Wednesday, January 9, 2013

Successful Weight-Loss Maintainers: Julie, the Fitness Enthusiast

Yesterday, we met Mark (as a prototypical representative of the National Weight Control Registry), who, deciding that enough was enough, managed to turn his weight around with a self-directed regimen of eating less and moving more (ELMM).

Today, we meet Julie (whose story I also made up), another prototypical weight-loss maintainer, who believes most vehemently in the power of exercise for weight control.

According to Lorraine Ogden’s paper published in OBESITY, Julie, is part of the largest cluster, which makes up just over half of all National Weight Control Registry participants.

Julie, is 48 years old, married, works full-time as a business executive, has two teenage children and has managed to maintain a weight loss of 62 lbs over the last six years, with remarkably little fluctuation.

Her current BMI is down to 23 from a high of 34.

She has always been relatively healthy, even at her highest weight.

She began gaining weight in high school and reports her mother as also being slightly overweight.

Over the years, Julie had made several previous weight-loss attempts with commercial programs but she does not attribute her current success to any specific program or contact with a health professional.

Rather, her “secret” formula is a rather impressive amount of exercise, easily expending almost 3000 Cal per week in 90 minutes or more of daily ardous exertion.

Apart from her daily runs and/or rides on her bike, she teaches a weekly Zumba class at the local YMCA and simply cannot emphasize enough how physical activity (which she now loves more than anything else) has changed her life.

Although, this rigorous exercise regimen is supported by weighing herself regularly, only keeping healthy foods around the house, and strictly limiting her caloric intake to below 1400 calories, it is ultimately the exercise that Julie believes is her “key” to success.

She is currently very happy with her weight, reports her mood as good and her stress levels as manageable.

Julie, is the dream of the fitness and sports utility industrial complex. She and her cluster mates are the ones most likely to have taken up a serious regimen of activity that now rules their lives.

It is therefore not surprising to learn that Julie is currently training for her second triathlon and wants to get in at least two marathons this year. This Summer vacation will be a visit to France, where she hopes to complete four segments of the Tour de France. For next year, she is contemplating riding her bike from Sacramento to Seattle to raise money for Breast Cancer research.

We all know people like Julie – their determination and drive is unparalleled and awe-inspiring – and, they are somewhat hard to be around (unless of course you happen to share their passion for physical activity).

The Julies that I have personally met, are surprisingly often also foodies – indeed, most things appear to somehow revolve around physical activity and food – the more intense and wholesome, respectively, the better – good for them!

I do not see a lot of Julies in my practice (at least not as patients) – they don’t need me – they are no doubt happier with their personal coaches, sport buddies and farmer markets.

Indeed, should Julie ever need the services of a doctor, it will more likely be from an orthopaedic surgeon than a bariatrician.

If you know of a Julie or perhaps happen to be a Julie yourself, I’d love to hear your story.

AMS
Comox, BC
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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18 Responses to “Successful Weight-Loss Maintainers: Julie, the Fitness Enthusiast”

  1. MsBatt says:

    And then, there are those of us who become morbidly obese and turn to weight-loss surgery…

  2. steve says:

    Very interesting and impressive! This and the last post have been particularly interesting.

    I know a sort-of Julie. I say sort-of as she’s never been overweight, but the food-exercise connection is very strong. Colleen is now about 35 and has been a professional beach volleyball player and was an All-American indoor volleyball player before that. She eats very healthy food and after she left volleyball was serious enough to become a chef – she currently is a personal chef and it is a passion. She also continues with daily exercise and is in fantastic physical condition with the same weight she’s had her adult life.

    What impresses me is her ability to eat just what her body needs and no more or less. Her weight is very stable at around 175 (she’s extremely tall at nearly 6’7, so her BMI is on the low end of “normal”). When she was in serious training she would have to constantly eat and 5,000 to 6,000 calorie days were not uncommon. When the intense training stops she instantly throttles back to the 2,000 to 2,500 range without thinking about it. Somehow the feedback mechanism works very well in her – something I can’t say for myself.

    A final note. She helped me put together an exercise program to go with my (successful) weight loss and maintenance program. She also helps with remote coaching. I can’t stress enough how useful it is to work with someone like a personal trainer when putting together an exercise program that will be effective and one you can stick with.

    but Julie rocks!

  3. Nicole Frandsen says:

    I am a Julie, of sorts. I had RNY gastric surgery in Oct 2007 and released 190lbs. I have kept off 170lbs and have maintained this same weight for the past year. Between 2009 and 2012 I put back on the 20lbs but this past year I have been steady at 190lbs. I am 5’8″ and wear a size 8-10 or medium. My BMI is over 25 but my body fat is 24% on average. I work out almost everyday, completed the Ironman Canada long distance triathlon Aug 2012, the Half Ironman July 2011 and am currently training for the Half Ironman and bike section of the Challenge Penticton 2013. I do a couple other sprint tris in the year, a half marathon and several shorter runs for various events ( Calgary Corporate Challenge, the Resolution Run, Stampede road race etc). My life consists of working, sleeping, training and eating for 30 weeks each year. This is how long my training program is that I follow. For the other 22 weeks, I try to run 3 times a week, swim and bike once a week and get out to do activities like snowshoeing, roller skating or leisurely bike rides with friends (we ride around the Glenmore reservoir or to Bragg Creek and back with a stop for coffee). I hope to get back into playing Ringette in the fall but depends on my triathlon goals for 2014. My partner and I have been talking about doing the Disney Goofy weekend to commemorate my turning 40 in 2014 and she turning 50. This is a half marathon on the Saturday and the full marathon on Sunday, back to back.

    I am terrified of putting my weight back on and view exercise as absolutely necessary in my life. I also love food and don’t count calories but limit my intake of any ‘bad’ food meaning sugar or high fats. I am trying to be more accepting of my body but still dislike how it looks, despite three reconstructive plastic surgeries. I continue to have fluid retention issues in my legs but can’t afford any more surgery as none was covered by AHC. No one told me my body wouldn’t go back to ‘normal’ when I was big.

    Many people in my life tell me how inspiring I am to them. My parents held up a sign during my Ironman race that said ‘From 360lbs to Ironman. Go Nicole Go!’ This sign now sits at my desk at work and even I don’t believe I did this. Yet inside, I still feel like the same fat girl who just wanted people to be nice to her. The mental game still plagues me. I see pictures of myself and am surprised that I am smaller.

    So, I am a Julie when it comes to working out but mentally, not a Julie as I am terribly insecure and still don’t believe I can maintain this body.

    Thank you for your blogs, I look forward to them everyday.

  4. Jane says:

    I’m definitely Julie. I love all the fitness activities that I do, though I realize that I overdo it a bit, and am trying to find more of a balance in 2013. Although I’m still on the losing trend (131 pounds GONE, 5 to go, thanks to healthy eating and exercise: NO SURGERY OR GIMMICKS), I’m still trying to figure out the sweet spot for maintaining my loss. I know it will take some trial and error, but I’ll get there. :)

  5. Julie says:

    How is Julie different from Mark? It seems like they both exercise a lot and count calories.

  6. Liz says:

    I would say this describes me almost to a T….except I am not quite there. I haven’t found a way to make 90 mins for myself a day and I get distracted by all my other assumed responsibilities and don’t put myself first….I know you don’t like Biggest Loser but one thing that the ‘doctor’ on that show said rang really true for me when he was listing all the obesity related comorbidities that the participants presented with…if you were told you had cancer and you had to go for chemo two hours a day to survive..you would make the time….wow! Its so true…
    I don’t have any illnesses now but at 48 years of age and family history of CAD, HTN, DM2 its only a matter of when not if.
    Thanks for all you do Dr. S

  7. Sports scientist says:

    Coming from an exercise physiology/sports science background, I have been surrounded by these people for most of my life. They are a small but vocal minority who tends to confuse the issues via their fixation on physical activity.

    I find they most often ignore the possibility that other factors than their high activity levels might be the reason for their health, and also that anything less than full on “exercise” and “training” is frowned upon, for example just getting a few 10 min walks in each is day.

    They tend to be campaigners and cheerleaders for activity, and to some extent the (health) world needs those types, but only in balance and concert with all the other messages.

    And yes, unfortunately they can often be difficult to spend time with if you are also not a super exerciser—although perhaps that is one of the traits that predicts such high activity levels?

  8. Lee Jordan says:

    My sister, a single mother of 4, had lost over 200lbs. She had weight loss surgery but as she says… The surgery doesn’t get her out a bed at 5am to walk – exercise etc… This slide show video tells her story better than I can … Exercise is a critical part of her journey.
    http://youtu.be/RLOqWv1ZqEM @300poundsdown

  9. LJ says:

    I can relate to Julie. I was never overweight, but lost some extra weight and I am a very dedicated runner. I believed it was my running that helped me maintain my weight, even though I am very careful about what I eat. Like you said, I didn’t need you, but I recently needed an ortho surgeon. I was having hip problems (unrelated to running) and needed surgery if I wanted to continue running. So I had the surgery and was 6 weeks non-weight bearing and weeks after that of gradual weight bearing. I was very nervous of gaining ++ weight because I wasn’t running……but guess what…..I maintained similar eating habits and haven’t gained weight despite not running……hmmmm

  10. DebraSY says:

    I was a Julie three surgeries ago. I have had to modify a lot. Originally my BMI was 35.2, I dropped to a 23.6 and maintained the Julie way for four years. Then my body rebelled, and I made changes both in food and exercise. Over 6 years I have slowly slid up to a BMI of 26.4. In a word, it’s hard.

  11. julie says:

    I am Julie, and I have gone from BMI = 34 to 26. I’ve gotten it below 25, but it requires a stricter lifestyle than I am able to maintain. Yes, the gym, and burning 2-3000 Cal/week make a big difference. Also, bike commuting and walking for groceries, I only have to get into the car once or twice a week – makes for a less stressful life. I eat sorta mostly clean, lots of veg and beans and fruit, but I’m not especially low-fat, and I enjoy a small cookie most days at lunch. I just try to not eat when not hungry, not stuff myself, and get in as much physical activity as I have time for or can tolerate.

  12. julie says:

    Oh, and a foodie? Sort of, I like the quality ingredients. I’m more of a peasant food eater than gourmet, other than the fruit, which I love love love. I’d say, more than gym, the strongest help I have is learning to cook. I used to eat out 2-3 meals a day, now it’s 2-3 week. I don’t cook low-fat or low-sugar or low-carb, though likely the glycemic load says sort of on the low-side.

  13. Kelly-Anne Hollingshead says:

    I’m never going to be a Julie, I’m afraid. I had WLS and am losing well, but accept the reality that my weight will stabilise when the diet I’m comfortable maintaining meets the amount of exercise I actually enjoy doing – which at the moment is aquasize a couple of times a week and a 40 minute walk with my dog 3-4 times a week. Radical, exuberant exercise? Not so much.

    With the 60# I’ve lost since surgery, I’ve lost high blood pressure, high cholesterol and the need for daily pain medication for arthritis and chronic bursitis. Anything more is pure gravy. :-)

  14. runner and maintainer says:

    Dear Dr. Sharma:

    I understand that you are trying to educate by translating a statistical summary into a personal story, but your translation is misleading and in the process you are making Julie, the average weight-loss maintainer, look super-human or inhuman.

    The “1400 calories per day” average is calculated based on a food frequency questionnaire that asks the respondent how frequently and in what portions they have consumed each of a list of foods over the past year. We know that this is a gross underestimate of what the average respondent actually consumed. Interestingly, this variable was not significantly different among the four clusters of weight-loss maintainers identified in the study. The 3000 (actually a bit less) Calories burned per week is also based on a questionnaire and estimates energy expenditure through exercise AND activities of daily living (walking to work, mowing the lawn, playing with the kids, etc.). This is likely an over-estimate of how much the energy the respondent actually used. 3000 Calories per week is 428 Calories per day. Estimating 100 Calories per mile and 2000 steps per mile, this is just 8571 steps per day, LESS than the 10,000 recommended as the MINIMUM daily activity level. Julie the average weight loss maintainer is definitely eating less and moving more than the average North American, but the amount of movement she is doing is still LESS than the recommended daily average.

    A person training for triathlons and marathons (as is your Julie) is burning a lot more energy (and eating a lot more). I’m an avid runner and a weight-loss maintainer (30 lbs. for 2 years). I have a pedometer and track calories carefully. As a 5’4″, 145 lb., 40 year old woman I burn an average of 1200 Calories per day through exercise and activities of daily living (I don’t own a car), and I consume an average of 3000 Calories per day. Assuming 10% of energy goes for digestion, this makes my basal metabolic rate ca. 1500 Calories per day, on the high side for a woman of my age and size, probably because of the additional caloric demand for tissue repair after high intensity exercise.

    Best regards,

    a runner and a weight loss maintainer

  15. NewMe says:

    My one new year’s resolution is to no longer read the blog of a “Julie” (not the Julie who commented above, BTW). The Julie I no longer read lost a considerable amount of weight and is keeping it off through huge amounts of daily exercise and extremely regimented eating. She also has uses hate and contempt for people who are less successful than she is as a source of motivation to keep her own weight down (this is self-reported–she admitted that demeaning others on the Internet helps her to keep herself on track).

    I wonder whether her extreme exercise regimen has increased the amount of testosterone circulating in her body. She’s a real tough guy.

    I also wonder what will happen to Julie’s weight when she finally injures herself (she has mentioned that she exercises despite back pain) to the point where she will no longer be able to do such strenuous, regular exercise.

  16. RG says:

    I think I’m a Julie although exercise hasn’t been a permanent solution to my ideal weight. About once a year I take a few days “off”, but yeah, 90 minutes of some exercise plus housework, walking etc. seems to keep my mood better and my fingers out of the cupboards. If I know I’m going for a run in the morning, I’m likely to delay breakfast until after, then for the actual run, and maybe another hour after the run while I cool off. But it’s complicated to separate cause and effect. It’s possible to sleep well, get sunshine, not obsess about things I can’t solve, play more without all the exercise, but for me personally these issues seem to tie together. When I’m happier, I like to go move my body, and that keeps me happier. I agree that caloric burn is marginally important; I’ve done more strenuous and less strenuous, but I don’t think 10 minute walks ever did much for me.

  17. Laura says:

    The least likely piece of Julie’s story to me is that she has children at home (albeit teenagers) AND works a full-time job which requires commuting plus a certain amount of grooming before she leaves her home. Does she spend any time with her children, or is maintaining her weight more important? Frankly, the people I know who have managed to pull off anything close to this either do not work full-time or are not raising children, and preferably neither.

    A friend just referred me to your site, and I’m finding it very interesting.

  18. Catarina says:

    Julies approach is not an option for me. Along with Laura I have only seen and heard of weight beeing lost this way in people who do not have children (or have grown children), or who make it their whole existens to work out and keep track of calories.

    I have three smal children, I study on universty full time, and have a husband who work shifts, I barly have a minute to spare between sun up and sun down. I even tried for a while to get in an hour of exercise every day, and the only solution was to forsake sleep and get up at 4.30 to go for a walk or a run before my family wakes up…….I could´nt keep it up….I was only sleeping for 5 hours a night witch was definitly not healthy. I also tried to restrict calories (1200-1400/ day) and do regular exercise…….and I did weigh all of my food, and did calculate claories from that and keept a food-journal of every morsel I ate……I did it for 3,5 months….and did not lose a pound. I would still like to lose weight but not at any price…..now I try to have a more health conscious approach instead and if my weight comes down fine…and if it does´nt ……fine. As long as have a livestyle I can maintain that is good for my health.

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