Suppose again that the premise of my post earlier this week (Well intentioned lies, doctors, and the diet industry) is right that very few people who lose weight keep it off. Most regain it, some regain more and only a teeny tiny few manage to maintain the new low weight.
You might well ask, why can’t I be one of the few? Why can’t I be one of those rare, mythical creatures, the weight loss unicorns?
In my case, I’m a classic type A personality, a lover of plans, structure, and schedules. I’m an analytic sort, a researcher and problem solver by temperament, and I’m highly motivated to achieve my goals.
So maybe I should just find out what those who’ve succeeded in the past have done and try be like them.
According to Canadian health researcher Timothy Caulfield, author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness (I reviewed his book here) people who keep off the weight they have lost are a pretty special breed.
Members of this group all have some traits in common and because they’re rare, have been studied closely. First, constant vigilance. They remain as focused and determined as they were when losing weight and they log and track just as carefully as when they started. Second, they exercise a lot. Third, they also don’t eat very much. Yikes. One of the women profiled in Caulfield’s book hasn’t eaten a full size entree since she began losing weight. She eats appetizers only and shuns all desserts and alcohol.
The Center for Disease Control which maintains the weight loss registry for people who’ve kept weight off long term also describes the traits that people who maintain a weight loss, long term, have in common. They exercise 60-90 minutes most days, they eat breakfast, they weigh themselves regularly, they track food intake, and they plan meals.
In an Atlantic article from a couple of years ago, What do we really know about losing weight? you can read a profile of one person who maintained a new lower weight. I’ll excerpt a bit here but it’s worth going to read the entire thing.
During the first years after her weight loss, Bridge tried to test the limits of how much she could eat. She used exercise to justify eating more. The death of her mother in 2009 consumed her attention; she lost focus and slowly regained 30 pounds. She has decided to try to maintain this higher weight of 195, which is still 135 pounds fewer than her heaviest weight.
“It doesn’t take a lot of variance from my current maintenance for me to pop on another two or three pounds,” she says. “It’s been a real struggle to stay at this weight, but it’s worth it, it’s good for me, it makes me feel better. But my body would put on weight almost instantaneously if I ever let up.”
So she never lets up. Since October 2006 she has weighed herself every morning and recorded the result in a weight diary. She even carries a scale with her when she travels. In the past six years, she made only one exception to this routine: a two-week, no-weigh vacation in Hawaii.
She also weighs everything in the kitchen. She knows that lettuce is about 5 calories a cup, while flour is about 400. If she goes out to dinner, she conducts a Web search first to look at the menu and calculate calories to help her decide what to order. She avoids anything with sugar or white flour, which she calls her “gateway drugs” for cravings and overeating. She has also found that drinking copious amounts of water seems to help; she carries a 20-ounce water bottle and fills it five times a day. She writes down everything she eats. At night, she transfers all the information to an electronic record. Adam also keeps track but prefers to keep his record with pencil and paper
Now some of you might find this horrifying. You might read about it and want to scream, “These are not my people” and run fast in the opposite direction.
But my reaction isn’t that extreme. I’m a fan of planning and tracking. I weigh myself regularly. I always eat breakfast and as readers of this blog well know, I get lots of exercise.
So maybe it’s not all bad. Consider Canadian obesity researcher Yoni Freedhodf’s view in Is It Really Scientifically Impossible to Keep Your Weight Off?.
In responding to the same piece that prompted this blog post, he suggests that we might be able to rebrand “constant vigilance” as “mindfulness” and think more positively about it.
Says Freedhoff, paying attention to every calorie, spending an hour a day on exercise, and never not thinking about weight does sound like not much fun.
“That does indeed sound rather severe, and she definitely writes about it with the spin of negativity. What do I think? I think negative depends on approach and attitude. For instance where Tara might use the word vigilance, I’d use the word thoughtfulness and that being aware of every calorie doesn’t mean you’re not eating indulgent ones.”
Okay, whatever we call it, vigilance, awareness, thoughtfulness, it seems required for keeping off weight. So is a commitment to lifelong mindfulness about food enough to stave off weigh regain? But my suspicion is that it’s not enough. My experience is that I’ve sometimes started to regain weight through practising the exact same habits that earlier resulted in weight loss. I’ve tracked food and exercise very carefully through periods of gaining pounds.
The problem is that these traits, mindfulness, tracking, weighing and on, might be necessary but not sufficient for keeping weight off, once you’ve lost it. That is, everyone who keeps weight off lives this way but not everyone who lives this way keeps the weight off. Tracy in her blog post yesterday about weight loss wondered how much weight regain can attributed to changing habits and how much to biology. I think there’s a significant biological component and that even vigilant people face further obstacles. Here are just four of them.
1. Changed body chemistry, Biological Changes Thwart Weight Loss Study Finds.
For years, studies of obesity have found that soon after fat people lost weight, their metabolism slowed and they experienced hormonal changes that increased their appetites. Scientists hypothesized that these biological changes could explain why most obese dieters quickly gained back much of what they had so painfully lost.
2. Smaller bodies use fewer calories: This is one of the tougher things to get used to. At my largest I’ve weighed 235 lbs and at my smallest 155 lbs (all adult weights). The thing is that my 235 lb body uses a lot more calories just getting about in the world than its lighter cousin does. (Using a standard base metabolic rate calculator and plugging in my age and activity level, I see I need just under 3000 calories a day to sustain my weight at 250 lbs and just over 2300 calories a day if I weighed 150 lbs.) Thus, I need to eat less and less as I lose weight. That’s not easy.
3. Fitter bodies use fewer calories too: When I first ran 5 km at 235 lbs, that was really tough going, not just because of my weight. I was also not used to running. As I got fitter, running 5 km got easier and easier. I burned fewer and fewer calories running 5 km.
Outside Online answers the question about fitness resulting in fewer calories used in this article, Do Seasoned Runners Burn Fewer Calories Than Newbies?
“One study published in the Journal of Applied Physiology determined that well-trained runners burn five to seven percent fewer calories than their nonathletic counterparts. A run you did as a newbie athlete that burned 500 calories, for example, might burn 465 to 475 calories when you’re better trained, assuming you’ve stayed the same weight.”
And there’s the rub. If you’re getting both fitter and smaller (both the goal of many people) you’re also now using fewer calories for an equivalent workout.
Yes, in theory you could making it equally hard. You could run more distance or run faster or add intervals. The reality is that few of us push ourselves as hard as we did when we started. Getting more efficient just is what getting fit is all about. And that’s great but it terms of calories, efficiency isn’t our friend.”
4. Age and metabolism: I’ve written about this one before. See Monday morning, perimenopause, and metabolism.
For runners, you need to run further and faster each year to burn the same number of calories. Getting fitter just means it takes less effort, hence fewer calories, to do the same thing. That’s just what fitness is. Ignore the calorie counters on exercise equipment at the gym.
And no matter what else you do, you’re aging and your metabolism is slowing down. And truth be told, few people run more or run harder as they age. Why that’s so was the subject of an earlier blog post, Is Aging a Lifestyle Choice?
There’s a sad funny story in Timothy Coalfield’s book The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness about a colleague who ran 18 marathons, one a year, and gained one pound per marathon.
So getting fitter and thinner and older means eating less and less, and working out more and more, to stay the same weight. Behavior and habits that at one point in one’s weight loss journey led to a loss on the scale, can, at a later point on the journey, lead to weight gain. Not exactly inspirational!
Caulfield’s book, like Gretchen Reynolds’ book The First Twenty Seconds, makes it clear that the truth doesn’t provide much fodder for catchy motivational slogans: Exercise intensely for long periods of time and you might just stay the same! Both cite the same study showing women who exercise a lot, and regularly, still gain weight as they age. They just gain less. That’s good health news but won’t exactly make for a very good poster at the gym.
I’ve got one more post on this subject left to go–it’s in the draft folder and is called “Impossible Weight Loss: Questions and Quibbles”–and after that I promise I’ll return to fitness, which I don’t actually think is connected to fatness at all.
You raise lots of interesting issues in this post, Sam B. I have to say, though, that I really disagree with the rebranding of “vigilance” about weight and food as “mindfulness.” The activities you describe in terms of vigilance revolve around using signposts and maps external to the body, and focussing on the past and the future. Mindfulness is precisely the opposite kind of activity: its about present-tense embodied awareness.
The reason Bridge and her vigilance are off-putting is that they offer a text-book case study of sub-clinical eating disorder symptoms. A lot of eating disorder treatments–for better or worse–prescribe mindfulness as an intervention into Bridge-like behaviour, in order to shift the person’s relationship with herself and her body. Mindfulness is supposed to train people to trust and follow things like hunger and satiation signals (as opposed to counting calories, weighing food, and tracking).
I’m not trying to prescribe mindfulness for everyone, or trying to undermine anyone’s valuation of moderate vigilance. But I think it’s important to keep these practices distinct, because they really do do different things.
Right. The rebranding isn’t my suggestion. It’s Freedhoff’s. The question can tracking/planning/self monitoring be successfully replaced by mindfulness. I’m very skeptical about that too.
Where might mindful reading, intuitive eating and vigilance come apart? Well suppose you experience the increased appetite that comes with weight loss. You’re hungry. To eat or not? The intuitive eating approach says to eat when you’re hungry. The vigilant person ignores the hunger because they know eating will cause weight gain. So yes, I’m with you skeptical that one could ever be equivalent to the other. And I’m skeptical that in the face of hormonal cues to eat, that intuitive eating “works” in the sense of working to maintain weight loss.
Excellent post. Lots to think about.
I agree, lots of “food for thought”. I think there is a very fine line between obsessive vigilance and tracking and healthy positive mindfulness. I used to write down on a piece of paper every single thing that went in my mouth and how many calories that was. I was obsessed by that and by exercise (1.5 to 2 hours per day, every day). Since I have broken out of that obsession, I am now mindful, and will skip a day exercising if I have to or if I really don’t feel like it and not obsess over it. Have I regained weight? Yes. Do I feel better? Heck yeah! As you say, weight and fitness have nothing to do with one another and I like to think of fitness of the body and of the mind. An obsessive mind is not a fit mind for me.
Right. It might be the higher weight is the healthier weight, all things considered.
At the risk of engaging in the “I think this is true because one time I saw a case like this” anecdotal quicksand: the one person I know who used to be quite overweight and has kept it off consistently fits this pattern perfectly. I actually don’t know how overweight she was at her heaviest–she just says she was extremely heavy–but now she is “normal” (not particularly thin), runs marathons (in Boston-qualifying time), exercises constantly, and watches every calorie. Seeing her approach to eating was frankly exhausting. I assumed she had some sort of unhealthy fear of fat (tied to her history) that led to this compulsive behavior. And my initial assumption, I think, hits on the re-branding question: does classic compulsive behavior become non-obsessive/compulsive and indeed appropriate-for-that-person simply because such behavior is necessary for maintaining a normal weight? for not being obese? for not being morbidly obese? for satisfying any X (where the significance and or applicability of X is not linked to some crazy context involving mad scientists, runaway trolleys, of nuclear bomb-wielding terrorists)?
There sure were a boatload of unicorns 8 years after the Look AHEAD trial began – even among those with the most minimal of interventions: http://www.weightymatters.ca/2014/06/more-on-almost-impossible-feat-of.html (sorry if this is a duplicate comment – after I logged in it didn’t seem as if comment sent to moderation so am resubmitting)
Thanks for commenting. Off to go look at your post on the Look AHEAD trial.
Right. So this gets to a point I discussed on Facebook and on comments to another post on the blog two days ago. Maybe we need to rethink what counts as success. The weight loss impossible stuff is all about people who got down to their goal and didn’t stay there. The trial you mention is about people losing just ten percent of their body weight. Likely for most people they have goals in mind that are more ambitious. I went from 235 to 165, regained half of it, but even then I was still a success by your measure because I’d kept off more than ten percent of my starting weight.
I love that Christine notes that she *feels better* when she is not engaged in vigilant, obsessive, or whatever we want to call them, behaviours (amazing! :)). Of course one can *feel* fine with, say, high blood pressure, so feeling better might not be the only metric, but the idea that mental strain — and speaking from experience, it *is* mental strain, obsession — is extraneous to health is mind-body dualism writ large, isn’t it? Also, as a fellow type-A, I would be shocked if my body (and others’!) didn’t respond to this sort of strain, as it does when one is under ongoing, if not front-of-the-mind, stress… which probably raises blood pressure, and causes other stress responses, in many of us.
Planning need not be this sort of strain. On the other hand (not unlike women who enjoy “femme”-y clothing and behaviour, etc.), given the circumstances in which planning must currently arise, it might be hard for many of us to tell what is a matter of “interest” in what one’s body is doing on any particular day, and what is a matter of larger social “interest” in what one’s body is doing on every particular day. Similarly, being “mindful” of one’s body’s own needs and desires is, I find, difficult to separate from being “mindful” of what one’s body needs and desires as shaped by social forces. Actually, moving around might be easier on this point than eating… many of us feel goodness and light in a more noticeable and immediate way by moving our bodies around than by changing diet (though that, too). (one part of why fitisafeministissue ROCKS!) And I do sometimes wonder, in all of the mainstream reporting on this stuff, where talk of the good life is…
Sam, I’m just fascinated by your unicorn exemplar. I’m a unicorn, in fact (love this descriptor – think I might keep it!), but honestly don’t recognise myself in the models above at all. In 2000 I weighed 195lb; I went into a Gap store on my birthday, found red trousers I wanted, and was shocked when I had to buy a size larger than I’d ever worn before. So I began changing my diet and exercising, for the first time in a while. Over 16 months I lost 40 pounds, bottoming out, like you, at 155. Gradually I settled around 160 and am still there now. What do I do to stay at this weight? Different things each time, if I notice my baseline creeping up a bit. I frame it for myself like this: I’d prefer to weigh about this much, but if I gain a bit that’s fine, as long as I realize other benefits (like I’m riding my bike faster – more muscle; or, the clothes I love still fit comfortably, and look nice on me). If I don’t feel fine anymore, I make subtle changes. Each time I need to adjust downward a bit I change one thing and test its efficacy: last year it was fish oil and foregoing seconds unless I’d been out on a ride; this spring I’m cutting down on sugar (though not cutting it out – that seems a recipe for depression to me!). The goal is always just a touch of nuance, and I try to keep in mind that as I age and as I become much more athletic the circumstances shaping my weight change, requiring new strategies. So I think I fall into the ‘mindfulness’ camp, at least as far as my own anecdotal evidence is concerned, though as a researcher, like you, I bring those skills to bear on working out what to try, and what not to try.
I know the fact that I’ve been successful in this very rigged game makes me very fortunate, but I just want to emphasize that I have been successful while having no obsessive habits around food. (And I only weigh myself once a week, or thereabouts.)
Wow Kim. I have a similar story, with a similar time line. I weighed 225 in 2003. It didn’t seem like I was that big. I didn’t see myself as weighing that much. But when I looked at pictures of myself I realized that I needed to start losing some weight. So I took a mindful approach. I started to really look at what, and how much, I was eating. I also started a fitness regiment. I walked with a combination of running, until I could comfortably run a 5k.
So fast forward to over a decade later. I am 5’6″ and I now weigh about 155. Which is awesome, I have managed to keep off the weight over a period of years. The only thing is, I feel like I have some major body image issues. I still see myself as the “bigger” person that I was. Its very strange. When I look in a mirror I see a different image than I see in a picture. Not a good feeling.
For me it’s not that my habits slip or I go back to my old ways. Rather it’s that the very same habits that earlier resulted in loss no longer work. Eventually they lead to weight gain. In order to stay at the lower weight I’d have to white knuckle it, like Craig. I regain weight very quickly.
So my sense is that intuitive eating and mindfulness wouldn’t do it for me.
Aging– no kiddin’ that is a wild card that must be factored in when trying to remain healthy weight for life.
Yes, it’s true being more fitter means you are burning fewer calories efficiently.
A woman at work who I work for, has recently lost over 70 lbs. via Weight Watchers. She wants to become a WW leader after she retires in a few years.
Honest, I’m bewildered by how food is viewed in terms of points. I could never live like that. I also noticed that she avoids attending most of our work-related luncheon functions: Is that a healthy attitude at all?? After all, I never help myself to diet coke/pop at the luncheons because I never liked that taste nor gassy feeling…
As someone who has kept the weight off for a few years, despite bulking up on a few occasions to gain strength and then slowly losing it again (I’m currently in a bulking phase again) , I can’t comment on other than my experience. Whether my experience is possible physically for others and whether it is possible for women, again – I can’t comment. I know only the following for myself: (1) weighing myself everyday or almost every day is ABSOLUTELY KEY – it would be impossible without doing it; (2) I do not always eat breakfast, but when I do I eat only green vegetables; (3) I eat ALOT of green vegetables! (4) I work out 1 to 2 hours 5 to 6 times a week; and (5) I do not eat sweets, however, I do eat protein bars with very low sugars. I do not track my food or calorie intake. However, as I am almost like clock-work in what I do, there is no need – or so so it seems. Whether what I do would make others and perhaps women especially, neurotic, given the societal pressures on women to look a certain way which most certainly do not act on me in anything even approaching the same way, or would otherwise harm others emotionally or psychologically again, I cannot say. Lastly, I do not much care what I look like, or at least I do not care that much relative to most women in our society, from what I have seen and heard. I have the strong feeling that this helps me a lot, because if I was constantly checking myself out in the mirror I think I’d be crazy-compulsive about my appearance and whenever I’m crazy-compulsive about something external to myself, it can’t last because it’s impossible at least for me to maintain interest and dedication to something external to myself. For me, the lifestyle I’ve adopted is simply how I have now chosen to live. It is now quite simply who I am. But as Tracy has said in her blogs, I guess
I’ll have to wait and see if this remains me for the next 3 years.
Sounds like you have all the unicorn habits! And I say that in the nicest possible way. Jealous!
Great great great post, really worth think about these (usually) less discussed factors. Also, I love the phrase “weight loss unicorn” 🙂
As a carb-and-cheese-atarian (thanks to Jenica Rogers for that term!), I will never be one of those unicorns. I’m okay with that. I love the foods I love too much to sacrifice them for a goal I may never be able to achieve. Which is why I am focusing on being stronger, not thinner.
Stronger sounds good to me too.
I too lost weight about eight years ago and have maintained the loss with a few fluctuations. I weigh myself every morning (even on vacation) and I am conscious of everything I eat (mostly meat, fruit and vegetables), although I don’t log it. I very rarely eat dessert because I have tasted cake and cookies and frankly, I can live without them. I do drink wine because I love it! I exercise one hour five times a week, and I enjoy it. I have made lots of great friends at the gym and the local run club. I was around 34 when I was at my heaviest, and I felt old. It was hard to bend, it was hard to climb and it was hard to feel good in my clothes. Now, at 42, I can run and jump and dance and lift weights and (forgive my vanity or aquiescence to societal pressures) I can buy jeans.
I am happy and healthy, and I guess that in my opinion, it comes down to a choice. I choose to forego nachos, pancakes and cookies and to spend some of my time most days exercising because I prefer feeling the way I do now.