Relapsers
— ate inconsistently, with low-calorie and higher-calorie swings;
— hit fast-food joints more often;
— watched more TV;
— skipped breakfast;
— were more likely to suffer from emotional eating;
— were more prone to depression.
THEY KEEP CLOSE WATCH ON THEIR WEIGHT,
NIPPING ANY GAIN IN THE BUD
The bathroom scales of successful maintainers aren’t collecting dust: They weigh themselves at least once a week. What seems to work best for maintenance is establishing a regular weigh-in routine that works for you—whether it’s daily, weekly, or a little less often—and sticking with it. What didn’t work for NWCR participants: going from frequent weigh-ins to less frequent checks. Over a year’s time, those who stopped weighing themselves as often as they used to gained nine pounds, compared to four pounds for people who didn’t change their weighing routine. But it’s not only a decrease in the frequency of weigh-ins that’s a problem: Any adjustment seemed to be accompanied by weight gain. For instance, those who decided to step on the scale even more frequently than they usually did gained slightly over two pounds.
Regular weigh-ins are a good idea when you’re in the maintenance phase, but I caution clients about using the scale during the initial stages of weight loss. During this time, the body is adjusting to eating healthier and exercising more, and the numbers on the scale often don’t reflect these changes. Not only does your weight naturally fluctuate in the first few weeks after starting a weight loss plan, but I find that people are most vulnerable during this period. The scale can wreak havoc in the initial stages of weight loss: you’re working hard and making tough changes, and if you don’t see results right away, that can be very frustrating.
My recommendation: Weigh yourself when you first begin a weight loss program for a baseline, or starting point. Then hold off for four weeks before stepping on the scale again. After that, you should keep tabs on your weight on a more regular basis. I recommend once a week. (To get the most accurate reading, try to weigh yourself on the same day each week, at the same time, using the same scale and wearing the same clothes.) In fact, the scale is a reliable early warning signal that something’s amiss with either your diet or exercise habits. When the numbers go up, you have an opportunity to fine-tune your diet or exercise regimen. If you know that the numbers on the scale tend to make you nutty, try using a pair of pants as a gauge instead. If they get too tight, maybe it’s time to tighten the reins on your diet and/or fitness plan.
THEY DON’T EAT FOR EMOTIONAL REASONS
Given the prevalence of emotional eating in the general population, it’s safe to assume that a large portion of maintainers struggled with emotional eating. Indeed, most of the people profiled in this book who’ve kept off the weight they lost admit to dealing with emotional eating. To examine just how big a problem it is, Brown University researchers gave NWCR members a questionnaire assessing the degree and type of emotional eating they were prone to, then checked in on them a year later. They did the same for a group of men and women who’d recently lost weight on a diet and exercise program called TRIM. (This group didn’t have a maintenance track record yet.) In both groups, those who had the biggest emotional eating problems gained back the most weight. Still, NWCR participants scored lower—in other words, had less severe emotional eating and gained back less weight—than those enrolled in TRIM, which is probably why they were able to make it into the NWCR in the first place.
The statistics are clear: If you want to get your weight under control, you’re going to have to eliminate emotional eating, just as Ann helps you do in chapter 2.
SURGICAL OPTIONS: WHEN YOUR
BEST EFFORTS DON’T WORK
For some people, cutting calories and increasing activity as well as doing the emotional work required to remedy the issues that led to weight gain in the first place aren’t enough. They just can’t lose weight. In many of these cases, bariatric surgery may be an option.
Bariatric surgery is a blanket term for many different procedures, including gastric bypass and lap-band surgery. I’m not recommending any of the procedures for everyone, or even for anyone who can’t seem to overcome nature’s will. But if your body weight poses significant danger to your health—that is, if the risks of staying obese outweigh the risks of surgery and the lingering side effects—then you may want to consider surgery.
The procedures have been shown to be quite literally lifesavers for certain people. In one study, people who had a BMI of at least 35 (which is considered obese) and underwent weight loss surgery were 40 percent less likely than obese people who didn’t have the surgery to die from any cause—including heart disease, cancer, and diabetes— seven years after the procedure.
Bariatric surgery has gotten some bad press, probably because too many people who could trim down with diet and exercise are opting for the surgical solution. But on the flip side, many people who would probably benefit most from the surgery aren’t getting it. In fact, of the fifteen million Americans with a BMI over 40 (which is considered morbidly obese), only 1 percent undergoes bariatric surgery. Of course, no surgery is without risks or complications, and that’s true for this type of surgery as well. In addition to the risks during surgery, there are also lasting side effects after the procedure, such as an inability to absorb certain vitamins and minerals and an intolerance to specific foods.
Finally, the surgeries are not a guarantee against future weight gain. Research from McGill University in Canada suggests that 20 percent to 35 percent of gastric bypass surgeries are considered failures because of weight regain after ten years. In a separate study published in the medical journal Obesity Surgery, 79 percent of patients who had undergone bariatric surgery reported weight regain—though only a third of them regained a significant amount. (“Significant” was defined as 15 percent of the weight they’d lost. For instance, if someone lost one hundred pounds and gained back fifteen or more pounds, it was considered significant.) Further research from Switzerland indicates that 40 percent to 45 percent of people fail to achieve sufficient weight loss two years after having the lap-band surgery partly because of complications.
Are you a candidate? The National Institutes of Health recommends meeting these three criteria:
1. A body mass index (BMI) of 40 or more, which represents about one hundred pounds overweight for men and eighty pounds for women. A lower BMI, between 35 and 39.9, is also considered an appropriate criterion if it’s accompanied by a serious obesity-related health problem such as type 2 diabetes, coronary heart disease, or severe sleep apnea. To find out your BMI, turn to appendix 2.
2. You are healthy enough to withstand the operation without a high likelihood of major complications.
3. After the surgery, you also must be able and willing to exercise and to cut back on eating. Counseling is highly recommended; otherwise the weight will likely come back.
The two most common types of bariatric surgery are the adjustable gastric band (AGB), or lap band, and gastric bypass (also called Roux-en-Y gastric bypass, or RYGB). The point of AGB surgery is to shrink the normally football-sized stomach to the size of a golf ball by wrapping a silicone band around it, making it impossible to eat very much at any one sitting. However, with time, you can stretch the stomach, and if you’re not careful, you can override the band, regaining weight.
The second procedure, gastric bypass, involves connecting the stomach to the middle of the small intestine. (It normally attaches to the first of the three sections of the small intestine.) Food is typically broken down and absorbed at the beginning of the small bowel, so if you bypass a large portion of it, you reduce the number of calorie-containing nutrients (carbs, protein, fat, and alcohol) that the body can absorb. In addition, the stomach is sewn, leaving just a small pouch. As with lap-band surgery, the stomach can stretch, so it’s possible to undo the effects of this operation by overeating. However, bec
ause the procedure also helps limit calorie absorption, it’s more effective than AGB. That’s why gastric bypass makes up 80 percent of all bariatric surgeries. There is an even more drastic version of this operation, in which the stomach is connected even farther down the small intestine, so you absorb very little of your meals. That procedure, called biliopancreatic diversion with duodenal switch, is riskier and rarely performed.
THEY DON’T HAVE A PERFECTIONIST MENTALITY
Judging yourself to be either “on” or “off” a diet, or “bad” or “good,” is a typical pitfall for people trying to maintain weight loss. On the other hand, cutting yourself some slack and getting right back on track when you veer off the path is a common attitude among successful maintainers—and not only those among the NWCR group. Researchers at the University of Western Australia, for instance, found that 73 percent of people who gained back lost weight were black-and-white perfectionist thinkers, as compared to just 7 percent of weight maintainers.
It’s so easy to gain back the weight when every little cookie or missed workout signals failure. The occasional rich dessert, the business trip that interferes with your gym day, or other ways you stumble are normal and inevitable. To survive them, you’ll have to roll with it. Says Jennifer Demuth, profiled on page 150, “I allow myself regular little indulgences like ice cream, birthday cake, chocolate, and French fries. The key is that my indulgences are only in small portions and aren’t an everyday thing.”
Strangely enough, I’ve found that some people who are prone to perfectionist thinking are actually subconsciously waiting for a slipup (a twisted ankle, a bad eating day) so they have a reason or excuse for returning to their bad habits. If you subscribe to the all-or-nothing train of thought, you’ll need to give yourself an attitude adjustment. Slipups are inevitable. You’ll need to be somewhat flexible and forgiving if you’re going to stay the course.
GOOD NEWS! IT GETS EASIER
If losing weight is or has been a struggle, and your attempts at maintenance have been no picnic, here’s some welcome news: The longer you maintain, the easier it gets. Former drug or alcohol abusers have the same experience. The longer they stay clean, the less likely they are to relapse. Two years seemed to be the magic number for NWCR participants. If they stuck it out for that long, their odds of gaining back five or more pounds were cut in half. Those who maintained for five years had even better odds: just a 30 percent chance of gaining back more than five pounds.
As they say, old habits die hard—but they do die if you work at it, and I think that successful losers prove that point. After a certain amount of time, preparing a healthy meal at home, ordering the leaner dish at a restaurant, or making it to the gym doesn’t feel like a big deal anymore. “The longer people eat well and exercise, the more these may become ingrained habits that require less conscious effort,” explains Dr. Phelan.
There is also some other positive news about maintaining weight loss. Ninety-five percent of the NWCR successful losers say that their quality of life has improved. They have more energy, an improved mood, and increased self-confidence. Most of them also reported that their relationships with spouses, friends, the opposite sex, parents, and strangers also improved.
If you go back and read the stories of Terane Weatherly, Mary Jo Schneider, and Shaun Tympanick, it’s obvious that losing weight dramatically bettered their lives in ways they appreciate. But it’s also important to note that I’ve seen plenty of people lose weight—sometimes well over one hundred pounds—yet not really appreciate it. They’re lighter, they move better, they’re more socially active, but when really pushed, they can’t see or enjoy how much their life has improved because they’re still hung up on the issue that caused their weight gain in the first place. So the weight, which is often a symptom of a bigger problem, might go away, but the problem (a bad relationship, an inability to set boundaries, pain you suffered as a child, feeling unworthy of happiness) remains until it’s addressed. I can’t stress how crucial this is: People who slim down the right way are happier overall, and they appreciate the fact that their life is better. That makes staying motivated to maintain these changes so much easier.
MEASURING SUCCESS
In this chapter, I’ve used the word successful a lot. But what exactly is success? For the National Weight Control Registry, it’s the criteria I described earlier: losing at least thirty pounds and maintaining that loss for at least a year. For your doctor, it might be maintaining a loss of 5 percent or 10 percent of your body weight, just enough to lower blood pressure or blood sugar or improve your health in some other way. I tend to view success in terms of improved health and happiness—that is, you live life in a way that not only puts you at a healthier weight but also brings more joy into your life. Happiness is such an important piece of the puzzle, as Ann will make clear in the following chapter.
How you define weight loss success is critical to your, well, success going forward. To feel like you’re a successful maintainer, you must first be more or less comfortable with the weight you’re maintaining. And you don’t even have to get all the way down to your goal weight to be satisfied. You can still be happy and comfortable with weight loss even if you fall short of this mark. To do that, you have to understand and accept your body and your genetics. Once you accept your shape, life gets a whole lot easier. Then you can maintain a weight that’s healthy but realistic, without having to make sacrifices that would detract from your overall happiness. As Ann explains, “This weight might not be the number you initially had in mind, but it’s the point at which you’re comfortable with your weight and shape and are still able to do all the things that are important to you, such as travel, play with your kids, hike, and so on.
“Having a healthy life requires balance,” she continues, “and you can’t have balance when losing more weight would require having to eat so little or exercise so much that you would not be able to engage in other important aspects of your life.”
In fact, many people eventually settle in at a slightly higher (but just as healthy) weight than they’d originally planned. Consider that you will probably never be rail thin (and this is the case for about 98 percent of Americans, by the way), and that it’s okay. Your genes might dictate that you will be solid and muscular or curvy. When you set your goal weight, remember to consider all the factors that affect weight, including genetics, your body shape and muscle mass, and how you functioned at various weight levels. For instance, if you struggled to maintain 140 pounds in the past, but were just as healthy— and much happier—at 150, then you may have to adjust your goal weight up slightly.
No matter what you weigh now or what weight you’re trying to get to, it’s crucial that you look beyond the scale for measures of success. There is, for instance, that improved lab report from your doctor and the sense of satisfaction you get from looking better in your clothes, or simply feeling better. Exercise milestones are especially satisfying—progress from five-pound weights to fifteen-pound weights, and you’ve tripled your strength! And how gratifying is it to double your miles on the treadmill? Being able to walk your dog, play with your children, have the energy to cook a healthful meal when you get home from work, do anything that you once couldn’t—there are so many ways to mark achievement. Continue to strive for the things you want and deserve in life and congratulate yourself for every barrier you knock down and every triumph (big and small) along the way. Many, myself included, believe that the ultimate success is being happy, as it is a reflection of all that is important and meaningful to you in this life.
7
* * *
BEING HAPPY
* * *
By Ann Kearney-Cooke
TO BE SUCCESSFUL AT losing weight and maintaining that loss, you have to do more than simply count calories and stick to a regular workout schedule—this is a key theme that we keep coming back to throughout this book. Overcoming barriers, such as our physiological wiring, emotional eating, and poor body image, are also vital to the
process of slimming down and staying that way. But there’s one more important factor that you can’t overlook: finding pleasure, happiness, and fulfillment in your day-to-day life.
Being happy might seem like a bonus or side effect of losing weight—the end result of all your hard work. Many people mistakenly believe that they’ll be happier once they’ve shed pounds. But being happy—or, more specifically, finding sources of happiness in your life on a daily basis—is more like a prerequisite for taking off the weight. In fact, you could even say that the essence of motivation is in finding happiness in moving toward your goals, or in the pursuit of happiness. For instance, taking even small steps, such as going for a ten-minute walk or packing a healthy snack so that you don’t raid the vending machine at work, can be very satisfying. But many people simply aren’t able to find joy in these types of accomplishments because they’re too busy obsessing about something else: often the fact that they’re not burning enough calories or losing weight quickly enough. Sure, that short walk or healthy snack choice is probably just a drop in the bucket, but the act itself reinforces the belief that you’re worth it, that you deserve to be nurtured. These little acts, which can bring small hits of happiness, are the fuel for motivation.
Unfortunately, sometimes the weight loss process itself can be detrimental to long-term weight loss success and, ultimately, your happiness, particularly if you do focus too much on losing weight and ignore other important areas of your life. Bob has often said that people mistakenly put all their emotional eggs in the weight-loss basket, so inevitably, when weight loss slows or stops, they fail to get the emotional high that they used to get from seeing the numbers on the scale drop. They may then look to other areas of their life for this sense of satisfaction, but because they’ve ignored these areas, they’re left frustrated. As a result, they often return to their old habits.
The Life You Want Page 23