What we can gain from a few losers

Well, most of them did.

 A few—I’ll be honest, maybe ten or twenty out of hundreds—have lost weight and have kept it off for several years. I make a point of questioning these patients closely about how they did it, and what fascinates me is how diverse and yet how similar their stories are. The ways in which my patients have lost weight vary. Some joined Weight Watchers or another commercial program, some worked individually with a dietician or personal trainer, some had gastric bypass surgery, and some devised their own diet and exercise plan. (It should be noted that I have had many patients who did these things and didn’t lose weight or maintain weight loss). I’ve noticed, though, that all of my successful “losers,” have three things in common:

1.       They all exercise regularly and most come to enjoy exercising

2.       They each have a deeply personal reason for wanting to lose weight

3.       They see their new way of eating, exercising, and—most of all— thinking as permanent.

Though one doctor’s observations are often viewed skeptically by scientists as “anecdotal,” it turns out that my handful of patients mirror a group of over 5,000  patients who have been studied for years in a project known as the National Weight Control Registry (NWCR). This project tracks registrants who have lost at least 30 lbs and have kept off for at least one year. They receive detailed questionnaires and annual follow-up surveys to examine their behavioral and psychological characteristics, as well as the strategies they use to keep weight off.

These people are self-selected (that is, they chose to participate) and therefore represent only successful “losers,” not the entire population of people who have tried to lose weight. There is no evidence that the techniques and approaches these people use are the key to success, because many other people (such as most of my overweight patients) have used similar approaches without success. Nonetheless, their stories may prove helpful or inspirational for some people.

They are also highly motivated to continue these behaviors over the long term. Some are motivated by an experience that frightened them — for example, finding out that they were at high risk for a serious illness. Others reported feeling extremely unhappy with the way they looked and felt.

Their diet plans and physical activities differ widely, but one thing that these individuals have in common is that they chose strategies that they liked, that fulfilled some personal goal, and that they could stick with

Research has identified several characteristics of people who have successfully kept pounds off. These are listed below. People who want to lose weight might consider following their example.

·         Many people in the NWCR ate on a schedule of three meals and two snacks a day and didn’t deviate from it.

·         Most also ate healthier foods in smaller amounts and exercised regularly — and kept on doing these things even after they reached their target weights.

·         They generally reduced their consumption of junk foods, such as cookies, donuts, and ice cream.

·         They typically did not lose weight quickly, but they lost it consistently. Some people lost weight over a period of several years.

Other research shows that among half of all people who lost weight over the long term, frequent contact with a health care practitioner led to more successful weight-loss maintenance. Such visits, even if they lasted only a few minutes and consisted of little more than being weighed by a nurse, helped keep people motivated to eat healthfully and stay active enough to maintain their weight loss.

The bottom line: The high failure rates for maintaining weight loss can be discouraging but walking (and jogging) among us are many successful losers from whom we have much to gain.

Dr. Suzanne Koven practices internal medicine with a special interest in weight issues at Massachusetts General Hospital in Boston, and teaches at Harvard Medical School.

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