Most successful dieters regain the weight they lost. But new research shows that stepping on a scale every day, then cutting calories and boosting exercise if the numbers run too high, can significantly help dieters maintain weight loss. The study, conducted by researchers at The Miriam Hospital and Brown Medical School, reports results of the first program designed specifically for weight loss maintenance. The study appears in the New England Journal of Medicine.
Unlike other obesity studies, which focus on how to lose weight, the clinical trial called STOP Regain tested a method that taught participants how to keep those pounds from coming back - regardless of what method they used to lose the weight in the first place.
Led by Rena R.Wing, PhD, Director of the Weight Control and Diabetes Research Center at The Miriam Hospital and Professor of Psychiatry and Human Behavior at Brown Medical School, the study taught successful dieters a technique called "self-regulation." With the goal of maintaining their weight within five pounds, participants were taught to weigh themselves daily and to use the information from the scale to determine if they needed to adjust their diet or exercise routine.
The intervention worked: Significantly fewer participants regained five or more pounds during the 18 month long program. The program was most successful when delivered in face-to-face meetings, although the Internet also proved a viable delivery system to help participants maintain their weight loss.
"If you want to keep lost pounds off, daily weighing is critical," Wing said. "But stepping on the scale isn't enough. You have to use that information to change your behavior, whether that means eating less or walking more. Paying attention to weight -- and taking quick action if it creeps up -- seems to be the secret to success."
"We know that losing weight and keeping weight off is very tough for many people," said Robert J. Kuczmarski, Dr. P.H., R.D., director of the Obesity Prevention and Treatment Program at the National Institutes of Health. "However, the results of STOP Regain show that there are definite actions that people can take before their weight begins to creep upward. Weight control and better health are not one-shot deals and this study will help people see that," he adds.
In the study, Wing and her team enrolled 314 participants who'd lost at least 10 percent of their body weight -- averaging nearly 20 percent of their body weight or 42 pounds -- within the last two years. A third of participants were assigned to a control group, and received quarterly newsletters about eating and exercise in the mail for the duration of the study period.
The other two-thirds were assigned to groups that would test the weight maintenance program. One third received the intervention over the Internet, the final third in face-to-face group meetings. Whether delivered over the computer, or in person, the education and support program was virtually identical.
Participants were taught strategies specific to preventing weight regain, many gleaned from Wing's National Weight Control Registry, a registry of more than 5,000 people who have successfully lost weight and kept it off for at least one year. Strategies taught in the trial included eating breakfast, getting an hour of physical activity each day and regular weighing - participants were given a scale and urged to use it daily. They also reported their weight weekly, either over the Internet or by phone, depending on the study group.
Participants were also introduced to a weight-monitoring system based on color zones. If they were within three pounds of their starting weight after the weekly check-in, they were in the "green zone" -- and received encouraging phone messages and green rewards, from mint gum to a dollar bill. If they'd gained between three and four pounds, they landed in the "yellow zone" and were instructed to tweak their eating habits or exercise routine.
If they gained five pounds or more, they were in the "red zone" and encouraged to restart active weight-loss efforts. They were urged to pull out a red toolbox they received at the start of the program that included items such as a meal replacement shake, a pedometer, a diet diary -- and their own weight success loss story. Participants who were in the "red zone" also had the chance to get one-on-one counseling by phone, email or in person. Both groups attended weekly meetings for the first month of the study period, then monthly meetings either in groups or via a computer chat room. Internet participants received a laptop computer, an Internet connection and technical support.
Results were resounding: In the control group, 72 percent of participants gained five or more pounds during the year and a half study period. But only 55 percent of Internet participants -- and 46 percent of participants in the face-to-face group -- gained back that much weight.
"The Internet intervention worked, but the face-to-face format produced the best outcomes," Wing said. "Both were successful because the message that people got -- pay attention to your weight, then take action to maintain it -- was effective. People were told to take personal control of their health and were given the tools to do it. And they kept off the weight."
The authors note that daily weighing was strongly associated with prevention of weight gain, but only in the Internet and face-to-face groups. Intervention participants who weighed themselves daily had an 82 percent reduction in the odds of regaining five or more pounds compared to those who did not weigh daily. However, daily weighing in the control group had little effect on the amount of weight regained.
"This suggests that participants in the intervention groups were able to use the information from the scale to make constructive changes in their eating and exercise behaviors," says Wing. "It's further evidence that getting on the scale each day is only part of the solution."
Wing and her team conclude that the concept of an intervention exclusively designed for weight-loss maintenance is an important approach to the successful treatment of obesity. Future studies should examine ways to refine the Internet format, as well as test interventions designed to last longer than 18 months.
The STOP Regain team also includes Deborah Tate, PhD, an assistant professor in the School of Public Health at the University of North Carolina -Chapel Hill, and Amy Gorin, PhD, Hollie Raynor, PhD, and Joseph Fava, PhD, of The Miriam Hospital and Brown Medical School. The National Institute of Diabetes and Digestive and Kidney Diseases funded the work.
The Miriam Hospital, http://www.miriamhospital.org, established in 1926, is an academic medical center affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, as well as weight management and obesity research. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times, is in the top 25 of all hospitals nationwide in terms of National Institutes of Health (NIH) funding and is committed to excellence in patient care, research and medical education.
Brown Medical School (http://bms.brown.edu) is Rhode Island's only school of medicine and the hub of the state's academic medical enterprise. As part of an Ivy League university, the medical school attracts leaders in teaching and clinical care and, with its seven affiliated hospitals, brings in nearly $200 million in external research funding each year. Brown Medical School's Department of Community Health, ranked sixth in the nation by US News and World Report, offers comprehensive graduate programs in epidemiology, biostatistics as well as a Master of Public Health degree
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