New weight control strategy urges ‘maintain, don’t gain’ approach

Despite the health risks associated with obesity, convincing someone who is apathetic about weight loss to shed excess pounds can be a struggle.

With this dilemma in mind, researchers at Duke University sought to explore whether a ‘maintain, don’t gain’ strategy– in which overweight or slightly obese people are taught to follow simple health rules to prevent further weight gain – would prove effective.

In a study published in JAMA Internal Medicine, Duke professor Gary Bennett worked with a group of 194 black women, ages 25 to 44, for a period of 18 months. Half of the women were placed in an intervention program in which they received counseling on weight maintenance techniques, while the other half received normal care from physicians, typically involving weight loss counseling.

“We’ve known for a long time that black women who are overweight or slightly obese have a lower risk of a range of health conditions like hypertension, heart disease, diabetes and also are less likely to want to lose significant amounts of weight,” Bennett, associate professor of psychology and neuroscience and global health, told FoxNews.com. “But if they gain – which they do, at a rate of about 2 to 4 pounds per year – they quickly move from low obesity with low health risk to higher level of obesity with more concerning health risks.”

In an attempt to curb weight gain and the health risks associated with it, each of the participants in the experimental group were given customized health goals to follow for 18 months. The objectives were simple and involved regulating habits like the number of sugar-sweetened drinks consumed, fruits and vegetables eaten, hours of time spent sleeping and amount of time spent briskly walking.

“These goals make a slight calorie deficit, enough to prevent weight gain,” Bennett said. “You only need to reduce 100 to 200 calories a day to prevent weight gain, whereas if you want to lose, you have to reduce by 500 calories a day.”

Each week, women received an automated phone call asking them to rate their progress. Based on that feedback, they would then receive counseling from registered dieticians.

After a year in the program, 62 percent of women in the weight maintenance program were at or below their weight at the start of the program, compared to 45 percent of the women in the normal care group. Furthermore, after 18 months, women in the maintenance program continued to maintain their weight while women in the normal care group continued to gain weight.

While researchers didn’t notice any immediate indicators of improved health, they suspect health benefits for the weight maintenance group will become more apparent over time.

“I think we’ll see these women will maintain weight for quite a long time, and if we can prevent (weight gain) for long enough we will see changes in cardio metabolic primers,” Bennett said. “Blood pressure is very likely to increase with increasing weight, so if we can keep weight stable, we can contain increases in blood pressure – and that would be a major clinical finding for us.”

Bennett attributes the program’s success to the fact that they didn’t try to force weight loss on a group that wasn’t interested in it.

“We didn’t ask them to go against their inclinations and lose a lot, they just want to tighten up, feel better, feel better in their jeans and have energy,” Bennett said. “And by preventing weight gain you can improve those things.”

Overall, Bennett believes these findings are also applicable to much larger segments of the population. While patients who are very obese (a body mass index (BMI) over 40) should still prioritize weight loss, people who are overweight or slightly obese could benefit from weight maintenance programs.

“For an obese patient, losing weight is the most important thing to do. But you have to want to do it in order to lose weight, and there are large segments of the obese population not interested or motivated for weight loss,” Bennett said. “For that group, the priority should be maintaining, not gaining weight. Real health risks begin to kick in as folks gain weight year after year after year, so the fundamental priority is maintaining.”

For people interested in starting a weight maintenance program, Bennett said there’s one easy way to get started.

“I can tell you certain things are easy to change right away – sugar-sweetened beverage consumption,” Bennett said. “Most people can reduce calories by 100 to 200 a day simply by changing one soda a day or one iced tea a day to water or unsweetened tea, and for many a change that simple can help prevent weight gain.”