Weight Loss Maintenance

Brief Personal Counseling May Help Maintain Weight Loss

Losing weight can be a struggle, but keeping it off can feel like a losing battle. Now a large clinical study shows that monthly personal counseling—usually just 10-15 minutes by phone—can help people who've lost weight keep much of it off for over 2 years. A web-based program also showed modest success in helping people keep lost pounds at bay.

Excess weight is a significant public health problem. Nearly two-thirds of U.S. adults are overweight or obese. This excess weight is the nation's second-leading cause of preventable death. Extra pounds can lead to increased blood pressure, cholesterol and diabetes—all risk factors for cardiovascular disease. Weight loss can reduce these risk factors, but keeping that lost weight off is notoriously difficult.

A multi-site team of scientists, led by Dr. Laura Svetkey of Duke University, decided to compare the success rates of 3 relatively low-cost approaches to maintaining weight loss. Their study, called the Weight Loss Maintenance Trial, is funded by NIH's National Heart, Lung and Blood Institute (NHLBI). It's the largest and longest-lasting trial to date that's tested different strategies for weight-loss maintenance.

As reported in the March 12, 2008, issue of the Journal of the American Medical Association, the study initially enrolled 1,685 overweight or obese adults who had high blood pressure, high cholesterol or both.

After a 6-month weight-loss program, 1,032 of the participants had lost an average of nearly 19 pounds. They were then randomly assigned to 1 of 3 approaches for maintaining their weight loss: monthly personal counseling on diet and physical activity; an interactive web-based program that provided similar information; or self-directed maintenance, where participants received little input from study staff.

The personal counseling sessions included monthly 5- to 15-minute telephone conversations with a health and weight-loss coach. Participants and counselors also had in-person meetings 3 times each year, lasting up to an hour. The web-based program provided advice similar to the personal counseling but involved no personal contact. It also included interactive features that allowed people to set personal goals and to graph weight and other data over time.

After 2.5 years of trying to maintain their weight loss, the participants who had personal counseling had the most success. At the end of the study, they retained an average weight loss of 9.2 pounds. At the 18 and 24 month checkups, the web group had retained more weight loss than the self-directed group, but by the end of the study, their numbers were statistically similar: an average of 7.3 pounds for the web group and 6.4 pounds for the self-directed one.

"Most people in the study regained at least some of the weight they initially lost," said Dr. Svetkey. "However, both the personal counseling and the web-based program modestly alleviated weight re-gain for up to 2 years, with the personal counseling ultimately proving to be the most beneficial by the end of the 2.5 year study."

Other studies suggest that even minor weight loss can have significant health benefits, the researchers note. They recommend that future studies try to refine and improve the success rates of these relatively low-cost and potentially wide-reaching approaches to maintaining weight loss.

An Example of Brief Personal Counseling With Dr. Judith Beck

From The Beck Diet Solution-Dr. Judith Beck

BACK TO BASICS March 24, 2009

Marta was dismayed. After 20 months of maintaining her weight loss with relative ease, she had gone off track and had gained back five pounds.

“I wouldn’t mind it so much if I had decided in advance to eat more,” she said, “but that’s not what happened. A couple of weeks ago, we had company for the weekend. I was fine at first, but then everyone else was eating and drinking so much, that I wanted to, too. I just stopped using my usual weekend plan. So by Monday morning, I had gained two pounds. I felt really bad about that, and I was okay for the next couple of days. But then, for some reason, I started snacking too much after dinner. I’d have that old sabotaging thought, ‘I’ve eaten too much. I might as well start again tomorrow.’ I didn’t go way overboard the way I used to, but I did eat more than usual for the rest of that week and this week, like larger portions at meals, bread and butter at dinner, and extra snacks at night. I keep promising myself that I’m going to get back in control but I can’t seem to do it. My weight is up and I’m afraid I’ll just keep gaining more.”

Marta and I talked about the two choices she could make:

1. She could plan to eat extra food, including bread and butter at dinner and an extra snack at night. It would be planned eating, though, not spontaneous deviations from her plan. Depending on how many extra calories she planned to have, she might gain a little more weight, plateau at her current weight, or lose a little. 2. She could go back to her previous plan and lose the five pounds she had gained.

Either plan was completely legitimate and either way, she’d need to go back to practicing her daily CT skills (e.g., reading her Advantages Deck and Response Cards right after dinner, going to her Distraction Box if she felt the urge to eat unplanned snacks).

Marta called me several days after our “booster” session. She was back on track, felt in control, and didn’t need another appointment. I asked her what had made the biggest difference. She said going back to the basic CT skills had done the trick.

Tags:dieting, Maintenance, Planning, sabotaging thoughts, skills Posted in Diet, Maintenance, Planning | Leave a Comment » How to Keep Your Weight Loss Resolution

Brief Personal Counseling May Help Maintain Weight Loss

There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.

American Journal of Clinical Nutrition

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