Q&A with 'Refuse to Regain' author Dr. Barbara Berkeley, Part 1

January 19, 9:36 AMWeight Loss ExaminerGail Gedan Spencer

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Congratulations, you're at goal!

Now what?

As someone who has lost weight and regained it a couple of times, the act of maintaining weight loss can be far harder than losing the weight. Dr. Barbara Berkeley (at right) has chosen to devote most of her career to obesity management and has written the book Refuse to Regain! 12 Tough Rules to Maintain the Body You've Earned! Berkeley, former medical director for the Optifast program and founder of Weight Management Partners, also writes the Refuse to Regain blog with my pal Lynn Haraldson Bering, who lost 168 pounds and has kept every pound of that off for nearly two years. She blogs about her weight maintenance at Lynn's Weigh -- The Journey Continues.

Since this year starts Project "Holy Crap, I've got a High School Reunion Next Year" for me, I hope to be maintaining a big ol' weight loss soon, so I chatted with Dr. Berkeley:

Q. Which is harder, losing weight or keeping it off?
A. The reflexive answer is that keeping it off is harder, but the truth is that they are BOTH hard. Losing weight, however, is a sprint and requires a shorter period of intense focus. Maintenance is much more of a lifetime marathon. A completely different sort of skill set is needed to be successful. One simple measure of which task is more difficult is to try making two lists: the first:the names of all those you know who've lost weight . The second, the names of those who've kept real weight off for a meaningful period (years). The first list is bound to be significantly longer.

Q. Why do so many people fail at maintaining their weight loss?
A. I believe that there are a number of reasons. Here are some of the biggies:

1. Most people lack a definite plan for maintenance. That's not their fault. The diet literature has been woefully lacking in specific guidance for maintainers. On the other hand, the reason that they lost weight in the first place was their adherence to a specific plan (their diet). Going into a much more difficult phase with no strategy or a weak strategy is very likely to lead to failure.
2. Weight loss is all about depriving the body of calories. Many people can lose weight without exercising, for example, as long as they cut calories enough to force the body to use its fat stores. For this reason, weight loss diets are necessarily depriving. Additionally, they are sometimes composed of odd food combinations such as pots of cabbage soup, nothing but meat and bacon rinds, or huge amounts of grapefruit. Each of these strange ways of losing weight may work, but they can't be used as long term diets. Long-term maintenance diets look different than weight loss diets and can't feel depriving if they are to work.
3. There is no mystery to why we regain. We regain for exactly the same reasons we gained in the first place. The cycle re-establishes itself. Most people believe that gaining is the result of eating too much and exercising too little. While I can't totally discount this explanation, I'm not a fan of it. I don't think that it tells the whole story. My belief is that each body is built with a balance mechanism for eating. If that mechanism is functioning well (as it is in those who don't gain weight easily), it disposes of excess calories and makes up for sedentary behavior. People with functioning balance mechanisms weigh the same on Dec 31st as they did on January 1st without ever thinking about what they eat. (By the way, I used to be one of these people and believe me, I was able to eat more than most of my patients ever dreamed of eating). Clearly, this mechanism is disrupted in those who gain weight easily.
   
   For me, the explanation that makes the most sense is that this disruption comes from various elements in the modern diet that our genes were never exposed to and are not prepared to handle in large amounts. What comprises the full list of bad guys in the diet remains unclear...certainly our enormous intake of starches and sugars is one element (salt, saturated fats may be others). While we are actively restricting calories and forcing the body to use fat, this problem is not in evidence. The minute that we resume eating the modern American diet, however, we start to regain. This is the reason I advocate stripping the diet down to its ancient essentials...as least during the early months of maintenance. Following this period, a kind of elimination diet, maintainers can try adding back small amounts of more modern foods (whole grains, some sugars, etc..).
   
   This should be done slowly, carefully and while watching the scale so that each maintainer can determine his or her particular level of sensitivity. Each person is different. Some can add back quite a bit. Others very little.

Tuesday, we'll do Part 2.