Keeping off the pounds
‘The majority who try to do it alone will gain it back,’ says an expert who sees problem as a chronic disease
This is part of an occasional series addressing the problems that can arise after meeting a long-sought goal.
It was more than 14 years ago, but Sandra Elia vividly remembers the day she decided to change her life.
She was 29, trapped in a bad marriage, overwhelmed with caring for her mom, who had bipolar disorder, and was herself struggling with depression and food addiction.
“My whole life was spiralling out of control and my weight was one of the symptoms,” says Elia, who at the time weighed more than 260 pounds.
“Every part of my life seemed broken and the only coping mechanism I had developed was to eat, was to binge.”
But there came a day in 2003, when Elia was at an “all-time rock-bottom,” that she took the first important steps to transform her life.
She started by eliminating addictive foods from her diet — for her, these include breads, pasta and sugary sweets — and by walking, at first just 15 minutes, every day.
Soon, those slow, short walks turned into fast-paced, long walks, which in turn led to jogging, then running.
With time, commitment and hard work, Elia lost more than 100 pounds. Along the way, she learned to love her body and her new healthy habits — an outlook that has helped her maintain that weight loss for more than 14 years.
“For me, the prize is not a number on the scale,” she says.
“The prize is how I’m living my life and how I feel about myself.”
A common narrative in our diet-obsessed world, fuelled by TV ads and magazine covers that flash before-and-after photos of people going from heavy to slim, is that those who reach a weight-loss goal have finished the fight against unwanted pounds.
But mounting research, along with the personal experiences of many thousands of people, show that staying at a healthy weight can be harder than the initial weight loss.
Reaching a weight-loss goal, whatever that might be, is not the end of a journey, but a beginning, says Rena Wing, a professor of psychiatry and human behaviour at The Warren Alpert Medical School of Brown University.
“There are two misconceptions about longterm weight loss,” she says. “The first is that nobody is ever successful. The second is that after doing the hard part — losing weight — maintaining is easy.”
Research has revealed that it is largely our biology, and not our strength of will, that makes it so easy to regain lost weight. A suite of physiological factors, including appetiterelated hormones, metabolism and even neurological pathways, make our bodies fight against weight loss.
This is why the majority of people who lose a substantial amount of weight gain it back within months or years.
Despite this discouraging evidence, Wing insists long-term weight loss is not a hopeless cause. She is the co-founder of the National Weight Control Registry, which began more than 20 years ago, and now tracks more than 10,000 Americans who have lost at least 30 pounds and have kept the weight off for more than a year.
“It shows that maintaining weight loss is definitely possible,” she says. “Yes, it can be done. But it is hard.”
A key finding of the registry is that people who succeed at weight management are able to find a way of life — a diet, an exercise regime, a collection of healthy habits — they can stick to forever.
Ximena Ramos Salas, managing director of the Canadian Obesity Network (CON), says that while long-term weight loss success is possible, most people are unable to do it on their own.
“The majority who try to do it alone will gain it back,” says Ramos Salas, a PhD candidate at the University of Alberta studying weight bias in public health. It’s for this reason the CON is pushing governments to recognize obesity as a progressive chronic disease and offer longterm health supports to patients, just as people with type 2 diabetes, hypertension or depression receive followup care.
“These patients don’t just get six months of treatment and then are let go from the health system,” she says. “But we do that with obesity because of weight biases and the stigma, which says people did this (obesity) to themselves and need to manage it on their own.”
Unlike other life successes — earning a postgraduate degree, for example, starting a family or buying and renovating a dream house — weight loss is not a permanent state, says Dr. Valerie Taylor, chief of psychiatry at Women’s College Hospital in Toronto.
“Weight loss is something that, if you don’t stay on top of it, you can absolutely backslide. That can become psychologically challenging.”
Rather than set big, far-reaching goals, such as losing 20 pounds in four weeks, Taylor advises patients to focus on small, obtainable goals, such as walking 10 minutes a day, ballroom dancing on Friday nights or losing enough weight so a seatbelt extender isn’t necessary for airplane travel.
“People build on successes. They don’t like to build on failures.”
Elia, now 44, has faced difficulties during her 14-year weight-loss journey, including two relapses when old, unhealthy habits took over and her weight crept back.
But overall, Elia says she has followed through on her vow to change her life in profound ways, including leaving her marriage and changing careers.
She eats fresh, whole foods as a way to sustain her body, not placate her feelings. She exercises, whether running, lifting weights or hot yoga, three to five times a week. And she meditates, nearly every day.
Elia, a certified food addiction counsellor, draws on her personal experience while running the food addiction clinic at the Wharton Medical Clinic, which treats people with obesity and diabetes and which has six locations in Ontario, including in Toronto.
The main message she has for people who want to lose weight — and keep it off — is to find their big motivation to change their life. Something bigger than fitting into a tiny dress or getting slim for a high school reunion, goals which she says are fleeting and unsustainable.
For Elia, it’s her 6-year-old daughter who brings inspiration.
“Every time I get off track, or lose motivation, I look into my daughter’s eyes and ask myself, what kind of life do I want her to live?
“I want her to be happy and healthy. And then I show her how to do it.”