Psychology Today endores WLS, however here is a scary thought: Unfortunately, studies also show that 90-95% of overweight and obese people who successfully lose weight subsequently regain it within 5 years. Reflections of a Buddhist Physician by Alex Lickerman, M.D. Alex Lickerman is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989. See full bio October 15, 2009, Diet

The Truth About How To Lose Weight

A summary of new research on weight loss.

1. First, recognize there's no way to lose weight and keep it off that's easy. Completely discontinuing an addictive behavior is far easier than moderating one—and obviously you can't ever stop eating. People whose brains seem to want them to be obese must accept that, in order to achieve and maintain a healthy weight (which need not be perfectly thin), they will likely have to work at it for the rest of their lives. As science and technology advance, this may eventually not be the case, but for today it is simply the truth.
2. It's extremely difficult to lose weight without regular exercise. Not impossible. Just much more difficult. Exactly what exercise routine is best, however, remains debatable. Evidence exists that if you exercise past a certain level of intensity ("intensity" being variably defined in the medical literature) you'll actually induce an increase in your resting metabolic rate that lasts up to 11-14 hours after you've finished exercising. Some think this shift may counteract the tendency of brains with higher weight set points to lower resting metabolic rates when weight loss begins. In other words, jogging for 30 minutes may only burn 400 calories or so, but by raising your resting metabolic rate for 11-14 hours afterward, you may burn up to as much as an extra 1000 calories! Interestingly, anaerobic exercise (like weight lifting) may actually be more effective than aerobic exercise (like jogging or aerobics) in producing this effect. On the other hand, studies of people who walked on treadmills (a low intensity exercise) while actually at their desk jobs (instead of sitting at their computers they walked at their computers!) also lost significant amounts of weight over the long-term. Unfortunately, while many people attempt to lose weight with low intensity exercise, most don't do nearly enough of it to be effective. Finally, the key to maintaining a good exercise program is to think creatively about how to fit it into your busy daily schedule. The glass is always half-full: any amount of exercise you manage to do is worth it. Even just 15 minutes a day.
3. Get adequate sleep. Through complex mechanisms only partly understood, inadequate sleep is now known to make it more difficult to lose weight. In addition, it's hard to exercise regularly or intensely if you're chronically tired.
4. To cut calories reducing carbohydrates may be better than reducing fat, and is certainly better than reducing protein. Though I'm not endorsing any one particular diet over another, one thing from the medical literature seems clear: when you reduce your calories, don't do it by reducing protein.
5. Make all lifestyle changes gradually. Don't expect to be able to run a marathon on your first day of exercise. Don't expect to cut your calorie intake in half the first week. Pick an exercise you like (or at least don't hate), begin it slowly, and build up intensity gradually. Consult your physician if you have health problems that may make exercising dangerous. Alter your diet gradually and make choices you can tolerate and maintain in the long-term.
6. Keeping a food diary may help. Studies have shown most people tend to underestimate the amount of calories they eat (Mrs. Withers turned out to be a case in point). Studies have also shown keeping a food diary itself tends to cause people to reduce their calories spontaneously. How long that effect lasts, however, may be limited.
7. Figure out if you're overeating for secondary gain. In other words, does eating fulfill some other purpose for you besides satisfying hunger? Many people overeat to deal with unpleasant feelings such as anxiety or depression. This actually works because pleasure of any kind is extremely distracting. If you find yourself eating for comfort, think creatively about substituting another pleasurable activity besides eating that can distract you from whatever unpleasant feelings you're trying to avoid. And take steps to challenge those unpleasant feelings directly.
8. In general, avoid diet pills. I advise this for three reasons. First, the diet pills that work (and many do) typically only yield an additional 10% weight loss (despite this modest benefit, some of my patients still want them—to date, however, no one to whom I've given them has chosen to stick with them). Secondly, once you stop the pills, that 10% of weight you lost will come back. Thirdly, some diet pills aren't safe (does anyone remember fen-phen?). Millions of dollars are being spent every year on research to find effective, safe diet pills so I suspect eventually we'll have some good ones—but I see none now. As a side note, beware exaggerated claims made by manufacturers of over-the-counter diet pills. None of them that have actually been studied have lived up to their claims.
9. Gastric bypass may be a good option. You have to meet strict criteria to qualify as a possible candidate (BMI>40 or BMI>35 associated with a serious weight-related health problem) and all surgery carries risk. However, with a BMI>30 you're also at risk for a premature death. Also, this surgery cures diabetes and hypertension in 90% of patients who also have those diseases! No medication we have can do anything like that. If this path seems like it might be right for you, ask your doctor for a referral to a beriatric surgeon.

As I told Mrs. Withers the last time I saw her, losing weight and keeping it off is incredibly hard, but hard is easy compared to impossible. And though she hasn't yet managed to lose a significant amount of weight, she yet may. As may you.

 

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Thanks, Pink.  Interesting info. At almost 6 years out, I'm still 28 pounds from my surgeon's goal so i'm always I'm always interested in the regain stats.  Sometimes I'm glad that I lost slowly because several of my friends who had wls (before me or around the same time) have regained--one has gained 100 pounds. The others from 40 to 70 and they were all very close to their goal weights.   I agree about changing habits slowly too, because i sure did.  I didnt want to try to be perfect and only do it for a short time--like when I was constantly dieting, because I know how I am, and knew it wouldnt last.  So I did give myself permission to change gradually -- some things I'm STILL working on ... 





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