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Common attributes of successful long term weightloss maintainers.


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This video came up in my recommended videos on YouTube today.

 

It's very recent and based on studies documented in this past months Dieticians Journal. An easy watch, the registered dietician talking speaks in a way that is easy to understand. I have to admit that I agree with everything she says, not least of which that maintaining weightloss is actually harder than achieving it in the first place. I'd be interested to hear from those who've managed to maintain their weightloss long term, which of the habits discussed are an integral part of their lifestyle. For myself, the only one I don't do consistently is eat breakfast...that's a Reactive Hypoglycemia thing for me though, in that I don't eat until any necessary driving is done and dusted for the day... More often than not that means breakfast just doesn't happen, and lunch can also end up being quite late in the afternoon. 

Edited by Aussie Bear
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  • Aussie Bear changed the title to Common attributes of successful long term weightloss maintainers.
2 minutes ago, Aussie Bear said:

I have to admit that I agree with everything she says, not least of which that maintaining weightloss is actually harder than achieving it in the first place. I'd be interested to hear from those who've managed to maintain their weightloss long term, which of the habits discussed are an integral part of their lifestyle. 

First of all I disagree with this. I don't think that maintaining is harder than losing. I never understood why maintaining should be harder than losing? What's the reasoning behind that theory? "Losing weight" is hard work for the body and while "maintaining" might still require work and vigilance, being in a calorie deficit feels much worse than being at equilibrium.

23:36 min - does she provide a summary of the list at some point?

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I agree with this dietician's core argument that everyone needs to have an individualized plan for how to avoid weight regain.  For me the key points are eating a high protein healthy diet with occasional treats (like a cookie or a few potato chips) to prevent a feeling or being deprived, leading a physically active life, always having breakfast, and relying on eating foods that I love that also happen to be relatively healthy.  But other people might find that eating a few potato chips a day would be a big mistake, as they would not stop and eat the whole bag or feel deprived when only a few are eaten.

I do not think that the post-surgery weight loss period is any harder or easier than the maintenance period as these two periods are totally different in both approach and duration.  During the post-surgery weight loss period, one is recovering from major surgery, experiencing dramatic weight loss and adjusting to (and accepting) a totally new mind set on how and what to eat.  This period typically lasts about year - maybe a bit longer or shorter for some people.  On the other hand, the maintenance period should last for the rest of your life after you reach your goal weight - a period which should be many decades long - and should be based on an eating and life plan that is sustainable and enjoyable in the long term .  

One thing is clearly true, weight loss is truly meaningless without developing and following an individualized plan and a strong commitment to maintain your weight once you reach your goal weight.

On a related note, I found this interesting 2019 article from Today's Dietician (the magazine that she referenced) about the reasons for weight regain after bariatric surgery.

https://www.todaysdietitian.com/newarchives/0419p46.shtml

Here is an interesting slide from this article.

 

 

0-1.jpg

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12 hours ago, summerset said:

First of all I disagree with this. I don't think that maintaining is harder than losing. I never understood why maintaining should be harder than losing? What's the reasoning behind that theory? "Losing weight" is hard work for the body and while "maintaining" might still require work and vigilance, being in a calorie deficit feels much worse than being at equilibrium.

23:36 min - does she provide a summary of the list at some point?

We are all different, so I can't talk for anyone other than myself on this. Firstly, I'm just going to put out the reminder that this video is not talking about bariatric surgery, but is more general in approach.

In my circumstance weightloss was about hitting a specific short term goal so I would qualify for a orthopaedic surgery. At the time I wasn't even considering a WLS revision (that came later due to medical necessity). The pain with each step was a constant reminder of why I needed to lose weight and was an excellent motivator. It really didn't matter what my calorie intake was as long as I was in deficit. I was very successful, just as I had been every other time I dieted with a specific goal. Maintenance on the other hand is far more finely balanced. Both over-eating and under-eating are equally undesirable. Getting the vitamin/mineral, macros etc balanced are far more important because they are life long. It's easy to lose sight of why you are doing sowing (particularly if you feel you're depriving yourself) when you've already achieved the end goal. One of the things this dietician points out, is the need for the goal to be lifelong, not specific. For example, if you've already worn that bikini by the pool on your holiday in the Bahamas, or fitted into that smaller size dress for a wedding....then the goal is no longer relevant. 

I'll go through the video again later today and do a bullet point and the study findings.

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4 hours ago, Res Ipsa said:

 

On a related note, I found this interesting 2019 article from Today's Dietician (the magazine that she referenced) about the reasons for weight regain after bariatric surgery.

https://www.todaysdietitian.com/newarchives/0419p46.shtml

Here is an interesting slide from this article.

 

 

0-1.jpg

Great slide, yet so simple. Really sums up every regain story I've heard over the years.

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20 hours ago, Aussie Bear said:

I'll go through the video again later today and do a bullet point and the study findings.

That would be great. I actually found it kind of hard to listen to her so I stopped pretty soon into the video. Might be because I'm not a native speaker.

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On 10/6/2020 at 8:13 PM, Res Ipsa said:

I agree with this dietician's core argument that everyone needs to have an individualized plan for how to avoid weight regain.  

I think that this might be the real keyword in the whole debate around weight re-gain: "individualized".

We're always talking statistics, e. g. when looking at the "importance of breakfast" that is emphasized so often: as it seems (IIRC it was the nation weight control registry finding out about this?) 80% of successful maintainers are eating breakfast. However, what about the other 20%? They're obviously not eating breakfast. So there is at least a 20% chance that one is in the group of people doing quite fine or even better without having breakfast.

In the end there is a lot of trial and error involved and that seems to be something many WLS patients are terribly afraid of.

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20 hours ago, Aussie Bear said:

Great slide, yet so simple. Really sums up every regain story I've heard over the years.

Every regain story I ever read about seems to contain the following:

"and then life happened"

"then I went back to my old ways/habits".

People usually attribute this to a lack of willpower and/or commitment. I attribute this to having failed to adopt a lifestyle that is sustainable even in rough times from the beginning, one of the reasons being the rush of quick weight loss being irresistible and that ludicrous talk about "the window of weight loss" contributing to this on top.

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On 10/8/2020 at 5:15 AM, summerset said:

That would be great. I actually found it kind of hard to listen to her so I stopped pretty soon into the video. Might be because I'm not a native speaker.

Sorry this has taken me so long to get around...life happened pretty quickly the last couple of days.

She starts out by talking about medical professionals,  fitness coaches etc concentrating on how to lose weight, but not on how to keep it off once the weightloss phase is over because goal weight has been reached. These are the common lifestyle habits she talks about to be able to avoid regain. These are from a compilation of past studies that date back decades, using the national weightloss registry amongst other resources. It's not bariatric surgery focused,  but rather of folk who've lost weight and maintained their weightloss over many years. She talks about the weightloss phase first and what studies have found works in the longer term

1. An individualised approach to the weightloss part for the person...not a cookie cutter approach. Lifestyle change needs to be sustainable for life, so has to fit the individual. Giving folk flexibility within guidelines (calories, macros etc), to be able to tailor their new lifestyle to themselves. So no set meal plans etc because no-one will sustain that for life.

2. Understanding the physiological changes that go with weightloss. Hormones in particular.  Less metabolic as weight goes down and the body adapts.

3. Making food choices that consistently work for the person. Within this is where they found that nearly all those who maintained their weightloss, ate breakfast and weren't intermittent fasters...no reasoning given but it was a common denominator.  They also kept eating simple. They had a few favourite staple  "palate pleasing go to meals" and rotating them, always having the ingredients handy to make meals you know you enjoy that are also healthy and work for you.

4. Mastering and implementing a positive psychological mindset about weightloss and food choices, and being able to implement behavioural changes. This is really about what your "Why" is. Short term goals don't cut it, because once the short term is over there's no more reason to continue. The "why" you want this needs to be a forever thing so it doesn't run out. Once you've lost weight you need to have an ongoing why it's important to you to keep it off. It's all about purpose.

5. Implementing a consistent and sustainable physical activity program. This was found to be "the most critical factor in maintaining weightloss". It's about "optimising metabolism"  being cognisant of the hormonal changes that occur with weightloss. If you don't enjoy the physical activity you choose, then it will be very difficult to just maintain it, let alone be able to increase it when needed later on. Also be flexible about making changes and adapting when necessary. 

6. Enhancing and building new skills around food. Learning about planning, preparing, shopping, reading nutritional labels, and learning how to cook. Simple skills everyone should have, but many don't. Being able to do these things makes it easier...and being easier makes us more likely to actually do them.

7. Creating a relapse plan. Successful maintainers had a plan...like a spot at which they would pull things back together after "life happened" and they started to regain. Part of this involves keeping in touch with your scale, tape measure etc. So people who could self-assess their weight and had a plan on how to address any relapse. So no out of sight out of mind mentality.

That's sort of it in a nutshell.

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On 10/10/2020 at 9:45 AM, Aussie Bear said:

That's sort of it in a nutshell.

Thanks a lot for summing this up. I agree with the majority of it but I want to comment on three points anyway:

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6. Enhancing and building new skills around food. Learning about planning, preparing, shopping, reading nutritional labels, and learning how to cook. Simple skills everyone should have, but many don't. Being able to do these things makes it easier...and being easier makes us more likely to actually do them.

I was in awe that I was suddenly able to really implement and use that knowledge I already had. Before WLS it seemed to be impossible. In my experience quite a few obese people are very educated around food/eating.

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4. Mastering and implementing a positive psychological mindset about weightloss and food choices, and being able to implement behavioural changes. This is really about what your "Why" is. Short term goals don't cut it, because once the short term is over there's no more reason to continue. The "why" you want this needs to be a forever thing so it doesn't run out. Once you've lost weight you need to have an ongoing why it's important to you to keep it off. It's all about purpose.

I like touching my bones. Does that count?

No, seriously... that's why I think it's so important to find a lifestyle and reach a weight one is happy with. Because if you're happy with both, you don't need to be motivated constantly by some "goal". You don't need to have the goal of being able to run a 10k a minute faster than last year if you truly enjoy running for the sake of it.

Somehow I got tired of having ongoing weight/food/exercise goals.

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She starts out by talking about medical professionals,  fitness coaches etc concentrating on how to lose weight, but not on how to keep it off once the weightloss phase is over because goal weight has been reached.

She talks about the weightloss phase first and what studies have found works in the longer term

IMO thinking in terms of "weight loss phase" and "maintenance phase" can be somewhat detrimental when it comes to maintaining. Whenever a change is needed (i. e. "upping your calories") there is always the chance that something goes terribly wrong.

When weight loss is slowly tapering off you simply need to continue doing what you've done to lose weight. However, this approach takes more patience and not-believing in that "window of opportunity" myth. In the long run it provides you with a strong and sustainable lifestyle though.

 

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@summerset I really like touching my bones as well. Does that make us weird? I also have developed the habit these days of playing with (rolling up) my loose abdominal skin...that's only started though since I decided to go ahead with abdominoplasty... currently on hold though until a decision is made regarding some potential abdominal surgery. The surgeon doesn't want to try to do that in a tight abdomen if he can do it in a loose one and knowing the plastic surgeon eill be able to remove the evidence later.

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1 hour ago, Aussie Bear said:

@summerset I really like touching my bones as well.

Can't help of thinking about this as kind of... disordered, dunno. In my own ears it sounds weird enough that I usually wouldn't be mentioning it because I don't want to get into a discussion about it and I feel admitting to this has some potential for discussion.

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I also have developed the habit these days of playing with (rolling up) my loose abdominal skin...that's only started though since I decided to go ahead with abdominoplasty... 

My body image changed for the worse the moment I decided to have plastics and started the process. Before that I somehow just lived with the skin. It didn't really bother me enough to risk more surgery. It bothered me, yes - but not enough to take the risk and shell out the money.

Anyway, after having lost only a bit more weight after revision in February (it was one stinking BMI point, mind you) it got way worse with the skin. I often have these little micro lesions when the skin kind of "crumples up" when compressed. Not these rashes under the belly or breast fold so many people talk about, but within these little crumpled up folds. And that's not only bothering me from an aesthetically point of view now.

Insurance company doesn't give a damn of course. I got myself a specialized lawyer but chances are slim that insurance will have to cover it so I'm going to press for paying myself and then trying to get at least part of the money back once some more pressing issues regarding work/moving have been resolved when the new year arrives.

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9 hours ago, summerset said:

Can't help of thinking about this as kind of... disordered, dunno. In my own ears it sounds weird enough that I usually wouldn't be mentioning it because I don't want to get into a discussion about it and I feel admitting to this has some potential for discussion.

 

I certainly don't tell anyone this either...just in this instance you bought it up. I don't know. I tend to think of the bones like a new car sitting in the driveway. It takes a while before we can stop ourselves looking at it with some admiration.  For many of us the bones we see now we have maybe never seen in our lives before. Touching them gives us tangible evidence that they are real, and continuing to do so confirms that they haven't gone away.

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Personally I believe it is 90% mental, meaning that you have to adopt the right mind frame to be successful long term, weight loss is not a diet; it is a whole way of life, a new way of living and thinking and changing all the bad habits we learnt that got us to be so unhealthy.

It takes so much commitment to change and learn new habits and to not let anyone influence us nor make excuses that will allow us to return to the old life we came from...

If you start making excuses for yourself you will most likely go back to your old habits, so if that is an issue then you should seek professional help to deal with any hardship in your life so that you don't turn to bad food and bad habits to cope.

 

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3 hours ago, Casper666 said:

 weight loss is not a diet; it is a whole way of life

 

Diet is just a word that describes what/how we eat. Like it or not weightloss is all about "diet". I wish folk would stop demonising the word. It doesn't mean crash diet, fad diet, etc. It simply means the food we eat. 

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Yes but my point is it takes more than just what you eat, there is a huge mental component to changing bad habits and making long term changes

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Changing "bad habits"...

Just be careful that you don't adopt new "bad habits" while losing weight. There is a plethora of "bad habits" (I always cringe when I read that term) leading to weight loss: obsessive calorie/macro counting, compulsive exercising, ignoring hunger cues, ritualized eating, eating foods with ingredient lists that read like chemistry class...

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Yes true I was just talking about the heading of this topic that asks about long term success any habits that inhibit our long term health can be deemed bad; there's no need to get so literal just offering my own personal story and how I've managed to be successful which meant I had to adopt new healthy habits and learn to do better in future and not go backwards. thank you

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10 hours ago, Casper666 said:

Yes true I was just talking about the heading of this topic that asks about long term success any habits that inhibit our long term health can be deemed bad; there's no need to get so literal just offering my own personal story and how I've managed to be successful which meant I had to adopt new healthy habits and learn to do better in future and not go backwards. thank you

Unfortunately these days we live in a world gone made when it comes to any words related to weight /weightloss....thanks in a very large part to the HAES/FA/BoPo movement, and many dieticians do seem to be pandering to these movements. In some ways I don't blame them because their core group of clients are going to be folk with weight issues at either extreme. These are the people that are going to be referred to them by doctors and specialists. To highlight this, I was recently referred to a new dietician and received a questionnaire (to be filled out prior to the first appointment),  and 90% of the questions I had to answer as "not applicable" because I'm neither looking to lose or gain weight, and my "goals" aren't routinely measurable (and definitely not measurable by a dietician). I'm probably going to cancel my appointment if I'm honest. I just can't stand the "no diet, no restriction"  approach that every dietician I've seen since my surgery adopts. If there's "no diet" then why pay for a dietician? Even my bariatric surgeon used to say in the past to "just go to the appointments,  nod your head like you're listening, and do as I say instead". 

Weightloss is all about calories out exceeding  calories in, while maintenance of weight is about balancing these. The easiest, and more importantly healthiest,  way to achieve this is by changing our diets (as in the way we eat) along with ensuring some kind of healthy exercise routine. Clearly whatever we were doing before surgery wasn't a diet or lifestyle that was appropriate for our bodies or we wouldn't have needed WLS. 

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Yes of course it's related to calories but we all know if you don't work on the underlying issues that lead to this destructive way of life then most likely you'll fail just as we see in 600lb life, every single one of the patients needed psychological counseling to help understand and deal with the trauma in their lives that made them turn to food for comfort. If you don't work on your mental health nothing else will matter.

I know from my own experience i have to be 110% committed mentally to the process to stay true to the correct path and not undo everything I've done thus far :)

 

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8 hours ago, Casper666 said:

Yes of course it's related to calories but we all know if you don't work on the underlying issues that lead to this destructive way of life then most likely you'll fail just as we see in 600lb life, every single one of the patients needed psychological counseling to help understand and deal with the trauma in their lives that made them turn to food for comfort. If you don't work on your mental health nothing else will matter.

I know from my own experience i have to be 110% committed mentally to the process to stay true to the correct path and not undo everything I've done thus far :)

 

I'm going to disagree with you yet again. I never had any kind of eating disorder, wasn't addicted to food, and didn't turn to food for comfort or for emotional reasons. I just liked the high sugar, high fat foods too much, as well as enjoying a few fermented beverages. I never really said no to myself. We don't all have underlying issues to work on, some of us just need to pay more attention to how much we actually eat. Certainly there are many folk that do have underlying mental health issues, and there are those that have eating disorders, but it pays to not talk in absolutes when it comes to this topic, because everyone is different.

By the way, I never even had to have a pysch evaluation before my surgery nor did I have any therapy after my surgery for eating issues. My surgeon always has his patients have pysch evaluations but he said as far as he was concerned I didn't need it.

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21 minutes ago, Aussie Bear said:

I'm going to disagree with you yet again. I never had any kind of eating disorder, wasn't addicted to food, and didn't turn to food for comfort or for emotional reasons. I just liked the high sugar, high fat foods too much, as well as enjoying a few fermented beverages. I never really said no to myself. We don't all have underlying issues to work on, some of us just need to pay more attention to how much we actually eat. Certainly there are many folk that do have underlying mental health issues, and there are those that have eating disorders, but it pays to not talk in absolutes when it comes to this topic, because everyone is different.

By the way, I never even had to have a pysch evaluation before my surgery nor did I have any therapy after my surgery for eating issues. My surgeon always has his patients have pysch evaluations but he said as far as he was concerned I didn't need it.

Why do you feel the need to argue every point someone makes?

okay it is very well known that most people do need help with underlying issues...

We see it so many times people hit a road block when they go through stressful situations or life events and without appropriate help they end up going backwards.

You are one person out of millions that suffer with mental health issues related to obesity; every doctor I ever dealt with made certain we address mental health before they would even consider surgery and to seek counseling to be successful in the long term.

 

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1 hour ago, Casper666 said:

Why do you feel the need to argue every point someone makes?

 

Because you're wrong. You are looking at your own situation and believing you're just the same as every other morbidly obese person. The fact is none of us is the same as another. While I'm sure there are many people that would benefit from psychological counselling both before and after surgery, there are probably just as many that don't need it. I've actually had this very discussion with many people that have had WLS, and at the time not one of them believed they had either a food addiction or eating disorder, and none believed they'd experiment kind of trauma that caused them to turn to food. None played the victim of either genetics or childhood/adult trauma. Most just felt they simply enjoyed food and calorie laden drinks too much. I agree that we need to determine why we've become obese in order to be successful at turning it around, but sometimes it's just overeating for no other reason than enjoyment of calorie dense foods.

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Both of us are right, there are people who need psychological help and there are some that don't.

My point is to be successful each person needs to address whatever it is that lead them to where they were morbidly obese.

If it's psychological or if it's food addiction; either way help and guidance is needed.

 

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