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Vol. LVIII, No. 8
April 21, 2006

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Maintenance Is Priority One
Wing Presents Hopeful Findings in Weight Control

You diet; you exercise; you finally reach your goal. To celebrate, you have a treat, and gradually, over time — you regain.

You're not alone. Only 2 out of 10 people who lose weight keep it off. What happens to the other 80 percent?

Dr. Rena Wing of Brown Medical School  

They suffer an increased risk of type 2 diabetes and heart disease, and Dr. Rena Wing of Brown Medical School knows how to help.

Wing, professor of psychiatry and human behavior at Brown, also directs the Weight Control and Diabetes Research Center at the Miriam Hospital in Providence, R.I. In a Feb. 15 lecture, "Winning at Losing: The Art and Science of Long-Term Weight Control," she presented the results of two promising studies in the behavioral treatment of obesity.

Diabetes, one of the leading causes of death and disability in the United States, leads to complications including blindness, heart disease, stroke, kidney failure and lower limb amputation. It also complicates pregnancy, and babies born to diabetic moms have an increased incidence of birth defects.

Wing began by describing her work in the Diabetes Prevention Program, a major, multicenter NIH-funded trial with 5,000 adults at high risk for type 2 diabetes. "The results were so dramatic," she said, "that the study was stopped early."

The study included three groups: placebo; a group receiving metformin (a medication used to treat diabetes — here used to see if it would prevent diabetes); and a lifestyle intervention group (using diet, exercise and one-on-one contact).

Among placebo-treated participants, about 40 percent converted to type 2 diabetes. Metformin was effective, but about 30 percent still developed the disease.

In the lifestyle intervention group, only 20 percent developed type 2 diabetes. They reduced their risk by a whopping 58 percent, significantly greater than placebo and twice as successful as metformin. Notably, lifestyle intervention worked across the board in the different age groups, ethnicities and body-weight groups — a very robust effect.

"The trial really proved that lifestyle intervention can work," said Wing.

And then what happened? "Although weight loss was extremely effective, we found that many of our participants were not able to maintain their weight over time. This suggested to me that the number one challenge facing our field is maintenance of behavior change. This needs to be our number one priority," Wing stressed.

Against this backdrop, she presented findings from two separate approaches to weight control maintenance.

The first was a questionnaire sent to a group of about 4,000 people in a database known as the National Weight Control Registry. The registry, operated by researchers at Brown and the University of Colorado, was created as a self-selected cohort of successful weight losers. Participants had to have lost at least 30 pounds and have kept it off for a year. On average, they maintained the loss for over 5 years, going from body mass index (BMI) of 37.6 to 25.1. How did they do it?

"'What makes them successful?' is the wrong question," Wing noted. "The better question to ask is 'What makes them successful this time?' Because many had lost, regained and lost again."

Each year, Wing's team sent this group a questionnaire to see what was working.

Nothing magic: a combination of diet and exercise. Most successful participants (55 percent) didn't struggle alone but worked with a nutritionist, a weight loss program or their family doctor.

Wing’s research demonstrates how behavioral treatment improves weight loss maintenance.  

Their diets varied, but on average they were low-fat (not Atkins, she stressed) and low-calorie. Most folks ate breakfast daily (preventing subsequent bingeing). Most weighed themselves daily; and they were consistent in their intake, even on weekends and holidays. As for exercise, on average the successful people briskly walked 3 to 4 miles a day.

How did they find time to exercise? "They watched very little TV," Wing stressed.

Next, Wing presented the results from an NIDDK-funded randomized trial (completed at Miriam Hospital) called "Stop Regain." The program's goal was to test the efficacy of face-to-face and Internet interventions and then compare these two groups to a control group that received only a quarterly newsletter. It was different from most other studies in that it focused on preventing a regain of greater than 5 pounds over 18 months. It was offered only to participants who had already been successful in weight loss, that is, a loss of at least 10 percent of their body weight in the past 2 years (the period when people are at most risk of regaining).

Both the face-to-face and the Internet groups received the same teaching content, treatment materials and amount of contact. At the end of the 18-month study, significantly fewer participants in the face-to-face and Internet conditions had regained 5 pounds compared to the newsletter control group. Participants in the face-to-face group consistently obtained the best results.

The most striking difference in the face-to-face and Internet groups compared to the newsletter control group was the percentage of participants reporting weighing themselves daily over the 18-month program. Those who weighed themselves daily in the intervention groups were less likely to regain weight.

"Weighing yourself daily was strongly associated with a reduced risk of regaining in the Internet and face-to-face programs," reported Wing. The bottom line was that while the control group may have weighed themselves daily, they had not been taught how to use the information to make adjustments in their eating and exercise behavior.

"Just weighing yourself was not sufficient," said Wing. In the treatment offered the successful groups, "something about the whole constellation let them use the weigh-ins to reach their goals." Behavioral treatment, she said, really can improve health.

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