Weighing in on a maintenance plan

Experts know losing weight is easier than keeping it off

08/02/2003

BY BRYAN ROURKE Journal Staff Writer

PROVIDENCE

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Eat less. Move more. Lose weight.

It works, for a time. Then, slowly, insidiously, corpulence comes back.

Rena Wing knows. The director of Miriam Hospital's Weight Control and Diabetes Research Center has seen it plenty.

"They may have lost the weight over a year," she says. "But if they're 50, they have 49 years of bad habits to overcome."

So failure is frequent. Of those who are obese -- now a staggering 30 percent of Americans -- only 20 percent, according to studies, achieve long-term weight loss.

But Ring has seen success. And she wants to share its secret.

Not only are there people who prevail in their fight against fat, but lots of them. More than 4,000 are listed in the National Weight Control Registry (NWCR), which Wing co-founded in 1994. These are people who have maintained, on average, a 60-pound weight loss over six years.

"People can lose weight," Ring says. "The problem is maintaining it."

And wouldn't you like to know how it's done?

That's now the subject of a five-year, $1.8-million National Institutes of Health study at Miriam Hospital's weight-control center. And while it will be a couple of years before it's complete and conclusions can be drawn, there is a strong working hypothesis: support is essential.

"Without some type of help," Wing says. "People are likely to regain weight."

In this study, which will ultimately involve 330 people who will participate for 18 months, everyone receives weekly consults with a therapist.

One-third will get quarterly newsletters about diet and exercise, one-third will participate in a monthly Internet chat, and one-third will participate in monthly in-person support sessions.

Pauline Marcussen of Westerly is part of the study. She more than met its qualifications: a loss of at least 15 pounds within the last two years.

Marcussen lost 102 pounds.

"I have a fear I will wake up one morning and all the weight will be back," she says.

So Marcussen maintains her vigilance against weight gain, and sought help through this study to help her. "It's been a lifesaver," Marcussen says.

The in-person support group has been so well received that its members organized a second, informal, meeting each month in order to give each other a little more encouragement and motivation.

Marcussen, who a couple of years ago wore a size 22 dress, now wears a 4 or a 6.

"My goal was a single digit," she says.

Stephen Mecca of Jamestown is a study participant, too, having lost 50 pounds that he never wants back.

"People here might say 'Steve, you're all set,' " he says. "But they'll also say you need someone looking over your shoulder a bit."

Stop Regain is the name of the center's program and research study. Its goal is to see which form of support works best on a population that's particularly precarious.

"If you've lost weight recently, you're at the greatest risk of regaining," Wing says. "You're still vulnerable. Your skills aren't cemented yet."

And, perhaps most importantly, without a support group, you're on your own.

"When you're losing weight, you get a lot of reinforcement," Ring says. "There's excitement. Everyone notices. Once you've lost the weight, nobody mentions it again."

"Interest fizzles," says Natalie Robinson, program coordinator of Stop Regain. "You need to find new ways to stay motivated."

Most people don't. As a result, they put back all the pounds they lost.

Knowing that is often enough to make people find motivation.

"I have the sense if I gain five pounds, I'll be on the road of no return," Marcussen says.

Marcussen lost her weight through a national weight loss organization, which she found effective. But, she says, the organization's focus is on losing weight, not maintaining weight loss.

"I need the support to make sure I stay here [at this weight]," she says. "I didn't want to risk that."

In the study, Marcussen, who "begged not to be in the newsletter group," was randomly placed in the in-person support group.

Mecca, meanwhile, lost his weight through an Internet program and feels fortunate to have been placed in the study's Internet support group.

"I don't have the time [for an in-person group]," he says. "I'm also not much of a people person."

How people effectively lose weight isn't much of a secret. A study of the NWCR members reveals four principles: a low-fat and low-calorie diet; regular exercise; frequent weigh-ins; and eating breakfast.

About half of NWCR members -- primarily women -- lost weight through organized programs; about half -- primarily men -- lost weight on their own. The majority of members, 89 percent, lost weight through diet and exercise; 9 percent did it through diet alone and 1 percent through just exercise.

But none of that matters in this study.

"People can lose weight in a lot of different ways," Wing says. "We don't care, although we do ask. What we're interested in is the idea that no matter how they lost weight there are certain things they need to do to maintain it."

Following the Atkins diet isn't one of those things.

A low-carbohydrate diet may help people losing weight, Ring says, but there's little evidence it helps people maintaining weight loss.

Of the 4,000 people in the NWCR, only 1 to 8 percent follow a low-carbohydrate diet.

"That's a very hard diet to follow," Ring says. "Most people don't want to just eat protein and fat."

"You can't carry on your life with such limited food choices," Robinson says. "It's very appealing at first, but over time you realize you've cut out a lot of foods."

Mecca, who wore a size 50 jacket a few years ago, now wears a 40.

"The experts say if you can keep the weight off a certain amount of time, you can keep it off a lifetime," he says.

In a little less than a year, Marcussen and Mecca's participation in the study will end. But Mecca says he's not worried. By then, he says, he'll have reaped its benefits and will no longer feel susceptible to regaining weight.

"I will have been changed," he says. "My lifestyle will have changed."

For more information or participation in the Stop Regain study, call the National Weight Control Registry at 793-5522 or go online at www.weightresearch.org.