As anyone who has ever struggled with weight loss knows, dropping pounds can seem about as easy as taking a weekend trip to Shangri-La. Experts call losing weight and keeping it off it “sustained weight loss,” but at what point can one consider weight loss sustained, anyway?
“The medical definition of sustained weight loss is maintaining a 10 percent total body weight loss and maintaining it for at least a year,” says Dr. Sonia Humphrey, clinical medical director for Mission Weight Management Center. In other words, a 200-pound person would need to lose 20 pounds and keep those pounds off for at least a year. “Of course, sustained weight loss could be well past that,” she adds. “Some studies are looking out 10 years and still defining sustained weight loss as maintaining at least a 10 percent weight loss from your starting weight.”
Find a diet that works
But it’s not easy to drop 10 percent of one’s body weight, especially in the age of fast food, fad diets and sedentary jobs.
“There is no one diet that works for everyone,” says Sarah Haske, registered dietitian and owner of Neumann Nutrition & Wellness in Asheville. “It has to be an individualized approach.”
Humphrey echoes Haske’s sentiment. “The preferred method of weight loss is the method that is sustainable for you,” she says. That means that what works for your sister or your best friend won’t necessarily work for you. Humphrey says that a large study published in the Journal of the American Medical Association in 2005 compared weight loss programs and found that some patients gained weight, some lost weight and some stayed neutral while following the same diet. “Researchers began asking, ‘Well, how can someone gain on this diet and someone else lose on it?’ It has to do with patient preference, patient compliance and also with the underlying metabolic predispositions a person may have,” says Humphrey.
Resting metabolic rate
There’s a lot of weight packed into the words “metabolic predisposition,” which refer to the tendency of some people to burn calories faster than others. And the more body fat you have, the slower those calories will burn. “If you have a higher body fat, then the calories you would be predicted to eat for the day to maintain your weight loss will be lower,” says Humphrey.
“Fat for the body is like money in the bank,” she continues. “We’re all meant to have fat because it’s protective. It’s considered a survival backup mechanism for us. But obesity is that storage capacity of the body gone too far.”
Beyond a certain point, she notes, the body reacts to preserve stored fat. “The body will allow a certain amount of fat to go, but the lower it gets, the more it is going to try to resist — especially if you have a stronger genetic predisposition to storing fat.”
It doesn’t seem fair, does it? Those with higher percentages of body fat will have a harder time sustaining the same weight than someone with a lower percentage of body fat. But if we are all just victims of our resting metabolic rate, what are those of us with slothlike metabolisms to do?
“Activity is the No. 1 predictor of weight-loss maintenance,” says Humphrey. The key, she explains, is to try to outsmart the body with exercise, which increases resting metabolism.
And the best kind of exercise for maintaining weight loss is muscle building. “You want your muscles to be requiring more of the energy you bring in to use, maintain or repair themselves,” she says. “That way the energy you bring in goes towards keeping the muscles ready for you to use instead of turning that energy into fat.” Haske adds that when you build muscle, “you’re boosting muscle mass in proportion to fat mass,” and that, in turn, increases your resting metabolic rate.
So cardio exercise and building muscle are important. But let’s go back to the diet bit for a minute. Both Humphrey and Haske bristle at the word “diet.” “Putting the focus on numbers can work against you,” says Haske. “If you’re focused on a 2-pound weight loss per week and you don’t achieve that number, you can feel bad about yourself. It’s a better idea to focus on the lifestyle changes.” Humphrey adds that patients have the best results when they approach weight loss with a long-term mindset. “It’s a lifestyle-change mentality versus a diet mentality,” she says.
Susan Hutchinson of Weaverville, who happens to be advertising manager of Xpress, knows a thing or two about how lifestyle change contributes to weight loss. “I’m a pretty average garden-variety Southern Appalachian,” she says. “My grandparents, parents and cousins were chubby. It was the cultural and genetic norm, and I seemed to be headed down the same road,” she says.
Although Hutchinson led an active lifestyle and generally ate healthy food, her weight slowly crept up. “I didn’t feel good,” she says. “I had to keep buying new clothes that were bigger, and that made my self-esteem tank. It’s really depressing and demoralizing to think that you are trapped in that,” she says.
It wasn’t until Hutchinson tried the ketogenic diet that she developed new insights about her body. The keto diet focuses on consuming low carbs and high fat, a combination that worked well for her.
What Hutchinson ended up doing was discovering the holy grail of weight loss: finding what works for the individual.
“At the end of the day,” says Humphrey, “the consensus is that one should do the diet that works for them.” That can be a wide range of diets, from low fat to low carb to high protein or meal replacements. “It’s really what matches your preferences and how you can make it work within your daily life,” says Humphrey, although she notes that across the board, the diet does need to be in a calorie deficit — fewer calories than normally consumed. “Most of the studies show that low fat is an important part, too,” she adds.
Sustaining weight loss
Humphrey says that patients who succeed at keeping the extra weight off do several things. First, they are physically active. Second, they have dietary restraint. “That doesn’t mean you restrain yourself from everything,” explains Humphrey. “It just means you use your judgment and do some things and don’t do others based on your target.” Self-monitoring is important, too. “You have to weigh yourself,” says Humphrey. “Just like people with diabetes check their sugars, you have to check your weight. Don’t see it as a judgment call. See it as a vital sign.”
Motivation also plays a major factor in sustained weight loss. “It’s really important to know what your motivators are,” says Humphrey. “The motivators need to be pretty strong and clear, and they are unique to the individual.” That’s because it is human nature to avoid stress and pain, she explains.
“If you see dieting as stress and pain, yet the stress and pain of being overweight is bigger, what happens is that stress and pain motivate you,” she continues. “But as soon as you aren’t in that pain and stress anymore, the pain and stress switch now to the diet. Then you don’t want the stress and pain of the diet, so you go back to what you were doing before. That’s what causes weight cycling.”
Obesity as a chronic disease
Even if you’ve conquered your weight loss and maintained a healthy weight for over a year, “you have to think of obesity with a chronic-disease mindset,” says Humphrey. “It can relapse and remit. And there’s an escalation model depending on the severity of the disease. So as you treat the disease, you may start with lifestyle changes, then you may escalate to medications, and then you may escalate to surgery.”
It’s also helpful to remember that there’s no quick fix when it comes to losing weight and sustaining weight loss. “Within your treatment, you may lose more rapidly at the beginning, and someone else may lose slower,” says Humphrey. “It’s hard to control that. What you’d rather do is say, depending on if you lose fast or slow, ‘We are in this in for the long haul.’”
And although people look for simple answers when it comes to weight loss, they really don’t exist. “If they did,” says Humphrey, “this wouldn’t be an epidemic.”
Mission Weight Management Center
Neumann Nutrition & Wellness