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:
- 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?
- 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.
- 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.
- 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!
- 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.