Keeping Weight Off: What It Takes
Thanks to several serious diet efforts–from Weight Watchers to South Beach to the Two-Day Fasting diet–Monica has kept her weight within a healthy range over the past 30 years. “I have to keep at it,” she said. “If I didn’t, it would get out of control.” Like many others, Monica persists despite some popular beliefs that tell her she may be wasting her time.
One of those beliefs is that persons who succeed at weight loss will simply gain all or most of it back within a year or two. This myth probably stems from a 1959 study of 100 obese subjects who lost 20 pounds or more. Two years later, 98 of those subjects had gained most or all of the pounds they had shed.
Recent research, however, suggests that the long-term success rate after significant weight loss is more like 20 percent–not great, but no reason for giving up hope.
The other belief, also discredited by several studies, is that weight cyclers, persons who have lost and regained 10 or 15 pounds numerous times over the years, have a disadvantage when it comes to maintaining weight loss. This provides a good excuse never to diet in the first place.
In fact, studies show that, for persons like Monica, weight loss maintenance may become increasingly easier rather than harder with repeated efforts. And even when some weight is regained, the net effect may be positive. A meta-analysis of 29 studies found that persons going through a structured weight loss program sustained 23 percent of their initial weight loss after four or five years. Those who lost 20 kilograms or more (44 pounds) ended up with a 7 kilogram (15 pound) reduction–not what they wanted but a significant change.
Profiles of Success
One well known model for weight loss maintenance is the National Weight Control Registry, a self selected group of 4,000 plus adults who have lost at least 30 pounds and kept it off one year or longer. According to their self reports, these persons succeed by:
- continuing to follow a low-calorie, low-fat diet,
- exercising regularly at a high level,
- weighing themselves frequently and
- eating breakfast every day.
The most commonly reported physical activity is walking at a moderately intense pace for at least an hour each day. Women use up an average of 2,500 calories a week; men, about 3,300 in this physical activity.
A Swedish review of studies published in 2005 also produced a profile of the “successful weight maintainer.” Such a person:
- starts early with an ambitious goal and reaches it;
- is physically active with leisure activities such as walking or cycling and minimal TV watching;
- continues to monitor weight-related behavior by counting calories and weighing regularly;
- eats less than before with less snacking and fewer high-fat foods; and
- has a regular eating pattern of healthy meals, including breakfast.
These two profiles are remarkably similar. Both characterize persons who are serious about weight loss and willing to alter their behavior significantly to maintain it. One study of National Weight Registry members found that those who succeeded in keeping weight off for two years or longer had a 50 percent reduced risk of regaining that weight later.
Eating breakfast shows up on both profiles. Four of five members of the National Weight Loss Registry reported eating breakfast every day. The typical breakfast is cereal and fruit, both of which offer important nutrients plus energy to start the day. Studies show that persons who skip breakfast–or any meal, for that matter–end up eating up eating more food or higher calorie foods later in the day.
Likewise, in the Swedish study, successful weight maintenance was associated with regular meal rhythms and an emphasis on healthy foods with minimal visits to restaurants and fast food outlets.
While exercise by itself is rarely enough to produce desired weight loss, it is apparently crucial for maintaining that loss. Several studies have found that subjects who logged the greatest number of miles or hours also had the greatest chance of maintaining their weight loss.
One reason may be that exercise can reverse any slowing of metabolism that occurs after extended calorie restriction. Another theory is that regular exercise improves insulin sensitivity and helps the body become better at regulating calorie intake and consumption. One study found that very inactive subjects were least able to match these two parts of the weight formula.
Exercise becomes easier once weight starts coming off, and many individuals become hooked on the benefits of improved mood, energy and appearance they experience.
Conversely, persons who start cutting back on their exercise once they have reached their weight loss goal are almost guaranteed to gain weight even if they continue their new eating behaviors.
Many persons reach their weight loss goals through putting extreme restraints on themselves–denying themselves all sweets, for example, or the foods they most like. Over the long term, this approach can lead to overeating or, in some cases, to eating disorders. According to the Swedish study, it’s better to be flexible rather than rigid in learning to control your eating behaviors, particularly during the maintenance period. Allow yourself some treats from time to time; just be aware of the need for long-term restraint.
Obesity is generally associated with episodes of overeating and binge eating. Learning to control these behaviors is part of any weight loss program, and those who are successful at keeping weight off are able to incorporate these changes into their lifestyle.
Stress is often a factor in weight gain, and learning to control this stress is crucial. As the Swedish study concluded, “social support is an important aid for weight maintenance.” This may mean continuing in a weight loss program such as Weight Watchers or Jenny Craig or participating in a support group. Support from a spouse or life partner, though, can be either negative or positive.
Maintaining weight loss is indeed easier said than done. But it can be done, and it is well worth the effort.