By Jason R. Karp, PhD, Special AFS Contributor


Adapted from Lose It Forever: The 6 Habits of Successful Weight Losers from the National Weight Control Registry by Jason R. Karp, Ph.D.


In a national television interview with Barbara Walters in 2014, Oprah Winfrey confessed that not being able to maintain her weight loss was her biggest regret. In that interview, Walters asked Winfrey to finish the sentence, “Before I leave this Earth, I will not be satisfied until I…”

“Until I make peace with the whole weight thing,” Oprah replied.

Losing weight is hard; keeping it off is even harder. What is unique about those who succeed? The answer is buried deep in the archives at the Weight Control and Diabetes Research Center in Providence, Rhode Island: The National Weight Control Registry (NWCR), the largest database ever assembled on individuals successful at long-term maintenance of weight loss. Founded in 1994, the NWCR includes more than 10,000 individuals who complete annual questionnaires about their current weight, diet and exercise habits, and behavioral strategies for weight loss maintenance.

Habit #1: Live with Intention

Living with intention eliminates the random approach to weight loss maintenance in favor of the systematic and methodical one that leads to results. The NWCR has shown that, when intention is behind weight loss maintenance, 21 percent of overweight people are successful weight losers.[1]  

The longer people keep their weight off, the fewer strategies they need to continue keeping weight off.[2] In other words, weight maintenance gets easier. The longer your clients persist in their intention and behave in accord with that intention, the easier it is for that behavior to “stick” and turn into a habit.

What makes one individual persist at a specific behavior while another individual doesn’t? For starters, the persistent individual has a conscientious personality. In the most recent NWCR study published in 2020, conscientiousness was compared between successful weight losers from the NWCR and non-NWCR weight regainers.[3] The successful weight losers were found to be more conscientious than the weight regainers and scored higher on measures of order, virtue, responsibility, and industriousness. The scientists suggest that being conscientious may help individuals maintain their weight loss by improving adherence to specific behaviors.

In a review of 56 studies that contained 58 health behaviors, researchers at Université Laval in Quebec, Canada and the University of Limburg in The Netherlands found that intention remained the most important predictor of health behavior, explaining 66 percent of the variance.[4] In half of the reviewed studies, perceived behavioral control (believing that you have control over your behavior) significantly added to the prediction.

Habit #2: Control Yourself

Being a successful weight loser requires a lot of self-control, delaying gratification now (e.g., dessert) for the more desirable reward later (e.g., a slimmer waistline, better health, enhanced self-esteem, and happiness).

Compared to typical unsuccessful dieters, successful weight losers are better able to resist temptation, control themselves, and push back against the environment. They restrict certain foods,[5] weigh themselves regularly,[6],[7] and use digital health technology.[8]

One of the key factors of self-control is disinhibition, which literally means not being inhibited. Some inhibition is good, because it prevents people from not giving into temptation and eating whatever and how much they want. High levels of disinhibition are bad, because it leads to risky behavior. Disinhibited eating is a failure to maintain control over eating. The opposite of disinhibited eating is dietary restraint. Several NWCR studies have found that increased disinhibition leads to regaining lost weight.[9],[10],[11],[12],[13] Other studies have found strong relationships between a lack of self-control—impulsivity—and obesity.[14],[15],[16]

Habit #3: Control Calories

Successful weight losers consume fewer daily calories than the general population. Table 1 shows the number of calories the NWCR members consume per day, from the several studies that have reported it, along with the amount of weight they lost at the time they entered the NWCR.

Successful weight losers consume a low-calorie diet of about 1,400 calories per day, with women consuming about 1,300 and men consuming about 1,700 calories per day. By comparison, the U.S. adult population consumes an average of 2,120 calories per day (women consume about 1,820 calories per day and men consume about 2,480 calories per day).

Successful weight losers control calories several ways, including limiting how often they eat out at restaurants,[26] rarely eating fast food,[27] and limiting how many calories they drink.[28] They are also more likely than normal-weight individuals to have plans to be extremely strict in maintaining their caloric intake, even during times of the year when it’s easy to consume calories, like during holidays.[29]

Habit #4: Eat a Low-Fat, High-Carbohydrate Diet

Successful weight losers eat a low-fat, high-carb diet. Table 2 shows the percentage of carbohydrate, fat, and protein the NWCR members consume, from the several studies that have reported it.

NWCR members consume an average of 25 percent of their calories from fat, 55 percent from carbohydrate, and 20 percent from protein, with no difference in the macronutrient percentages between women and men. 

In the early 2000s, when low-carb diets were becoming all the rage, the fat content of the NWCR members’ diet increased and the carbohydrate content of their diet decreased compared to earlier years. The percentage of NWCR members consuming a low-carbohydrate diet (less than 90 grams, which is less than 25 percent of daily calories) increased from 5.9 percent in 1995 to 7.6 percent in 2001 to 17.1 percent in 2003, although it still remains low for successful weight losers, despite the media’s attention on low-carbohydrate diets. Even with the increasing percentage of NWCR members consuming a low-carbohydrate diet, the fat content of the diet still remains far below the national average. Hardly anyone in the NWCR is consuming a very low-carbohydrate or ketogenic diet. The word “ketogenic” doesn’t even exist in any of the NWCR’s published studies.

Habit #5: Eat Breakfast

Seventy-eight percent of NWCR members eat breakfast every day, while only four percent never eat breakfast.[36] These successful weight losers lost an average of 71.3 pounds and maintained the NWCR-required minimum weight loss of 30 pounds for an average of six years. Eating breakfast every day is also common among other successful weight losers: The NWCR’s sister registry in Portugal (Portuguese Weight Control Registry) has found that daily breakfast is one of their members’ most common strategies.[37]

Skipping breakfast is associated with consuming more total daily calories.[38] Skipping breakfast makes people hungry and therefore more likely to eat more later in the day to compensate. Breakfast skippers also tend to weigh more than breakfast eaters, and obese individuals are more likely to skip breakfast.

Eating breakfast is important for several reasons. When your clients get out of bed in the morning, their blood glucose is on the low side of normal. Their bodies need energy for the day’s activities. Since it has been many hours since their last meal, they need to break the fast, literally. The macronutrients they eat at breakfast will be used for their important jobs—carbohydrate will be used to replenish their blood glucose from their overnight fast to provide immediate fuel for their cells and to store muscle glycogen for later use; protein will be used to maintain the structural integrity of their cells and tissues and to transport nutrients in their blood; and fat will be used to provide energy, absorb fat-soluble vitamins, and maintain their bodies’ temperature. Because your clients are in a metabolically needy state when they get out of bed, all those calories from carbohydrates, protein, and fat that they eat at breakfast will be used to fulfill their bodies’ metabolic demands. Skipping breakfast only serves to deny their bodies the fuel they need.

Habit #6: Exercise (a Lot) Every Day

Successful weight losers exercise a lot every day, burning a lot more calories than the general population.[39] Table 3 shows the number of calories the NWCR members burn per week during physical activity, from the several studies that have reported it, along with the amount of weight they lost at the time they entered the NWCR.

Successful weight losers burn about 2,700 calories per day. Seventy-two percent burn more than 2,000 calories per week and 35 percent burn more than 3,000 calories per week.[48],[49]

A consistent, high level of exercise is one of the most important predictors of whether or not someone will be able to keep the weight off.[50] A major finding of the NWCR is that a large part of regaining weight after losing it is due to the inability to maintain exercise habits for the long term.[51],[52]

While it may be easy or convenient to think that the reason why some people exercise and others don’t is because the ones who do have the time and resources, like access to a gym or personal trainer, or because they simply like to exercise, the NWCR has shown that what makes a successful weight loser exercise has little to do with these factors. Whether or not someone exercises comes down to his or her commitment and the creation of and persistence in the habit. See habit #1. Live with intention.

 


A competitive runner since sixth grade, Dr. Jason Karp quickly learned how running molds us into better, more deeply conscious people, just as the miles and interval workouts mold us into faster, more enduring runners. This passion that Jason found as a kid placed him on a yellow brick road that he still follows all these years later as a coach, exercise physiologist, bestselling author of 11 books and 400+ articles, speaker, and educator. He is the 2011 IDEA Personal Trainer of the Year. His REVO₂LUTION RUNNING™ certification has been obtained by fitness pros and coaches in 25 countries. His books can be found on Amazon.

 

References

[1] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[2] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[4] Godin, G. and Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2):87-98, 1996.

[5] Wing, R.R. and Phelan, S. Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82:222S-225S, 2005.

[6] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21: 323-341, 2001.

[7] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[8] Goldstein, C.M., Thomas, J.G., Wing, R.R., and Bond, D.S. Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health. Obesity Science and Practice, 3(2):117-126, 2017.

[9] McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W. and Hill, J.O. What predicts weight regain among a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67:177-185, 1999.

[10] Niemeier, H.M., Phelan, S., Fava, J.L., and Wing, R.R. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity, 15:2485-2494, 2007.

[11] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[12] Thomas, J.G., Bond, D.S., Phelan, S., Hill, J.O., and Wing, R.R. Weight-loss maintenance for 10 years in the National Weight Control Registry. American Journal of Preventive Medicine, 46(1):17-23, 2014.

[13] Lillis, J., Thomas, J.G., Niemeier, H., and Wing, R.R. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obesity Science and Practice, 2(1):83-87, 2016. 

[14] Chamberlain, S.R., Derbyshire, K.L., Leppink, E., and Grant, J.E. Obesity and dissociable forms of impulsivity in young adults. CNS Spectrums, 20(5):500-507, 2015.

[15] Fields, S.A., Sabet, M., and Reynolds, B. Dimensions of impulsive behavior in obese, overweight, and healthy-weight adolescents. Appetite, 70:60-66, 2013.

[16] Amlung, M., Petker, T., Jackson, J., Balodis, I., MacKillop, J. Steep discounting of delayed monetary and food rewards in obesity: a meta-analysis. Psychological Medicine, 46(11):2423-2434, 2016.

[17] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill, J.O.  A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66:239-246, 1997.

[18] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[19] Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., and Seagle, H.M. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 98:408-413, 1998.

[20] McGuire, M.T., Wing, R.R., Klem, M.L., Seagle, H.M., and Hill, J.O. Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity, 22:572-577, 1998.

[21] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[23] Ogden, L.G., Stroebele, N., Wyatt, H.R., Catenacci, V.A., Peters, J.C., Stuht, J., Wing, R.R., and Hill, J.O. Cluster analysis of the National Weight Control Registry to identify distinct subgroups maintaining successful weight loss. Obesity, 20(10):2039-2047, 2012.

[24] Wright J.D., Wang, C.Y., Kennedy-Stephenson, J., Ervin, R.B. Dietary intake of ten key nutrients for public health, United States: 1999-2000. Advance Data From Vital and Health Statistics, 334:1-4, 2003.

[25] U.S. Department of Agriculture, Agricultural Research Service. Energy intakes: percentages of energy from protein, carbohydrate, fat, and alcohol, by gender and age. What We Eat in America, NHANES 2015-2016, 2018.

[26] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[27] Thomas, J.G. and Wing, R.R. Maintenance of long-term weight loss. Medicine & Health Rhode Island, 92(2):56-57, 2009.

[28] Catenacci, V.A., Pan, Z., Thomas, J.G., Ogden, L.G., Roberts, S.A., Wyatt, H.R., Wing, R.R., and Hill, J.O. Low/no calorie sweetened beverage consumption in the National Weight Control Registry. Obesity, 22(10):2244-2251, 2014.

[29] Phelan, S., Wing, R.R., Raynor, H.A., Dibello, J., Nedeau, K., and Peng, W. Holiday weight management by successful weight losers and normal weight individuals. Journal of Consulting and Clinical Psychology, 76(3):442-448, 2008.

[30] Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., and Seagle, H.M. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 98:408-413, 1998.

[32] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[33] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[34] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[35] Phelan, S., Wyatt, H., Hill, J.O., and Wing, R.R. Are the eating and exercise habits of successful weight losers changing? Obesity Research, 14:710-716, 2006.

[36] Wyatt, H.R., Grunwald, O.K., Mosca, C.L., Klem, M.L., Wing, R.R., and Hill, J.O. Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research, 10:78-82, 2002.

[37] Santos, I., Vieira, P.N., Silva, M.N., Sardinha, L.B., and Teixeira, P.J. Weight control behaviors of highly successful weight loss maintainers: the Portuguese Weight Control Registry. Journal of Behavioral Medicine, 40(2):366-371, 2017.

[38] Farshchi, H.R., Taylor, M.A., and Macdonald, I.A. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. American Journal of Clinical Nutrition, 81(2):388-396, 2005.

[39] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill. J.O. Psychological symptoms in individuals successful at long-term maintenance of weight loss. Health Psychology, 17:336-345, 1998.

[40] McGuire, M.T., Wing, R.R., Klem, M.L., Seagle, H.M., and Hill. J.O. Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity, 22:572-577, 1998.

[41] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill. J.O. Psychological symptoms in individuals successful at long-term maintenance of weight loss. Health Psychology, 17:336-345, 1998.

[42] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[43] Wing, R.R. and Hill. JO. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[45] Phelan, S., Wyatt, H., DiBello, J., Fava, J.L., Hill, J.O., and Wing, RR. Three-year weight change in successful weight losers who lost weight in a low-carbohydrate diet. Obesity, 15:2470-2477, 2007.

[46] Catenacci, V.A., Ogden, L.G., Stuht, J., Phelan, S., Wing, R.R., Hill, J.O., and Wyatt, H.R. Physical Activity patterns in the National Weight Control Registry. Obesity, 16:153-161, 2008.

[47] Ogden, L.G., Stroebele, N., Wyatt, H.R., Catenacci, V.A., Peters, J.C., Stuht, J., Wing, R.R., and Hill, J.O. Cluster analysis of the National Weight Control Registry to identify distinct subgroups maintaining successful weight loss. Obesity, 20(10):2039-2047, 2012.

[48] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[49] Catenacci, V.A., Odgen, L., Phelan, S., Thomas, J.G., Hill, J.O., Wing, R.R., and Wyatt, H. Dietary habits and weight maintenance success in high versus low exercisers in the National Weight Control Registry. Journal of Physical Activity and Health, 11(8):1540-1548, 2014.

[50] Thomas, G., Bond, D.S., Hill, J.O., and Wing, R.R. The National Weight Control Registry: A study of “successful losers.” ACSM’s Health & Fitness Journal, 15(2):8-12, 2011.

[51] McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W., and Hill, J.O. What predicts weight regain among a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67:177-185, 1999.

[52] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

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