Sunday, August 02, 2009
This topic seems to be cropping up a lot around here, lately.
Birdie wrote a blog about it.
(Update: Birdie retired her personal page when she became DR_BIRDIE. There were some real gems among her blog posts. You can read her newer "official" posts here:
WALKWITME wrote a blog about it.
Nancy Howard wrote a blog about it.
We've been collecting information about it at my regional spark team page.
I believe this is the single biggest problem with weight loss, and too few discuss it. I think SP would be an excellent place to disseminate the scientific findings from groups like the team managing the NWCR. I would like to see a whole system set up for tracking maintenance on Spark People that is as visible as the weight loss.
After the initial loss a person is not even halfway "done." I suspect that there needs to be training in maintenance mentality before someone even gets to goal weight. I'm trying to train myself in this, now, so that when I get to goal I will have the hard realistic view I need in order to manage my maintenance, long-term.
I lost over 100 lbs in my 20s through diet and exercise and gained it all back plus a lot more. This time I am playing for keeps, because I will NOT go down this road again. I simply refuse. I've seen what can happen - from the inside - and I WILL NOT go there again.
To that end I've been drawing on all the resources I have, including my skill at reading the scientific literature (I'm a research scientist by trade). I am attempting to prepare myself mentally for what I consider the REALLY hard fight, the one that will come AFTER the loss, the fight of maintenance.
There are a lot of reasons why maintenance is harder. It's not flashy - you're not changing in appearance, so there aren't all those nice external encouragements from other people noticing. In fact, as time goes by, the people who meet you after the loss often have no idea where you've come from. To them you've always looked fit. It's tedious to log food and activity. The temptation to relax is strong, because you already do look and feel good; there isn't the pain of plantar fasciitis or the embarrassment of chairs with arms or airplane seatbelt extenders to remind you of why you're doing this.
When's the last time you saw a media story celebrating someone having maintained a large weight loss? Exactly. They don't, because it's not news, and it's not exciting, and won't sell commercials.
I've been combing the literature for articles about maintenance of weight loss and found a nice 2009 one written by the team behind the national weight control registry www.nwcr.ws
This paper (which is written a bit more with the lay reader in mind) summarizes statistically significant predictors for successful weight loss maintenance.
Here they are:
1) longer duration of weight loss maintenance (more than 2 years)
2) dietary consistency
3) less fast food consumption
4) less TV viewing
5) more frequent breakfast consumption
6) lower levels of depressive symptoms and dis-inhibited eating
Key behaviors identified as associated with weight loss maintenance in the article are:
1) activity levels of over 200 minutes per week (at least for women in the cited study)
2) high levels of dietary restraint, such as:
- a) deliberately taking small helpings
- b) avoiding certain foods
- c) counting calories
3) having lower levels of depressive symptomology
4) controlling overeating
They suggest that keeping contact with maintainers is important for continued maintenance if the loss was facilitated by a program of some kind.
An earlier paper by the same team says that one of the best predictors of weight loss maintenance is to have maintained the loss for 5 years. So once I get to my goal I am going to think about it like cancer. I will stay vigilant and won't consider myself "done" or "fat free" until I've maintained for 5 years.
I will celebrate every month that I've maintained on a countdown to 5 years (60 months).
Statistically, 5% of people who lose a large amount of weight manage to keep it off. That 5% is made of real, live people, living real lives somewhere out there. I am going to do everything in my power to be one of them.
All this points to the need to remain active in places like SparkPeople for many years after reaching goal levels. Which is probably good anyway, because it helps encourage the people just starting out, too.
P.S. There's also a really nice 2005 paper reviewing weight management behaviors by a pair of Swedish scientists:
P.P.S. Here's a nice USA TODAY article from 2005 about weight maintenance: www.usatoday.com/news/health/2005-10
P.P.P.S. RAYLINSTEPHENS reminded me that the chapter on weight maintenance in the Hacker's Diet is excellent:
There is a Spark Team for people using the Hacker's Diet tracking tools:
P.P.P.P.S. RUSSLANE has a site he runs, focused specifically on articles about maintenance. It's well worth checking out:
P.P.P.P.P.S. There are some detractors to the NWCR, although they may be misinterpreting the data (see ELISADEL's comment):