HEALTH | WEIGHT LOSS

Successful, long-term weight loss can involve many strategies

2013-12-29T07:00:00Z Successful, long-term weight loss can involve many strategiesDAVID WAHLBERG | Wisconsin State Journal | dwahlberg@madison.com | 608-252-6125 madison.com

Amy Gilliland lost 100 pounds through a commercial weight loss program.

Paul O’Flanagan dropped 60 pounds with help from Outward Bound.

Sara Watts is 30 pounds lighter since she started taking a new diet drug.

Shaylea Stensven weighs 190 pounds less than she did before bariatric surgery.

With New Year’s Day coming and the nation’s obesity epidemic continuing, it’s likely many people will try to slim down.

There are many ways to lose weight, most with mixed long-term results. The most important factor in getting started might not be how people attempt to shed pounds but why they are overweight, experts say.

“If it’s depression, and we start talking about weight-loss medications, that doesn’t match up,” said Dr. Janet Droessler, a family physician and registered dietitian with Dean Clinic’s Comprehensive Weight Management Program.

Doctors are concerned about obesity’s ties to diabetes, heart disease, cancer, joint problems and conditions such as sleep apnea. But medical organizations can provide only limited help, said Dr. Michael Garren, a surgeon who is medical director of UW Health’s Medical and Surgical Weight Management Program.

Bariatric surgery — such as a gastric bypass, which shrinks the stomach — is often the best option for people who need to lose 100 pounds or more, Garren said, but most Madison-area insurance plans don’t cover it. For people who need to lose 30 pounds or less, helping them eat better and exercise more can work, he said.

“The group in between is really in limbo,” Garren said. “We don’t have a great answer for them.”

A national registry

Gilliland and O’Flanagan, both from Madison, are among more than 10,000 Americans on the National Weight Control Registry, a study of people who have maintained a weight loss of 30 pounds or more for at least a year.

The “successful losers” on the registry have lost an average of 66 pounds and kept it off for more than five years. About 45 percent lost weight on their own and 55 percent did it through a program, including a small percentage who had bariatric surgery, according to the registry.

Most people on the registry eat breakfast every day, weigh themselves at least once a week, watch less than 10 hours of TV a week and exercise an average of an hour a day.

“These people have remade their lives. They’ve remade their environments,” said James Hill, a University of Colorado obesity researcher and co-founder of the registry, which started in 1994.

They’ve also found ways to battle the biological urge to return to their previous weight, said Dr. Daniel Bessesen, an endocrinologist at the University of Colorado.

Weight loss makes the body more efficient, so people require fewer calories to maintain their lower weight, Bessesen said. A 200-pound person who loses 20 to 30 pounds can consume about 2,250 calories a day compared with 2,600 calories before, he said. But hormones still make the brain want more.

“They are using their cognitive brain to override that,” Bessesen said.

Gilliland, 52, weighed nearly 300 pounds before she dropped to 198 pounds a decade ago on the California-based Lindora Clinic diet. The program focused on weight loss for four weeks and weight stability for two weeks, in cycles.

“By the time you reached your goal weight, you had the experience of maintaining your weight,” Gilliland said.

O’Flanagan, 44, said he was heavy as a child, weighing 245 pounds by age 16. He lost 20 pounds on an Outward Bound program, which encouraged him to lose more on his own.

He got down to 185 pounds by age 20 through diet and exercise, he said, especially by greatly reducing his intake of Coca-Cola.

“The longer you do it, the easier it is to make better choices,” he said.

He and Gilliland have had setbacks, however.

Gilliland, a doula, shot up to 245 pounds two years ago after caring for her dying mother and being in a car crash. But she’s weighed about 210 for more than a year.

O’Flanagan, an attorney, got up to 200 pounds in his early 30s when he lived in New York City and was “surrounded by lots of good food.” He’s been back around 185 for more than 10 years.

He runs or lifts weights for an hour five days a week and eats many high-protein foods, such as lentils and pinto beans. “They fill you up,” he said.

Medical help

Watts, 42, a stay-at-home mother from Baraboo, has lost 30 pounds since she started taking the drug Qsymia in June. She had weighed 230 pounds.

“It takes the edge off of cravings,” Watts said. “It’s still a struggle, but it helps.”

Qsymia and Belviq, approved by the Food and Drug Administration last year, usually can help people lose about 5 to 10 percent of their body weight, said Droessler, the Dean doctor. She prescribed Qsymia for Watts.

“The medications don’t work on their own,” Droessler said. “It’s really important to have an eating plan, an activity plan, a mental health management plan and a sleep plan.”

Stensven, 29, a career counselor from Madison, had a gastric bypass at St. Mary’s Hospital in May 2012. Her insurance covered the procedure, which shrinks the stomach to the size of a shot glass and allows people to feel full more quickly.

“I can eat what I want to,” Stensven said, “but I have to make really conscious decisions about food.”

Most bariatric surgery patients lose large amounts of weight and keep most of it off, but the pounds can return if people aren’t careful about what and how they eat, Garren said.

Mindful eating

Being mindful about eating helped Charlene Avery and Andrew Osmond take off pounds. They’re also on the National Weight Control Registry.

Avery, 44, an occupational therapist from Middleton, lost 60 pounds over four years ending in 2008, in part through taking mindfulness classes. “The weight went pretty quick after I started the mindfulness,” she said.

She remained at 160 pounds until back and shoulder injuries led her to become more sedentary the past couple of years. She shot up to 195 but is now about 185.

Osmond, 35, a halfway house case manager from Milton, weighed nearly 240 pounds in his late 20s, when his knees started to ache and he learned his cholesterol level was high. The conditions inspired him to lose 80 pounds on his own over four years, through diet and exercise.

“It’s about going slow, making small adjustments and sticking with them,” Osmond said.

Now he has a hobby that illustrates his new control over food, he said. He makes exotic flavors of ice cream, such as five-spice with rum, candied jalapeno with sweet corn and roasted strawberry and black pepper with balsamic red wine sauce.

“I’ve changed my perception of food,” he said. “If it doesn’t have power over me, I’m not going to be tempted by it.”

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(6) Comments

  1. PatBaroneMCC
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    PatBaroneMCC - December 30, 2013 2:47 pm
    I'm a proponent of long-term, permanent weight loss and found the Registry when I began research on the topic in 1996. (I think I'm still a member of it.) I've lost 92 lbs and kept it off almost 14 years. The most important thing my research showed me was that only about 1% of people using ANY weight loss method keep substantial weight off. Heavily restricted diets cause even bigger regains.

    I vowed to be one of the 1%.

    Starting out with that goal in mind makes the journey a different one. Before discovering the Registry, I thought I was the only person (read: failure) who regained weight after substantial weight loss.

    In order to be successful long-term, you have to understand how the body works and work WITH it, instead of dieting and over-exercising it to the point of failure. Willpower means nothing long-term because it has a short-term (3 week) shelf life.

    Since I've been working with clients as a certified personal trainer and certified weight loss coach (since 2001), I've worked with many people who had bariatric surgery and regained all their weight. Around 70% regain all their weight, and many become cross addicted to other substances, bringing the "success" rate to a mere 12%. (Numbers from Humana Health Care). Clearly, if you don't go deeper into why you overeat, or are food addicted, you will not solve the problem long-term.

    I think the most important thing media can do is show the big picture. Articles about fast losses (more than 3 lbs a month) or weight loss sustained less than 2 years are detrimental to the public... giving them only the snapshot of rapid loss without the real world picture of what it takes to get healthy and stay there. Unless you are a celebrity, your weight regain is never seen. And my clients who regained after bariatric surgery? They all just dropped out of programs, out of sight, never seeing their docs again and therefore not having their regain documented.

    FYI, permanent weight loss is defined as "weight loss maintained for 5 years" by the medical profession. Believe me, the weight loss is one reward, but what you learn about yourself along the way is the real prize.

    Pat Barone, MCC
  2. YetAnotherStateEmployee
    Report Abuse
    YetAnotherStateEmployee - December 30, 2013 4:08 am
    Only a tiny fraction (between 3% and 15%, depending on which studies you believe) of people who deliberately lose weight - regardless of method - and that includes ALL pills, surgeries, diets, lifestyle modifications, exercise plans ... EVERYTHING, allegedly "sensible" or not ... of people who lose weight manage to maintain that weight loss for 5 years or more.

    Given the 10's of millions of Americans who try to lose weight every year, and the Billions of dollars and enormous amount of effort spent annually on weight loss attempts, the fact that there are only 10,000 people in that "registry" who've maintained a modest weight loss for 5 years (actually, the criteria for getting into that Registry are just that you need to have lost 30 lbs and maintained it for ONE year), I would suggest that rather than there being many effective weight loss options, the evidence suggests that chances of long term weight loss are extremely low and achieved by only a small fraction of those who attempt to do so.
  3. snoebird
    Report Abuse
    snoebird - December 29, 2013 2:00 pm
    Read "Eat to Live." Eat as much of the right kind of food as you want. You won't have to sweat the pounds off, and you'll lose the cravings for junk food. You can cheat on occasion and still lose more weight effortlessly than you can imagine.
  4. Ego Vigilabo Vigilum
    Report Abuse
    Ego Vigilabo Vigilum - December 29, 2013 11:01 am
    Crow Barr;

    The "Purple Diet" is a great way to lose weight; you only eat after a vikies victory...
  5. Crow Barr
    Report Abuse
    Crow Barr - December 29, 2013 10:47 am
    I see anyone over 55, long term unemployed with no jobs being created or available here in Wisconsin as a great way to lose a lot of weight.
  6. sarge
    Report Abuse
    sarge - December 29, 2013 10:10 am
    Bariatric surgery is rarely successful. People quickly learn to eat milkshakes and ice-cream to get around the smaller stomach and then eventually stretch the smaller stomach enough to start seriously overeating again. It's also a fairly dangerous surgery to have in that if things go wrong they go really really wrong and those people who have bad outcomes are disabled for life. I read a diet book written 120 years ago that stated it as it should be stated: "whatever pleasure you got out of eating all that food you will have to pay back and whatever guilt or anxiety you paid out over being fat will be payed back to you as a result of losing the weight". There are no easy solutions that will really work and believing that it should be easy or that one can simply take a pill or have a surgery are deluding themselves and are likely to fail. You have to take control of your life by whatever means necessary

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