How Not to Regain Weight (July 28, 2015)
My father was obese throughout my entire childhood. This was at a time when no one else had a fat daddy or was fat themselves (or so it seemed to me at the time). That is a human landscape that one doesn’t see much anymore.
So I was a youthful spectator to what was then an uncommon phenomenon -- someone doggedly taking up one diet after another and often losing quite large amounts of weight, only to gain it all back, usually quite rapidly. It may be a far more common sight now than it was back then, but just because it occurs frequently does not make it any less painful, either for those experiencing it or for those who give a hoot about them.
At the time of my father’s struggles, about a third of American adults were overweight, and a little over 10% were obese. Those figures have at least doubled (the latter number has tripled) since then. Although there are some people who believe that between the 1960s and now there was a sudden sharp increase in American self-indulgence and laziness large enough to account for this extraordinary physical change in the population, my thought is that that is stretching it quite a bit. It is far more likely that there has been some kind of change in our patterns of life and living, and most Experts are in accord on this.
It seems sometimes like everyone has a different theory as to what has changed, a reason usually that could be summed up in a few sentences but somehow in order to be communicated effectively has to be expanded out to book length. Of course there is most likely more than one reason, and theoretically if we could eliminate all those contributing factors we would see our national weight problem vanish as well.
That’s all well and good, of course, but in the meantime our surroundings militate against leanness in every way except to ridicule those who don’t possess it. Most of us stocky types have managed to get down to a healthy weight at one time or another, only to find ourselves beset on all sides by a heartless inactivity-promoting food-pushing environment, without the tools to push back. So, positing that someone, like my poor father, has gritted his or her teeth and managed to get down to some semblance of a normal weight -- how to stay there, when only about 5% of us can maintain a weight loss of 10% or more of our initial body weight for five years?
Well, the news is a little better than that. About 20% of us manage to keep off that weight for a year or more, and some Scientists decided about 20 years ago to try to discover some common attributes of this group. The result is a very useful website and organization called The National Weight Control Registry, and it purports to track people who have lost at least 30 pounds and kept it off for a year or more. Their members have lost an average of 66 pounds and kept it off for an average of over five years, and those are some brains I would definitely want to pick.
So, keeping my dad in mind here, I would have two questions to research with this group: (1) How do you know if, once having lost weight, you’re in a high-risk group for regaining it? and (2) How do people who HAVE kept it off, managed to do so? (42% of them say that it is easier for them to maintain the weight loss than it was to lose it, and I REALLY want to talk to THEM.)
Question (1) here. Once you’ve lost it, what are the odds you’ll be able to keep it off? Well, the single best predictor of maintaining weight loss was – are you ready for this? – how long you’ve already kept it off. (Oh, GREAT.) If you start gaining it back right away -- meaning, in the first year after you've finished losing it -- you’re toast.
More specifically, if you’ve kept it off for two years, you’re 50% more likely to avoid regaining it after that. And once you’ve made it to five years, your odds of staying at your goal weight improve even more markedly. Well, that’s worth something. But it’s still not giving us anything to go with.
The next most reliable predictor of successful weight loss maintenance is, very interestingly, something called “lower level of ‘dietary disinhibition’”. “Dietary disinhibition” is a ten-dollar term meaning “periodic loss of control of eating”. It is measured in a questionnaire that also evaluates two other factors ("hunger" and "cognitive restraint") thought to be important in weight maintenance. But at this stage of the game, when you’re getting ready to embark on life as a newly thin person, the only meaningful one of the three is the ability to stop at one piece of key lime pie, even when OVER HALF OF THE PIE IS LEFT OVER. If you are good at this, you are 60% more likely to maintain your weight loss through that crucial first year.
People who were prompted to lose weight by a “medical trigger” (meaning a medical event or maybe a doctor with a particularly choice command of language) were marginally more successful at keeping weight off. I say “marginally” because we’re talking a difference of four pounds over two years, in people who averaged a 66-pound weight loss to start with. I’m no statistician, but this doesn’t really sound significant to me. My thought is that it’s probably just an indirect measurement of motivation, a medical scare more likely to leave a lasting impression than simply catching sight of yourself in a full-length mirror. Or that's what I would say if someone asked me
A very helpful habit here was keeping diet consistent, all the time. People who did not “loosen up” on the weekends were 50% more likely not to regain weight over that first year. This also applied to holidays, although it looked like if you’re good all year including weekends, a few holidays aren’t going to mess you up too badly.
So in summary, if something or someone in a white coat lit a serious fire under you about your health and your weight, you lost the weight but then continued your dietary discipline AND stuck to it day in and day out, and if you regained any weight you immediately lost it again, for at least the first year and better for two, you’ve got a very good shot at staying thin. After what you went through to get there, you deserve it.
But -- what ARE those helpful disciplines? Do we know? Well, yes we do. And after next week, you will too.
--dr. diane holmes
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