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Diet 'Coaches' Help Keep the Weight Off

Posted on: Wednesday, 12 March 2008, 06:10 CDT

Dieters who had regular contact with a weight-maintenance coach kept off more pounds than people who got support on the Web or simply went it alone.

That finding -- from a new national weight-loss study led by Duke University researchers and published in today's issue of the Journal of the American Medical Association -- provides an indication of how hard it will be to tackle America's burgeoning obesity epidemic.

About 62 percent of Americans and 63 percent of North Carolinians are too heavy, which increases risk for heart disease, Type 2 diabetes and other ailments. Although much is known about how to lose weight, little is understood about the best ways to keep it off. And almost all people who successfully trim down end up regaining at least some weight -- a phenomenon commonly referred to as yo-yo dieting.

In the study, which enrolled 1,032 men and women nationwide and about 260 at Duke, participants followed three weight-loss maintenance approaches. After they lost weight, some were randomly assigned to have short monthly meetings with a personal weight-maintenance coach, while others were advised to use an interactive Web page that provided similar information and support. A third group was told to continue doing what had helped them in the first place, such as being more active, eating less and dining on mostly fruits, vegetables, low-fat dairy and whole grains.

People in all three groups regained at least some of the pounds they shed in the initial slimming phase. But people who had short, monthly sessions with a counselor, either in person or by phone, kept off an average of 3 pounds more than the others.

More than 75 percent of people assigned to the personal contact group maintained at least some weight loss for 2 1/2 years. Sixty-nine percent of participants in the Web group kept off weight, and 67 percent of those who got no help did.

"Part of the problem is we're looking for an easy fix," said Dr. Laura Svetkey, the Duke physician who led the national study, which was the largest and longest to look at ways to maintain weight loss. "This is very hard. It's going to be hard to lose the weight and hard to keep the weight off."

Robert Sanders, a retired postal worker who lives in Raleigh, said he enlisted in the study nearly three years ago, and lost about 30 pounds to a more comfortable 216.

"I was big. I was real big," Sanders said. "My doctor was telling me to lose weight."

And for good reason. Sanders said his blood pressure was elevated, his cholesterol was high, and he was having irregular heartbeats. After enrolling in the study at Duke, he said, he embarked on a lifestyle makeover that included exercise and a new approach to eating. He began cooking with healthful fats such as olive oil, ate lots of fruits and vegetables, and cut portion sizes. Monthly conversations with his nutritional coach, he said, gave him the incentive and knowledge to keep off the pounds for almost three years. He's also taking fewer pills for his cardiovascular issues.

"I will never go back," Sanders said, noting that previous diets resulted in weight loss but subsequent gains after a few months. "You will never see me again at 245 pounds, because I know the lifestyle change has taken over what I do."

Such an approach suggests a lifelong commitment that can be learned, but under rigorous terms. Svetkey said she is unaware of any sort of weight-loss intervention available in the community that provides what the study offered.

"And if you found something like this, it would be hard to afford," she said. "That's a whole other problem we need to solve."

Gail Orrin, director of exercise and fitness services for the Institute of Lifestyle and Weight Management in Raleigh, said her organization provides outpatient services for an average of three months, and will soon offer two- and four-week residential plans. She said she agrees that maintaining weight loss is a difficult challenge.

"It's a long process and team effort to get to the point where they can maintain self-control for a lifetime and be okay with that," Orrin said.

Like Sanders, a majority of study participants were able to maintain a weight loss significant enough to have health benefits, Svetkey said.

"The good news is that you don't have to lose a lot of weight," Svetkey said.

A person's risk of developing Type 2 diabetes falls 16 percent with every two pounds of weight loss, she notes. And losing just 1 pound is associated with a one-point drop in blood pressure.

"So if you lose 10 pounds, your blood pressure can drop 10 points," said Svetkey, who also directs the Duke Hypertension Center. "That's as much as we get with medication, oftentimes."

Overall, 70 percent of participants maintained some weight loss, no matter what maintenance group they were part of. People in the personal contact group did best, retaining an average weight loss of about 9.2 pounds. Participants in the Web group maintained a loss of 7.3 pounds on average, compared to an average loss of 6.4 pounds in the self-directed group.

"Even the control group retained weight loss," Svetkey said. "That's enough to have significant health benefits."

Source: The News & Observer

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