Weight loss: The big question

by ruthlaugesen / 20 December, 2012
It's the season for slimming resolutions. But once you've shed the bulk, how do you keep it off?
Bernard Hickey after bariatric surgery, with his wife, Lynn Grieveson
Bernard Hickey after bariatric surgery, with his wife, Lynn Grieveson, photo David White.


Graeme Peters was euphoric when, after 10 months of rigorous dieting and exercise, he lost 20kg from his 95kg frame. The chief executive of agriculture industry group Agcarm felt healthy, clothes fitted him more easily and he enjoyed looking good for himself and his partner. But more than a decade later, globule by globule, the extra padding has crept back on. “I feel disappointed in myself. Unfortunately, I just started eating too much again. It’s got to the point where I’m thinking I have really got to get that weight down again,” says Peters.

His experience is as common as it is soul-destroying. Movie director Sir Peter Jackson became thin in 2005 but is now as well-laden as a hobbit’s dining table. Actor Pamela Stephenson jettisoned 12kg while taking part in Strictly Come Dancing, but has just confirmed she has regained it. Oprah Winfrey’s figure balloons and shrinks with alarming regularity.

Losing weight and keeping it off is a Herculean task. But it isn’t impossible. Researchers who looked at more than 4000 dieters from 29 longterm studies found that contrary to popular belief, not everyone regains all the weight they lose. After four or five years, the average dieter kept off about a quarter of her or his initial weight loss. Others beat the odds and keep off all the weight they have lost. Experts say the key is to want it so badly that you are willing to change a lifetime’s habits so that the architecture of the brain itself becomes altered.

“Essentially, you have to develop a new lifestyle that trumps the old obesigenic one. But you’ve got to practise and practise the new lifestyle until it becomes second nature,” says Professor Doug Sellman, a researcher in obesity, author of a weight-loss book and head of the National Addiction Centre at the University of Otago. Twelve years ago he changed his lifestyle, gradually brought his weight down from 86kg to 70kg, and has kept it there.

He says our mind may decide we want to lose weight, but it is not until we practise new eating habits over and over that the grooves laid down in our brain begin to change. “There have to be real changes in the brain, and of course changes in the brain relate to protein synthesis. Most of what we do is automatic behaviour in relation to environmental cues. It’s said that it takes 10,000 hours to achieve or master something complex, like a trade, musical instrument or new language. I suspect it’s the same principle here – 10,000 hours of practising a new lifestyle gets the brain developing new circuitry, new memory, new structure that underpins that new lifestyle. It takes months to years, rather than weeks to months.”

SLOWLY BUT SURELY


So far, so agonising. But, argues Sellman, although change is hard, slowly losing weight is more successful than rapid, punishing weight loss. There are two reasons for this. One is the dieter’s dilemma, the metabolic backlash that comes after sudden weight loss. The body goes into famine mode and unhelpfully lowers its energy requirements so you can put weight back on again. Slow weight loss is more likely to sneak in under the metabolic radar. Second, the sort of diet that will yield quick weight loss is unlikely to be what you will want to keep eating forever. “You’ve got to say I’m changing my life for the rest of my life. It’s not just a project for a few months.”

He recommends setting targets for weight loss as a percentage of total weight. People categorised as overweight based on BMI should lose no more than 5% of their weight over a year. So someone who is 80kg should lose up to 4kg in a year. For those who are obese, based on BMI, he suggests aiming to lose 5-10% of their total weight. For Graeme Peters, that means a 20kg loss will have a better chance of sticking if it takes several years, not months, as part of a lasting shift in habits.

Sellman puts his sustained weight loss down to becoming obsessed with a different way of living, and practising it every day until it felt normal. His regime includes daily stretching exercises, weighing himself every day, always having breakfast, taking lunch to work, eating fruit and vegetables often and having “treat food” only occasionally. He drinks alcohol and eats ice cream weekly rather than daily, rides his bike most days rather than taking the car and uses the stairs instead of lifts at every opportunity. He reckons it took three or four months for his new habits to start to bed in, and about two years for them to become more automatic. “Now it would feel odd for me to get in the car and go to work, as a routine.”

ADDICTION INTERRUPTER


Shape-shifter: Sir Peter Jackson at the November 28 Hobbit premiere, photo Mark Mitchell/NZH


If the weight creeps back on, it should be seen not as a failure but as a learning opportunity, Sellman says. He is halfway through a five-year study of 25 obese people who want to lose weight. “It’s the relapses we’re finding in our obesity groups that really are the learning bits – when people slip up, being able to come back and talk about why they slipped up without shame.

“What has emerged is this relationship people have with food, which looks very similar to the relationship people with drug addiction have to drugs. An intense, intimate and ambivalent relationship with food. Overcoming that means developing new rules around food and then practising those rules.”

A food rule acts as a conscious line in the sand that breaks through old habits, like an “addiction interrupter”. Each participant worked on three to four new food rules to begin with, such as “no eating after tea”, “no seconds”, “no chocolates, biscuits, cake or ice cream”, “no eating between meals”, “no pudding unless on track with weight goals”.

Members of the weight-loss group have found they need to develop a new relationship with themselves. “Everyone does have a relationship with themselves, but many people aren’t aware of it. It’s really parenting yourself through it. It’s kindness; it’s also boundary-setting and a kind of loving sternness.” Beating yourself up for slip-ups definitely doesn’t work, says Sellman, as it just makes you want to eat more.

America’s National Weight Control Registry collects information from people who have managed to keep weight off long term. On average they have lost 33kg and maintained that loss for more than five years. Those who succeed report that they have high levels of physical activity of about an hour a day; eat a low-calorie, low-fat diet; eat breakfast regularly; monitor their weight; and keep a consistent eating pattern throughout the week. Continuing to monitor weight allows them to catch small weight gains and nip them in the bud. Maintaining weight loss seems to get easier over time, with success rates increasing for those who have already kept weight off for two to five years.

Catching slips before they turn into larger relapses appears to be critical. And those most likely to regain all their lost weight were those who put weight back on in the first year, even gains as small as 1-2kg. The importance of a low-fat diet in sustained weight loss has been confirmed in new research published in the British Medical Journal this month, co-authored by University of Otago human nutrition professor Murray Skeaff. A review of 43 studies involving more than 73,000 people found people who ate less fat lost 1.6kg after six months, and lost half a centimetre in girth around the waist. All the trials were ones in which the weight loss was not intended. The weight loss happened rapidly and was sustained for at least seven years.

UNDER THE KNIFE


For some fighting a losing battle against weight gain, bariatric surgery is increasingly touted as a good option. However, it isn’t a silver bullet, as it involves drastic surgery, reducing the size of the stomach, removing part of it or bypassing it. On average, there is some weight regain, and some even regain all the lost weight and have to have repeat surgery. A 2004 Swedish study over 10 years of 600 people who had had bariatric surgery recorded an initial weight loss of about 23%. Ten years later, that had reduced to a 16% loss.

Business writer Bernard Hickey decided to get a full gastric bypass in 2009 after years of weight problems, and because he had pre-diabetes and a family history of diabetes. He peaked at 140kg before the operation and lost about 40kg. Today he is watchful about how much he eats, ever aware of the threat of weight regain.

His weight bottomed out at 97kg and is now 101kg – a 4kg gain. Pretty good, surely? “No, if I kept doing this for the next three years, it would be back up there again.” He avoids all food with sugar or fat in it. “I have a habit of cycling everywhere: I cycle to work, I cycle home again, I cycle into town, I cycle to school. Basically I have worked out I need to keep exercising, because it makes me healthy. And while I’m cycling, I haven’t got any temptations to sit down at a cafe and have a juicy muffin,” says Hickey.

He believes habit rather than metabolism is the big driver in regaining weight. “I haven’t lost the tendency to really enjoy food and eat more than I should. You have to be wary of it. The other danger is you think you can get away with overindulging, and you can’t.” Will Christmas bring any special challenges? “No mince pies, no brandy snaps. I shouldn’t talk about it or I will start salivating. I have turkey and chicken and ham. I will just avoid the cakes and pies and tarts and the alcohol. I only need to have quarter of a glass of wine now and I’m quite happy. I’m a cheap date.”

DON'T OVERREACT


Clinical psychologist Karen Nimmo
Clinical psychologist Karen Nimmo, photo Angela Vidal.


Psychologist Karen Nimmo says a good understanding of one’s hidden drivers is needed to truly conquer weight problems. The author of weight-loss book My Bum Looks Brilliant in This: The One True Secret to Lasting Weight Loss>, Nimmo battled weight problems until she threw away the scales 25 years ago.

“Most people do regain weight after they’ve lost it. I think the main reason that happens is they’ve targeted the weight, instead the reasons they were carrying it in the first place. They’ve gone from the outside rather from the inside. This might be a big call, but I think it’s relatively easy to maintain a healthy weight when you fully understand yourself, your thought processes, your feelings and your behaviours.

“The trouble is people don’t. I’ve seen heaps and heaps of clients for weight loss, and when people are carrying quite a bit of extra weight, there’s always a link between weight and low self-esteem.” Maybe the low self-esteem is due to being overweight? “I’m saying the low self-esteem or the feelings of worthlessness are a precursor, they’re at the core. The weight is the symptom.”

Nimmo says often food is used to block bad feelings, or to comfort and nurture at times of stress. She works on helping people understand their “operating systems” and how they respond to food. One trap can be that even after losing weight, some people deep down feel they don’t deserve to be thin. “A lot of the time people will just sneakily increase their eating again, and it slowly goes up. You need to realistically assess what you’re eating. Be very mindful. People eat unconsciously and they almost don’t want to face it. Then they slip into that whole self-loathing cycle of ‘I can’t do this, I’m useless, I’m fat anyway’, and that just perpetuates the behaviour.”

She recommends that if you slip up, don’t overreact. “You have to stop yourself and say, ‘Okay, I’ve had a bad day but tomorrow’s a fresh day. Let’s do this again. Let’s go back to the start and begin again.’” Graeme Peters, meanwhile, is steeling himself to face his weight problems, amid the season of bingeing. “It feels like I have a mountain in front of me. I’m not sure I have the willpower to do it again or the motivation. You’re not sure if you can pull one out of the bag again.” But he is going to sign up again at Weight Watchers and give it his best shot.

Karen Nimmo's tips on psychology of weight loss


Three-step plan for countering the urge to eat:

1. EMOTION Identify the emotion that is making you want to eat. Knowing your emotional trigger makes you aware of what you’re doing. Awareness is the first step in changing behaviour.

2. QUESTION: Before you head for the fridge or pantry, ask, “Will eating this make me feel good about myself?” The answer is almost always no.

3. DISTRACT: Do something to take your mind off food. Clench your fists, send a text, shake the car keys. Simple portable activities are best. The aim is to break the spell so you can make a good choice.

Psychological tips:


  • Believe you can stay in the weight range you choose for the rest of your life.

  • Change your behaviour – it’s essential to kick-start new thinking.

  • Analyse your relationship with food. Are your beliefs, thinking and behaviour relating to food faulty? Develop some healthy alternatives and start to live by them.

  • Think of food as food. Never label it as “good” or “bad” or a “treat”.

  • Set goals beyond your physical appearance.

  • Try something new every week. Even if it leads nowhere, your life will be more interesting for having made the effort.

  • Work on yourself – not your weight. Think about how you could be a more fun, interesting and healthy person and put small goals in place to guide you.


Absurd practices of the past


Dietary fads, chewing slowly, jazzercise – it’s all been tried before.
Absurd practices of the past
Visitor: “What are you going to do when you are as big as Mummie, Joan?” Joan: “Oh! Slimming exercises.”


The rise of the beanpole-thin flappers after an era of padded, corseted Victoria silhouettes helped kick off the modern obsession with watching our figures. Although 1930s adults were nowhere near as overweight as we are now, news reports of the time abounded with the latest on “the slimming craze”, and advice on how to achieve a svelte form.

The enthusiasm for weight loss led to the extensive use of dieting potions that were later banned because they caused deaths, both in England and in New Zealand. One was dinitrophenol, which speeds up the metabolism but causes the body temperature to rise excessively.

One fad was the claim that chewing food slowly would lead to weight loss. American diet specialist Dr WG Anderson was quoted in local papers in 1934 claiming that a patient of his had shrunk from 15 stone to 11 stone 9 pounds after three months, simply by taking longer to eat his food. Well-chewed food is brought “much more completely into contact with the myriads of tiny nerve endings in the mouth which are called ‘taste buds’. Thus the sensation of taste is satisfied much more quickly, and by a much smaller amount of food than when meals are eaten rapidly.”

Butter, these days considered dangerous ground for the weight-conscious, cropped up frequently in “slimming” diets because of its image as a health-giving substance. A diet published in the Ellesmere Guardian in 1937 consisted of two slices of bread and butter five times a day, with half a pint of full cream milk for breakfast. “This diet can be followed over any period without any sensation of hunger. There is no suggestion of weakness, lassitude or nervous energy being burnt up.”

There was also an obsession with good digestion, which was thought to be promoted by conditions of “mental calm”. “Dr Winifred Cullis said x-rays showed that there was a ‘complete cessation of movement’ after a meal if any strong emotion such as anger, pain or extreme anxiety is aroused. That is why it is so important that if people quarrel with their families, they should not do it at meal times.”

A flurry of reports from London heralded the rise of physical activity as a way to get slimmer. The Auckland Star carried a 1931 report on the latest “slimming parlour”, which it called “a refined torture chamber”. The parlour sounds like a forerunner to a gym. Its correspondent “changed into a bathing dress in a luxurious cubicle and entered a huge room filled with every conceivable gymnastic gadget, on which many were concentrating, while many were lying on mattresses jerking their arms and legs to the time of a jazz tune.” After 30 minutes in the gym, which included time being pummelled by a machine with leather fists, she emerged having supposedly lost half a pound of weight.

Sparring and shadow boxing were also promoted as answers for how to lose weight. “There is no reason why an ordinarily healthy woman of from 20-30 should not adopt boxing. Tired housewives taking up boxing forget their domestic worries and become new women,” said Miss Annie Newton, physical culture expert in London.

But not everyone agreed with this focus on the body beautiful: “The present enthusiasm for physical culture and games was highly commendable, but it must be remembered that the mind and its faculties were of a superior order to the physical body and that character and grit were mental rather than bodily attributes,” said Dr HE Magee, in a 1937 Evening Post report headlined “Absurd Practices”.

'You have to do it for you'


With intensive exercise, one woman lost 30kg in a year.
Veronica Hale
Veronica Hale: wants to stay active.


Veronica Hale had always been a “big girl” as a teenager, with a dress size of 14-16. But many things changed in her life when as a university student in her early twenties, she took on a momentous task that many much more mature adults would have found utterly overwhelming. Her partner developed a rare cancer, a soft tissue sarcoma. Hale became his sole caregiver in the two and a half years until his death.

Over that time, life revolved around visits to the hospital, keeping up with medication, and myriad tasks to keep her partner comfortable. Hale put herself second. “Being a caregiver for a cancer patient, you eat where you can, when you can.” That often meant McDonald’s or KFC or fish and chips. By the time her partner died in 2005, Hale had become very large.

Almost a year to the day after his death, and still weighed down by grief, she decided she wanted to change her life. She had grown to a size 20 or 22, and weighed 132kg. “I was having trouble bending over to tie my shoelaces; I couldn’t walk up stairs without being out of breath.” She signed up at a gym, having sessions with a personal trainer twice a week. Her goal was to get back to the size she used to be.

“It was a decision to focus on me and getting me happy and healthy. I made the change for me. You have to be doing it for you and not for anyone else, otherwise it just doesn’t work. It’s making a decision that you’re important enough, that you’re worth it. It brought me out of my shell and I’ve met lots of inspirational people as a result of getting out there and doing some exercise.”

Now, Hale says, she is addicted to exercise, going to the gym four days a week. She has also become a cyclist, which she would never have imagined herself doing previously. Within a year her weight had dropped to 95-100kg, which is where it has stayed. She has returned to her old dress size, which she is happy with.

She regulates her eating carefully, emphasising fruit and vegetables, but still has takeaways once a month or so. She closely monitors her weight. There have been occasional setbacks when she has put a little weight back on, but she has been powerfully motivated to stamp on them. She wants to be able to keep being active to play with her baby cousins, and to play with her own children one day. “I never want to go back to where I was.”
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