Saturday, October 3, 2009
Dieting consistency
The topic of dieting consistency was also recently examined in the registry. Participants were asked whether they maintained the same diet regimen across the week and year, or if they tended to diet more strictly on weekdays and/or nonholidays (18). Few people said they dieted more strictly on the weekend compared with the rest of the week (2%) or during holidays compared with the rest of the year (3%). Most participants reported that their eating was the same on weekends and weekdays (59%) and on holidays/vacations and the rest of the year (45%). The remaining groups reported that they were stricter during the week than on weekends (39%) and during nonholiday times compared with holidays (52%).
We evaluated whether maintaining a consistent diet was related to subsequent weight regain after 2 y. Interestingly, results indicated that participants who reported a consistent diet across
the week were 1.5 times more likely to maintain their weight within 5 lb over the subsequent year than participants who dieted more strictly on weekdays. A similar relationship emerged between dieting consistency across the year and subsequent weight regain; individuals who allowed themselves more flexibility on holidays had greater risk of weight regain. Allowing for flexibility in the diet may increase exposure to high-risk situations, creating more opportunity for loss of control. In contrast, individuals who maintain a consistent diet regimen across the week and year appear more likely to maintain their weight loss over time.
Recovery from relapse
We also examined different patterns of weight change among registry participants followed over time. We were particularly interested in evaluating whether participants who gained weight
between baseline and year 1 were able to recover over the subsequent year. We found that few people (11%) recovered from even minor lapses of 1–2 kg. Similarly, magnitude of weight
regain at year 1 was the strongest predictor of outcome from year 0 to 2. Participants who gained the most weight at year 1 were the least likely to re-lose weight the following year, both when “recovery” was defined as a return to baseline weight or as re-losing at least 50% of the year 1 gain.
Although participants gained weight and recovery was uncommon, the regains were modest (average of 4 kg at 2 y), and the vast majority of participants (96%) remained >10% below their
maximum lifetime weight, which is considered “successful” by current obesity treatment standards.
These findings, nonetheless, suggest that reversing weight regain appears most likely among individuals who have gained the least amount of weight. Preventing small regains from turning
into larger relapses appears critical to recovery among successful weight losers.
SUMMARY
Results of random digit dial surveys indicate that =20% of people in the general population are successful at long-term weight loss maintenance. These data, along with findings from the National Weight Control Registry, underscore the fact that it is possible to achieve and maintain significant amounts of weight loss.
Findings from the registry suggest six key strategies for longterm success at weight loss: 1) engaging in high levels of physical activity; 2) eating a diet that is low in calories and fat; 3) eating breakfast; 4) self-monitoring weight on a regular basis; 5) maintaining a consistent eating pattern; and 6) catching “slips” before they turn into larger regains. Initiating weight loss after a medical event may also help facilitate long-term weight control.
Additional studies are needed to determine the factors responsible for registry participants’ apparent ability to adhere to these strategies for a long period of time in the context of a “toxic”
environment that strongly encourages passive overeating and sedentary lifestyles.
RRW is the cofounder of the National Weight Control Registry (with James O Hill). RRW coauthored the manuscript with SP, who is a coinvestigator of the National Weight Control Registry. RRW and SP have no financial or personal interest in the organizations sponsoring this research.
