Monday, January 16, 2012

Is weight maintenance challenging? It's not in your imagination...


Tara Parker-Pope

I have long been an admirer of Tara Parker-Pope, a journalist/columnist/blogger for the New York Times.  My memory of her goes back to when she was at the Wall Street Journal at which she wrote an article (circa 2001) that gave me my very first quote in a major publication.  She has one of the most powerful voices in the world of health, which is a function of her intelligence, command of research, curiosity and passion.  With all of this gushing enthusiasm, it was with great interest that I read her long piece in the New York Times magazine a couple of weeks ago, titled “The Fat Trap”.

“The Fat Trap” makes a number of important points that should be part of the broader dialogue on this very important topic.  For those who haven’t read it, I recommend it however counter-intuitive that may seem given my role at Weight Watchers.

Here is the original article...

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?pagewanted=all

Here is her follow-up interview (equally recommended)

http://6thfloor.blogs.nytimes.com/2012/01/03/behind-the-cover-story-tara-parker-pope-on-obesity/?ref=magazine

I won’t attempt to re-write the article (she’s a far better writer than I), but I will list some of the key takeaways.  Let me first start by saying that my first reaction is that this article can be read as discouraging.  While I totally understand that reaction, I think there is something incredibly positive to take from it.  I would also say that Tara's article focuses on a particular set of arguments focusing on the difficulty of weight maintenance, and it would seem to be more than a little down on the notion that we can sustain our weight loss.  Of course, I have met many, many people who have lost weight, and kept it off, albeit often with some ups and downs.

However, given how many people who have encountered disappointment with weight regain, I think they can take some important and ultimately positive messages away.

#1:  Maintaining weight loss can be hard

All of us who have had weight issues, present company included, know this on a deep and personal level.  We ask ourselves why we struggle to suppress our desire to eat foods we aren’t supposed to.  We wonder why we cannot seem to kick the mind numbing desire to slaughter a heaping of our favorite trigger foods.  In her article, Tara does a nice job of summarizing some of the recent research suggesting some of the leading theories as to why:

  1. Some people are genetically pre-disposed to suffer from obesity.  There is a lot of great research that has been published and more that is in process that suggests that certain DNA markers (e.g., the FTO gene) make us more likely to eat foods we shouldn’t and eat too much of them.  
  2. A recent study in the NEJM suggested that after losing weight following a Very Low Calorie Diet (VLCD – in other words shakes) certain hormones (ghrelin’s) that trigger hunger increased and stayed higher.  As a result, the subjects of the study felt more deprived even a year after they had lost the weight.  
  3. Other studies have shown that after losing weight, our body attempts to retain its remaining fat stores by lowering our metabolism.  Therefore, to maintain our weight loss, we may have to stay at a lower daily calorie target than someone else who was at that weight, but didn’t have to shed pounds to get there.  
  4. Other studies using MRI technology have shown that people with weight problems have brains that light up like Christmas trees when they are staring down their trigger foods (btw, I’m one of them).  This doesn’t happen to nearly the same degree with people who do not suffer from obesity.  

So what does all of this suggest?  For me, it says that if you are a person with weight problems, you are wired to respond aggressively when functioning in our now obesogenic food environment.  It suggests that there may be biological functions that cause you to do this.

#2:  For the 10,000th time, can we please dispel the notion of willpower

It’s pretty amazing how misunderstood obesity is and how grossly over-simplified the challenges are.  I cannot tell you how many times I hear people say something along the lines of “You just need to eat less and exercise more.  It would be simple if people would just take responsibility!”  The assumption is that if you have a weight problem you are somehow lazy and of weak moral fiber.  This is completely inane.

As Tara puts it, no one wants to be fat.  The reason we struggle is because it’s hard.  What we now realize is that the difficulty of maintaining our weight loss is not in our imaginations.  There seem to be a host of biological factors that make it all that much harder.

I know fully that I will always struggle with my weight.  I know that I will always have to be careful.   I know that I will have to get in my hour of exercise each day and every day.  I have a condition that requires treatment.  With 34% of the American public classified as clinically obese and another 30%+ overweight, most of us do.  I’ve met some pretty amazing, driven and powerful people who are also significantly overweight.  Does this mean they are weak?  Of course not.

When we stop treating obesity as a simple equation that only requires a little elbow grease, we will be way ahead of the game.  For me to maintain my weight loss, I have had to work at it.  I’ve worked to build healthier habits by creating routines.  I’ve had to work to create a personal environment that makes it harder for me to indulge my unhealthy habits.  I no longer blow through a tub of ice cream because I make sure that said tubs are in the downstairs freezer where I don’t have to see them every time I open the door.  The biggest problem I have with the notion of willpower being the key to solving obesity is that it’s essentially a lie.  If I have to stare down my ice cream because I’m supposed to have the “willpower” to ignore it, I will fail.

Let me be clear.  Establishing healthy habits and getting rid of bad ones is not easy.  Period.  I believe it can be done, but it bugs me to no end when I see people trivialize this process.

#3:  We need to manage our expectations

OK.  I’m a Lifetime member, but I would also remind everyone that I had to lose less than 20% of my weight to get to my goal weight.  In other words, I didn’t have as far to go.

One of the most important changes at Weight Watchers in recent years has been the degree to which we now focus most of our conversations with our members on goal setting on getting to  a 5% and 10% weight loss.  Remember, a 10% weight loss massively improves your health and vitality.  It’s not about becoming the next swimsuit model.  Also, remember, that a 10% weight loss looks pretty good too.

#4:  We need to cut ourselves (and others) a break

One of the most heartbreaking aspects of watching someone struggle with their weight is the way to react when they find that they have re-gained weight.  It is horrible to watch people go through a ritual of self-character assassination and other forms of self-flagellation when they fall back on old habits or succumb to temptation.  I know it because I’ve been there.

For many or most of us, we should expect that we will periodically fall down.  We still have to live and survive in an obesogenic environment.  There are going to be times when it just wears you down.  Knowing that there may be biological triggers that make it worse can perhaps give all of us some comfort that when we do trip, it’s not because we are bad people.  It’s just nature at work.

Oh by the way, knowing all of these challenges can also help us have that much more empathy for those who struggle with their weight.

#5:  Ironically, knowing it is a challenge can actually make us more successful and happier at the same time

At no point in writing her column or in any of her many follow-up interviews did Tara say we should all throw in the towel.  Rather, my take is that she is creating the possibility of breaking out of an all-too-familiar doom loop:

  • Feel bad about being overweight
  • Lose weight
  • Regain weight
  • Hold ourselves in bitter contempt
  • Repeat

If we know that we are going to periodically trip and skin our knees, we can accept the fact that we can pick ourselves up and try again.  We can skip all of the drama and self-abuse.  We can recognize that this is a process that we have to work at forever.  If all of that sounds a little grim, consider 1) the alternative, which feels even more grim and 2) everything we gain when we succeed.  Further, if we know what we are getting into, we can be all the more positive and feel even better when we do succeed.  Because we can.

While it is absolutely possible to lose weight and keep it off over time, it’s not necessarily always easy.  Back-tracking happens, and that is totally normal.  Dealing with a weight issue does require effort that must be sustained for a long time.  It can be frustrating, but for me personally, it has been completely worth the sometimes struggles.

24 comments:

  1. I read this article last week and I really feel like it kinda missed the point. It basically ended with, "Only 5% of people who lose weight manage to keep it off for more than 3 years, and of those people, about 3% are regaining. But that doesn't mean we shouldn't stop trying." Um, I kinda think it does.

    Don't get me wrong, I don't think it means that we should stop eating healthily, or moving more, or any of that, but I think we need to stop gauging our success by the scale, because obviously it's not an indicator of health. There is more and more research coming out that proves being overweight does not always equal unhealthy, and thin doesn't always equal healthy either.

    Take a look at the woman quoted in the article who HAS succeeded in keeping weight off: many people would classify her as having an eating disorder. She has a militant attitude towards food, weighs herself daily and cuts back on calories if there's any upward fluctuation, and exercises compulsively. Is that how we want to live our lives?

    Personally, I don't think I'm going to be on my deathbed thinking, "I wish I dieted more." I think I'm going to be hoping I lived my life and enjoyed every second of it, and these mindsets about body size are really the antithesis of that.

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  2. When I sit in my WW meeting with LOTS of other lifetime members who have lost both large and small amounts and who proudly proclaim they've kept it off for years and years, I believe that I can do this too. In fact I KNOW I can do this too because I have done it for about seven years. Reading articles like this kind of chips away at my confidence and makes me question myself. That's not a good thing.

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  3. Weight loss maintenance is a continual challenge. Sort of like household chores and having a job. The effort required never ends. That's just the way it is, either accept it or have a weight that you're not happy about.

    People's behaviour is very hard to change. It's well known that it's hard to convince people who have had heart attacks to eat healthy and take their medicine.

    But for people who *can* change their behaviour, and are prepared to put in the effort, it's possible. Thinking about their weight every day. Just like they think about brushing their teeth, wearing appropriate clothes and turning off electrical appliance when they leave the house.

    I know that I'm one of these people. Someone who deep down believes that they can do it. Where did this come from? I have no idea.

    I think that more research needs to be done on people and psychological issues. People like me. People who know that they can do it.

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  4. As a LT member that lost over 115 lbs(&kept it off 2 yrs)and is now struggling to re-lose 20 of them I find Tara's article both comforting and terrifying. I KNOW I need to be hyper-vigilant about my habits, that the minute I relaxed because I was tired of thinking about weight loss 24/7......that minute rolled into many more and "hello" 20 lbs, in just a couple months......so EASY. Armed with how easy that was to re-gain, even easier than I've always joked about! Armed with the knowledge that it's not just me......now I again am faced with a CHOICE. I can CHOOSE to succeed, again. Or I can say I'm destined to be fat, it's genetics, my body wants to be that way, etc. Well, I CHOOSE to re-claim my weight loss. I liked being thinner. I was happy at that weight. I BELIEVE I can be that weight again. Now I know, not just from my own standpoint, but from research, that I can't let my guard down. Because if I CHOOSE to stop consciously thinking about my choices I WILL gain weight. The choice is mine to make....and if people think I have an eating disorder, that I'm over obsessed with my weight or the PointsPlus values of foods, so be it.

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    1. I have not made lifetime yet (but I have lost 80 pounds or 32% of my original body weight); but I am still plugging along (less than 20 pounds left to lose).

      I feel like Laura above, that you have to remain focused or it is so easy to slip back into obesity. You must remain vigilant or just that easily, the pounds will come back on.

      This attempt at weight loss (there have been many and when I've lost focus; I've regained the pounds) has been different for me. Perhaps it's my age (57) and the realization that there is no rush to get to lifetime. This journey began July 2010 and I've never felt better. Although this time around also have been consistently exercising along with eating healthy. Also, when WW switched to Points Plus I think it was a great move. I don't believe I've eaten this healthily (is that even a word) in my life.

      Good luck to all of us in our quest for a healthy weight!

      PamF

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  5. Tara's follow-up interview http://6thfloor.blogs.nytimes.com/2012/01/03/behind-the-cover-story-tara-parker-pope-on-obesity/?ref=magazine was almost as intriguing as the original.

    She particularly addressed the criticism of her writing from Slate (and from many others, like Natasha's comment above) that accuses those who have successfully maintained weight loss of behaving as if they have eating disorders.

    She asks if we would similarly criticize diabetics who know they must carefully plan, track and eat certain foods at certain times for the rest of their lives? Or do we criticize those with high blood pressure who are careful about reading labels for sodium content to limit their salt intake FOR THE REST OF THEIR LIVES?

    This is a very important message from your post, and from Tara Parker Pope's original piece. I have to stop looking at weight loss as some kind of a temporary challenge "until my daughter's wedding" or some other special occasion function, which somehow implies needing the dreaded "will power" tool, gritted teeth and all, while I white-knuckle cravings until an arbitrary date circled on the calendar - at which time, I can go nuts!

    Instead, what helps is to picture myself as what I am: a heart attack survivor who will always need to be hyper-vigilant about heart-healthy eating, DAILY exercise and what that scale is telling me. More on this at: "How to Stare Down That Plate of Chocolate Chip Cookies" - http://myheartsisters.org/2012/01/04/end-of-overeating/

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    1. PS David, forgot to mention that I quoted you in the Heart Sisters "chocolate chip cookies" piece!

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    2. RM (@feministrunner)January 18, 2012 at 9:31 AM

      THIS.

      When I read the Slate criticism I had the same thoughts about extremes. Society basically says: hate obese people for having no willpower (fallacy #1)and hate people who lose and keep weight off because they have an eating disorder (fallacy #2.) If you're overweight or obese, you can't win for losing.

      Thank you for putting it so succinctly.

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  6. Great blog! I never thought that it would be easy to maintain my loss. I am still on my way to reaching my goal weight, but I have always believed that I would reach the goal weight one day and be able to maintain it.

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  7. Timely...struggling and am in the "Hold ourselves in bitter contempt" phase and desperately trying to shake it before this 5 lb gain becomes more. I'm at least giving myself kudos for exercising through this. Thanks for sharing!

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  8. Thankyou for the links to such excellent articles and a well-thought out discussion.

    I've just begun my weight loss journey, and am working through the issue of "before" and "after", and getting rid of the idea that there will ever be an "after", all free from food issues, weight watching and maintenance.

    "After" doesn't exist. Instead, everyone who is serious about permanent weight loss needs to recognise and accept that losing weight is a lifelong journey and challenge that never ends.

    I know that I will always have to watch my weight, weigh in daily, eat less than those around me and eat more healthily than my peers, and exercise more. But if that's the cost of being healthy and slim, I'm more than willing to pay it.

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  9. In April 2012 I will celebrate 10 years of lifetime membership at goal. Easy? No! It requires continued focus on making good choices. I attribute my success to my WW leader and the fact that I'm in her meeting room & on her scale every single week except for the occasional week when work or family obligations interfere. I need the encouragement I get from the other members and from my leader. I also get motivation from seeing the health issues afflicting my family due to obesity. I know I cannot prevent all health issues through good food and lifestyle choices, but I will do my best to give myself a headstart toward good health!

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  10. RM (@feministrunner)January 18, 2012 at 9:44 AM

    I'm so glad you addressed this! I've been wanting to see anyone from the weight loss industry comment on it, and your comments are insightful.

    I'm especially fond of #2 and left wondering:
    What kind of efforts can we make to really dispel the notion of willpower? Every weight loss blog I read usually follows some narrative of the "I used to be fat and lazy then I got off my ass and worked really hard and now I'm not! It was HARD, but if you're not willing to put in the hard work you are a failure!" variety.
    Meanwhile, articles like these prove that's not true, and that you can actually be fat and fit. Whether or not you choose to be happy is totally up to you.

    I'm also fascinated by how many *I* statements I see in the comments. Yes, *I* recognize that weight loss is a "personal journey" for many people. But *I'm* not sure how you can walk away from reading the original article or David's piece and still not see that if you've lost weight and if you've kept it off for more than three years, you're a statistical anomaly, and that, quite honestly, your status can change at any time because your body is fighting against you. Does that mean you should stop working at it? No. Does it mean that you're having the most common experience? Absolutely not.
    But the "don't hate me because I succeeded you aren't" sorts of stories are profoundly disheartening.

    Guys, the personal is political. And every time you walk around talking about your "personal weight loss journey" in terms that proffer your success as evidence that *anyone* can do it, you're undermining the fact that we need to get to the root causes of our societal obesity problem.

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  11. I love your take in #2, "All you need to do is eat less and move more!" As my WWOnline alter ego, SnappyMcUnderpants, I took this on in my blog post, "I'll Never Tell."

    My supervisor is a 56 year-old military officer who's fairly fit. He's also made awful remarks about his son being overweight. I know he's the type to say that phrase.

    I've told my closest friends about restarting WWOnline but my boss? He'll never know. Even if he remarks about how I might look thinner over the next few months I need to figure a way to deflect it.

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  12. i also started a new weight-loss program, which was honestly speaking long due.
    i am running to the scale every morning to keep a solid record of my progress. the small downward slope in my chart helps me to keep my motivation. because as perfectly addressed in this article here, keeping the weight part is harder than weight-loss part.

    many thanks for the nice article and Tara Parker-Pope links.

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  13. Read the feature on you in Wired Magazine today and went looking for your blog so that I could leave you a note about how frustrated I am with Weight Watchers e-mail responses. There's no actual way to leave feedback or suggestions about things about your service that frustrate me and get a thoughtful response. When I try to, I get responses that have absolutely nothing to do with my message, like no one actually read them. You may not read this either, but I thought I'd at least try to put a bug in your ear. I've been really happy with the program and have been successful, but if you're moving to a retail-store based model, there are some important and frustrating ways that you are sorely lacking.

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  14. Sorry, that last comment shouldn't have been "Unknown". Google was having problems with my ID for some reason.

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  15. Hi David,

    Your article is well written and very true. I became a lifetime member back in 1990 after losing 18 pounds. For me it was wonderful but many felt because they had more to lose, they could not understand why I was there. I kept off the weight for many years, but over the past few, as I have gotten older, it has slid back on with a few extra pounds to boot, so now I'm looking at 25 pounds.

    It seems that many who have more to lose seem to lose faster in the beginning, which gives us losing one or two pounds, a feeling that perhaps we aren't doing what we are supposed to, but we are. We are losing or maintaining in the right way and I know that I have not given up anything, I have just taken control.

    If email isn't working for responses some of our members should pick up the phone, I did today and got exactly what I needed. And I see those around me getting motivated to watch what they eat because I made a conscious decision and I am moving back to the old thin me.

    I have an added tool which I don't think many have and it helps me to see how much exercise and sleep I get, and I know when I haven't slept well that I need to have a better plan for that day to keep myself motivated.

    I'm so glad you're our CEO and speaker and lifetime member.

    Perhaps our paths shall cross one day soon.

    I'm four kids later and two careers and I'm still making it work, it's all about what we want for ourselves in life, and we can't hide forever.

    Thank you,

    Dori

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  16. Hi David,

    Maintenance is the hardest part. Why?

    People look at weight loss to simply. Calories in and calories out. This statement is true but misleading. People gravitate toward a short term fix.

    Weight loss / maintenance is a LONG TERM PROCESS. It is a food issue but it is also unraveling habits and thoughts learned over a life.

    A person needs to deal with both. They are not exclusive.

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  17. I thought these articles were interesting although a bit disheartening. I do agree that it's easier to meet a challenge when you know what you are up against. One book that I think is incredible is "The Smarter Science of Slim." The author reviewed thousands of studies to get to the bottom of effective and permanent weight loss. It has changed the way I look at everything. I'm 61 pounds down and counting using WW.

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    1. Thanks so much for telling us about the book. It is GREAT! And you can get it in ebook format. I love the way you use it along with WW.

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  18. Weight loss treatment need perfect struggle and control which hard. That all depend on goal and work of its.

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  19. As a WW Leader & Lifetime member since 2008, I thought I was immune to weight gain... Then 2lbs became 4, then 6. With the accountability of having to winch in every week and then finally seeing the reality of my weight graph on E-Tools I got back in the game. Although I see it in the meeting room every week, it is reassuring to know that even our CEO struggles. One of the motivating quotes I often repeat to myself is: losing is hard, Getting to goal is hard, maintaining is hard, rejoining is hard... pick your hard. It is a marathon not a sprint and definitely a lifetime commitment that is better than the alternative and so worth it. Before WW I had never met anyone that had kept their weight off. Now I know why. I feel fortunate to now know many and be part of a community and compant that supports every state of the journey.

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