Thursday, January 10, 2013

Successful Weight-Loss Maintainers: Gertrude, the Poor Eater

Now that we have met Mark, the Golden Boy of Weight Loss, and Julie, the Fitness Enthusiast, we turn our attention to Gertrude, the Poor Eater.

According to Lorraine Ogden’s paper in OBESITY, people like Gertrude (who I invented) would make up about 10% of National Weight Control Registry participants.

Gertrude, is 53 years old, works as a retail clerk, and is divorced. Her current BMI is 26, down from 37 almost six years ago. Like Julie, Gertrude also began gaining weight in her late teens and has parents, who are slightly overweight.

In contrast to Julie, who was has always been relatively healthy, Gertrude has a history of high blood pressure, arthritis, “poor” thyroid function and mild depression.

Gertrude also has a lengthy history of weight loss attempts but only once tried a commercial weight-loss program. It was only after consulting with her physician and a psychologist and joining a self-help group (run in her Church basement), that she managed to “conquer” her weight.

Unlike Golden Boy Mark and Fitness Enthusiast Julie, Gertrude made no change to her physical activity levels. In fact, she barely gets a 100 Cals a day from exercise (if you can call it that).

Her “secret” essentially consists of not eating very much. She often eats only a couple of meals a day and reports getting more of her 1300 daily calories from fat and fewer from carbs. Yet, she feels that she can eat whatever she wants, often does not feel very hungry and seldom has cravings.

All in all, Gertrude is happy with her current weight and lifestyle although she continues to struggle with mild depression.

The Gertrudes of this world are not all that rare in clinical practice. They often report not eating much to begin with and do not appear to have much trouble eating even less. They are certainly not the ones to take up any form of regular or rigorous physical activity – they would rather simply focus on eating (even) fewer calories.

In my experience, depression and often pain is a common problem with Gertrudes and once this is effectively managed, cravings are generally well controlled.

Gertrude is definitely not a “foodie” and will be quite happy eating pretty much the same foods everyday.

Gertrudes, respond well to support systems (e.g. TOPS or Weight Watchers), which often become an important part of their social life. Connecting Gertrude to such groups is often the best help we can give them.

Unfortunately, Gertrudes, although more commonly seen in clinical practice, are even rarer than the Golden Boys and Girls like Mark, making up only about one in ten registrants in the NWCR.

If you know people like Gertrude, I’d love to hear about them.

AMS
Medicine Hat, AB

ResearchBlogging.orgOgden LG, Stroebele N, Wyatt HR, Catenacci VA, Peters JC, Stuht J, Wing RR, & Hill JO (2012). Cluster analysis of the national weight control registry to identify distinct subgroups maintaining successful weight loss. Obesity (Silver Spring, Md.), 20 (10), 2039-47 PMID: 22469954

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7 Responses to “Successful Weight-Loss Maintainers: Gertrude, the Poor Eater”

  1. Kristen says:

    I find this series very interesting. I don’t think I fit in this category, or the other two you’ve written about but see some things that describe me.

    I come from a family where everyone is very obese. I had 4 children and gained between 40 (premature baby) and 60 pounds with each pregnancy but gradually went back down to my pre-baby weight. Each time it took me a year or so to lose the excess weight. I started running after the third baby and now run an average of 20 miles a week with a yearly marathon and a month or two off thrown in but am otherwise sedentary. I eat what I consider the standard American diet circa 1985; not solely junk, but not over healthy; I cook most days (meat and potatoes, western rancher type food) and don’t drink sugar drinks unless running for more than 90 minutes. I eat as much as I want but usually not more than 2-3 times a day. My weight is stable to within 5 pounds (BMI 20.5) and has been for the last 4 years.

    If a diet has an expiration weight after which one can eat “normal” again it won’t work for maintenance. I think it’s important to understand many people who are slim, even those who have never been heavy, have somewhat disordered eating and/or exercise habits; our environment almost makes it mandatory. I find that even my friends who think their weight maintenance is effortless live a lifestyle others might find very difficult to follow.

    TLDR: everything works for someone; nothing works for everyone. I wonder how many “normal weight” people who have never had to lose weight fit in these same categories.

  2. runner and maintainer says:

    Hi Dr. Sharma:

    I would hope that you would work with Gertrude to help her increase her activity level since as a clinician you are interested in her health, not just in her weight, and exercise, independent of its effect on weight, is beneficial for alleviating just about everything that ails us. As Gertrude ages, simply eating less and less to maintain her weight is a recipe for declining health and quality of life.

  3. Alexie says:

    I have some things in common with Gertrude, in that I am happy being boring about food, which helps me stick to a lower calorie diet. I can happily eat the same thing all the time. Maybe there’s a heritable component to this? We used to tease my Dad because if left to his own devices would eat a tin of baked beans every night.

    I should add that in my professional life I’m involved with food and hospitality, so I’m exposed to both a lot of creative food and foodies. I can talk trends with the best of them, but while my colleagues go home and devise restaurant-quality meals every night, I am happy with steamed veggies.

    What changed me weight wise was going from chaotic eating to ordered eating – now I have a routine and I stick to it, and am secretly annoyed when work intervenes and throws a lot of high calories foods my way that it would be churlish and even a bit Philistine not to eat.

    What I notice is that if I have a hectic week of eating out, my hunger levels rise considerably, but after a day or two of my normal eating and battling hunger and cravings, my need for food drops markedly.

    Unlike Gertrude I enjoy physical activity.

  4. julie says:

    I’ve met people who would be thrilled if someone just invented a pill or some slop that they could eat every day and not bother with food, but these are thin people who find eating inconvenient. I’ve met others who do no exercise at all, won’t even walk a block or two, but most are thin. I notice that when I can’t fit in any exercise, I eat much less, but if I don’t exercise, I get very depressed, so really not ideal. I enjoy exercise, and really like active transport-the last thing I would want to do is spend more time in my car, I love walking and biking, driving makes me cranky.

  5. shany says:

    Interesting!!
    Thanks!

  6. Marilyn says:

    Just a few comments. I’m a member of that national registry. They have you fill out a form and sometimes – maybe more often – my answer isn’t available. So that would skew the results.
    I guess, too, that my mood when I’m filling out the form may also color the results.

  7. Ellen May says:

    Having a healthy diet and exercise plan is key to maintaining a healthy weight. Gertrude may not have mild depression if she ate a healthy balanced diet and exercised more frequently.

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