You diet; you exercise; you finally reach your goal. To celebrate,
you have a treat, and gradually, over time — you regain.
You're not alone. Only 2 out of 10 people who lose weight keep
it off. What happens to the other 80 percent?
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| Dr. Rena Wing of Brown Medical School |
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They suffer an increased risk of type 2 diabetes and heart disease,
and Dr. Rena Wing of Brown Medical School knows how to help.
Wing, professor of psychiatry and human behavior at Brown, also
directs the Weight Control and Diabetes Research Center at the
Miriam Hospital in Providence, R.I. In a Feb. 15 lecture, "Winning
at Losing: The Art and Science of Long-Term Weight Control," she
presented the results of two promising studies in the behavioral
treatment of obesity.
Diabetes, one of the leading causes of death and disability in
the United States, leads to complications including blindness,
heart disease, stroke, kidney failure and lower limb amputation.
It also complicates pregnancy, and babies born to diabetic moms
have an increased incidence of birth defects.
Wing began by describing her work in the Diabetes Prevention Program,
a major, multicenter NIH-funded trial with 5,000 adults at high
risk for type 2 diabetes. "The results were so dramatic," she said, "that
the study was stopped early."
The study included three groups: placebo; a group receiving metformin
(a medication used to treat diabetes — here used to see if it would
prevent diabetes); and a lifestyle intervention group (using diet,
exercise and one-on-one contact).
Among placebo-treated participants, about 40 percent converted
to type 2 diabetes. Metformin was effective, but about 30 percent
still developed the disease.
In the lifestyle intervention group, only 20 percent developed
type 2 diabetes. They reduced their risk by a whopping 58 percent,
significantly greater than placebo and twice as successful as metformin.
Notably, lifestyle intervention worked across the board in the
different age groups, ethnicities and body-weight groups — a very
robust effect.
"The trial really proved that lifestyle intervention can work," said
Wing.
And then what happened? "Although weight loss was extremely effective,
we found that many of our participants were not able to maintain
their weight over time. This suggested to me that the number one
challenge facing our field is maintenance of behavior change. This
needs to be our number one priority," Wing stressed.
Against this backdrop, she presented findings from two separate
approaches to weight control maintenance.
The first was a questionnaire sent to a group of about 4,000 people
in a database known as the National Weight Control Registry. The
registry, operated by researchers at Brown and the University of
Colorado, was created as a self-selected cohort of successful weight
losers. Participants had to have lost at least 30 pounds and have
kept it off for a year. On average, they maintained the loss for
over 5 years, going from body mass index (BMI) of 37.6 to 25.1.
How did they do it?
"'What makes them successful?' is the wrong question," Wing noted. "The
better question to ask is 'What makes them successful this time?' Because
many had lost, regained and lost again."
Each year, Wing's team sent this group a questionnaire to see
what was working.
Nothing magic: a combination of diet and exercise. Most successful
participants (55 percent) didn't struggle alone but worked with
a nutritionist, a weight loss program or their family doctor.
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| Wing’s research demonstrates
how behavioral treatment improves weight loss maintenance. |
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Their diets varied, but on average they were low-fat (not Atkins,
she stressed) and low-calorie. Most folks ate breakfast daily (preventing
subsequent bingeing). Most weighed themselves daily; and they were
consistent in their intake, even on weekends and holidays. As for
exercise, on average the successful people briskly walked 3 to
4 miles a day.
How did they find time to exercise? "They watched very little
TV," Wing stressed.
Next, Wing presented the results from an NIDDK-funded randomized
trial (completed at Miriam Hospital) called "Stop Regain." The
program's goal was to test the efficacy of face-to-face and Internet
interventions and then compare these two groups to a control group
that received only a quarterly newsletter. It was different from
most other studies in that it focused on preventing a regain of
greater than 5 pounds over 18 months. It was offered only to participants
who had already been successful in weight loss, that is, a loss
of at least 10 percent of their body weight in the past 2 years
(the period when people are at most risk of regaining).
Both the face-to-face and the Internet groups received the same
teaching content, treatment materials and amount of contact. At
the end of the 18-month study, significantly fewer participants
in the face-to-face and Internet conditions had regained 5 pounds
compared to the newsletter control group. Participants in the face-to-face
group consistently obtained the best results.
The most striking difference in the face-to-face and Internet
groups compared to the newsletter control group was the percentage
of participants reporting weighing themselves daily over the 18-month
program. Those who weighed themselves daily in the intervention
groups were less likely to regain weight.
"Weighing yourself daily was strongly associated with a reduced
risk of regaining in the Internet and face-to-face programs," reported
Wing. The bottom line was that while the control group may have
weighed themselves daily, they had not been taught how to use the
information to make adjustments in their eating and exercise behavior.
"Just weighing yourself was not sufficient," said Wing. In the
treatment offered the successful groups, "something about the whole
constellation let them use the weigh-ins to reach their goals." Behavioral
treatment, she said, really can improve health. 
