The Fight Against Flab -- NAH December 1997


December 1997 — U.S. Edition

Fen/phen is gone. America's epidemic of obesity is still here.

Something is making us fatter than we've ever been. One out of two Americans is now overweight. As recently as the early 1980's, it was "only" one in four.

Clearly, we're eating too much and moving too little. Many people sit in front of computers all day, then go home and sit in front of the TV 'til bedtime. It doesn't help that restaurant entrees -- and even appetizers -- can pack 1,000 calories or more. We're drowning in "value meals," "two-pizzas-for-the-price-of-one," and other incentives to stuff ourselves.

Some people have just thrown in the towel. They've had it with diets, had it with weight loss clinics, had it with health clubs. They feel destined to be fat. But not everyone.

Rena Wing of the University of Pittsburgh and co-workers have identified a group of some 2,000 people who have fought back. They lost an average of 60 pounds and kept it off for an average of six years.

Here's what you can learn from them . . . even if you only have 10 or 20 pounds to lose.

Q: What is the National Weight Control Registry?

A: It's a study-the largest ever done-of people who have lost weight and kept it off for at least one year. I set it up with James Hill of the University of Colorado Health Sciences Center because we wanted to debunk the myth that nobody ever succeeds at weight loss. There are people who are successful weightlosers and we wanted to figure out how they're doing it.

Q: Who's in the registry?

A: Participants must have lost at least 30 pounds and kept it off for at least one year, so someone who lost 50 pounds but regained ten of them would still be a candidate. To enroll, successful weight-losers call our toll-free number and we send them questionnaires.

Q: Describe the average participant.

A: Of the almost 2,000 registrants, 80 percent are women and 97 percent are white. We would like to extend our data to more men and minorities. The average age is 45 and half are 34 to 55.

Most went from overweight to normal weight. Their average weight dropped from 220 to 154 pounds and their average body mass index (BMI) went from 35 to 25. The average person in the registry has lost about 60 pounds and kept it off about five years. But we're also interested in people who have lost less. We chose a 30-pound minimum because researchers would agree that's a significant weight loss.

Q: Were the people in the registry overweight as children?

A: Yes. It's a common belief that if you're overweight from childhood, you'll have much more trouble losing weight and keeping it off. But almost half of our successful weight-losers were overweight before age 11 and another 25 percent were overweight before age 18.

Q: So it's not all in your genes?

A: Clearly, there are genetic factors in obesity. Over 70 percent of the people in our registry have at least one overweight parent. Many people who look at their overweight parents say: "I'm destined to be overweight and there's nothing I can do about it." These people have genes that pre-dispose them to be overweight, but they succeeded in losing weight.

Q: Most tried to lose weight before?

A: Yes, and that's also encouraging. People may have to try several times, but that doesn't mean they can't be successful.

Q: So we can't assume that this group is typical?

A: No. It's not a random sample of the population. These are people who've identified themselves as weight-losers. So what they do may not be representative of all weightlosers or all overweight people.

Q: How did they lose the weight?

A: About half were not members of any type of program. The other half got some type of assistance. It could have been a program like Weight Watchers or Overeaters Anonymous or a weight loss clinic. Or it could have been individual sessions with a psychologist or a dietitian. We don't know how many were in each type of program.

And almost all -- 89 percent -- said that to lose or maintain their weight, they changed both their eating and their physical activity.

Q: How did their eating change?

A: To lose the weight, the most common strategy-used by 88 percent was to eat less of certain types of foods. We didn't ask which foods. The second most common strategy used by 44 percent-was to eat all foods, but limit the quantity. The same percentage said they counted calories. People could report using more than one strategy.

Q: Did they cut back on fat?

A: Yes. About a third limited their percent of calories from fat and a quarter counted fat grams. A fifth used liquid formulas. Very few used fad diets. Only five percent said they ate just one or two types of foods, like carbohydrates. And only four percent used weight-loss medication.

Q: What made them decide to lose the weight?

A: Roughly 75 percent reported some triggering event. Men were more likely to report a medical trigger like low back pain, fatigue, high cholesterol, or varicose veins. Women were more likely to report an emotional trigger like 'my husband left me and my lawyer told me it was because I was fat."

For roughly a quarter, there was a "lifestyle" trigger-'I was going back to my 10th reunion," for example. "I saw myself in the mirror or a photo," was reported by three percent. And seven percent said: "I just decided to do it." For some, the trigger was having somebody say something about their weight.

TIPS TO GO

Watching your weight? Our tips may help:

Do the "doggie-bag." Thanks to ballooning portions, even some lower-fat restaurant meals -- like linguine with clam sauce, chicken chow mein, shrimp with garlic sauce, chicken fajitas, or pancakes with syrup and no butter -- have close to 1,000 calories. (A fatty meal can run you Close to 2,000.) Your best bet: Take home half for tomorrow's lunch.

Avoid the "SnackWell's syndrome." You can save calories by eating low-fat or fat-free cookies, cakes, ice cream, and other sweets but not if you eat the whole box. Limit low-fat sweets to the (rather small) serving listed on the package.

Load up on vegetables and fresh fruit. Sometimes you just gotta have some (low-fat) candy, cookies, or cake. But to keep excess weight off -- and stay healthy -- make your usual snacks fresh fruit or vegetables. They're fairly low in calories, they fill you up, and they lower your risk of cancer and heart disease.

Eat less. Some people still eat the same portion sizes they ate when they were younger. But most people need fewer calories as they reach middle age and beyond. Maybe you could get by with just one or two slices of pizza instead of three or four. Maybe you'd be fine with just half of a (rather hefty) sandwich from the local deli. If you're still hungry, have an apple, a salad, or some other fruit or vegetable.

Don't deny yourself. Food is one of life's pleasures. If you can't face the day without your favorite fattening foods, eat just a very small portion. If you don't deny yourself, you might not feel compelled to cheat.

Think before you drink. Don't forget that soft drinks, fruit drinks, alcoholic beverages, Frappucinos and other fancy coffee drinks, and even healthy beverages like orange juice and low-fat milk usually have somewhere between 100 and 200 calories per serving. Water, seltzer, coffee, and tea are essentially calorie-free.

Watch the condiments. Regular salad dressing, mayonnaise, cream cheese, butter, and other "extras" can pour on the calories. When you eat out, ask for mustard on your sandwich and low-fat salad dressing (or vinegar and a few drops of oil). If you must have cream cheese on your bagel, get fat-free or light "on the side" and spread on a thin layer. When you order a baked potato, use just one tablespoon of sour cream and no butter.

Fast food strategies. Most people know that a Quarter Pounder isn't diet food. But few realize that a large fries has the same number of calories. The best options- a grilled chicken sandwich (with either light mayo, mustard, or ketchup), a grilled chicken salad (with fat-free or low-cal dressing), a stuffed vegetable or chicken Pita without dressing (if you're at Wendy's), or a baked potato topped with sour cream and chives.

-Bonnie Liebman

Q: How do they keep weight off?

A: They watch what they're eating, particularly their fat intake, and they keep up a high level of physical activity. On average, they report eating 1,380 calories per day and they get 24 percent of their calories from fat. That number-1,380 calories-is very low and may not be accurate. Previous studies have shown that people tend to underestimate their calorie intake. But it does suggest that they're watching what they're eating. Data on percent of calories from fat are more accurate, so we're more comfortable standing behind that.

Q: Do they eat out at all?

A: Yes. On average, they eat in non-fast-food restaurants two to three times a week and they eat in fast food restaurants a little less than once a week, so they're not hermits. They eat roughly five times a day which is typical for Americans.

Q: What about exercise?

A: They report very high levels of physical activity-about 2,800 calories a week. Experts typically advise people who want to lose weight to expend 1,000 calories a week. Burning 2,800 calories is equivalent to walking 28 miles a week, or about three to four miles a day.

Q: That must take a lot of time.

A: Yes, but most are not doing it all in walking. They're doing some combination. On average, they spend about 1,000 calories per week walking. Other common activities are bicycling, aerobics, and stair climbing.

As they get fit, a fair number do higher-intensity activities like step aerobics, weightlifting, and running. I think some move to higher-intensity activities because you can burn the same number of calories more quickly.

Q: Do they weigh themselves?

A: Very often. Half do it every day, and 75 percent weigh themselves at least once a week. That seems to be part of their strategy of self-regulation.

Q: Is it hard to keep the weight off.?

A: Everybody always says that it's much harder to maintain than to lose weight. These people don't say that. About half-42 percent-say that maintaining weight is actually easier than losing it. This is a very important message.

Q: So they're not miserable?

A: No. That's another myth. We've always felt that the only way to keep weight off was to have such a horrible life that all you did was dream of food. That wasn't what our data showed.

These people feel good. Ninety-five percent said that the overall quality of their lives improved, and 92 percent said that their level of energy was greater. Less than one percent said that their lives were worse. They were overwhelmingly positive.

Q: Did the weight loss cut their risk of disease?

A: We didn't measure their risk factors. But many other studies have shown that if you lose weight-even if it's minimal-and keep it off, it will lower your cholesterol, your blood pressure, your insulin, and your blood sugar levels. If they lost 60 pounds and kept it off for six years, I know their health has improved.

Q: What's next for your research?

A: We're doing a population-based survey to see how common it is for people to lose weight and keep it off. We suspect that it's more common than researchers think.

We also want to know whether people who have kept weight off have a slower metabolic rate than people of the same weight who don't have a history of weight loss. If so, successful weight-losers would have to eat less-or exercise more-than those people.

Another study is comparing people who expend 1,000 calories a week to those who expend more. And we have a study in which we're telling one group to exercise for 40 minutes at a time and another group to do four ten-minute bouts of exercise. In a previous study, people were more likely to stick to the exercise if they did short bouts.

Q: Why do so many people fail to keep the weight off?

A: Perhaps because we live in a society where there is so much emphasis on eating and inactivity. From remote controls to gas-powered leaf blowers, a growing number of things keep us inactive. We're spending more time in front of televisions and computer terminals. And restaurants are serving larger and larger portions. There's food everywhere.

Q: So it may not be easy?

A: No. Obesity is a disease. It increases the risk of a large number of medical problems. Rather than blame overweight people, we need to use data like this to help more people lose weight and keep it off.

If you've lost at least 30 pounds and kept it off for at least a year, the National Weight Control Registry want you. Call 1-800-606-NWCR or write to NWCR, c/o Dr. Rena Wing, 3811 O'Hara St., Pittsburgh, Pennsylvania, 15273. You'll be sent a series of questionnaires that you can fill out at home. You must be 18 or older. There's no charge -- and no payment, except to know that the secrets of your success may help others.