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Monday, June 20, 2011

Are You In Or Out- Why Some Succeed and Others Fail at Long Term Weight Loss

What motivates some people to get on the path to personal fitness and achieve long term success? This topic has probably been debated for as long as there has been deep-fat fried food. As I examine my own successes and failures and speak to others with combat experience in the bulge battle, I have come to believe that there is much more to successful weight and fitness management than dedicating ones self to counting calories and power walking, especially if the individual is plagued with a chronic illness or orthopedic condition.

I believe that to achieve success in a wellness program, it is advantageous to have some strong stimulus that will jump start the program and to have the proper behavioral mindset from the outset. In other words, we have to be so fed up with the condition we are in that we are truly ready to make a change.
The first time I thought about this was several years ago when I was treating an elderly man for an orthopedic injury who was in particularly good shape. In questioning him I learned that he had always been around the same size with some fluctuation. When I asked him what his secret was, he told me very simply..... "well, every time my pants got tight, I realized I needed to stop eating so much." This was profound to me that something as simple as not wanting to buy a new pair of pants could be one's "trigger" for pushing away the plate. It made what is so complicated for myself and others so simple. 
In contrast, there are many others who can pass one obesity milestone after another without reaching the "tipping point" as Malcolm Gladwell put it, to actually motivate them to a lasting healthy lifestyle. What is the difference between those who succeed and those who fail?
There is evidence-based research on this topic and the various findings are pretty interesting.
First, it helps if you are willing and able to take on the physical activity necessary to achieve results. One of the greatest predictors of weight loss failure is the belief that one cannot do more physical activity than they are right now 1. The fact is, everyone of us, with few exceptions, can do more. A patient with hemiplegia can get on an arm bike, a woman with MS can spend a little more time doing water walking, and an overworked dad can get up 20 minutes early to get on the treadmill. Those who truly think otherwise when initiating a weight loss program can be reasonably certain of one thing: failure. As well-known trainer Tony Horton says, "Stop saying 'I can't' and replace it with 'I currently struggle with'!"
Second there are several behavioral traits of individuals who achieve long term success in their weight loss program.
In a recent study of 225 middle aged women they found that those who achieved weight loss for at least two years usually:
  • had flexible cognitive restraint. That means that when faced with the opportunity to make good decisions regarding their nutrition and exercise, these women make them. They don't get the cheese on the burger. They eat half of the bread when they get a sandwich. They take the stairs instead of the elevator. Day in and day out, they make good choices.
  • they were disinhibited. In other words, they really don't care what others think. They do what is best for themselves and continue pursuing their goals.
  • they had exercise self-efficacy and exercise intrinsic motivation. They loved to exercise, saw the benefit of it, and didn't need some external force pushing them to do it. 2
I think that last trait is the key. It is so simple and cliche' but true. If you love it, you'll do it. So are you intrinsically motivated because you want it for yourself? Or are you exernally motivated to lose the weight to please someone else or just to achieve some short term goal. Are you in or are you out?
Recently, my wife and I started an exercise program incorporating yoga. We get up very early to do downward dog, tree pose, and vinyasas. I have noticed it has made my back and neck feel less pain and I feel more functionally flexible. I see some real benefit! My wife, Susan, however, just feels like it is messing with her chi. When we are supposed to be calm, intense and focused, she is irritated, bitter and distracted. If you had to guess, who do you think is more likely to continue doing yoga 5 years from now? My guess is Susan is much more likely to be on an elliptical machine or doing tai-Bo than in the yoga crane. However, she is rather fond of the corpse pose, so she will probably still be doing that position all night for many years to come.
The point is, initially focusing on counting calories and "dieting" may help you lose a few pounds, but you will have a struggle achieving long term success. Those who keep the weight off and truly achieve wellness find enjoyment in the process even if it sometimes makes them cry; and learn to love the activity, even if it hurts. 3
So, again I ask, are you in or are you out? Check your attitude, be honest with yourself about what motivates you and make the decision. A friend who I just saw after a long absence and has lost over 100 lbs in the interim said this when I asked him how he got started:  "I asked myself, if not now, when?" We all would do well to ask that same question.
References
1. Kong, et al. Predictors of success to weight loss intervention program in patients at high risk for diabetes. Diabetes Research Clinical Practice. Nov 2010.
2. Teixeira PJ, et al. Mediators of weight loss and weight loss management in middle aged women. Obesity. Apr 2010.
3. Teixeira PJ et al. Exercise motivation, eating and body image variables as predictive of weight control. Med Sci Sports Exerc. Jan 2006.

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