Cut the strings of yo-yo dieting

Oprah Winfrey recently used her magazine to discuss her battle with weight loss.

Oprah Winfrey’s on-again, off-again battle with weight has garnered much attention because of her fame and her penchant for letting the world in on her personal heartbreaks and triumphs.

But shimmying up and down the scale isn’t unique to Oprah. In fact, regaining weight is the norm and not just because of a lack of willpower or having an ample supply of Twinkies.

Experts cite many reasons for weight regain, including:
— Relying on fad or crash diets that are too hard to stick to and that often make people feel deprived.
— Practicing bad habits, such as skipping meals, that set people up to overeat.
— Setting unrealistic weight-loss goals.
— Not having enough support.

There also are the everyday pressures of life that can get in the way of healthy eating and exercise, as well as the whole idea of changing one’s life temporarily to achieve weight loss.

“When you go on a diet, it usually implies you’re going to go off a diet,” says Lexington, Ky., dietitian Maria Boosalis. “What I think we need to focus on, instead of going on and off a diet, is ... what habits and what practices do we need to incorporate in our way of life to achieve and maintain a healthy and realistic weight for us?”

But even when people try to adopt long-term changes, they often find it hard to maintain their new lifestyle because their own bodies work against them.

“Dieting leads to regain, and that’s because we have an enormous amount of biology that is pushing us to maintain a particular weight,” says Randy Seeley, a professor and associate director of the University of Cincinnati’s Obesity Research Center.

Your brain monitors the amount of fat that you have in your body with the help of leptin and other hormones, Seeley says.

When you lose weight, the levels of the hormones change, and your brain reads that as, “’By the way, I’m beginning to starve to death,’ and does things to your body to push you in the opposite direction, so it hunkers down, makes you burn less calories and makes you hungrier,” he says.

Your natural instincts tell you, “By the way, you need to go out and hunt and gather; don’t sit here in this cave,” and eventually, you gain the weight back, Seeley says.

“The ability to have a willpower over this level of biology is very difficult,” he says.

Often, people wind up weight cycling — repeatedly losing and regaining anywhere from 5-10 pounds to 50 pounds or more, according to the federal Weight-control Information Network.

Familiar story
Those yo-yoers include Winfrey, who knows what it’s like to go from hefty to svelte to hefty again. She worked her way down to a trim 160 pounds in 2005 but recently lamented hitting the 200 mark again.

“I thought I was finished with the weight battle,” she wrote in an essay in the January issue of her O magazine. “ ... I was so sure, I was even cocky. I had the nerve to say to friends who were struggling, 'All you have to do is work out harder and eat less!’ ”

But then karma set in, in the form of a hectic schedule, a thyroid problem, heart palpitations, food addiction and more, according to the essay.

These days, Winfrey is trying to turn things around. She’s back to doing cardiovascular exercise and adhering to “commonsense basics,” such as “eating less sugar and fewer refined carbs and more fresh, whole foods like fish, spinach and fruit,” according to the essay.

But her goal, she says, isn’t to be thin, according to the magazine. It’s “to be strong and healthy and fit.”

That may be a more realistic goal, for some people, than pledging to become Skinny Minnies.

“Eating right and exercising are extremely good ideas,” Seeley says. “But when we set up weight loss as the only reason that they’re good ideas, sometimes we give people false expectations, and they’re more likely to give up on them when they don’t produce a lot of weight loss or at least a lot of sustained weight loss.”

But that doesn’t mean they can’t achieve some success.

“There are definitely yo-yo dieters, but there are a lot of people who learn to maintain it,” says Dr. Julie Temes Ellis, an internist with Associates in Internal Medicine in Louisville. “Finding the diet and the exercise program that works for you is what’s important.”
Ellis also thinks it’s important for patients who want to lose weight to get support, one way being to work one-on-one with a registered dietitian. “I facilitate that quite often,” she says.

Realistic goals
Boosalis, who is a registered dietitian, says nutrition professionals can help determine a realistic weight for clients by looking at such factors as their current weight, what their weight has been most of their adult life, their health status and their body mass index (a number calculated from a person’s weight and height that provides an indicator of body fatness).

Some people want to be as skinny as a runway model or a rail-thin actress, but they may not have “the genetic make-up” to achieve that or be able to work out as much, says Boosalis, who directs the clinical nutrition division in the University of Kentucky College of Health Sciences.

A dietitian also can serve as a “cheerleader,” of sorts, to keep people from feeling like a failure and can help pinpoint bad habits, such as skipping meals and eating out too much, that might be contributing to weight gain, says Nancy Kuppersmith, a registered dietitian who works for the University of Louisville Department of Family and Geriatric Medicine.

Seeing a doctor also is sometimes recommended. Ellis, who is with The Physicians Group of Jewish Hospital & St. Mary’s HealthCare, likes patients to check in with her as they’re trying to lose weight, so she can — among other things — give them feedback on how their efforts are affecting their health.

She sees a lot of patients from their 20s to 50s who have health issues that are related to their weight, such as high blood pressure, high blood sugar and musculoskeletal complaints, such as back and knee pain. But after losing weight, “they feel better and their numbers are better and they get that positive reinforcement and they’re able to be more successful because of that,” she says.

Effects of yo-yoing
It’s unclear whether weight cycling, in and of itself, is detrimental to health, according to the Weight-control Information Network. Some studies suggest a link to such problems as high blood pressure, high cholesterol and gall bladder disease, it says.

But some of the research has been criticized, and a network publication on weight cycling still encourages people who are overweight or obese to try to achieve and maintain a modest weight loss, noting, “an initial goal of losing 10 percent of your body weight can help in your efforts to improve overall health.”

If setbacks occur, Ellis says, “you encourage them to try again in hopes that this time is going to be the one that sticks.”