December 29, 2005 -- Part of the popular mythology about weight loss is that rapidly lost weight always returns rapidly. This notion comes in part from our collective sense that crash diets rarely do any good in the long run, which is true. However, some important research suggests that rapid weight loss can actually help produce better maintenance of weight losses, at least some of the time.
In 1958, in the New York State Journal of Medicine, Professor Albert Stunkard wrote the most famous two sentences in the history of research on weight loss summarizing the prior 30 years of obesity research: Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it.
Stunkard found that only 12% of participants in weight loss programs in the first half of the last century lost 20 lbs. or more. State-of-the-art treatments today fare far better. Professionally conducted programs that include specialized cognitive-behavior therapy and a very low-calorie diet (usually a liquid diet) help approximately 90% of participants lose 20 pounds or more; 50% lose 40 pounds.
Despite the ability of people in the best professionally conducted programs to lose weight far more effectively than the prior generation of programs, even today a clear majority of participants do not succeed in maintaining weight losses when followed up over several years. Several studies point the way to better long-term outcomes, but the following findings do not fit with the prevailing view about rapid weight loss. This research suggests rapid weight loss can increase the sustainability of weight loss.
Dr. Tom Wadden and his colleagues at the University of Pennsylvania studied the effect of weight loss medications combined with instructions on reducing total calorie intake, materials on behavioral strategies, and two different levels of professional support (Obesity Research). Twenty-six women who averaged about 75 lbs. overweight maintained weight losses, on average, of more than 30 lbs. at the end of one-year. Those who lost the most weight during the first month lost the most weight at all subsequent assessments.
Dr. Robert Jeffery and his colleagues (Journal of Consulting and Clinical Psychology, 1998) examined weight losses and psychological effects in 130 overweight people 2.5 years after participants received professional cognitive-behavioral weight loss therapy for 18 months. Researchers divided the participants into three groups based on outcomes at 18 months. Those who were most successful at 18 months maintained weight losses far better at 2.5 years than the other participants. An earlier study by Jeffery and colleagues (International Journal of Obesity, 1989) showed that participants who lost the largest amount of weight initially maintained their superiority at a 4-year follow-up.
Participants in all of these studies received professional counseling and focused on a reduced calorie, lower fat, and balanced diet, increased exercise, and improved understanding of principles of behavior change that support healthier lifestyles. The people who lost weight most rapidly may have developed stronger and more positive convictions about their abilities to lose weight successfully than their peers who lost weight more slowly. This improved self-efficacy (I know I can; I know I can.) reportedly promotes better weight loss over time (Hartigan et al., Journal of Counseling Psychology, 1982).
Dr. Daniel Kirschenbaum and his colleagues (Behavior Therapy, 1992) noted that weight controllers experience several stages on the road to success, some of which might be affected by rapid weight loss. The honeymoon stage is filled with energy and enthusiasm and effort. Unfortunately, after a while the motivational picture weakens. Weight controllers then find themselves in the frustration stage. It is possible that more rapid weight loss keeps people in the honeymoon stage longer and helps them get through the frustration stage to the final acceptance stage more rapidly and effectively.
Rapid weight loss during a professionally directed course of lifestyle change may prove far more helpful than harmful in the long run. These results do not support crash dieting. They support working very hard in the early stages of a weight loss effort in the context of an approach that has a strong scientific foundation. Driving weight down rapidly may prove very encouraging and help dieters believe they can accomplish their weight loss goals. This means that as you attempt to realize your 2005 New Years Resolution to lose weight, remember to go all out especially in the early stages. Go for it!
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Hartigan, K.J., Baker-Strauch, D., & Morris, G.W. (1982). Perceptions of the causes of obesity and responsiveness to treatment. Journal of Counseling Psychology, 29, 478-485.
Jeffery, R.W., Wing, R.R., & Mayer, R.R. (1998). Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients? Journal of Consulting and Clinical Psychology, 66, 641-645.
Kirschenbaum, D.S. et al. (1992). Stages of change in successful weight control: A clinically derived model. Behavior Therapy, 23, 623-635.
Kramer, F.M., Jeffery, R.W., Forster, J.L., & Snell, M.K. (1989). Long-term follow-up of behavioral treatment for obesity: Patterns of weight regain among men and women. International Journal of Obesity, 13, 123-136.
Stunkard, A.J. (1958). The management of obesity. New York State Journal of Medicine, 58, 79-87.
Wadden, T. A. et al. (1997). Lifestyle modification in the pharmacologic treatment of obesity: A pilot investigation of a potential primary care approach. Obesity Research, 5, 218-226.
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