Long-Term Weight Loss Success: Regain Is Not Inevitable
That quote is from a CBC news article published about a year ago, but I’ve heard it many times over the years. Lately I’ve seen an increasing trend in articles and blog posts discussing the futility of permanent weight loss. As a dietitian, I find this message discouraging, and I can’t even imagine how people who are obese (and currently losing or planning to lose weight) feel when they read this.
Many of my dietitian friends and colleagues believe in a Health at Every Size (HAES) approach. On one hand, I feel there’s merit in many of the goals of HAES proponents. I agree that striving for an unrealistic body size is harmful and that it’s important to love and accept yourself at whatever weight you’re at. One of my clients recently sent me a link to a great slogan T-shirt: “You Cannot Weigh Health, Beauty, Value, Intelligence, Kindness, Love, Worth, Success.” There’s no denying that we have a great deal of value beyond our physical size, and it’s certainly not my intention to offend anyone or make waves with the HAES community. I think fat shaming is despicable and should never be tolerated. If you’re truly happy weighing significantly more than what’s considered “ideal,” there’s no reason to read any further. I sincerely wish you all the best.
But I completely understand the desire to achieve a weight at which you feel attractive, happy, and healthy — and this may be very different from where you currently are. As I said, it can be frustrating to repeatedly hear the message that lasting weight loss is almost impossible. Fortunately, the National Weight Control Registry provides evidence to the contrary by collecting data from over 10,000 people in the US who have maintained a weight loss of 30 pounds or more for at least one year. The majority of NWC Registry members have done so for much longer. Although my own story isn’t dramatic in terms of pounds lost (about 35), I have managed to maintain within 5 pounds for the past 30 years (not via low carb for the first 26, incidentally), and I’ve decided to sign up to be a member of the NWC Registry. Better late than never!
“Losing weight is hard. Maintaining is hard. Being overweight is hard. Choose your hard.” – Unknown
There’s evidence linking obesity to increased risk for many health conditions, including diabetes, cardiovascular disease, and certain cancers (1). And while it may be politically incorrect to say this, people often report that they hate carrying extra weight because it’s physically uncomfortable, compromises their mobility, and reduces their self-confidence — ultimately, it has a profoundly negative effect on their quality of life. But losing more than a few pounds can be challenging, and maintaining even more so. Researchers have found that a number of factors make weight maintenance difficult, particularly after massive weight loss, including increased hunger related to a decline in leptin levels (2) and a reduction in resting metabolic rate (3).
Carbohydrate restriction can modulate these effects to some extent via its effects on satiety and hormonal regulation (4), and it may be more effective than other methods of weight loss in the long term (4,5). A well-balanced low-carb lifestyle is arguably one of the most pleasurable and easiest to follow for weight maintenance. However, it’s easy enough to find people who’ve reached or gotten close to their goal weight this way, only to regain some or all the pounds when they resume eating higher amounts of carbohydrates and/or calories.
Long-Term Low-Carb Weight Loss Success Stories
There are several individuals I know who have maintained a loss of at least 50 pounds for three years or longer by following some form of carbohydrate restriction. These inspirational low-carb successes differ quite a bit in their approach. Some follow an autoimmune protocol (no dairy, nuts, or legumes) and avoid artificial sweeteners, while others include some or all of these as a regular part of their diet. Their carb level intakes range from very low (less than 20 grams of total carbohydrate per day) to low-moderate (up to 50 grams of net carbohydrate daily). Regardless of the differences in their diets, they share many commonalities that contribute to long-term maintenance success. And first and foremost among them is they feel undeniably happier and healthier now, and they take the necessary steps to ensure they don’t ever return to their former weight.
Here , in their own words, are the strategies they’ve used for successful maintenance.
Maintaining a loss of 70 lbs for 3.5 years
“I feel I’ve been able to maintain my weight loss by doing several things:
- Daily weighing and treating information like data (with the absence of good or bad, just data)
- Making quick or at least mindful corrections in either types of food and/or amounts of food based on the data of daily weighing
- Not allowing slippery slope thinking, like ‘Oh, I’ve blown it, I might as well have treats.’ So in other words, staying focused on the task at hand
- Reading everything I could get on weight maintenance and keeping only what I knew would work
- Looking back at past gains and discarding the thinking that led to regain (moderate eating of all foods)
- Looking at blood markers, especially glucose and high-sensitivty CRP to help decide if I was heading in the right direction, long term
- Looking at how I felt joint pain, puffiness, acne, ability to sleep, hot flashes, along with the correlation of what I was eating, and choosing only what made me well
- Daily movement of 10,000+ steps including the use of a Fitbit device, 2 short strength training sessions at the gym, occasional Tabata Style sprinting
- Identifying binge eating triggers or sources of emotional eating and reducing or eliminating them (example: food such as emulsifiers), and also developing other coping methods for stress
- Adaptation of the steps in the book “Refuse to Regain” by Barbara Berkeley, MD, who is also now a board certified obesity specialist
- Getting 23andMe genetic testing so I could confirm things like lactose intolerance and know my disease risks (type 2 diabetes and obesity- many, many markers) and designing my diet around that (example: Paleo-ish low carb food template works better than counting points and moderately having cheese and tropical fruits)
- I do still track, weigh meats and proteins, and collect data using My Fitness Pal. The trending and tracking help me decide certain macros or total intake and/or integration with days where I do long hikes or am very active.
- Support. I attend either a weight loss support group with a large number of other maintainers and separate support as needed for binge eating management (my support must be abstinence based or the group will tolerate my abstinence based approach- say, not eating grains or most processed sugars).”
Woo/Jane Plain, blogger
Maintaining a loss of more than 150 lbs for 10.5 years
“The biggest factor in my maintenance, and this is really quite clichéd, is not cheating.
1) Always stay on the diet, even on holidays. I cheat by making on-plan treats. I don’t ever go off of VLC although I flex how low carb I am. Most people can keep weight off if they just KISS (Keep It Simple, Stupid) and focus on eating on-plan food all the time. You can’t regain much weight, no matter what’s going on in your life, if you limit yourself to VLC foods.
Also:
2) Pay huge attention to nutrition, and that includes using supplements. Don’t believe the idea you can get everything you need from food — that only works for healthy people. If you’re a weight loss patient you may need to take EXTRA supplement pills like zinc and magnesium. Low-grade deficiencies can cause big problems, like anemia and a low functioning thyroid. The frustration or poor well-being these very preventable health problems cause can lead to total relapse. I’ve seen it in others. The problem can be prevented if one makes a long-term nutrition supplement organizer and takes them every day. (I take zinc, magnesium, vitamin C, vitamin D, multimineral, multivitamin, extra inositol, carnitine, amino acids, etc.)*
Finally:
3) Little boosts from herbals can help a lot. EGCG in green tea really helps fat burning and appetite. Vinegar also helps with low blood sugar and hunger/fatigue periods. These things can make the difference between maintaining easily and being hungry/hypoglycemic.”
*Note: Please speak with your health care provider before taking any of the supplements above other than a multivitamin/multimineral, especially if you take prescription medications.
Maintaining a loss of more than 140 lbs for 4 years
“Probably the single driving force would be the memory of what it was like to weigh more than 350 lbs. Never forget.
Just to give an example, I largely live in Mexico, and everywhere in Mexico are these cheap plastic chairs (typically sponsored by Corona). Five years ago, there was about a 20% chance that I was going to break through one of those chairs and fall in the middle of a meeting, restaurant, date, what-have-you. I had a 1 in 5 chance of making a quick, loud, surprising and sad little scene. You crash and tumble through enough cheap plastic chairs, it tends to stick in your mind. To this day, I’m still afraid of those terrible menacing plastic chairs.
I just make sure that I never ever forget how bad it was. Maintenance through fear! 😉
The other aspect would be a largely rebooted lifestyle. I’d spent so many years behind a computer that I’d completely forgotten how much fun it is to be active. I dropped the weight, gained some confidence, a modicum of health and my habits just changed. I go to the gym regularly, but am also constantly trying to find new ways to “mix it up.” This evening, for example, I’m taking a tennis class with a friend. On Sunday, I went to go do SUP (“Stand Up Paddle” … the waves were too big, though. They wouldn’t rent us the boards. We bobbed and floated around a pool, instead).
The point is, the weight loss (and the effort) rekindled a new way of life for me. I also tend to run with a pretty active crowd. When I’m sitting behind my computer for too long, they tend to bust me and make me participate in something. I used to decline. Now, I don’t!
So … better habits, newfound lifestyle, keep it fresh, and built-in support.”
Linda Genaw, low-carb recipe blogger
Maintaining a loss of 50 lbs for over 12 years
“What allows me to maintain my weight is the realization that being thin feels so much better inside and outside than being overweight. I just never want to be fat and miserable ever again.”
Low Carb Brian
Maintaining a loss of 100 lbs for 5 years
“I would say the biggest thing for me was, once I lost the weight, I had a real desire to never return to there, so I knew I had to keep myself from craving the foods I ate most of my life. So I hit the internet and found the best low carb recipe websites and compiled a list of my favorite ones, after a lot of trial and error. I kept the best ones and made a cookbook out of them, so now whenever I crave something sweet, fatty, or spicy, I just crack open my book and cook it up. This has helped me stay on track and not even crave the bad stuff anymore. My list of recipes continues to grow, and I have everything I need between my cookbook and internet to maintain my weight loss and stay on point. I lost my 100 lbs in 2009 and have maintained from 2010 to present. “
Shari Bambino
Maintaining a loss of more than 150 lbs for 10 years
“I went from about 325 lbs to 155 in the span of about 3 years eating what was basically Dr. Atkins’ prescription for weight loss. During this time I lost no weight for a good 10 months. Weight loss finally started again and I ended up in the 150’s. I was struggling to maintain at that weight so I came up about 15 lbs and found that a much easier weight to defend long term. Yes, once you are post-obese you defend your weight loss for the rest of your life.
I came to accept that, contrary to the saying “There’s a skinny girl inside of you trying to get out,” the exact opposite is true. My body — any post-obese body — wants to be fat again, and I have to stay on my toes to prevent that from happening. I have done so for the better part of 10 years now. It can be done, and once you get the hang of it, it’s relatively easy to do. Once you get the hang of it. That bears repeating. I’m on autopilot now but I still stand guard. I am beyond grateful to have the opportunity to do so.
If I had to choose the most important thing that has helped me to maintain I think it’s been the fact that through my weight loss journey I came to truly understand that food restriction of some kind was going to be part of my life for the rest of my life. I had previously been done in by my subconscious anger and resentment of having to always and forever be dieting, restricting, watching, being careful. I had thought that the weight loss was enough suffering and that maintenance should be free and easy going. I also thought I’d be so happy to be a normal weight that I would just figure it all out. I learned the hard way that that was not the case.
So, after a lot of work with myself I was finally able to let go of all of this resentment and the idea that I should be able to expect to ever just eat what I wanted with only minor attention. It used to all feel like a punishment. It no longer does. Through the magic of the internet I have come to understand that I am a part of a large community of people who restrict certain foods on behalf of their health. Instead of the resentment and anger that I used to feel, I now have an appreciation for the gifts that my restriction brings. People always ask me how I did it. I tell them, “I changed my mind.” In the end, it is what it is. None of us are special enough flowers to be able to keep the weight off without a great deal of attention. This is a life-long journey. Find a way to accept it, run towards it, and embrace it in whatever way works for you.”
Maintaining a loss of over 200 lbs for 3.5 years
“I’ve maintained an over-200-lb weight loss for almost 4 years now, and have been eating a low-carb, high-fat diet since November 2009. For me, the biggest factor in maintaining that weight loss has been following Eric Westman, MD’s Low Carbohydrate, Ketogenic Approach: No Sugar, No Starch Diet. I have finally found a way of eating and living that allows me to feel full, nourished from the inside out. Eating good dietary fats, moderate protein, and very, very little to no sugar or starch (only those occurring naturally in certain foods allowed on Dr. Westman’s plan, which limits carbohydrates to 20 grams total per day), I find that I am no longer hungry. My blood glucose levels stay stable, so I’m not driven to eat empty calories (low-fat foods) in an effort to find something that will quiet hunger signals, and I’m forever grateful for that. There are wonderful recipes out there…using real ingredients…LCHF food is delicious!
Stay with it and don’t be discouraged…this works!!”
Here’s an excellent presentation Lynn gave at the Central Coast Nutrition Conference in March of 2014, where I was fortunate to meet her in person for the first time:
“The Journey from Obesity to Health: A Patient’s Perspective”
https://www.youtube.com/watch?v=vkOKhKXW8kU
“Anything in life worth having is worth working for.”
– Andrew Carnegie
My goal for this post was to inspire you and share useful advice from successful maintainers rather than warn that if you do manage to lose weight, you’re very unlikely to keep it off. It is possible, but it takes diligence, discipline, and doing whatever you can safely and healthfully do to remain at a size you’re comfortable with. I know there are hundreds (thousands?) of similar long-term low-carb successes out there, and that those featured here feel that if they can do it, you can too. I wholeheartedly agree and wish you the very best of luck!
References
1. Kopelman P, et al. Health risks associated with overweight and obesity. Obesity Reviews 2007;8:13-17
2. Kissileff HR, et al. Leptin reverses declines in satiation in weight-reduced obese humans. Am J Clin Nutr. 2012 Feb;95(2):309-17
3. Heshka S, et al. Weight loss and change in resting metabolic rate. Am J Clin Nutr. 1990 Dec;52(6):981-6
4. Paoli A, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate ketogenic diets. Eur J Clin Nutr 2013 Aug;67(8):789-96
5. Bueno NB, et al. Very-low-carbohydrate ketogenic diet vs. low-fat diet for long-term weight loss: a meta-analysis of randomized controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87
Great post from my wife here. I really enjoyed reading everyone’s experience and what they did to lose weight and keep it off.
I have been very lucky that I had a high metabolism and for the first 40 years of my life I have been very skinny. Actually, too skinny. But after 40, I gained about 30 lbs. With Low Carb and my wife’s help, I lost about 20-25 of them and have kept it stable.
This is definitely, not as amazing as the stories in this blog post.
There was one statement in the stories, that I feel is huge. Something that not only applies to weight loss and keeping it off, but in many areas of life that you want to improve on, and how to do it.
“I tell them, ‘I changed my mind.'” – Shari Bambino
Very powerful quote.
What at terrific and useful post, Franziska! It seems to be that part of the nature of humans as a species is to adapt to a higher body weight, and then defend that as the new normal. Like all traits, some people express this more strongly than others, but it is the general rule. It takes a while for this adaptation to occur, so someone who has not previously been at a higher weight may, for example, gain 15 lb on a holiday and loose it again, giving that person and others the false impression that weight control is easy.
Once a person’s body has become adapted to a higher body weight, if we look at the situation from the point of view that the body is fulfilling it’s normal functioning by defending that weight, then the penny drops that for many people, even a terrific healthy lifestyle is not enough to meet their weight control goals. Taking great care of your health helps your body function well. As a general human trait (variable among people) defending a higher body weight IS functioning well, as far as your human physiology is concerned!
That is were extra “leverage” comes into play – such as keeping insulin levels low – and the many other strategies described according to the individual experiences of those inspiring “success story” folks above.
Much thanks for this post, and especially for the input of those who contributed.
Thanks so much for your comments and sharing your insight, Dea. Very much appreciated!
For many, just low carb is not enough and does not even address our problem. It may even make maintenance more difficult.
Thanks for your comment, Fred. While low carb may not work for everyone, there are many who’ve found that it’s the only way of eating that allows them to maintain. Also, there was quite a bit of advice about incorporating strategies that complement carb restriction provided by the people featured in this post, particularly Karen P and Woo.
I agree with this as I had been LCHF for more than 10 years and VLCHF for 5 more. I lost a grand total of 17 Lbs. It was not until I started intermittent fasting that I started losing weight. I have lost so far 33 Lbs and have at least 60 more to be at a healthy weight. I do still eat LCHF on non fasting days. I find it easy to do and plan to do it the rest of my life. Also all my lipids and BG are all lower as well!
Thanks so much for your comments, Nell. Congrats on the weight loss, keep up the great work, and best wishes for success in reaching your goal!
Just a small side note, my beautiful baby sister Fancy”s name was also Franziska. When I see your name it reminds me of her, she passed away In April from lung cancer. Seeing that spelling always makes me smile!
My sincere condolences on the death of your beloved younger sister. I’m smiling knowing that we share the same name and spelling 🙂 Also love the nickname Fancy!
When I’d come to the end of your post and read your goal Franziska it certainly was / is a good one … and yes, I do think this post will help many.
Thanks to all who have given their stories. Exchange of real life experience is such a positive.
All the best Jan
Thanks so much for your kind words, Jan, and your continued support. They mean a lot to me.
Warmest regards,
Franziska
Thank you. Franziska, for all that you do to help people with whatever they need, whether it be weight loss, diabetes, etc. Most dietitians make matters worse by following the old protocols even if they are not effective. You are open minded enough t think for yourself.
I’m so touched by your words of encouragement, Andrea. Thank you very much for taking the time to read and comment here.
After a heart attack 15 years ago, I went from 237 pounds to 150 in about 4 months on an ultra low fat essentially vegan diet. I splurged once a week to keep my sanity and settled at 160 pounds for years. But my heart was never healthy in spite of being pretty skinny (160 at nearly six feet) and eating all those heart healthy whole grains. Slowly some weight would creep back and so I would have to get more strict about the low fat and it was, frankly, torture.
Over 2 years ago, my wife and I decided to follow the advice of a friend who had gone low carb. At first it was just to lose 20 extra pounds. Within 3 months we were 20 pounds less. I started to really read up and study the whole low carb/low fat question. A year after going low carb, I had another heart test (cardiolite) and for the first time in 13 years and 7 cardiolite tests, had the results that my cardiologist and I wanted.
There is no doubt that a person can become skinny on a low fat/vegan diet. But I wasn’t healthy until I went low carb.
The food is delicious and so filling. I just had my version of fauxtato salad and cold salmon for lunch. We never splurge as we had to on the low fat diet. We just say that it is like it is our birthday every day.
Another excellent article Franziska
Thanks for sharing your own inspirational story, Rick! Congratulations on achieving great results on your cardiac stress test after following a carb-restricted diet for one year. I agree that being thin is no guarantee of optimal health — food choices definitely matter. And a low-carb diet based on whole foods can have a profoundly beneficial effect on cardiovascular health, as you’ve experienced first hand. I’m so glad you and your wife are enjoying your low-carb lifestyle so much that each meal feels like a celebration 🙂
Thanks for your nice feedback on the article, and keep up the fantastic work!
An encouraging post. Thank you once again for fair-minded treatment of a hot topic. Love the personal accounts. Know many who’ve starved themselves on unhealthy, unnecessarily restrictive diets only to gain everything, & sometimes, more back. Not being hungry, not feeling deprived on VLC or LC is a boon, in addition to the benefits of a healthy diet.
Thanks so much for your comments, Gerri! Great points made.
I’ve maintained a 30-pound weight loss for over two years now! I lost the weight doing a low-carb paleo diet (I can’t seem to lose weight if I eat dairy). My maintenance plan is a bit more lenient: I stay gluten-free 100%, sugar-free 98%, dairy-free only about 50% of the time (feel better without, but I love it). I let myself have a few GF, sugar-free carbs on the weekends (in moderation) and follow the low carb/paleo during the week. Eating this way, I don’t gain the weight back and I still feel good.
Thanks for sharing your story, Diana! Glad you’ve found a way of eating that allows you to maintain your weight loss and still enjoy many foods you love.
What a wonderful post! One of infinite hope. I myself have gone down significantly and never went up quite that high, but until I found ketogenic eating, I just rode that roller coaster. Finally (and maybe blessedly) my hormone specialist (medical doctor), told me I had a1c of > 5.8 and well on my way to T2 diabetes if I didnt make some adjustments. I stay on the course and I agree with Wooo, cheating should be on-plan. And I enjoy all the nice meals that one simply cannot on all those low fat diets!!
Thank you so much, Helena! I’m so glad you enjoy your low-carb lifestyle and have managed to improve your health as well as lose weight. Congratulations!
Thank you! I was looking for hope that your article provided today. I know many maintainers in my support group and knew there had to be more out there.
I have grown tired of comments and articles that say LC of any form in not sustainable. I know it is not the answer for everyone, but for me this lifestyle is working. I am only a few months in, and believe for me it is a life long commitment. My health has improved tremendously and I just don’t ever want to go back to where I was. I have never ate better or cleaner. The 40 lbs down for me is just a bonus on top of how I feel. Thank you again for such a great article.
Thanks so much for your comments and nice feedback, Lynn! Congratulations on losing 40 pounds and reducing many health risks with a low-carb lifestyle. I’m glad you’re eating so well and feeling great. Thanks again for taking the time to comment and share your own story. Keep up the great work! 🙂