WebMD Live Events Transcript; Event Date: Wednesday, September 8, 2004
By Anne Fletcher MS, RD, LD
WebMD Weight Loss Clinic - Live Events Transcript
Do you feel like you can't win at losing? Do you diet, but then gain it all back and more? If so, get some insight from someone who has talked with the masters -- men and women who have lost weight and kept it off. We learned what it takes to maintain a healthy weight for life when Anne M. Fletcher, MS, RD, LD, author of "Thin for Life," joined us on Sept. 8, 2004.
If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Welcome to WebMD Live, Anne. It seems everybody from Atkins to Dr. Phil, from South Beach to L.A. has a sure-fire way for us to lose weight. Where do we even begin to select the right method or plan?
Much of what I'm going to say today will be couched in my findings from more than 200 people who have lost weight and kept it off. Specifically, I located 208 people who have lost an average of 64 pounds and kept it off for an average of about 11 years. And when I asked them how they were successful after many failed attempts at weight loss, they essentially told me "I had to find something that was right for me." In other words, what works for one person doesn't necessarily work for another; it's a highly individual process.
You interviewed a lot of people for your book who were able to keep off their weight. My question is, were any of them able to ever stop obsessing about what they ate? I hate how thinking about food all the time consumes so much mental energy!
What I found when I asked people if it gets easier over time during maintenance of weight loss is that yes, it does get easier with time. In the beginning, vigilance, a fair amount of paying attention to detail when you're maintaining weight loss, is in order. But it starts to become a way of life. And the need to be as vigilant subsides for most people, I would say. For instance, many people counted fat grams and paid attention to calories when they first lost weight but they don't do it as frequently now. They might do it if they gained back a few pounds, but not necessarily every single day. With time, it becomes a way of life.
I've been struggling with my weight for quite some time. Earlier this year I joined a gym and started working out three to five days per week. Generally, I will do about 30-45 minutes of cardio and some light weight training. I have lost weight, gained it back, and lost it again. I also tried Xenadrine, which worked for the first week and helped me lose another 10 pounds. I seem to have hit a plateau in my weight loss, and it's getting me down. I can't seem to control my portions when I eat, and I'd just like to know if you have any advice.
First I would ask if you have had or would consider any professional counseling with a registered dietician or some other health professional who has expertise with weight management. This might give you some insights into the barriers that are getting in your way and perhaps might inform you about some little things you're doing that you might not be aware of that are impeding your progress.
I did find that at least periodically about two out of three of these masters of weight control, which is the term I use to describe these weight loss success stories, keep track of what they eat. In other words, they might keep a diet diary to keep track of food groups in their mind. It might help you to journal exactly what you're eating, and sometimes it helps to keep track of your thoughts and activities while you're eating. This can help you identify patterns of behavior that might be getting in your way.
But again, a health professional with training in this area might better be able to help you sort that out.
How long do you have to keep a food diary? Just during the weight loss, or also during maintenance?
I think the length of time varies from person to person. Personally, I find it helpful to keep a food diary when my weight is up 5 pounds. I keep it until my weight is back down again. It makes me aware of all the little things I do in a day's time that might add up that I'm not aware of. Diet diaries also make people feel more accountable for what they're eating, and part of it is, "Oh, do I really want to eat those 15 peanuts, because I'm going to have to write it down." Some people do it just a few days out of the week. One person told me she might do it one week out of the month. I think you have to find what's right for you.
I think I need professional help to shed the 50 pounds I want to (need to) lose. Who is best suited to help me? My doctor? A dietitian? One of those weight loss centers like LA weight loss or Weight Watchers?
In my book, Thin for Life , I offer guidelines for determining whether you're more of a group person or a person who would benefit from more of a solo approach to weight loss. I found about half of the masters had professional help and about half did it on their own. I guess I would start by getting your doctor's blessing that it's OK for you to proceed with weight loss, and make sure you don't have any medical problems that are responsible for your weight gain.
In my book I review the basics of the reputable weight loss programs used by the masters, including Weight Watchers, Jenny Craig, Health Management Resources, and Optifast. All good, sound programs, but with very different philosophies and approaches. I would encourage you to read about them, check them out on the Internet, and see which would be the right fit for you.
You also might want to consider seeing a registered dietician who specializes in weight management for a more individualized approach.
Among the people you interviewed, how many were men and how many were women, and what differences did you see in their approaches, success, amount of weight lost, etc.?
Seventy-five percent of the masters were women and 25% were men. I did not look at differences in what the men did to be successful versus the experiences of the women. The masters come from all walks of life -- everybody from a chocolate scientist to state senator, secretaries, schoolteachers... The important thing to know is that there are success stories out there, because we hear that over and over that 95% of people gain their weight back. In fact, there are many men and women that have succeeded. I feel it's more important to pay attention to them and what they do to be successful.
Help! I'm addicted to carbs. I love chips and pasta and bread. I'd rather not bother eating than to eat a meal without a carb-loaded side dish. Am I doomed to never lose weight, or is the low-carb craze overrated?
Great question. A review just was published on all the studies on low-carb diets to date, and the research shows that while a low-carb diet seems to help some people stay with the dieting process a bit longer than a more conventional low-calorie approach, in the long run so far it appears there's not an advantage to following a low-carb diet. In other words, it does not look like a low-carb diet is any more beneficial than a low-calorie diet in keeping the weight off in the long term.
In fact, I found that most of the masters of weight control do not deprive themselves of their favorite foods. Many people find that when you do that it's unrealistic, they can't stick with it, and when they finally break their rules about not eating carbs they go completely overboard.
A huge study called the National Weight Control Registry is following about 5,000 people who have lost weight and kept it off. They found, and I found, that successful maintainers eat diets that are relatively high in carbohydrate and low in fat. So it would appear that most people who maintain weight loss are not eating the low-carb way.
Why do you think the Atkins diet is so successful? Is it just because people can eat lots of meat? Or is there more to it? It looks a bit dangerous to me, but maybe that's just me.
It depends on what you mean by successful. I think that people are attracted in our society to anything that offers a quick return. And people often experience quick initial weight loss on a low-carb diet because the food choices are limited, and because part of what you lose on a low-carb diet initially is a lot of body water (when you go back to eating normally again that water weight is regained). So there's the attraction of quick initial weight loss, but the big questions remain: Are you going to keep the weight off? Is this a food plan you can live with for life?
You also raise the question of whether this is a healthy way to live. The healthiest societies on this earth tend to eat diets that are relatively high in carbohydrate and rich in fruits and vegetables; they're not diets that are high in steak, butter, bacon, and pork rinds.
Some people find, too, that they are less hungry on high protein, low-carb diets, and they also find it easier to stick with them because the choices are very limited.
How do I stay motivated?
That is the key question I asked the masters for my second book, Eating Thin for Life . I sent each of them a five-page questionnaire about their eating habits and discovered that they're doing the things most people know they should do to be able to lose weight and keep it off. In other words, they're eating a low-fat diet; they're eating lots of fruits and vegetables and watching their portions.
The real question for me was "How do you get yourself to do this; how do you stay motivated to do this for the rest of your life?" When I asked the masters this question, they told me they stay motivated by keeping a vivid picture in their minds of how unhappy they were when they were heavier, and they contrast that with thoughts and comments about how wonderful their lives are now.
So what if you're not there yet? I encourage people to keep a diary from the day they start losing weight of all the positive changes that are occurring in their lives en route to their goal. These changes should be changes that you're noting in mind, body, and spirit. For instance, are you sleeping better? Do you have more energy? Even though you're not where you want to be, are your clothes feeling looser, is your blood pressure going down, are you feeling less crabby? Any time you feel discouraged, pull the diary out because this will help you to stay motivated along the way.
What about motivation that's not exactly "pure," like losing weight for the class reunion or for vanity reasons, not just healthy reasons?
I think it's fine if that motivates you, to have a goal that's not spiritual or health related, but I think the more reasons you can find, the stronger your motivation will be. Try to look more at the big picture of the returns you're going to get beyond the class reunion or beyond looking in the mirror or stepping on the scale. Most people who lose weight find there are other benefits they receive, from health to psychological benefits.
Did your weight loss masters in your book have success more when weight loss became a health issue and not a "trying to fit into those jeans" issue?
There doesn't seem to be a strong correlation between the turning point or reason for losing weight and whether or not you'll be able to keep the weight off. Some experts suggest doing the following exercise: make a list of all of the benefits of losing weight all the things you will gain if you lose weight. For example:
- I'll have more energy.
- My feet will hurt less.
- I can wear more trendy clothing.
- My blood sugar will come down.
Then make a list of your reasons why you might not want to lose weight or things that are getting in your way, which might include:
- I like to eat.
- I don't want to limit what I eat.
- I'll have to buy new clothes, which is a financial expense .
- I hate to exercise.
This helps people sometimes really sort out whether they're ready to change, and it often will help them to figure out whether their reasons for losing weight are more compelling than their reasons for staying right where they are. In other words, it helps you better identify the returns or benefits of losing weight.
Doesn't weight loss always just come down to eat less, exercise more?
Yes, that's the bottom line. The trick is how to get yourself to do it. For the masters, most of whom had dieted and regained the weight many times before they were finally successful, it really wasn't that simple. There were many things that had to happen before they were really ready to lose weight for good. One of them was that over and over they told me "I wasn't ready to lose the weight until I was doing it for me, not because somebody was on my back or my parents wanted me to do it, but I was doing it for me."
They also talked about how, when they were finally successful, they accepted responsibility; in other words, I heard things like, "I finally realized there was no magic bullet; it was up to me and in my power to lose weight." The masters shared many other psychological strategies that they used in order to be able to get themselves to eat less and exercise more.
Another example that I heard over and over again had to do with getting more out of life. People told me that when they lost weight they had to find other ways to find fulfillment and happiness than turning to food. For a guy, that might be taking an afternoon and going fishing. Women told me things like, "Now I take time to get my nails done." One woman even occasionally sends herself flowers. They learned to gratify themselves and reward themselves with things other than food.
Do you think some people are just naturally big? My sister runs, bikes, eats right, she even did a triathlon. But she'll never look like Julia Roberts. What do you think?
Yes, I think that many of us are biologically programmed to be bigger than other people. In other words, to a large extent our weight is genetically predetermined. However, that doesn't mean it's all genetically predetermined. At least 50% of weight is determined by the environment and individual choices and how much exercise you get. Many of the masters are somewhat heavier than their initial goal weight. They found it was easier to maintain at a weight somewhat higher than their fantasy weight.
I talk about the concept of a comfortable body weight in the book. A comfortable body weight is a weight at which you can say, "I feel pretty good, given where I've been" (it may not be your dream weight). A comfortable body weight is one where you have no medical problems caused by your weight, and finally it's a weight where you don't have to starve yourself and exercise like a fanatic to maintain it. For most of us, that means not being model thin.
I continue to try to lose weight but it is so hard to stay away from the chocolate. What to do?
Most of the masters told me they do not deprive themselves of their favorite foods. When I asked them, in an open-ended question, to describe their eating habits in 25 words or less, one of the top five responses was, "If I want something, I have it." This does not mean they're eating hot fudge sundaes every night. It means they occasionally allow themselves to have treats.
Some people did tell me they had "trigger" foods they had to stay away from, but most people allowed themselves their favorite foods some of the time, but they also use control strategies to make sure that eating these foods does not get out of hand. For example, for our chocolate lover here, rather than buy a pound of chocolate and bring it into your home, the masters might suggest buying an ounce of your favorite or a delectable truffle and enjoying that one truffle.
Some people told me they eat desserts only in restaurants where the portion is controlled or they share it with a friend. One man told me he loves nuts, but he'll only buy an ounce or two at a time. Most people did tell me they make an effort to avoid keeping their most tempting foods in their homes, and if they do have them they keep them out of sight.
We are almost out of time, Anne. Before we wrap things up for today, do you have any final words for us?
I think my last piece of advice it to tell people to stop listening to all the failure talk --that is this notion that nobody succeeds at permanent weight control. There are many, many people who have succeeded, and their examples prove you can do it, too. I'm not suggesting that it's easy and that it doesn't take effort, but over and over the masters' stories and exhilaration about how great their lives are, after having lost the weight, shows over and over again that it's worth the effort. Who better to show us how to lose weight and keep it off, than people who have been there?
For more information, feel free to visit my web site, www.annemfletcher.com.
Our thanks to Anne M. Fletcher, MS, RD, LD, author of Thin for Life, for joining us.
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