STANFORD, Calif. — Would you take part in a weight-loss program in which you were explicitly asked not to lose any weight for the first eight weeks?
Although the approach sounds counterintuitive, a study from researchers at the Stanford University School of Medicine found that women who spent eight weeks mastering weight-maintenance skills before embarking on a weight-loss program shed the same number of pounds as women who started a weight-loss program immediately. More importantly, the study showed that the "maintenance-first" women had regained only 3 pounds on average a year later, compared to the average 7-pound gain for the immediate dieters.
The study's authors say that the maintenance-first approach may offer a way to halt the cycle of yo-yo dieting.
"Those eight weeks were like a practice run. Women could try out different stability skills and work out the kinks without the pressure of worrying about how much weight they had lost," said lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center. "We found that waiting those eight weeks didn't make the women any less successful at losing weight. But even better, women who practiced stability first were more successful in maintaining that loss after a year."
The study will be published online Oct. 31 in the Journal of Consulting and Clinical Psychology.
Obesity contributes to a variety of health problems, including heart disease and diabetes. Previous research has shown that losing 5-10 percent of your body weight can decrease the risk factors for heart disease. Yet despite the plethora of diet books and programs, many people who lose weight are unable to keep it off.
Over the years, Kiernan has interviewed both those who have succeeded and those who have failed at keeping the pounds off. She was particularly struck by one woman who said that she had never "maintained" her weight in her life; instead, she was always either losing or gaining.
"She had no sense what she was aiming for," Kiernan said. "We wanted to see if there was a way to help people get away from this all-or-nothing approach that is associated with losing weight."
Kiernan noted that weight maintenance may require a different set of skills and behaviors than those used for losing weight. So she and her colleagues came up with the idea to teach weight-maintenance skills first so that people could experience how to fine-tune their behavior in response to everyday pleasures and disruptions rather than being "on" or "off" a diet. Among these stability skills are searching out low-fat or low-calorie foods that taste as good as high-fat/high-calorie options to avoid feelings of deprivation; occasionally eating and savoring small amounts of favorite high-fat/high-calorie foods; weighing daily to see how their body weight naturally fluctuates from day to day; identifying a personalized weight-fluctuation range of about 5 pounds to account for common disruptions, such as water gain and vacations; strategically losing a few pounds before a known disruption (such as a vacation) to minimize its effects; and eating a little more when reaching the lower limit of the personalized 5-pound range.
Kiernan said the approach is designed to help people make peace with the scale and learn how to pay "relaxed attention" to their weight in ways that can be maintained over the long term — without keeping food records.
"Losing a significant amount of weight requires a lot of focused attention to what you're doing, and most people can't keep up that intensity over the long term," Kiernan said. "For weight maintenance, we wanted something that would make the day-to-day experience positive while not requiring overwhelming amounts of effort."
For the study, 267 overweight/obese women were randomized into one of two groups. The women in the control group immediately began taking part in a 20-week behavioral weight-loss program that encouraged greater intake of vegetables and fruit, increased physical activity and use of proven dieting strategies, such as keeping daily food records. The women attended weekly 90-minute sessions with a group facilitator to learn problem-solving skills aimed at losing weight. At the end of 20 weeks, they spent eight weeks using a similar problem-solving approach to learn weight-maintenance skills.
By contrast, the women in the maintenance-first group spent the initial eight weeks learning the stability skills Kiernan's group had developed. The women were asked not to lose any weight during that time; if they did lose a few pounds, they were asked to gain them back. Kiernan said this skill mimics a more real-world approach for maintaining weight within a range of a few pounds, rather than aiming for a single number on the scale. After the eight weeks were up, the women embarked on the same 20-week weight-loss program as the women in the control group.
After both groups completed their 28-week programs, Kiernan said the results showed that the women on average lost a similar amount of weight — about 17 pounds, or roughly 9 percent of their initial weight. Once the weekly group sessions stopped, the women were on their own for the following year.
"We scheduled the weekly sessions to end in October so that the women would have to navigate the holidays by themselves, without any guidance from the group facilitators," said Kiernan, the principal investigator for the study. "We wanted this to mirror real-life conditions as much as possible."
When the women were weighed one year later after no contact with their group facilitators, Kiernan said she and her collaborators were pleased to see that the maintenance-first women had regained only 3 pounds on average, compared to a 7-pound average gain for the control group. She added that the 3-pound gain falls squarely within the personalized range that the women were taught to use. Additionally, 33 percent of the women in the maintenance-first group displayed what the researchers categorize as a favorable pattern — that is, losing at least 5 percent of their body weight without regaining more than 5 pounds over the course of a year — compared with 18 percent of the women in the control group.
Kiernan said the maintenance-first approach, though sounding a bit unorthodox, could be a useful tool for those who are trying to slim down and be healthier. "This approach helps people learn how to make small, quick adjustments that can help them maintain their weight without requiring a lot of effort," she said.
In the future, she hopes to further test the approach to see if people are able to maintain the weight loss for more than a year, and would also like to test it in larger, more diverse populations including men. She also noted that the initial study did not recruit any participants who had reported binge-eating behaviors, and so researchers would need to determine whether the maintenance-first skills were viable for vulnerable subgroups of people.
Kiernan's Stanford co-authors include Susan Brown, PhD, a former postdoctoral scholar; former research assistants Danielle Schoffman and Katherine Lee, MS; Abby King, PhD, professor of health research and policy and of medicine; C. Barr Taylor, MD, professor of psychiatry and behavioral sciences; and statistician Nina Schleicher, PhD. The senior author is Michael Perri, PhD, dean of the College of Public Health & Health Professions at the University of Florida.
The study was funded by the National Institutes of Health. Information about Stanford's Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.
The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.
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