It's summer. It's hot! And I'm thinking cocktails!
Boy time flies when you’re having fun! And yes, I’ve been having fun writing the Nutrition Q&A column in The Washington Post. Publication of the June 1st column marks column #20. This column came to be because I and several colleagues saw a big need at The Post for a column written by a dietitian to offer readers reliable, evidence-based answers to popular nutrition questions.
Losing weight is one tough challenge, but not as tough, research shows, as keeping those lost pounds at bay over time. What are the THE TRUTHS about keeping lost pounds at bay?
Research shows that the most weight most people, on average, lose, even with pretty constant expert support, is about 6 to 10% from your starting weight. Example: 200 pounds that's 12 to 20 pounds. For sure, some people lose more (but do they keep the weight off?). Losing this 6 to 10% of weight hardly seems worth it compared to those triple digit losses touted by the Biggest Loser TV show or some weight loss plans.
Research also shows people lose these 12 to 20 pounds by about the 6 months to 1 year point of their effort. It’s simply tough to lose more weight. Read Weight Loss, Control: Expectations vs. Research-based Realities.
Just before I departed for a week’s vacation and last blast of summer I spotted an intriguing tweet about the article A Call for an End to the Diet Debate in the August 21, 2013 issue of Journal of the American Medical Association (JAMA). I clicked to the recap in the tweet and was further intrigued. I recognized the name of the first author, Sherry Pagoto, PhD. Ah yes, I follow her on Twitter (@drsherrypagoto).
After arriving at our first home away from home in Asheville North Carolina and enjoying a yummy and healthy dinner of sushi, I sat down to digest the article...and sushi.
It warmed my heart. Thank you Drs Pagoto and Appelhans! I applaud your efforts and absolutely concur with your sentiments. They echo those I penned over a year ago in a blog titled How Much Carb, Protein or Fat? Does it Really Matter for Weight Loss or Keeping Pounds Off? and continue to speak about.
Have you heard the terms insulin resistance, insulin sensitivity and metabolic syndrome in the same breath as prediabetes and type 2 diabetes? Do you wonder how these terms are intertwined with prediabetes and type 2 diabetes?
Learn the terms and gather action steps put them in reverse or at least slow their progression over time.
What Is Insulin Resistance?
Insulin resistance most often occurs in people who are overweight. People who carry their extra weight around their middle – the abdomen or waist line - are at increased risk. The medical term for that apple shape is central adiposity.
As a dietitian and diabetes educator I know the critical importance of weight control as part of disease prevention and/or control and healthy living. I also know how challenging it is to keep pounds lost ….well, lost forever. It takes inner strength, fortitude, perseverance and much more. Compared to taking the pounds off, keeping the pounds off is THE hard work and it goes on endlessly. Good news is experts say it gets easier over time.
In this blog I’m dialoging with Bob Wilson, a dietetic technician in his day job. Bob was a morbidly obese teenager. He weighed 400 pounds in the 8th grade. He lost 250 pounds over 2 years when he hit 21. He has now kept his weight between 155 and 160 for 39 years. He’s been on a remarkable journey. Through his struggle to manage his weight Bob has amassed many learnings and skills and shares these at his website: balancedweightmanagement.com and in his book "Lighter and Free from the Inside Out". Bob wants millions of others to win “The Biggest Maintainer of Weight Lost” award. He graciously agreed to share.
HW Q: You discuss 12 Essential Skills for long term weight loss/control. Can you list the top 5 and briefly state why they’re most important to long term success?
BW: A: My overarching message: for lasting success discover skill power, not willpower!
I’ve just got to share the sheer joy and reward I’ve recently experienced facilitating yet another chat-based online weight loss group for the program called vtrimonline.com.
Picture this: It’s Tuesday evening at 7pm ET. Somewhere between 10 to 20 people who range in age, health concerns and pounds to shed; log on to the vtrimonline website for one of our 12 weekly chats. No phones, no cauliflower ears or hoarse voices. Just our fingers!
During the hour I, as the registered dietitian facilitator, get group members to share their weeks’ weight loss wows and woes (with no mention of pounds lost). I deliver key content to help arm people with nutrition, fitness and psychological expertise to lose weight and (hopefully) keep it off. Topics range from how to get moving more each day, to tactics to deal with emotional eating, to healthy choices when eating out, and much more.
A few facts are crystal clear:
- Myriad adults would improve their health status and potential longevity by losing a few pounds. Five percent seems to be the magic number to reap health benfits.
- Two thirds of adult Americans are overweight or obese, including many Medicare beneficiaries.
- Losing weight, even a few pounds, and keeping those pounds off is tough work which requires tenacity.
- Primary care providers (PCPs), including general and family practice physicians, nurse practitioners, physicians assistants and others; aren’t known for addressing or spending the time it takes with clients to counsel them on weight control. (In all fairness, they haven’t been allotted the time until now.)
- Susan Yanovski, MD, in her 11/24/11 New England Journal of Medicine editorial Obesity Treatment in Primary Care – Are We There Yet? (abstract), stated: “less than 50% of PCPs report consistently providing weight-control advice to adults and less than 25% report regularly referring people to other providers who may help them with weight control.”
- It’s well known that PCPs receive a minimumof nutritional science in training and it’s highly unlikely that many have obtained the skills known to be effective in weight management counseling from studies on long term weight management.
Yet despite these facts, on November 29th, Medicare (Centers for Medicare and Medicaid Services) announced in their Decision on Intensive Behavioral Counseling for Obesity that it will start to cover obesity counseling services when provided by PCPs (as defined by CMS).