“I intuitively knew that anything I did would have to become part of my lifestyle indefinitely.”

On Monday morning, forty-eight-year-old Lynn Kata stands on one leg and squats on a Wii Fit Balance Board in her living room. The exercise video game, a gift she requested for Mother’s Day, includes more than forty exercise activities, including yoga, strength training, aerobics, and balance games. As she follows the fitness trainer demonstrating the exercises on the screen, the balance board detects and tracks Lynn’s center of balance and measures her weight. At 155 pounds, she is told by the game’s avatar that she is overweight.

An active child and teenager in the Chicago suburb of Oak Lawn, Lynn was on the Pom Pom Squad in high school and spent her summers taking gymnastics classes. After high school, she spent a good part of her late teens and early twenties working, attending college classes, and going out with her friends to dance in local discos. She took dance lessons and joined the local dance troupe Dance Mania when she was twenty years old. “Dancing had always been an enjoyable part of my life and kept me in really good shape,” she says. As a young adult, life was good. She graduated from college in 1986 with a degree in media management, got married in 1987, moved to Crestwood, Illinois, and had her first child in 1988. A second child came two years later. She lost her baby weight and became a busy stay-at-home mom.

In 1991, Lynn quit smoking and gained ten pounds. After Lynn’s third child was born when she was thirty-seven, she was unable to get back to her pre-baby weight. “I wasn’t a dieter, so I just settled in with the extra weight,” she says. For years, she kept busy as a mom, serving as the choreographer for her kids’ school’s annual fashion show fundraiser and teaching art classes at their school. “I loved being a mom and was very active in my kids’ school and sports activities,” she says. She continued to eat what she had always eaten—meat, dairy, and processed carbs. During the next several years, she gained another twenty pounds.

In May 2008, at age forty-eight, she decided to leave teaching and pursue other opportunities. “The photos from my going-away party were my wake-up call,” she says. “I was shocked by my appearance. I knew I had gained weight because I had to keep buying bigger clothes, but, in my mind, I was still a normal-weight person. Those photos showed me someone I didn’t recognize as myself. I decided it was time for a change.” Lynn made herself a promise that she was going to lose the extra weight for her fiftieth birthday, which was a year and a half away.

***

Your coworker’s sister’s husband can make you fat, even if you don’t know him. Such was the discovery of Yale physician and sociologist Nicholas Christakis, MD, PhD, whose fascinating work at Harvard University revealed that obesity, much like the spread of a disease, can spread through social networks. Dr. Christakis found that the risk of obesity among acquaintances or friends of an obese individual was 45 percent higher in a connected network of people than in a random network.9 Specifically, the risk of obesity was about 20 percent higher for an obese individual’s friend’s friends (two degrees of separation) and about 10 percent higher for the obese individual’s friends’ friends’ friends (three degrees of separation). By the fourth degree of separation, like your coworker’s sister’s husband’s bowling partner, there was no longer a relationship between an individual’s obesity and the fourth-degree person’s obesity. Dr. Christakis also found that relational distance plays a stronger role in the spread of obesity than even geographic distance, so it doesn’t seem to matter if your colleague’s sister’s husband lives anywhere near you. Studying obesity within families, Dr. Christakis found among pairs of adult siblings that one sibling’s chance of becoming obese increased by 40 percent if the other sibling became obese. This phenomenon was more marked among siblings of the same sex than among siblings of the opposite sex. Same-sex mutual friends also have the strongest influence on each other’s weight gain. Among married couples, when either the husband or wife becomes obese, the other spouse is 37 percent more likely to become obese. The opposite phenomenon also seems to be true: to lose weight, weight-loss interventions that modify the overweight person’s social network are more successful than those that don’t. In other words, if you want to lose weight, it’s beneficial to hang around thin people.

But just picking the right friends and relatives isn’t enough to stay slim. Since most people who go on a diet and lose weight gain the weight back, the only reliable proof of what works for permanent weight loss comes from the people who have actually achieved permanent weight loss. What is unique about those who succeed? And how can you succeed like them?

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 by Rena Wing, PhD, Professor of Psychiatry and Human Behavior at Brown Medical School and director of the Weight Control & Diabetes Research Center at The Miriam Hospital, and James Hill, PhD, chair of the Department of Nutrition Sciences and director of the Nutrition Obesity Research Center at the University of Alabama, Birmingham (formerly professor of Pediatrics and Medicine at the University of Colorado Health Sciences Center at the time he cofounded the NWCR), the NWCR includes more than 10,000 individuals who complete annual questionnaires about their current weight, diet, exercise habits, and behavioral strategies for weight-loss maintenance. The goal of the NWCR, which started with ninety-two people enrolled in its first year,10 is to identify the behaviors used by successful weight losers to help others become successful weight losers. According to Drs. Wing and Hill, part of the reason for developing the registry was to counter the belief that no one succeeds long-term at weight loss.11

The NWCR is a gold mine of successful weight-loss information, containing extensive data on individuals who have lost at least thirty pounds (which represents a minimum 10 percent weight loss for most overweight and obese individuals) and have maintained a weight loss of at least thirty pounds for at least one year.

Who are the people in the NWCR? Eighty percent are women and 20 percent are men. The average woman is forty-five years old and weighs 145 pounds, while the average man is forty-nine years old and weighs 190 pounds. Ninety-five percent of members are Caucasian, 64 percent are married, and 61 percent have a bachelor’s degree or higher. Forty-five percent lost the weight on their own and 55 percent lost the weight with the help of a formal weight-loss program. Before becoming successful weight losers, 90 percent of NWCR members had failed at keeping their weight off, many failing multiple times. They had also struggled with their weight for a long time—46 percent became overweight before the age of twelve, and 72 percent became overweight before the age of eighteen. Forty-six percent have one parent who is overweight or obese, and 27 percent have both parents overweight or obese.

The average weight loss of the NWCR members upon entry into the registry is 68.9 pounds (which decreased their body mass index from 35 to 25 kg/m2), kept off for an average of five and a half years. Although these average numbers are impressive, they hide a lot of diversity: NWCR weight losses range from thirty to three hundred pounds, nearly 20 percent have lost at least one hundred pounds, and the duration of successful weight loss ranges from one year to sixty-six years!

To date, thirty-nine scientific papers have been published using the data from the NWCR on the strategies and habits of successful weight losers, characteristics associated with weight-loss maintenance, and the risk factors of weight regain. The earliest of these studies, which was published in American Journal of Clinical Nutrition in 1997, described some of the basic habits of 629 female and 155 male members.12 The researchers found that 55 percent (60 percent of women and 37 percent of men) used a formal weight-loss program or professional assistance to lose weight, and 89 percent modified both their diet and physical activity to lose weight.

From this initial descriptive study has grown dozens of studies that have delved into the habits of the largest database of successful weight losers. When individuals enroll in the NWCR, they’re asked to complete several questionnaires that detail how they initially lost weight and how they maintain their weight loss. They are tracked yearly to determine changes in their weight and in their weight-related behaviors.

In one of the earlier NWCR studies, which included 893 members (81 percent women, 19 percent men; average age of forty-four), 447 said they lost weight on their own, 313 said they lost weight through an organized program (e.g., Weight Watchers, Jenny Craig, etc.), and 133 said they lost weight through a formal program that used a liquid formula diet (e.g., Optifast, New Directions, etc.).13 Those who used a liquid formula diet to lose weight relied more heavily than the others on specific dietary strategies, such as counting calories, limiting percentage of calories from fat, and limiting the quantities of foods consumed. Individuals who lost weight on their own were more likely to be male and have less history of weight cycling. These individuals were more likely to weigh themselves at least once a week, suggesting that weighing may be an important part of their self-regulation of body weight. Those who lost weight on their own expended a greater number of calories through strenuous activities than the others. These individuals were more likely to regulate their body weight through exercise rather than diet. A later study on 2,964 NWCR members compared young adults (eighteen to thirty-five years old) and older adults (thirty-six to fifty years old) to see if there are age-based differences in approaches to weight loss.14 Young adults placed greater emphasis on physical appearance and social factors for losing weight and less emphasis on their health compared to older adults. They also were more likely than older adults to take exercise classes and to lose weight on their own without help and were less likely to use a commercial weight-loss program.

Because it’s so common for weight losers to gain the weight back, many of the NWCR studies have examined the factors that contribute to and even predict weight regain.15-20 Believe it or not, whether or not you regain weight after losing it is predictable. Not surprisingly, a greater amount of initial weight loss is a predictor of weight regain. It’s harder to keep off eighty pounds than to keep off thirty pounds. One of the NWCR studies found that individuals who had lost 30 percent or more of their maximum lifetime weight at the time they entered the registry had a greater risk of gaining weight after one year compared to those who lost less than 25 percent of their maximum weight.21 Several other factors that predict which individuals would gain weight versus those who would remain successful weight losers include weighing more to begin with, a shorter duration of weight-loss maintenance, a greater history of weight cycling (many ups and downs of weight), dietary disinhibition, binge eating, depression, and several eating and exercise behaviors (e.g., increased caloric intake, TV watching, and decreased physical activity). If consuming many daily calories, watching TV, and not exercising are habits that are toxic, leading to weight regain and unsuccessful weight loss, the opposite habits are tonic, leading to successful, permanent weight loss.

Although very successful, the members of the NWCR are not superheroes who are immune to the pitfalls that cause weight regain. Like other weight losers, many NWCR members have regained weight. One year after entering the registry, 35 percent gained five pounds or more, with an average weight gain of 15.5 pounds. However, 59 percent have maintained their weight loss, and 6 percent have lost additional weight. Weight trajectories are curvilinear, with more rapid regain early and very little regain after five years. Heavier individuals have regained weight more quickly initially, but have maintained significantly greater weight losses over ten years. Encouragingly, 88 percent have maintained a weight loss of at least 10 percent of their lifetime maximum body weight for five years and 87 percent for ten years, with weight losses averaging 52.4 pounds (23.8 kg) after five years and 50.8 pounds (23.1 kg) after ten years.22

It often takes a catastrophic event or trigger to change behavior. A medical trigger is one such event, because it threatens our health. People who have medical triggers for losing weight lose more weight and are more successful at maintaining their weight loss than those with nonmedical triggers for losing weight or no trigger at all. That was the conclusion of a NWCR study, published in the journal Preventive Medicine in 2004, that asked 917 NWCR members (average age of 46.6 years) if there were a specific incident or triggering event that prompted them to begin their successful weight loss and, if yes, to select from multiple options what type of event it was (medical, emotional, lifestyle, inspiration or impetus from another person, weight-loss program became available, saw picture or image of self, reached lifetime high weight or size).23 Changes in body weight over two years were compared between three groups: (1) those who had medical triggers, (2) those who had nonmedical triggers, and (3) those who had no trigger for weight loss. Eighty-three percent of NWCR members had a trigger to lose weight, with a medical trigger being the most common (23 percent). Those with a medical trigger lost significantly more weight (80.3 pounds) compared to those with nonmedical triggers (70 pounds) or no triggers (70 pounds). In addition, members with a medical trigger regained significantly less weight after one and two years compared to those with nonmedical triggers and no trigger. A medical trigger can be a powerful initiator of behavior change.

As much of a gold mine of information that the NWCR is, it’s not without its limitations or criticisms. For starters, its members are not randomly selected from the general population. They are self-selected, volunteering to become members of the NWCR after seeing an advertisement for it or discovering it on their own. As a result, the registry’s members are not a representative sample of the population of weight losers or dieters. It’s possible that individuals who are the most successful at weight loss may be more inclined to join the NWCR. Therefore, the results of the NWCR research have limited generalizability to the entire population of overweight and obese individuals. The NWCR should not be viewed as a magic formula for successful weight loss for everyone.

Another limitation is that nearly all the data on the NWCR members have been collected via questionnaires that are sent to them, in the early years via mail and, in more recent years, via email. In questionnaire-based research, individuals report on the studied variables themselves, rather than those variables being directly measured by the researchers (for example, if I ask you to tell me how much you weigh instead of weighing you myself). This necessitates a good memory and the ability to estimate things, like the amount of food eaten and the amount and intensity of exercise done. While some self-reported variables are generally accurate, like body weight and height, other variables, like caloric intake and amount of exercise, are subject to larger errors. Most people underestimate how many calories they consume and overestimate how much they exercise. Questionnaires are also subject to a response bias. For example, individuals more likely to regain weight after joining the NWCR may choose not to answer the follow-up questionnaires, perhaps because they are embarrassed or otherwise don’t want to admit their failures. It would be virtually impossible to directly measure every studied variable on each member of the NWCR, especially when many of the variables are retrospective in nature (e.g., an individual’s maximum lifetime weight, number of years having kept the weight off, or how many minutes of exercise done last week).

The large sample sizes of the NWCR studies, which are in the hundreds and even thousands, help to alleviate (but not eliminate) these limitations, and are major strengths of the studies, since sample size is one of the main factors that affects the statistical power of scientific research. To try to get around the self-selection limitation, the founders of the NWCR also did some research outside of their database. To determine whether there are characteristics of successful weight losers in a population-based sample (compared to the self-selected sample of the NWCR) that distinguish them from unsuccessful weight losers and from never-overweight individuals, the scientists of the NWCR made some phone calls—2,382 to be exact—to people in the community, which resulted in 500 completed calls and data from 238 people to be analyzed.24 These 238 people were divided into three groups: (1) successful weight losers (those who had intentionally lost at least 10 percent of their maximum weight at some point in their lives, were currently at least 10 percent below their maximum weight, and had maintained at least 10 percent weight loss for at least one year); (2) weight-loss regainers (those who had intentionally lost at least 10 percent of their maximum weight, but were not currently at least 10 percent below their maximum weight), and (3) weight-stable individuals (those who had never lost 10 percent of their maximum weight, were never at least 10 percent above their current weight, and had maintained their current weight within ten pounds for the past five years). The scientists discovered that 21 percent of this random, population-based sample were successful weight losers and, even more interesting, they had similar habits to keep the weight off as did the members of the NWCR. The study’s results contrast sharply with the popular belief that no one ever succeeds in losing weight or maintaining their weight loss. This finding, and others like it, hold out the promise that weight regain is not inevitable, and that people can recover from even the most severe weight gain. The good news, then, is that behaviors as profound as those causing obesity can change, and that the route to such change is through the creation of habits.

The research from the NWCR has been largely ignored by those who can make a difference—medical professionals, fitness professionals, weight-loss coaches, even social media influencers and your next-door neighbor. When was the last time you saw research from the NWCR posted on Instagram or Facebook? Unfortunately, the general public does not read scientific journals and so is not aware of the information. Shockingly, no one has written a book to introduce the data and give practical advice based on it. That’s horrible, because the public needs to know! Lose It Forever does just that. In the pages that follow, you’ll find the pertinent data and learn what other people in the same position have done, and continue to do, to keep their weight off.

Given the plethora of weight-loss programs, books, social media anecdotes, and next-door neighbor accounts, it’s clear that there are many ways to lose weight. You may know someone who lost weight by eating less fat or less carbohydrate, going to the gym, or by adopting a ketogenic diet. Perhaps you have tried one or more ways yourself. An interesting finding of the NWCR research is that, while approaches to lose weight differ greatly, with no commonalities in type of diet modification, there is much more similarity in the strategies used to maintain weight loss. Successful weight losers act like other successful weight losers. Weight loss and weight maintenance are not the same; they require different strategies. When you review all the data and research on successful weight losers from the NWCR, as well as that from outside of the NWCR, one thing becomes very clear: to be a successful weight loser for the rest of your life, you need to adopt specific behavioral strategies. That’s what this book is all about.

Unfortunately, there is no cure for obesity or being overweight. While maintaining lost weight gets easier over time, people still have to work hard to keep the weight off, even fifteen to twenty years after losing it. Behavior is not an easy thing to change. Most of us know how easy it is to get stuck in a rut, doing the same thing over and over again. It’s difficult and uncomfortable to do something we’re not used to doing. To be a permanent, successful weight loser, it is essential to totally restructure your food and exercise behaviors. Sounds hard, but so is anything in life that is worth doing. In the pages that follow, the successful weight losers of the NWCR show you how.

***

“Since I never followed a diet before, I really had no idea where to start,” Lynn Kata says. “Since exercise had kept me in shape before, I was willing to try to get back into moving and burning off some calories.” In addition to exercising with Wii Fit, she walked about a mile with her dog every morning. “My dog won’t leave me alone until I take her for a walk,” she says. “It felt good to be outside in the fresh air. It helped my mental health as much as my physical health.” She also stopped putting sugar in her coffee and stopped drinking sweetened beverages, including soft drinks and juices, replacing them with carbonated water. It worked. “The first ten pounds came off easily,” she says.

Since success often breeds the motivation to do more, Lynn started walking farther. She began walking about three miles around her neighborhood. As she became fitter, she walked faster, adding music for inspiration. “Every morning the Wii Fit graph displayed a chart, showing my weight decreasing,” she says. “Looking back, I believe the tracking of my progress helped to keep me motivated.”

Although Lynn was walking a lot, her diet remained the same. Then she learned that walking one mile burns approximately a hundred calories. “That was an ‘aha’ moment for me,” she says, “because I realized I could wipe out my calorie burn from my one mile walk by eating just one cookie!” As Lynn found out, it’s too easy to replace calories after completing a workout—the twenty minutes of walking to burn a hundred calories can indeed be negated in just a few seconds with a cookie, even a healthy one.

Lynn started paying much closer attention to how much she ate, not simply what she ate. “I stopped eating desserts. I cut down on snacks,” she says. She lost the weight slowly—about a pound a week, sometimes two weeks, but it worked. Her next goal was to increase the amount of exercise. “I purchased a set of DVDs called The Lotte Berk Method, primarily because the picture on the front of the package showed an extremely fit woman,” she says. So, Lynn worked out thirty minutes every morning to “Hip Hugger Abs” and “High Round Assets.” Her body started transforming back to her younger, fit body. “I loved seeing the progress,” she says. Other people began to notice. She bought new clothes to fit her new body and immediately got rid of the clothes that were too big. “There was no going back,” she says. “I liked the new me!”

She was offered a job as a front desk attendant at a local health and recreation center. Inspired by that environment, she decided to become a certified group fitness instructor. She heard about a workout called Zumba, a group fitness class that combines dance, music, and a fun atmosphere. She attended a class and was hooked. After getting certified to teach Zumba, she started teaching classes in January 2010. “My first class was attended by over seventy people!” she says. “My fitness career had begun.”

When asked about her weight loss, Lynn says, “I didn’t know specifically what I should do, so I just came up with my own method. It was a learning process to figure out what would work for me. I wasn’t interested in trying out any fad diets or pre-packaged meals. I wasn’t interested in using supplements or pills. I intuitively knew that anything I did would have to become part of my lifestyle indefinitely. I knew too many people who had tried those other methods and were unable to sustain their weight loss. I believe now that sustainable changes that slowly became my new normal were the key to my success.”

Ten years later, Lynn still walks every day and teaches Zumba classes at the recreation center. She takes Zumba instructor courses to learn new formats and attends Zumba conventions. She has even taught Zumba on Celebrity Cruise lines, traveling to Europe and the Caribbean, and was cast as a Zumba class participant on an episode of the TV show, Chicago Fire in 2014.

Now sixty years old, Lynn weighs 115 pounds. She has lost a total of forty pounds and has maintained that forty-pound weight loss for more than ten years, avoiding the yo-yo dieting that is so common among weight losers. She joined the NWCR in 2012 because she was interested to find out how the registry helps people gain the knowledge they need to maintain their weight loss. After submitting her success story to the NWCR, she was contacted by a few national publications and news outlets, and even had an article published about her weight loss in Better Homes and Gardens. She became a National Board-Certified Health Coach in 2017 to help others set achievable goals and hold them accountable. “I now know that being healthy is not just about moving your body and eating healthy food, but also about creating a lifestyle and habits that support health and happiness,” she says. “ ‘Eat less, move more’ is a catchy phrase, but some people need help creating those habits.”

Lynn’s successful weight maintenance habits include weighing herself every day, educating herself on healthy eating, eating more fruit, vegetables, whole grains, nuts, seeds, and legumes, and eating less meat, dairy, processed carbs, unhealthy fats, and sugar. She still walks every day, which is the most common exercise of the NWCR. She doesn’t drink sweetened beverages and doesn’t eat sweets.

Working at a fitness facility, Lynn sees many people whose workouts are so ambitious and unsustainable that they quit. “Most people go all-out for a few days or weeks in January and then never come back,” she says. When asked what advice she has for others, she says, “Find the physical activities that you enjoy and do them. You have to start small and build. Join a class if you like being in a group environment. You meet people and motivate each other. Or get a workout buddy.

“It’s not about the fancy fitness equipment, as anyone who has ever bought a treadmill or other home gym and then used it as a clothes hanger can attest. It’s not about the gym memberships that go unused every year. It’s not about the latest bestselling book on the newest diet. It’s not about dietary supplements that are a short-term solution. It’s not about cosmetic medical procedures for a temporary fix. You can buy every gadget or workout DVD being hawked on television that promises quick results and shows amazing before-and-after photos and testimonials. When the disclaimer says, ‘Results are not typical,’ they’re not kidding. Stop kidding yourself. It’s about being healthy from the inside out. You have to focus on what your body really needs.”