|Winning at Losing: Secrets of Long-Term Weight Loss
Len Kravitz, Ph.D.
Wing, R. R. and Phelan, S. (2005). Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82 (suppl), 222S-225S.
Although dieting books, products and programs dominate consumer advertising and sales, very little evidence-based research has been published describing the characteristics of persons who actually succeed in long-term weight loss maintenance. Successful weight loss maintenance has been defined by Wing and Phelan (2005) as intentional weight loss of 10% of body weight, which is kept off for at least one year. This criterion has been established because weight loss of 10% of initial weight in overweight and obese persons is associated with meaningful reductions in risk to heart disease and diabetes. The following review will summarize the current scientific findings on what is known about those persons who have attained successful long-term weight loss maintenance.
Introducing the National Weight Control Registry
The National Weight Control Registry (NWCR) was established in 1994 by Jim Hill and Rena Wing (Wing and Phelan, 2005). All of the 4000 members (current membership) in the registry are at least 18 years or older and have lost at least 30 pounds, and maintained this weight loss success for at least one year. However, most members have lost approximately 72 lbs and maintained this weight loss for an average of 5.7 years. NWCR volunteers (no compensation for participation) are recruited using national and local television, radio, magazine and newspaper advertisements. Each new member first calls a toll-free number 1-800-606-6927 or completes a WEB application form (www.nwcr.ws/NWCR_join.htm) to determine their eligibility for the NWCR, and then (if eligible to join) is sent a consent form and detailed questionnaire packet that includes questions on lifetime maximum weight (and dates at this weight), current weight, education, ethnicity, age, gender, exercise habits, and methods of weight loss used. All registry members are tracked annually to determine weight changes that have occurred as well as associated weight-related behavior modifications (if any). Further descriptives reveal that 95% of this population are Caucasian, 64% are married, 77% are women, and 82% are college educated. Fifty percent of the registry participants were overweight as a child and 75% have one or two obese parents.
It is interesting to note that 55.4% of the registry lost their initial weight with the intervention of a commercial diet program, physician or nutritionist, while the remaining 46% report losing weight entirely on their own. Eighty-nine percent used diet and physical activity for their weight loss intervention while 10% reported using diet only. It should be highlighted that 1% utilized exercise only for attainment of their weight loss. The most common dietary interventions involve a combination of restricting food (87.6%), limiting food quantities (44%), and counting calories (43%).
Successful Strategies for Long-Term Weight Loss Success
Initial research on registry members in 1997 uncovered three common strategies among members for successful weight loss maintenance that remain consistent in current registry members.
1) Doing high levels of physical activity
2) Consuming a low-calorie, low-fat diet
3) Weighing themselves frequently
Of recent, a fourth common strategy most (78%) members report is eating breakfast (typically cereal and fruit) every day. As well, current members eat 2.5 meals/week at a restaurant and 0.74 meals/week in fast food establishments.
A common personality trait in registry members is their personal vigilance regarding weight loss maintenance. Forty-four percent of registry members weigh themselves daily, while 31% weigh themselves at least once per week. Further investigation of this population reveals that successful weight loss maintainers continue to act like recently successful weight losers for many years after their weight loss (Wing and Phelan, 2005).
How Much Physical Activity are Registry Members Doing?
A common behavior of successful weight loss registry men and women is their high levels of physical activity each week. Men report an average physical activity of 3,293 kcal/week and women report an average of 2,545 kcal/week. This level of physical activity is equivalent to about 1 hour/day of moderate intensity activity. Seventy-six percent of members report that walking is their main form of physical activity. Other physical activities reported by men and women in the registry include resistance training (20%), cycling (20%) and aerobics (18%). Previous research on this population shows that as registry members decrease their physical activity >800 kcal/week, there is a tendency to regain some weight (McGuire et al., 1999).
What Happens to Registry Members Who Regain Weight?
Wing and Phelan (2005) examined differences in registry members who regained >5 lbs after 1 year of weight loss success to determine what predictors might indicate weight regain. Those who regain weight tend to have periodic losses of control of eating. As well, those with higher levels of depression showed greater odds for regaining weight. McGuire and colleagues (1999) add that increases in percentage of calories from fat in diet is also associated with some weight regain.
However, a most important finding was that those persons who were successful at weight loss for maintenance for 2 or more years had significantly greater chances of keeping the weight loss success. Wing and Phelan state that if individuals can succeed at maintaining their weight loss for 2 years, they can reduce their risk of subsequent regain by nearly 50%. Although not fully understood, one explanation for this phenomenon is that the added length of time provides individuals with opportunities to acquire, practice and refine long-term coping skills associated with weight loss maintenance (McGuire et al., 1999).
What Sparks Most People in the NWCR to Initially Start Their Weight Loss Plan?
It appears that the majority (83%) of the men and women in the NWCR have some type of prompt or trigger that sets off their weight loss initiative. Activators to weight loss and continued maintenance include medical conditions (23%), all time high in weight (21.3%), and observing themselves in a mirror or a picture (12.7%). Medical reasons were generally described as conditions that would lead to a heart attack if nothing was done.
What Commonalities are Observed With NWCR Members Diet?
Consistency in dietary regime appears to be a commonality with NWCR members. Fifty-nine percent of members say their eating habits were the same on weekends (and holidays) and weekdays, while 39% of participants noted they followed stricter diets during the week as compared to the weekend. Wing and Phelan (2005) state that members who were more consistent with their diets during the week and weekend were 1.5 times more likely to maintain weight loss during the subsequent year. The researchers further assert that allowing for too much flexibility in the diet may expose the person to high-risk situations, creating more opportunity for loss of control.
Practical Message to Fitness Professionals
Fitness professionals and personal trainers can help clients achieve long-term weight control success by supporting, educating and guiding them utilizing many findings from this study, as opposed to listening to the media barrage of empirical claims seen in advertisements and infomercials. Clearly, high levels of moderate intensity physical activity (accumulating ~1 hour per day) is a common behavior to successful weight loss maintenance and a goal to achieve. Eating a low-calorie, low-fat diet as well as eating breakfast is a consistency to long-term weight loss maintenance success. As well, regular self-monitoring of weight (either daily or weekly) and constancy in diet throughout the week and weekend appears to keep people from triggering loss of control lapses with diet. In addition, educating clients about depression mood swings (and seeking proper help if necessary) is important because low levels of depression are associated with long-term weight loss success. Also, it appears that a person who is successful in weight loss success for 2-5 years significantly increases her/his odds for continued long-term success. Perhaps the greatest message to remind clients is that long-term weight loss success is a reality they can attain with determination and watchfulness.
McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W. and Hill, J.O. (1999). What predicts weight regain in a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67(2), 177-185.