When you compare existing research, you discover how "maintenance" is defined varies wildly
Maintenance isn’t always what you think it is, scientifically. What you see in all the success stories is skinny people, folks that lost weight and presumably stayed there. But the research doesn’t necessarily define maintenance that way, or even stick to one prevailing idea.
So if you’re confused about what’s actually “maintaining,” don’t worry. What we’re trying to say is, “Look, not only do you not have a universal definition of maintenance, nobody does.”
One of the problems with interpreting the scientific literature in weight management is that the working definitions of “successful maintenance” may not match our own notions. And even worse, the definitions are not consistent from one study to the next, even sometimes in papers from the same research group!
Defining “Maintenance”
No matter the differences, every definition contains two basic parameters:
- The amount of weight lost
- The amount of time the weight was kept off
From a range of scientific studies, here are a few different interpretations:
Maintenance can be measured in terms of the original maximum weight or the lowest weight ever achieved, or both. I selected a few studies from my collection to provide some examples. The 2000 paper I mentioned in my previous column defined successful maintenance as keeping at least 5 percent of weight off for 15 years. As I mentioned earlier, roughly 6 percent of the subjects accomplished that. The data from this study span 1975 – 1990.
In 1993, the National Weight Control Registry (NWCR) began with a different definition. To participate in the program, you must keep 30 lbs. off for a minimum of a year. To participate in the Registry at all, that’s still true today.
But even then, individual studies from the NWCR use different definitions of “success.” A 1999 NWCR paper defined “successful maintenance” as staying within 5 lbs of goal weight for one year. This is what I think of when I say “maintenance,” and I’m fairly certain it’s a common idea.
This changed in 2001. Since then, NWCR publications frequently define successful weight loss maintenance as keeping off at least 10% of the starting body weight. This amount of weight loss will not usually take someone from obese to non-obese status.
They use this definition because it’s rare for many obese people to achieve a healthy BMI, what they called “weight normalization” in this paper.
So the NWCR scaled back the definition to mean a loss that is more modest in terms of actual pounds (10%) but still significant in terms of health benefits.
With the definition also comes the caveat that research draws a distinction between whether the maintenance was intentional or the result of illness.
Without a consistent definition of maintenance in the scientific literature, it makes determining your own idea of maintenance that much more confusing. Some studies consider the lowest weight within any time point between the lowest weight and now, even if it has been regained. Others consider regain between the lowest weight and now as unsuccessful maintenance, even if the subject lost the weight again later. When you actually take the second data point is significant with a process like weight management, where fluctuations are common.
Even with all of the differences between our personal definitions of “successful” maintenance and between those in various scientific studies, these are the best data we have, so we will use them. When I summarize papers in this column I will attempt to clarify the specific working definition of maintenance for each study.
But the bottom line is you’re weight’s always going to creep up. You just have to keep pushing it down. We have to do the best we can with whatever information is available. Strategies that help people keep 10 percent of their weight off presumably will help me keep 54 percent of my weight off. At least that’s my hope.
Not having thought about the different aspects or views of what “maintenance” actually means, I quite a while back got away from having one weight as THE target weight. I established a weight-window. So of the 4 categories discussed or listed, the one that most fits my definition of “maintenance” is the one of being within 5 pounds of the target weight after one year.
Although I didn’t know it at the time, around June 8, 2009 is when I was in “maintenance.” On average since that day, I have been in my weight window between 168 to 173. So that is the definition or interpretation I am using for what maintenance is.
LOL. I know what you mean about having personal definitions of “goal.” Because I actually have THREE of them!
1) Getting my BMI under 25
2) Getting my % body fat under 25
3) Getting my average body weight (according to physicsdiet.com) to 150
I hit #1 in late December. I found out via a DXA scan in January that I’d actually surpassed #2 (% bf was 19 !!)
I’m still working on #3. Once I get there, I figure I’ll try to keep the *average* between 147 and 153 and the actual scale number between 145 and 155 before taking action in the form of restricting calories.
So on one hand I’m already maintaining in the sense of continuing to stay within #1 and #2, and yet I won’t feel like I’m fully on maintenance until I also hit #3.
Bizarre how this stuff works in our heads, huh?
A maintenance window is the key to your sanity, I’m convinced.
Lord help me if I didn’t have a range … my brain would fry.
But I’m going to hush my mouth, lol. I’ll have plenty chance to sound off tomorrow. Thanks Shane!
There are people who reach goal and APPEAR to remain thin, but aren’t exercising to any great extent, and over the years actually lose muscle and gain fat. Their weight may stay the same on the scale, but their clothes get tighter. They are thin/fat. Looks ok, but as the years go by their metabolism gets slower and slower due to the muscle loss, and eventually they will gain weight on few calories – won’t be able to stop the weight gain, unless and until they exercise and build muscle to boost their metabolism back up.
Amber
Absolutely true. Fitness in general should probably be measured in something like body fat percentage rather than actual weight.
If that were the case then maintenance could be defined by preserving a specific ratio of body fat and I think that would address the sort of thing you mention here…
Y’all are on to something … it would provide a “sliding scale,” (hardee har har), which given some of John Thomas’ comments we’re running later today (I’m finishing up the article now), would alleviate a lot of the “how do you make an encompassing definition of maintenance?” debate.
Hi 4A,
I have a buffer zone I have a max high weight and low weight.. If my weight is to high in the morning when I weigh in no extra food I eat my basic food- if I am too low I eat more.. I am now up around the 2000 calories- we have to be active to do this.. I weight train 3 times a week and powerwalk my resthome circit of clients… I go for slow gentle swings on the scales..
I also watch which foods I can use as extras- fatty food makes the scales smack me in the chops.. I can better eat a little sweet now and again it burns off easier than heavy fatty food..
I eat to the high side the days I exercise hard and eat to the low end when not doing the exercise to warrant eating extra..
When on holiday I have to be careful I am out walking each day- or am down around 1500 calories in the lossing phase.. I have lost 176lbs and kept it off 3 years..
Good luck..
Hi Rena,
Thanks for the insights. I’m still working on the mechanics of this, so any tips or hints are always helpful and welcome!
Just curious, how often do you find yourself *below* your buffer zone?
I don’t like the idea that NWCR loosened the standard. I mean, I’m all for even moderate losses that are significant in terms of health benefits, but lowering standards to meet what people achieve doesn’t seem like a good answer. And as far as I’m concerned, losses have little to do with maintenance from a data / academic-study perspective (but see below for the caveats). But me, I’m not really a “yay let me celebrate what I’ve done so far” sort of person, I’m more of a “I’m getting to X by hook or by crook” person (even if it often takes longer than initially expected or hoped for).
I’m going to take the Hacker’s Diet standpoint and say that maintenance should just be for stabilization. At that rate it’s more useful to say “body weight varies by no more than 5%”. If one exceeds 105% of goal weight (or goes below 95%) then one has not successfully maintained. If you exceed but then lose it again, then you failed at maintenance but successfully lost again. Yes, I just pulled a number from the air but I kind of like 5% because it gives the smallest people what feels like a reasonable margin to me (100lb person gets +/-5lb). Also, I don’t especially like the “one year”, I like the “forever”. Obviously a study will have to be over a certain period of time, but a year of maintenance, while perhaps correlated in the aggregate to likelihood of longer-term success, is useless if in an individual case the weight is then immediately regained over, say, a 3-month period. That’s not successful maintenance.
Defining goal weight is a bit of a trick, but then that’s a discussion for elsewhere. Also, I could rant for pages about how poor a measure BMI is, regardless of its aggregate correlation to health outcomes.
For me, maintenance may be measured with BF% rather than weight or BMI (since I hope to lose down to a BF%). However I could see a definition based on weight being useful in the future also, if at some point I become less able to maintain my fitness, or as I age. I could also see the lower sensitivity of BF% making this less useful, so we will see. But I think of it this way: if I could gain 5lb of muscle and no fat I wouldn’t turn it down, heck if I could gain 5lb of muscle and .5lb of fat I would still be fitter yet I would weigh more. Obviously not true for those with single digit body fat percentage, but that isn’t really the target group for any discussion of weight management.
Academically, I think terms should be fairly precise, and “loss” should not be confused with “maintenance”. The loss-maintenance confusion is automatic in any definition that includes “keeping off x% or Xlb of starting body weight”, and that doesn’t strike me as a useful universal measure. So a term like “weight loss maintenance” seems a bit unsure of its meaning to me.
I guess I don’t really like any of the cited measures, though the “within 5 lbs of goal” one is close. That one does not include one of the two basic parameters “The amount of weight lost” – which is good since I think none should.
This area just cries out for really good data analysis, it seems to me.
I apply concepts from Taguchi method experimental design to this loss vs. maintenance idea. In Taguchi methods, the focus is on stabilizing the process and making it insensitive to noise factors (which includes anything you cannot control) first, and then second on shifting the output to where you want it (since you now have a predictable and known system response). As such, it would actually make sense to me for people to learn maintenance skills first, then after their weight is under control to adjust that program to diet down to target. Then it’s a smooth transition back to what you learned how to do before – possibly not at exactly the same levels but using exactly the same skills.
Come to think of it, I guess maybe loss and maintenance are easily mixed in one’s mind because they can involve exactly the same skills. The “learning maintenance” scenario would usually enforce such a thing (e.g. healthy, sustainable diet rather than “dieting”). Unfortunately, it seems that most people want the quick fix and don’t think long-term. Let’s face it, the diet industry is consumer-led just like anything in a capitalist system. If people were to reject quick fixes, crash diets, fasting, fad diets, pseudoscientific methods such as “food combining”, even bariatric surgery, soon they would no longer exist. My feeling is that without them, there would not be so much of an issue about maintenance / relapse / etc.
John,
Dude! Thanks so much for such a thoughtful post, seriously.
re: BMI *laughs* I keep on wanting to do a “BMI is useless for maintenance” article, but frankly the more I look into it, the more BMI is a bottomless pool of confusion and writing it about it wouldn’t accomplish much to clarify anything. When Angela and I talk about it over the phone, we usually wind up settling for “BMI is useful to determine whether or not you’re obese, then otherwise ignore it.”
Of course, with BMI being questionable, you have to also question the obesity “epidemic.” — an equally problematic concept. I think it’s largely agreed upon that weight and weight-related health issues are a huge problem (drum roll), but as much as we want to pin it down, there are no hard and fast numbers. Which is frustrating — both from a scientific standpoint and from the very simple, human standpoint of just figuring out what to do with your life and how you want it to be.
Your last paragraph also lept out at me. Weight maintenance is a long term game; weight loss is more measured and structured. Yes, they’re the same in terms of revolving around your eating and exercise, but the strategies do differ (as Angela shows from the mechanics standpoint, from the stuff I explore from the “rest of life” standpoint). She and I will have to talk about it more, but I think really explaining the differences between weight loss and maintenance is something both Angela and I will put on our radar later this year.
But because they’re so similar-but-different, I don’t think you’ll ever be rid of “Quick fixes” from a capitalism standpoint. Nor should you, really. If you look at Rethinking thin, you’ll see most of the current diets have a historical precedent dating back to late 19th century. The diets aren’t going anywhere. There’ll always be a need for a method of losing weight.
Instead, I think adding to — not taking away from — the usual diet industry stuff might be a solution. Of course I think about this from the standpoint that I run a Web Magazine and at some point I need to make rent and not stay awake 20 hours coding/publicizing/trying to get a few articles in. But in the bigger picture, I actually feel capitalism could actually help deal with obesity beyond having some starlet or hot guy on a pill box. If you make maintenance acknowledge, sexy and marketable, if it was actually on the public radar in a serious way — what else could be possible?
So for me the science, pop culture, business and the very human emotional/spiritual/psychological stuff all fit together. It doesn’t surprise me that CDC only measures BMI and not weight regain or maintenance statistics. It does not surprise me everyone talks about “keeping weight off” all the time and yet it’s such a struggle for so many — where in the science, advertising, pop culture is maintenance acknowledged and examined in any serious way? It doesn’t happen, and in the process people are getting thrown to the wolves once you hit goal and the world thinks you’re “cured.” NOTHING pisses me off more than seeing people slip through the cracks.
And that’s why Angela, Kevin, Patty and I do what we do, as different as our individual skillsets are — the stuff we’re exploring here needed exploring. And for whatever reason, the folks who should be aren’t. So we’ll do it our damn selves, thanks.
*Tee hee* Plus, the fun of getting a whole bunch of full-tilt unruly success stories together is nothing short of amazing. I fully believe if we gather up the folks tired of the “success story” hype and really want to talk about changing your lives long term, the will, determination and drive of that group would make a LOT of things happen.
Thanks for such a great post!
Russ,
You’re very welcome. It’s no coincidence I became known as the guy who would slow down people’s email reading. But I like to be precise, so people get to suffer through my encyclopedic tomes. Or probably just skip over them.
“BMI is useful to determine whether or not you’re obese, then otherwise ignore it.”
I entirely agree about BMI as a bottomless pool of confusion. It seems only useful to me since it is easy to measure. In my case, today I am well into the obese range for BMI at 31.6, while in ACE’s “acceptable” range of body fat percentage at 23.4. Of course I have a relatively high AFFMI (24.1) which probably puts me into the “has extra muscle” group that puts me out of the application group for BMI. I’d say that for me, even determining obesity with BMI is not useful. But I wouldn’t know that without having all this other data that I’ve checked multiple ways and double-checked with other measures, etc.
Questioning the obesity epidemic? Well, it is a good point that it might be questionable given the problems with BMI. But I think it’s sufficient to agree that in the aggregate there is a weight problem. I think it’s more of a public health issue than of figuring out what to do with your life etc – because I think it’s usually simple to make decisions individually. Guiding 300 million people to healthier living… now that’s a challenge. How to get people to stop consuming factory food, watch sports less and play sports more, use cars less? Here’s where I have to hold myself back from starting my neo-luddite rant.
I don’t necessarily think I’m saying that we should be rid of the quick-fixes (I’m all for individuality, competition, and choices), but I do believe that if the world were reasonable and sensible there would be much less of it around. And yes, I clearly have a bad feeling in general toward it – both because I think that would-be dieters are assaulted by too many choices, but also out of a complete sense that real lifestyle change works, that really changing your diet (not going on a diet) works, that if you have enough will and resources you can find out what works and do it forever, and that it is possible for almost everyone to lose weight without overly depriving themselves. And that they can be happy doing it.
I have not read “Rethinking Thin” and I doubt I will, because all the reviews on Amazon – even up to the four star ones – say it is negative and it sounds as though it is written by a fat apologist. Fatosphere? No thanks… it’s like Susan Powter turned inside out. I, and the world, don’t need negativity, loss of hope, or extremism in either direction.
I agree that it would be nice if weight control knowledge, real knowledge and not today’s fad diet, were on the public radar screen. I somewhat doubt anyone’s ability to put it there, though. I think people will have to find it for themselves, or more likely be led by their pocketbooks in some fashion. Then again it might be entertaining to watch the backlash when an insurance company sets rates based on body fat percentage.
You’re right, weight maintenance is not really given anything but a hand wave in any reasonably popular forum. Again, I think most people have a short-term view, especially in the United States. They also tend to have a view that doesn’t really extend much past their own individual well-being and comfort. Oh dear, I think I am starting that neo-luddite rant….
“I somewhat doubt anyone’s ability to put it there, though”
Thanks again for a great post!
If I really believed your quote, I wouldn’t exist, and this site sure as hell wouldn’t. If losing weight and being a food writer teaches you anything, it’s creative solutions to common problems. It’s not about “hope” or positivity or triumphing over cycnicism, but simply finding a way to do what needs doing. Like my momma used to say, “when there’s a will, there’s a way.” And lord knows all of us here have a will *laughs*
And I’d seriously give Rethinking Thin another chance, if only to disagree with it intelligently. Gina did some amazing reporting in that book, even if I don’t agree with all the conclusions it drew.
I really hope I can have a sit-down with her at some point.
Thanks again!
Oh, and tomorrow I’m going to shop around for better commenting programs, I promise.
“I somewhat doubt anyone’s ability to put it there, though”
That comes off as overly negative to me now that I read it again and it’s not the middle of the night. I suppose no one can bring weight maintenance issues more into view alone – but you’re right that a critical mass of people would do it. The website can be a step toward that. Certainly baby steps toward a giant, intractable issue are worth taking.
Better commenting programs? Hehe.. I’m somewhat entertained by seeing how thin we can make the text.
Darn right we all have a will!
Hmmm, OK, I guess I’ll consider reading Rethinking Thin. We’ll see if it’s available at my library. I did read the Time Magazine article that sounds like it was along some of the same lines. Comments from Venuto are here: http://www.burnthefatblog.com/archives/2009/08/why_time_magazine_owes_the_fit.php
Awesome discussion – thanks so much for commenting over here, John!
…and in case anyone wants to read more “neo-luddite ranting” (LOL) John wrote his own blog post over at Spark People with more thoughts on this topic:
http://www.sparkpeople.com/mypage_public_journal_individual.asp?blog_id=3013650
There’s a lot to digest in the discussion over here, so I’m going to cogitate a bit on it and write a real response tomorrow (or later today – but not at 3am, LOL)
You brainiacs lost me about the 5th post or so.
LOL. Nah, you just got lost because the comments became so narrow that they couldn’t support any words more than 5 letters long!
I’m so working on these blasted comments as soon as I finish up uploading the week’s articles. It’s starting to feel like “comment limbo!”. How narrow can you go ain’t a game I want to play — in comments, anyway.