weekly after meeting their weight loss goals. He also institutes a 5-pound “buffer zone” for maintaining the weight.

“If you’ve gained five pounds in a week, you have to be eating an awful lot,” he adds.

THE PSYCHOLOGY

But Thomas and others say there is psychology behind winning this battle or losing it. Why so many people gain all their weight back and then some has been baffling scientists and researchers for years. Thomas also admits there is very little data on what is happening in the brain to encourage poor eating habits and gaining weight back. He does add that another common theme among successful losers is that most are not on their first attempt at weight loss. Many were not successful for the long term after several attempts. And the failures have actually proven to be helpful to many losers.

“For many people that trial and error helps them create a combination of strategies that works for them,” Thomas says.

Another way to get around the psychology is physiological need. Keeping off weight for medical reasons like a recent diabetes diagnosis is also a great motivator.

White says people sabotage weight maintenance efforts because America is an “all or nothing” society.

“One of the first things we ask clients is ‘are you an extremist?’ Let’s face it a lot of us either want to win or we don’t want to play,” White says.

While Atkinson has helped many people achieve their goals through surgery, he remains intrigued by the brain’s role in keeping weight off. For some people, for some reason, their brain seems to still be telling them they are hungry even after they have already eaten quite a bit of food, the doctor notes. Meanwhile, others say they are hungry, eat a small chicken breast, for example, and don’t need to eat anymore.

“For whatever reason it take two plates of food (for an overweight person to become full) when the body doesn’t need it, but the brain seems to want it. … It’s a mystery … it’s easy for people to say ‘just stop eating.’ But you have to ask what is fueling that desire for it? That seems to be the problem and it gets more severe as people get heavier,” the surgeon points out.

Atkinson says there are three factors to weight control: appetite, satiety and metabolism. With appetite, a person indicates he or she is hungry and eats until they achieve satiety, or a satisfying “feeling full” state. Metabolism then breaks down and uses energy from the food. But the middle factor, satiety, Atkinson says is the most important.

“Satiety becomes more and more of a problem as you go up in weight,” he adds.

HORMONES?

One explanation Atkinson and other surgeons have offered is ghrelin, otherwise referred to as the “hunger hormone.” The hormone is produced in a certain area of the stomach and some theorize that after certain bariatric surgeries “the ghrelin center” is removed.

But Atkinson also says there are other so-called “hunger hormones” and he attributes a lot of surgical success to simply having a smaller stomach. Ultimately, the doctor says surgery is a tool for an extremely small portion of the population. Regardless, the behavioral change is needed.

“Unless you’re an Olympic athlete who does an enormous amount of exercise, it generally takes a certain lifestyle to stay thin,” he adds. “You have to have that behavior change. … To me it starts with recognizing the impulsive eating and then finding ways to prevent it.”

OTHER APPROACHES

It seems experts and researchers agree on the fact that there may be many paths to initial weight loss success. But the traditional and boring-sounding approaches of exercise and calorie and fat-consciousness when it comes to maintenance makes it a tough sell to the American consumer.

“It’s mostly stuff that people know, but you have it validated by a larger group of individuals. The message is that long-term weight loss is possible. It really comes down to finding a way to fit these healthy behaviors into your lifestyle,” Thomas adds.

The researcher says it all comes down to creating habits, like eating the same things each day or scheduling a specific time daily to exercise. Once barriers to those habits are broken down, maintenance goals can be achieved.

“Once you build a habit, certainly there’s an idea of behavioral momentum that makes it easier to keep it going,” he adds.

White says it’s important to keep making goals. A lot of people have goals of losing weight for a special event, like a wedding day, he says. But for some goals can be smaller, like being able to pick up grandchildren or sleeping better. For exercise, he says, many people don’t like it, but they tend to like the feeling afterwards. It’s about focusing on that feeling in order to keep them active.

“When you lose sixty or a hundred pounds, it’s horrible when you gain it all back. It’s horrible for the psyche, the confidence and the body,” he adds.

The trainer and registered dietitian says he has instituted follow-up contact procedures with his clients after they achieve their weight-loss goals. He emails every month for the first three months, calls on the third month and continues emailing. On the sixth month he sends the client’s “after” picture as a reminder.

“People are just so focused on the weight loss, but once they’re out of our jurisdiction, you can just hope what you’ve instilled in them is going to work,” he says. “We’re staying on them to keep the focus.”