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Lessons from Successful Losers: The National Weight Control Registry

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Title: Lessons from Successful Losers: The National Weight Control Registry


1
Successful Weight Loss Maintenance
Suzanne Phelan, Ph.D. Weight Control and Diabetes
Research Center Brown University/The Miriam
Hospital
2
Obesity is Increasing in Prevalence
  • 64 of Americans are overweight or obese
  • This is an increase of over 8 in the past 10
    years
  • 15 of children and adolescents are overweight or
    obese
  • This is an increase of 5 in the past 10 years
  • (10 increase in Mexican-American and Black
    adolescents)

3
Obesity and Disease
  • Obesity increases the risk for many diseases
    including
  • Hypertension
  • Hypercholesterolemia
  • Certain forms of cancer
  • Type 2 diabetes
  • With the increase in rates of obesity theres
    been a dramatic rise in type 2 diabetes
  • Medical costs of obesity exceed 100 billion/year

4
Obesity Trends Among U.S. Adults BRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
5
Obesity Trends Among U.S. Adults BRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
6
Obesity Trends Among U.S. Adults BRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
7
Obesity Trends Among U.S. Adults BRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
8
Obesity Trends Among U.S. Adults BRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
9
Obesity Trends Among U.S. Adults BRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
10
Obesity Trends Among U.S. Adults BRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
11
Obesity Trends Among U.S. Adults BRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 1519 2024 25
12
Obesity Trends Among U.S. Adults BRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 1519 2024 25
13
Obesity Trends Among U.S. Adults BRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 1519 2024 25
14
Obesity Trends Among U.S. Adults BRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 1519 2024 25
15
Prevalence of Diagnosed Diabetes, Adults 18
years and over, by State, United States
1994
2000
Age-adjusted percent
4-4.9
5-5.9
6
Note 1994 3-Year Average 2000 2-Year
Average. Source Behavioral Risk Factor
Surveillance Survey (BRFSS), CDC,
NCCDPHP. www.cdc.gov/diabetes/statistics/prev/stat
e/fig61994and2000.htm
16
Weight Loss Can Markedly Reduce the Risk of
Disease
  • Recent studies show benefits of weight loss for

17
Behavioral Treatment and Conventional Diet
(1988-90)
  • Complete Treatment 88
  • Initial Weight 91.9 kg
  • Length of Treatment 21 weeks
  • Weight Loss 8.5 kg (9)
  • Follow-up 53 weeks
  • Loss at Follow-up 5.6 kg

18
Weight Loss Using Comprehensive Lifestyle
Modification Program
Treatment
Follow-up
TIME IN WEEKS
Wadden et al., 1989
19
  • Most obese persons will not lose weight, and of
    those who lose weight, most will regain it.
  • Stunkard AJ, NY State J Med. 1958 5879-87.
  • Losing Weight An Ill-fated New Years
    Resolution.
  • New England Journal of Medicine
    Editorial (1/11/98)

20
Does Anyone Succeed at Long-Term Weight Loss?
Prevalence Study (McGuire, Wing, Hill, 1999)
Proposed Definition of success
  • Individuals who have intentionally lost at least
    10 of their body weight and kept it off at least
    one year.

21
Random Digit Dialing Survey
  • N 500 / 228 were overweight (BMI 27) at some
    point in their lives
  • N 69 of the 228 (30) had lost at least 10 and
    maintained it at least 1 year
  • (mean 42 lbs / 7 yrs)
  • N 47 of the 228 (20.6) had intentionally lost
    10 and maintained it at least one year 28 of
    these individuals had reduced to normal weight

22
National Weight Control Registry (NWCR)
  • Developed in 1994 by Rena Wing and James Hill
  • Registry of successful losers
  • Minimum of 30 lbs of weight loss for a minimum of
    one year
  • 18 years of age
  • N6,000

23
Questionnaires
  • Demographics and weight characteristics
  • Weight loss methods
  • Weight maintenance methods
  • Previous weight loss attempts
  • Difficulty of weight loss and maintenance
  • Effect of weight loss on other areas of quality
    of life
  • Paffenbarger, Food Frequency, Eating Inventory

24
Who is the NWCR? Characteristics of Registry
Members
N 4297 77.4 female, 22.6 male 82 college
educated 95.3 Caucasian 64.3 married Age 46.8
12.5 Past BMI 36.7 kg/m2 Current BMI 25.1
kg/m2
25
How much weight did they lose?
  • On average 33 kg
  • 32 kg in women
  • 34 kg in men
  • Maintained the minimum weight loss (13.6 kg) for
    5.7 years
  • 13 maintained the minimum weight loss 10 years

26
Weight Loss History
  • Most (70) had onset of obesity before age 18
  • 91 reported that they had tried to lose weight
    previously
  • Compared to previous efforts, this time they
    reported greater social and health reasons for
    losing weight, being more committed to behavior
    change, and using more intensive exercise and
    dietary approaches

27
How did they lose weight?
  • 89 reported both diet and physical activity
  • 10 reported diet alone
  • 1 reported exercise alone

28
Dietary Strategies to Achieve Weight Loss
  • Restricted certain foods 87.6
  • Ate all food but limited quantities 44.2
  • Counted calories
    43.7
  • Counted fat grams 25.2
  • Used liquid formula 20.4
  • Used exchange diet 22.5

29
How did they lose weight?
  • On their own 44.6
  • Formal program 55.4

30
What makes these people successful?
31
NWCR Weight Loss and Maintenance Strategies
  • No similarity in how weight was lost
  • Great similarity in how weight is being
    maintained
  • Low fat diet
  • Watching total calories
  • High daily levels of physical activity

32
Current Eating Habits
  • 55 still trying to lose weight
  • Energy intake (kcal/d) 1,385 557
  • Energy from fat () 26.6 10

33
Current Eating Habits
  • Fast food meals/week 0.74 1.5
  • Eat out 3 meals/week
  • Eating episodes/day 4.87 2.97
  • Most eat breakfast daily 78

34
Self-Monitoring
  • 75 weigh self more than once per week
  • 50 still count calories/fat grams
  • Dietary Restraint 15.0

35
Physical Activity in the NWCR
  • Only 9 report no physical activity in the weight
    maintenance phase
  • Most NWCR members far exceeded the minimum
    physical activity recommendations proposed by the
    Surgeon Generals Report
  • Almost half use walking and an additional form of
    exercise

36
Average Energy Expended in Physical Activity in
the NWCR
37
The Six Most Frequently Reported Activities in
the NWCR
  • Walking 76.6
  • Weight Lifting 20.3
  • Cycling 20.6
  • Aerobics 17.8
  • Running 10.5
  • Treadmill 6.3
  • Stair climbing 9.3

38
TV Viewing in the NWCR
39
Effect of Weight Loss on Other Areas of Life
40
  • What happens over time?

41
One-year follow-up
  • 35 gained 5 lbs. or more (mean 15.5 lb.)
  • 59 continued to maintain
  • 6 lost additional weight

42
One-year follow-up Predictors of weight regain
  • Shorter duration of weight loss maintenance (years)
  • OR for Gaining 5 lb. vs. Maintaining
  • Weight Loss Maint. Odds Ratio
  • 2 4.9 yrs .42
  • 5 yrs .29

43
One-year follow-up Predictors of weight regain
  • Higher disinhibition scores
  • OR for Gaining 5lb. vs. Maintaining
  • Disinhibition
  • Disinhibition 6 1.6

44
One-year follow-up Predictors of weight regain
  • More TV viewing
  • More fast food consumption
  • Less frequent breakfast consumption

45
One-year follow-up Behavioral changes
associated with regain
  • Decreased exercise
  • Increased TV viewing
  • Increased calories
  • Decreased restraint

46
Dieting Consistency
Do you maintain the same diet regimen on
weekends as you do on weekdays?
Do you maintain the same diet regimen on
holidays and vacations as you do during the rest
of the year ?
47
Dieting Consistency Scores in NWCR Participants
Weekend vs Weekday
of participants
1 2 3 4 5
6 7 8
Much stricter on weekends
Same on weekends and weekdays
Much stricter on weekdays
48
Weight Regain from Year 1 to Year 2 Based on
Dieting Consistency Score Weekend vs. Weekday
Weight regain in kg
4 5 6
7 8
Same on weekends and weekdays
Much stricter on weekdays
49
Triggering Events
  • 23 medical trigger
  • 60 non-medical trigger
  • 17 no trigger

50
Weight Loss Triggers and Magnitude of Weight Loss
51
Weight Loss Triggers and Two Year Weight Regain
52
Factors associated with weight loss maintenance
  • Higher duration of maintenance
  • Lower disinhibition and depression
  • Less TV viewing and fast food
  • Consistent eating pattern
  • Medical trigger

53
Strategies for weight loss maintenance
  • Continued contact
  • Structured diets
  • Higher amounts of physical activity

54
Weight Loss Using Behavior Therapy (BT) vs.
Behavior Therapy Plus Maintenance
BT
BT maintenance
0 1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17
Treatment
Follow-up
Time (months)
Perri et al., JCCP 1988 56529-534
55
(No Transcript)
56
Weight Loss Maintenance Using Meal Replacements
Standard then Meal Replacement
Meal Replacement
0 2 4 6 8 10 12 14 16 18 20
22 24 26 28
Time (months)
Ditschuneit et al., AJCN 1999 69 198-204
57
Trim High Exercise Study
  • 202 subjects mean BMI 31.7
  • Randomly assigned to
  • SBT with 1000 kcal/week physical activity
  • SBT with 2500 kcal/week physical activity

58
Weight Change (kg) Over Time by Treatment Group
Weight Loss (kg)
SBT
HPA
Baseline 6 mos 12 mos
18 mos
59
  • What can practitioners do to promote long-term
    successful weight loss?

60
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