Obesity Expert Discusses Importance of Weight Maintenance

EDJ_3065.NEFMedicalResearch.com Interview with:
Dr. Holly R. Wyatt, MD
Endocrine Society spokeswoman
Associate Professor, University of Colorado Denver
Medical Director, Anschutz Health and Wellness Center
Medical Director, ABC’s TV series “Extreme Weight Loss”.

MedicalResearch.com Editor’s note: Dr. Wyatt is a nationally known expert on obesity and weight control. Dr. Wyatt is co-founder of ‘The State of Slim’ behavioral weight management program and has been the National Program Director for the Centers for Obesity Research and Education (C.O.R.E.) since 1999. Dr. Wyatt publishes extensively in the obesity and metabolism literature including publications in the NEJM, Obesity, Annals of Internal Medicine, Journal of Clinical Endocrinology & Metabolism and American Journal of Clinical Nutrition among others. Dr. Wyatt kindly answered questions regarding weight loss and maintenance for the MedicalResearch.com audience.

Medical Research: How did you become interested in weight control?

Dr. Wyatt: Basically, because I struggled with my weight all my life. I was always planning on going to medical school and had been interested in learning more about the science of weight gain and metabolism, but at the time the subject was not well studied. When I came to the University of Colorado for my medical residency, I met researchers who were investigating the growing problem of obesity and were passionate about finding effective strategies for weight management. I have been active in clinical practice and obesity research since that time.

Medical Research: Why does weight loss or even weight maintenance become so much harder as we age?

Dr. Wyatt: We don’t know all the reasons for certain, but the problem is most likely multifactorial.

  • First, as we age we lose muscle mass. To a large degree, muscle mass determines our metabolic rate so even if our body weight stays stable, our metabolic engine slows down as we lose muscle and it becomes harder to maintain that weight.
  • Secondly, there is some role with for hormonal changes, but this role is incompletely understood. With menopause we tend to store weight centrally in our bodies, which may be a hormonal effect.
  • Perhaps most importantly, life changes as we get older and our lifestyle and environment evolves. We may not realize how much these changes affect the amount of energy we burn as our environment become more sedentary and obesogenic.

I should also point out that it is harder for everyone in our society to avoid gaining weight, even for children. Increasing numbers of children and adolescents are overweight and fighting obesity.

Medical Research: Is it true that women have a harder time losing weight than men?

Dr. Wyatt: A little bit, at least anecdotally, it seems women have a slightly harder time losing weight than men. It may be that men have a higher metabolic rate than women as men continue to have relatively more muscle mass.

Medical Research: Are some people genetically predisposed to weight gain?

Dr. Wyatt: Absolutely, there is no doubt that genetic predisposition plays an important role in determining our ability to gain or lose weight. We understand now that weight is affected not by one but by several genes (maybe even many) that influence a person’s weight in ways yet to be fully determined.

Medical Research: Does gaining weight make it more likely a person will develop diabetes or heart disease?

Dr. Wyatt: Yes, definitely, especially for diabetes. Even a small amount of weight gain can have a negative impact on the risk of Type 2 diabetes. Fortunately, a small weight loss can have a beneficial affect.

Medical Research: Which diets have scientific studies identified as the most effective?

Dr. Wyatt: Head-to head studies of the major commercial diet plans have found no one clear winner. What we have learned is that weight control is about adherence to a plan that an individual can stick with. Finding the right plan is dependent upon that individual’s temperament, physiology and environment.

Medical Research: What factors should dieters consider when selecting a nutrition plan?

Dr. Wyatt: What I recommend to patients is that they try to find a diet or eating plan they can adhere to. For some patients a high protein Atkins-type diet will work, for others a low-carb is not suitable if the person does not like meat. For some a pre-packaged meal replacement plan may be a good choice if convenience is a big issue.

In almost all cases, we can’t stay on a diet forever. Weight loss and weight maintenance are two different things. If a person can stick with a diet plan for 3-4 months, there will generally be enough weight loss that adjusting to the new weight and maintaining the weight loss becomes the goal. I find that trying to diet continuously often leads to frustration, regaining of the weight that was lost and the beginning of another yo-yo cycle of weight loss and gain.

In both the weight loss and maintenance phases, exercise is important but physical activity becomes the biggest part of success in weight maintenance.

Medical Research: What are some signs that a given diet may be unsafe?

Dr. Wyatt: If a diet is all about one food, such as only grapefruit, or a particular cookie, that may be a signal that the diet is potentially unsafe. If a plan is restrictive to 800 or fewer calories in a day, a medical professional should monitor the diet.

Medical Research: It seems everyone is talking about reducing carbs now.  Is a low carb diet safe?

Dr. Wyatt: There has been considerable recent research demonstrating that higher protein, low carbohydrate diets work for some people and are relatively safe. My colleagues and I addressed this in a paper published in the New England Journal of Medicine and found no serious health issues for most patients who could adhere to a higher protein diet. Again, the biggest issue is the transition to a weight maintenance phase one the diet phase is completed.

Medical Research: Why is maintaining weight loss the most important aspect of successful dieting?

Dr. Wyatt: The weight maintenance phase is the most important because it is the most difficult! Sometimes it is better to diet to drop some of the weight we want to lose, then work on maintaining that loss rather than continuing to diet. Otherwise we never learning what it feels like to maintain a lower weight, and risk repeating the diet-regain cycle all over again.


A Randomized Trial of a Low-Carbohydrate Diet for Obesity

Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D.

N Engl J Med 2003; 348:2082-2090
May 22, 2003DOI: 10.1056/NEJMoa022207