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Losing Weight: The Rebound Effect
Oh, why bother? Sure, there are hundreds of diets that will help you lose weight, but as soon as you relax the rigid controls, the ounces and pounds creep back on, right? Even after a dramatic weight loss, within a year or two, you're right back where you started, or worse.
Or are you?
The conventional wisdom seems to say so. Longitudinal studies of subjects in controlled weight- loss studies have tended to show that no matter how people lost their weight in the first place, by five years out, virtually everyone had gained back virtually all of their original weight, and then some. Anti-dieting and fat-acceptance groups often seize on these data to show that people should simply accept whatever size they are.
And most overweight people have their own frustrating experience that backs up the research. We lose and regain, lose and regain, over and over until some of us just give up trying. We hear those depressing statistics and look at our own history and figure, "Why would it be any different for me?"
Except that we sort of intuitively know that it can't be true that nearly every diet fails virtually everyone all the time. It simply defies logic. And we hear about people who succeed at losing weight and developing a healthier lifestyle that keeps them slim. Sure, most of those are testimonials for some product or program, so we're skeptical. But most of us do actually know someone who has lost a good deal of weight and kept it off. So why don't they show up in the research?
True data, false picture
The truth is, they do, but not very frequently, and it has to do with who gets studied and how. The best, most trustworthy science is that which can be tested and scrutinized and reproduced for veracity. That means careful control of the variables. Hence, most of the weight loss studies that produced those regain rates tended to be conducted in university or hospital-based settings where it's easy to control the variables.
And there's the rub. While those studies might have produced really good, clean, data, they may not apply to the general population very well. Folks who participate in those programs and studies really don't represent the majority of people who are trying to lose weight. They tend to be heavier in general and also to have a higher incidence of eating disorders along with their obesity, as well as other features that make them, as a group,different from the general population of overweight folks.
"Thus," write the authors of one study, "there is reason to believe that the nearly exclusive use of clinical populations in studies of the long-term effectiveness of weight-loss treatments may be producing overly pessimistic conclusions."
I could have told you that.
We help people lose weight and keep it off. They come, they lose, they go on with their lives, and they keep in touch, or we run into them around town. They're still maintaining. So we know that it can be done. But if you relied on the clinical statistics on maintaining weight loss, you might think these successes were such exceptionally rare cases that there was no point in you even trying, and you'd thus deny yourself all the benefits of improved health and function that come from even a 10 percent reduction in body weight.
Assessing commercial programs
Considering how many people use them for their weight-loss efforts, there really aren't much data available for commercial weight loss programs. That's because those are businesses. They're developed to make money, not to study the mystery of obesity. They succeed very, very well by relying on promotional techniques, by making emotional appeals to people's vanity and health fears. They don't need to invest money in researching the outcomes of their programs to convince anyone to try them. The hope they hold out is enough, so their promotional techniques work.
And as it turns out, so do their programs. At least for some people, some of the time, and certainly more than the statistics from controlled studies would seem to indicate. For instance, compared to the grim outlook those offered, a study of one national program showed that at five years after initially reaching their goal weight, nearly 20 percent were still within five pounds of that goal.
But get this: they were part of the 42 percent who were "at or below" goal weight at five years out, meaning that some continued to lose weight, even after they reached their original goal. And whether at, below or shy of their goal weight, fully 70 percent of the participants were still below their original starting weight. And that's an improvement, by nearly any measure.
Take note that this wasn't a study conducted or commissioned by the program, but rather, by researchers who have devoted their careers to studying obesity.
Rounding out the picture
Another long-term study, called the National Weight Loss Registry, started in 1994 gathering information about people who had lost 30 pounds or more, all kinds of people, from all kinds of programs. You must have lost more than 30 pounds and you must have kept it off for at least two years to participate in the registry.
Over time, using various data compiled from registry members, it is showing that a lot of people truly are able to reduce their weight and maintain at or below their goal weight over a long period of time. The researchers have also rounded out the picture of who gets that excess off and how they keep it off, discovering some interesting insights into what people are doing to keep their weight off, parsing out trends in eatings habits, activity levels, social interactions, dietary makeup. That's fodder for another column, or two or ten, but the bottom line is that it's providing more evidence to help us understand what we already know: that it's not pointless, and there is hope.
And it's also verifying what hundreds of studies have already shown: that less excess is better, that even when people can't reach their ideal goal weight, less is still more. Less weight equals more energy, better heart function, better sexual function, better social function, greater self-esteem, longer life expectancy.
And that's really the point.
Through Thick and Thin
Don't believe those depressing statistics that say everyone regains whatever they lose. That's information that very likely doesn't apply to you. When you see people who have succeeded at losing their extra weight and keeping it off, it's not that they've worked miracles, it's usually just that they've done the necessary work.
Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center.
This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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