Keeping Weight Off -- A Final Word (August 11, 2015)
There is no question that our environment encourages overeating and discourages exercise and physical effort at every turn. If that was not true, our national disease burden would be less than half of what it is now.
This state of affairs may exist because the reigning president in the early 1970s got so tired of being criticized for the repeated food shortages of that time that he ordered his Secretary of Agriculture to make sure that there would never again be any problems with the sufficiency of the American food supply. Calories produced (and consumed) per person have gone up 25% since then. So this is all Richard Nixon’s fault? Hey, why not.
Republican social engineering then or not, things are what they are. And until that changes, each person who wants to be healthy has to create his or her own environment. With that in mind, it should be useful to look at the environments that the successful weight loss maintainers in the National Weight Control Registry have created for themselves. And when you do THAT, you see that above all: 1) 90% of them exercise an average of an hour a day; and 2) they all “maintain a consistent eating pattern”.
Daily exercise of one hour plus is an intimidating concept for those of us who share ancestral DNA with potatoes. So I must mention here that I know several people who have maintained impressive amounts of weight loss for respectable lengths of time without exercising. But my feeling is that if you want to avoid exercising and still maintain your weight, you’d better be REAL good at #2.
The average American woman has gone from weighing about 140 to 166 pounds in the last 50 years, the average man from about 166 pounds to 196. Calorie expenditures decreased somewhat during this time but that stabilized around 1980. So although it is true that the general level of American fitness is terrible, most of our weight gain has not come from inactivity, but from eating more. So although we emphatically do not get enough exercise, that’s not the reason we’re overweight.
If that’s the case, why would exercising be a useful weight maintenance strategy? Because overeating 280 calories or so per day produces a 28-pound weight gain in a year, whereas walking between 2 and 3 mph (a fairly easy pace) burns between 200-350 calories per hour. So a little math here lets you see how even fairly easy exercise, as long as it's daily and as long as it is of sufficient duration, would be a useful weight maintenance strategy.
How about #2 then, this “maintaining a consistent eating pattern” thing? Is there an inside scoop to that? Well, there are a couple of tricks weight maintainers use that haven’t gotten much attention. One behavior is that they tend to eat a lot fewer different foods than weight regainers. “Registry members reported consuming a diet with very low variety in all food groups, especially in those food groups higher in fat density.” It's not hard to imagine how developing a habit like always eating substantially the same type of meal would be helpful in keeping eating controlled and in keeping the diet consistently lower in fat as well.
Maintainers tend also to eat about five times per day, eat fast food less than once per week, and generally prepare and eat their food at home (sit-down restaurant meals average about 200 calories more than the equivalent homecooked meal).
Another relevant tidbit of information is that how you lose the weight in the first place doesn’t have anything to do with whether or not you regain it – unless you lost it on a liquid diet, in which case you are far more likely to regain it. My opinion here, for what it is worth, is that people who lose weight on a liquid diet haven’t had much of a chance to develop long-term eating strategies. That would also account for the popular wisdom (which, by the way, is false) that the slower you lose weight, the easier it is to keep it off.
There’s a questionnaire that is very commonly used in the study of weight management that measures hunger, dietary restraint (which is deliberately controlling and/or restricting food intake) and dietary disinhibition (which is a tendency to overeat when presented with a motivation to do so, like stress or the hot light at Krispy Kreme). Of those three factors, the degree of hunger experienced hasn’t been proven useful to measure. “Restraint” is helpful, but only when it interacts with the most useful measurement, “disinihibition”.
To clarify. People with a lot of disinhibition tend to be more overweight and are more likely to regain weight, as you might expect. Whereas having strong restraint in itself does not correlate with fewer overweight problems. It’s only if strong restraint is paired with strong disinihibition that it makes a positive difference in weight maintenance. Additionally, people who manage to increase their restraint become less apt to regain weight, and those who become more disinhibited are more apt to regain it. None of this is particularly groundbreaking, although it probably cost a lot of research money.
This is all interesting but inadequate. And so I have been hoping these last couple of weeks that I might run into someone I had not already spoken with who would technically qualify for the NWCR. That way I could pick their brains directly about all this. Luck was with me! The enviable gentleman of whom I will now speak lost over 70 pounds and has kept it off for several years -- and WITHOUT EXERCISE! So I finally got to ask a real live person the “how DID you do it?” question.
None of the techniques (including cutting out fast food and most processed food, and eating more fruit and salads) or other characteristics (inspired to lose weight by health issues) that he mentioned to me were any different than we have been discussing the last couple of weeks. And he didn’t seem to feel himself that any one of them was key to his success. It sounded like fundamentally he just wanted to be healthy more than he wanted to keep eating poorly. Or to quote him, “I just ate less. That’s something that most people don’t want to do.” Ouch.
So I think that the missing piece I’ve been looking for is motivation. That’s not quite the same thing as willpower. Motivation can sustain you and keep you on track – or put you back on the rails -- when willpower fails. It also explains why people who have been inspired to lose weight by a medical issue are better at keeping it off. Avoiding another heart attack can be a pretty powerful motivator.
My father (whose failed diet history inspired me to examine this subject in the first place) was never able to keep weight off for long, despite many years of slowly developing health problems that were unquestionably related to his obesity. It’s clear in retrospect that in addition to the crummy genes he was kind enough to pass on to me, he had emotional issues related to eating that no amount of illness, pain and disability could counteract.
But that is not true for most people, even if it feels that way sometimes. Most of us just need to find the motivation to develop the wherewithal it takes to create and maintain an individually healthy style of living in the face of all persuasion to the contrary.
--dr. diane holmes
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