Long-running research program singles out maintenance research

J. Graham Thomas, one of the investigators of the National Weight Control Registry, still fields calls from journalists asking about "weight maintenance being impossible" statistics.

So much for impossibility: Thomas can fire back the 30-plus studies the registry began since its 1994 creation, and an even larger pool of individuals who back up the science with hard-won life experience. Never mind the voluntary survey features more than 6,000 successful maintainers, and averages 30 new participants weekly.

In a telephone interview, Thomas explained the Registry's staff operate on the outskirts of weight loss research. "One of the main points of the registry is that there are people doing this and it is possible," he said. "We (the scientific community) essentially know how to get people to lose; what we're not so good at is keeping it off."

What Has the Registry Discovered So Far?

Created by doctors Rena Wing and John Hill as part of the Miriam Hospital Diabetes and Weight Control Research Center, the Registry solicits volunteers who have lost 30 pounds and kept it off at least one year. After applying, participants receive a large packet of questionnaires asking for photos, time lines for their weight loss, and surveys examining all aspects of maintenance -- eating, exercise and the rest of your life. These questionnaires come annually, and from that the staff works its research magic. With the 30 studies already completed, the National Weight Control Registry's research has concluded some broad trends in its 6000 successful weight maintainers. Even then, Thomas called this work "groping around" to understand maintenance and its strategies.

"Of the pool of research available on maintenance, the National Weight Control Registry is among one of the first and most thorough -- and even we feel maintenance research is in its embryo state," Thomas said.

Still, broad patterns reveal themselves about how maintenance works. Last year in Medicine and Health, Thomas and Wing wrote an overview of some of the Registry's findings: More than 3 hours of physical activity a week (for women in the registry); Managing eating in some fashion, be it smaller portions, avoiding trigger foods or counting calories; Keeping a positive outlook. The paper also mentioned these key predictors of successful long-term maintenance: Keeping weight off longer makes it easier Dietary consistency Less fast food consumption Less TV viewing More frequent breakfast consumption Lower levels of depressive symptoms and dis-inhibited eating

It's mostly understood that you can lose weight purely through diet and no exercise. The early research reveals maintenance is more like a tapestry, combining several different strategies together, regardless of how weight was lost. And for these broad trends, the exact strategies vary wildly.

"One of the things that doesn't come across in these papers, is that each individual person has to figure out which strategies are most effective for them," Thomas said. At this point, the registry can provide insight on what you need to address, but can't explain exactly how yet. It something you do on your own terms, until more research can be conducted.

Who's on the Registry?

I cannot recommend volunteering for the Registry enough to help researchers, public policy makers and aspiring weight loss success stories actually have the tools and knowledge to keep their weight off far easier than any of us had. It's main requirement is maintaining a 30 pound weight loss for at least a year. Of those participating, 80% of persons in the registry are women and 20% are men. Weight losses range from 30 to 300 lbs. Duration of successful weight loss has ranged from 1 year to 66 years Some have lost the weight rapidly, while others have lost weight over as many as 14 years.

We have also started to learn about how the weight loss was accomplished: 45% of registry participants lost the weight on their own and the other 55% lost weight with the help of some type of program.98% of Registry participants report that they modified their food intake in some way to lose weight.9 4% increased their physical activity, with the most frequently reported form of activity being walking.

Funding and the Future

Last year the Miriam Hospital Diabetes and Weight Control Research Center received a total of $12 million in grants from the National Institutes of Health for a variety of weight loss and weight maintenance themed research, including Thomas' work on using modern technology like iPhones for weight control purposes. Some of these grants are extremely competitive: Wing's program was one of the 200 receiving the NIH Challenge Grant -- out of a larger pool of 20,000. When the registry began in 1993, Wing was one of the few scientists examining weight maintenance at all. Since then, receiving funding for maintenance-specific research has grown easier.

"If anything, behavioral treatment for weight control hasn't changed all that much in the last 10-15 years," Thomas said. "There's more attention to develop effective weight maintenance programs as opposed to weight loss programs. "

Their funding breakthroughs and increased interest in maintenance, do not guarantee smooth sailing financially. None of the Registry's articles examine weight maintenance past five years mostly because of the cost and logistics involved in multi-year studies make them less likely to garner funding, Thomas said.

Also, the funding increase don't address though individual studies receive sufficient funding, the registry itself has never been funded directly. Like the maintainers they study, the Registry staff just makes it work through leftover discretionary income.

In recent years, Thomas explained the Registry is diversifying. Among the staff are a variety of specialties, including neuroscience, genetics, psychology, intervention (as in "intervening behavior," not a TLC documentary) and future studies aim to implement registrants' strategies on a wider scale. They also hope to have its first 10-year study of maintenance complete this year.

"I think the ultimate goal is to say 'here's what you should be doing, and how to do it,' but I don't think we're right at the point where we feel confident enough to put forth a comprehensive plan," Thomas said. "I think we are getting gradually closer."

Russ Lane