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Hard Earned Weight Loss: How to Keep it Off!
By Cyndi Rook
 Elizabeth had been watching her weight increase, with a kind of resigned fascination, for several years. Finally at forty-one, fascination turned to alarm, and she realized action was needed. “I had become very depressed, and there might have been a different outcome. I could have stocked my kitchen with chocolate chip cookies and Coke Classic and let nature take its course. I may have done something kooky, like abandoning my (then) less than optimum vegetarian diet and turned to pork chops and fried eggs. Instead my apparently strong sense of self-preservation kicked in, and I decided that, at my age, this was my last best chance for a relatively healthy retirement. The speed of my weight loss became secondary to being healthier.”
“I began a daily food journal, keeping calories to 1500 per day and counting servings of fruits and vegetables. I started walking every day and doing Pilates several times a week. Not much happened for several weeks, but I didn’t give up, because I felt physically stronger and mentally sharper. I reduced my calories to 1400 and eventually settled into a kind of rhythm. I began losing one pound per week. Every Wednesday, my scale would show the decrease; then I would fluctuate during the week, but be down another pound come Wednesday. I lost thirty-five pounds, and all it took was about a year and a half of constant adjustments and daily diligence! That may seem like a long time, but I refused to be hungry all of the time. I’ve maintained the weight loss for four years, except for the occasional stress-related blip, and my cholesterol, blood pressure, and glucose levels are very low. When my weight starts creeping back up, I go back to counting calories and journaling.”
Nor everyone is as lucky as Elizabeth. Obesity causes 300,000 American deaths each year. It is second only to smoking as a cause of preventable death in the U.S. Obesity-related diseases cost Americans about 100 billion a year in healthcare costs. Having too much fat, especially around the waistline, raises one’s risk for health problems such as high blood pressure, high cholesterol, diabetes, heart disease, and stroke. A “high-risk waistline” is defined numerically as above 35” for women and 40” for men. Even if these known risks are not present, obesity by itself raises the risk of heart disease. It not only harms the heart and blood vessel system, but it is a major cause of gallstones and can worsen degenerative joint diseases like arthritis.
We spend 33 billion annually on weight-loss products and services—books, weight-loss drinks and bars, and weight loss clinical treatments—yet 60% of us are overweight, and that figure continues to climb. Lots of people do lose weight. According to some sources, however, 99% fail to maintain the weight loss for any appreciable length of time. Dr. James Hill and Dr. Rena Wing, of the National Weight Control Registry (NWCR), which has been tracking successful weight losers for ten years, contend that, although weight normalization among obese people is rare, maintaining even a 5% to 10% reduction in body fat can mean health benefits. For instance, a recent study, the Diabetes Prevention Program, found that with a 7% weight loss in overweight and obese people at risk for diabetes, risk for developing the disease was reduced by 58%.
Clearly, it is critical that Americans find a method of maintaining their hard earned weight loss. Participants in the NWCR may offer some hope to those struggling with this crisis. Membership requires at least a thirty pound weight loss maintained for at least one year. Through detailed questionnaires, the methods and habits of over 5000 people have been analyzed to determine how they lost weight and how they kept it off. The NWCR is a database, not a randomized and controlled study. Most of its subjects are white women aged 44 to 49. Men make up only 20% of participants, and there are few minority members. Despite these obvious weaknesses, the information obtained has been useful in the treatment of overweight and obese patients.
At the outset, there are some clear commonalities among the registrants. Most (71%) were overweight by age 18, and 28% became overweight as adults. Forty-six percent had one parent who was overweight, and in 27%, both parents were overweight. Ninety percent had previously attempted to lose weight but had failed to maintain it. The mean loss was 66 pounds maintained for a mean of 5.5 years.
No one type of successful diet was found to be common among these people. The methods they used to achieve weight loss ranged from strict calorie and fat reduction to eliminating certain types of foods to consuming mostly pre-packaged liquid meal replacements. Only a minority relied on high protein low carb diets. The only common characteristic found was that 89% used both diet and exercise. Ten percent used diet alone, and 1% used exercise alone.
In contrast, several weight loss maintaining behaviors were found, and they track with Elizabeth’s experience. The four strongest in the NWCR were: 1) consuming a low-fat high carbohydrate diet; 2) eating breakfast every day, without fail; 3) regularly monitoring weight by weighing at least once a week and 4) exercising 60 to 90 minutes per day, with walking being the favorite activity. A fifth factor, daily food journaling, was nearly as strong a commonality as the first four.
Most reported consuming about 1400 calories per day, 24% from fat. The earliest registrants reported consuming the lowest levels of fat. From 1995 until 2003 calories from fat increased to 30%, while carbohydrate calories fell seven percentage points. The lower calorie and fat diets appear to have the advantage as those individuals who boosted their fat and calorie intakes regained the most weight. (Those people were also among those who reduced their exercise.)
The success of the NWCR participants and individuals like Elizabeth indicate that permanent lifestyle changes encompassing intellectual, emotional, and physical elements are necessary. Only very rarely can weight loss be maintained with short-term behavioral modifications. Health issue-based motivations seem to be somewhat stronger indicators of long-term success. Still, there is no magic involved. We must burn more calories than we consume. “The magic bullet is hard work, “ says the NWCR’s Rena Wing. “It’s changing your whole lifestyle, to a healthier eating and exercise approach to living. And that’s the only magic bullet we have for long term weight loss.”
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