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After Atkins

By Katherine Tallmadge
Wednesday, August 11, 2004; Page F01

A new client shared a familiar story with me: This man, who has struggled with his weight for years, went on the Atkins low-carbohydrate diet, and the pounds seemed to melt away. But after a few months, they started to creep back on. Another woman on Atkins lost only part of her desired weight and then hit a plateau. Still others find that after success with Atkins, their cholesterol levels soar, a potential danger to their health. They all came to me fearful that going off the Atkins diet would mean gaining their weight back. But they knew they had to figure out a different way to achieve their goals permanently.

Their fears are well-founded and point to a central dilemma in weight loss: While losing weight is exhilarating and energizing, it also can be fleeting.

Strategic Eating

Have you reached your desired weight on a low-carbohydrate diet and now want to maintain it?

Slowly incorporate healthy carbohydrates into your diet until you get to at least 160 grams daily (that's three servings of dairy or calcium-fortified soy, five to nine servings of fruits and vegetables and four servings of whole grains, such as whole wheat, brown rice, barley).

Week 1

Add high-fiber, whole-grain cereal and milk for breakfast.

Week 2

Add two or more fruits as mid-morning and afternoon snacks.

Week 3

Add two slices of whole grain bread for a sandwich at lunch.

Week 4

Add a yogurt snack.

Week 5

Add a couple of high-fiber, bean-based vegetarian meals to your week.

Remember: If you add carbs back too fast, you risk gaining a lot of water weight. If high cholesterol is a problem, reduce saturated fats, which are found mainly in animal products. Switch from fatty meats, dairy products and butter to fish, poultry, lean meats, fat-free or low-fat dairy products and oil.

Many on the Atkins diet lose weight without exercise, but if you want to maintain your results or lose even more weight, adding physical activity to your routine will give you the boost you need.

-- Katherine Tallmadge

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"Unless people transition, they're going to fail, because the Atkins diet produces weight loss but not weight maintenance," says James Hill, director of the Center for Human Nutrition at the University of Colorado in Denver. "If people lose weight with the Atkins diet, they need to consider their weight loss as Phase 1 and be prepared to keep it off differently, which would be Phase 2." Hill was co-author of the Atkins diet study published in the New England Journal of Medicine last year. It found that those in the Atkins diet group had a greater weight loss after three and after six months compared with those on a low-calorie, low-fat diet. After one year, though, there was no difference between the two diet groups.

But weight regain is not a problem unique to the Atkins diet. The struggle has been going on for as long as people have been looking for quick-fix, formulaic diets. In the 1970s, people lost weight by cutting carbohydrates with Atkins or Scarsdale. The '80s brought us high-protein, modified fasts (remember Oprah and Optifast?). In the '90s, low-fat diets were the rage. Now we've come full circle with low-carb diets. All these diets work because they dramatically lower your calorie intake. But the challenge is the same no matter what diet you follow: At some point, you must transition from the diet to a healthy, everyday eating plan that will maintain your weight and enhance your health.

In 1994, Hill and others founded the National Weight Control Registry to study the characteristics of people who successfully maintain their weight losses (known as "maintainers"). People in the registry have lost an average of about 70 pounds and have kept it off for an average of seven years.

The registry and other studies have found many factors that separate successful weight-loss maintainers from unsuccessful regainers:

• Diet: The registry found maintainers eat a low-fat diet with 24 percent of their calories coming from fat, 19 percent from protein and 56 percent from carbohydrates (much of it low-calorie, complex carbohydrates). Only 1 percent eat a low-carbohydrate diet (with less than 24 percent of their calories from carbohydrates).

The registry and other studies have found that maintainers eat more vegetables and fewer calorie-dense foods, such as fried food, fats, fatty meats and sweets, and they often substitute low-fat for high-fat foods.

Maintainers reduce portion sizes, reduce frequency of snacking, and they eat foods such as cheese, butter, high-fat snacks, fried foods and desserts less than once a week. They become satisfied with smaller portions and are less attracted to sweet or fatty foods.

Regainers increase their fat intake while maintainers keep it consistently low. But maintainers don't completely deny themselves. They changed their basic food patterns, but they allowed themselves fewer but more meaningful indulgences. Regainers, on the other hand, went on very restrictive diets not permitting themselves any room for favorite foods. They felt deprived and easily fell back into old patterns.

• Eating style: The registry found successful maintainers prepare and eat the majority of their food at home, dining out about once a week, which is less often than the general population. The registry and another study found maintainers are more likely to eat five times a day, while regainers are more likely to skip meals, snacking on candies and chocolates more often. The registry found that a strikingly high number of maintainers eat breakfast.

• Self-monitoring: The registry reported that 75 percent of maintainers weigh themselves at least weekly or daily. This helps them nip any minor weight gains in the bud. On the other hand, regainers either accept larger weight gains or don't notice their weight creeping up until they gain a large amount. One study found that successful maintainers develop a "healthy narcissism" about their appearance and physical condition. The registry and numerous studies have found that maintainers monitor their eating by occasionally keeping food diaries to increase awareness.

• Physical activity: Nine out of ten of the registry participants engage in regular physical activity. "During weight loss, diet is the driver. But during weight maintenance, physical activity becomes the key," says Hill, whose new book, "The Step Diet" (Workman, 2004), incorporates elements from registry findings.

• Coping skills: Most people have comparable levels of stress and unpredictability in their lives, but some are able to handle it more effectively than others. Maintainers are more likely to face their problems, while regainers react emotionally or avoid problems by sleeping, drinking or eating. Maintainers are also more likely to seek support from friends, family and professionals.

• Lifestyle: Many maintain weight loss only upon making major lifestyle adjustments. One study found when home-bound women became more involved in activities outside of their homes, they were more likely to maintain weight loss. They became more confident and took responsibility for their lives and their size. The activities you choose to engage in and the people you spend time with influence weight-maintenance success. Often this means making new, healthier friends and including spouses in your lifestyle changes. Spousal support is necessary for long-term success, even if it may not be necessary short term.

• Goals and expectations: Maintainers are more likely to be patient, setting small, reachable goals. They accept dietary change as part of their lives rather than as part of a temporary diet. They realize they need to be continually conscious of their food and activity levels and work at staying in shape.

The evidence is clear: The battle of the bulge is won at the margins. Sweeping dietary overhauls are impractical and don't work over time. Shrewd, small, concrete changes that can be easily incorporated into your daily routine lead to success.

Katherine Tallmadge is a Washington nutritionist and author of "Diet Simple" (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.

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