DebraSY

Queen for a Day

In Weight-Loss Maintenance on January 11, 2011 at 11:02 am

In the discussion of my last post, Viajera asked me what I would do if I were queen of the National Weight Control Registry.  Ah, what an irresistible question!

I think for those of us who have committed to living in a state of weight-loss maintenance for as long as we are able and have submitted our names to the registry, the NWCR comes to represent many things.  It is our annual call-to-account.  Its presence hangs with us, not like a cloud, an itch, a funny smell or any kind of bad thing, but like the periodic recollection of a smart but nosy sister who lives in a distant city, and with whom we only touch base once a year.  She is guaranteed to ask about our weight – sometimes she grills us at length – and she’ll judge us, gently, if we’ve regained, so we anticipate our meetings with her with mixed feelings – angst, indignation, smugness, humility.   

I can’t say I’ve ever turned down a specific piece of my mother-in-law’s pie because of the NWCR.  I’ve never “prepared” for the arrival of the form by dieting or ramping up my exercise.  I pretty much continue with life as usual, but I have a sense of her always, and I’m sure she affects me.  This is pathetic to admit, but I probably think about the NWCR as much as I think about my own breathing sisters, who each live more than 100 miles away in different cities.  And I gotta give the NWCR credit, she may have all kinds of opinions about my weight, but she hasn’t lifted an eyebrow with regard to my housekeeping (or told me I should hold a garage sale).

In addition to being the nosy sister in Rhode Island, for those of us on her rolls, the NWCR is an affirmation (once all the cheering for our weight loss has long gone silent).  

Perhaps I’m being overly bold and should speak only for myself.  For me, she is affirmation.  I know many (most?) other maintainers go on to part-time jobs or even careers that support their maintenance – they work in fitness centers, teach aerobics classes, counsel for Weight Watchers, run weight control programs of their own, market for national sandwich chains, or work in other related areas – and they may get the affirmation and accountability they desire there or in other ways.  I have felt pretty much alone in all this, so I may place more significance on my NWCR participation than others do. 

At any rate, imagining the NWCR taking me seriously is quite the fantasy, and Viajera not only suggested that improbability, but made me QUEEN.  I think I alluded to most of my suggestions fairly directly in the letter I sent them in November 2009, but of course, I didn’t have royal edict.  I had to start from a position of deference.  Today, I am the queen, and here are my royal edicts:   

  1. Clean up your database.  Hire some interns and make good on that promise to check our contacts.  We (or at least I) do ask them whether they’ve heard from you.   How can you be sure we aren’t lying if we are pretty confident that you’re too understaffed to check?
  2. Re-examine your commitment to study only behavior.  If you cannot afford to hire more scientists of an empirical bent, then figure out a reasonable price for access to the database and put in place the process of selling it, in full and in pieces.  A random draw of 25 names and addresses would be less expensive than the full database.  Consider too what you would charge to include parts of your statistical collection – our answers to specific questions.  Contact us, your registrants, and get our permission to sell our information to legitimate empirical scientists.  If you word it right, if we’re confident that you’ll only sell us to scientists that will preserve your own reputation, we’ll support you.  Then go for it.  Sell us so that endocrinologists and others may try to add their wisdom to this complex puzzle.
  3. Use the money you make selling our info to do more and better science of your own.  You like looking at our behavior, and that’s actually great.  I apologize for giving you such a hard time for that.  The study of behavior is not a lesser science, but it is incomplete without knowing the contributions of biology that underscore it (and vice versa).  Please, remove the judgment of our behavior.  Consider meeting with people who have fallen off the registry to find out why they succumbed to a “failure to maintain behavior changes.” Don’t just let that language with your implied censure hang in the air and contribute to a “Biggest Loser” society.  The contact information for people who have dropped from the registry, by the way, would likely be of interest to empirical scientists too.
  4. Clarify your relationship between the Miriam Hospital and your Weight Control and Diabetes Research Center, and consider renaming your program.  “Body Weight and Diabetes Studies,” or the like, might help distinguish that you do not help people lose weight, or when you do, it is part of a study where you will accept a null answer.  You have nothing to lose but perceived conflict of interest.   For the same reason, sever relations with all other weight-loss programs (such as SlimFast) and vow never to allow your reputation to be linked with commercial products.  What a risky thing to do!
  5. Throw all your assumptions on the table and examine them with the scientific curiosity you had before you founded the registry and add the wisdom you have now.  Do this after you have executed step one above, which may be eye-opening.  Before you cut off contact with me, one of your scientists summarized your driving edict:  “The NWCR has no agenda, except for promoting weight loss and long-term weight maintenance as a realistic possibility for most people.”  The word “promoting” suggests an agenda, not merely a hypothesis. The phrase “realistic possibility for most people” suggests a conclusion not in evidence.  Perhaps his words to me were careless and regrettable.  I know I’ve said some things in this blog that are too “off hand,” but they probably reflect my state of mind, as his comments reflect some aspect of his and (probably) the NWCR’s. Fearlessly examine yourself.

Please know that I’m your biggest fan.  Your work is important.  I’ve said it in some comment somewhere – you are doing the right thing, studying maintainers, the true and only “experts” in this pursuit.  I merely want you to study us better.  For one blog post I get to pretend to be queen.  Just think what you’d have to pay a consultant for this advice.

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  1. Excellent!

  2. “…no agenda, except for promoting…”

    Had to go change my (wet) pants after that line. Don’t remember the last time I laughed that hard. 🙂

    Also, how do we know there aren’t WAY MORE than 6000 people who have maintained a significant weight loss by doing COMPLETELY different behaviors, but they have no desire to report to anyone about it? Maybe the NWCR just tallies records of a certain personality type, those inclined to join organizations? (Seriously, if I keep off the weight, I have no desire at all to report that info to any organization.) I’m not a joiner.

    I want to know the mechanism(s) with/by which human bodies signal that weight loss has stabilized and that *the attempt* at maintaining has now begun (as in: what physiological process turns on the signals, such as endocrine changes, making regaining weight/fat an imperative?)

    Let’s say, for instance, that I decide to slowly increase my calorie intake until I am no longer losing weight but basically staying at my current weight? How long before my system starts creating increased hunger signals and/or slowing metabolic processes so that I lack energy to exercise or move about? (Well, not that I actually do much, currently, in the way of exercise…)

    In other words, why does the NWCR focus only on so-called “successful” maintainers, rather than gathering data on people who have lost significant amounts of weight, kept it off for some time, but then start to regain at some point? It would be interesting to compare the differences in behaviors. Do most regainers eat breakfast? When did they start to regain? Do regainers continue to exercise? Do they start eating more in general or more of specific kinds of foods? If maintainers eat an average of 1300 calories a day (????), then what is the average amount of someone who is regaining, has regained, or has overshot their starting weight.

    In other words, what maintainers do (behaviorally) tells us next to nothing if we simply ASSUME that what THEY do is so very different from what the regainers do, or if we ASSUME that what the regainers do is any different from what other people do (people who have never been overweight, for instance.)

    If we continue to assume that eating fewer calories and increasing exercise is the cause of weight loss, and we continue to assume that those behaviors are the cause of maintaining weight loss, and we continue to assume that eating too many calories and exercising too little are the causes of weight gain…well, WTF do those things tell us anyway?

    I’m just not buying the whole premise any more.

    I’ve been abstaining from exercise for weeks now, eating exactly the same amount as before (calorie wise), and staying the same weight, right up until the past week…when more lbs disappeared as if playing catch up, as if I had been exercising the same as before. What is the only thing I’ve done differently besides becoming more sedentary? I increased the percentage of calories that are from fat.

    Gee, who knew that turning myself into a science experiment could be so much fun (funny weird, not funny Ha Ha.)

    My vote is cast: Debra as queen of the NWCR. We do get to vote, right, even if we have no desire to join?

  3. Gotta affirm turning yourself into an experiment, RNegade, but with caution. What you’re talking about is very close to Atkins, very Taubesian, and what history has shown us is that Atkins is probably one of the easiest ways to lose weight, but one of the hardest ways to sustain losses. Not only are we NWCR “joiners” not generally Atkins adherants, but even odd sources like Consumer Reports have found Atkins to have the lowest long-term success at sustaining losses.

    Keep asking yourself the questions you pose above as you proceed. Try to discern whether the challenge of sustaining those losses are social — living in a sugar- bread- and pasta-pushing culture — or maybe have their own endocrine complications. Note changes in your cues and impulses and take yourself seriously. Know that this “experiment” may drag on for years. Regardless, I will trust your experiences, RNegade, over a lot of research that begins on “expert” assumptions drafted by people merely observing us and not living la vida.

    Oh, and if you make it to the one-year mark, reconsider that joining thing. For all its biases and weaknesses, the NWCR makes and important contribution by acknowledging that RDs, MDs, PhDs and others may have something to learn from those of us in the trenches, and the NWCR goes to the trouble to find us (then, arguably, fumble how they deal with us). They don’t do anything to exclude low-carb/high fat participants, and I don’t think you have much of an argument that low-carbers are less likely to be “joiners.” Atkins has had its own bandwagon days and bandwagon revival days, with plenty of people “joining” the fun. You are right that the NWCR should NOT drop regainers like hot potatoes. I don’t know whether they do, actually. Since I haven’t regained enough weight, I’ve avoided any kind of fate like that. Again, it’s all quite mysterious.

  4. All hail the queen. Really.

  5. Debra, your suggestions are right on. So sensible. It would be a miracle if somehow, we could get this figured out. The Royal We, of course.

  6. All hail the queen *curtsies*. Thank you – that was a very interesting and well-thought-out response!

    Responding now to RNegade:
    how do we know there aren’t WAY MORE than 6000 people who have maintained a significant weight loss by doing COMPLETELY different behaviors, but they have no desire to report to anyone about it?

    I’m sure there are. I, for one, was a long-term maintainer (lost >35%, and maintained a 20-30% loss for ~9 years) who never even heard of the NWCR. Had I, I probably would have signed up – I was pretty pleased with myself back then, and all-too-happy to gloat about my results (of the “If *I* can do it, anyone can” variety. Yes, I was *that* girl, sigh).

    (TW for dieting talk)

    Your comments about Atkins worry me, Debra, as that’s the route I’m taking in my latest efforts. It’s working so far, too, much to my very tentative delight (my body has been incredibly resistant to any and all weight-loss efforts since the initial loss). It’s interesting to me just how much my body’s responses to food have changed since that first weight loss, whether due to age, dieting-induced metabolic changes, or who knows what. I initially lost the weight on a very low-fat and high-carb diet full of processed food. I remember summers living off of Cheerios, skim milk, baked tortilla chips, bagged salads w/ low-fat chemical-rich dressings, and the occasional Pasta Roni. I regained the weight on a low-fat, whole-grain, vegetable-rich, limited-meat, limited-processed-food diet that would have made Michael Pollan drool (well, it would have were more of the foods local). I would find that merely eating a small bowl of white rice or non-whole-wheat pasta or bread could result in a 4-5 (really!) pound gain the next day! Now I seem to be re-losing the weight on a high-fat, high-protein, vegetable-rich, very low-carb (Atkins induction) diet. It really makes no sense to me. I’m hoping I can maintain the loss, despite the low Atkins success rate, because as odd as the diet seems it actually feels good to me – I didn’t go through any nausea, I’ve been energetic, and my cravings are virtually non-existent. I rarely, if ever, miss carbs, so far. And besides, I know someone who has maintained an Atkins loss for 5 years, and hey: N=1 is all you need, right?!? 😉 But time will tell.

    All this leads me to wonder just how much generalizing we can do. If I’m experiencing this much variation within one body over time, how can we generalize across multiple bodies?

  7. I hate being such a party pooper regarding Atkins too, but I’m not optimistic for it long term. (Clearly, it has one of the best records for loss, however.) Cancelling your N=1 is my N=1, my brother-in-law. His picture should be in the dictionary next to the word “disciplined.” He lost a ton o’ weight on Atkins, and kept it off for about 6 months before the regain started. Of course, he made it back to square one after about a year. Damn. I don’t know what he thinks happened. I don’t bring it up, and I don’t see him enough to have a comfortable conversation with him anyway. All I know is that he wasn’t eating Atkins whole-heartedly anymore when he regained it. Was it because he just lost the taste for it? (Which might indicate an endocrine reaction?) I don’t know.

    I’m making my way through the new Taubes book now. Maybe he’ll put my heart more at ease, but so far I’m having an uncomfortable pencil conversation in the margins. Too much emphasis on insulin alone, no acknowledgement of the other endocrine players. (And, in the back of my mind, the Atkins’ failure rate.)

    The good thing about Taubes is that he DOESN’T play with volatile language. He doesn’t claim to possess a “breakthrough.” He just insists we need to test his theories, and there I would agree. You and RNegade are doing some personal testing now. Keep alert and TRUST yourself. Know that most of us on the registry, regardless of how we lost (and some did liquid fasts, for crying out loud), have ended up “low-cal,” or at least energy balanced (I don’t buy that we’re eating only 1,300 cal/day — we’re eating more and exercising to compensate — I average 1,800). Recently, I started limiting my grains radically (mainly for my joints) too, but I eat fruits daily (and I don’t exclude bananas), and I eat beans maybe once a week, roots or potatoes twice a week. By limiting grains, I mean zero to three servings/day — probably average about 70 calories a day. When I was a runner, I used to eat the 1993 food pyramid (ll servings), but mainly only whole grains. Not so any more.

  8. Debra- I haven’t read Taubes but here’s a scathing review on a Canadian site that I “sort of” like: http://www.weightymatters.ca/2011/01/book-review-gary-taubes-why-we-get-fat.html

    As usual, I’d be interested to hear your take on it.

  9. I’m going to chime in on some diet talk.

    I read Barbara Berkeley’s Refuse to Regain. Since then I’ve put the water back in but essentially I’m doing the primarian thing. Not much meat, though, mostly nuts. I’m liking it a lot and am not hungry as much as I used to be. I have plenty of energy. I have no clue how much or how many calories I’m getting. I don’t eat ANY grains, flour, sugar or very much dairy. I do have soy milk once a day. No potatoes, either. So far so good. I’m 68 and spent my whole life (fat or thin) being hungry. I NEVER ate to satiety.

  10. I’d like to follow up on the comment that the “Atkins” approach does not work once the weight is lost. I’m reading Taubes’ Good Calories, Bad Calories (I confess I skipped right to the chapters on weight loss) and on the strength of what I’ve read so far, I changed my breakfast this morning from oatmeal, dried fruit and nuts to a veggie and egg frittata. I don’t want to go any further down this path until I know more–thanks so much for the heads up, Debra.
    Should I simply google “Atkins long-term success” or something to unearth the info? Any help would be much appreciated.

  11. Thanks, NewMe, for the link. I know Barbara Berkley has reviewed it too, but I haven’t read her thoughts yet. I’m kind of trying to go in open minded, if that’s possible.

    Mo, what I like about Barbara is that she communicates well, and while she has a strong opinion, she is not dogmatic or condescending and she recognizes the vast variance that we humans present with this delimma. Moreover, she honors our experiences with our own bodies. I had a pencil “conversation” in the margins of her book, too — Some things positive, some neutral, some in outright disagreement. I told her I’d done this, and she allowed me to mail it to her. She handled my thoughts with such grace, and I discovered just how open-minded she is. Would that we could clone her. I’m glad her “primarian” eating is working for you. My eliminating grains (then reintroducing modest amounts) was at her prompting. I am happy with what I’m doing now, too. It is an improvement over what I was doing last spring, and, for the time, it’s sustainable.

    Alana, I think your plan is as good as any. I did a Yahoo search and page one was a mix of Atkins sponsored sites, Atkins detractors and some (presumably neutral) discussion boards. It would take some time to weed through it all and figure out who is credible, but it would be worth it, especially if that plan appeals to you. Don’t just rely entirely on Taubes. He is the current standard bearer of the anti-carb crew. It is his agenda to advance that in the marketplace of ideas. His agenda may or may not be of value to your personal health situation.

    My thoughts now are based on my recollections and accumulated experiences, many that I cannot clearly footnote. One that does stand out is the Gina Kolata book Rethinking Thin. She organizes that book in an entertaining way by alternating between drier chapters about science and more narrative chapters that follow a couple of diet groups over a two-year period, one Atkins based and the other calorie based. In the end, neither diet group fares well and they both end up illustrating how the science of weight maintenance is incomplete and the statistics are grim. I remember reading the Consumer Reports when it came out with its ratings on long-range success for diets, but I cannot recall its methodology. You could probably find that pretty quickly, however. Another reason I am cautious about Atkins is because its resurgence in the early 2000s was significant enough that it should have had an impact on the weight bell curve. The hooplah was spectacular and lasted several years, but then it fizzled. If there had been sufficient substance to it, the weight bell curve would have moved, the hooplah would have continued and many more of us would be on Atkins now. One thing I know, changing your breakfast to a veggie frittata won’t hurt you (unless the eggs have spoiled). You can do some personal experimentation while you research.

  12. Thanks Debra. I looked at the link provided above to the good doctor’s blog “weighty matters.” That was interesting–so many thanks to Newme.
    I shall keep searching and reading, indeed.

  13. I guess over 35 years of low fat eating, whole grains only (even our family birthday cakes were whole wheat), lots of fresh fruit, no white sugar, and very little red meat was a long enough experiment for me.

    Where I part ways with much of low-carbing philosophy is the concept of “net carbs” (by which grams of carbs consumed at a meal are totalled by subtracting grams of fiber) and the idea that modern protein and fat sources are not problematic (in spite of the hormones, antibiotics, pesticides, nitrates, etc.) Also, I stand by my concerns about our toxic drinking water (polluted with pharmaceuticals, including endocrine disruptors).

    Eating a varied paleo type diet (or primarian) is extraordinarily complicated for many of us, given the shockingly high economic costs, this culture’s overwhelming love for high carb foods and their accompanying cheap abundance, not to mention the warnings/criticism from well meaning people who often belive whole heartedly in the “scientific” stance of the ADA, USDA, Am heart association, etc.

    Mostly, though, it is very expensive to eat a primarian diet compared to a diet rich in highly subsidized grain-based and sugar-based foods! (Woman cannot live on Adams peanut butter alone.) Maybe that helps to explain why the wealthiest branch of my extended family is so supportive and approving of “low carb” eating, while the working class members are too polite to criticize but mostly see it as a kind of eating disorder. 🙂

    I would love to eat fish several times a week, for instance, or grass fed beef, or hormone free chicken. That won’t happen until I find a lucrative job. But at least I have a much better chance to get hired now that I am no longer obese.

  14. RNegade, I low-carb, and I’m certainly not above eating canned fish or non-organic vegetables, even though my doctor, who is otherwise a genius, woulid prefer I eat wild-farmed fish only (or whatever the hell) and organic veggies and fruit. I gently remind her we continue to be in a recession. We negotiate.

    That’s one of the ways I get around the cray-cray budgetary issues of low-carb.

    (And some of my family I just … don’t discuss it with anymore. They tried for awhile to test me by “forcing” me to eat simple-carbed stuff to “see if I was serious” — that ended when my cousin ended up with a large spoonful of chocolate mousse she’d tried to force-feed me smeared all over her face and shirt. But now they know what to expect to eat when they come to visit me — I never exclude bacon — and they know what I’ll eat of what they serve when we go to visit. Sometimes you just have to go to extremes. Sigh.)

  15. You guys are makin’ me feel so much more comfortable hiding in the bathroom with my wine glass! At least I’m avoiding food fights with my family. Yay.

    How funny that diet and weight have become such complex issues that so many of us feel possessed to turn our bodies into complex personal experiments, involving enormous time and effort in research, trial and error etc. We’re trying to find the formula, the scientifically supportable way to live in a trimmer body; we aren’t just “trying on” the latest women’s magazine diet (and then getting lazy and returning to our old ways). We’re approaching this with all our gifts, and yet our society reduces the whole thing to them who understand it’s all a zippy “lifestyle” vs. them who don’t. (And chocolate mousse is a mandatory part of a zippy lifestyle in certain families — in moderation, I’m sure.)

    Meanwhile, as you point out, RNegade, it may be the drinking water. An RN friend of mine recently brought that up in a conversation with the same passion and outrage that you presented it with here. She was particularly concerned with early-onset puberty in girls. It seems you nurses are on the forefront of seeing this.

    Meanwhile, I keep maintaining, and the scientists ask me again whether I eat breakfast. Yeesh.

    • Your most recent comment (re: wine glass in bathroom for measuring) reminds me of a study that suggests the beneficial results of moderate ETOH consumption, also known as the *French paradox* because of the apparently lower rates of diabetes and heart disease (at least until recently?) in a country where drinking wine is celebrated. Let’s leave smoking out of this one…:)

      http://cpr.sagepub.com/content/10/1/25.full.pdf+html

      Anyway, if you are a moderate drinker then perhaps either: a) the alcohol helps protect you from some of the insulin resistance problems other formerly obese folks have experienced, or b) the fact that you can consume alcohol in moderation suggests that your body does not respond to alcohol with an insulin surge (as does mine) and is therefore, apriori, different from people who are extremely carbohydrate sensitive, or c) drinking more wine correlates with drinking less water (and thus taking in less endocrine disruptors; okay that one’s maybe more of a stretch) and d) ?????? 🙂

      Alcohol (even low carb beer) acts in my body like straight glucose (or fructose), at least in the way I feel. The rush is almost immediate. The corresponding surge in carbohydrate craving is quite shocking. And very real. I wonder if some people who attempt low carb are sabotaged by moderate drinking, as I would be (and have been, in fact, in the past…before learning my lesson the hard way). I wonder, also, if any research has attempted to differentiate between low carb eaters who drink moderately, and low carb eaters who abstain from alcohol.

      Then again, as you remind us Debra, (thank you!) if it was all about a *simple* lifestyle change would we be here discussing theories linking ETOH and insulin response? Hummmph!

  16. “The NWCR has no agenda, except for promoting weight loss and long-term weight maintenance as a realistic possibility for most people.” The word “promoting” suggests an agenda, not merely a hypothesis. The phrase “realistic possibility for most people” suggests a conclusion not in evidence. Perhaps his words to me were careless and regrettable. I know I’ve said some things in this blog that are too “off hand,” but they probably reflect my state of mind, as his comments reflect some aspect of his and (probably) the NWCR’s.

    Yeaaaaah. “[P]romoting weight loss and long-term weight maintenance as a realistic possibility for most people” also flies in the face of a lot of research; I realize the NWCR is trying to find out what maintainers do that make them different, but research on turning “what successful maintainers do” into interventions would be interesting too.

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