Keeping Weight Off: Maintain a Healthy Lifestyle

Chapter summary

Maintaining a healthy lifestyle takes ongoing effort. Fewer than 20% of dieters keep weight off for a year and only about 8% after seven years.
Obesity leaves lifetime changes. Lower leptin production means former obese people may need to eat about 200 calories a day less just to hold the loss.
As you age, your energy need falls.

Biology view: Leibel and Rosenbaum (Columbia) say slower metabolism and changed hunger drive about 20% excess calorie intake, which accounts for weight regain. The Total Daily Requirement (TDR) stays the same even after two years. Appetite signals may not catch up with the new body mass, so you eat what you used to and return to the old weight. When Rosenbaum restored leptin to pre-diet levels, thyroid and metabolism normalised and appetite adjusted to the lower weight.
Behaviour view: Other research says it depends on individual behaviour: people return to the old lifestyle and the old habits.
The author: Both likely apply. Hormones and behaviour act together, which fits the three-legged stool.

Nackers and colleagues (2010) studied 59-year-old obese women (mean BMI 36.8) in the TOURS trial. They had a six-month lifestyle programme and a one-year extended care programme, aiming for 0.45kg a week.
The dropout rate was 48%.
Fast losers (11kg in six months) were five times more likely than slow losers (4kg) to reach a 10% weight loss at 18 months.
Conclusion: If you are obese, lose weight quickly. You lose more and keep more off.
Why is unclear: The hormones may adapt faster to the new body mass, or people who lose faster change their eating behaviour.
The opposing advice: Many health agencies recommend slow, steady loss of 0.5 to 1kg a week. A very low-calorie diet study (Ryttig 1997) is part of this debate.
Change-management view: Smokers who quit cold turkey do better than those who cut down slowly. Change fast to avoid a long transition.

Any lasting weight loss is a lifestyle change, not a diet.
Expect to keep monitoring weight and food.
Reduce your calories as you age.
Keep the habits that worked: take out sugar, take out simple carbohydrates, avoid seed oils, and fast two days a week if needed.

Plan for maintenance from day one.
Rapid initial loss may help, but check with your doctor if you have a medical condition.
If you regain some weight, return to the basics.

Nackers, L., Ross, K. and Perri, M. (2010) The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med 17:161-167.
Ryttig, K., Flaten, H. and Rössner, S. (1997) Long-term effects of a very low calorie diet (Nutrilett) in obesity treatment. Int J Obes 21:574-579.
Harris, R. (1990) Role of set-point theory in regulation of body weight. FASEB J 4(15):3310-8.
HBO (2012) The Weight of the Nation: The quest to understand the biology of weight loss.