Yesterday I woke up with ideas about where I was going with the Maintenance FANS weekly activities, in terms of making it into a workbook that really walks people through the NWCR survey and STOP Regain findings.
Something I have been dancing around the last few days is that in studies, addiction recovery systems don't do a lot better than what we see in weight maintenance. I am a recovering codependent, but it took many stabs to get 12 steps right for me.
From the studies I've seen about group support in maintenance it kind of looks like the medium isn't as important as the emotional connection.
In other words, online could be more effective than face-2-face or phone provided the participants are really invested in each other and the process.
It's been a while since I looked at those papers though so don't quote me on that. :-)
It might be interesting to consider papers discussing types of support in addiction recovery in general; I am not sure I ever did a literature search that included online support for alcohol or drug recovery but it might provide more papers to draw conclusions from...
(Maintenance literature is very sparse)
Edited by: 4A-HEALTHY-BMI at: 3/17/2013 (09:40)
Never, ever, EVER give up!
From BMI 53 (336 lbs) to under 30. Now aiming for less than 20% body fat.
moving on to the Group Followup Support heading, it does mention some initial findings for online maintenance support, including the STOP Regain results. That is, the proportion of participants to regain was similar between online and in person intervention, but the average weight regained was similar between online and mail (control) groups. A 2004 study found Internet support was as effective as in person support for maintenance.
This was good to see since an earlier part of the review article said peer support was less effective that professional support, but that was by telephone.
I've been posting a lot of my thoughts to my blog this week, and it's been my husband's spring break so I've not had has much sparktime as in the past, but I really want to get back to this. I'm continuing with "Weight Regain Prevention" from the American Diabetes Association. clinical.diabetesjournals.org/content/26/3 /100.full
One bit from the abstract I want to revisit is that while regain from particular studied regimens has discouragingly high, "a nationally representative survey estimates that 20% of individuals attempting weight loss are able to achieve and maintain 5% weight reductions for at least 1 year." While I would hope to keep of more than 5% from my high weight, it is a far cry from the depiction of a rebound where one regains all the weight plus some.
And now I wonder where the sparkpeople study is that came out a few weeks ago, though I think that one is about weight loss. Weight loss is about getting to a number on the scale, while maintenance is about accumulating a duration within a weight range.
I found an article that listed the myths, though the writer proceeded to debunk all the facts. I'm not usually one to use anger and stubbornness as a motivator, but I think this guy may have just earned a photo on a dartboard in my weight room. His message was that only weight loss surgery can help anyone. And he accused the NEJM article of being a pharmaceutical ad. I'm not going to link to it, because it's such a downer article, but if you google the NEJM article's title, his response is in the Portsmouth Daily Times.
P.S. The breastfeeding presumption is that breastfeeding confers some protection against obesity (not sure if this is for the mother or child, but I've heard both.) On the maternal side, breastfeeding makes me and everyone I know hungrier along with the calorie transfer.
Thanks! I peeked into it already, but I can't see the tables on the iPad. Dying to find out what they say about breast feeding.
Man, something I was reminded of going through blogs today is how when you're in weight loss, and you have a bad day, there's still that threshold of maintenance calories. But when you're in maintenance, or at least since I stopped calorie cycling, your calorie range is what it is. And to be honest, there no range with me. I set my calorie range where I did to reflect that I eat to the top of it.
I might also add, as a side-note, that the percentage of "successful" maintenance reported in a paper is also extremely dependent on the definition. I.E. the 20% success rate is tied to looser definitions (like keeping 10% of the original weight off) while the 5% success rate is tied to stricter definitions (like keeping within 5 lbs of goal weight).
I suspect that the NWCR may have adopted the "10% kept off" definition in an attempt to increase the sample pool of "successful" maintainers such that they could get statistically significant results on the data. As a research group they've used many different definitions depending on the study published.
I just went over the abstract today. Its a review of weight regain research, and it makes me consider the difference between regain, as in gaining some after reaching a goal, versus regaining to the starting/highest weight (or beyond). The studies I have been looking at dealt with the former, begging the question of how much is too much. When does a fluctuation turn into regain?
This was something I blogged about a long time ago. I'll try and look it up. I concluded that what I needed to be afraid of was not regain, but relapse. Relapsing into eating for entertainment or comfort. Relapsing into inactivity. Relapsing into complacency and helplessness about my health. Relapsing into not knowing or caring how much water or freggies I get in a day. Ah, here it is. It does range into discussion of the spiritual a bit, just fair warning. www.sparkpeople.com/mypage_public_journal_ individual.asp?blog_id=5051915
For me, at this point in life, I'm content to define maintenance for myself in terms of staying at or below a BMI of 25, with the caveat that obesity is actually a condition of excess bodyfat and not weight strictly speaking. But it's fairly difficult to monitor bodyfat accurately (I use calipers but I can't do it on myself). And bodyfat percentage is a percentage of weight, so it's not like you can discount weight in the end.
I just used to be someone who felt BMI was bogus, but in the process of trying to debunk it I learned it probably was important for the average person to be aware of. It's not perfect, but it's better than just comparing weight across the board. One of the articles linked in this blog mentions not everyone is able to achieve a normal BMI, so if that is the case, it may be better to define a goal for maintenance in some other way, if bodyfat was reduced and other metrics of health show improvement. If it's just about fitting the same size jeans, I think that's fine. That covers your waist/hip ratio, anyway.
In the end, of course, maintenance is not about weight but about behavior, and I guess that is why it seems to be so elusive. Everyone wants the result, but they may not be ready to change to being someone who exercises daily, or who eats for substance rather than escapism. I wasn't for many years. It's funny that we have this whole "don't say dieting" thing, but there isn't as apt a description for the fair weather exerciser. At the same time, we recognize that exercising has to be worked into gradually, but often assume dietary changes will happen more rapidly. But I'm just sort of rambling now. The thing that is so baffling about maintenance is whether you can do a thing for the rest of your life, whether 2 or 6 or fifteen years sounds like a long time. (They do to me, for sure). But what is the alternative? How long do we want the rest of our lives to last?
I was also intrigued to learn of their color code system, green for 3 lb. or less over goal weight, yellow for 3-5 lbs, and red for 5 or more lbs over. In the green zone, you get green rewards, in the yellow zone there was encouragement to apply problem solving skills to the situation. In the red zone, the intervention involved a return to weight loss strategies and a tool kit of reviewing their success story, a self monitoring diary, a food fact book (remember those?) a pedometer and some actual nutrition shakes. The red zone subjects also got individual counseling.
So the question is, how best to implement a similar program?
I was coming down with something yesterday and forgot to do this! The next segment of the Thomas and Wing article deals with a study that sought to apply the findings to over 300 people who had recently lost an average of 20% of their bodyweight. The essential thing they looked at was the effect of support groups on weight regain. A control group with no support meetings regained an average of 4.9 kg, the group with internet support meetings regained 4.7 on average, and the group with face to face support regained 2.5 on average. (now I've gotta go back and see where else they've used kg and I've said pounds.)
I guess I'll read ahead and see what they recommend in terms of face to face meetings. Ah, they don't get into that. Anyway, while face to face participants averaged less regain, the proportion of people to regain was not that different between Internet and face to face groups.
The next section is "Predictors of Weight Maintenance" which talks about the approximately 1/3 of respondents who gained 5 or more pounds and the traits and behaviors that differentiate them from those who continued to maintain.
The first factor is simply that people who had maintained for less than two years are less likely to hold onto it than those with over two years. And I guess that's what is important to keep in mind. When I finally undertook a lifestyle change, I knew it had to be slow and steady. I didn't do anything I couldn't keep up for a year, or the rest of my life.
Though that brings us to the next area, which is less dietary consistency (in the regaining group). I think there is such a thing as not enough variety. But it really comes down to whether you'll pop something in your mouth just because it's novel vs. thoughtfully retuning a recipe so it still complies with your nutrition plan.
Two behaviors I think go hand in hand are fast food consumption and TV viewing. The more you watch TV, the more you see all these ads for fast food. My mother in law was on a physician supervised diet for a while, and she would complain about how you can't turn on the TV without being bombarded with ads for food. It might be true, I don't watch TV except on the internet, where the ads are mostly different. I guess they've had some diet food ads lately.
Less frequent breakfast consumption was another one. I was a breakfast skimper when I was a teenager, and for me that relates to the final area which is depressive symptoms and disinhibited eating. Those may not seem closely related, but when I skip regular meals I go way overboard. I almost never do deliberately, but sometimes you wind up not in control of your schedule for whatever reason.
And depressive symptoms will strike at every other area when to comes to motivation and attitude, whether you feel like stuff just happens to you or whether you are in charge of your weight management.
Moving on to weight maintenance strategies in the NWCR, I found it interesting that 55% of respondents were still trying to lose weight. And I guess that makes me think about my own plans and goals, I am at a healthy BMI, but I don't think I'm swimsuit comfortable, any more than I used to be (though I just suit up and go with my kids when we swim. Their safety matters more than my vanity.) I do want to reach a balance between weight and strength where I can do a pull-up.
Eating strategies included more frequent meals (4.87 on average), avoiding situations that encourage overheating, preparing their own meals and eating at home, eating breakfast, less variety and not splurging on special occasions.
Self monitoring strategies included weighing more than once a week, monitoring calories or fat intake, and something called Cognitive restraint or mental effort spent on weight control.
For physical activity, most respondents preferred walking for about an hour a day though cycling and weight lifting were also significant. And they watch 6-10 hours of TV a week compared with the national average of 24.
I was doing calories cycling during transition which worked well because I'd do 2 or 3 days at my old losing range and then a higher (but not free/cheat) day. It was good to practice eating more without going crazy, while feeling confident I wouldn't suddenly balloon. I did still lose a pound a week, and it supposedly preps your metabolism to accept the higher number of calories. I imagine I'll do the same when I wean my tot.
Continuing on the Thomas & Wing article about the National Weight Control Registry, the stats on how people lost their weight was really eye opening. Now this is a group defined principally as losing at least 30 pounds and maintaining that for a year. Only 1% of the 6,000 respondents accomplished this through exercise alone, 10% used diet alone, and 89% employed both. Of those that exercised, 92% did so at home. I find that reassuring because I've sometimes felt like maybe I wasn't serious since I don't go to a gym. Though I have a high end treadmill, recumbent cycle, and extensive weight equipment in my house. So it's not like I'm lifting soup cans using a kitchen chair for a bench.
Took me about two months to fully transition into maintenance and stop loosing. So does take some time to get it right. I did it slow, as I was afraid I would start gaining if I quickly increased my calories and decreased my exercise.
current weight: 5.0 over
Fitness Minutes: (21,416) Posts: 2,610 2/26/13 9:39 A
I'm still messing with my calorie range! Despite being less active this last week due to a cold *and* eating consistently near the top of the range, I lost 1/2 pound. I'm done losing now. Don't want to lose any more. I recalculated using SparkPeople's instructions and have been following it pretty well.
Julia Sonoran Desert Joyfully owned by two retired racing greyhounds. Happily vegetarian for 38 years.
Team Co-Leader: SP Class of May 6-12, 2012 Team Co-Leader: SparkPhoenix - The Official Team
So looking at this first section, there are a bunch of biochemical reasons listed but I am interested by the statement that "Finally dieters motivation may decrease after an initial weight loss; clothes fit better, health may have improved, and the psychological effort or 'costs' of adhering to a weight loss regimen may come to outweigh the benefits."
Ideas I have heard on how to keep the cost of being overweight in mind include keeping one set of the biggest clothes (just one, and just the biggest), photos of you at your heaviest or near as you can find (I apparently avoided cameras quite effectively at my heaviest) and journal entries from when you started.
The two things that really made me think are that regain usually takes 2 or 3 years. Maybe people fall into a pattern of thinking "well, I'm not at my low, but I I'm also not at my high." I guess one way to guard against this is to donate the in between jeans. I already donated my 18s and 16s, time to let the 14s go.
The other point that actually surprised me is that there's no evidence that regained weight is harder to lose again. Now that I think about it, this is a scenario described in diet books about why you need a new, magic diet system. What we eat is important in terms of providing satisfaction at an appropriate caloric intake, but the idea that certain foods will unlock fat burning at any quantity is a myth.
10 best Strategies for Long Term Weight Loss success This article is a great basic reference, and it ends with a great thought: "Losing weight is about improving your life, not restricting it. So be sure that you're focusing on the positive and embracing your healthy choices each day." Jennipher Walters
The third S of success is Support. And I think this is one of the things that gives me the most hope about my chances of maintaining my healthy weight, because I have this and other great teams where people who have done it are helping others. And I believe as we'll that as I go forward giving support yo others, this also keeps me engaged with healthy behaviors.
The second of the 3 S's is self-monitoring, or watching our attitude for signs of trouble. It is natural to expect that the beliefs, attitudes and expectations that allowed our weight to get out of control before are just waiting in the wings to take over. Special focus is on the excuses to not take care of ourselves by taking it easy on ourselves.
Maintaining a healthy weight part 3: The 3 S'sof success
I'm going to go ahead and give this three days to work through. The first S is self efficacy. It's awesome that I just heard the podcast I blogged about on Valentines day about self worth and self efficacy. I mean, I've read this article before, who wouldn't want to know the three S'sof of success? But I understand it a lot better. The words are connecting.
As it says, self efficacy is task specific. And as we move out of weight loss to maintenance, the task is less about the numbers and more about sustaining motivation since we are not getting motivation from the scale or people noticing our changes. The tracking and numbers remain essential, but the new task is staying motivated to keep tracking even though we have "arrived."
to all the new members. I'm going on two years of maintaining a 40 lbs weight loss. I'm probably smaller now than when I got married. I'm comfortable in my own skin, although I wish it would firm up.
I recently started a cardio/strength training regime. It kicks my butt! I like how I feel when I stop though.
Take time to click and look around. It takes a while, but well worth the time!
current weight: -4.0 under
Posts: 1,393 2/20/13 10:46 A
The second half of yesterday's article covers intervening with the scripts of failure and replacing them with positive self talk.
I went and saw Wreck It Ralph the other day, and I thought it was a great illustration of how our self esteem is composed of an intrinsic element vs. extrinsic things. It is not that extrinsic things don't matter, but they can't give you something that isn't there intrinsically. Extrinsic esteem needs to build on your intrinsic value. It mattered for people to like Ralph, but like him for who he was and not who he thought he wanted to be. Well, this is turning into it's own blog.
But as far as the lesson goes, I have developed pretty good positive patterns in my physical health program. I have confidence in myself here, but I have other areas where I don't, like in my home organization. And a situation, let's call it an opportunity, has arisen for me to apply better thinking on that.
Maintaining a Healthy Weight Part 2 introduces the three Ps of failure or pessimism. I'm familiar with these from the book Learned Optimism. And I think the real takeaway here is that optimism and Motivation are skills, not qualities written into our DNA. We are not doomed to repeat the past. Where I really practice this is in analyzing my weigh ins. I don't take that number as a personal, permanent or pervasive evaluation of myself.
So moving on to page 2, metabolic issues. This part is a little confusing to me, but I will start applying it. I often check the nutrition feedback report on my meals. Or sometimes I plan a food grouping and check the protein/carb/fat ratios. I just did that this morning.
Though it seems counterintuitive that fat preservation would result from having less fat. (20 vs 30 percent). Maybe it's the satiety. I apparently need to re read. Okay. He's saying regain involves greater use of, and likely appetite for, carbohydrates. Slightly increasing protein is to contain satiety.
There are many diets that make it sound like there is a magic balance of nutrients that unlocks fat burning. Nutrient balance is crucial, but mostly because it helps us feel good at a proper calorie level.
On calorie range, have you set it up in SparkPeople's trackers? I'd be happy to help you if you want more detailed math, like in the calories 101 article. That's what I used to do before I got a fitbit.
This is exactly what I needed, being selfish, reading your message. I am brand new and do not really know where to start. Thanks so much for including the link. I will read through this. I am not sure what my ideal calorie range is. I need to play with it a bit more to say the least. It is different for everyone I know. I pay most attention to protein intake but need to be thinking about fiber, well I think it will help to think about fiber. Opps, I am going off on a tangent.
Welcome and thanks for posting.
I AM STRONG!
1/15/2011 - 1st Full Marathon - Riverfront Race Festival Charleston SC 5:17:16
5/09/2010 - 1st HM - - Pacers Funning Festival 2:26:45
current weight: 0.0 under
Posts: 4,857 2/17/13 12:41 P
Welcome to maintenance. Stick around these parts and ask questions. People here tend to be active and like to help others. I have been in maintenance now about 2 years and a couple months. At a healthy BMI and staying there!
current weight: 5.0 over
Posts: 1,393 2/17/13 10:05 A
Today I'm beginning a journey through maintenance. I've been in my goal range for 9 weeks, and I just ended my SparkCoach subscription so this will be my new home for program study. I followed the team resource links to the sparkpeople resource center on maintenance and am starting with Maintaining a Healthy Weight Part 1 by Dean Anderson. I read just page 1 today. www.sparkpeople.com/resource/wellness_arti cles.asp?id=488
I have experienced set point changes when I've been injured, so I'd guess set points take about 6 weeks of rest, at least on the going up end. I think I've found my best calorie range, though I've had a little trouble because of a tooth problem I need to take ibuprofen before bed and so I have a couple crackers to avoid stomach upset. So I'm consistently over. Also, PMS, I hope. And the ibuprofen is probably causing water weight. Could be any of these things. So my weight is one or two pounds over ideal, but still under the BMI cutoff.
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