Paula Muir and her identical twin sister, Karren Fraser, have always been very close.
"We're competitive, but always encourage each other," said Muir. "We always show massive support for each other."
That support and competitiveness helped the sisters, who are 46 and live in England, to achieve a remarkable goal: between them, they lost more than 300 pounds. Muir lost about 140 pounds.
Fraser had an easier time losing weight, since she opted for gastric banding surgery, a procedure that involves placing an adjustable band around the top of the stomach. The result is that the person feels full more easily and eats smaller portions of food, leading to weight loss.
"I couldn't get a gastric band because I didn't have the money," said Muir. But she was determined not to let that get in the way of her weight loss goal.
I didn't want to be the fat twin," she said. "After all, we're twins, so we have to look alike."
Thanks to her competitive spirit and the support of her sister along the way, Muir disciplined herself to eat the same-size portions as her sister did. She knew she wouldn't lose quite as much weight as her sister, but was determined to keep it close.
"It was so hard for me," Muir said. "She had to stop eating because of the band, but I could eat. I had to say no and tell myself I need to cut down."
Muir said that her sister's support was vital in the two-year quest to lose weight. She said she couldn't have done it without her sibling by her side, and experts say family members and friends provide the push people need to achieve their weight loss goals.
"It gave her the motivation and told her that if she eats the same amount, she should be able to lose the same amount of weight with everything else being the same," said Keith Ayoob, director of the nutrition clinic at the Rose R. Kennedy Center at the Albert Einstein College of Medicine in the Bronx, N.Y.
"It can be very helpful, especially if they spend a lot of time together," said Carla Wolper, nutritionist and clinical dietician at The New York Obesity Research Center at St. Luke's-Roosevelt Hospital Center in New York. "They could trade recipes and exercise together."
Motivated by Father's Death
Fraser and Muir ate most of their meals together, and when they went out, they shared a meal. Muir ate a little more, but rarely ate more than that one shared meal.
"She'd constantly remind me to chew and put my knife and fork down," said Muir.
The sisters committed themselves to losing weight after visiting their dying father.
"My dad was worried, even though he was dying," said Muir. "He was always fit and healthy."
Muir also said she and Fraser had been depressed about their weight and as they got older, worried about their future health.
"I thought that if I don't get slim now, I'm going to be old and fat with health conditions, and it's going to spoil things."
Can They Keep it Off?
Doctors say now that the women have lost all that weight, the real challenge begins.
"You can achieve weight loss just by reducing calorie intake, but the challenging thing is to keep it off for long periods of time," said Dr. J. Esteban Varela, associate professor of surgery at Washington University School of Medicine in St. Louis. "It's going to be difficult to stick to the plan in the long term, and she will have to restrict her portions for life."
They stress that in order to maintain weight loss, the sisters -- especially Muir, since she isn't physically restricted from overeating -- must make gradual lifestyle changes, including exercise and remaining mindful of portion sizes.
"A good guideline is to make one change every two to four weeks, but make them forever changes," said Ayoob.
Muir said she's started going to the gym regularly, and has learned a number of strategies for reducing her portions.
"I swapped my plate for a smaller plate. I put my portions on there. I was thinking I was eating a lot because I saw my plate full."
She also said she chews her food very thoroughly, which makes her feel full more quickly.
Weight loss specialists disagree about whether the sisters' story provides evidence that weight loss surgery isn't always necessary.
"The sister didn't need the surgery," said Wolper. "If they're similar in terms of their motivation and their can-do attitude, it's clear they both could have done it."
"If you can achieve this kind of weight loss without surgery, chances are that's not going to be successful long-term," said Varela. "Surgery helps bring about an attitude change toward food."
The experts say they are impressed by Muir's willpower and determination, and Muir's family told her the same thing.
She says she now enjoys shopping for new clothes and playing with her grandson. She wants to tell others who want to lose weight not to give up, believe in themselves and find a "diet buddy" to help.
"If I can do it, anyone can do it," she said.