by Barbara Berkeley, MD
I hope the message of Refuse to Regain (both book an blog) continues to be a clear one. Weight maintenance is tough and isn't accomplished without planning, strategies, and a healthy respect for its difficulties.
This week a study from Stanford University showed that women who studied the skills of weight maintenance before they ever started dieting were better able to avoid weight regain after one year.
The American dieting process is deeply flawed because it is tailored to focus solely on getting smaller. Look at the language we use: we 'shrink', we 'reduce', the pounds 'melt away'. We think we understand why we got too big....we ate too much. But what were the reasons we ate too much? They actually go far beyond the standard explanations. If we were to believe the magazines we read, all of our pounds could be chalked up to fast food, portion sizes, and emotional eating.
Dieting to lose weight puts us in a unique state. We deprive ourselves temporarily, and if we get calories low enough (and insulin low enough), we will start to burn the fat that is stored in what is usually a kind of locked closet. If we think that we can prevent that closet from filling up again, we'd better understand what caused it to get so overstocked in the first place. We'd better be well prepared for the challenges of maintenance.
The reasons that we gain weight are very complicated. The skills needed to avoid regain, however, are rather basic. Let's talk about both.
The idea that we gain weight because we have no willpower is beyond simplistic. Our weight balance is regulated by a hugely complex net of bodily factors. All of the pieces must be working correctly and in concert in order for appetite and weight stabilization to be healthy. Just a sampling: at the level of the fat cell, the hormones lipoprotein lipase and hormone sensitive lipase must be functional and able to bring fat into the fat cell and release it as needed. At the level of your intestines, the hormones CCK, GIP, PYY, GLP-1, oxyntomodulin and others must perform their assigned roles in tamping down your appetite after you’ve eaten. At the stomach, the powerful chemical ghrelin must be secreted in just the right amounts. Too much ghrelin and you will be very hungry. Ghrelin levels rise after you lose weight. In the brain, a delicate balance is maintained between chemicals that make you hungry, like NPY and Agouti Related Protein, and those that stop you from eating, like Pro-opiomelanocortin and CART. Back at the fat cell, the release of Leptin, a powerful modulator of hunger and fat balance, must be appropriate. Leptin stops hunger and should rise when are fat stores are high, but in obesity these high Leptin levels no longer work properly and the brain doesn’t “hear” them, thus appetite is not shut down. At the pancreas, Insulin needs to be released in response to carbohydrates and must drive blood sugar into fat and muscle. In obesity, the Insulin signal is not heard well by muscle and Insulin tends to drive everything into fat. At the gut level, billions of bacteria need to properly break down food and may be involved in signaling that affects weight balance. A rapidly developing area of science is examining our changing gut bacteria and the role this alteration may have in promoting obesity.
After weight loss, powerful changes in the balance of all of these factors, coupled with a body that has become more efficient at burning calories and thus needs fewer, tip the balance hugely in favor of regain. That is why Doing Unplanned Maintenance is D.U.M! Get started early in the game and use the time when you are losing weight to set up your strategy.
What is DUM?
- It’s DUM if you have fewer than 3 strategies for keeping weight off. If your whole plan is to eat more moderately, exercise more, and avoid sweets, that is not a strong enough plan.
- It’s DUM if you are not prepared for increases in hunger and cravings that will come after weight loss.
- It’s DUM if you think that you will be able to return to the habits you had prior to weight loss, but you will now be able to control them through willpower.
- It’s DUM if you haven’t spent time learning about the biology of weight gain and where your challenges will lie.
All of these are features of Doing Unplanned Maintenance.
Instead, get a degree in Strategic Maintenance Arts. That’s S.M.ART.
What is SMART? It’s having a comprehensive plan already in place by the time you’ve finished losing. This plan needs to take the following into account:
- You will have to eat in a prescribed way (a preconceived maintenance diet) that you set up.
- You will have to be very consistent.
- You will need to exercise a lot (5 days a week recommended at minimum) and will need to find exercise that you actually enjoy.
- You gained weight because your body reacts badly to the modern food environment, thus you can no longer eat the modern diet.
- You will need to find new foods to eat that give you lots of pleasure.
- You will need to monitor yourself, keep records, weigh daily and find fun in the process.
- You will need support.
While this sounds complicated, the bones of a good maintenance plan are actually straightforward. Following the plan, not figuring it out, is the element which presents the challenge.
I encourage you to develop your own plan and to tailor it to your special needs. To do this, you should consult other maintainers (on blogs like this one, on our Facebook page at Refuse to Regain:Barbara’s World, on diet websites, or in your community). You should also read as much as you can about successful maintenance.
To help you with this challenge, here is the basic maintenance plan that I recommend.
- Weigh daily and allow yourself a five to eight pound margin for change. Set a definite “Scream Weight” that you never want to exceed.
- Reverse regains above Scream Weight immediately with no exceptions. Figure out in advance what your reversal plan will be. The easiest reversal plan is to go back to your weight loss diet until weight comes down.
- Practice 90-95% avoidance of all carbohydrates except for vegetables and fruits. The two major hormones that control weight---the big guns---are insulin and leptin. You can’t control what happens to leptin (it will make your hungrier after weight loss), but you CAN control insulin. Don’t make much and you will avoid regain. That means, don’t eat carbs. They are the foods which stimulate insulin production.
- Keep your daily diet reasonably limited. Eat things you love but which you can rely on. Overstimulation triggers hunger in maintenance.
- Find exercise you can love NOW. Don’t wait until you are in maintenance. Exercise as vigorously as you comfortably can if you enjoy it. Otherwise, just walk. Plan on finding at least an hour five days a week to devote to this.
- Sleep about 7-8 hours most nights. This might mean figuring out how to get to sleep earlier. Turn down lights and turn off TV and computer as the evening goes on. Sleep is essential for weight mechanisms to work properly.
- Find a support mechanism. Form a group with other maintainers, become a faithful follower of our Facebook page, hook up with a like-minded dietician or counselor. Don't’ try to go it alone.
- Don't’ be afraid to use meal replacements like shakes or bars once or even twice a day. Many research studies show that they work.
- Appetite suppressant medication may help you if all else fails. Don’t be afraid to ask your doctor or bariatric specialist. Relapse is common. You wouldn’t be ashamed to continue getting treatment for diabetes, so don’t be ashamed to view overweight as a chronic condition that will need periodic “tune-ups”.
No difficult tasks can be accomplished without smart thinking, so be S.M.ART and start early in practicing the art of strategic maintenance.