The National Weight Control Registry

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The largest observational study of successful weight losers is the NWCR in the United States. The NWCR is a registry of individuals who have lost at least 13.6 kg and kept it off at least 1year. On average, these participants have lost more than 27.3 kg and kept it off more than 6 years. Information that registry members have provided has aided in learning about the weight loss maintenance process.

Registry participants are recruited through newspaper and magazine articles and thus are a self-selected population. The registry members are primarily female (80%) and Caucasian (97%). Many have a strong genetic predisposition to obesity, with 73% having one or both parents with obesity and 46% having been overweight as a child.

Participants in the registry are asked to indicate how they lost their weight in this successful effort. Approximately half say they lost the weight entirely on their own, whereas the other half reported receiving some type of assistance from a physician, dietician, or commercial program. The combination of diet plus exercise was used by 89%, with the most common dietary strategy being restricting intake of certain types of foods.

Although there is marked heterogeneity in the approaches used for weight loss, there appear to be some common themes for weight loss maintenance. The first common element is consumption of a low-calorie, low-fat diet. Registry participants are consuming an average of 1381 kcal/day, with 24% of calories from fat, 19% from protein, and 56% from carbohydrates. Very few (less than 1%) report consuming a low-carbohydrate diet (less than 24% of calories from carbohydrates).

Registry members report eating an average of 4.87 meals or snacks per day. More than three-fourths of the sample report eating breakfast every day of the week, whereas less than 5% report never eating breakfast. Consuming breakfast may be an important behavioral characteristic of successful weight losers.

These long-term changes in diet in registry members are accompanied by long-term changes in physical activity. Women in the registry report 2545 kcal/week of physical activity and men report 3293 kcals/week. This is equivalent to 1 h per day of brisk activity. Approximately half of registry members engage in walking plus another form of physical activity, including cycling, weight lifting, aerobics, running, or stair climbing. Only 9% of registry members maintain weight loss without physical activity.

The final characteristic of registry members is that they weigh themselves regularly. More than 44% weigh themselves daily and 31% weigh themselves at least once a week. Frequent monitoring of weight may allow these individuals to quickly catch small weight gains and institute corrective actions. See Table 1 for a summary of the strategies that registry

Table 1 Strategies used by successful weight loss maintainers in the National Weight Control Registry




Consuming a low-calorie, low-fat diet

Consuming breakfast regularly

Physical activity

Engaging in 1 h of moderate-intense

physical activity per day

Behavioral tools

Self-monitoring of weight

members have reported as being helpful for successful weight loss maintenance.

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