The Doctor Weighs In

The evidence is piling up that daily weighing is an important strategy for successful weight loss maintenance.  I first wrote about the issue in a blog earlier this year titled "To weigh or not to weigh.  That is the question."  A review of the medical literature at that time suggested that frequent, usually daily, weighing helps dieters stay on track.  A follow up blog, "You got it off - now, can you keep it off?" reviewed a study published by researchers from the Centers for Disease Control and Prevention.  That study examined differences in habits between people who lost weight and were able to keep it off compared to people who either didn't lose weight or lost weight and regained it.  Again, self-monitoring behaviors, including frequent weighing were determined to be key to success.

Now, another study, "A Self-Regulation Program for Maintenance of Weight Loss," has just been published in the prestigious New England Journal of Medicine.  It once again highlights the importance of daily weighing in weight loss maintenance.  The study was conducted by Rena Wing, PhD and her colleagues and is based on the "Study to Prevent Regain (or STOP Regain)" randomized clinical trial.

Three hundred and fourteen (314) individuals who had lost at least 10% of their body weight during the prior two years were recruited to participate.  They were divided into one of two groups:  those that had lost 10-20% of their body weight and those who lost more than 20% of their body weight.  They were then randomly assigned to one of two intervention groups or a control group. 

The intervention groups were either face-to-face or Internet-based.  Both had the same frequency of contact and taught participants the same content.  Everyone in these groups was given a scale and taught to initiate weight loss behaviors when their weight increased. 

The intervention program had a strong component of personal accountability (daily weighing and weekly weight reporting), reinforced by feedback from others.  Feedback was via an automated telephone system for the face-to-face group and via a Web-based form for the Internet group. 

A weight gain of less than 1.4 kg (~3 pounds) over starting weight was considered to be successful weight maintenance.  Participants who achieved this were told they were in the "green zone."   They also received positive automated messages as well as small green monthly gifts (e.g., green gum, green tea, or a green dollar bill).  Participants who gained between 1.4 kg and 2.2 kg (~3 to 5 pounds) were told they were in the yellow zone.  They were taught how to use problem solving skills to bring their weight back into the green zone.  Participants who gained more than 2.3 kg (~5 pounds) were told they were in the red zone.  They were encouraged to start active weight loss efforts again, including modifications to their diet and exercise.  They were also offered individual counseling by email or by telephone until they returned to their starting weight.

Forty-three percent of those in the face-to-face group remained consistently in the green or yellow zone, as did 37.5% of those in the Internet group, and 22% of those in the control group.  The differences between the intervention groups and the control group were statistically significant. 

Participants who regained more than 2.3 kg (~5 pounds) were unlikely to return to the green or yellow zone regardless of what group they were in.  Only 19%, 16%, and 8% of the face-to-face, Internet, and control groups respectively made it back to green zone.  The differences between the groups did not reach statistical significance...this means the differences could have occurred as a result of chance, not as a result of real differences.  (Note:  It is possible, however, that these differences could have reach statistically significance if more people had been in each of the study groups.)

There were significant differences between the intervention and control group in the percent of people who reported weighing themselves at least daily.   Thirty to 40% of control group paticipants weighed daily compared to 71 to 79% of people in the face-to-face group and 65% to 81% of people in the Internet group.  On the other hand, a smaller proportion of intervention group participants who weighed themselves daily regained more than 5 pounds compared with those who weighed themselves less often.  

Although daily weighing was only one strategy used by successful weight loss maintainers, it does appear to be an important one.  By the way, it is also a strategy that is pretty simple to implement:

• Buy a scale
• Get on it every day
• Take action if your weight starts to climb--even a little bit.  

All of us who have dieted and regained and then dieted again know that it is much easier to knock off a pound or two right after it accumulates than to face the challenge of losing 20 or more pounds gained and retained because you were not paying attention.

So, what's the bottom line:  Weigh away and weigh every day.   You have more to lose than gain.