Category Archives: Weight Regain

Think Diets Don’t Work? Think Again

Claims that “diets don’t work” are based on the assumption that any weight lost is simply gained back quickly.

The Endocrine Society met in Toronto in June of 2007.  Experts presented data on maintenance of weight loss by overweight people.  What percentage of people who lost 10% of their weight kept the weight off for one year?  About 20%.  Not great, but better than many would expect.  That’s a 200-pounder losing down to 180 and staying at 180 pounds for a year.  This degree of weight loss will improve many cases of high blood pressure, knee arthritis, and type 2 diabetes mellitus.

The U.S. Centers for Disease Control and Prevention reports even better data.  Almost 60% of 1,310  people in the National Health and Nutrition Examination Survey who lost 10% of body weight maintained 95% of the loss for one year.

How do they keep the weight off?  Characteristics of “successful losers” include a low-calorie diet (probably 1,6oo-1,800 on average), weighing at least once per week, and burning about 2,600 calories per week in physical activity.  (A 150-pound person expends 1260 calories a week by walking 3-4 mph for 30 minutes daily.)

Many successful losers cycle through weight loss and gain several times before determining which combination of diet and physical activity ultimately works for them.

So don’t give up!

Steve Parker, M.D,

References:

McGuire, M.T., et al.  International Journal of Obesity, 23[12] (1999): 1,314-1,319.

Weiss, E.C., et al.  American Journal of Preventive Medicine, 33[1] (2007): 34-40.

Prevention of Weight Regain Is NOT Impossible

I often hear from the general public, and even my physician colleagues, that losing weight and keeping it off is a hopeless goal.  So, why try?

Because it’s not hopeless.

The March 12, 2008, edition of the Journal of the American Medical Association includes an article from the Weight Loss Maintenance Collaborative Research Group.  Researchers identified a group of 1,032 overweight or obese adults who lost at least 8.8 pounds (4 kg) during a 6-month weight loss program.  These adults had high blood pressure, blood lipid abnormalities, or both.  38% were African American and 63% were women.

Average weight of the group before losing weight was 213 pounds (96.7 kg).  The weight-loss program consisted of 20 weekly group sessions, exercise goal of 180 minutes per week (26 minutes per day, usually walking), reduced caloric intake, and adoption of the Dietary Approaches to Stop Hypertension eating pattern.  The goal rate of weight loss was 1 or 2 pounds per week (0.45 to 0.91 kg per week).  Study subjects were taught how to keep records of their caloric intake and physical activity.

Except for the weekly group sessions, this program is similar to the Advanced Mediterranean Diet.

So each of these folks lost at least 8.8 pounds on this program.  Researchers followed them over the next 30 months to see how much weight would be regained.  Average weight loss for the entire group actually was 19 pounds (8.6 kg).  As expected, many people did regain weight over the next 30 months, between 6 and 9 pounds on average.  Of course, some individuals lost much more weight initially, and didn’t gain any back.  Some regained all of the lost weight, plus extra.

Overall, 42% of participants “maintained at least 4 kg [8.8 pounds] of weight loss compared with entry weight…” over the 30 months of follow-up.  37% remained at least 5% below their initial weight.

The “5%” figure stands out, for me, because we see improvement in obesity-related medical problems with loss of just 5 to 10% of body weight.

The authors cite studies indicating that “each kilogram [2.2 pounds] of weight loss is associated with a decrease in systolic blood pressure of 1.0 to 2.4 mmHg and a reduction of incident diabetes of 16%.”

To summarize the weight changes:  Study participants weighed 213 pounds before the behavioral weight-loss program.  Average weight loss was 19 pounds, down to 194 pounds.  Average weight regain over 30 months was in the range of 6 to 9 pounds.  Participants were still pretty big, but 37% of them probably saw some improvement in their medical status.

A huge amount of effort went into this study, on the part of both researchers and study participants.  Nevertheless, average results are relatively modest.  Keep in mind, however, that the numbers are averages, and you are not average.  I’m sure some of the participants went from 220 pounds down to 150 pounds and stayed there.  That could be you.

Steve Parker, M.D.

Reference: Svetkey, Laura et al.  Comparison of Strategies for Sustaining Weight Loss: The Weigth Loss Maintenance Randomized Controlled Trial.  Journal of the American Medical Association, 299 (2008): 1,139-1,148.

Is Exercise Important as Part of a Weight Management Plan?

While physical activity alone seldom results in significant and sustained weight loss, maintaining weight loss without physical activity is nearly impossible.

The quote above is from James Early, M.D., Clinical Associate Professor, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita (Wichita, Kansas), as printed in Clinical Cornerstone, 2007, volume 8, No. 3, page 69.

It’s a simple truth, one that bears repeating, as the truth too often is submerged in a roiling sea of misinformation and trivia.

Exercise is extremely important for the vast majority of people who want to lose weight and keep it off, but it’s encouraging to know that it is possible to be successful if you don’t want to or can’t exercise.

This second quote is from the first edition of Thin For Life: 10 Keys to Success From People Who Have Lost Weight and Kept It Off, by Anne Fletcher, page 20.  Out of the 160 “weight-control masters” studied by Anne, 70% exercised three or more times per week.  Nine percent told her they didn’t exercise at all.

For help with your exercise program, consider Physical Activity for Everyone and Shape Up America!

Steve Parker, M.D.

Is Exercise Important for Maintenance of Weight Loss In Women?

This news is a bit stale, but I wanted my readers to be sure to see it.

An article in the July 28, 2008, issue of Archives of Internal Medicine teaches us the role of regular physical activity in keeping lost weight from returning to once-overweight women.

Methodology

201 overweight women (body mass index 27-40) aged 21 to 45 wanted to lose excess weight.  They were sedentary at baseline, exercising fewer than three days a week for under 20 minutes.  Sound familiar?  Depending on baseline weight, the participants were assigned to eat either 1200 or 1500 calories per day, and to exercise according to one of four different exercise programs.  Exercise recommendations were to burn a certain number of calories per week (1000 or 2000 calories) at either moderate or vigorous intensity.  There were weekly group meetings for discussion of eating and exercise for the first six months, twice monthly meetings during the next 6 months, and monthly for the next six months.  There was telephone contact for between months  19 to 24.  This is pretty intense contact.  Each participant was given a treadmill to use at home, but my impression is that other forms of exercise were permitted and discussed.

Ten subjects were excluded from follow-up analysis, mostly because they got pregnant.  Nineteen others lost interest and dropped out.

Participants self-reported their physical activity levels.

At 24 months into the study, 170 of the original 201 participants were able to provide objective weight loss data.

Findings

Of the 170 subjects available for full analysis at 24 months, 54 either gained weight or lost none.  Thirty-three lost 0 to 4.9% of initial body weight, 36 lost 5 to 9.9% initial body weight, and 47 (24.6%) lost 10% or more of initial body weight.  [Who says diets don’t work?]

People who lost 10% or more of initial body weight at 24 months reported performing more physical activity – 275 minutes a week – compared with those who lost less than 10% of initial body weight.  This amount of exercise equates to 55 minutes of exercise on five days per week above the baseline level of activity, which was sedentary as you recall.  Whether they were assigned to “moderate” or “vigorous” exercise intensity didn’t seem to matter.  Whether they actually performed at the assigned level is unclear.

These women who sustained a weight loss of 10% or more of initial body weight at 24 months were burning 1835 calories a week in physical activity.

Women who lost less than 10% of initial body weight, or lost no weight, exercised an average of 34 minutes a day on five days a week.

By 24 months, participants on average had regained about half of the weight they had lost during the first six months  [which is typical].

Take-Home Points

After six months of dieting, many people start to regain half of what they lost.  We saw this phenomenon in the Israeli study of low-fat vs low-carb vs Mediterranean diet (DIRECT trial).

If you have a lot of excess fat to lose, you have to wonder if it would make sense to start a different diet program every six months, until you reach your weight goal.  Maybe there’s something about the novelty and excitement of a new diet program that keeps you motivated and disciplined for six months.

The authors note there are few similar long-term studies examining the amount and intensity of physical activity needed to improve weight loss success.  So this is important information.

In using exercise to help prevent weight regain, it may not matter whether the exercise is moderate or intense.

The authors write:

…the inability to sustain weight loss appears to mirror the inability to sustain physical activity.

Long-term sustained weight loss is possible for a significant portion of overweight women.  Although most women won’t do it, success is enhanced by exercising for 55 minutes on five days a week.  Most men won’t exercise that much either.  Which camp do you fall into?

[For physical activity instruction and information, visit Shape Up America!, Physical Activity for Everyone, or Growing Stronger: Strength Training for Older Adults.]

Steve Parker, M.D.

Reference:  Jakicic, John M., et al.  Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women.  Archives of Internal Medicine, 168 (2008): 1,550-1,559.  

The Role of Exercise in Maintenance of Weight Loss In Women

A 2008 article in Archives of Internal Medicine teaches us the role of regular physical activity in keeping lost weight from returning to once-overweight women.

Methodology

201 overweight women (body mass index 27-40) aged 21 to 45 wanted to lose excess weight. They were sedentary at baseline, exercising fewer than three days a week for under 20 minutes. Sound familiar? Depending on baseline weight, the participants were assigned to eat either 1200 or 1500 calories per day, and to exercise according to one of four different exercise programs. Exercise recommendations were to burn a certain number of calories per week (1000 or 2000 calories) at either moderate or vigorous intensity. There were weekly group meetings for discussion of eating and exercise for the first six months, twice monthly meetings during the next 6 months, and monthly for the next six months. There was telephone contact for between months 19 to 24. This is pretty intense contact. Each participant was given a treadmill to use at home, but my impression is that other forms of exercise were permitted and discussed.

Ten subjects were excluded from follow-up analysis, mostly because they got pregnant. Nineteen others lost interest and dropped out.

Participants self-reported their physical activity levels.

At 24 months into the study, 170 of the original 201 participants were able to provide objective weight loss data.

Findings

Of the 170 subjects available for full analysis at 24 months, 54 either gained weight or lost none. Thirty-three lost 0 to 4.9% of initial body weight, 36 lost 5 to 9.9% initial body weight, and 47 (24.6%) lost 10% or more of initial body weight. (Who says diets don’t work?)

People who lost 10% or more of initial body weight at 24 months reported performing more physical activity – 275 minutes a week – compared with those who lost less than 10% of initial body weight. This amount of exercise equates to 55 minutes of exercise on five days per week above the baseline level of activity, which was sedentary as you recall. Whether they were assigned to “moderate” or “vigorous” exercise intensity didn’t seem to matter. Whether they actually performed at the assigned level is unclear.

These women who sustained a weight loss of 10% or more of initial body weight at 24 months were burning 1835 calories a week in physical activity.

Women who lost less than 10% of initial body weight, or lost no weight, exercised an average of 34 minutes a day on five days a week.

By 24 months, participants on average had regained about half of the weight they had lost during the first six months [which is typical].

Take-Home Points

After six months of dieting, many people start to regain half of what they lost. We saw this phenomenon recently in the Israeli study of low-fat vs low-carb vs Mediterranean diet.

If you have a lot of excess fat to lose, you have to wonder if it would make sense to start a different diet program every six months, until you reach your weight goal. Maybe there’s something about the novelty and excitement of a new diet program that keeps you motivated and disciplined for six months.  For someone with lots of weight to lose, I wonder if they’d do better switching to a new diet every six months.

The authors note there are few similar long-term studies examining the amount and intensity of physical activity needed to improve weight loss success. So this is important new information.

In using exercise to help prevent weight regain, it may not matter whether the exercise is moderate or intense.

The authors write:

…the inability to sustain weight loss appears to mirror the inability to sustain physical activity.

Long-term sustained weight loss is possible for a significant portion of overweight women. Although most women won’t do it, success is enhanced by exercising for 55 minutes on five days a week. Most men won’t exercise that much either. Which camp do you fall into?

For physical activity instruction and information, visit Shape Up America!, Physical Activity for Everyone, or Growing Stronger: Strength Training for Older Adults.

Steve Parker, M.D.

Reference: Jakicic, John M., et al. Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women. Archives of Internal Medicine, 168 (2008): 1,550-1,559.

Prevention of Weight Regain

Clinical Diabetes recently published a review article, “Weight Regain Prevention,” summarizing effective strategies for prevention of weight regain after a successful weight-loss program. The article is not specifically for or about people with diabetes. You are probably aware that regain of lost weight is a huge problem.

“One more rep then I’m outa here!”

The authors start with a review of various weight-loss strategies, including low-calorie diets, very low-calorie diets, commercial programs such as Weight Watchers, behavior modification therapy, meal replacements, weight-loss drugs, etc. I recall no mention of bariatric surgery.

To its credit, Weight Watchers is the only commercial program to report data from randomized controlled trials, the gold standard in clinical scientific studies of effectiveness. [Weight Watchers lost more weight than the self-help control group.]

By way of review, here is the typical pattern of a weight loss effort. Maximal weight loss occurs in the first six months, at least for people who are compliant and don’t drop out of the program after the first few weeks. After the initial six months, weight regain starts. By one or two years after start of the effort, most people – but not all – have regained all the lost weight, if not more.

The authors’ recommendations for prevention of weight regain are mostly based on well-designed, published, peer-reviewed, scientific studies. They identified characteristics of successful weight loss maintainers – what I call “successful losers.” The idea is that a person will enhance her odds of keeping the lost weight off by incorporating these habits into her lifestyle:

  • Maintain high levels of physical activity. Consider at least 60 minutes daily of moderate activity. Ouch!
  • Limit television to less that a few hours a day.
  • Eat a diet low in fat and calories. [I disagree with the accross-the-board low-fat recommendation.]
  • Maintain a consistent eating pattern throughout the week and year. Successful losers often report less variety, compared to other people, in all food groups except for fruits.
  • Eat breakfast routinely.
  • Control emotional eating.
  • Weigh frequently, whether daily or weekly.
  • Catch and address weight regain early, before it gets out of hand.
  • Consider sequential medications. E.g., sibutramine for months, then orlistat for months.
  • Individual and/or group follow-up support. Even follow-up by phone works.
  • Have realistic expectations. Most dieters only lose about half the weight they expected in the first place. The resulting sense of disappointment sabotages efforts to keep the weight off. Anticipate the universal tendency to regain lost weight.
  • Helpful diet patterns: eat more than five servings a day of fruits and vegetables, watch portion sizes, self-record food intake, plan meals, limit fast food.
  • “Exercise is central to weight loss maintenance.” And finally . . .
  • “Exercise is central to weight loss maintenance.”

Steve Parker, M.D.

Reference: Ulen, Christina, et al. Weight Regain Prevention. Clinical Diabetes, 26 (2008): 100-113. DOI: 10.2337/diaclin.26.3.100

Yo-Yo Dieting In Women Has No Effect On Death Rates

Yo-yo dieting isn’t so bad after all.

Fifteen years ago there was lots of hand-wringing in the medical community about the potential dire physical consequences of “weight cycling” – also known as yo-yo dieting. You know, lose a bunch of weight, gain it back, lose it again, gain it back, etc.

After a while, yo-yo dieting as a medical issue dropped off the radar screen. 

A 2009 study in the Archives of Internal Medicine reported on the cardiovascular and mortality effects of yo-yo dieting in women in the massive Nurses’ Health Study. One in four of these women could be classified as weight cyclers. The worst ones were defined as those who lost at least 9.1 kg ( 20 pounds) at least three times.

It turns out the weight cyclers had the same rates of death from cardiovascular disease or any cause as the women who didn’t cycle. They did eventually gain more overall weight as they aged, compared to the non-cyclers.

Note that this study investigated death rates only. So there may have been effects on rates of high blood pressure, diabetes, gout, stroke, etc, that we wouldn’t know about.

Steve Parker, M.D.

Field, Alison, et al. Weight cycling and mortality among middle-aged or older women. Archives of Internal Medicine, 169 (2009): 881-886.