Get healthy in the gym; get thin in the kitchen??

I want to talk today about a piece of "conventional" wisdom I see floating around the weight loss boards, one that I find deeply troubling. It is the mantra that one may get healthy in the gym, but that weight loss is about eating alone. I don't understand why this pernicious idea circulates unchecked, but it is frequently intoned as if fact. But it is neither true nor helpful, and doesn't even make any sense.

I have a lot I'd love to say on this topic, but for today: the science. If you want to lose weight AND KEEP IT OFF PERMANENTLY, then you should at least seriously consider looking at what those who have lost weight AND KEPT IT OFF PERMANENTLY have done. The best place for this information that I know is the National Weight Control Registry (http://www.nwcr.ws/). This is an ongoing study of those who have lost 30 pounds or more and maintained their loss for one year. These are the people who are getting it right. I encourage you to read through their site, but I want to point out two essential statistics:

* 98% of Registry participants report that they modified their food intake in some way to lose weight.
* 94% increased their physical activity, with the most frequently reported form of activity being walking.

This is pretty self-explanatory, but let me put it another way. Only 6% of those who maintained weight loss did so without increasing physical activity! Think about that the next time you think about skipping your workout.

The NWCR posts abstracts from dozens of research studies on their site. Here's the abstract of the results of one chronological study: "Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss. To define long-term weight loss success, we need an accepted definition. We propose defining successful long-term weight loss maintenance as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, the picture is much more optimistic, with perhaps greater than 20% of overweight/obese persons able to achieve success. We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years)  share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase."

Here is the abstract from another study: "There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success."

On weight loss boards, people often bemoan the fact that their physical activity in any given week does not necessarily show up on the scale. But if you are trying to lose weight not for one week but forever, then please think longer term!