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Secrets of successful losers
Nutrition Action Healthletter, Jan-Feb, 2008 by Rena Wing
Losing weight is the easy part. Keeping it off is the real killer. Rena Wing knows. For more than 10 years she has tried to ferret out how some people manage to lose weight and avoid regaining it. Here's what she's learned from the 6,000 successful weight losers in her National Weight Control Registry.
Q: What is the National Weight Control Registry?
A: Researchers know little about people in the real world who have lost weight and managed to keep it off. We wanted to identify a large group of them, so that we could describe the strategies they used.
We have 6,000 successful weight loss maintainers whom we've recruited through newspaper and magazine articles. Most are white, middle-aged women. We ask them to fill out a series of questionnaires, then we contact them once a year to ask about their weight and weight-related behaviors.
Q: What led them to lose weight?
A: Almost all had tried before, but few had succeeded at keeping the weight off. In nearly every case, something triggered them to try again, usually a medical condition that threatened their health, or they reached their all-time high, or they saw themselves in a mirror or picture.
Q: How much have they lost?
A: To be eligible for the registry, participants had to have lost at least 30 pounds and kept it off for at least a year. But that's just the minimum. Our average participants have lost about 70 pounds and kept it off for six years. One in eight has kept the weight off for more than 10 years.
Q: How did they lose it?
A: Usually through some combination of diet and exercise. Only about 10 percent used diet alone, and just I percent relied on exercise alone. Half got help with their weight loss efforts, such as joining Weight Watchers or working with a nutritionist. That's what the women preferred. The men preferred doing it on their own.
Q: What kinds of diets did they use?
A: There was no one successful type. Many restricted specific foods like desserts. Some controlled the amount of food they ate. Others counted calories or fat grams. A few used liquid formulas or exchange system diets.
Q: How do they keep the weight off?
A: They do seven things primarily. They eat a low-calorie diet, they eat a consistent diet from day to day, they eat breakfast, they're very physically active, they weigh themselves frequently, they watch only a limited amount of television, and they don't let a small weight gain become any bigger.
Q: What kind of low-calorie diet?
A: It's relatively low in fat and high in carbohydrates. Very few of them eat a low-carb diet. And they eat four to five times a day.
Q: Why does eating breakfast matter?
A: It probably helps reduce hunger later in the day. Most registry participants eat breakfast every morning.
Q: What's the advantage of eating the same way every day?
A: We thought participants would give themselves a break and eat differently on weekends or holidays, but they don't. And they eat a smaller variety of foods than, say, other people who have recently lost weight. Reducing the number of foods they eat may simplify their diet and make it more boring, which helps them eat fewer calories.
Q: How physically active are they?
A: More than most other people. They work their way gradually up to about 60 minutes a day of moderate-intensity physical activity. Walking is their number-one exercise.
To find out how much they walked, we asked some of the participants to wear pedometers. It turns out they took 11,000 to 12,000 steps a day. That's equivalent to 5 1/2 to 6 miles. And they watch only about 10 hours of television a week--a third of what the typical American watches.
Q: What other exercises do they do?
A: About half of the participants combine walking with something that's more planned, like aerobic class, resistancetraining, biking, or swimming.
Q: Why do registry participants weigh themselves regularly?
A: Three-quarters weigh themselves at least once a day or once a week. It's part of an ongoing vigilance that lets them keep conscious control over their weight.
Although about two-thirds keep their weight stable or even lose more, the other third do gain five or more pounds during any given year. Those who are successful at preventing this relapse take action immediately when their weight increases even a little bit, by modifying their diet or stepping up their physical activity.
Q: Why do some participants regain weight and others don't?
A: The single best predictor is how long someone has kept their weight off. Maintaining the loss for at least two years cuts the risk of regaining weight by more than half. We've also found that weight gain is more likely in those who scale back their physical activity, increase their fat intake, or start watching more television.
Unfortunately, once people start to regain weight, very few are able to fully reverse it. Still, 96 percent of the participants manage to stay more than 10 percent below their maximum weight, which is considered successful by obesity experts.
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