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Losing Weight vs. Keeping it Off: What Works?
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Keeping It Off
We all know that it's one thing to lose weight - and quite another to keep it off for the long term. A study funded by the National Institute of Health and published recently inJAMA (2008;299(10):1139-1148) compares two strategies people might use to help maintain their weight loss: regular personal contact with a counselor via telephone or unlimited access to an interactive weight maintenance website. 


 

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Maintenance First!



It's sad, but usually true: most people who lose weight eventually gain at least some of it back - and all too many gain back more than they lost. As you might expect, preventing that bounce-back and helping people to maintain their weight loss is becoming an important part of research into overweight and obesity.

One idea that is drawing attention is the notion that weight maintenance requires different skills than weight loss. A few of those skills, researchers believe, include learning how to be more active in one's daily life as well as learning how to follow a healthy diet with appropriate portion sizes - with a minimum amount of effort and without feeling deprived or inconvenienced.

The researchers involved in today's study (J Consulting Clin Psych 2013;81(2):336-346) theorized that learning weight maintenance skills might be more effective if they were learned before beginning a weight loss program. The participants, they thought, would see themselves as more capable of maintaining their weight and would therefore be less likely to regain their weight.

To test their theory they recruited 267 overweight or obese women who wanted to lose weight, were free of chronic health conditions, and were able to participate in physical activity. They randomly assigned the women to one of two six-month programs: either a Weight Loss First program or a Maintenance First program.

Just as it sounds, the Weight Loss First program involved a 20-week weight loss program of calorie counting, problem solving, physical activity, and weekly group meetings, followed by an 8-week problem-solving maintenance module. While the weight loss program suggested that participants keep diet and exercise records at least 5 days per week, the weight maintenance program suggested keeping those records only 3 days per week (with calories and physical activity goals adjusted for weight maintenance), among other skills.

The Maintenance First program, however, started with what the researchers called a "stability skills" program lasting 8 weeks. The women were asked not to lose any weight during this program, but instead to focus on maintaining their current weight, using five skills taught in weekly meetings:

  1. Learn about energy balance (calories in vs. calories out) principles;
  2. Learn about appropriate portion sizes and be more physically active "without feeling deprived or dissatisfied;"
  3. Weigh themselves daily and monitor changes "without feeling guilty or alarmed;"
  4. Fine-tune lifestyle habits (i.e., make changes in caloric intake or exercise amounts) "without a lot of extra effort or attention;" and
  5. "Navigate inevitable disruptions [such as a vacation or the holidays] - with confidence."

After the initial 8 weeks the women in the Maintenance First program participated in the identical 20-week weight loss program as the Weight Loss First group. The researchers then followed up with all of the women 12 months later to see if they had regained weight - and if so, how much. Both groups lost about the same amount of weight through the weight loss program (between 16 and 17 pounds), but the women in the Maintenance First program regained an average of only 3 pounds (or about 20% of the weight lost) while the Weight Loss First group regained an average of 7 pounds (about 43% of the weight they had lost).

What this means for you

This isn't a huge study, and because the two groups were taught different skills during their weight maintenance module, it doesn't prove that one set of maintenance skills is more effective than the other. That said, the researchers' theory that learning how to maintain weight with a healthy diet and exercise - without feeling deprived or inconvenienced - before beginning a weight loss program makes a great deal of sense, and in this study it appeared to work well. This goes along with my recommendations for making New Year's Plans: make small, incremental changes toward eating healthier - in effect, learning those weight maintenance skills - and you'll be more successful at managing your weight in the long term.

First posted: January 9, 2013