The Grit of Weight Loss Maintenance

12/15/2017 07:57 am ET
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Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future day-in-day-out, not just for the week, not just for the month, but for years and working really hard to make that future a reality. Grit is living life like it’s a marathon, not a sprint” – Angela Duckworth

Angela Duckworth’s insightful book, Grit: The Power of Passion and Perseverance, highlights stories of people applying grit principles to excel at swimming, spelling bees, football, and even drawing cartoons; they all succeeded by sustaining long-term perseverance to reach their goals.

The act of weight loss maintenance easily could have been included as an example too. Again, the key word is maintenance.

As a society, we are obsessed with weight loss. Search for a weight loss book on Amazon and you’ll receive over 100,000 results. We watch TV shows about it, and we read magazines that fetishize it.

When we do attempt to lose weight rarely do we think about how to maintain these changes long term. Most people that attempt weight loss perceive it as a phase; a phase where you implement drastic behavior changes for a bit but then return to your previous habits. It’s an all or nothing approach too. People perceive that eating just one “non-diet food” is enough reason to quit.

It’s not surprising people have this mindset.

Just look at the number of “documentary diets” depicting this approach: juice diets (and this one, and this one), fasting, plant- based , and low-carb. All emphasizing a diet for a set amount of time. In my opinion, this dieting mindset is part of the reason why research shows that 95% of people that attempt diets will regain that weight (if not more than what they initially lost).

However, a group of people have overcome this diet mindset and found behavior changes they can sustain.

Members of the National Weight Control Registry (NWCR) have grit.

Since 1993, the National Weight Control Registry study has collected information from over 10,000 people who have successfully lost weight (at least 30 lbs.) and most importantly, kept it off (for at least a year).

Let’s look at their grittiness:

Overall, one study looking at over 2,800 participants highlighted that after ten years NWCR members maintained an average weight loss of 50 pounds. This is grit.

To put this feat into context, most people that participate in an exercise and diet study maintain only a 3.4lb weight loss (over a 12-month duration). In comparison to less complex behavior changes, almost 50% of people simply discontinue taking their high blood pressure medication after the first year.

Unlike other paragons of grit, day-in-and-day-out NWCR members need to overcome their biology that tells them to eat more.

When you lose weight (i.e., a negative energy balance) your body responds by decreasing satiety (i.e., the feeling of being full after eating); increases hunger, and food reward (i.e., increased pleasure from eating); and decreases your overall energy needs (approximately 300-400 calories per day). In other words, your body actively tries to put back on the weight you just lost.

Research currently shows that over time these adaptive responses do not change and may even increase in strength. NWCR members use gritty behavior change strategies to overcome these adaptations long-term.

Before I sing their praises too much, let’s make sure to mention some limitations:

  • They’re a self-selected sample of successful weight loss maintainers.
  • They’re not diverse; 95% of the sample is white and 78% is female (this makes it hard to extrapolate to the greater population).
  • Sixty-three percent are highly educated (college degree or higher).
  • Around 65% are married and are in their mid-40’s (again, not representative of the entire population).

It does make sense a large majority of members are female. Sadly, as a society, we created a social expectation that food and weight are female interests; in large part due to the fact women are more strongly judged by their appearance. Research also shows the “obesity wage” penalty is greatest for white females. For each additional 10 pounds their wages are 2.8% lower than they should be. Being a female that is obese also affects your overall employment opportunities.

The fact members are highly educated also matches a popular theory of behavior change maintenance; if you have basic resources covered (e.g., stable income, housing, and a steady job) it’s easier to enact change and maintain it.

Nonetheless, NWCR members have grit. The beneficial habits they have adopted can provide insights on how the rest of us can take individual steps to improve our health: not drinking sugary drinks regularly, incorporating physical activity into our lives as much as possible, getting enough sleep, and limiting screen time.

However, the biggest take away from their experiences is that many different approaches can help people sustain weight loss. Members’ share similar habits, but each used their own approach.

IMO, these members followed the two-key weight loss maintenance principles: adherence and enjoyment. To maintain weight loss, you need to adhere to whatever changes you made to maintain a negative energy balance and enjoy them enough to do them the rest of your life.

Too often diets, exercise programs, and food beliefs are made into one size fit all solutions. Unfortunately, a group of outspoken people have made following a specific diet into rooting for a sports team: low-carb, keto, paleo, Whole30, plant-based, juice cleanse, low-fat, etc.

Some promote their diet team to sell their latest book, documentary, and to increase their presentation fees at conferences. Others with less commercial interest I truly believe are well intentioned. They probably had personal success in adopting a diet and wanted to share this approach with other people who are struggling.

The issue is when they turn their food preferences and lived experiences into dietary dogma. They shun any research that goes against it, and only use their personal narrative as evidence to defend it. Diet wars are a waste of our time.

Do you eat low-carb and feel it has improved your health (while enjoying it)? Fantastic! Only eat plants and feel better? Neat! Keep up the great work! But just keep in mind because a diet works for you doesn’t mean it will work for everyone.

The NWCR members should be applauded for their grit; however, it’s important to mention that these individuals are also an incredibly small fraction of success stories compared to the 117 million US adults that struggle with obesity.

Anyone that works in the field of nutrition and public health will tell you it’s the wrong approach to deal with excess weight after the fact at an individual level. It’s best to prevent it in the first place and address the root cause system issues.

NWCR members’ personal narratives can help serve as an example for a more nuanced view of the obesity epidemic though.

As a society, we should also remove stigma and financial barriers for people currently struggling with obesity to pursue beneficial medical procedures like bariatric surgery.

In the end, as the 2018 “diet season” approaches, keep these ideas in mind:

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