Maintaining Weight Loss: Keeping an Eye on the Pounds

ByJAMES HSIAO, M.D., ABC News Medical Unit

Oct. 11, 2006 — -- People who lose weight can't just sit back and bask in the glory.

They need to check their weight on a daily basis to keep off the pounds, a new study in the New England Journal of Medicine shows.

The study found that a "self-regulatory" maintenance program in which patients weighed themselves daily and made appropriate adjustments to their diet and exercise helped keep off the extra pounds.

Patients who weighed themselves daily and attended face-to-face meetings with therapists and other program members regained an average of 5.5 pounds after 18 months, compared with 10.8 pounds regained by patients who weren't enrolled in a similar maintenance program.

The face-to-face meetings were found to be better than Internet messages and chat rooms in keeping off the weight.

Patients in maintenance programs who were followed through Internet contact regained an average of 10.3 pounds, not far from the 10.8 pounds regained by patients not in any maintenance program.

Checking daily weights may be the way to go in keeping off the extra pounds.

"It obligates the patient's continuing attention to the task. It enables patients to make multiple small adjustments rather than face large changes, which may be noted if they assess their status at less frequent intervals," said Dr. Arthur Frank, medical director of the George Washington University Weight Management Program.

"If you do this every day as part of your usual routine, you will notice any weight gain and be able to take early action, rather than getting a wake-up call after you've gained 5 [pounds] or 10 pounds," said Dr. George L. Blackburn, S. Daniel Abraham associate professor of nutrition and associate director of nutrition at Harvard Medical School.

For dieters, losing weight is only half the battle.

Once the weight is lost, they have to keep the pounds from reaccumulating.

Most dieters regain a third of the weight lost during the next year and are typically back to baseline in three years to five years.

"People always recognize that losing weight is a transient phenomenon," Frank said. "An effective maintenance program has to be sustained indefinitely."

"Weight loss is relatively easy, while maintenance is harder, and at most centers isn't even done," said Dr. Ken Fujioka, director of nutrition and metabolic research at the Scripps Clinic.

In the study, 314 patients who had lost an average of 43 pounds were assigned to receive a quarterly newsletter (control group), participate in a maintenance program with face-to-face meetings, or participate in a program with discussions via the Internet.

Patients in the face-to-face group met weekly for four weeks, then once a month for a total of 18 months.

Patients in the Internet group received messages at the same frequency.

After 18 months, patients in the face-to-face group had regained few pounds (5.5 pounds) than patients on the Internet (10.3 pounds) or in the control group (10.8 pounds).

The value of the daily weighing, however, isn't favored by all.

"It promotes continued preoccupation with caloric intake and food restriction, and promotes a continuous state of anxiety and fear about becoming 'out of control,'" said Joanne Ikeda, a cooperative extension nutrition education specialist and lecturer.

Some experts stand in the middle.

"I used to suggest weekly weighings so people wouldn't get too uptight about day-to-day fluctuations," said Keith-Thomas Ayoob, associate professor in the Department of Pediatrics at Albert Einstein College of Medicine.

"But our society is different today. We seem to need more immediate feedback. As such, I recommend more frequent weigh-ins," Ayoob said.

"Over time, once the correct trajectory is established, less frequent monitoring is warranted," said Dr. David Katz, associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

The self-regulation program has other advantages as well.

"There's the feeling that the subject is taking responsibility. They have all the tools they need at their disposal, so they gain a level of control," Ayoob said.

Why did patients who attended face-to-face meetings do better than patients monitored over the Internet?

"Face-to-face intervention has [a] higher level of accountability," said Rena Wing, professor of psychiatry and human behavior at Brown University School of Medicine, and lead author of the study.

"Patients are weighed each time they come in, and they are accountable to therapists and other members of the group," Wing said.

"When you are looking someone in the eyes, there is a sort of social contract you feel you are signing. That affects people much more than an e-mail message," Katz said. "The challenge is to make sure that accountability does not result in judgmental behavior by the person doing the monitoring."

Patients who shed pounds can't stop with the calorie counting and aerobic exercises.

They need to watch their weight on a daily basis to keep it from climbing up again.

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