NUTRITION COMMENT

Winning at the Weight Loss Game

Debbie Lucus, MS, RD, CDE

How many times have patients been told tolose weight, only to wonder how or which

diet is best? If weight loss were easy, then wewouldn’t be faced with the current obesity epi-demic. While recent research has indicated thatthere are a number of diets that may be effectivefor weight loss, the best plan varies depending onthe individual. The downside to a ‘‘diet’’ is thatonce the dieter stops following the plan, theweight returns. Rather than following a strict diet,sometimes the best way to promote weight loss isto develop small behavior changes over time thatcan be continued throughout the lifetime. Thesesmall changes are both more achievable and moreacceptable to patients.

We are fortunate to have a number of strategiesthat have been documented by a database called theNational Weight Control Registry (NWCR) to sharewith patients desiring weight loss. The registry repre-sents more than 5000 adults who have lost at least 30pounds and maintained that loss for more than1 year. The NWCR was established in 1994 by RenaWing, PhD, and James O. Hill, PhD. According totheir Web site, it is the largest prospective study oflong-term successful weight loss maintenance. Ques-tionnaires and annual surveys are used to determinebehavioral and psychological characteristics of theweight maintainers. As data are being collected andtabulated, researchers are beginning to find commoncharacteristics that can be shared with patients whodesire or need to lose weight.

Overall, the NWCR found that 98% of theirparticipants stated that they modified their foodintake in some way in order to help them loseweight, and 94% increased their physical activity.A referral to a registered dietitian can give patientsthe opportunity to explore the most healthful wayto modify their food intake. Some of the followingtips also appear to be frequent tactics in the successof participants.

Following a low-calorie, low-fat diet is a com-mon strategy among the registrants. A healthyweight loss is generally 0.5 to 2 pounds per week.To reach this goal, a daily 500- to 1000-calorie def-icit needs to be created. Reducing fat intake canhelp to quickly produce this deficit, as fat contains9 calories ⁄g vs 4 calories ⁄g for protein and carbohy-drates. For example, 2 tablespoons of mayonnaiseon a sandwich each day yields 200 calories fromthe mayonnaise alone. By switching to fat-free may-onnaise, nearly 190 calories can be eliminated daily.If fat-free mayonnaise is not an option, then reduc-ing the portion is another way to limit fat and calo-ries. Looking at ‘‘extras’’ in the diet can help incalorie reduction, too. For someone drinking 2 cansof regular soda a day at 150 calories per can, a sav-ings of 300 calories can be achieved by switching toeither diet soda or another calorie-free beverage(water comes to mind). Changing the mayonnaiseand soda intake would create the 500-calorie dailydeficit needed for 1 pound of weight loss eachweek. In the typical daily intake of most Americans,it is quite easy to find ways to save calorically.

Another approach that is found among theNWCR success stories is at breakfast, which is con-sumed by 78% of the registrants every day. Ourmothers always told us that this was the ‘‘mostimportant meal of the day,’’ and it seems they wereright. Eating breakfast helps to reduce midmorninghunger that results in yielding to temptations suchas the donuts someone brought to the office or afateful trip to the vending machine. ‘‘Breaking thefast’’ from the night before helps us to maintain ourbasal metabolic rate and limit overeating at our nextmeal. Depending on what is consumed at breakfast,it can also help patients to increase their fiber intake(which can help to reduce cholesterol, produce sati-ety, and maintain regularity).

Physical activity was increased among 94% ofthose questioned in the NWCR. Walking was themost common form of exercise, and 90% of per-sons exercised for an average of 1 h ⁄d. Currentrecommendations advise 30 to 60 minutes of dailyphysical activity to prevent weight gain and 60 to90 minutes a day for weight loss.

The thought of walking 60 to 90 minutes a daymay seem daunting, but patients do not have tostart at that level. Their first attempt may be 5 min-utes long or walking 1 block, from which they can

From the University of California, Davis MedicalCenter, Sacramento, CAAddress for correspondence:Debbie Lucus, MS, RD, CDE, University of California,Davis, Medical Center, Sacramento, CA 95817E-mail: debbie.lucus@ucdmc.ucdavis.edu

doi: 10.1111/j.1751-7141.2008.00009.x

237FALL 2008 PREVENTIVE CARDIOLOGY

then build. Pedometers are an excellent way to pro-mote motivation for movement. The most basicstep counter can be found for as little as $5 or $10.The beauty of the pedometer is that patients canget an idea of where they are on the activity spec-trum (by wearing the pedometer for a few days andthen averaging their steps) and then build on thatbase by adding a number of steps each day or week.This approach challenges them to find easy ways toincorporate more movement, while getting a realitycheck about how much or little activity they reallyare achieving on a daily basis.

Three-quarters of the participants weighed them-selves at least once a week. This is an importantstep in accountability and tracking success. If thescale does not move in the desired direction, then ittakes a little investigative work on the part of thepatient to determine what changes can be made thenext week. Weight loss does appear to be moreeffective when it is tracked or monitored. Otherthings that can be monitored are food intake (keep-ing a food journal), activity level (tracking steps orminutes of activity), calorie consumption (helps todetermine where that deficit can be created), fatgrams consumed, or all of the above. Tracking anyof these things helps to increase awareness of whatpatients are really doing and lets them determinewhat steps need to be taken to help reach theirgoals.

Limiting television time appeared to help theweight maintainers, as 62% watch <10 hours oftelevision per week. This has been studied in thepast, particularly in children, but this researchshows that it is also true in adults. Americans aver-age about 4 hours a day, or 28 hours a week, oftelevision viewing. Not only does this take awayfrom time that could be spent moving (not necessar-ily exercising, but just moving), but any televisionwatcher knows that there are foods to eat alongwith our favorite shows and reminders that we needto get up and grab a snack as a result of the cuesfrom the many television commercials. There is nodoubt that limiting our television time can help tocreate a more healthful lifestyle.

While there are many diet plans that can be ben-eficial in weight loss, just making small behaviorchanges may be more achievable and can promotelong-term sustained weight loss. The NWCR hasshown that following a low-calorie, low-fat diet,daily activity, eating breakfast, limiting televisiontime, and monitoring weight are common denomi-nators among >5000 successful weight loss main-tainers. These are simple tips that we can pass onto our patients who can benefit from weight loss.

REFERENCE

1 The National Weight Control Registry. http://www.nwcr.ws. Accessed August 14, 2008.

238 PREVENTIVE CARDIOLOGY FALL 2008