Maintaining Weight Loss: Lessons from “The Biggest Loser” study

mature woman having green salad

Maintaining weight loss can be challenging but with the right attitude, commitment and willingness to discover what works for you it is possible and rewarding.

Dr. Kevin D. Hall, lead author of the study and a scientist at the National Institutes of Health, published a study in the journal Obesity this week that has made the news. If you haven’t already seen it, you can read it here, and you should. It’s a great example of how important news can be taken out of context to create discomfort and doubt.
Click here to read the NY Times article.

The study provided some important and additional insight into what we know intuitively. Losing weight can be hard and keeping it off is often harder. He has demonstrated that metabolism slows with extreme weight loss, and for some, remains lower than expected even if we regain weight. That coupled with decreased Leptin levels, a hormone that normally signals when we’ve eaten enough, leads to increased hunger.

There are several things that the article does not state clearly.

Fourteen extremely obese people lost 75-225 pounds over a 6-7 month period of time. They exercised 7-9 hours a day and after the first 12 weeks were left to their own devices, competing to lose the most weight and win the $250,000 prize. For some, this meant extreme calorie restriction with no nutritional oversight. Likewise, they were revisited after 6 years and although many retained parts of a healthy lifestyle, none could sustain the restrictions and activity levels of the competition. They typically did not have continued support or instruction.

Most distressing is the suggestion that maintaining a significant weight loss is nearly impossible. I know many people read the article and considered throwing up their hands and giving up, or worse, not trying at all.

But I, for one, hate resignation. The study helps explain why it’s hard, but we already know that. To suggest that it’s impossible is not a service to anyone. I tell all my patients that it takes as much work to keep the weight off, but it’s a different set of skills.

I’m the first patient. I can tell the same story and describe the same trail of weight up and down as many of my patients. I love the way I look and feel since losing 50 pounds 10 years ago and my commitment to continue to care for myself keeps me learning how my body works and how to maintain my weight. This is what I’ve learned.

We know that approximately 85% of people who lose significant amounts of weight, gain all or part back. For me, that has meant waking up each day and asking “how will I beat those statistics?”.

To maintain weight loss, here are a few tips and strategies I use daily.

  • I practice structured undereating. I eat carefully every day, and indulge on occasion. Remember Occasions are Occasional.
  • I self monitor. For me that means weighing myself daily. Unless you are truly saddened or discouraged by seeing your weight on a scale, I recommend a minimum of 3 times a week. It’s also important to wear fitted clothes so you can feel a change sooner rather than later and make adjustments.
  • I practice Red – Yellow – Green light for maintaining my weight. By managing my weight in a narrow range, I find it easier to stay close to my goal. If I’m within 1-2 pounds of my desired weight, a normal variation, Green Light. If my weight is up 3 pounds, that’s Yellow Light – slow down. It’s time to do some good environmental control, get some support, and get back to your routine. It’s easier to lose 3 pounds 10 times than it is to lose 30 pounds. Up 5 pounds? Red Light – STOP. This is an emergency (one of the first and most profound things I learned when I started my studies as an obesity specialist). Get support, get back to your program, whatever it takes. As you learn to manage your weight in this narrower range, it will become easier.
  • You will practice your new behaviors and skills until they become as automatic and natural as whatever you were doing before.
  • I stay part of (all right, I lead) a community where being healthy is the norm. If you live in a culture where 70% of the people are overweight and you’re genetically inclined to be overweight, then if you don’t have a plan, you will be overweight too.

The body is primed for survival, not for abundance. It is very good at keeping you from wasting away, but not for coping in a world of plenty.

“Diets” may not work, but many people lose weight and keep it off. Many people learn to manage their weight. Many people transform their relationship to their food, their health and their life. In the end, all that matters is our willingness to discover what works for us and do what we need to do to be happy and healthy.

You can be happy and healthy!

Dr. Gail Altschuler

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