The National Weight Control Registry was established as a research project in 1994 and is the most extensive prospective investigation of long-term successful weight loss maintenance. It has over 10,000 members. All subjects are at least 18 years old and have maintained a body weight loss of 30lb or more for at least one year. In fact, the average participant has maintained a weight drop of just over 65lbs for more than five years. This registry gives us a real-life model of how to maintain human weight loss. It is a testament to the fact that it is not only possible to lose a ton of weight but many can indeed keep it off.
Obesity is now recognized as a serious chronic disease. It affects approximately 40% of the American population. To make matters worse, there is strong pessimism surrounding successful treatment. A general perception is that almost no one succeeds in long-term weight loss maintenance. Most people believe that 95-97% of all weight loss efforts fail. Thankfully this stat is simply not true. This high failure rate harkens back to a study done by Stunkard and McLaren-Hume in 1959 with 100 subjects from an obesity clinic. Funnily enough, even Stunkard doesn’t support the 95% statistic being used today. He told the New York Times in 1999, “That was state of the art in 1959. I’ve been sort of surprised that people keep citing it; I know we do better these days.” The fact is we don't actually know the true number, but most current data suggests it is more in the neighborhood of a 20% success rate. This is still abysmal but not Sissafean.
The problem is multifaceted and highly individual. Losing body fat and moving one's set point is difficult. If it were easy, we'd have no obesity epidemic in this country. It is not as simple as "eat less and move more." On the surface, this adage is true but without nuance, it isn't very meaningful. Humans are not robots. Our environment, hormones, psychology, genetics, microbiome and social group all have sweeping influences on our ability to lose and keep weight off. The major drivers in weight regain are:
Food environments (fast, cheap and ultra-convenient)
Fad diets don't work long-term and are almost impossible to maintain
Lack of exercise and general movement (non-exercise activity)
Unwillingness to permanently change lifestyle/habits
Dysregulated satiety signals
Ultra-processed food intakes
Not enough support
Unwilling to partially give up one's high calorie/sedentary lifestyle
For most people, losing weight is a battle, even in the short term. Losing weight and keeping it off permanently is a challenge akin to climbing Mount Everest. It takes dedication, skill, a robust social group and the right mindset to do it successfully. And just like summiting Mount Everest is a death-defying feat, not losing weight (for some) is almost as dangerous. Many start their weight loss journey because of health issues tied to being overweight. Initially this may get one started but motivation couched in fear usually wanes. The key to success is to find positive motivation along the weight loss path; learn to love (or at least like) the process.
After 25 years, The National Weight Control Registry has compiled a list of commonalities that its members share for successful long-term weight loss. Here is a list of identified common behaviors and strategies used by these successful individuals:
Low fat/low-calorie diet
Stand on the scale at least 1x per week
Eat breakfast daily
Workout 1 hour every day (fast walking is included)
Watch fewer than 10 hours of TV per week
Practice daily dietary restraint
Track weight, exercise and diet regularly
Most of these trends are not secret or even eye-opening. Some of these commonalities don't even have good science to back them up. What works for one person or population may not work with another. What is definite is the habit of consistency. Staying the course is the foundation of all these strategies. Finding a way to make these lifestyle changes enjoyable and permanent is central. It is essential to develop an individualized plan that works for you and never quit. Sustainable lifelong habits make the biggest difference in success.
BONUS: Here are a few more evidence-based ideas that have been shown to assist in weight loss:
Limiting ultra procced foods
Refrain from drinking calories
Eat home-cooked meals more often
Eat more vegetables and fruits (more fiber)
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