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Maintenance & fighting regain

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/he

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):
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Member Comments About This Blog Post
    What a terrific round up of key research -- as topical today as back in 2009.

    MAINtaining continues to be the MAIN thing and these resources are worth checking out!!
    988 days ago
    A clue to maintenance is keeping portion control in mind, keeping exercise as a regular part of my life and being as patient with myself as I was during losing.
    2886 days ago
    Awesome resources!

    Thank you so much!

    -- Hilary
    2931 days ago
    Great resources, thanks for paving the way! I'm going to need good resources for maintenance in the not too distant future - hopefully some time next year!
    What I have found helpful on my way there is practicing a mindset like this: To not do anything to lose weight that I couldn't do every day for the rest of my life. Teaching myself new habits and un-learning my old bad ones instead of being on a diet creating a new "normal" for myself. It's a slow process, and I realise that it's a lifelong process, but I also hope it is a sustainable one.
    I haven't been losing weight before so I don't know if I'll be one of the successful 5%, but I aim to be, and I aim to always be aware and not slip into denial again.
    2933 days ago

    Very good points! I actually didn't catch that.

    Not surprising, though, given that Eades' opinions are listed in a blog rather than a peer-reviewed journal. LOL

    Maybe I'll move it to the bottom of the list...
    2933 days ago
    Thank you for putting all of this together, very interesting stuff!

    I have some serious doubts about the value of the Michael Eades blog, unfortunately.

    He says:
    "If you analyze these figures something interesting comes to light. 87.6% of successful maintainers (the NWCR database) lost their weight by restricting certain foods, i.e., fat, carbohydrate or protein. No one really restricts protein; it’s always fat or carbohydrate. According to the above data, 25% of the people lost their weight by counting fat grams) a low-fat diet), so subtracting this from the 87.6% means that 62.6% of them must have counted carbs, which, I’m sure, was a bitter pill for ol’ Jim to swallow. And is no doubt why it’s reported as it is, i.e., in such a way that it has to be dug out instead of presented directly."

    That's "restricting certain foods" but he immediately interprets that to mean "restricting certain macronutrients".

    I haven't personally seen the NWCR questionnaires to know whether the original questions are phrased in a way that implies that restricting foods means that you're restricting fat, carbohydrates, or protein instead of... you know... actually restricting FOODS.

    Were I a person who just could not be around Oreos and could not eat one Oreo without trying to gobble up an entire bag, so I kept Oreos out of my house entirely, and someone said "Did you lose weight by restricting certain foods?" I would say "Yes, absolutely".

    Unless there's something in a piece of context he didn't include, or in the way the questions in the original forms are phrased that I'm not seeing to justify the interpretation (entirely possible, but I'd have thought he'd cite that context to back up his point if so), it really gives the impression that Dr. Eades is so eager to look for something he can jump on that he didn't consider what it actually says and just ran with what he wanted it to say.
    2933 days ago
    Good info, thanks for sharing it with us!
    2935 days ago
    You are so right! I always thought weight loss business' like Weight Watchers didn't do much with maintenance because it was financially more lucrative to keep you needing to pay for their services. SparkPeople is free and while the friend support is phenomenal, you are right that it's so tempting to backslide on tracking nutrition and fitness. Maybe some additional incentives for us maintainers would be beneficial! Thanks for addressing this!
    2936 days ago
    Thx for summarizing, re-visiting and sharing NCWR's insights and findings!

    Maintaining is tricky, treacherous territory...we need to be SO careful...as I've found during some recent travels and backslides...back to SPARKIN' away again, though!

    I've been a member of NCWR and HIGHLY recommend anyone here at SP to join if you are able. There is much that we can contribute to their research and findings which in turn can benefit ourselves and others!

    2936 days ago
    Very fascinating information. Though I haven't reached the maintenance spot yet, definitely something to bear in mind!

    2986 days ago
  • SLCB1023
    YUP, been "at goal" too many times to even count. NEVER maintained. Like you though this time yes, it will be different. This time I am not losing weight, I am working at getting healthier. No maybe it is just a fancier way of saying I am losing weight but I am not feeling that way. Symantics though just might be the mind jump start I need. emoticon
    3054 days ago
    WOw--5% that shocking but thanks for the post b/c now I feel like I have more information then I did before and I agree I think maintaining will be the hardest journey! Good luck and keep it up!

    3055 days ago
    emoticon I Love All This Information...

    Knowledge Is Power

    I Take It 1 Day At A Time

    3057 days ago
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