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. On the other hand, some important research evidence suggests that rapid weight loss can actually help produce better maintenance of weight losses, at least some of the time.
Rapid weight loss during a professionally directed course of lifestyle change may prove far more helpful than harmful in the long run.
In 1958, Professor Albert Stunkard wrote the most famous two sentences in the history of research on weight loss which summarized the prior 30 years of studies on this most difficult quest:
"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 lbs. or more; 50% lose 40 lbs. or more versus 1% in the earlier treatments.
Despite the ability of people in the best professionally conducted programs to lose weight far more effectively than the prior generation of programs, the clear majority of participants do not succeed in maintaining weight losses when followed up over several years, even today. Several studies point the way to better long-term outcomes, but the following findings do not fit with the prevailing views about rapid weight loss:
- Dr. Tom Wadden and his colleagues 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. 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: week 18, week 26, and week 52.
- Dr. Robert Jeffery and his colleagues (in a 1998 study) examined weight losses and psychological effects at 2.5 years in 130 overweight people (69 men, 61 women). These participants received professional cognitive-behavioral weight loss therapy for 18 months. The researchers divided the participants into three groups based on outcomes at 18 months. The most successful Tertile at 18 months maintained weight losses far better than the other participants. 23% of those who lost the most weight initially maintained weight losses of at least 10% of initial body weight vs. 9% of those in the second Tertile and 2% among those who lost the least weight initially. The initial goals of the biggest losers and their psychological status both initially and at 30 months were similar to those in the other groups.
- An earlier study (1989) by Jeffery and colleagues 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.") promotes better weight loss over time, according to research by Dr. Kevin Hartigan and colleagues.
Both I and my colleagues 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, often after achieving some initial success, the motivational picture weakens. Weight controllers then find themselves in the "frustration" stage. Perhaps 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.
Conclusions
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 really hard in the early stages of a weight loss effort in the context of an approach that has a strong scientific foundation.
Driving the weight down rapidly may prove very encouraging, engendering more favorable self-efficacy beliefs and maintaining the honeymoon stage longer. Then, as the focus and motivation almost inevitably decline somewhat, some degree of weight regain won't have as much of an impact. This means that as you attempt to realize your last New Years Resolution to lose weight, remember to go all out especially in the early stages: go for it!
Bibliography
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.
About Dan Kirschenbaum, Ph.D
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