Tuesday, January 8, 2013

Successful Weight-Loss Maintainers: Mark, the Golden Boy of Weight Loss

We all know people who have apparently “conquered” obesity by losing weight and keeping it off (many go on to become personal trainers, motivational speakers and authors of bestselling miracle diet books).

Who, you may ask, are these people and wherein lies their key to success?

Researchers who have turned finding answers to this elusive question into a considerable enterprise (in the form of the US National Weight Control Registry), in a paper published in OBESITY, now describe four distinct clusters into which these successful maintainers tend to group.

One fictional but rather prototypical representative is Mark, who belongs to (what I would call) the “Golden Boys & Girls of Weight Loss”.

As it so happens, Mark is a 52 years old college graduate, married and unencumbered by a family history of obesity. In fact, Mark, did not begin gaining weight till well into his mid-thirties. Discovering on his 40th birthday, that despite maintaining relatively good health, his BMI was now a portly 32, he decided it was time for a change.

Although he had never made any attempt at losing weight before, he embarked on a diligent self-directed program of regular exercise (about 400 Cal per day) and caloric restriction (to about 1400 Cal per day), as a result of which he dropped 56 pounds to a BMI of 23.

This was almost 11 years ago. Today, Mark continues to maintain his weight loss and finds this relatively easy. He weighs himself regularly, has no problem following his daily exercise routine (about 90 mins of rigorous workouts), does not obsess about what he eats (despite limiting his intake to 1400 Cal), has few cravings and is generally happy with his life (and weight). He seems relaxed and his mood is excellent.

When it comes to his success, Mark does not understand what all the fuss is about. He found a problem, he fixed it, end-of-story! No big deal!

(This, of course, is all according to Mark – the data in the NWCR is self-reported and should therefore perhaps be taken with a grain of salt.)

As it turns out, Mark is a member of a rather elite segment of the NWCR – making up just 13% of registrants. It is not surprising that Mark is male, as this segment is the only cluster of NWCR registrants, where men are well represented (42% to be exact).

Of note is that Mark, like others in this cluster, did not require much help from anyone to turn things around. He may well have glanced at the occasional diet or exercise book, but that’s about it. Mark is certainly not the diet industry’s dream client, largely because he has no need for their services.

But then again, Mark is a rare bird when it comes to “conquering” obesity – only slightly more common than Gertrude, who we will meet later this week.

I have not seen too many Marks in my practice (why would I?). In the rare cases, where I have met folks like Mark (outside my professional life), they tend to be well-adjusted, not too bad to hang out with, and their general attitude seems to be, “I got over my weight, now you get over it too, like, what’s the big deal? – Eat Less – Move More – easy peasy!”

Congratulations Mark – I am sure many out there wish they could just be like you – sadly, you are special indeed!

If there is a Mark out there who happens to read this (although I doubt that Mark would have much interest in a blog about obesity), please feel free to leave a comment.

If you know of a Mark (male or female) – perhaps you can share their story here.

AMS
Edmonton, 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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21 Responses to “Successful Weight-Loss Maintainers: Mark, the Golden Boy of Weight Loss”

  1. Alexie says:

    Two things jump out at me about ‘Mark’. One is that he’s male. The second is that he has no history of dieting.

    It would be interesting to see the situation of a male in the same demographic who does everything the same, with one difference: he has a history of losing and gaining weight.

  2. Melinda Munro says:

    What jumped out at me was that he still restricts his caloric intake to 1400 calories per day as well as doing exercise. He has tremendous will-power and obviously a slow working metabolism despite the exercise.

  3. Chloe Dawson says:

    Sounds like Mark is seriously under-reporting his calorie intake.

  4. Pamela says:

    1. Mark is a man. 2. He never had an injury that prevented him from doing all that exercising after his big weight loss. 3. We don’t know the full story.
    …etc. etc.

  5. Lucy .A says:

    Still elmm something is not right he should still be losing. Bit he isn’t. This guy is fake.

  6. Lucy A. says:

    Something is not right if Mark is still eating the same amount he did when he was losing weight and moving the same amount he should still be losing weight. But it says he isn’t all most makes me think that Mark is fake.

  7. freeman dennis says:

    i may be a modified mark. in 1996 werighed 190. lost to 168 through restricting cal and exercise. by 2006 up to 180. had high glucose so lost to 145 by restricting and greatly increasong exercise-1 hr or more. cals about 1800 per day. had a relapse(flu) and gained to 160. began having statin side effects and cut exercise greatly. now still at 160 but have a hard time maintaining. must restrict cals and exercise. since i’iam now 160 and was once 190 do i qualify. as others comment its a bit more complicated at least in my case. i am male 70 yrs of age. hae had swings of weight all of my life like those described.

  8. Arya M. Sharma, MD says:

    @Chloe: you are right that Mark is probably under-reporting his caloric intake, but even if was a few hundred calories higher, it is still a highly restricted caloric intake. This is not at all unusual for someone, who has lost a lot of weight, even if they do exercise a lot. Research shows that many people expend far less energy for the same amount of physicial activity than before losing weight.

    @Lucy: Most dieters believe that if they stick to their diet, they will keep losing weight – this is never the case! Actually it is completely normal and adequate that Mark is no longer losing weight despite continuing to restrict his calories. This is exactly what happens to anyone losing weight (even to people who have bariatric surgery). Everyone ultimately reaches a new steady state, where energy expenditure is reduced to a level that equals current intake (no one loses weight till they disappear!). Every diet will ultimately appear to “stop working”, which of course it does not (just go off the “diet” and see what happens).

  9. Arya M. Sharma, MD says:

    @Freeman – I like the term “modified Mark” lol – It sounds like you started out as Mark and then things got more complicated. Look out for the other folks I’ll be describing in the next few posts – you may find yourself better reflected in their profiles.

  10. Steve says:

    I’m 60 now. Male and 6’1. Five years ago I went from 220 to 155-160 and have held that since. I weigh myself a few times a week and track exercise and calories carefully. About 2300 calories a day and five 75 minute aerobic sessions a week (mostly rowing). My lunch hour is a 45 minute walk. I’d go crazy eating much less than this. For what it’s worth I’ve been a vegetarian for 30 years – yes, there are overweight vegetarians.

    To be honest it is still a battle. I’ve tried many variations without any luck when it comes to just ignoring it.

  11. Meghann Douglas says:

    Mark = MALE, exercizing 90 minutes daily on 1400 calories? Don’t buy it. Not at all.

    In the past 1.5 years (since June 2011) I have lost 125 pounds as of today. My turning point was when I could not walk from my desk to the printer in the office without a cane.

    I have gone from a bmi that was north of 53 to a current bmi just south of 34. Through trial, error and a LOT of research I have settled on a ketogenic diet of 2000 calories per day. I swim 30 minutes each workday, ie 2.5 HOURS per week, and when there was no snow I would bike to & from work (24 km round trip). I have also gradually worked my way into using the weight room, the exercize bikes, and the rowing machine.

    At my darkest hour I gave serious consideration to bariatric-type surgery and was talking to people who had it. One girl told me she couldn’t eat more than a cup of food at a time or she would vomit. Wow. I thought to myself that if you had to hold yourself to that standard after surgery, then I wonder what I could accomplish on my own with the same discipline?? That was in June 2011. I have since learned a LOT more about nutrition and physiology for HUMANS.

    The funny thing (well maybe not so funny) is that I have a degree in animal & poultry science. I was actually quite convinced that I understood nutrition and physiology. THEN it hit me. The whole purpose in a livestock ration is to feed the animal to ideal “harvest” weight in the shortest amount of time for the least cost. OH MY. Perhaps this is NOT the ideal approach to human management!!!!!!

    I’m very much concerned about when I reach a healthy body fat percentage and how to maintain it. My research is so very far from over!!!!!

  12. RedPanda says:

    I wonder if I’m a Mark?

    I was overweight or obese from babyhood, put on my first diet by the family doctor at age 12 and yo-yo dieted from there, up to my highest weight of 220 pounds. I have lost 90 pounds and maintained my weight loss steadily since 2003.

    I vary my calorie intake through the week from 1500-2000 calories and exercise, on average for about 15.5 hours a week; this includes intense cardio and weight training as well as lighter forms of exercise.

    I’d say that I find maintaining my weight loss fairly “easy”. I don’t have any health issues and all my blood work etc is fine.

    Oh yes, I’m a fiftysomething woman.

  13. RedPanda says:

    I forgot to address the point someone else made about being unable to exercise due to injury.

    Since my weight loss I have had severe low back pain which left me unable to walk for any length of time without pain (this was caused by an abdominal diastis which was surgically repaired); a very painful shoulder injury; and two rounds of plastic surgery to remove excess skin.

  14. E. says:

    My husband is a Mark, although he doesn’t restrict calories like the example. he started gaining weight when he was in his late 20s, over a period of about 3 years he went from 160 to 220 pounds, mostly due to a job where lunches and dinners out were standard and due to a long commute he didn’t have time to go to the gym (which he had always done 4-5 days a week before that job).

    After moving to a new job closer to home, he decided he’d had enough, started going to the gym, and restricted calories to 1600-1800 a day (easier to do once he had a job where he wasn’t expected to be eating so many meals out!). Lost the weight easily, has been around 160 pounds for close to 10 years now. He works out 5-6 days a week, watches portion sizes (but no longer counts calories) and has had no problem keeping the weight off.

  15. ksol says:

    I’m trying to figure out how he restricts to 1400 calories, with or without fudging the numbers a little, and doesn’t experience cravings. I’m female, in my 40s, stable weight (although not in “correct” BMI range) and if I tried to restrict that much I would want to eat the formica off the kitchen counters. Just different bodies?

  16. Gina says:

    @ ksol – I guess that Mark doesn’t experience cravings because he doesn’t eat the kind of food (sugar, refined carbohydrates and highly processed food) that leads to cravings?

  17. Chloe Dawson says:

    @Gina – eating too little will definitely lead to cravings, regardless of whether you’re doing low fat, low carbohydrate, paleo, weight watchers whatever. Hunger is part of the system.

  18. Gina says:

    @Chloe Dawson – the term “cravings” usually refers to cravings for a specific kind of sugary and/or fatty food, such as cookies, ice-cream etc, as opposed to hunger which can be satisfied by almost any kind of food.

    This is why I suggested that Mark avoids the types of foods that spark cravings. But then again, as ksol talked about “eating the formica off the kitchen counters” perhaps she was talking about true hunger?

  19. ksol says:

    @Gina — I was, indeed, talking about true hunger. I’m not someone who typically eats a lot of processed food, sugar, etc. I will admit I go through short phases where I do, but I tend to get back to my preferred, healthier diet. I am not thin, but I am someone who does crave veggies on a regular basis. Cravings for the specific foods you describe are rare enough that I generally simply eat the food I crave and get on with my life and don’t crave it again for quite a while. For one reason, I don’t feel as good afterward. One of the times that I am most likely to binge on the carbs is if I am overly hungry — they’re fast and easy. I would definitely be overly hungry on 1400 calories, no matter what kind of food I ate.

  20. Susanne says:

    Thank you so much for “translating” this article! I remember reading it when I came out and not really understanding the difference between some of the categories. I am basically a female “Mark”, but I am only about 2 1/2 years maintaining, so I still use my LoseIt on my phone (they sent me a free premium membership on my 3rd anniversary, ha ha :). I don’t have to restrict my calories quite as low, or exercise as much, as “he” does, so it is still sustainable.

    But I know that if I lived a slightly different life (one in which I had to eat out regularly instead being able to make time to cook, have to spend a lot of time commuting rather than work out) I could easily gain again. And I know that not everyone’s body works like this, and I never give diet advice to anyone unless they ask (and phrase it as “this worked for me, but everyone is different.” So I hope I don’t sound as much like a jerk as “Mark!”

  21. Stuart says:

    1400 calories for a guy + lots of exercise… Every day!? He’s superman!… Not. I find this very hard to believe. I thought my diet of 1800 calories (no exercise really) for over the past year was a strict one. I would be surprised if a woman could maintain 1400 calories with all that exercise and not give up within 6 months. If I thought I had to maintain my 1400 calories, I wouldn’t even bother.

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