By Barbara Berkeley
It’s interesting that Lynn picked last week to write about the things that maintainers have in common. I had just been thinking about the very same thing, but for somewhat different reasons.
Every couple of years, spring ushers in what I call “CME Season.” Luckily for patients, medical boards require that docs keep up to date with the latest in medical science, a process called CME or Continuing Medical Education. When it’s time for a doctor’s license to be reviewed, he or she must also produce proof of being up to date with those CME activities. I have a little folder which houses the certificates that attest to the fact that I’ve attended conferences, watched presentations, or sat through grand rounds. But this year, I got a jolt. My total hours fell a few short. At first I thought, ‘Well, it will be fine. I’m sure that researching and writing a book will count.’ But since I wasn’t sure, and I really like to sleep at night, I headed for the great big supermaket of CME, the internet; you can pick up just about anything there.
As it turns out, one of my favorite sites was offering a series of lectures on obesity and one, in particular, caught my eye. It was a talk by James Hill, co-director of the National Weight Control Registry, on weight maintenance. These internet seminars are really terrific because they include the audio and slides from original presentations done elsewhere. So, for the past hour, and right before receiving Lynn’s blog, I’d actually been listening to James Hill describe the things that successful maintainers have in common – at least in the opinion of the NWCR.
As we have a very sophisticated readership, I’m sure most of you are familiar with the NWCR. Just on the odd chance that you are not, however, the National Weight Control Registry is a study of people who are trying to maintain a weight loss. It was begun in 1993 and is a joint venture of Brown University and the University of Colorado. In order to join (and I always urge successful maintainers to do so), you must have lost at least 30 pounds and have kept it off for a minimum of one year. Most members of the registry have achieved much larger losses and have been successful over far longer periods. Because there are now over 6,000 people in the study, researchers have been able to collect a large amount of data on commonalities between study members.
So, now that Lynn has brought up the topic, here are the common behaviors of NWCR maintainers as described by Dr. Hill. Do they seem to reflect you? And if not, why not? I have added my own thoughts in italics after each one.
1. They eat a low calorie, low fat diet.
Actually, the fat percentage given was 26%. While this is lower than the national average, it is not actually that low. The Ornish diet, for example, is about 10% fat. Despite touting the low fat diet, Hill showed a slide from a recent New England Journal of Medicine study that showed statistically better weight maintenance at 24 months on either a Mediterranean or low carb diet than on a low fat one.
In terms of calories, members are reporting an average of 1385 calories per day, plus or minus 500. That’s awfully low and Hill assumes it reflects underreporting of the true calories consumed. What makes that interesting is that this inaccuracy then casts doubt on other reported measures, such as fat consumption.
2. They are very ‘restrained’ eaters.
This is Hill’s choice of word. I believe he means that maintainers carefully calculate what they eat and limit choice.
3. They are consistent.
Hill illustrated this point by saying that the researchers wondered if maintainers used the technique of taking “days off” and having holidays from their eating plan. He was clear that this was not usually the case and that most of those reporting ate the same way every day.
4. They weigh frequently.
75% weigh more than once a week. 44% weigh daily. 50% still count something (calories, fat grams, etc..)
5. They are highly active.
OK. This one is really interesting. Hill and others in the study have frequently said that they believe physical activity to be the biggest key to successful maintenance. However, when you look at their data, the breakdown is actually this:
27% exercise A LOT: more than 90 minutes a day
25% exercise between 60 and 90 minutes a day.
26% exercise moderately, between 30 and 60 minutes a day.
25% exercise less than 30 minutes a day.
Assuming that there is some overreporting here, we can see that probably upwards of 50% of maintainers in the registry don’t exercise all that much.
6. They eat breakfast
This is one of the Registry’s favorite maintenance tips. Don’t forget that successful maintainers eat breakfast. What do you think of this one? Do you think that eating breakfast helps you to maintain better?
7. They watch less television
62% claim to watch less than 10 hours per week (national average is 28 hours).
So here’s how one particular maintainer (me) compares.
1. Low Fat, Low Cal? My diet is, in fact, low calorie and low fat, but it is also almost devoid of modern carbohydrates, so it’s a different kind of eating.
2. Dietary restraint? For sure.
3. Consistent? Yes. Key for me.
4. Weighing? Every day.
5. Exercise? Yes. I find it vital to maintain.
6. Breakfast? Not unless you consider coffee and skim milk to be breakfast.
7. TV? Definitely on the money. I’m pretty much down to CNN and the Cleveland Cavs.
Are there other ways to maintain? I’m not sure. Pretty much any successful maintainer I’ve ever met fits the profile above in most respects. But there are sure to be outliers. Let us know if you have found another – perhaps more clever – way to keep it off. In the meantime, I’m going to print out my CME certificate, watch Wolf Blitzer, and get a good night’s sleep!
