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The Elephant in the Room: Weight Maintenance

So, you’ve lost 22% of your body weight in 3 months, now what? I am so happy when people ask me in their initial consultation, “What is your maintenance plan?” I had a conversation with a patient the other day about the name “Rainier Medical.” I did not choose it just because we are close to Mt. Rainier. In fact, after I opened, I realized how many businesses are named “Rainier” and wondered if it was the right choice. But, I have seen that it is perfect! Why? Because losing weight and keeping it off is like being a mountain climber! It takes courage to look at that peak and decide to start. It takes planning and training and physical and emotional pain to summit. It takes heart, grit, and the ability to envision the incredible view from the top when your knees hurt and your chest burns and you are grinding away at the switchbacks in a forest. Then, when you get to the top, you get to enjoy the view for about 5 minutes until you have to start the climb down to get to the car before the sun goes down. Lo and behold, the way down is harder than the way up! Your knees hurt even more, you are mentally and physically fatigued, and you do not have that victorious peak to look forward to. Then, once you revel in the glory for a few months and you have conquered that mountain, you may suffer from the apathy of not having a goal. You may feel lost and not no where to go next. With that picture of maintaining weight loss, let’s look at how I approach weight maintenance. I have used resources to clarify a few simple rules. I am not saying they are easy, but I am saying they are simple and effective. The good news? You already learned most of how to maintain weight during weight loss, and you may not have even realized it! Remember the movie “Karate Kid?” Remember when Daniel was waxing the car and painting the fence and did not even know he was creating muscle memory? Well, you create habits during the Rainier Medical weight loss program that are the cornerstone of weight maintenance. So, the transition phase from weight loss to weight maintenance is crucial because you have to know what to change and what to keep. People who regain weight and come back frequently say the transition was what was missing. It happens when people go on vacation at the end of their weight loss and then do not return to make the transition phase.


As with most of my blogs, there is an evidence basis for my recommendations. The basis for this blog comes from a few sources. One is the National Weight Control Registry.

Another basis is the literature search I performed for my talk on this program, available as a podcast if you would like (stay tuned for it posted on website).


Section One: Nutrition


Rule 1: Eat the Same Things most of the time.

Have you heard the nutrition advice to eat a variety of foods or to try a new food each week? In actuality, the science shows that a smaller variety of foods is associated with prevention of weight regain. Choose a few meals/food combinations for breakfast and lunch. You may read this with a sense of relief. You may recall with fondness how simple things were when you were on meal replacements and did not have to think about what you were going to eat. Keep that pattern when you substitute the meal replacements with grocery store food. The good news? You have just been on a meal replacement weight loss plan, so you have eliminated all food from your diet. Most people have to get to a small variety of foods by cutting out one food per week. You get to add back food to your diet, just don’t add back too many. But, to you, it will seem like a lot of variety right now. So, this is the first crucial part of transition. Go from no foods, to just the foods you want on your plan. It will seem like a large variety to you! Part of the value of the meal replacement plan is that taking away food is a powerful way to change your relationship with the food. Your hypothalamus is reconditioned. Your palate is cleansed. You can appreciate the subtle deliciousness of a ripe tomato and a crispy vegetable. Protect that! Refer to my previous blog on how quickly the hypothalamus can be reconditioned to crave high fat foods. You do not want to have to go through withdrawals again.