Winning at the weight loss game.

Abstract

How many times have patients been told to lose weight, only to wonder how or which diet is best? If weight loss were easy, then we wouldn’t be faced with the current obesity epidemic. While recent research has indicated that there are a number of diets that may be effective for weight loss, the best plan varies depending on the individual. The downside to a ‘‘diet’’ is that once the dieter stops following the plan, the weight returns. Rather than following a strict diet, sometimes the best way to promote weight loss is to develop small behavior changes over time that can be continued throughout the lifetime. These small changes are both more achievable and more acceptable to patients. We are fortunate to have a number of strategies that have been documented by a database called the National Weight Control Registry (NWCR) to share with patients desiring weight loss. The registry represents more than 5000 adults who have lost at least 30 pounds and maintained that loss for more than 1 year. The NWCR was established in 1994 by Rena Wing, PhD, and James O. Hill, PhD. According to their Web site, it is the largest prospective study of long-term successful weight loss maintenance. Questionnaires and annual surveys are used to determine behavioral and psychological characteristics of the weight maintainers. As data are being collected and tabulated, researchers are beginning to find common characteristics that can be shared with patients who desire or need to lose weight. Overall, the NWCR found that 98% of their participants stated that they modified their food intake in some way in order to help them lose weight, and 94% increased their physical activity. A referral to a registered dietitian can give patients the opportunity to explore the most healthful way to modify their food intake. Some of the following tips also appear to be frequent tactics in the success of participants. Following a low-calorie, low-fat diet is a common strategy among the registrants. A healthy weight loss is generally 0.5 to 2 pounds per week. To reach this goal, a daily 500to 1000-calorie deficit needs to be created. Reducing fat intake can help to quickly produce this deficit, as fat contains 9 calories ⁄g vs 4 calories ⁄g for protein and carbohydrates. For example, 2 tablespoons of mayonnaise on a sandwich each day yields 200 calories from the mayonnaise alone. By switching to fat-free mayonnaise, nearly 190 calories can be eliminated daily. If fat-free mayonnaise is not an option, then reducing the portion is another way to limit fat and calories. Looking at ‘‘extras’’ in the diet can help in calorie reduction, too. For someone drinking 2 cans of regular soda a day at 150 calories per can, a savings of 300 calories can be achieved by switching to either diet soda or another calorie-free beverage (water comes to mind). Changing the mayonnaise and soda intake would create the 500-calorie daily deficit needed for 1 pound of weight loss each week. In the typical daily intake of most Americans, it is quite easy to find ways to save calorically. Another approach that is found among the NWCR success stories is at breakfast, which is consumed by 78% of the registrants every day. Our mothers always told us that this was the ‘‘most important meal of the day,’’ and it seems they were right. Eating breakfast helps to reduce midmorning hunger that results in yielding to temptations such as the donuts someone brought to the office or a fateful trip to the vending machine. ‘‘Breaking the fast’’ from the night before helps us to maintain our basal metabolic rate and limit overeating at our next meal. Depending on what is consumed at breakfast, it can also help patients to increase their fiber intake (which can help to reduce cholesterol, produce satiety, and maintain regularity). Physical activity was increased among 94% of those questioned in the NWCR. Walking was the most common form of exercise, and 90% of persons exercised for an average of 1 h ⁄d. Current recommendations advise 30 to 60 minutes of daily physical activity to prevent weight gain and 60 to 90 minutes a day for weight loss. The thought of walking 60 to 90 minutes a day may seem daunting, but patients do not have to start at that level. Their first attempt may be 5 minutes long or walking 1 block, from which they can From the University of California, Davis Medical Center, Sacramento, CA Address for correspondence: Debbie Lucus, MS, RD, CDE, University of California, Davis, Medical Center, Sacramento, CA 95817 E-mail: debbie.lucus@ucdmc.ucdavis.edu