Don't worry, this is a good "new normal!" With an average weight loss of 22%, the question for most people who do the Rainier Medical program is not whether the weight is going to come off, it is how to keep it off. We know that there are 3 highly effective clinical treatment options for longitudinal treatment of the chronic metabolic condition of excess weight: meal replacements, medications, and surgery. But, as effective as those things are, the reality is that not even those things are sufficient as stand alone approaches and there are important potential barriers to each of them that makes the practical need for additional lifestyle measures crucial to the durability of ambitious weight loss results such as the 20 to 25% seen at Rainier Medical. For example, current anti-obesity medications are either controlled substances with common contraindications and intolerances (phentermine/topiramate), have a $1300 a month price tag with most people not having insurance coverage (GLP-1 agonists), or offer only modest weight loss (buproprion/naltrexone). Regarding bariatric surgery, still only 1-2% of people eligible have this surgery, and 40% of those that do experience weight regain, so that more bariatric surgical procedures conducted these days are "re-dos" than primary procedures. Medical meal replacements have the advantage of being neither surgery nor a pharmaceutical, and are safe, effective, cost about $4 a meal and have very few contraindications, but few people remain on them as primary source of nutrition long term, although many people ask about it and it may be a better idea than it seems! So, let's look at some specific features that have been shown in the National Weight Control Registry and other sources to be associated with maintaining a healthier weight.
Engineering the Food Environment
It is hard to realize how much the food environment has changed over time in our society, until you are not eating anything except meal replacements, perhaps. Then, you may have a heightened awareness of the odd places in which you are exposed to ultra-processed, calorie dense, added sugar-laden foods. Home depot, your kid's ball game, a few times on every street block, every check out at every store...it seems you can not go anywhere with out advertising targeting your cravings center. Some of it is so blatant as to actually say things like "happiness is just a (insert sugary drink name here) away." We have all seen the comparisons of the sizes of everything from plates and cups to apples and donughts from those our parents had. Engineering the food environment is take everything under your control and only put into it what you need. You can take a mindful, global view on this also. In America, there is so much food thrown away that ends up in landfills that creates methane that is harmful to the atmosphere. Food packaging creates a large amount of garbage and food transport creates emission as well. Food production, transport, packaging, waste, and consumption plays an important role in our global health.
What does this mean specifically? Try these steps:
- Clean out the refrigerator and pantry. Start fresh.
- Ony stock foods that you want to be part of your normal, everyday eating patterns. If it is a treat, you will go out and make a special trip and purchase it for a special occasion in the quantity you are going to eat for that occasion.
- If possible, buy small amounts of fresh fruits and vegetables, so you can eat them when they taste their best. Keep some frozen ones for back up.
- stock canned goods that are whole and unprocessed, such as lentils, chick peas, white beans, red beans, tomatoes
- stock bulk grains like brown rice, oatmeal, quinoa, or couscous
- have a stocked spice rack. Use whatever spices you like and minimize jars of sauces that may contain added sugars, high fats, or endocrine disrupting chemicals
- don't be afraid of good old fashioned whole foods like eggs, butter, and fruit.
- avoid the snacks and processed foods. If you don't have them, you are much less likely to eat them. If you are physically hungry, you will eat a whole food. People are less likely to snack when they are not hungry on whole foods.
- reshape your thinking and expectation of what is "normal" in the context of health. Try asking yourself if something is healthy and make your decisions that way, instead of based on the norm.
- avoid buying bulk frozen, processed foods. While it may seem like you are paying a small amount of money per unit of food, you are not doing yourself any favors in the long run most likely, unless you are counting your calories and budgeting your money that way, in which case you are likely eating one meal a day of those typical foods.
Engineering the Physical Environment
There are many studies linking our physical environment to our physical health. Some connections are obvious: clean air, clean water, accident free zones, while others are more subtle: freedom from excessive noise, clutter, and access to personal space. Take a look at your home, where you spend most of your time. Is the TV the center of the main room? Do you actually dine at your dining table? Do you do anything other than sleep and have sex in the bedroom? Do you have a quite place that you can go to when you need some personal time? Are the surfaces and floors clear from clutter? Are the surfaces and cupboards in the kitchen free from visible food other than perhaps the fuit basket? Are there some art pieces or items to remind you of things you love? Wellness comes from the inside out. There are many studies linking the environment in hospitals to faster recovery times, fewer errors, and less need for pain medication. If you feel stress, trouble sleeping, low energy, pain, or have food cravings, your environment may be a place to start.
What does this mean specifically? Try these steps:
- If you need to, declutter your space. Many times, taking things out makes people feel better, rather than putting things in. Make sure that you can see the floors in the closets and can close all the closets and cupboards.
- clear off surfaces of tables, bookshelves, and other furniture
- move anything out of the bedroom that is not for sleep or relaxation. If you have a TV or computer in there, move it if you can. If you can not, try putting up a screen around it or laying a sheet over it when you are not using it.
- clear off the dining room table if there is anything on it. Set it for a dinner meal, as if staged to sell. Use the dining room table to eat and start a rule that you only eat there, not while standing or watching TV or in bed
- try making the TV and computer not a focal point of your space. Studies clearly link screen time to increased BMI, and statistics on the amount of time most Americans spend on a screen are concerning to most.
Are there certain people with whom you always seem to go out to brunch, or happy hour, or meet for a drink? Are there others that are more likely to want to go for a walk or a hike? There is an old adage, "Birds of a feather, flock together." Of course, there is an expensive medical study that showed that people tend to either gain or lose weight with those around them. There are exceptions of course, but why swim upstream if you don't have to? There are many social circles shifting these days for many reasons. Try to engineer one that sets you up for health and wellness.
How can you do this specifically?
- Look up some local hikes. Invite a few friends. Those that show up are your allies!
- Pick a landscape project. Ask someone to help and offer to help them with one in exchange. You both get a new garden and feel great, too! There is no better way to make a great friend than to ask for a favor!
- Bring and offer health food at your next get together. Watch and see how much people appreciate the extra effort you put in! They will probably pay it forward and do the same!
Nurturing an Active Lifestyle
After losing significant weight, many people feel much more energy, less joint pain, and want to be more active. This is important to nurture, since our society is mostly engineered for us to be either driving or sitting at a computer unless we are exercising! When did getting steps become the exception, rather than the rule? For this, the most important thing is to minimize screen time. It does not really matter what you are doing, as long as you are not sitting. How do you do this? Here are some ideas:
-walk in the yard or just around the house to some music while drinking your coffee instead of reading the news. This also avoids the news!
- of course, park farther away when you go places
- when you have a break, go for a quick walk, even if just a few minutes and inside
- "walk and talk" if you can, whether you are on a phone call or in person
- in the evening, turn off the screen. Maybe you are not sure what you are going to do? That is okay. You will find something, as long as the screen is off!
Most people have triggers for weight gain. They may be trigger foods, trigger situations, trigger people, or trigger drinks. Recognize what yours are, and avoid them as strictly as possible for as long as possible.
When you do all of these thing and put them together for two years, studies show you are more likely to develop a new "autopilot" or a "new normal." This is the longterm lifestyle change that is linked to weight regain prevention. Ironically, it looks a lot like the "old normal" of a few generations ago. But, these things only address societal and environmental issues related to excess weight. They do not address the chronic metabolic physiologic processes. For this, studies also show that access to and a relationship with a trained and trusted professional over time with whom you can partner is also linked with improved long term weight outcomes. Whether that is with Rainier Medical or elsewhere, the Obesity Medicine Association has a provider finder for clinicians trained in treating the condition of excess weight nationwide.
Take Back Your Lifestyle,
Valerie Sutherland, MD