Long-Term Weight Loss Success: Regain Is Not Inevitable

"Only About Five Percent of People Who Try to Lose Weight Ultimately Succeed."

That quote is from a CBC news article published about a year ago, but I've heard it many times over the years. Lately I've seen an increasing trend in articles and blog posts discussing the futility of permanent weight loss. As a dietitian, I find this message discouraging, and I can't even imagine how people who are obese (and currently losing or planning to lose weight) feel when they read this.

Many of my dietitian friends and colleagues believe in a Health at Every Size (HAES) approach. On one hand, I feel there's merit in many of the goals of HAES proponents. I agree that striving for an unrealistic body size is harmful and that it's important to love and accept yourself at whatever weight you're at. One of my clients recently sent me a link to a great slogan T-shirt: "You Cannot Weigh Health, Beauty, Value, Intelligence, Kindness, Love, Worth, Success." There's no denying that we have a great deal of value beyond our physical size, and it's certainly not my intention to offend anyone or make waves with the HAES community. I think fat shaming is despicable and should never be tolerated. If you're truly happy weighing significantly more than what's considered "ideal," there's no reason to read any further. I sincerely wish you all the best.

But I completely understand the desire to achieve a weight at which you feel attractive, happy, and healthy -- and this may be very different from where you currently are. As I said, it can be frustrating to repeatedly hear the message that lasting weight loss is almost impossible. Fortunately, the National Weight Control Registry provides evidence to the contrary by collecting data from over 10,000 people in the US who have maintained a weight loss of 30 pounds or more for at least one year. The majority of NWC Registry members have done so for much longer. Although my own story isn't dramatic in terms of pounds lost (about 35), I have managed to maintain within 5 pounds for the past 30 years (not via low carb for the first 26, incidentally), and I've decided to sign up to be a member of the NWC Registry. Better late than never!

"Losing weight is hard. Maintaining is hard. Being overweight is hard. Choose your hard."  - Unknown

There's evidence linking obesity to increased risk for many health conditions, including diabetes, cardiovascular disease, and certain cancers (1). And while it may be politically incorrect to say this, people often report that they hate carrying extra weight because it's physically uncomfortable, compromises their mobility, and reduces their self-confidence -- ultimately, it has a profoundly negative effect on their quality of life. But losing more than a few pounds can be challenging, and maintaining even more so. Researchers have found that a number of factors make weight maintenance difficult, particularly after massive weight loss, including increased hunger related to a decline in leptin levels (2) and a reduction in resting metabolic rate (3).  

Carbohydrate restriction can modulate these effects to some extent via its effects on satiety and hormonal regulation (4), and it may be more effective than other methods of weight loss in the long term (4,5).  A well-balanced low-carb lifestyle is arguably one of the most pleasurable and easiest to follow for weight maintenance. However, it's easy enough to find people who've reached or gotten close to their goal weight this way, only to regain some or all the pounds when they resume eating higher amounts of carbohydrates and/or calories.


Long-Term Low-Carb Weight Loss Success Stories

There are several individuals I know who have maintained a loss of at least 50 pounds for three years or longer by following some form of carbohydrate restriction. These inspirational low-carb successes differ quite a bit in their approach. Some follow an autoimmune protocol (no dairy, nuts, or legumes) and avoid artificial sweeteners, while others include some or all of these as a regular part of their diet. Their carb level intakes range from very low (less than 20 grams of total carbohydrate per day) to low-moderate (up to 50 grams of net carbohydrate daily). Regardless of the differences in their diets, they share many commonalities that contribute to long-term maintenance success. And first and foremost among them is they feel undeniably happier and healthier now, and they take the necessary steps to ensure they don't ever return to their former weight.

Here , in their own words, are the strategies they've used for successful maintenance.

Karen Parrott, aka Garden Girl, blogger
Maintaining a loss of 70 lbs for 3.5 years

"I feel I’ve been able to maintain my weight loss by doing several things:

• Daily weighing and treating information like data (with the absence of good or bad, just data)
• Making quick or at least mindful corrections in either types of food and/or amounts of food based on the data of daily weighing

• Not allowing slippery slope thinking, like 'Oh, I’ve blown it, I might as well have treats.' So in other words, staying focused on the task at hand
  
• Reading everything I could get on weight maintenance and keeping only what I knew would work
  
• Looking back at past gains and discarding the thinking that led to regain (moderate eating of all foods)
  
• Looking at blood markers, especially glucose and high-sensitivty CRP to help decide if I was heading in the right direction, long term
  
• Looking at how I felt joint pain, puffiness, acne, ability to sleep, hot flashes, along with the correlation of what I was eating, and choosing only what made me well
  
• Daily movement of 10,000+ steps including the use of a Fitbit device, 2 short strength training sessions at the gym, occasional Tabata Style sprinting
  
• Identifying binge eating triggers or sources of emotional eating and reducing or eliminating them (example: food such as emulsifiers), and also developing other coping methods for stress
• Adaptation of the steps in the book “Refuse to Regain” by Barbara Berkeley, MD, who is also now a board certified obesity specialist
• Getting 23andMe genetic testing so I could confirm things like lactose intolerance and know my disease risks (type 2 diabetes and obesity- many, many markers) and designing my diet around that (example: Paleo-ish low carb food template works better than counting points and moderately having cheese and tropical fruits)
• I do still track, weigh meats and proteins, and collect data using My Fitness Pal.  The trending and tracking help me decide certain macros or total intake and/or integration with days where I do long hikes or am very active. 
  
• Support. I attend either a weight loss support group with a large number of other maintainers and separate support as needed for binge eating management (my support must be abstinence based or the group will tolerate my abstinence based approach- say, not eating grains or most processed sugars)."

Woo/Jane Plain, blogger
Maintaining a loss of more than 150 lbs for 10.5 years

"The biggest factor in my maintenance, and this is really quite clichéd, is not cheating.

1) Always stay on the diet, even on holidays. I cheat by making on-plan treats. I don't ever go off of VLC although I flex how low carb I am. Most people can keep weight off if they just KISS (Keep It Simple, Stupid) and focus on eating on-plan food all the time. You can't regain much weight, no matter what's going on in your life, if you limit yourself to VLC foods.

Also:
2) Pay huge attention to nutrition, and that includes using supplements. Don't believe the idea you can get everything you need from food -- that only works for healthy people. If you're a weight loss patient you may need to take EXTRA supplement pills like zinc and magnesium. Low-grade deficiencies can cause big problems, like anemia and a low functioning thyroid. The frustration or poor well-being these very preventable health problems cause can lead to total relapse. I've seen it in others. The problem can be prevented if one makes a long-term nutrition supplement organizer and takes them every day. (I take zinc, magnesium, vitamin C, vitamin D, multimineral, multivitamin, extra inositol, carnitine, amino acids, etc.)*

Finally:
3) Little boosts from herbals can help a lot. EGCG in green tea really helps fat burning and appetite. Vinegar also helps with low blood sugar and hunger/fatigue periods.  These things can make the difference between maintaining easily and being hungry/hypoglycemic."

*Note: Please speak with your health care provider  before taking any of the supplements above other than a multivitamin/multimineral, especially if you take prescription medications.

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DJ Foodie, low-carb recipe blogger
Maintaining a loss of more than 140 lbs for 4 years

"Probably the single driving force would be the memory of what it was like to weigh more than 350 lbs.  Never forget.

Just to give an example, I largely live in Mexico, and everywhere in Mexico are these cheap plastic chairs (typically sponsored by Corona).  Five years ago, there was about a 20% chance that I was going to break through one of those chairs and fall in the middle of a meeting, restaurant, date, what-have-you.  I had a 1 in 5 chance of making a quick, loud, surprising and sad little scene.  You crash and tumble through enough cheap plastic chairs, it tends to stick in your mind.  To this day, I’m still afraid of those terrible menacing plastic chairs. 

I just make sure that I never ever forget how bad it was. Maintenance through fear! ;)

The other aspect would be a largely rebooted lifestyle.  I’d spent so many years behind a computer that I’d completely forgotten how much fun it is to be active.  I dropped the weight, gained some confidence, a modicum of health and my habits just changed.  I go to the gym regularly, but am also constantly trying to find new ways to “mix it up.” This evening, for example, I’m taking a tennis class with a friend.  On Sunday, I went to go do SUP (“Stand Up Paddle” … the waves were too big, though.  They wouldn’t rent us the boards. We bobbed and floated around a pool, instead).

The point is, the weight loss (and the effort) rekindled a new way of life for me.  I also tend to run with a pretty active crowd.  When I’m sitting behind my computer for too long, they tend to bust me and make me participate in something.  I used to decline.  Now, I don’t!

So … better habits, newfound lifestyle, keep it fresh, and built-in support." 


Linda Genaw, low-carb recipe blogger
Maintaining a loss of 50 lbs for over 12 years

"What allows me to maintain my weight is the realization that being thin feels so much better inside and outside than being overweight. I just never want to be fat and miserable ever again."


Low Carb Brian
Maintaining a loss of 100 lbs for 5 years

"I would say the biggest thing for me was, once I lost the weight, I had a real desire to never return to there, so I knew I had to keep myself from craving the foods I ate most of my life. So I hit the internet and found the best low carb recipe websites and compiled a list of my favorite ones, after a lot of trial and error. I kept the best ones and made a cookbook out of them, so now whenever I crave something sweet, fatty, or spicy, I just crack open my book and cook it up. This has helped me stay on track and not even crave the bad stuff anymore. My list of recipes continues to grow, and I have everything I need between my cookbook and internet to maintain my weight loss and stay on point. I lost my 100 lbs in 2009 and have maintained from 2010 to present. "


Shari Bambino
Maintaining a loss of more than 150 lbs for 10 years

"I went from about 325 lbs to 155 in the span of about 3 years eating what was basically Dr. Atkins' prescription for weight loss. During this time I lost no weight for a good 10 months. Weight loss finally started again and I ended up in the 150’s. I was struggling to maintain at that weight so I came up about 15 lbs and found that a much easier weight to defend long term. Yes, once you are post-obese you defend your weight loss for the rest of your life. 

 I came to accept that, contrary to the saying “There’s a skinny girl inside of you trying to get out,” the exact opposite is true. My body -- any post-obese body -- wants to be fat again, and I have to stay on my toes to prevent that from happening. I have done so for the better part of 10 years now. It can be done, and once you get the hang of it, it’s relatively easy to do. Once you get the hang of it. That bears repeating. I’m on autopilot now but I still stand guard. I am beyond grateful to have the opportunity to do so.

If I had to choose the most important thing that has helped me to maintain I think it’s been the fact that through my weight loss journey I came to truly understand that food restriction of some kind was going to be part of my life for the rest of my life. I had previously been done in by my subconscious anger and resentment of having to always and forever be dieting, restricting, watching, being careful. I had thought that the weight loss was enough suffering and that maintenance should be free and easy going. I also thought I’d be so happy to be a normal weight that I would just figure it all out. I learned the hard way that that was not the case. 

So, after a lot of work with myself I was finally able to let go of all of this resentment and the idea that I should be able to expect to ever just eat what I wanted with only minor attention. It used to all feel like a punishment. It no longer does. Through the magic of the internet I have come to understand that I am a part of a large community of people who restrict certain foods on behalf of their health. Instead of the resentment and anger that I used to feel,  I now have an appreciation for the gifts that my restriction brings. People always ask me how I did it. I tell them, “I changed my mind.” In the end, it is what it is. None of us are special enough flowers to be able to keep the weight off without a great deal of attention. This is a life-long journey. Find a way to accept it, run towards it, and embrace it in whatever way works for you."

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  Lynne Ivey
   Maintaining a loss of over 200 lbs for 3.5 years

"I’ve maintained an over-200-lb weight loss for almost 4 years now, and have been eating a low-carb, high-fat diet since November 2009.  For me, the biggest  factor in maintaining that weight loss has been following Eric Westman, MD’s Low Carbohydrate, Ketogenic Approach: No Sugar, No Starch Diet. I have finally found a way of eating and living that allows me to feel full, nourished from the inside out.  Eating good dietary fats, moderate protein, and very, very little to no sugar or starch (only those occurring naturally in certain foods allowed on Dr. Westman’s plan, which limits carbohydrates to 20 grams total per day), I find that I am no longer hungry.  My blood glucose levels stay stable, so I’m not driven to eat empty calories (low-fat foods) in an effort to find something that will quiet hunger signals, and I’m forever grateful for that. There are wonderful recipes out there…using real ingredients…LCHF food is delicious!  

Stay with it and don’t be discouraged…this works!!"

Here's an excellent presentation Lynn gave at the Central Coast Nutrition Conference in March of 2014, where I was fortunate to meet her in person for the first time: 

“The Journey from Obesity to Health:  A Patient’s Perspective”
https://www.youtube.com/watch?v=vkOKhKXW8kU


“Anything in life worth having is worth working for.” 
- Andrew Carnegie

My goal for this post was to inspire you and share useful advice from successful maintainers rather than warn that if you do manage to lose weight, you're very unlikely to keep it off. It is possible, but it takes diligence, discipline, and doing whatever you can safely and healthfully do to remain at a size you're comfortable with. I know there are hundreds (thousands?) of similar long-term low-carb successes out there, and that those featured here feel that if they can do it, you can too. I wholeheartedly agree and wish you the very best of luck! 

References

1. Kopelman P, et al. Health risks associated with overweight and obesity. Obesity Reviews 2007;8:13-17 
2. Kissileff HR, et al. Leptin reverses declines in satiation in weight-reduced obese humans. Am J Clin Nutr. 2012 Feb;95(2):309-17
3.  Heshka S, et al. Weight loss and change in resting metabolic rate. Am J Clin Nutr. 1990 Dec;52(6):981-6 
4.  Paoli A, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate ketogenic diets. Eur J Clin Nutr 2013 Aug;67(8):789-96
5. Bueno NB, et al. Very-low-carbohydrate ketogenic diet vs. low-fat diet for long-term weight loss: a meta-analysis of randomized controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87 

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