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Refuse To Regain

Quote:

Responding to Rebecca: The Two Questions
Posted: 17 May 2009 01:53 PM PDT
By Barbara Berkeley
Our recent post featuring Rebecca’s question about the possiblity of long-term maintenance has been one of our most viewed and discussed entries. We knew there would be lots of terrific responses from readers and our expectations have been more than fulfilled. Your comments and encouragement have been superb. Thanks to all who have written. As usual, your words are thoughtful, well-written, and completely on target.
Lynn and I decided that we would post our responses to Rebecca after most of you had a chance to comment first. Since we are now a week or so out, I thought I’d write from my own perspective. Please feel free to continue commenting on the original post, however. This is a question that can’t be discussed too much.

As a clinician, I see two very distinct questions in the maintenance puzzle. Rebecca addresses both in her email, but most of our responders spoke to just one. The two questions are:
1. Is there something physical or psychological that makes regain inevitable?
2. Are there specific behaviors that allow someone to successfully maintain?
Those of you who are doing a good job staying at steady weight have figured out an answer for question two. As a result, most of you spoke to that second question in your responses. In the real world, the second question is, in fact, the more important one. If you’ve got that one licked, question one becomes nothing more than a curiosity.

For clinicians, though, the first question is hugely important. If doctors and scientists knew whether something hormonal or physical drove the body to regain weight, they might potentially design a treatment that would make maintenance much easier. Question one boils down to this: do we regain weight because we simply fall back into bad habits or do we regain because we have a physiologic disorder that encourages - even demands - that fat be reaccumulated?

Of course, we don’t know the answer. At this point, we can only take an educated guess. Based on patient observations, the information I have on human physiology and what little direct evidence exists, I have formulated the following opinion, but it’s only that - an opinion.

It seems to me that when someone starts to accumulate fat fairly extensively, something has already gone wrong with the body’s innate calorie balance mechanism. (For more on this theory, see earlier post on IBM). This malfunction can occur because the balance mechanism has had years of exposure to the SAD (Standard American Diet) or because of excessive caloric intake over shorter periods. It seems to me that once the system has malfunctioned, it tends to remain fragile permanently. This fragility predisposes POWs to weight regain unless they are extremely careful to avoid it. The analogy I often use in the office is that of the knee that has suffered a cartilage tear. If you stop exercising on that knee, it can heal up. Eventually you may be walking on it just fine. However, if you go back to stressing that knee (say, by running the marathon), it will probably start being a problem again. It remains fragile, a weak point in the body. This is one of the reasons that I believe so strongly in preventing weight gain in children. If we can prevent kids from weakening their IBMs, they will not have to struggle with bodies that tend to regain weight easily. Heading obesity off at the pass is the biggest favor we can do for the next generation of American children.

Reduced bodies belong to people who have already proved that they gain weight easily. That tendency remains. On the other hand, it flies in the face of any logic to claim that maintaining weight loss is impossible. Since the caloric balance system has been weakened, the answer to maintenance lies in finding a formula that avoids putting stress on that weak point. Once the formula is known, success comes from constant attention to this very individual plan.

A starting formula for weight maintenance is laid out in Refuse to Regain, but this is just one type of jumping-off point. Since the hormone that is most central to weight gain is insulin, a Primarian diet keeps weight off by asking the body for very little insulin secretion. Some individuals may have additional problems with fatty foods and salt. Each maintainer needs to start at some sort of baseline and work out his or her personal formula while watching the scale. The diet and lifestyle changes that only you can discover should become clear once the scale pivots around a fluctuation of several pounds. If you are staying within that small range, you have found the right formula for you. One person’s formula will not be the same as another’s, but certain constants are generally found.

First, total calories are kept rather low. Second, starches and sugars and much less prominent than in the SAD. Third, the diet tends to be low in saturated fats. Within these general guidelines, various maintainers will be able to add more or less foods, depending on their personal sensitivities.
Is it possible to maintain over the long run? Clearly, the answer is yes. But the effort takes constant attention, little tweaks to diet and behavior, and a real desire to be successful. There are many people in the world who eat diets that don’t conform to SAD norms. Each one of these people proves that various types of dietary formulas can be sustained permanently if they are important enough to the individual.

Nothing I’ve written above addresses the psychological components of regain. There is no question at all that many people regain because they use food in a drug-like way. This does not mean that they are weak or without willpower. It simply means that they have succumbed to the way most Americans eat--for the thrill of it. If a new maintainer finds that he or she is driven to eat by stresses or simply by habit, that person will benefit greatly from more intensive support. If eating is truly functioning as medication, psychological counseling may be in order. If it’s more a matter of habit, participation in group meetings or talking to other maintainers on the internet may work just as well.

Obesity is not destiny. If I did not believe that, I would have to close my doors and stop practicing. Having said that, I also believe that to truly love and care for your body (particularly when such care involves constant attention) is the stuff of personal heroism. Let’s continue to affirm that each one of us is capable of being a hero. As a community, we can assure those who are still in doubt that maintenance is not only possible, it’s a larger experience that will change the way you view not only your weight- but your life.