As most of you know I have embarked on a “lifestyle change” these last six months or so. Recently I came across an article that has completely changed my outlook on weight loss, weight loss goals, and how we define success when we talk about those things.
Yoni Freedhoff is an obesity doctor who wrote an article a few years back for Vox. It’s a long title but definitely worth the read- I’m an Obesity Doctor. I’ve Seen Long-Term Weight Loss Work. Here’s How.
I think what hampers people more than anything else with weight loss is how success has been defined. Whether that definition comes from the glorification of extreme weight loss on idiotic television shows, or from public health messaging around the risks of obesity, or doctor’s discussing “normal” weights or body mass indices with their patients, or from personally held desires, the shared goal post is one of losing every last bit of excess weight.
Wow! Like most people out there who decide to go on a diet or change their lifestyle, I tend to think in concrete, non-negotiable terms. I want to lose this much weight. I want to wear this size again. I’m not looking at it in terms of, “Hey, I lost 15% of my body weight. That’s awesome! I’ve lowered my risks for heart disease and stroke. Way to go, me!”
No! I look at it as, “I’m still fat. I still want to lose more. I’ve got x number of pounds to go before I finally feel like I’m at a respectable weight.”
He goes on to talk about a 1997 study done by Gary Foster and colleagues. In this study 60 women were enrolled in a weight loss program and prior to the start they were asked to describe their goal weight, their dream weight, their happy weight, their acceptable weight, and their disappointed weight. Disappointed was defined as “a weight that is less than your current weight, but one that you could not view as successful in any way. You would be disappointed if this were your final weight after the program.”
What happened? Nearly half of the subjects didn’t lose enough weight to even be disappointed. A quarter reached what they deemed to be an acceptable weight and only 9% reached a “happy” weight.
By the way… those goals? They represented anywhere from a 17% loss (disappointed weight) to a 38% loss (dream weight), with the average weight goal being a 32% loss. Acceptable weight loss clocked in at 25%. As a person who has lost somewhere between 35-40 pounds and is rocking a 16-17% weight loss I can tell you that this shit is hard! A 32-38% weight loss is a lot of weight.
Bear with me for a moment while I veer off to another point. I promise this is going somewhere.
He is a runner. This is fortunate for me because I, too, am a runner. I’ve long said running a marathon is on my bucket list. Did you know that in order for me to qualify for the Boston Marathon I would have to run it in 3 hours and 55 minutes? For comparison’s sake I run 4 miles in about 50-52 minutes on a good day. A marathon is 26.2 miles so multiply my 50 minutes by 6 and then add another 25 minutes. I’ve calculated 325 minutes. That’s 5 hours and some change. I’m nowhere close to running the Boston Marathon. Truth be told, I’m tired after five miles. I’m nowhere close to running any marathon. Shit, I’m not ready to sign up for a 10K!
Should I quit? Should I give up running? If I can’t run the Boston Marathon, or any marathon, or even a 10K, why should I bother?
How silly does that sound? I bother because I enjoy it. I bother because even though I’m only running 3-4 miles I enjoy challenging myself and seeing if I can get my time down. I do it because I’m hoping there will come a day that my limit isn’t 5 miles, but rather 6 miles, or 10 miles. I do it because there’s always the possibility that even if I don’t run a marathon I may still sign up for a 10K or a half marathon. My dream, even if it’s never realized, is to be able to participate in a Ragnar Relay.
Yet when it comes to weight, it would seem that everyone is trying to qualify for the Boston Marathon of weight loss, and society is not only not pointing out how backward that goal is but reinforcing it.
Truth bomb! Why is it all or nothing with weight loss? Either we go from a size 22 down to a size 2, or we’ve failed. Isn’t it a victory if you go from a size 20 to a size 16? Sure, it may not be where you’d like to be but it’s a win. You’ve lost weight. You’ve done something. Maybe you want to do even more. But maybe even when you do more you still don’t reach that size 2. Will a size 10 suffice? Can you live with being 150 pounds instead of 130?
…what if, like running, the goal with weight loss and/or healthful living was for people to simply do their best? For people to determine their own best efforts, and respect their realities?
There is so much truth to that. Some of us have physical ailments. There are genetics at play. Some people are dealing with illnesses or caregiving responsibilities or travel commitments. It is not a one size fits all. I also appreciate how he recognizes the very important role that food plays in our lives. As he puts it, “…food is not just fuel, but also something that we as a species use for comfort, for celebration, and as the substrate of the world’s oldest social network.”
So many diet gurus try to convince us that food isn’t important, that we shouldn’t use it as anything except fuel for our bodies. They try to guide us towards not indulging at the Christmas parties over the holidays, and not using food as a social gathering.
How do we do this, you may be asking? How do we do our best and determine our own best efforts while respecting our realities? Dr. Freedhoff points to another study, the Look AHEAD, study that explored the impact of weight loss and exercise on reducing heart disease risk among patients with both excess weight and Type 2 diabetes.
In this study patients were divided into two groups. One group called the intensive lifestyle group received what was described as “rigorous, frequent, and lengthy behavioral support and education” while the other group, the casual care group, received infrequent group meetings where diet, physical activity and social support were discussed.
The weight loss goals were a mere 10% of the participant’s body weight.
By year eight 50.3% of the intensive lifestyle group and 35.7% of the usual care group were maintaining losses of greater than 5%. 26.9% of the intensive group and 17.2% of the usual care group were maintaining losses of greater than 10%.
That’s eight years later! Long term weight loss is possible.
Furthermore, did you know that there is a National Weight Control Registry? In order to qualify for enrollment you must have lost more than 30 pounds and you must have kept it off for over a year.
There are currently more than 10,000 registrants on that list. On average they’ve lost 66 pounds and have kept it off for five and a half years.
The secret to their success?
…the one common theme is that while maintaining their losses requires ongoing effort, that effort isn’t perceived by these weight loss masters as a hardship but rather as just living with their new lifestyles, and lifestyles that they enjoy… Liking the life you’re living while you’re losing weight is the key to keeping it off.
That’s why it’s called a lifestyle change and why the word “diet” has become a four letter word. I can eschew carbs all day long but if I hit my so-called goal weight and go back to eating a spicy chicken sandwich, fries, and a small chili with cheese at lunch every day, followed by a bag of chips and salsa, plus eat a piece of cake every night, I’m going to put every pound back on.
The trick is to enjoy whatever it is that you’re doing to lose weight. It has to be something you can do forever.
Hopefully for me one of those things will be running. I’ve given it up several times but I always seem to come back to it.
Another thing I’ve been doing is drinking more water instead of focusing on diet Coke. It won’t help me if I turn around and start chugging diet soda once again.
Finally, I have long said that once I reach a weight where I’m comfortable my long term plan is to let myself eat carbs on the weekend but watch what I eat the rest of the week. Does this mean I’ll never have chips and salsa on a weekday? Of course not. But it does mean that chips and salsa on a weekday is a rare occurrence and not something I do all the time. Does it mean I can stuff my face full of carbs all weekend long? Well, ideally no. I’m sure that will happen on occasion, and the good doctor understands that. But, if I’m out camping and we’re all making S’mores, I’ll allow myself to have one. If I’m spending the weekend with the mobster and we want to go to a winery and have a dish of spinach and artichoke dip served with pita chips or bread, I’ll indulge. Maybe I’ll even have pancakes or biscuits and gravy on the weekends once in a while.
It just has to be something you can do long term. And what works for one person may never work for another. MyFitness Pal comes to mind. The mobster loves it. He is a fan of counting calories. I hate it. I much prefer watching my carbs. For others maybe it’s eliminating fat or going vegan. Whatever works for you and you can live with is the best plan for you.
The mobster has been asking me forever if I have a goal weight in mind. I like to mess with him and tell him I’d like to get down to my birth weight. His goal weight is 165. I think he looks fabulous where he is, which is about 10 pounds from that goal. But, it’s his goal and if that’s what he wants then I will support him. I don’t have a set goal weight. I’ve told him many times it depends on how my clothes look on me and how I feel. It could be 150; it could be 130. I could get crazy and decide I want to be somewhere around 120-125. We’ll see as the months go by. This is how Dr. Freedhoff describes it:
The term I coined to describe it is “best weight,” where you best weight is whatever weight you reach when you’re living the healthiest life that you actually enjoy.
If your efforts can be summarized as cyclical, episodic, concentrated bouts of suffering, during which your aim isn’t the healthiest life that you can enjoy but rather the healthiest life that you can tolerate, well, go figure you’re not likely to keep it off.
I love this. I also love how he tells us to embrace both reality and imperfections. He reminds us that our best efforts are going to vary. There will be times that life is challenging. There will be times when everything is going great. There will be times you are on vacation and times you are celebrating a birthday. He even says there will be times you are celebrating a holiday and that might mean indulging a bit.
He leaves us with this:
The truth is there will come a point where you can’t happily live any better- where you can’t happily eat less and you can’t happily exercise more- and your weight, living with that life, is your best weight. In every other area of our lives we readily accept our best efforts as great, and we need to do that with weight and healthful living too.