Vigilance Is the Price of Weight Control

WEDNESDAY, Oct. 11, 2006 (HealthDay News) -- Want to keep off those pounds you've lost? Then weigh yourself daily and have an "action plan" you can turn to when your weight creeps back up five pounds.

The result may be a lifetime of weight control, according to a study in the Oct. 12 issue of the New England Journal of Medicine.

"We've all known that weight loss management is the biggest problem we have, and most things don't work," said study lead author Rena R. Wing, a professor of psychiatry at Brown Medical School and Miriam Hospital, both in Providence, R.I.

"We have presented an approach here that does work," she added.

In the study, Wing's team evaluated 314 men and women who had lost at least 10 percent of their body weight within the last two years. On average, they had lost about 20 percent of their original weight, or about 42 pounds. They lost the weight through a variety of ways -- some in organized programs and others on their own, but none had undergone bariatric or weight-loss surgery.

The researchers assigned the participants to three groups. One group was the "control group," getting quarterly newsletters that told them about eating and exercise habits for the entire 18 months of the study.

The second, a "face-to-face intervention group," underwent regular weigh-ins and received instruction and weight counseling in face-to-face group meetings. The third group received similar advice and counseling but did so through the Internet.

Participants in the two intervention groups learned how to prevent weight gain using strategies from Wing's National Weight Control Registry, which now includes more than 5,000 men and women who have lost at least 30 pounds and maintained the loss for one year or longer.

All study participants were followed for 18 months. Typically, Wing said, successful dieters achieve their maximum weight loss at six months, hold their own from six to 12 months, and at 12 months start to regain weight. "If you keep the weight off for three to five years, it markedly improves your chances of long-term weight control," she said.

The participants in the two intervention groups were told to weigh themselves daily and to report their weights weekly, either by phone or the Internet. They were also introduced to a color-coded weight-monitoring system. If they were within three pounds of their starting weight, they were in the "green zone" -- a reason for congratulations and rewards. If they'd gained back three or four pounds, they were considered in the "yellow" or cautionary zone, and were advised to think about adjusting their intake of food or increasing their exercise.

A gain of five pounds or more landed them in the "red zone" -- and they were told to restart their weight-loss efforts by upping their exercise or decreasing their calorie intake. They were also encouraged to go to their "red toolbox," which they received at the start of the study, and take advantage of contents such as a meal-replacement shake or a pedometer.

At the end of the 18 months, 72 percent of the control-group members who got newsletters only regained five or more pounds, compared to 55 percent of Internet intervention participants and just 46 percent of the face-to-face participants.

According to Wing, success was based not just on the daily weigh-ins but the fact that participants in the intervention groups had to be accountable by reporting their weight weekly and had to have an action plan when their weight crept back up.

"Just getting on the scale is not enough," she said. "You must use that information, make adjustments in your eating and exercise" when warranted.

The research, Wing added, also suggests that some people may need an organized program to keep weight off, just as many need an organized program to take if off. "When you are losing weight, there is lots of reinforcement," she said. "Your clothes fit better, the scale goes down, people comment. When you get to maintenance, there is not a lot of reinforcement."

Other weight-control experts praised the new study.

"This article is very useful," said Dr. Michael Dansinger, assistant professor of medicine at Tufts-New England Medical Center, in Boston, who has researched weight-loss diets. "It gives us some of the best insight on the natural history of weight regain and what can be done to minimize it."

But, Dansinger added, the study participants may not be typical of the general population. While study members lost about 20 percent of their body weight, many people lose just 10 pounds or 5 percent of their body weight, and do it quickly.

Cathy Nonas is a spokeswoman for the American Dietetic Association and director of obesity and diabetes programs at North General Hospital, in New York City. She said the study demonstrates the importance of intervention even during weight maintenance.

"It's too hard out there without a significant amount of intervention or help," Nonas said, adding that a dieter's surroundings are partly to blame. "The environment is so conducive to gaining weight." From huge restaurant portions to unsafe parks to budget cuts that de-emphasize activity in schools, the environment can sabotage efforts at weight control, she said.

More information

To read success stories about weight loss, visit the National Weight Control Registry.