Saturday, April 6, 2013


FANS is an acronym for Fitness, Attitude, Nutrition, and Self-Monitoring. It started out as my personal effort to emulate the STOP Regain study conducted by the National Weight Control Registry. From Maintenance of Long Term Weight Loss (2009), I knew the program was called STOP regain, and my imagination came up with what STOP could be an acronym for, that would cover the predictors of successful weight maintenance. It turnes out it stood for “Study TO Prevent Regain.” I wanted another catchy acronym and came up with FANS.

Maintenance FANS is a practical guide to the findings of the NWCR survey of 1 year maintainers and its STOP Regain study on teaching those behaviors to new maintainers. It is designed to be used either as a personal workbook or as a discussion guide for a support group. The 13 chapters cover the Getting Ready post and then three cycles through key predictors of sucessful maintenance represented by FANS:

Fitness The NWCR study found most successful maintainers exercised consistently and at fairly high levels. This not only burns calories, but keeps the metabolism conditioned.

Attitude Key predictors of success included fewer depressive symptoms and less disinhibited eating. There is significant overlap between mood disorders and obesity.

Nutrition Eating breakfast and practicing cognitive restraint in eating habits are an important difference between maintaining and regaining. The NWCR has found that people using many different nutritional strategies can be successful maintainers. The patterns that have emerged address ways to eat more than what to eat.

Self-Monitoring Weighing yourself seems like it would be a simple matter, but demotivation from weigh-ins is a major area of concern in many lifestyle change programs. Rather than discouraging frequent weighing, we strive to understand the significance of weight and other tracking data.

Disclaimer: I am not a doctor, you should see a doctor before undertaking an exercise or calorie restriction regimen, information is provided for educational purposes and does not constitute medical advice.

Maintenance of Long-term Weight Loss 2009 9-02/2009-02-53.pdf
The STOP Regain Study aspx?articleid=181605
Long-term Weight Loss Maintenance /1/222S.long

Table of contents

Maintenance FANS: Fitness, Attitude, Nutrition, Self-Monitoring
A practical guide to the findings of National Weight Control Registry findings on long-term weight maintainers
0 Getting ready: your success story and maintenance plan
F I gradual buildup of physical activity (If you're not already active)
A I depressive symptomology and support
N I breakfast and regular meals
S I frequent weigh ins (not what you've probably been told)
F II target fitness levels (1 hour a day or 200 min/wk)
A II disinhibited eating (negative emotional eating, eating to distract)
N II situations that encourage overeating (These vary but I have a few ideas)
S II cognitive restraint (How do you decide what to eat?)
F III lean bodymass and metabolism (when you lose weight, you lose calorie burning capacity)
A III Emotional self regulation (Handling setbacks, self care)
N III dietary consistency (weekends and holidays?)
S III data vs intelligence (applying the numbers)
Link to chart layout:

Getting ready: Your success story and plan

Getting Ready Your Story Your answers to these questions may be long or short. I’d encourage you to shoot for about a paragraph about each question. The purpose of the resulting document is to celebrate your success and to give you something to think about if you find yourself in relapse. A success story was part of the intervention kit used in the STOP Regain study. Why were you overweight? Some of us have been chronically overweight for as long as we can remember. Some experience a trauma or illness, or life event and find ourselves overweight. Many medications can cause excess weight as a symptom. Very often we start to carry excess weight as we age (technically, as our muscle mass decreases).

When did you decide to do something about it? For many of us there is an “ah ha” moment when we realized enough was enough, or we had a paradigm shift that we could make a change where previously we had not. The NWCR identified such moments as a predictor of success in long term weight management.

How did you lose the weight? What was your initial plan or strategy? Did it change as time went by? What would you tell someone just starting out? Is there maybe something you would have done differently?

What is different about your life now? Recognizing that weight loss does not in itself fix everything, what are some specific things you couldn’t do before that you can do now? What feelings and attitudes are different? Are there behaviors that are different?

Pictures! Find a picture of you before you lost weight. You may not have had one taken (I got very wiley about avoiding cameras when I was at my high weight). I wound up capturing images from video footage. Have a nice picture of yourself at goal.

Your Maintenance Plan

Think of the FANS acronym:

Fitness What is your balance of cardio and strength? Where will you work out? How will you fit it into your day?

Attitude Key predictors of success included fewer depressive symptoms. What is your support system like? What kinds of challenges to do think are likely, and how will you respond?

Nutrition What do you eat, when and how much? Do you have a plan from your weight loss, or a maintenance plan from some other source? Do you monitor or track quantities, or do you avoid particular types of food? Do you get enough water, and how?

Self­-Monitoring Do you have a system for tracking weight, food and fitness?

Fitness I Gradually build up fitness

Fitness I

One of the strongest predictors of maintenance success is physical activity. Weight lost through diet alone will generally decrease lean body mass, resulting in a lower total daily energy expenditure (TDEE or calories burned). People who reach goal weight without exercise will be unlikely to maintain because they do not have the lean bodymass to keep up their metabolism at a reasonable calorie level.

However, it is not wise to jump full throttle into an intense exercise regimen (besides the disclaimer that you should always see your doctor to get cleared for increased physical activity.) Too much activity too soon will raise your TDEE too fast, resulting in increased hunger and the likelihood of overeating. Over exercising can also cause transitory water weight gain. In the STOP Regain study new maintainers were instructed to build up their level of physical activity gradually.

Action step: evaluate your current level of physical activity and find ways to increase it gradually each week -- five additional minutes of moderate to intense activity or ten minutes of walking per day. Increase this each week unless you already do 35-60 minutes a week.

Attitude I Depression and Support

One of the less obvious predictors from the NWCR surveys is depressive symptoms. So depression awareness is something that would be important to discuss in a maintenance support group. I am not a doctor or therapist, but if you experience symptoms of depression please get in touch with local resources.

What is Depression? (from NIH)
"Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.

Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression."

Link to signs and symptoms

One of the key strategies that the STOP Regain study looked at was how different levels of support affected maintenance, including depressive symptomology and de motivation. The control group received a newsletter, and then there was an interactive website group and a face to face group. The newsletter group regained the most weigh on average and had the most participants regain. The Internet group regained nearly as much weight on average as the newsletter group, but the number of participants who regained was close to the face to face group (which met with a professional counselor). So Internet support had mixed results, at least in 2006.

Developments with Web 2.0 could hold more promise for maintenance support. There are communities of maintainers on sparkpeople, reddit, and Other resources (like this one) are being developed. The action step for this week is to investigate options for support in you maintenance.

Nutrition I Breakfast and meal pacing

Nutrition I Breakfast and Pacing

The importance of eating breakfast for maintenance comes from the NWCR survey reported in Maintenance and Long-Term Weight Loss. It is a common rule of thumb in other diet and lifestyle change programs. The Sparkpeople survey of 100+ pound losers found that this group ate a breakfast of at least 400 calories as a key nutrition behavior (along with 8 cups of water and 5 fruits or vegetables a day)(Downie, Chris The Spark pg 213). When I implemented this breakfast suggestion, I found a decrease in my mid afternoon cravings.

The NWCR members ate several small meals spaced throughout the day (4.87 meals on average) as a strategy to decrease overeating. Though care must be taken to avoid a total increase in calories consumed. In my experience, six meals a day was too many because I never really stopped thinking about food in between these mini meals.

One of the challenges to getting daily breakfast is time, especially if you work and have children to get to school. Prepared breakfast items are often very carb-heavy which may not provide sustained energy. Consider supplementing them with milk, an egg, or nuts, keeping appropriate portion sizes in mind. These protein and fat sources also pair well with fruit, though I always need some kind of complex carb with fruit.

If you are already a breakfast eater, what are some of your favorites, and what are their nutritional advantages? If you struggle to eat breakfast, look for ideas that you can implement. Start simple and work up gradually to the ideal of a balanced and substantial breakfast.

Self-Monitoring I: Frequent weighing

Self-Monitoring I

If you’ve been on a diet/lifestyle change in the last 20 years, chances are you’ve been advised to avoid weighing yourself too often. I’m not sure if this advice is something that will prove one of the things that separates weight loss from maintenance. The impetus for such advice seems to be concern that too frequent weighing might be demotivational.

However, studies over the last 10 years are finding that frequent weighing is correlated with successful weight loss and weight maintenance, and the particular issue of weighing in and mood was explored by researchers at the University of Minnesota:

"Results from this study suggest that, after adjusting for BMI, there is no significant association between depressed mood and self-monitoring of body weight in a community-based sample of adult women.” (Linde et al. 2007)

The National Weight Control Registry identified frequent self-weighing as a predictor of successful weight maintenance in its 1 year maintainers, and included it their STOP Regain program for new maintainers, or people who had recently reached a weight loss goal. They found:
“Since self-weighing is a key component of the self-regulation model, we compared the proportion of participants in each group who reported weighing themselves at least daily… In addition, in the face-to-face and Internet groups, a smaller proportion of participants who weighed themselves daily regained 2.3 kg or more, as compared with those who weighed themselves less.” (Wing et al. 2006)

But does weighing in cause successful maintenance or does it follow it? The discussion of the STOP Regain study looked into this, and there is more to self-monitoring that simply weighing oneself and writing it down, which is why this is but the first lesson on self-monitoring. Knowing what to do with the weight data is key (and you’re free to skip ahead to data vs. information if you wish.)

If you’re not persuaded yet and are interested in further discussion of what the numbers on the scale mean, you might check out my blog “Talking back to the scale” which provides some tools for applying critical thinking to weigh in data.

The key is whether a higher reading on the scale makes you throw up your hands, or if you use that as a reason to try harder at your healthy habits. Seeing the scale as a tool and not an end unto itself can turn it into a powerful ally.

“Results support the idea that daily weighing is valuable to individuals trying to lose weight or prevent weight gain. Daily self-weighing should be emphasized in clinical and public health messages about weight control." (Linde et al. 2005)

References: Linde et al. 2005, Self weighing in weight gain prevention and weight loss trials) Wing et al. 2006, A Self-Regulation Program for Maintenance of Weight Loss Linde et al. 2007, Relation of body mass index to depression and weighing frequency in overweight women