Keeping the Weight Off :: Diabetes Self-Management

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Mar 25, 2008

Keeping the Weight Off

Tara Dairman

A new study has highlighted some methods that can help people who have lost weight keep the pounds off over the long term. In the longest and largest study of this nature yet published, researchers found that person-to-person interaction with a weight-loss professional worked best, and that using an interactive Web site also helped people keep weight off over a period of two years.

There were 1,032 participants in the Weight Loss Maintenance (WLM) study, the results of which were published in the March 12 issue of The Journal of the American Medical Association (JAMA). The participants were all overweight or obese and had either high blood pressure, high cholesterol, or both. Two groups that are often underrepresented in weight loss studies—African-Americans and men—were purposely included in this study: Almost 40% of participants were African-American and more than one-third were men.

The participants lost at least 8.8 pounds over six months in the first phase of the study, with an average weight loss of about 19 pounds. This phase consisted of weekly group meetings led by a trained weight-loss professional, who helped participants learn to increase their physical activity, consume fewer calories, and adopt the Dietary Approaches to Stop Hypertension (DASH) eating plan, which can help lower blood pressure.

After six months, the participants were then randomly assigned to one of three weight-loss maintenance groups: a "self-directed" group, which received little intervention (the control group); an interactive-technology–based group, in which members logged on to an interactive Web site as often as they liked and used it to monitor their eating and exercise and set personal goals; and a personal-contact group, in which members spoke on the phone with a weight-loss professional each month and had in-person sessions three times a year.

Both the interactive-technology–based group and the personal-contact group interventions were designed to provide motivation, support, problem solving, and relapse prevention by offering features such as continued contact, motivational interviewing, self-monitoring, and accountability.

While all three groups regained some of the weight they had lost during the first six months of the study, the people in the personal-contact group were able to keep off more weight than those in the other two groups over the long term. After two years, both the personal-contact group and the interactive-technology–based group kept off significantly more weight than the self-directed group. However, after two and a half years, only members of the personal-contact group kept off significantly more weight (an average of 3.3 pounds) than the self-directed group. This may sound like a small difference, but the researchers point out that even modest weight loss can improve a person's cardiovascular risk factors.

The researchers concluded that the human connection provided to the personal-contact group seemed to make a difference in helping people maintain their weight loss. They also pointed out that the Web-based intervention provided early benefits, which lasted longer in this study than in previous smaller studies. In conclusion, they stated that both of these methods have potential and deserve further study.

What have your experiences been with losing weight and keeping it off? Have you found any in-person or Web-based programs to be helpful? Share your experience (through a little interactive technology!) by leaving a comment below.

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I've found Dr R. Bernstein's Diabetes Solution to be effective in weight management. This restricted, low-carb diet reduces the need for insulin (the primary fat-building hormone in the body) which, in turn, also inactivates lipase (the enzyme responsible for fat-burning). The long-term performance has yet to be determined, but this is certainly the metabolic state in which I need to be as a Type 2 diabetic.

Reading the material and following the plan has gotten me comfortably to the low end of a normal BMI and decent BF %. Regular exercise and regular self-monitoring have also contributed.

Posted by: John | Mar 25, 2008 01:26 PM

My diet is as simple as 'Do not eat anything with white sugar or refined flour'. I fill up on vegetables, fruit and protein. I also do 40 minutes aerobic exercise and 10-15 minutes strength exercises daily(almost). My weight stays at the low end of the BMI scale and I feel great. I use very little insulin at this level. It takes effort, but I'm worth it.

Posted by: Linda | Mar 26, 2008 05:23 PM

Dear Tara. The blog by John above is interesting as my wife and I are trying a modified (try to reduce saturated fats) Atkins diet. I have made an Excel spread sheet were you write down everything you put into your mouth and break it down to Calories, carbs, protein, total fat, saturated fat and fibre. Also exercise is logged as negative calories. The idea is to eat 300 calories per day on average net of exercise less than you need to maintain body weight which can be determined by doing the spreadsheet. After a 10 lb loss I stop loosing weight for a few weeks and after things stabilize start again. So far down from 255 in Nov to 235 now.

Posted by: CalgaryDiabetic | Mar 26, 2008 05:49 PM

Dear Tara. Amen to John comments. It is important to minimize insulin and at the same time keep your blood sugar near normal. This is like a shoe big on the inside and small on the outside. I was using insulin liberally to keep the BG near normal and headed towards 500 lb (actually I think I would have died at around 265 lb like my friend Bob's brother in law). So do whatever it takes to minimize insulin use or the use of insulin enhancing pills. A support group pointing this out 3 years ago would have been very helpful. It is hard to reinvent the wheel and everything else you need to know to survive diabetes by yourself.

Posted by: CalgaryDiabetic | Mar 26, 2008 06:15 PM

I agree that classes attended regularly result in more and longer weight loss progress. The fact that a person is allowing themsleves to be held accountable is the significant factor here. However, what is done in these group classes is as important as having them. Focusing on behaviors that produce a calorie defecit and are measurable can't be overlooked. Lastly, making sure that participants have a nutritionally complete diet, low in fat and high in nutrients is a pre-requisite. Point systems that do not encourage nutrition, but just have a point assgned for calories will never sustain healthy weight loss. Since we are supposed to function in balance of calories, nutrients and water, simply cutting back on a poor diet won't do it. Lastly, you have to move your body through space. Movement is critical to health.

Posted by: Denise | Apr 02, 2008 03:31 PM

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