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How to prevent weight regain long term |
Quite frankly just about anybody can lose weight by some means or other, but keeping it off long term is another matter. Because the health gains in losing 5-10% of one’s weight are lost on regain it seems prudent to see just how those who succeed in losing this amount of weight and maintain the loss for many years actually manage to do it. Unfortunately most effort seems to go into studying behaviours that contribute to losing weight short term rather than long term.
To look at the longer term success in weight control, The National Weight Control Registry (NWCR) was established in 1994 by Dr James Hill et al from the University of Colorado Health Sciences Centre, Denver, Colorado. The NWCR is the largest ongoing study of individual successful weight loss maintainers. The registry consists of >2900 reduced-obese subjects across the US. To qualify for NWCR membership individuals must have maintained a weight loss of >/= 13.6 Kgm for >/= 1 year.
Several identified behaviours have been found amongst these successful weight loss maintainers (1). They are eating a diet low in fat and high in carbohydrate; regular self-monitoring of body weight and food intake; and high levels of physical activity (PA). A more recent finding is eating breakfast on a regular basis (2). 78% eat breakfast on every day of the week. Very few (<5%) report never eating breakfast. Skipping breakfast seems to be far less prevalent than among successful weight-loss maintainers than among the general public.
At a symposium presented to the World Conference of Obesity in Sao Paulo in Sept 2002 James Hill updated the NWCR findings. The average weight loss is now 13.6 kgm maintained for at least 5.5 years and about 3200 people are now being followed. As regards initial weight loss 90% had tried many times before success. 90% reported modifying energy intake and increasing PA to lose weight whilst only 10% lost the weight with diet alone and 1% with exercise alone. Some succeeded by themselves (40% women and 63% men) whilst 60% women and 36% men used a formal program to lose the initial weight. There was no similarity in the types of diets used for weight loss but there were the above mentioned similarities in those that maintained the loss.
For those low carb diet enthusiasts it was notable that < 0.9% used such diets (<24% CHO) for long term maintenance.
As regards PA only 9% were sedentary. High levels of PA (ie about 2700 kcal were needed per week) - this amounts to 60-90 mins per day. Walking was the most common form of activity. Half used walking plus some other activity whilst 14% used entirely other activity. As regards pedometer readings 11-12,000 steps per day were needed. 20% did weight lifting, 20% cycling, 20% aerobics. It appears that once overweight or obese lots of exercise is needed to maintain a significant loss.
Also examined was whether or not a lower than expected resting metabolic rate might contribute to a tendency to weight regain in these subjects. In a subset of NWCR subjects the resting metabolic rate was found to be no different than that of never-obese controls.
This study has shown that it is possible to lose and maintain substantial amounts of weight loss. This could be achieved whilst maintaining a relatively ‘normal’ lifestyle including visiting the occasional fast food restaurant and having regular meals and snacks. As regards quality of life, 100% of study individuals recorded improvement.
The take home message for GPs advising their patients is that you can lose weight and keep it off long term, but to achieve that you must persistently have a low fat, high CHO/fibre diet, exercise a lot, eat breakfast and monitor progress regularly and be prepared to tighten the reins if straying off the rails. Success is achievable without having an overly restrained lifestyle and improved quality of life is guaranteed. People who succeed will tell you how a great deal of effort is required but that at the end of the day it is all worth it.
(1) Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO. A descriptive study of individuals successful at long-term maintenance of substantial weigh loss. Am J Clin Nutr. 1997;66: 239-46
(2) Watt R, Grunwald GK, Mosca CL, Klem ML, Wing RR, Hill JO. Long term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research. Feb 2002, Vol 10, No.2, 78-82
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