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Strength in Numbers Predictors and Behaviors of Maintenance

Sunday, June 26, 2011

While Russ gets the wekeepitoff.com site back up and running, I'm going to repost my columns from there on my blog here so I can refer to them when I need to.

Strength in Numbers Predictors and Behaviors of Maintenance
What are successful maintainers actually doing? Scientists are actively researching these questions and publishing their findings. Our resident fat ass-now-bad ass, computational biologist Angela Baldo, reviews those findings and distills their wisdom for you.

“Maintenance of Long-Term Weight Loss”
By J. Graham Thomas, MS, and Rena R. Wing, PhD

Published In: Medicine and Health Rhode Island, February 2009

Full text available:

If I hear one more person say, “just keep doing what you did to lose the weight,” I think I will scream. I have gained and lost 100+ pounds twice — losing weight wasn’t the problem, but keeping it off sure was.

Because while similar to weight loss, maintenance has subtle, important differences, both in procedure and in psychology. This is the whole point of the Second Helping Online, and today I will focus on some specific strategies that have been shown to be statistically associated with successful weight management after loss.

One of the most exciting aspects of emerging weight loss maintenance research is that it can help us understand what kinds of things we need to do in order to keep the weight off. The big difference between this approach and others I have seen is that there is actual scientific research backing up the claims, rather than some “expert” speaking about his or her individual personal experience or philosophy.

National Weight Control Registry team member J. Graham Thomas (interviewed recently by our own Russ Lane) published an article last year with Rena Wing in Medicine and Health Rhode Island, the official member newsletter of Rhode Island Medical Society. In this paper Thomas outlined the strategies that are most statistically associated with weight management.

Here are the best predictors of keeping weight off:

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 associated with weight maintenance 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:

Deliberately taking small helpings
Avoiding certain foods
Counting calories
3. Having lower levels of depressive symptomology
4. Controlling overeating

Yes, this means that it’s important to continue logging and/or controlling eating. It’s important to keep exercising. A lot. If you want to keep the weight off, these behaviors need to continue.

One of the more interesting behaviors listed was controlling depression. This means getting help in the form of therapy and/or antidepressants, if necessary. It is not a factor one usually hears about in terms of controlling weight, but it makes sense: how is a person going to make rational, healthy decisions while suffering from mental illness?

Along with summarizing the strategies taken by successful maintainers, the article discusses how to teach these strategies. One of the most important factors associated with weight management was frequent weighing and using that information to regulate behavior.

Thus, as with any feedback system, the best control is achieved by:

1. Frequent monitoring
2. Immediate correction

Given these research findings, I find it stunning that there are no dedicated evidence-based weight management programs. Most programs focus on the weight loss, and tack on a slipshod “management” guide at the end as an afterthought. At best they tend to be based on the personal philosophies of “experts.”

I would love to see a program that leads people through the transition from loss to management, walking that delicate tightrope between exploring the wonderful new options that a healthy size offers in life while staying grounded and accountable to maintenance. There are plenty of weight loss programs out there, but why are there none oriented specifically toward weight management after loss?

Is it because weight management doesn’t pay as well as loss? Management isn’t as exciting as loss? So few people focus on management that there isn’t a market for it? A combination of these reasons?

People do successfully lose weight using weight loss programs. But unfortunately they also tend to usually gain back the weight. Is it any wonder? I would like to see this changed. Please, someone, develop an evidence-based program. But please, develop it!

Not only for me, but for the thousands upon thousands of us who spent so much time and energy (and even money) on getting the weight off. It is too important in terms of our health and our quality of life, just to let the pounds slip back on.
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Member Comments About This Blog Post
    I shy away from the idea of weighing myself with a scale. This is because I know that obsession with numbers is a symptom of ED (eating disorders) such as anorexia nervosa and bulimia. There are other newly documented EDs as well, such as one that involves excessive exercise. That's why in my first year (and several months into my second year) I have avoided a scale, in fact I didn't even own one! I let myself be weighed whenever I needed to visit my doctor for whatever reason. I was losing weight steadily at 1-3 lbs a month. I was only one pound away from my goal weight, and then I slipped up because I had a health set back. I had no idea how much I gained back, so I did finally buy one. In 5 1/2 months, I gained 5 lbs back. BUT THIS IS GOOD to know. And I don't think owning a scale or weighing myself is excessive BECAUSE SparkPeople has taught me the importance of consistency. And for me, that means ONCE a week (Friday mornings). Spark People is the voice of sensibility. Really glad to have joined the maintenance team.
    606 days ago

    Comment edited on: 3/20/2018 4:35:08 PM
    emoticon for sharing.
    975 days ago
    "One of the more interesting behaviors listed was controlling depression. This means getting help in the form of therapy and/or antidepressants, if necessary. It is not a factor one usually hears about in terms of controlling weight, but it makes sense: how is a person going to make rational, healthy decisions while suffering from mental illness?"

    This is such an important insight. Weight gain (comfort eating) may have been the result of depression: but if the weight gain was also "protective" -- for example, to avoid sexual attention -- then losing protective weight may retrigger vulnerability and depression and subsequent comfort eating and weight regain.

    And so treating depression may be essential for maintaining weight loss.
    1688 days ago
  • BOPPY_
    One of the most powerful forces in social psychology is "it takes one to know one". This can be stated in many different ways:

    * Identification is the most powerful force in learning
    * Role models show the way
    * Existence proofs: "If X can do A, then I can too, because I'm the same as or better than) X.
    * Competition: I can outdo X

    What I've noticed about many/most of the successful folks that have reached maintenance, and then been able to stay there for any length of time:

    * Recognition why change is hard. And, if you're here (at SparkPeople) "you" have recognized. at least at some level, that you need to change.
    * Change requires a program, and requires consistent, continuous effort to be effective.
    * They understand the purpose of measurement and recording ("tracking")
    * They understand the importance of empirical data
    * They understand the importance of (a) identifying a problem, (b) understanding a problem, (c) finding a solution through measurement and empiricism.
    * When and how to get help.
    * Setting up a feedback system that uses observation and measurement to modify program parameters both quantitatively and QUALITATIVELY to make sure that the program progresses through all stages of its evolution

    Many (most?) of the folks I've "seen" on SparkPeople do not have the skill set I've outlined above. Moreover, many of them are "dedicated" to avoiding those issues. Sometimes the culprit in these mis-efforts is defense mechanisms, but most often it is a world view (including but not limited to religion) that precludes the skills from being "entertained" much less learned.

    I'm trying to figure out how to make this skill-set, or meta-program more attractive or digestible to more people.

    What makes Angela's efforts above and elsewhere so interesting and important is that she's made the transition from applying her powerful skill set from losing to maintaining.


    Lee emoticon
    2055 days ago
  • no profile photo ELIZADUCK
    Thanks for posting this info! I remember the first (of six times) I reached my goal weight, and was concerned about maintenance. So I went to a Weight Watchers meeting. I just wanted to check it out to decide whether to join. They kicked me out! never went back THERE!

    On the depression side, I think the connection is between neurotransmitters affecting hunger hormones and consequently insulin levels.
    2086 days ago
    The point about there being no money in weight maintenance programs really struck me. I'm an early bird and usually watch the local 4 am news. I forgot that today is Sunday and thus no news cast so I spent 10 minutes channel surfing. More than half the channels were paid programs and three-fourths of those featured some sort of weight-loss-for-profit plan.

    As in so many things, follow the money. I guess a "before" picture of someone at a healthy weight and an "after" picture at the same healthy weight doesn't make for sales.
    2135 days ago
  • MAMMAC66
    emoticon Thanks for posting this article. It was very concise and made a lot of sense. emoticon
    2184 days ago
  • OOLALA53
    The only thing I took from the NWLR is that it seems to take 2-5 years for new habits to become ingrained, and even then there is a chance for relapse.

    I think we would have more success if people were to accept this from the beginning and not be so drastic in their attempts to lose weight in one fell swoop. I've been stepping my weight down over time and don't really feel that maintenance is that hard because my changes have felt very fair. I'm more concerned that even the NWLR represents such low success rates because of the emphasis on speed and consistency of loss.

    We've got whole nations that live with an abundance of food but keep low average BMI's, meaning they are not thin because they are poor. I see a lot more potential in supporting people here to adopt more of their practices than on focusing on what are actually normally failed strategies with a few exceptions getting all the attention. emoticon
    2274 days ago
    There is one factor I have not seen dealt with anywhere. I was almost to my goal weight 6 months ago when I went on prednisone for RA; then 3 months later I went on again for another course. The result was about a 10 pound weight gain! I have decided that prednisone (steroids) are no longer an option for me and I hope this will resolve my problem with regaining weight. I'll just have to deal with the pain and use physical therapy type treatments.
    2351 days ago
  • KEEPFIT2013
    Thanks for sharing this. I need to be reminded of these indicators to help me stick with my nutrition and fitness tracking. So easy when life gets busy to drop off!!
    2360 days ago
    This is just what I needed this morning!



    2405 days ago
    This is one of the most interesting blogs I have read on maintanance - thank you for collecting all this helpful information! I am already aware of the beady (envious?) eyes of a number of people watching to see how long it will take for me to start regaining weight... I like my revamped body and rejuvenated mindset and am really interested in finding out how to sustain this momentum. emoticon
    2408 days ago

    While I've been boning up on the research and talking with folks in public health about this, I came across an interested study of attempted interventions and all the criteria used to demonstrate is viability.

    I thought "Sweet. A checklist!"

    Moreover, other researchers are just beginning studies to distinguish behaviors between losers and maintainers (a study from two years ago that was my little "I told you so!" moment, lol).

    The psychological and social implications of maintaining are really what set keeping weight off apart from weight maintenance, in my opinion. Actually hitting goal, staying there and dealing with all the changes to life it brings (not just the fun stuff) is what truly separates the two.

    This is more my own data having worked on this for so long -- journalism's just ethnographic data by another name, really -- is it being common one of the big reasons people stop trying -- they hate the attention they're getting in "new body" so they get fat again.

    It can be a drag, frustrating, all those things. Or those of us who've learned its ins and outs can actually show people that you A) don't have to regain or B) feel like you're in life sentence of weight-loss jail.

    So I truly believe that for anything with maintaining to change (amount of research, public policy, mass media attention, intervention programs) two things need to happen, as jaundiced as it sounds:

    A) Maintenance must be proven to be successfully monetized. Once money's made capitalism works its magic.

    B) Most businesses (including this one) look at weight regain statistics and then wonder why they should invest in maintenance programming because the market seems so low. Because there's little support (I mean infrastructurally, or attention, not "motivational speak) it's become a Catch-22. That's even more true when you factor in the amount of marketing dollars companies spend on "the success story."

    Even most of the research that exists stems from folks like us putting ourselves out there. I'm always looking for men and women up to putting themselves out there a little more and breaking that Catch 22 with me.

    2463 days ago
    Thank you again for this blog post. I am at the point where I've gained back almost all I lost and reading this helps me recommit and refocus. I want to be a maintainer, not a constant yo-yoer!
    2463 days ago
  • JOHN__
    The conclusions of this analysis certainly resonate with my experience.

    Both my wife and I are participants in the NWCR.

    It may be up to a group of we long-term maintainers to create an evidence based program.

    I just visited wekeepitoff.com. This looks like a great idea. It looks inoperable at present as I could not register. Please let me know if I can be of any help with such a project. I am a former broadcaster and journalist. I have often thought that a portal where maintainers could share their experience would be helpful in the extreme in starting a real discussion about the realities of long-term lifestyle change in the management of weight.

    I am new to Sparkpeople. I never knew this resource existed. I'm looking forward to reading the backposts of your blog.

    Thanks for bringing this to the front!


    2464 days ago

    Comment edited on: 2/17/2013 1:08:27 AM
    Interesting. Thank you for sending me the link.
    2493 days ago
    Thank you for posting this!!! I am new to maintenance mode AGAIN and this is SO important to me!
    2498 days ago
    Depression has been a long time problem for me and now I take regular medications and see my therapist weekly. It helps. However, and this is a big one, many of the medications cause weight gain. emoticon
    2554 days ago
    I would never been able to lose weight without focusing on depression and addressing it with a good therapist. Depression casts a shadow on life possibilities and makes us think doors are closed that can open. Many Spark tools help depression, but do not replace addressing it. Great blog.
    2614 days ago
    I wonder sometimes if certain foods doesn't trigger depression and over eating? For me, the weight maintenance suddenly became SOOOOOOOOO much easier than it was before after I found out about my 20 something allergies/intolerances. My mood stabilized as well (used to have severe mood swings and crying episodes in which I felt depressed). I also used to binge eat then exercise twice as hard to try to work off the calories I ate. Once I found out what was making me so sick all these years, a light bulb switched on and I suddenly figured out the connection.

    I know about sugar, but I've done a lot of research into gluten intolerance and celiacs disease and I think gluten is affecting the population more than they realize.

    Very interesting blog!! Thaks for posting! I agree that there needs to be more focus on maintaining!! Thats the hardest part of the game, I think.
    2642 days ago

    Comment edited on: 8/22/2012 10:04:02 AM
    Thank you for detailing the article's main points. I agree that the transition from weight loss to maintenance is an undersupported, underacknowledged, and underinformed area. It's also probably one of the most important, pivotal times, where those who have released weight are vulnerable and need the most support and guidance.

    I'm so glad this community exists!

    Thank you.
    2645 days ago
    2659 days ago
    This is my third or fourth time "at maintenance". Based on my past "failures", I KNOW that regular weighing-in and daily tracking are critical to my maintaining my weight. It is what it is and if that is what I have to do, so be it.
    In the past, I haven't incorporated less TV in to my maintenance plans. Given how easy for me to come home from work and mindlessly eat supper while mindlessly watching watch, I will work on changing this. Physically and emotionally, I will be better for it.

    2729 days ago
    While depression can have a big impact both in weight gain and weight loss, that does not seem to be an issue for me at this time. I have found that my appetite is larger now than when I when I was in the weight loss mode -- or even when I was overweight. I have been reading that this is common and there is scientific basis for it. That after the body has loss a significant amount of weight, it thinks it might be starving and wants to gain the weight back so it releases hormones to stimulate appetite and withholds hormones that make you feel satisfied. However, with what I have read, other than will power, I have not heard any solution to the problem. Yes, we do need a good weight maintenance program that addresses these issues!
    2784 days ago
    For me depression is like a catch 22. I gain weight and that makes me feel depressed, I eat sugar goodies to make me feel better that causes me to gain weight and so on and so on. Just thinking about the fat depression keeps me on track, I never want to go back to that dark place. Great blog and very thought provoking. emoticon emoticon
    2791 days ago
    I know this blog is not a new one, but as I approach my goal (though I still have a significant ways to go at this point) and having been close to goal before after losing 70 lbs, just to gain it all back and more, maintenance is something I am looking towards getting as much information as possible on. Maintenance actually scares me. I don't ever want to go back to the old way of being. I enjoy my healthy foods and exercise. So I read as much as I can on it.
    2805 days ago
    A sad irony of dealing with depression is that weight is often MUCH harder to keep off when you're taking antidepressants. I haven't been on them myself, but I've seen several friends & a sister gain significantly while on the meds & then drop quite a few pounds easily once they're off.

    I used to struggle with dysthymia (low-grade depression) a couple of times a year. Vigorous cardio exercise (outdoors when weather allows) now keeps me free of it. I know it doesn't solve the problem for everyone, but it does help--I wish doctors would prescribe it as readily as they prescribe drugs!

    I'm close to my own goal & look forward to joining your maintenance team very soon.
    2906 days ago
    I think all that was said is valid. Depression part , can be valid, it can be a excuse. It pocks around in other addictive behaviors.
    Maintenance of weight after loss in itself is the battle of the mind, what we do or fail to do. I know depression , but I don't blame it, for emotion grab and eat attitude to make me feel better. I am on my 10 th month of maintenance and it is a continual evolving mind set , towards keeping this more fit body and mind.
    It is to easy to blame Depression on one aspect the obesity problem.
    I am an expert of myself to take charge of this gift that has been given to me.
    Sparkpeople would make a killing on a book on maintenance.
    Where are the experts and authors, like diets, so is maintenance , there are so many ways to keep the goal.
    3000 days ago

    Comment edited on: 8/30/2011 10:46:43 AM
    It would be nice to have a program geared toward maintenance that was structured and evidence based.....in our dreams for now, I suppose! For now I'll continue to hobble along w/ Spark and adjust to my current needs.

    The part about depression is really interesting, and so true! Mental health is such an integral part to weight gain, loss and maintenance, just from the aspect of how one sees oneself in the world. Something else to work into the program.
    3065 days ago
    It's great to hear someone zero in on depression....not to minimize the other factors, but I KNOW depression is a biggie!

    Thx for sharing...haven't thought to stop by Russ' site in a while!

    3065 days ago
    3065 days ago
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