By Lisa Ellis
InteliHealth News Service

People who lose large amounts of weight and keep it off for a long time have four things in common: They follow a high-carbohydrate, low-fat diet, eat breakfast just about every day, monitor their weight closely and get a lot of exercise.

So says James Hill, Ph.D., co-director of a long-term study of 3,000 people in a database called the National Weight Control Registry. Members of the group have lost an average of 60 pounds and kept it off for an average of five years.

The people in the study originally lost their weight -- anywhere from 30 to more than 100 pounds -- using "every way known to man," Hill says. "The similarity is in how they maintain it. I think we need to give more attention to how to help people maintain weight loss."

Hill, a physiologist and director of the Center for Human Nutrition, University of Colorado Health Sciences Center in Denver, pressed that message during a news conference on trends in obesity research sponsored by the American Medical Association.

In an interview, Hill said the research he described had been published in medical journals, most recently in the Annual Review of Nutrition 2001. The authors were Hill and co-director Rena Wing, Ph.D., a behavioral psychologist at Brown University.

The National Weight Control Registry was founded in 1993 in an attempt to discover what makes some people successful in keeping off the weight they lose, Hill says. "We're trying to say, 'What can we learn from these people that can help other people to be successful?'"

Surveys show that in any given year, about half of U.S. adults are trying to lose weight. But if they are successful, most of them don't keep the weight off. According to the National Institutes of Health, more than half of adult Americans are overweight, and about one in four adults is obese, or at least 20 percent overweight. Obesity substantially increases the risk of death from coronary heart disease, stroke, diabetes and several forms of cancer.

Harold S. Solomon, M.D., director of the Weight Loss and Lifestyle Enhancement program at Beth Israel Deaconess Medical Center in Boston, says this research shows that people can keep weight off and points to how to accomplish it.

For many people who have been successful, "it's almost like they've had a religious conversion," says Dr. Solomon, an associate professor of clinical medicine at Harvard Medical School.

"They become almost obsessive about it," he says. "Those are successes, but is that what you have to do? Are there people who can be successful with a little less exercise and a little less rigidity? What (Hill and Wing) have not done is to define the minimum required to maintain a 50-pound weight loss. Many of my successful patients seem to have made minor, but permanent, changes in their lives."

To be enrolled in the registry, a person must have maintained at least a 30-pound weight loss for at least one year. Some people on the list simply meet the minimum requirements. "We have people on the other end who have maintained a 100-pound loss for 40 or 50 years," Hill says. About half lost weight on their own and half used some sort of formal program, Hill says.

According to questionnaires, most members of the registry have these habits in common:

• High-carbohydrate, low-fat diet: This is not necessarily the diet they followed to lose the weight, but it is their long-term eating plan. Although some low-carbohydrate, high-protein diets are popular, "we looked for people who were eating a low-carbohydrate diet in this group, and we couldn't find any," Hill says.
• Self-monitoring: "They weigh themselves a lot and they record what they eat on a regular basis," Hill says. This is important because it allows people to catch weight fluctuations early and act to correct them.
• Breakfast: "They eat breakfast, so they're spreading out their calories over the day." Hill says researchers are just starting to gather data on what the participants actually eat.
• Exercise: "They get a lot of physical activity. I think this is the most important," Hill says. The average participant burns up about 2,700 calories a week in physical activity, the equivalent of about one hour of moderately intense activity every day -- for example, five miles of walking. The National Institutes of Health recommends at least 30 minutes of moderate activity at least five times a week, but surveys show only 22 percent of U.S. adults get that much exercise. Most of those in the weight registry walk a lot, but many do weight lifting, cycling and other activities, Hill says.

Although people in the study have lost a great deal of weight, the average participant currently has a body mass index of about 25, the borderline number for overweight. But Hill says the average BMI before weight loss was 35, well into the obese range. "That's a huge amount of weight loss."

Based on his years of experience with patients, Dr. Solomon says he thinks the key to long-term weight loss is to set up rules for yourself about eating and exercise, and to internalize those rules so they become second nature, like brushing your teeth every day.

He gives the example of someone who eats a salad every day for lunch, but still thinks about a cheeseburger. At some point, he or she will give up and eat the cheeseburger. In contrast, people who have permanently lost weight often say they do nothing in particular to keep it off, because they have internalized their rules, and that is a permanent change, he says.

"They have sort of drummed the cheeseburger out of their minds," he says. "They have a new reality."

If you are starting on a weight-loss program, Dr. Solomon advises making rules for yourself based on knowledge of good nutrition and your own eating style. There is no right way, he says, only a way that works for you. Dr. Solomon advocates weighing yourself daily, as most people in the weight-control registry do, to keep track of how you are doing and to help you stay focused.