Why Are Some People Successful At Maintaining Weight Loss?
Tuesday, January 15, 2013
Over the past few posts, I have been discussing the findings of the National Weight Control Registry, which found that the people, who successfully manage to keep weight off, fall into roughly four clusters.
As readers will recall, the prototypical representatives of these clusters (Golden Boy Mark, Fitness Enthusiast Julie, Poor Eater Gertrude, and Struggler Janice), all have lost considerable amounts of weight, but each is using a different approach and coping differently.
But why are they successful?
Frankly, I have no idea!
Of course, we now know “what” Mark, Julie, Gertrude and Janice are doing – we know “how” they are keeping the weight off – but nothing in the NWCR data tells us “why” they can do what they do.
Not only, do we not find any answers to why these folks are “successful” at something that the overwhelmingly vast majority of people with excess weight tend to fail at, nor does the data tell us how to take someone, who is not “successful” and lead them to “success”.
In fact, we do not even understand what makes Mark, Julie, Gertrude and Janice different from each other. Are the reasons for their different strategies genetic, physiological, psychological, social, or environmental?
Does Mark find it effortless to manage his weight because of the make up of his mitochondrial DNA, his mental resilience, his extra-ordinarily large frontal lobe, or simply the fact that he has a job that allows him ample of time to pursue his healthy eating and physically active lifestyle. Perhaps, he has a social support system that supports rather than sabotages his efforts. Perhaps he has a healthy dose of narcissism (some might call it “selfishness”) that allows him to put himself before others.
We don’t know.
What led Julie to take up her active lifestyle and why has she decided to devote such considerable energy to her sporting activities – has she perhaps simply transferred here addictions from food to workouts?
We don’t know.
Why can Gertrude get by by eating so little.
We don’t know.
So, while it is of considerable “academic” interest to know “what” successful weight-loss maintainers do, it is not at all clear how to turn an average Joe into Mark or an average Jane into Julie.
Which brings me back to clinical practice.
If I were simply to tell my patients that successful weight loss maintainers tend to eat 1400 Cal (reportedly!) and exercise 2800 Cal (so they say) and so all they have to do is to also only eat 1400 Cal and simply start exercising enough to burn off 2800 Cal, I do not think I would be of any use to them.
Unfortunately, we live in a culture that assumes that anyone can do anything if they really want it – in other words, if you can’t do it, you simply don’t want it enough – this is not a recipe for success, it is a recipe for self-blame, disappointment, and further damage to your self-esteem. It is a recipe for unrealistic expectations.
The folks in the NWCR are remarkable, exactly because they are so few and far between – if their “success” was more common, there would not be anything worth remarking on.
So, while I appreciate the effort that goes into maintaining the NWCR and the time that the registrants spend providing their data, I am not sure that I learn anything from this exercise apart from the fact that we need better treatments that go beyond “eat less – move more”.
But perhaps my readers see this differently?
AMS
Edmonton, AB
Tuesday, January 15, 2013
The NWCR, to my knowledge did ONE empirical study to try to explain “why” and not just how. They performed a functional MRI on some of us (I didn’t get picked) and found that we have been able to develop a “yuck” response to certain foods that other people find irresistable and triggering. Had they picked me, I think I would have upheld their findings. I see a commercial for fast food and all I can think is, “Ewee. I don’t want THAT in my body.”
I wrote them a letter affirming their empirical research and begging for more. The questions they need to be asking us — in addition to “Will you put your head in this machine?” — might include “Will you pee in this cup?” “May we please have a vial of your blood? A swab of your saliva?” “How ’bout you consider donating your body to us when you die so we can dissect you and figure out the distribution and chemistry of your fat, gut peptides and other hormones?”
The blog posts of yours that I have most enjoyed are on Rudy Liebel and other unbiased scientists, especially in the area of endocrine. (The NWCR’s haypothesis has, over two decades, morphed into an agenda to advance maintenance through behavior control, so it doesn’t qualify as unbiased.) We know now that in weight-loss maintainers, our leptin levels and systemic response to leptin are altered, our ghrelin is chronically elevated (and yet we somehow over-ride its cues or overpower them to some degree), and other gut peptides and chemicals are different from our counterparts who maintain at their highest established weight (regardless of BMI). Funding and clinical support needs to be redirected from weight loss (which is commonplace) and toward weight-loss maintenance (which is so much more rare than our culture or the NWCR wants to acknowledge). Also redirecting energy from behavior and toward endocrine would be helpful. My two cents.
Tuesday, January 15, 2013
I found this series really interesting, and one of the thoughts I have in response to this post is that ignoring weight for the moment, most of the people I know are living far overextended lives, with too much work and obligation, and little time for creativity, rest, rejuvenation, and simply staring into space. In my own experience, that kind of overextension is, for the vulnerable, a recipe for weight gain, because pleasure from food in our society is easily squeezed into the corners that are left of our leisure lives, and other pleasures (a walk, a visit with friends) require more space.
So beyond eat-less and move-more, I wonder if going back to the registry folks to think about their lives in a more sociological fashion might be worthwhile.
Tuesday, January 15, 2013
It was a major change in personal philosophy that helped me recover from hyperinsulinemia and obesity. Low carb is the only treatment available that can work. No recovery was possible until I understood hyperinsulinemia, which according to some doctors does not exist.
Tuesday, January 15, 2013
I think for some people, like “Mark” it really is just a matter of ELMM. But for the rest of us, I think to answer the question of “why” we keep it off (80 pounds for me over 15 years) you first have to ask the question of “why” we were overweight in the first place! If it is simply due to lack of information about (or attention to) calories in vs. calories out, then that’s how “Mark” would be successful. “Julie” likely substituted one addiction (food) for another (exercise) – I am a “Julie” with a bit of “Janice” thrown in for good measure. To be honest, I have no clue how “Gertrude” and “Janice” manage to maintain. Other questions I’d ask is, “How long did it take them to lose the weight?” and “Did they lose it in a linear/downward fashion, or over time with ups, downs and plateaus along the way?” For me, losing weight was as much an emotional journey as a physical one. the “thinner” me is a completely different person than the “fatter” me.
Tuesday, January 15, 2013
I think the value of the NWCR is that it’s the harsh reality shown in real life folks. Anyone who thinks they can crash diet or short term diet and then stop is deluded. What these folks teach is what I accepted as reality when I began to commit seriously to losing (eat less, move more) after getting to 300 lbs high. It took yeras and years to work through things and fail and fail until I was able to lose and get under 30 BMI. It was no “golden” one. I’m a struggler. I still do. I’d rather NOT exercise, and I’d rather eat ad libitum. But when I committed in 2010, I face the fact that it was essentially a diet for life. I could never return to ad libitum eating. NEVER, or I’d be 300+ pounds again.
I know very well the odds are not in my favor. Regain is what usually will happen. But the NWCR shows folks who ARE keeping it off, but they STAY on a diet. Some controlled eating plan that’s low calorie FOR LIFE.
No one likes the idea of eating 1400 cals for life. It’s like a death sentence to food lovers. BUT..once we accept that’s how it is, there is a sense of taking it on as a challenge. This is what must be done, so will I do it.
Tough. Hard. I fear failure. But I like that in the internet age, I can visit blogs of folks keeping it off and they do the SAME THING. Stay on a controlled eating plan and usually exercise more than the norm–and do it day in and week out and month in and year out and handle regains before they get out of hand.
I hope they do continue to study our brains and hormones and figure out ways to make it easier. In my case, post-menopausal, with Hashimoto’s Thyroiditis/hypothyroidism, I am no longer diagnosed as having Metabolic Syndrome (no bp meds anymore, sugar normal). BUT…the spectre of all that returning terrifies me.
I struggle and keep struggling cause diabetes is scary stuff and it was hard to move morbidly obese. I focus on the gains. And I look to the folks who are doing it to give me inspiration. I thank them for telling their stories.
Tuesday, January 15, 2013
Thank you so much Dr. Sharma for your reasoned and brilliant awareness, and your powerful reality check that “what ‘works’ for one may not for another – and for people to please keep their unrealistic perspectives and stigmatizing beliefs to themselves.
I work with the eating disordered population (young and old alike) and know too well that for every Mark, Gertrude, Julie and Janice – there are many who will be catapaulted into the abyss of a raging eating disorder when they try to restrict and exercise, or simply restrict to the degree that many in the weight loss registry have managed. Anorexia, Bulimia and Binge Eating Disorder all have at their inception a focus on weight loss and a belief of not being acceptable – whether in their family, peer group or culture, because of their weight.
We don’t know why some develop anorexia and others bulimia. Why some flip into a life of yo-yo dieting and others develop binge eating disorder. For some, genetics may play a role. For others it may be related to social or psychological history; family systems and the environment could be significant factors. Regardless – the continued cultural myth that “if you only tried hard enough you too could be thin…and acceptable” is not only damaging, it is far too frequently deadly.
Your blog, Dr. Sharma, brings a rare ray of hope into this domain. Please keep up the excellent work.
Shelagh
Tuesday, January 15, 2013
I completely agree with you. It’s important – essential – to understand why some people are able to make these changes and others are not.
When the successful weight maintainers tell their stories, perhaps there are things we are not asking about that make a difference. Why are some people able to stop when their hunger has been quelled and others feel the need to continue until they are full, or beyond. The enjoyment of a particular food at a meal diminishes somewhat with each successive bite. The first bites of a dessert are the most delicious. Once the eater’s hunger or curiosity to taste the dessert has been satisfied, why is eating more better?
Clearly, food and social eating play many roles in our lives. But what does it take to be satisfied? I believe this includes physiological and mental health considerations, with the latter often not given enough attention.
I come to this from two perspectives. Firstly, at the beginning of my career, I practiced as a dietitian in a family medicine centre, often counseling people for weight reduction. During that time, I gave information on diet and activity but lacked the skills to address their deeper personal or social issues. In some cases, it seemed that they were eating to fill a hole in their soul. Some use alcohol or other substances for this, some use food.
The second perspective is from the vantage point of a formerly overweight person. I was thin until my late teens and then gained weight. Later, as a dietitian I knew the calorie count of every food and all the behaviour modification tips. I started a diet every day but went through 5 years of ups and downs and ups. Finally, I moved to a new city, began to swim or run, and used a volumetrics approach to eating. I didn’t feel hungry and I stopped what I later realized was emotional eating. It is now 30 years later and I’ve maintained a weight loss of 25 lbs. I do this by continuing the same approach. I never diet. I do stop eating when I’m satisfied and don’t deprive myself of anything. Knowing how rare it is to be successful at maintaining weight and having failed at it for several years, I consider this to be almost miraculous.
So, when we ask why it is that some people can successfully maintain weight loss, I believe that as a basis they need the tools – a good understanding of how food and activity contribute to weigh status – and they need to be in a head space so that they’re not eating to satisfy emotional needs.
Keep up the good work!
Tuesday, January 15, 2013
Since I have been struggling for years to keep it off – but with success – it comes down to finding motivation. For me it is the approval of a friend who acts as my coach. Having someone who is a pro athlete brag about your progress is a big motivator. I also feel much better and people tell me I look better. In the evening when I’m in danger of overeating (oddly I can do well at breakfast and lunch and rarely snack during the day), I have a rule that when I really want to eat something I take a few minutes and think about it balancing the pros and cons. It is still a struggle, but that helps a lot.
There is nothing special about will power. People invoke that too often. Somehow I am to the point where I can question an eating choice and think about it. I still get hungry and think about food. I wish I could find satisfaction without having to think about things.
Tuesday, January 15, 2013
There’s no doubt in my mind that success comes through a combination of factors, including genetics, free time, and culture. I went through a fairly thorough re-doctrination of eating and exercise habits, which started at age 21 when I saw both my own weight issues and the health problems rampant in my extended family. I faced ridicule and isolation in refusing to join my fellow (well educated, liberal graduate degree) students in junk food and sedentary hobbies. It took 15-20 years before most of my colleagues started facing their mortality and found the same health advice I’d followed. In part, however, they never needed drastic changes. One set of friends were exercise nuts, playing sports at a level my body has never achieved, while fulfilling PhD requirements and a teaching load. I suspect they burned 2800 calories of “exercise” before we even include the varsity team sports – again, despite spending 40 hours or more a week tied to a chair for academic pursuits. another set of friends were the non-eaters; the rare diet to “look good for wedding pictures” was annoying but not painful. Many could get absorbed in work and “forget to eat”, and although they all enjoyed a good meal once in a while, they didn’t turn to food as a solution to every emotional problem.
Wednesday, January 16, 2013
There is a common thread for me in the weight management articles that you have posted even though I did think Mark was fake versus aligorical. I needed to start somewhere I had all the knowledge of the weight wise dietitions it only neede to be tweeked and implemented. In my case it was not working harder but working smarter. I don’t care for the rural primary care network dietitians–something just doesn’t seem rightabout them.
I needed to adjust my intake of food and drink considerably. The amount of juice, pop, and coffee without thinking it was any kind of problem–many people say that healthy food is expensive but in my case it was the beverages that were what was killing my budget. Sstarting to measure my foods and condiments made a differnce.
The little things that I used to change my eating patterns was what started the loss–moving more is too much of a challenge because I need to ware a brace on my right foot to keep an deformed bone from rubbing on other bones in my foot. The loss has stablized at a 30 pound loss.
The psychologically nice benefit of losing weight is that I now fit into size 18 clothing. Medically this may seem meaningless, but from a self-esteem front it is nice and shouldn’t be ignored.
To encourage more weight lose I have decided to try using meals-on-wheels, to get a healthier more balanced meal earlier in the day on week days. This will be challenging because I like cooking and handling food. I wonder if the weight management looked at the group of people who liked to cook to see how they lost weight and kept weight off.
I am glad that you can find information to post on your blog that is refreshing and meaningful. I also enjoy the feed back of other readers–thanks.
Saturday, January 19, 2013
FINALLY someone is spotlighting the REAL issue! I wrote a book about how it does not matter how many times someone says “Just follow this diet” because the real problem is if you’ll struggle to follow it. The converse of this is blaming people, assuming that all fat people are damaged, filled with self-loathing—fat because they can’t handle some psychological issue in their lives and they “turn to food for comfort.” It’s become so easy to label overweight people as out of control “addicts.”
Diets and blame and shame accomplish nothing. The keys are in our brain wiring, our body chemistry, our lifestyles, our environment, our experience and some discrete combination of factors that we finally discover we can put to productive use in our own unique way.
Wednesday, February 20, 2013
so its hopeless nothing else to be said
Thursday, June 27, 2013
Having read this I thought it was rather enlightening. I appreciate you finding
the time and effort to put this short article together.
I once again find myself spending a significant amount
of time both reading and posting comments. But so what, it was still worth it!
Friday, April 4, 2014
Obesity is a socio-biological condition that has complex antecedents, is multifactorial, has variable etiologies, and often impairs or hijacks frontal lobe function (so-called “willpower”). We are years away from any major breakthrough in treatment, but should start tackling the prejudice and misinformation immediately. Dr. Sharma, you are one of the voices that bring science, experience and reason to the table. Thank you for that.