The Skinny on Super Losers
After integrating weight loss surgery with psychological and lifestyle based interventions, Linda is now a weight loss super star. She had her first gastric by-pass surgery in 1997 at her peak weight of 409. In two years she lost 140 pounds but then began to relapse and re-gained 40. In 2000 she had a revision surgery and began losing more weight. But life didn’t cooperate and she relapsed again during a period of intense work and family stress. In August of 2006, at 325 and still gaining, she enrolled in a psychologically oriented residential weight control program.
The fear of losing control motivated her to add a new set of skills that she hoped would empower the tool of the surgery to do its job. It worked, and by February of 2008 upon a renewal visit to the program she was 205, a total loss of 204 pounds from her peak.
The changes Linda made in order to restore control were substantial and included: 1) An exercise routine of walking 20-25 minutes every day; 2) Commitment to using a food diary in which she records everything she eats and especially monitors her salt and sugar intake. 3) Eating nutritiously 3 meals a day, having some protein at each meal, and eliminating all in between meal eating. 4) Managing restaurants assertively, insisting that the food be cooked the way she wants it, with no fat or salt added. 5) Monitoring and tracking weight, blood pressure, fitness progress and changes in her clothing sizes. 6) Altering her lifestyle by making a job change that reduced pressure , responsibility, and created more time to take care of herself.
Linda’s success echo the findings from a recent study reported at the annual scientific meeting of The Obesity Society in October 2007. The study, titled “The Skinny On Super Losers,” probed the weight loss strategies of 29 subjects who lost from 11-51% of their starting weight over a 3 year period. When integrated into a comprehensive program of weight control, the behavioral techniques used by these masters can prevent the slow but progressive re-gain experienced by some past surgery patients. Here are the highlights of the Super
Losers project: Simplify eating: 97% of the participants ate 3 meals a day, and most had no snacks. They also tended to narrow the scope of the meal choices.
“My breakfast is the same every day, and my lunch seems to repeat as well. Dinner varies but is always planned out.”
Regular meals and simplified choices will tame the battle with urges and cravings. Plan ahead and control the surroundings: Meals are more controlled when written and planned ahead of time, often a day or two before. This applies to grocery lists and social outings. The general attitude is to eliminate surprises by having a plan, and by controlling the eating environment: eat at regular times, at a table with the TV off, keep tempting foods out of the house. Be mindful of healthy diet choices. Diets shifted toward more filling but lower calories items: more fiber, fruit and vegetables, less fast food and buffets. Food is seen more as fuel, not love, reward, or numbing.
Get active: 89% of the all stars did some form of cardio exercise (walk, treadmill, elliptical) and 59% did strength training (free weights, weight machines).
Recommendations included: “Find a physical activity you enjoy, enlist the help of a personal trainer, vary your workout.” Exercise burns calories, tones the body, and boosts the metabolism.
Change the lifestyle: Kern views lifestyle change as necessary to building the platform for success. Subjects said “don’t go it alone”- elicit help from friends and family, attend a support group, talk to a therapist or nutritionist. Be willing to change potentially food risky routines; if eating out or social entertaining are triggers, then reduce their frequency. One master said: “I keep busy at social events and avoid temptation by asking my husband to fix my plate at the buffet line.”
Monitor yourself. Studies suggest we eat twice as much as we think we are eating. Success requires honesty and self -awareness through tools that give you feedback and track what you are doing. Study subjects wrote down everything they ate in a food diary, they weighed regularly and kept graphs of weight trends, and they kept exercise logs. Keep motivated. Surprisingly, the desire to improve appearance was not always the top motivator. Instead, some were driven by the wish to be healthier and to enhance daily functioning—to have more energy, to shop for smaller clothes, to improve social confidence. It is helpful to pay attention to small signs of progress- improved blood pressure and body measurements, or indicators of better fitness. For some, changing on the inside, such as a greater sense of control, was more important than changing on the outside: “The biggest relief I have had is finding a sense of peace and control about food. I feel like I got a monkey off my back.”
Maintain a positive attitude. These all stars stressed that having the right mindset was critical to success. 1)Even if it is uncomfortable, tell yourself you are worth it and that you have to put yourself first: “At first I thought it was selfish to put myself first, but then I realized that by taking care of myself I have more to pass on to others.” 2) Accept that your plans won’t go perfectly; you have to forgive yourself and get back on track. 3) Have the courage to look within, to address what is eating you in order to deal with what you are eating. 4) Remember that long-term weight loss is not just a diet; it is the process and result of living life in incrementally healthier ways.
Lee Kern, L.C.S.W. is the Clinical Director of Structure House, a residential weight loss program for adults.
