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.