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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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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.