By Nanci Hellmich, USA TODAY
VANCOUVER, B.C. — One of the largest clinical studies on keeping off the pounds after weight loss supplies more evidence that even when the battle of the bulge is won, the war is far from over.
Researchers at Brown University in Providence say the safety zone around weight maintenance is about 5 pounds. That’s the marker indicating it’s time to stop in your tracks and immediately reverse course before all is un-lost.
“The key factor is you must continue to monitor your weight after you’ve lost it, and if you start to regain, then immediately rein in your eating and step up your exercise,” says Rena Wing, a professor of psychiatry at Brown University and lead researcher on the new study called Stop Regain.
The researchers presented the new data Sunday at the annual meeting of the NAASO, the Obesity Society, an organization of professionals working in obesity research, treatment and prevention. NAASO stands for the North American Association for the Study of Obesity.
Scientists have long sought clues to the mystery of how to keep diet-weary Americans from regaining weight they’ve lost. Researchers here are talking about why that’s so hard to do for both behavioral and biological reasons.
“Weight-loss maintenance is the No. 1 problem in the treatment of obesity,” Wing says. “The question is: Can we stop regain? The answer is a resounding yes.” The government-financed Brown University study of about 300 people over 1½ years encouraged participants who had lost weight to do the following:
• Step on a scale every day.
• Try to be physically active at least an hour a day.
• Participate in face-to-face weight-maintenance classes or Internet programs that offer support and instruction.
• And if they regain 5 pounds, put on the brakes by following a better eating and exercise plan.
Fast start, then reversal
Several studies released at last year’s obesity meeting showed that dieters on aggressive programs lose an average of 20 to 22 pounds — or about 10% of their starting weight — in the first six months and then quit losing. Many then start to gain the weight back, which is frustrating to dieters and weight-loss professionals.
In considering behavioral obstacles, NAASO members considered other research Sunday on the effect of stress on 69 African-American women who had lost weight.
That study found that the women were more likely to regain weight if they were stressed or a little down, because that’s when they ate more high-calorie, high-fat foods, says Paula Rhode of the University of Kansas School of Medicine. She says the study focused on black women because they are at a high risk for obesity and obesity-related diseases. “These findings suggest that adding stress-management strategies to weight-loss programs may help prevent or delay weight regain,” Rhode says.
But experts now know that there’s a lot more to the problem than coping or lifestyle.
“Weight loss is not just about behavior and willpower; it’s biological,” says obesity society president Louis Aronne. “There is a coordinated mechanism in the body — designed to prevent you from starving to death — that makes weight loss difficult.”
Aronne explains that dieters’ own hormones start working against them as the body fights to get back to its former weight. In an effort to keep the dieter from starving, a hunger hormone called ghrelin increases and a fullness hormone called leptin decreases.
“So weight loss is not easy because the body is essentially working against you,” Aronne says.
But some people are able to overcome the obstacles. Researchers have learned a lot from members of the National Weight Control Registry, a study of about 5,000 people who lost an average of 73 pounds and kept off at least 30 pounds for more than six years.
As one of the founders of the registry, Wing used the data from the registry to design the latest study.
She and colleagues recruited 314 people who had lost 10% or more of their body weight in the past two years in a variety of ways, including following Weight Watchers, Atkins and other programs. The average weight lost was 44 pounds; some dropped more than 100 pounds.
Participants were randomly assigned to one of three groups. A control, or baseline, group received only a periodic newsletter with weight maintenance tips. A second group went to classes regularly for 18 months. The third group used the Internet to get educational information similar to the material covered in the classes. (Related story: The Internet as a weight loss tool )
The class and Internet groups were taught secrets of success from registry members and encouraged to follow their examples. They wrote their own weight-loss success stories to refer back to if they started gaining.
The dieters in the treatment groups kept track of their weight and plotted it on a chart that had green, yellow and red zones. Each week, the classroom participants called an automated answering service, and the other group entered their weight on the Stop Regain website.
If they were within 2 pounds of their goal, they were in the green zone and received small rewards once a month, such as green gum, a green Frisbee or a dollar bill.
If they went 3 to 4 pounds over that weight, they were in the yellow zone, which meant they should start watching their diet more closely and exercising more.
If they gained 5 pounds or more, they hit the red zone. Those in the face-to-face treatment group received a call from a weight-control counselor who would help them get back on track. Internet dieters got an e-mail from a specialist.
To combat the extra weight, dieters were advised to read their own weight-loss story and reinstate those behaviors or follow a low-calorie plan that included exercise.
The fruits of their labors
The findings after 18 months:
• About 70% of the newsletter group regained 5 pounds or more; 54% of the Internet group regained that much, as did 38% of the face-to-face group.
• The median weight gain was 10 pounds for the newsletter group; 6 pounds for the Internet group; 2.5 pounds for the face-to-face group.
• Among those who weighed in daily, 61% maintained their weight within 5 pounds. But weighing daily only helped those in the class and Internet groups.
• People who were the most successful exercised for about an hour a day.
“Face-to-face classes and the Internet support program were helpful because participants were taught how to make changes in eating and activity to immediately reverse small weight gains,” says Deborah Tate, assistant professor at the University of North Carolina and a co-investigator on the study.
The program really worked for some participants.
I’m a long way off this stage but thought it was really useful. Maybe we should have a maintenance forum and encourage weekly weigh ins to keep track of the 5lb marker
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