Dieters are more likely to lose weight and keep it off if they have contact with a weight-loss counselor, a new study shows.
The report, led by researchers at Duke University Medical Center and published today in The Journal of the American Medical Association, shows just how difficult it is for dieters to maintain their weight loss. The study began with 1,685 overweight or obese adults who weighed on average 213 pounds. The group was successful at losing weight, with an average weight loss after six months of 18.7 pounds.
About 1,000 people who lost 9 pounds or more took part in the second phase of the study. Some used an Internet-based weight counseling tool, while others had regular personal contact with a weight-loss counselor. A third group received basic instruction on maintaining weight loss, and those dieters attempted to keep the weight off on their own.
Monthly personal contact meant the participants had telephone contact with a counselor for 5 to 15 minutes each month, except for every fourth month, when they had a 45- to 60-minute individual face-to-face session. The Web-based program gave participants unlimited access to a Web site designed to support weight loss maintenance, with interactive features allowing participants to set personal goals and action plans for the next week and to graph personal data over time.
More than two years later, most everyone had gained back some of their weight. The people who tried to maintain their weight on their own fared the worst, gaining back an average of 12.1 pounds. People who used the Web-based tool gained back 11.5 pounds. However, those people who took part in the personal contact group gained back the least — regaining 8.8 pounds.
Although personal contact only resulted in a 3.3 pound additional benefit, the study authors noted that even small losses can improve health. Every kilogram (2.2 pounds) of weight loss is associated with an average decrease in systolic blood pressure of 1.0 to 2.4 mm Hg and a 16 percent reduction in diabetes risk, the authors said. At the end of the study, more than 45 percent of those who had received counseling were still maintaining at least 9 pounds of weight loss, an amount with clear clinical benefits, they noted.
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From 1 to 25 of 49 Comments
Here’s what worked for me after I got my BMI down to 25 following a diabetes scare with a fasting sugar in the glucose intolerance range between 105 and 126.
First I limited the number of calories I need to maintain my weight by multiplying 15 calories/pound times my normal weight. (Some dietitians recommend 13 or 14 calories per pound.)
Then I religiously use a food scale and carefully study the nutritional information on packaged food. Calories really count. An extra 100 cal/day translates to an annual weight gain of 10 pounds.
No matter what I also weigh myself every morning.
— MARK KLEIN, M.DMark,
That is very interesting. I am a pre-diabetic, and am very scared of becoming a diabetic. I feel though, that no matter what I do, it is impossible to lose weight. This may be because I have other problems associated with insulin resistance, like PCOS, but it is very hard with the way my body processes insulin.
— RachelRachel,
It was being diagnosed with PCOS that finally got me to lose weight. After losing the first 35 lbs on Weight Watchers, my symptons were gone without any medication. I’ve kept off the 85 lbs I lost for over 4 years now. I still write down everything I eat and try to attend WW meetings every week. It really does help.
Susan
— SusanAfter years of trying and failing to lose weight on my own, I succeeded with Weight Watchers several years ago. Doing so included going to a weekly, 30-minute meeting where I weighed in and discussed problems and successes with others in the same boat. The process also includes setting intermediate goals on the way to reaching goal weight. On Weight Watchers you eat normal food, so you can get suggestions at the meetings for dealing with situations like holiday dinners, restaurants, and travel.
I couldn’t have succeeded at losing the weight — more than 30 pounds — without the moral support, the camaradarie, and the various helpful techniques the group gave me. Since reaching my goal weight, I still attend the weekly meetings. The moral support and reminders have enabled me to keep off the extra weight for 4 1/2 years. It’s all very well to say I should be able to control my eating on my own — but, as with exercising, I do it more consistently and more effectively when I have a group of like-minded people around me working toward the same goal. And there’s no shame in that. What works for me works for me.
The process of keeping off the weight is the same as losing it. It never gets easy. But having the fairly frequent support of other people makes the difference, makes maintenance possible for me. A counseling session once a month wouldn’t be often enough.
— MaryPersonally, I got my blood sugar levels down by eating and drinking less stuff with added sugar and high fructose corn syrup. My weight stayed the same, but over the course of 1 year the blood sugar reading went from 103 to 97, and two years out, is 87. Didn’t require any calorie counting, and the fact that I didn’t lose weight didn’t bother me at all. My blood sugar got back into the normal range and that was what I cared about. Of course, YMMV.
After reading the post, it seems to me that the title “Even with Counseling, Most Dieters Regain Most Weight They Lose” would be more appropriate. But of course the folks at Duke (don’t they run a for-profit weight loss clinic there?) wouldn’t spin it that way, would they?
— JMRachel–Here’s how lost about 50 pounds about 4-5 years ago.
Instead of dieting I ate as if I weighed the 204 pounds I should be to have a BMI of 25. I’m 6-4 so that’s about 3000 calories daily (15 x 204). By doing that I must have pushed the appetite “reset” switch in my brain which prevented me ever since from overeating again.
I also swam 20 minutes of laps daily while the weight gain off over a period of about 15 months.
With the weight off back to my usual sedentary ways.
Doesn’t make any difference what I eat so long as I stay under 3000 calories. I’m a very big chocolate fan. Works to me to eat for pleasure. That means I don’t eat a dietitian approved balanced meals. I compensate by taking high potency vitamins and some specialized supplements recommended for seniors.
I also test my fasting blood sugar daily with a home test kit (Freestyle). Very pleased the weekly averages have progressively fallen from the high 90s to the high 80s over time.
67 this month believe getting the most out the time left for me turns on good self care, regular doctor and dentist visits and following their recommendations to the letter, and regularly rising stock dividends.
Best of luck!
— MARK KLEIN, M.D.I wonder if the sessions included a “weigh-in.”
Sometimes knowing that you’ll need to hit a certain number can help you hold the line on all the temptation.
Suppose they were more successful than Weight Watcher’s participants? That’s the most successful program I’ve run into.
— GingerBSusan,
That’s great! Keep up the good work!
— DianaThis study makes sense. When I went to a gym with one-on-one trainers, I was able to maintain a constant regimen, lost 25 lbs and was in generally great shape. When circumstances intervened and I joined the neighborhood gym, I slacked off, both in commitment, and work per session. I think it was having to face the trainer that kept me on the straight and narrow.
— DonOI think for many people who’s bodies are in such bad shape with diabetes, etc it really takes a whole life change to lose the weight and get healthier. It takes work and dedication to measure food, count calories, cook healthy food and sadly there a some people who for whatever reason don’t think that they are capable.
— RebeccaI can see how the counseling would help.
The weight didn’t just get put on over six months or a year in most cases. It required years of established habits.
A lot of times when people diet, they cut out a lot of things they really like, instead of learning how to enjoy those things in smaller portions, ‘buy’ them with exercise (I ‘bought’ myself some Easter candy with an extra half-hour on the elliptical last week, for example), or transition them to special events instead of daily habits.
My first big post-divorce weight loss of about 60 lbs was a matter of a few months, but that was based in depression and cutting out all the things my ex-husband had liked to eat that I didn’t really enjoy (turkey burger and macaroni and cheese is *NOT* what I consider a balanced dinner…).
The real big habit-based weight loss has taken longer, but I’ve made long term life changes, like only taking seconds of vegetables, eating dessert once or twice a week instead of every day, going to the gym two or three times a week, eating a big high-fiber breakfast to keep my sugar from crashing at 11am, that sort of thing.
It’s been quite a while since I started the little habit changes, and the weight loss has been slow, but as I progress without ever feeling deprived or like I’m giving up something I want, and as I’m able to do it eating good, real, organic food (instead of “I’ll cut out all my sugar and replace it with Splenda!” which doesn’t change habits AT ALL), the one thing I can say is that not one pound I’ve lost in the last couple years has come back, and they’re slowly but steadily fading.
It seems to me that counseling would be a great resource for those little life changes, for finding ways to transition from ‘dieting’ to ‘having a healthy diet.’ Had I considered a weight-loss counselor two years ago, maybe I might have had even better results…
— RowanVery interesting study. Is there some database on weight loss counselors out there? It seems like a sort of unregulated field so it’s hard to tell who is qualified for this. Also, I wonder what sorts of things counselors discussed with their clients.
In response to some of the diabetes comments…
I have type 2 diabetes and wish that everyone could have a chance to live with it for a few months, just for the insight it can give on the effects of diet and exercise. The amount of insulin I take when I am exercising at an intense level–I am currently training for an Ironman–is anywhere from 50-75% of the amount I take when just maintaining a more modest exercise regimen (and this is for more food). When I have to take a rare break from exercise, all hell breaks loose. I also require much less insulin when my weight is down. The changes in insulin sensitivity occur in everyone–most people just have no idea because their sturdy pancreas does the work for them. (Lucky!)
Although type 1 diabetes cannot be prevented (yet), exercise & diet can improve control in a dramatic way. Likewise, exercise and a good diet can keep type 2 at bay for most people. (Some people who are fit and active can still develop type 2, although this is less common.) Diabetes is a serious disease. Do try to avoid it (type 2) if you can!
-Anne
— AnneI can well believe that having an accounting with a “real” person (as opposed to a virtual one) would help a dieter stay on track. As a lifetime Weight Watcher member, I used to go to meetings, even after I lost the weight (25 lbs). I kept it off for 5 years until I had a child.
Now however I find that as I age the WW plan doesn’t work anymore and have switched to the Atkins diet (Protein Power is another similar plan). After 3 months on the diet I feel better than I ever have. While I still want to lose a few more pounds I have had more success with this than WW. However, I find the main thing was keeping a food diary and writing in it every day, every meal (the same as WW recommends). I find writing and reviewing meals helps me keep on track.
I think the message here is to find what works for yourself personally and stick with it. Its not a diet, its a lifestyle!
— Carolyn FerrellI am slowly realising that I have to choice but to get into a program to lose weight. I have lost weight on Weight Watchers, but have regained 50% of what I lost. I have been trying to lose the weight that I gained on my own, but find it very difficult. I think I need to go back to a program that expects some accountability.
— Rituja1-3, great comments, very helpful. One reminder: don’t forget the beneficial effects of moderate exercise, especially in combating a pre-diabetic state! I am a pharmacist and had a close friend who has been a vegetarian and very light drinker for years and therefore never overweight. He had no other history of chronic disease. He walked to work in DC 2-3 days per week. What a shock when he went to the doctor and found out he was pre-diabetic! Now he goes to the gym for 30-45 minutes four to five days per week, and his blood sugar has returned to normal. So, don’t forget to get out there! Check the website of the American Diabetes Association for more suggestions: http://www.diabetes.org/home.jsp.
— MarthaRachel,
I can totally empathize with your frustration over PCOS. I was diagnosed a year ago, and my immediate step was to go back on the Pill to ensure ovulation. I, too, was pre-diabetic and couldn’t tolerate the constant feeling of unhealthiness and fluctuating weight gain. I ultimately contacted a nutritionist, who has radically improved my health. I’ve lost 15 pounds in 4 months and have felt consistently healthy for the 1st time in years. It’s so important to seek guidance around weight stabilization. Whether you use Weight Watchers, like Susan, or a nutritionist, you can begin to control PCOS and experience a renewed sense of well-being.
— SabrinaI also had success with Weight Watchers which (sort of) has a counselor in a group setting. I have stayed within my “goal” weight for a long time, but really do best when I go to the meetings regularly.
— JJI agree with Martha (#15) 100%. In addition to following WW, I also try to exercise 3-4 times a week. It helps both with weight loss/maintenance and regulating your insulin levels. It also makes you feel great!
— SusanI’m with JM (#5). How could anyone define re-gaining an average of nearly 50% of their weight loss as “keeping pounds off” ?
>After reading the post, it seems to me that the >title “Even with Counseling, Most Dieters Regain >Most Weight They Lose” would be more appropriate.
— Ashley>— Posted by JM
I’m sorry, but going from 213 to 204 really isn’t likely to have much health benefits. It’s not even a 10% loss. The only thing that has been shown to lead to significant weight loss (at least 50% of excess body weight) long term (more than 5 years) is bariatric surgery. I think the insurance companies are going to have to seriously consider approving bariatric surgery, perhaps the restrictive only operations such as the Vertical Sleeve Gastrectomy and Lap-Band, for people with BMIs of 30+ with comorbidities, rather than BMIs of 35 and 40.
— Sarayou are what you eat, processed food is bad for you. There is a lot of sodium in diet pop, canned soup, and prepared food. Make your own and notice the diference in your body.
— terri hallRachel–I also recommend reducing variety in your diet. I strongly suspect human neuroendocrine saiety genetics aren’t wired up to work their best with constantly shifting food choices.
Been my experience in life a major factor in success in most everything turns on developing sound habits. Why should dietary choice be any different?
An unfortunate characteristic of advanced industrial societies is encouraging people to continually experiment with unfamiliar foods. If such food is unfamiliar to the palate, it’s even more unfamiliar to the very complex neuroendocrine systems controlling saiety.
— MARK KLEIN, M.D.Sara:
Not everyone needs to lose significant weight. *You* might not consider 213 to 204 a big change, but if it comes about as part of a diet and exercise program that increases muscle while it decreases body fat, it can represent two or three dress sizes and a massive increase in health and functionality.
Losing ten pounds dropped me an entire dress size, because I put on a good five or six pounds of muscle - meaning my actual fat loss was closer to fifteen pounds.
This is why BMI is broken, frankly. Dress it up all you like with fancy formulas, it’s still a height/weight table with a new name. And those don’t work because they don’t account for body type or muscle mass. At my ‘ideal’ size (the one at which I look and feel the best), my BMI is still ‘overweight’. To get to, say, a BMI of 24, I have to hit a weight I haven’t been since before puberty, at which I look unhealthy and feel tired all the time.
This whole ‘by the numbers’ health game is stupid.
— RowanI am writing again after reading all of the variety of comments. I have known about having PCOS for 4 years or more. I feel as though what was lacking was a doctor who cared. When I was diagnosed, I never even had my blood sugar levels tested (nor was I told that it was PCOS-I was just put on the pill)! I am only about 10-15 lbs overweight for my height (according to the BMI), and am a very active person. I exercise 3-5 days every week, and lift weights about twice a week with a workout dvd. I even saw a nutritionist, but that didn’t help. I know a lot about food, but just haven’t found anything that works for PCOS.
Sabrina-Did your nutritionist give you basic principles around nutrition, or was it tailored to your PCOS nutritional needs? PCOS is a very under-studied subject, and I am so frustrated with the lack of diet reccomendations.
Mark-I’ve also read in Dr. Oz’s book “You on a diet” that variety is what hurts our healthy eating habits. Too much variety can be very harmful-very interesting!
All in all, being healthy takes work and diligence.
— RachelDefine weight-loss counselor. If it’s a paid sales person without credentials, I would be leery. If it’s a psychologist or another mental health professional, then it would have more credibility.
I participated in a program lead by a psychologist and the insight I acquired helped me to lose 26 pounds during the program. Since being out of the program, I have lost an additional 11 pounds and have only 15 more to go.
Prior to the program, I had lost 30 and then gained 15 back, which is why I joined the program. I knew something was going on in my head that was keeping me from being successful. The program I was in helped me to understand how to break a lifetime, 42 years, of bad habits and why they are difficult to break or replace.
Mental health support before, during and after weight loss is incredibly helpful. Successful weight loss and maintenace is about changing the way you eat, changing your activity level, and changing your thoughts, beliefs and attitudes. However, to make those changes, new habits are needed, and this is why a mental health professional can be very helpful.
Meeting in a group setting, which I did, also contributed to the insight I acquired, and gave me the support I needed as wasn’t getting from family and friends. Should I start to gain, I will find a support group led by a mental health professional because I know it works for me.
— Emma