PREVENTING REGAIN: HOW TO KEEP LOST POUNDS OFF

Weight loss, even just 5-7% of bodyweight has been shown to substantially improve heart health risk factors including high blood pressure, high cholesterol, sleep apnea, and insulin resistance/elevated blood sugar.  But, weight loss is notoriously hard to maintain.  A recent study of participants from a season on the “Biggest Loser” presented some disheartening findings.  The report found that six years after dropping an average of 129 lbs., participants had regained 70% of lost weight and their bodies were burning about 500 fewer calories a day than other people their age and size.  This report underscores just how difficult it is to maintain weight loss.  Still, many people do achieve significant weight loss and manage to keep it off.  The National Weight Control Registry (NWCR) is a database of more than 10,000 persons who have lost more than 30 lbs. and have kept it off for more than 1 year.  Investigations of these individuals reveal that maintaining weight loss is an active process requiring just as much focus as weight loss.  Let’s identify the actions that are essential to keeping weight off.   

Alter your mind-set

The key to maintenance is to accept that the changes made in one’s lifestyle during weight loss must be kept up during maintenance.  Choosing healthier foods, taking home half your restaurant meal, lacing up your sneakers for a walk – it is all about making and repeatedly practicing healthier behaviors until they become your new way of living.  It is also important to have a relapse prevention plan and implement it when your weight starts to creep up.  Slip-ups are a normal part of life but preventing slides and getting back on track is essential for effective weight loss maintenance.  Proactively coping with setbacks appears to be another strength of NWCR participants

Tweak rather than overhaul what you eat

When losing and subsequently maintaining weight loss, follow a plan that is not radically different from your “normal” patterns but just different enough that it supports effective weight management.  For example, while people on average lose weight more quickly on very low carb diets such as Atkins, these intake patterns are rarely adopted long-term.  When the diet is abandoned, the carbs come back in and so does the weight.  Instead of eliminating carbohydrates, moderate them.  In general, choose a weight loss plan that incorporates a variety of whole foods, including fruits, vegetables, whole grains, beans, nuts, lean sources of protein, and healthy fats.  Apply the 80/20 concept. Eat healthfully and calorie-consciously 80% of the time and allow for planned splurges.

Control calorie intake

Obesity experts estimate that the metabolic adaptation, or handicap, from weight loss is roughly about 15 calories for every percentage of body weight lost.   For example, if a 250 lb. person lost 50 lbs. (20% of their original weight) than they would need to take in approximately 300 less calories than someone who always weighed 200 lbs.  To compensate for the lower calorie needs, you can eat that number fewer in calories, burn the calories through exercise or do a combination of the two.  It is not known if the metabolism of persons who have lost weight adjusts over time.  In the case of the “Biggest Losers” it appears that the metabolic handicap of weight loss persisted 6 years after the initial loss.   Also, as we lose weight, there is simply less of us so we require fewer calories.  Therefore, after having lost weight we must consume substantially fewer calories than we needed for maintenance before losing weight. 

How do we effectively control calories?  Our environment is teaming with food cues and highly palatable high fat high sugar food choices.  A large percentage of the weight loss maintainers from NWCR record their intake daily.  Journaling is a way to self-monitor intake and stay accountable to yourself about your choices.  Eating similar foods day-to-day is another common behavior of NWCR’ers.  When there is less variation in the diet it is easier for to gauge an appropriate amount of intake and control portions.   Less variety also likely spurs less unplanned eating. 

Exercise, exercise, exercise!

While exercise is often not essential to lose weight, it appears that it is critical to keep off lost pounds. Therefore, it is essential to integrate physical activity into your lifestyle.  90% of NCWR participants get an average of one-hour of cardiovascular activity in six times per week.  The Dietary Guidelines for Americans advises weight loss maintainers get 60-90 minutes of moderate activity most days.  This is twice the general activity recommendation for adults.

It is also important to incorporate resistance training using weights or bands 2-3 times per week.  During weight loss, resistance activity helps to blunt muscle loss associated with weight loss.  Building muscle while in maintenance also helps to combat the metabolic slowdown associated with having lost weight. 

Watch out for TV

Sit less in front of a screen or TV.  Over two-thirds of NCWR participants watch less than 10 hours of television per week.  The average 35-49 year old American watches three times this much!  Monitor you leisure screen-time and rein it in.

Weigh yourself often

Over three-fourths of NWCR participants weigh themselves at least once per week.  Weighing yourself allows you to know when you are gaining weight and need to reevaluate your intake and lifestyle.  If you notice the weight creeping up, implement a relapse prevention plan.  For example, you might re-start measuring your portions and recording intake in a food journal.

Create a healthy environment

Make the places where you spend big chunks of time — your home, workplace, where you socialize — supportive of your healthier weight and lifestyle.  Join an exercise group.  Make activity part of your commute.  Use small plateware, utensils, and containers for your foods.  Engage family members in creating a healthy household eating environment and keep trigger foods out of the house.  Maintain a healthy respect for your own needs that allows you to prioritize the behaviors that help you be well.  The more weight-maintaining behaviors get incorporated into the backbone of your daily life the more likely you are to beat the odds and keep that lost weight off.

Sources:

Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M., Walter PJ, & Hall KD. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, published online May 2, 2016 ahead of print. DOI: http://dx.doi.org /10.1002/oby.21538

Kushner, RF & Bessesen DH.  Lessons Learned From the National Weight Control Registry.  Part 2 of Treatment of the Obese Patient.  2007, pp 395-403.  DOI:  http://dx.doi.org/10.1007/978-1-59745-400-1_21.  Print ISBN:  978-1-58829-735-8.  Online ISBN:  978-1-59745-400-1.

Magkos  F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly SC, de las Fuentes L, He S, Okunade AL, Patterson BW Klein S. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism, published online Feb. 22, 2016. DOI: http://dx.doi.org/10.1016/j.cmet.2016.02.005

Raphaelidis, Leia.  Maintaining weight loss: Lessons from the National Weight Control Registry.  Journal for Nurse Practitioners.  2016 (April) Volume 12, Issue 4, pp 286 – 287.  DOI: http://dx.doi.org /10.1016/j.nurpra.2016.01.009