Blog About Health & Medicine

Many of the changes discussed above that occur over the longer term with slimming make relapse a key issue in fat loss maintenance. Long term studies (i.e. over 10 years) show that the cure rate for obesity is usually no more than 5-10 per cent. Even 1-2 year follow-ups with females show a high attrition rate (i.e. 40-60 per cent) and the success rate for males is largely unknown. About 80 per cent of people who go on a fat loss program can lose 10-20 per cent of their weight in up to 20 weeks without too much pain. However, within 12 months, about one-third of those who have lost fat will have regained it. The problem is even worse for those following a very low energy diet. Regain occurs around 76 per cent of those who were successful at keeping weight off over the long term had built exercise into their lifestyle compared with only 36 per cent of those who had failed. More maintainers than regainers (73-40 per cent) had also developed a personal eating plan as a lifestyle habit, whereas more regainers had used structured ‘diet’ programs, followed prescription from doctors, or used advice from books or magazines. Regainers snacked more during the day, and used chocolate and candy more often as their usual snack.

The other major difference between these groups and a control group of women who had never had a weight problem was in psychological techniques of coping with stress. The controls and those who were able to maintain their weight usually dealt with difficult situations by problem solving or confronting the issue. Significantly more regainers on the other hand used escape/avoidance techniques such as sleeping, eating or not dealing with the problem, in response to stress. This is consistent with other research that suggests that unless adequate coping skills are developed, individuals who don’t make behaviour changes will return to their former negative pattern when a high-risk situation develops.

These three factors: lifestyle changes in eating patterns, regular exercise and successful coping techniques are now recognised as key factors for long term maintenance of fat loss. In addition, Stern and her colleagues have shown that weight cycling through ‘yo-yo’ dieting and ‘exercise cycling’ (i.e. exercising for a period and then stopping) may have long term effects on dietary fat preference and fat intake. These are, therefore, also long term dangers for maintenance and reinforce the fact that long term techniques of fat loss, to be successful, must incorporate long term changes in lifestyle rather than short term aberrations such as dieting or exercise ‘programs’.

Dr Tim Wadden, a psychologist from the University of Pennsylvania, has also analysed relapse and maintenance by studying the habits of those who are successful with fat loss over the long term. He suggests that:

• although diet may be important in helping to lose weight, those who develop a lifetime pattern of exercise manage to keep it off better

• greater maintenance occurs in women who do long, regular (although not necessarily vigorous) exercise like walking

• people who regularly eat just one fatty food have no increased risk of regaining. But those who eat two, might just as well eat six—all are a recipe for relapse.

• most successful weight loss maintainers:

- don’t count calories, but develop a personal eating plan

- exercise regularly

- closely monitor their weight

- monitor their food intake

• Best maintenance comes from setting realistic goals. In some severely obese people, there may be biological limits to big reductions. Satisfaction with more modest goals can improve the situation.

*206\186\4*

In any operating manual or handbook, there is always a section on trouble-shooting—how to handle problems and what to do if things go wrong.

Now what can go wrong with the control of our in-built sleep mechanism? The main failure with the psychological switch is our lack of perseverence in maintaining the THS. We lose confidence and let our thoughts go wild without coming back repeatedly to the THS. We must control that spotlight so that it will only focus on our relaxing thoughts. Self-hypnosis is an active exercise, and we must activate that spotlight to focus on the relaxing parts of our bodies. Do not reject any intruding thoughts, as rejection means focusing on them.

Not being able to follow good sleep hygiene is another failure. Too much caffiene, not putting the alarm clock away, or waking up at different times every morning are all detrimental to good sleep.

If you suffer chronic insomnia because of chronic stress, you must learn how to manage your stress properly. Normal ordinary stress should not cause insomnia, as we experience this everyday. Look at the 80 per cent of what you have achieved and ignore the 20 per cent of bad luck, as one can never be always lucky. Revise chapter 16 on Sleep and Stress if you still have a problem coping.

Sleeping pills are useful in only a limited number of circumstances, and they should not be used for more than two weeks. When you stop them, they must be stopped very gradually to minimize rebound insomnia. You must distinguish between true insomnia and rebound insomnia.

You cannot fall asleep if you already have had too much sleep. Also you cannot fall asleep easily at the wrong time of day, according to the biological clock.

Finally, if all else fails, call in the professionals.

*102\174\4*