What, like I wasn't going to chime in on a question like this? :-)
I was just writing something for somebody on this. I'll just paste below. This itself is just a more succinct version of The Second Helping Manifesto www.secondhelpingonline.com/?p=294
There's so more to this process than the mechanics of diet and exercise, and the mechanics overshadow all the other things that are going on.
A) First is the idea that we're "cured" of fat when we hit goal. People talk about obesity nowadays like a disease ("epidemic," etc.); personally I feel I have a lot more in common with AA or NA members. Rather than a disease, I view more like an addiction (a perpetual set of habits and beliefs with negative consequences). I don't think it never really ends -- you just learn to manage it better, and stay present to what you really want your life to be.
B) There's this assumption that when your weight changes, your life (quality of life, health, etc.) automatically changes with it. That's true enough to be grossly misleading. It's the whole "Life is perfect thin" idea we all know is BS -- the thing is the reality of that "life isn't perfect thin" can be stressful if not downright overwhelming. There's a lot of mental adjustments at play, on top of the fact you cannot ignore the mechanics, either.
C) Losing weight and managing it are two separate, related animals: dieting, at its core, is basically doing thing someone else told you to do -- eat-this-move-that. A diet's just a method for reduced and wiser intake and physical output to change your body. It's quite mechanical.
Keeping it off, on the other hand, is less about following and more about leading -- deciding where to take your life from there. I.E. Asking yourself "Now what?" and having the courage, compassion, creatvity and chutzpah to come up with your answer. And ask it again and again.
It's why sustaining a weight loss -- a life change -- is so damn hard. When life's stressors -- and weight loss can create a few more new stressors, mind you -- it's hard to stay present to Life B when Life A, by comparisson, was a lot simpler. You could just eat and stay still and cope just fine. With that defense mechanism gone, you have to come up with new methods of coping.
That's not to say that this isn't, or can't be, a permanent life-changing event; I argue it just requires the extra step of applying the lessons learned from weight loss to all the other areas of your life -- really changing the fundamentals of your life to the point that your day-to-day existence cannot support pre-weight loss's habits.
But there's a beautiful opportunity in that ... taking on the challenge of making life, post-weight something beyond your wildest imagination.
I didn't lose 250 pounds so I could lose 250 pounds; I lost it because I wanted to have an extraordinary life. And I could have that at my heaviest -- but I was so preoccupied with my weight and tuned out from eating so much that I couldn't see myself clearly. And I wanted to know who Russ Lane was, without all the masks and obtuseness.
*Laughs* and compared to that goal, losing three movie star's worth of weight was a breeze.
The trick is staying aware and present to that no matter what's going on around me. And even if I fail at that in the moment, giving myself the grace to start fresh. There's nothing more powerful in life than giving yourself a second chance.
A note on the statistics: The basic "90 percent of people gain it back" statistic was determined back in 1958. 1958. How many medical advancements have their been since?
Now add in the fact that this with the fact that focus groups don't focus on weight-regain, backslides, etc. and only BMI (which can be misleading), the statistics provide a broad overview of obesity but don't tell the whole story.
And lastly, couple this with the fact that all the mental challenges -- all the emotional/mental/spiritual stuff -- is all but ignored in the public discussions of obesity. No wonder people struggle with losing weight; no wonder people yo-yo; no wonder it's so hard to keep it off.
In all the sexiness and intelligent conversations of the mechanics of weight loss, there's very little wisdom on all the deeper, more subtle aspect of weight loss. And those subtleties have a way of inevitably biting you in the fat ass.