Maintaining significant weight loss: how do you do it?
December 26, 2013 8:29 AM   Subscribe

A year and a half ago, I lost a large amount of weight, i.e. 75 lbs, or about 30% of my body weight on a very low calorie diet, under medical supervision. Although I was not able to follow the official maintenance program after moving to a new city, it was relatively easy to keep things stable for the first year. But, about four months ago, I notice that some of the weight--about eight lbs worth--had crept back on. Although I've lost five of them, the last three seem determined to stick around. This, combined with the dismal statistics on long-term maintenance (97% of people regain within five years), has me pretty scared. Have you beaten the odds, and if so, how do you do it? Also, what is the balance of food vs. activity in your regime?

I'm a 48 year old female, and I went on my first diet when I was five. My weight has been a constant issue my whole life, and I was extremely relieved when I managed to shed it. At first it seemed like I'd found the answer in a Primal/low-carb style program, but this summer's regain has me questioning that. I've gone back to weighing myself every day, keeping a food diary, eliminating carbs that do not come directly from fruits and vegetables, but what else should I be doing to maximize my long-term chances? One thing that is missing is a structured exercise program (I do walk about eight miles per day and do yoga), and I'm wondering if strength training and more intense cardio would make a difference.

Recommendations for books, blogs, and other resources would also be most welcome. I'm looking for personal stories and advice from those who have accomplished this themselves more than generalized advice.
posted by navizzar to Health & Fitness (18 answers total) 23 users marked this as a favorite
Get rid of your scale. You don't need to worry about three pounds. You will know -- without some machine telling you -- if you are really starting to put the pounds back on.
posted by Etrigan at 8:34 AM on December 26, 2013 [5 favorites]

Wow. It sounds like you did a great job, but I think you are working way (way, way) too hard to keep it off. Some whole grain carbs are good, and I think they'd help balance your energy levels and make you feel....better. I would definitely consider finding a strength training program in your area. It may increase your metabolism and balance our your workout routine. Maybe one tailored for women at a local gym. I think sometimes less is more, and regaining 5-10 pounds but keeping active and an overall healthy lifestyle may be great for you! There is no way I could maintain your diet for an extended period of time and you may be inadvertently setting yourself up for failure.
posted by Kalmya at 8:46 AM on December 26, 2013 [3 favorites]

The National Weight Control Registry has good research findings and success stories about long-term maintenance. It's hard. I think you're on the right track with the food logs, which are definitely shown to help, but I suspect that the strength training is the missing piece for you - give it a try and see.
posted by judith at 9:24 AM on December 26, 2013 [1 favorite]

You are doing everything right.

3 pounds is nothing. Your weight goes up and down by about this much during the day. It is the couple of glasses of water you had this morning. (or the imminent waste you are about to expel next time you go to the bathroom).

Please don't let this stress you out and keep up the good work!
posted by TheOtherGuy at 9:27 AM on December 26, 2013 [5 favorites]

Get rid of your scale. You don't need to worry about three pounds. You will know -- without some machine telling you -- if you are really starting to put the pounds back on.

NO. As someone without a good internal compass for how much and what to eat and a talent for rationalizing away poor behavior, an external, objective measurement has been key to keeping a large amount of weight (~75 pounds) off for nearly five years.

I weigh myself every day at the same general time each day (in the morning, before eating). I get the whole muscle weighs more than fat thing, but over the years I have found that my weight and clothing size go pretty much in lockstep with each other no matter what my body composition. It may be different for you so you may want to use body measurements instead.

The reason I don't recommend relying on clothing is that it's too inexact, too easy to make excuses (the dryer shrunk my clothes, I'm just bloated), and by the time your clothing really, really doesn't fit, it might be too late - it can take a gain of 10 pounds before I get too big for a particular piece of clothing depending on the cut, fit, and material. It's much easier to maintain weight than lose it. It sucks, but you DO need to worry about three pounds. You need to nip any weight gain in the bud as quickly as possible.

I also know your body weight is affected by things like the point in your menstrual cycle, so you shouldn't freak out if you gain three pounds overnight. But if those three pounds keep sticking around after a few days, you should do something. And if you're weighing yourself all the time, you will get a feel for how your cycle or a big meal the night prior will affect your weight (how much it will increase, how long it will stick around).

The National Weight Control Registry says of people who successfully kept their weight off:
75% weigh themselves at least once a week.
posted by unannihilated at 9:49 AM on December 26, 2013 [27 favorites]

(I do walk about eight miles per day and do yoga), and I'm wondering if strength training and more intense cardio would make a difference.

Also, to answer this piece: There's a lot of research out there on types of duration and exercise that I'm not up on and that maybe someone else can come along and summarize, but personally I've found things like walking and yoga to be good for maintenance but not great for losing weight. I had to ramp it up to things like running, biking, weight training, etc. to make bigger changes.
posted by unannihilated at 9:53 AM on December 26, 2013 [1 favorite]

Get rid of your scale. You don't need to worry about three pounds.

Do NOT get rid of your scale. I lost 90+ pounds and have kept it off for many years. I wouldn't personally worry about three pounds, but it would set off a little reminder for me to make sure I'm eating healthy and getting in my exercise. I weigh myself almost everyday, simply because it is easier for me to keep close track of my efforts and make small tweaks than it is to have to make big changes when I realise I've gone far off course.
posted by Nightman at 10:08 AM on December 26, 2013 [6 favorites]

As someone who is on a very similar journey, I think that you are asking exactly the right questions, especially in seeking advice from people who have done what you want to accomplish. There is considerable research that indicates that the formerly obese have a different physiology than those who have never carried, let alone lost, that much weight. That is probably why a lot of well-meaning fitness advice can get us into a lot of trouble.

In my case, I loved the idea that I could get rid of the scale and just focus on the way I felt in my clothes. Loved it, that is, until I had to get on one for my physical and found that I had put on twelve pounds!!! I know the scale is a very crude measure, but I need that external, objective number. I just can't trust myself otherwise. Maybe someday, but not now.

I'm also beginning to suspect that I lost a lot of muscle during my own rapid and extensive weight loss, and that strength training might well be the missing piece.
posted by rpfields at 10:14 AM on December 26, 2013 [2 favorites]

I've lost 160 lbs and have kept it off for four years now.

I maintain a regular strength-training schedule, using free weights/dumbbells/cables with very little machine-based work. I do very little steady state cardio (walking/running/aerobics-whatchamajiggers) during the winter because I find treadmills and classes stultifying. During the spring/summer I ramp up my outdoors running to where I can do two miles at a clip. That's all I've determined that I need and serves me well for 98% of what I do without a large investment in (precious) time.

Eating: I count calories. Day in, day out. I hit my daily protein macros (~170-200g) and fill the rest with quality, non-processed foods. Think of food as fuel and not as entertainment/reward.

Stay busy. Don't waste your life watching TV or surfing the internet. Go outside. Volunteer. Have a lot of sex. Do something that scares you. Make sure you have a regular sleep pattern. Get up early. Show love to those around you.
posted by unixrat at 10:56 AM on December 26, 2013 [6 favorites]

What's working for me: I quit thinking about my weight, and now make my food decisions based on what's healthy. I wasn't able to make the psychological shift until my blood pressure had become elevated, my blood sugar levels reach the "high normal" range, and my knees started to hurt.

At 48, you're approaching menopause and other physical issues that tend to happen in one's 50s. So if health isn't much of a motivation now, in a few years you might become "inspired" by how your body feels and what your lab results show.

My diet now is lots of protein and vegetables, with very little in the way of processed carbohydrates. I try to consume my carbs in the form of whole grains and beans, which have a good amount of fiber. I eat fruit but shun fruit juice because it has loads of sugar and almost no fiber.

One thing that influenced me a lot was a lecture by Dr. Robert Lustig at University of California San Francisco Med School. It's all about what the body actually does with the sugar and carbohydrates we eat. He's very firm about the fact that "a calorie is a calorie" is false -- that idea that weight gain is caused by the number of calories one consumes. The lecture is reasonable and clear, though it does go on for quite a while.
posted by wryly at 10:59 AM on December 26, 2013

That's one helluva weight loss, and the fact that you've kept it off since without any sort of extreme dieting is really great. It shows to me that you made a lifestyle choice that is in fact sustainable. You're doing it! Eight miles is a really nice low-and-slow-burn habit for your body, and good for your soul, too. Yoga is excellent on top of that.

Here's how I look at it: now that you have this sleeked-down bod, what sorts of amusing and invigorating activities can you add into your lifestyle? Things that make you happy and exhilarated, while also using your muscles in a perhaps new way. You might just try out different things -- a martial arts class; a boxing class; rockclimbing class; kayaking class -- and see what clicks with you. Think of it as adding pleasure and fun to your already-healthy lifestyle, dialing up your quality-of-life a few clicks, and see what happens.

I will say though that since you mentioned paleo, and an interest in a structured exercise program, you can check out the basic bodyweight stuff on Weather permitting, you could integrate the exercises into your recreational walking -- find an outdoor area, and bust out the moves. This is what I do, and love it. It gives you a nice "RAWR!" feeling when you workout those particular muscle groups for even a handful of minutes. I'm a lady your age-plus, and I think this activity is what has kept me healthy through all the mid-life hoohah.

You're doing great. Explore, have fun.
posted by nacho fries at 11:13 AM on December 26, 2013 [1 favorite]

Strongly disagree with dumping the scale. I'm just about hitting the five year mark I think, What helps me maintain more or less is that I'm able to whittle down the few extra pounds when they creep on, and I pay attention to this both by how certain parts of my body look (the parts that plump up first when I'm gaining) and by the scale.
It's not a big deal to lose 5 pounds, a couple of weeks of being careful and working out more or harder will do it. Losing 10 pounds plus, well that's a whole different thing. Thats a project.
I don't weigh myself daily...I do this weird self fake out thing where if I feel like I'm gaining weight, I only eat greens and lean protein and go to the gym a few days, and *then* I weigh myself...Odd, I know, but I don't want to be bummed out by the high number on the scale, and when I do see the slightly smaller number after a few days of restricted eating, it's not so bad and then it's much easier to keep the momentum going.
Avoiding carbs seems to be the holy grail of thinness for me, that and avoiding alcohol (and working out pretty hard a few days a week...I get my heartrate up into the anaerobic phase, keeps the metabolism higher longer throughout the day). I go through periods when I feel like I eat a lot and poorly, and then immediately cut back when I start to feel sludgey...My weight probably fluctuates within a 6 pound range or so...but I'm normally a few pounds around my goal weight either way.
I think you have to find a system that works for you. For me it's keeping an eye on things and nipping it in the bud quickly.
I wouldn't worry about the three pounds, it's normal to not stick to your lowest weight if you were struggling hard to get there. If you're happy with your weight with the three pound addition, make this your base weight and maintain it there.
posted by newpotato at 11:40 AM on December 26, 2013 [3 favorites]

I do this weird self fake out thing where if I feel like I'm gaining weight, I only eat greens and lean protein and go to the gym a few days, and *then* I weigh myself...Odd, I know, but I don't want to be bummed out by the high number on the scale, and when I do see the slightly smaller number after a few days of restricted eating, it's not so bad and then it's much easier to keep the momentum going.

I did not have as much of an extreme weight loss (more like 15% of my body weight and kept it off for five years with one blip when I had a death in my immediate family and went off the wagon) but this is me too, actually. I am one of those people who is lucky enough that my body is just a machine and a calorie is a calorie. So I keep track of food on MyFitnessPal and weigh myself a few times a week and that way I know things are never getting out of control. I make sure I am at the gym 3-4 time a week and the big deal is that if I'm not going, I have to be a lot more careful about what I eat. Everyone has their Achilles heel and mine is that I like occasional snacks. I can do this as long as I have a regular exercise plan. I can NOT do this if I am not going to the gym (or walking or bike riding, or hiking) regularly and I'm pretty hardass with myself about it. The other thing that was tough for me was trying to balance "special occasions" with the rest of my life. So while I basically tossed it out the window for Xmas (big food and family holiday) and my birthday (cake!), basically everything else still needed to stay in line with my regimen even if that meant an awkward explanation to someone at a fancy dinner (no, really, no dessert, I'll have coffee) or eating something less awesome but more in line with my food plan when I was out to eat.

I'm a creature of habit, terribly so, and so the more healthy eating stuff I could build into my routines (coffee without sugar/cream in the morning, twig protein-y breakfast cereal, certain slots in certain days to go to the gym) the easier it was for me to keep up with it without having to think about it all the time. It's also, like I said above, mostly math, so I am forgiving with myself on times when I wind up having surprise eggnog and don't let the giving myself a hard time about eggnog turn into four days of less healthy eating. 3500 extra calories is actually sort of a lot so even if you go whole hog on one or two holiday days, you're still not gaining 20 lbs because of it, so be kind to yourself. As many other people have said, you are really doing everything right. Go you.
posted by jessamyn at 1:02 PM on December 26, 2013 [3 favorites]

You might want to check out Runs for Cookies. The blogger chronicled her experience losing 100+ lbs and maintaining her weight loss. I find her very inspiring. It's one of my favorite daily reads.
posted by mbidi at 2:14 PM on December 26, 2013

Congratulations on your weight loss. That's a big achievement.

The only thing that works to keep me from regaining weight is to constantly keep a careful eye on what I am eating and the number on the scale. My weight fluctuates by up to 6 pounds daily, which is very frustrating. Even if I write the number down every day it's easy for me to rationalize away daily variations that turn into a real gain.

I have found that using a running average and visualizing the trend with a graph is the best way for me to get a real sense of whether my weight is going up, going down, or staying the same. Beeminder has the best graphs I've found online and although their main business is charging you money for missing goals, you don't need to give them your credit card number or wager $ to use the graphing feature. At the bottom of this page you can see an example of a weight loss graph with a trend line and a broad 'ok' zone. This is designed for weight loss but it should work for maintenance as well.
posted by bq at 3:55 PM on December 26, 2013 [1 favorite]

Some strength training could have a lot of benefits for you. I'm a big fan of "Starting Strength" as an efficient full-body workout. It will do good things for your skeletal system, you'll like what it does for the shape of your body, increase your resting metabolic rate, and it can handy to be stronger.

Stay away from those strength machines. You want free-weights. You don't work the smaller stabilizing muscles on the machines and, eventually, you'll injure yourself (ask me how I know!).

Don't be afraid of low-rep high-weight programs. A lot of people think of programs like Starting Strength as exercise programs for men or that you'll get big gross muscles. Unless you make body-building your full-time job (and probably add steroids besides) you just won't. Here is a good example of what power-lifting does for a woman's body.

Whatever strength program you choose, read the book (if there is one, and hire a personal trainer for at least a few sessions to help you get the form down.

Since muscle is denser than fat, you may find yourself losing volume but gaining weight or, more likely, maintaining weight while losing volume. So keep tracking your weight with the scale but add a measurement or three to you're getting the whole picture.
posted by VTX at 5:53 PM on December 26, 2013 [2 favorites]

I lost about 10 kgs (or a little more) over a year ago, taking me from borderline overweight to middle of healthy BMI. I used a very low calorie diet initially. I'm just about middle aged, and almost everyone in my family struggles with weight & diabetes due to our ethnicity. I am one of the few people in my family and in my age group who is a normal weight.

I exercise much less now than at my higher weight. Exercise makes you hungry, not immediately, but in the short term, so it's best to focus on the diet and keeping your weight stable. I think exercising too much is a mistake if your main aim is weight loss. Once your weight is stable, you could consider higher levels of exercise. A half hour walk most days is enough to keep you healthy in the meantime.

During the week, I eat low calorie the majority of the time and have a very restricted diet - low fat/low sugar yoghurt, unsalted nuts, dried fruit, fresh fruit, steamed vegetables, eggs, 2% milk, soup, low fat crackers, protein powder (I'm vegetarian), sugar free Coke, tea, coffee. I am really strict about this during the week. In the evenings, I snack a bit more, but only within this list.

On weekends, I enjoy myself & don't force myself to stick to the diet. This is a time to have some of the things I miss eating regularly.

I have just accepted that certain things are not part of my regular diet anymore. They are ok to enjoy on the weekends, but I don't keep them in my cupboards/fridge. These are things like bread, pasta, sugar, baked goods, high GI carbs, cheese, alcohol etc. I almost never eat junk food, except at Christmas and Easter when I eat a lot of chocolate.

I watch my weight, and when I put on a little, I diet a bit harder for a week or so til it comes off.

I find it much easier to maintain my weight, now after a year than initially. I used to look at food and put weight on - now I can eat a fair bit and my weight doesn't move. I think once your body adjusts to the lower weight, which might take 6 months or so, it is easier to maintain.

I'm not sure this would have worked had I been obese to start with. Once you become obese, I think your metabolism and hormones change in ways that make weight loss much more difficult.
posted by JeanDupont at 6:30 PM on December 26, 2013 [2 favorites]

Response by poster: Thanks everybody, I really appreciate these answers. It is so great to hear from people who have managed to maintain even bigger losses than mine for longer periods. Thanks also for reminding me that I have done pretty well this time around--certainly, this is the longest I have managed to keep this much weight off.

A trainer friend has recommended alternating 4 reps of a circuit-training app called "the 7-minute workout" with 30 minutes of intense cardio. I am going to start that right away while I research some of the other ideas here.
posted by navizzar at 7:32 AM on December 27, 2013 [1 favorite]

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