Pediatricians have a laundry list of age-specific issues they talk to parents about. These issues include advice about immunizations, when to add certain foods to the diet, counseling on behavioral issues, and much more. They also have checklists of things they monitor at each scheduled visit: The height and weight of the child are carefully plotted on growth charts and age-specific behavioral milestones (when the child started rolling over, talking, walking, and so forth) are noted in the medical record. Now, pediatricians are being encouraged by their own specialty society, the American Academy of Pediatrics (AAP), to add routine monitoring of physical activity of their patients and their families. I say bravo!
Although the article I read about regarding this new policy in the San Francisco Chronicle began by saying the AAP wants to turn children’s doctors into “activity police”—a decidedly negative framing of the issue—who better to counsel and cajole parents and kids about an activity that is so vital to their lifelong health? Dr. Berry interviewed 20 women she recruited by posting flyers at the local Weight Watchers and Take Off Pounds Sensibly (TOPS) meeting spaces. Of the 20 who responded and agreed to participate, 18 had maintained their weight loss for at least a year. Four had maintained their weight loss for very long periods of time (13, 17, 20, and 27 years). Weight loss ranged from 15 to 144 pounds. Only two women had failed to lose weight. The author said she included them to contrast with the successful weight maintainers. However, a comparison group of only two is unlikely to reveal any generalizable information.
The researcher interviewed the women twice, each interview lasting from 60-75 minutes. The focus of the interviews was based on a theory the researcher wanted to explore, known as Newman’s theory of Health as Expanding Consciousness. This theory proposes that lifestyle transformations occur when one understands one’s own life patterns through a reflective process. Because of that, during the first interviews, the researcher encouraged participants to “tell me about the most meaningful persons and events in your life.” After “dwelling” with the data from the interviews, Dr. Berry constructed both verbal and diagrammatic life patterns of each of the individuals. At the second interview, they were shown these appraisals of their life story and they were asked to reflect on the accuracy of the portrayal. Revised patterns were constructed and then analyzed “in relation to Newman’s theory.”
6 life patterns of weight loss and maintenance
Dr. Berry identified 6 life patterns of weight loss and maintenance:
- Before losing weight, women were self-conscious, vulnerable, and unaware of events that contributed to their weight gain. A majority of the women talked about having low self-esteem as an integral part of a difficult and unhappy time in their lives before losing weight.
- The women experienced a recognition of the problem, a readiness to take action, and a decision to make a change. For some, it was a physical problem that provoked the readiness to change (shortness of breath, a diagnosis of high blood pressure); for others, it was deciding they did not like the way they looked, did not want to buy a larger dress size, or did not like how much they weighed. One woman said she stepped on the scale and “…saw the two hundred. It was like a stop sign. That is what woke me up.” Once the recognition, readiness, and decision occurred, many of the women described having more energy and a renewed commitment to embark on the lifestyle changes necessary to achieve and maintain a healthy weight.
- Women took control and actively engaged in behavior change. The sense of taking control over one’s life was described as a feeling of empowerment that moved them forward and helped sustain the process. Many of the women joined weight loss groups. They learned to control portion sizes, avoid trigger foods, and find more time for themselves. Some women couldn’t sustain these behaviors and cycled back into weight gain before finally losing the weight and keeping it off for good.
- As women lost weight, they incorporated new behaviors. They became comfortable with sustained monitoring of portions, avoidance of trigger, or comfort foods and they all made exercise a part of their everyday life. They self-monitored their weight and used this information to adjust food intake in order to lose or maintain weight.
- They all talked about the value of social support and validation to reinforce their behavior change. Support came from family, friends, and/or a weight loss group. A majority of the participants attended weekly weight loss meetings and described the importance of support from the group members in their continued weight loss/maintenance success. (BTW, we hear this over and over from PEERtrainer participants as well).
- Personal integration and weight maintenance brought decreased vulnerability and increased self-confidence, self-esteem, and control of their lives. Here are some quotes from the participants that document that change:
- “I am a different person today. I feel stronger and more in control;”
- “I think this has given me more personal incentive to balance my life. It is a lifestyle change;”
- “You have to take care of yourself first and then your relationships all fall into place.”
- “I feel like a new person. My whole life has changed. I could never go back again.”
- “My addiction is food and as long as I know what triggers me and I maintain some control over it, I will be able to maintain the changes I have made.”
The article notes that the two women who were unable to maintain weight loss both continued to have low self-confidence and self-esteem. They were unable to sustain lifestyle changes and, therefore, cycled back into weight gain. They knew about portion control and were aware of food but did not follow guidelines on a regular basis. They exercised regularly but seemed surprised that this was not enough to control their weight. Both engaged in a weight loss program but dropped out several weeks later. Neither reached personal integration and both described their lives as being out of control.
So what can we take away from this study that can help us lose and maintain weight loss? It seems to me that there are four key elements. One is recognizing there is a problem. Another is making a decision to be in control over this aspect of your life forever. The next is integrating healthy habits into your daily life—this is who you are and what you do. And the last is being sure you have social support and validation to help gain control and institutionalize the behavior changes.
Group participation with regular log-ins and comment postings is the foundation of PTs social network for weight loss/fitness support and validation. PT provides a concrete means of self-monitoring weight, exercise, and caloric intake. Being successful at weight loss and maintenance has many valuable rewards…not just weighing less, looking better, and improving your health, but also gaining a new sense of personal power and control. Who wouldn’t like to wake up every morning and say, “I am stronger and more in control?“