By Elise Moser
COLUMBIA, Mo. – Lily Escobar* starting gaining weight in high school. For years, the 65-year-old St. Charles, Mo. resident let her weight creep up without paying much attention to it. Her first home didn’t have any full-length mirrors, and she avoided looking at her body.
“When I moved into our condo and had a full-length mirror in the dining room, I screamed when I saw myself,” she said. “Who was I kidding? It wasn’t out of sight. It was definitely in-sight.”
Over 30 years later, she now starts every day the same way: with one and a half cups of Cheerios cereal and milk. For dinner, she eats 6 ounces of protein, usually chicken or fish, a sweet potato and a large serving of vegetables, often a salad without dressing. She has been eating this way for more than 15 years as a strategy to fight a food addiction and maintain an 120-pound weight loss. For Escobar, consistency is the key to weight maintenance over the long-term.
“I feel like it’s the Battle of the Bulge every day of my life,” she said. “I used to say if I’m breathing, I’m gaining weight.”
Escobar is one of thousands of participants in the National Weight Control Registry, one of the largest studies of people who have achieved both weight loss and weight maintenance at their lower weights. The registry tracks people who have lost at least 30 pounds and have maintained the loss for at least one year. NWCR participants seem to have achieved the impossible: successful weight maintenance over a long period of time.
The odds are against them. More than 80 percent of people who lose weight gain it back within two years. With so many different strategies, it can be difficult to discern which is the most effective. Popular diets promise weight loss by restricting carbohydrates, upping animal proteins or swearing off sugar. Plant-based diets recommend cutting out as many animal products as possible while Paleo diet followers consume large quantities of meat.
The diet industry is oversaturated and conflicting information comes at every turn. Diets prescribed by popular fitness magazines suggest low-calorie amounts for weight loss and weight maintenance. In fact, eating too-few calories can actually cause weight loss to stagnate. As the metabolism adapts to low calorie totals, damage can occur that makes weight loss and weight maintenance difficult. Finding the secret to weight loss, and later, weight maintenance, is a difficult balance to strike.
Finding success in weight loss and weight maintenance
The NWCR is one of the largest studies of people who have achieved both weight loss and weight maintenance at their lower weights. The registry tracks more than 10,000 people.Participants fill out a detailed questionnaire detailing their weight loss techniques and the study follows up with them each you to monitor their weight maintenance progress.
The registry looks at the weight loss and weight maintenance strategies of these “success stories,” painting a picture of what a successful weight loss story looks like. J. Graham Thomas, co-investigator at the NWCR and professor at the Weight Control and Diabetes Center at Brown University, said the goal of the registry was to see if people were successful at maintaining a large weight loss and what strategies they used to achieve that maintenance.
“There is diversity, but we do find commonalities among (participants),” Thomas said. “They’re a very active group. Many of them keep track of what they eat. Many of them keep track of their body weight. They eat breakfast.”
For registered dietitian Jennifer McDaniel, the NWCR is the gold standard guide to effective weight loss and weight maintenance habits.
“The National Weight Control Registry group is very conscious of small changes,” she said. “They were aware of smaller increments of change. I encourage my clients to weigh themselves daily. People who are successful won’t let themselves get out of that comfortable range.”
McDaniel is a spokesperson for the Academy of Nutrition and Dietetics, the national professional organization for registered dietitians. She also works in St. Louis as a private nutrition counselor, and she recommends her clients track their daily food intake, something registry members consistently report doing.
“Journaling is something that’s very important for the weight-loss phase,” she said. By writing down their daily calorie intake, patients learn proper portion control. Once someone is maintaining their weight, returning to journaling from time to time can help avoid regaining weight.
“If they step on the scale and a couple of days in a row are up a few pounds, they might start journaling just to get themselves back on track,” she said.
For Escobar, support from others at Overeaters Anonymous has helped her maintain her weight loss. She has been a member of the support group for 33 years.
“I ate to feel happy,” she said. “I ate when I was sad. I ate if my boss gave me a compliment at work. I ate for negative criticism. I ate for any reason and no reason.” As a member of Overeaters Anonymous, she attends weekly meetings with other people struggling with emotional eating. Her membership in the organization requires anonymity, which is why she chose to keep her name private in this story.
“We’re there for each other,” she said. “I can call somebody anytime, day or night.”
More than half of the members expend more than 2,000 calories per week through moderate-intensity exercise, such as walking. This usually equates to spending 60 to 90 minutes a day exercising. Exercise came into play for Escobar when she plateaued after losing 80 pounds by changing her diet alone.
“I wanted to lose more weight, but I just couldn’t,” she said. She joined the Edward Jones Family YMCA in Maryland Heights, Mo. in 1998 and became a regular at the gym. But it wasn’t easy.
“I absolutely hate exercise,” she said. “With every fiber in my body I hate it. But I do it because I have to do it.”
She started exercising three times per week, but then upped it to five times. She frequented the elliptical trainer, took yoga classes and lifted weights. When she was working as a teacher, she packed her workout clothes and brought them with her to school to keep herself accountable.
“Going home after work was deadly,” she said. “I went right from work to work out.”
For John Jennings of Ladue, Mo., exercise has always been a part of his daily routine. Jennings lost 45 pounds when he was inspired to lose weight in 2002 after St. Louis Cardinals pitcher Darryl Kile died of a heart attack. His exercise routine includes a mixture of running and weight lifting.
“I like the challenge of running marathons,” he said. “You have to train differently than you do for a half marathon or a 10K.” On days he can’t get to the gym, he does pull-ups at home and takes his dog on a long walk.
Metabolism at play
Metabolism is the body’s process of burning and storing energy from food. It plays a big role in weight loss and weight maintenance. Metabolic rates are unique to each person, and account for why some people are more at risk to become overweight, according to Elizabeth Parks, professor of nutrition at MU and associate director of the MU Clinical Research Center. When someone loses weight, they burn less energy as their weight decreases.
“The amount of energy that you burn everyday is based on your body size, Parks said. “The best indicator of that is how much muscle you have. When people reduce their food intake, they lose muscle.”
McDaniel said metabolism slows during calorie restriction, which makes weight loss more difficult as one loses more weight.
“As one becomes ‘lighter’, they expend less energy in both everyday activities and exercise,” she said. “In my practice as a registered dietitian, I test resting metabolicrate with an indirect calorimeter machine, and consistently find that individuals who have lost significant weight or who have “yo-yo” weights have slower metabolic rates than expected.”
This slowing of the metabolism makes weight loss a tricky balance between cutting calories, increasing physical activity and maintaining a metabolism that will induce weight loss.
Parks said she recommends maximizing muscle while losing weight. The most effective strategy is maintaining calories from protein while decreasing calories overall, she said.
“If I reduce my portion size of everything, now I’m cutting my protein intake and that makes muscle loss worse,” she said. Parks also said the body will burn excess protein instead of storing it like it does fat and carbohydrates.
“If you eat extra glucose, you store that as glycogen,” she said. “If you eat too much fat, you have plenty of places to store extra fat. But we have no storage depot for extra protein. You live on that protein immediately.”
McDaniel recommends a gradual weight loss for her clients.
“Typically a weight-loss goal is half a pound to two pounds a week,” she said. “In order to create a deficit like that, we’re looking at cutting 250-500 calories a day.”
By losing weight gradually, her clients avoid damaging their metabolism, something that can happen when following an extreme diet. Fitness magazines popularize extreme low-calorie diets, but they might not be the most effective tools for weight loss. The average person needs at least 1,300 calories daily to maintain regular bodily functions, according to registered dietitian Robyn Coale.
“If you’re eating 1,200 calories a day, you’re going to suffer from metabolic damage and hormonal imbalance,” she said. Coale, based in Charlottesville, Va., worked with an endocrinologist at Revolution Health Center who specialized in metabolic damage.
She said the 1,200-calorie diets promotedby magazines cause the metabolism to slow. People who use these diets regularly, particularly women, find themselves losing weight at first, but as their metabolisms adapt to extremely low calorie amounts, weight loss stalls.
“You will initially lose weight on a low-calorie diet,” Coale said. “But the second time around, it’s going to become harder and harder. And you’re actually going to maintain your weight at a low-calorie amount.”
Coale said other signs of metabolic damage include lack of hunger cues, fatigue and an irregular or stopped menstrual cycle. Weight gain is also a symptom.
“Any sort of weight gain despite hard efforts to be healthy,” Coale said.
McDaniel said these low-calorie diets not only reduce metabolic rate, they can decrease the rate of lean body mass, which is more metabolically active material.
Coale works with patients to help repair their damaged metabolisms and work toward healthy weight loss. She said it’s important to recognize when weight loss is truly necessary for health.
“It’s not like weight loss is impossible if weight loss is healthy for your body,” she said. “For someone who can really stand to lose weight, you have to go about repairing their metabolism before they can actually lose weight. No weight loss can ever happen if your hormones are out of balance.”
A 2011 study found that obese people who lose weight experience a change in the hormones that regulate appetite. Patients experienced a decrease in leptin, the hormone that indicates satiety to the brain. The study suggested that feeling less satiated could be a reason for weight regain.
Personalizing the diet
The NWCR participants have a wide variety of diets that use to maintain weight loss. While Escobar’s diet consists regularly of chicken or fish, Jennings lost his weight by switching to a vegan diet. He avoids all animal products including meat, dairy and eggs, something Escobar wouldn’t dream of doing.
“You can’t pay me enough money to eat tofu,” Escobar said. “I eat what I like but I keep it to protein and vegetables and the sweet potatoes,” she said.
Their diets may differ quite a bit, but both have succeeded in weight maintenance. This might be due to their personal taste preferences.
Parks said people who are successful at maintaining weight loss choose diets that allow them to eat the foods they like. Considering personal taste preference is important in choosing a diet.
“If our senses of taste are different, then dietary advice from one person to another is different,” she said. That’s why the Paleo diet works for some people and plant-based diets are better for others. Finding a diet that allows for the foods you find satisfying is key. For Escobar, that’s a daily sugar-free ice cream bar. For Jennings, it’s allowing alcohol in his diet.
“I couldn’t do a diet like this that was no alcohol,” he said.
Parks said eating foods that are lower in calories but higher in concentrated flavor can also help keep you satisfied. She compared a caramel candy to a bowl of ice cream.
“A caramel is so intense in flavor,” she said. “It’s concentrated, so for less calories you get this huge effect.”
Working on weight forever
Maintaining weight is the most difficult part of the process. Since so many people fail to maintain any sort of weight loss, mirroring those who have achieved success is important. That’s the goal of the National Weight Control Registry.
Registered dietitian McDaniel said maintaining healthy habits becomes easier after some time, but it never stops requiring conscious effort.
“It’s work forever,” she said. “It’s certainly going to get easier, and they say it gets easier after 3-5 years, which is still a really long time. Those behaviors can become more intuitive, so that transformation is key.”
Jennings said sticking to veganism for 12 years has been difficult. He said he’s seen many friends try the diet only to switch back to eating animal products.
“You have to love it,” he said. “Whatever diet people pick, they need to be obsessive about it. It’s incredibly hard, especially as I get older.”
For Escobar, ending her battle with emotional eating and taking food off its pedestal has helped her maintain her weight loss.
“Food used to be God to me, and I lived for it,” she said. “I still enjoy my meals, but I don’t live to eat. I eat to live.”