The triumphant dieter: anyone can lose weight. The trick is keeping it off Cheryl Simon
2004
The triumphant dieter Dieters are a diverse group, but they share one common goal: to make their current diet their last one. Unfortunately, lasting results aren't what most get. In fact, the odds are overwhelming--9 to 1--that people who've lost weight will gain it back.
The structured nature of most diets helps people stay with them. Trouble starts when their goal is reached and rules and regulations relax. Maintaining weight loss does demand discipline--changing the way you eat permanently. But rethinking old habits need not require unbearable sacrifice. In fact, today many weight-control therapists are developing ways to make maintenance dieting downright pleasurable.
If Duke University psychologist Susan Schiffman invites you home for dinner, for instance, she might treat you to one of her specialities: frozen pumpkin mousse. It's delectable, creamy and seemingly rich. And there's a bonus--it has virtually no fat.
In a kitchen stocked with aromatic spices and nonstick pans, Schiffman, who has spent 18 years as a weight-loss therapist and researcher in nutrition, has developed low-fat substitutions for (among other temptations) eggs in souffles, heavy cream in soups and shortening in pie crusts. If you want to maintain weight loss, she contends, don't diet. Learn how to cook.
Schiffman's research shows that overweight people have heightened requirements for foods that are fatty, flavorful and highly textured. These exaggerated needs doom most diets because, she says, "When you cut back calories, you frequently cut out the fat. You also cut out a lot of the taste, smell and texture." If you don't add these qualities back into the food, she says, you'll never keep the weight off. These findings have added a new element to Schiffman's work with patients--low-fat cooking lessons. She even has put a kitchen in her clinic.
Eat Right, Change Your LifeSchiffman's approach reflects an important philosophical shift among weight-loss experts. Few today exhort their clients to count every calorie or proselytize for cottage cheese.
What they ask instead is harder: "We try to help people see that they are making a lifelong commitment," says psychologist Michael Perri, who studies weight loss and maintenance at Fairleigh Dickinson University in Teaneck, NJ. "I'm not talking about dieting for a period of time and maintaining the results of that diet. I'm talking about maintaining a new lifestyle."
Of course, the prospect of doing anything forever can be discouraging, a reaction Perri meets head-on by making behavior therapy an integral part of his program's maintenance strategy. Even so, he says, those who've lost weight have to swallow tough news: Research shows that a person who has been heavy and wants to maintain a lower weight must eat 15% to 20% less than a person who weighs the same but has never been overweight-- or make up the difference with physical activity.
To avoid what's called the refeeding effect--the rapid weight gain many dieters experience when they reach their goal and return to normal eating--Perri's patients increase the number of calories they eat very gradually to find how much they can handle without gaining. For example, dieters who were losing 1-1/2 pounds a week eating 1,200 calories a day may up the ante to 1,300. If after two weeks they have not gained, they can raise their daily intake to 1,400, then pause again to gauge the effect.
Exercise and social support are also important. With colleagues, Perri followed the progress of 123 mildly to moderately obese adults for 18 months after a six-month weight-loss program. They found that clients who exercised frequently, had post-treatment contact with a therapist and support group, and received behavior therapy maintained an average of 99% of their weight loss. In comparison, clients who received only behavior therapy sustained just one-third. Three national weight-loss organizations, Weight Watchers, Nutri/System and Diet Center, have maintenance programs with similar strategies.
Outside a structured setting, how does one who has lost weight keep from gaining it back later? There are no easy answers but, experts say, a few basic steps are essential:
* Convince yourself that this diet is different from past ones. People who have tried numerous diets don't see themselves as successful at taking and keeping weight off, explains Barbara Sternberg, a psychologist in New York's Westchester County who developed the behavioral component of the Weight Watchers International program. She cautions: "Don't treat weight loss as something you can do every month or two. Ask yourself, 'How am I going to make this diet the last diet?'"
* Develop substitutes for the place dieting occupied in your social interactions. While you're losing weight, people say, "Wow, you look terrific!" But after the pounds are lost, they forget to say, "Look how well you've been keeping the weight off!" Fill this gap with other sources--a new hobby or interest, Sternberg suggests--that build self-esteem.
* Regular exercise, of course, is the single best maintenance strategy. It boosts the amount of energy you expend, reduces lean-tissue loss during weight loss and counter-acts the metabolic slowdown that comes with dieting. An added plus: Exercise can provide a new, positive focus for relationships.
* Accept the challenge of low-fat cooking. Be creative with substitutes. Master a high-taste but low-fat cuisine, such as Japanese. Be sure to acquire cookbooks with reduced-fat recipes (see list below) and try to keep total fat intake within recommended limits--no more than 30% of total calories.
Also, pay attention to the kinds of fat you eat. To cut cholesterol and the risk of heart disease, the American Heart Association recommends that: Saturated fats (meat, butter and other whole-milk dairy products) make up less than one-third of your total fat intake; polyunsaturated fats (liquid vegetable oils and margarine) constitute up to one third; and that monounsaturated fats (olive and peanut oils) make up the rest.
* Don't abandon the strategies that made your diet succeed. If a particular habit such as going for a 10-minute walk after dinner or keeping records of food intake was especially helpful while you were losing weight, stay with it religiously when you reach the maintenance stage. Though tedious, record keeping in particular is a great tool--it helps maintain awareness.
Outwitting RelapseThe last important skill required for keeping weight off is learning to prevent the inevitable slips from snowballing into a full-blown relapse. Ground-breaking research by psychologists G. Alan Marlatt and Judith R. Gordon at the University of Washington presents relapse as part of a process of habit change--not an isolated event that simply happens. In this approach, a slip is a mistake, not a disaster. It is not something that happens to a person; rather it's the end result of a series of decisions over which the dieter has control.
Most initial slips by dieters fall into two categories. Roughly 50% of first slips, studies show, occur when the dieter is experiencing a negative mood, such as anxiety, boredom or depression. Uncontrolled eating is an especially common response to such moods when a person is alone.
Another 50% or so of first slips are tied to interpersonal factors, notably positive events such as parties when one's guard is down and social pressure is high. In light of these findings, weight-control programs are helping people plan how to deal with these moods and situations.
As part of his comprehensive weight-control program called LEARN--an acronym for Lifestyle, Exercise, Attitudes, Relationships, Nutrition--psychologist Kelly Brownell of the University of Pennsylvania advises participants on how to keep slips and mistakes from happening and how to respond if they do.
The core of the method is understanding the lapse, relapse and collapse process. A slip or mistake--eating an illegal food, skipping exercise--is viewed as a lapse. If the lapse leads to negative feeling--guilt, shame or embarrassment--it can gnaw away at the person's restraint. Then a person can slip again, discarding self-management techniques until a full-blown relapse develops. If this happens in a series, collapse--a return to old, destructive eating habits--can result.
The way to avoid this slide is to intervene early. Brownell suggests that it is possible to prevent a lapse in the first place by dealing correctly with urges to eat. "Gratifying the urge by eating makes urges stronger and more frequent," Brownell says. "In contrast, letting the urge pass will weaken it. If you can outlast enough of the urges, they will fade to obscurity."
Sometimes other techniques are necessary. Brownell also cautions clients to be wary of dichotomous thinking, such as being "on" or "off" the diet, or that foods are "good" or "bad." According to this mindset, one is either perfect or a failure. Brownell describes other self-defeating internal traps that can be recognized and countered. For example:
Fat thought: The diet was the only reason I lost weight. Now that the diet is over, I will have real trouble keeping the weight off.
Counter: I lost weight because of my own efforts. Just because I lost the weight doesn't mean my new habits will vanish. I don't want to give up now and waste the effort. I can stick with it.
Important, too, is learning to recognize the situations and moods that make you most vulnerable. Here, all those past "failed" diet attempts become valuable for the clues they contain. "When you're actually in the situation is not the time to start thinking about how you're going to cope," Sternberg says. "If you can think about when you're most likely to be tempted, you can plan ways to distract yourself in advance: Take a walk, telephone a friend, whatever you enjoy. If leaving isn't an option, such as when you're at a friend's buffet dinner, decide before you get there how you're going to stay in control around all that food. For instance, decide to help yourself to a little salad first. That way you can take the edge off your hunger and the rest of the buffet won't be quite as big a temptation."
This mechanism, like the others, doesn't guarantee success every time, but it will stack the odds in your favor. In-depth knowledge of yourself will put you in control. Once you know which attitudes and situations give you trouble and have learned to manage them, you'll be able to make your weight loss last.
Source:
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