PART 4: Long Term Weight Loss

Keeping off the weight you lose. The tried and tested ways.

We’ve arrived at Part 4 of this blog series. We started when we were all adjusting to the “new normal” of a coronavirus pandemic, and now the world is slowly getting back to the way things were—restaurants are opening, and some friends and family are enjoying summer visits together, even if at a physical distance. 

Interestingly, while for some people being home – with less structure, and under significant stress – has resulted in pounds gained (“the corona 15”), many of my patients have actually had more time for meal prepping, exercise, and self care now that they haven’t been commuting and sitting in an office all day – and they’ve been able to lose weight, sometimes after years of previous unsuccessful attempts. 

So, I thought we should talk about how to keep the pounds off, and keep up the healthier habits, after you’ve worked so hard to lose weight. I hate to be the bearer of bad news, but it’s really no secret that keeping weight off in the long term is at least as hard as losing it in the first place.

First, let’s understand why it is so hard to keep weight off in the long term.

Eat less, lose weight, then hit a plateau?

When we cut calories over a period of time and manage to lose weight, our body adapts and alters the way it uses energy, to try to conserve it—this is called metabolic adaptation. Our body recognizes that the calories consumed have decreased, that fat stores have been depleted, and perceives all of this as a starvation threat. So it begins to burn energy more sparingly. We think this is how we have evolved, because in times of famine, these adaptive changes helped us prevent starvation and death. But our bodies adapt in the same way – by slowing metabolism – even when lower calorie intake and lower weight are purposeful. This makes it harder to continue to lose weight—and contributes to hitting the dreaded “plateau”. That’s not all: our body also adapts to lower calorie intake and reduced weight by increasing hunger hormones – another way it fights to conserve energy stores, and defend a previously higher weight. So there are many biological factors that contribute to how hard it is to keep lost weight off.

Is there any chance of keeping the weight off?

There definitely is. Over the years, research has provided evidence-based strategies for long-term weight  loss. My patients who have lost and maintained a healthy weight over the long term are always reaffirming that these strategies can, and do, work, and that there is hope!

Much of what we have learned about how to be successful at long-term weight loss comes from the National Weight Control Registry, which has tracked more than 10,000 people who maintained a minimum of 30 lbs weight loss over at least one year (on average they have lost 66 lbs and kept it off for 5.5 years). They all lost weight in different ways, but the interesting thing: they kept it off using similar strategies.

1. Ate breakfast every morning
2. Carefully monitored their calories (Average = 1400 cal/day)
3. Stayed active with high levels of exercise (Average 60-90 mins/day)
4. Did some form of daily self-monitoring
5. Remained consistent with these behaviors—even on weekends and holidays

So, there’s a secret to long-term weight loss?

You already know the “secret”. Yup, the same strategies that worked for you to lose weight will help you maintain your weight. But you can’t give them up when you get to your goal – you have to continue doing what worked in the first place! We have to shift our thinking that weight management is about following a specific type of miracle diet, and understand that it is much more about forming habits that stick over the long term.

Sticky habits to stick with:

1. Keep track of what you eat. Yes, it does get tedious and people are less vigilant about this over time. But if you find your weight trending back up, resuming this practice can really help. Do what’s most convenient for you—keep a log book or a photo journal, use an app on your phone… but commit to writing it if you’re biting it.
   
   
2. Monitor your weight regularly. Keeping an eye on the scale helps. Research shows that people who routinely monitor their progress are more likely to maintain weight loss and fitness goals. 
   
   
3. Stay connected with your support team. They helped you be successful in the first place. Call, email, text… support and accountability are critical for initial as well as long term success. Our patients at Form Health have our support whenever they need it. We use our expertise in obesity medicine to help people improve their health, and we’re by their side every step of the way because we know this is what it takes.
   
   
4. No guilt about slip ups. It happens to everyone. Focus on rewarding yourself for the positives rather than berating yourself for the negatives. Shame is not a good motivator. However, we naturally repeat things that make us feel good. Celebrate your wins, choose non-food rewards for yourself, and work on noticing your positive changes even when they are not totally obvious.
   
   
5. Take a walk. Hit the gym. Studies show that those who exercise at least an hour a day, every day, are most likely to keep weight off over longer-term. The more physical activity, the better.
   
   
6. Manage stress. Many people eat when they are tense or anxious. We now know the biology behind it—certain foods soothe the stress centers of the brain. Additionally, if you’ve been stressed over a long period of time (chronic stress), your body releases the stress hormone, cortisol, which can lead to weight gain. Find ways to relieve stress without turning to food. Meditate. Do yoga. Read a book. Listen to music. Practice a hobby. Try making a list of activities that help calm you. When you’re feeling stressed, try something on the list instead of reaching for something in the kitchen.
   
   
7. Plan ahead. You know yourself best—which situations are “high risk” for you? Is it while you binge-watch your favorite show? Cravings before bedtime? End-of-the-week pizza night? A well thought out plan for such situations can help you make the best decisions. And allow yourself some occasional indulgences – if you plan ahead so you can be mindful and feel in control, you can feel good about eating a portion of something you love – enjoy the experience with all your senses! 
   
   
8. Get a good night’s sleep. Make it a priority to get enough sleep. Sleep deprivation has negative effects on metabolism, and on hormones that regulate appetite, and makes it hard to stay physically active.
   
   

Remember, fad diets don’t work for the long haul. Instead, if you want to lose weight and keep it off for years to come, embrace a new lifestyle that includes a variety of healthier habits, and strategies to make them stick. And know that weight loss is hard, because a lot of complex biology determines your weight, and drives re-gaining. If nothing is working, and your weight is affecting your health, seek help from an obesity medicine team. We’re here to help!

I hope this four-part special series (Part 1, Part 2, Part 3) helped you to begin or continue your journey, and taught you something new. 

Dr. Florencia Halperin is the Chief Medical Officer at Form Health. She is a Harvard-trained endocrinologist dedicated to helping people lose weight to improve their health.