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-   -   Refuse to Regain (http://www.3fatchicks.com/forum/maintenance-library/155451-refuse-regain.html)

AnneWonders 11-02-2008 12:23 AM

Refuse to Regain
 
I’ve just finished reading Refuse to Regain! 12 Tough Rules to Maintain the Body You’ve Earned! by Barbara Berkeley, M.D. Berkeley is an internist who runs an obesity specialty practice (which includes the Optifast program), and is a 5 year maintainer of a 20 lb weight loss and seems well qualified to write a book like this. My very long review follows along with some questions for discussion to those of you who've also read the book.

First, a summary of the book. Refuse to Regain is a book designed to provide a weight maintenance plan to new maintainers, who Berkeley calls Maintenance Juniors (after Just Reduced, J.R.) to enable them to beat the often-quoted long odds on maintenance. The book is divided into four major sections. The first is Ten Foundations which introduces the challenges of maintenance and lays out the social, biochemical, nutritional, and emotional environments that maintenance must successfully navigate—the facts on the ground, so to speak. This includes an extensive discussion of an eating style Berkeley calls Primarian, which is essentially a Paleo diet with the addition of low- and non-fat dairy and a few modern “treats.” The second section is a discussion of the 12 Tough Rules themselves, and the steps to take to understand and implement them. The rules are as follows.
  1. Be Tough, Not Moderate
  2. Commit yourself to a 3 Month Opt out Period
  3. Weigh yourself every day
  4. Reverse small gains immediately
  5. Eat Primarian 90 percent of the time
  6. Eat one major meal a day
  7. Perform a daily “Scan & Plan”
  8. Stop eating at 8 pm
  9. Eat from a limited menu
  10. Have one acceptable treat per day
  11. Have a love affair with exercise
  12. Maintain with support and support others
Section 3, Five Lives in the Balance, gives several successful Maintainer’s stories, and Section 4 provides Primarian meal plans and recipes.
Berkeley’s plan is very heavy on her Primarian approach, so named so that Maintainers can give name to a diet of conscience, and their choices will therefore be respected similarly to those following, say, vegetarian or Kosher diets. The description of the diet, the reasons for avoiding all “S foods” (starches and sugars—including whole grains, tubers, and legumes) make up a large portion of the book.

I ordered this book after finding the Refuse to Regain blog (co-authored with Lynn Haraldson-Bering), which discusses many of the issues associated with maintenance, with interaction from readers, and thought provoking questions and issues. I was surprised to find that the book and the blog were completely different beasts. The book is a prescription on how to maintain weight loss, and a detailed plan is given to the reader. If you do this, you’ll maintain the weight loss. No thoughts on how to create your own plan, or what to do if something about the prescription doesn’t work for you, just be tough, do this, and you’ll keep that weight off. I did find two places in the book that acknowledged that people have to find a way that works for them, and if something in the book doesn’t work, discard it, but I had to look hard for that, and there were no answers on how one might go about finding that something that would work instead.

I found the Primarian eating approach a bit strange. I do find the Paleo diet concept interesting and logically somewhat compelling. People did not evolve in an agricultural world where grains and milk were readily available and it makes sense that the addition of these foods to the diet in large quantities could potentially cause people issues including weight gain, and moving closer to this primitive diet could improve health and well being. However, Primarian isn’t Paleo in that it allows dairy as well as non-starchy modern foods like sugar free Jello, Lean Cuisines, or diet Coke. But it doesn’t make sense to me either to outlaw all grains, including whole, low glycemic load varieties and preparations, just because wheat can also be used for cake, and corn can end up as gummi bears. I just don’t believe there are that many of us that got fat, stayed fat, and got fat again because we ate a portion-controlled bowl of oatmeal in the morning. I was also a bit put off that I was being asked to tell my friends that yes, I was following an ancient diet of conscience called Primarianism, so don’t question my refusal of your whole grain bread, and could I have a diet Coke with that. Huh? But it is hard to argue that eating lots of fruits, vegetables, and lean protein sources is bad, and avoiding junk food is the right thing to do, and if you can get past the grains/tubers/starchy legumes thing, it doesn’t appear to me that this is an unhealthy plan, just one that is hard to live with in our culture. And, yep, I’m a 6 year maintainer come December, if not a perfect one (who is?), and I eat carbs and lots of them, trying to get whole grains as much as possible and limiting added sugars. I know a lot of us have issues with carbs, and we should respect that, but Primarian eating is not a one-size-fits all approach.

There is a list of other disagreements I had with the book, including its assertion that counting calories is essentially useless and no one does that anyway (I know lots of us do here), arbitrary rules like don’t eat after 8 pm, and the notion that somehow after a year that you just kind of get Maintenance and it gets easier (graduating from a JR to a SLIM, Senior Level Maintainer).

My last major issue was that the book had no footnotes, for fact checking, monitoring changes as time passes and such. It did have an extensive bibliography, but footnotes are better for those of us who actually go to the original literature from time to time. Yes, I’m a geek.

The Maintainer stories were nice, but not especially compelling (perhaps because of the Maintainer’s board here at 3FC where we have living examples), and I just don’t do recipes so Section 4 was wasted on me, but probably useful if you want to give the Primarian thing a go.

There were several things I liked about the book, including the fact that there is a Maintenance book out there. The book emphasizes the difficulty of the task, the need for planning, the difficult food culture (think marketing) that we live in now, and other tidbits like sabotage by friends, family and coworkers. It also called out the need for support and exercise as very important, but didn’t spend a lot of time with either of these factors.

So would I recommend this book? Maybe to someone who didn’t want to put much thought into their Maintenance plan and wanted a lot of guidance, and a switch from the plan that got them to their goal weight. But probably not to most people. I believe that what we need to do to have long term success is something that we all have to figure out for ourselves and not something that can be handed to us. 3FC has shown me that without a doubt, we have common threads, but we are all doing this differently. While the book has a few interesting ideas, and the occasional good point, it does not include the tools for making that individual plan and the strategies that support it. Personally, I probably follow about half of the rules. I have a handful of books I return to (including the excellent Thin for Life) and Refuse to Regain won’t be on that shelf in my library. My recommendation is to bookmark the excellent blog, and leave it at that.

I would love to hear from the other Maintainers here.

How many of the rules do you follow?

What do you think about the low-starch (low carb?) approach of Primarian eating?

Do you, and if so, how do you control “S Foods,” starches and sugars in your diet?

If you’ve read the book, was there any particular idea that really resonated with you, perhaps an “aha!” moment?

Do you feel like you are a Junior or Senior Level Maintainer and why?

Anne

JulieJ08 11-02-2008 12:47 AM

Thanks for the detailed review!

Quote:

Originally Posted by wndranne (Post 2435028)
There were several things I liked about the book, including the fact that there is a Maintenance book out there.

I really agree with that. I think one particular value of a book like this, even if you don't quite (or even much) agree with its details, is as a model. I think it is a very valuable thing to put your maintenance approach, whatever it is, into black and white.

(Not quite at maintenance yet, but it's very much on my mind these days!)

Barbara Berkeley 11-02-2008 12:38 PM

Appreciated reading the review
 
I appreciated the long and detailed look at Refuse to Regain that was reflected by the review above. I wanted to respond to the way the book was perceived(and I undoubtedly should have made this message clearer when I wrote the book)...

I wrote Refuse to Regain in order to attempt to open up the discussion of maintenance. There have been very few books written on the topic. In my view, a new focus on maintaining lost weight is the most important shift we can make over the coming years.

The book was written to provide just one view of how to achieve success. But just as with the weight loss phase itself, finding a plan that works for each individual is key. While I do believe that significant limitation of sugars and starches makes sense biologically and physiologically, each person can tailor this approach (or any other) to fit his or her own profile. Maintenance is really an ongoing personal science experiment and each maintainer is doing the research. What I've found is that those people who become most invested in figuring out their personal requirements are the ones that do best. This kind of intense commitment is reflected in the posts of maintainers on sites like this one. They are really exciting!

So, to sum up: I am not one of those people who feels that I have all the answers or that any one plan is right for everyone. I do, however, believe that intensity and consistency and learning about every detail of your own response to food is key to success. Let's hope that there will be many more books suggesting all kinds of approaches to maintenance from here on in. And thanks to all!

AnneWonders 11-02-2008 03:09 PM

Dr. Berkeley, I have so many questions for you. I hope you stick around here because in your profession as an obesity specialist you have a unique perspective that most of us here don't.

I guess my main question is why did you approach your book in this way? I really like your blog, and it is obvious from reading it that you really get the ambiguity and constant struggle that maintainers have. I guess most of us here on this board could fall into that 5-20% of successful maintainers, whatever successful means, and so may not be your primary audience? And everything you say in your post is indeed in your book somewhere, but it was just dominated by the 12 Rules.

I find myself wanting to have a more in depth discussion with you to ask more followup questions, because it is obvious from the bits and pieces that I did really like that you have a lot more information there. What if this doesn't work, or what then? I guess that is where I found myself frustrated. Perhaps it is the nature of a book, which is a static thing written for a specific audience, and the information presented must be selective, versus a blog, which is often more interactive?

My second question would be, do you really see such a drastic difference in weight loss and maintenance in your practice? That really surprises me--it is so alien to my own experience and I know some people around here have modified their plans, but your book seems to call for such an abrupt shift.

I must thank you for thinking about maintenance and making the effort to write about it. It is a topic that is so often ignored, and I think it is so important.

Anne

Barbara Berkeley 11-02-2008 04:42 PM

Happy to continue the conversation
 
Hi Anne,
I just finished writing you a detailed answer and it somehow didn't get posted! So here I go again.

I appreciate the opportunity to answer some of these questions. I'll do the best I can.

The format of the book, in terms of the Rules and focus on Primarian plan, was what I needed to do in order to get it published. When I first tried to sell the idea of a maintenance book to agents, they said it would never sell to a publisher. The reason was that publishers (according to knowledgeable agents) would not take a book that did not address a perceived problem. In their view, people who had completed a diet did not feel they had a problem any more!

This argument ran completely counter to my own professional experience. I interview new patients every week, and almost without exception they have lost and regained weight many times. They are completely frustrated by their inability to maintain. I was finally able to convince a book agent on this point. I then presented the book at a writer's conference for physicians in Boston. I was advised by publishers there that the book needed "rules". I guess there are certain formats that seem comfortable to buyers from their point of view. Since my main goal was to get the topic of maintenance into public view, I worked to create a book that would be saleable.

As it turns out, the rules I went with actually do form the backbone of the maintenance plan I advocate. However, there are many other rules and behaviors that are kind of buried in the text.

In terms of making a drastic change from the weight loss diet to maintenance, that's actually not the case for the patients I treat. We reduce them with a combination of liquid supplement during the day and a Primarian meal at night, plus snacks. They are already comfortable with this style of eating and we simply add back more Primarian-type food when they enter maintenance. In truth, a Primarian diet is not as drastic as you may think. I have suggested that people choose basic (non S foods) 90% of the time That means, most-- but not all by any means. I picked 90% because I find that a tough message means that maintainers give more thought to their departures. I completely understand that people will add back bread, pasta and even sweets. But I really want them to think about it and to realize that the potential for re-triggering of their old eating patterns lie mostly in those foods. I also firmly believe that the tendency to overproduce insulin and therefore store fat more avidly, remains in POWs (previous overweight people). If you give yourself too much of a chance to slip back into the insulin cycle, you'll start gaining.

You astutely have observed that this book is really not targeted at those who are already successful in maintenance. You, and many of your readers, have already figured it out and so merit the title of experts! Success is the real marker of good maintenance and any program that works for an individual is acceptable, as long as it's healthy. The next book should look at all the different takes on maintenance that individuals have developed. Maybe you'll write that one!

Lastly, your question about 'what if this doesn't work?' The answer is: this is just one approach. If this were a weight loss diet, someone could put this book down and go read Ornish, Atkins, Agaston, Dr. Phil, Suzanne Somers...etc, etc... Unfortunately, maintenance plans are currently few. But I hope that this will be just one of many books to come on the topic. In the meantime, we all have to continue to do our own personal science, as i mentioned above. Let's all work together!

Barbara

Meg 11-02-2008 04:55 PM

Welcome to the Maintainers Forum, Barbara! We're honored to have you join our little outpost of maintenance!

It's tremendously exciting for us to have you as a resource, especially while so many of us are in the process of reading your book. We all appreciate you taking the time to respond in such a detailed and understandable way and to share your many years of expertise with us. I know that all of us felt lost once we entered the maintenance phase of weight loss for precisely the reason you mentioned -- there's nothing out there for us! I'm saddened but not at all surprised by the response you got from publishers about there being no need for a book about maintenance, so huge thanks for stepping into the breach.

I'm looking forward to joining in the discussion as soon as I finish the book. :)

AnneWonders 11-02-2008 08:03 PM

Quote:

Originally Posted by Barbara Berkeley (Post 2435706)
Hi Anne,
The format of the book, in terms of the Rules and focus on Primarian plan, was what I needed to do in order to get it published. When I first tried to sell the idea of a maintenance book to agents, they said it would never sell to a publisher. The reason was that publishers (according to knowledgeable agents) would not take a book that did not address a perceived problem. In their view, people who had completed a diet did not feel they had a problem any more!

This argument ran completely counter to my own professional experience. I interview new patients every week, and almost without exception they have lost and regained weight many times. They are completely frustrated by their inability to maintain. I was finally able to convince a book agent on this point. I then presented the book at a writer's conference for physicians in Boston. I was advised by publishers there that the book needed "rules". I guess there are certain formats that seem comfortable to buyers from their point of view. Since my main goal was to get the topic of maintenance into public view, I worked to create a book that would be saleable.

I was sort of wondering if this might be the case. This must be frustrating to fit your experience and advice in a short list adapted to someone else's format and I'm sorry you had to do so for your publishers to feel your book would be commercially successful. I rarely find mainstream diet books that I find helpful, since I can barely follow my own plan and never anyone else's. On the other hand, I really enjoy the kind of dialog that this thread has evolved into, and I'm grateful that you are taking the time to talk with me/us, especially since I expressed some difficulties with your book.

I do have another question about the use of artificial sweeteners in a Primarian diet, which as I alluded to in my original post I find counter intuitive. I've heard a lot of people here discuss how they also trigger cravings for additional sweets and junk foods, even though they don't (we think) trigger an insulin response, they do trigger a psychological one. Have you found that to be the case in your practice?

Anne

CountingDown 11-02-2008 09:58 PM

Anne, Barbara, and others - thank you for your posts. This has been and informative and interesting thread! As a new maintainer, I am fascinated by the topic and information presented.

Thank you!

Circebee 11-03-2008 08:34 AM

Another voice of gratitude here! Thank you so much, Barbara, for presenting weight mainenance as a seperate, vitally important phase in the persuit of a healthy lifestyle. Your book , blog, and other work bring a great deal of medical credibility to this young field. And, Anne, thank you for the thoughtful, insightful review and follow up questions. I also feel that this plan is probably not one that would easily fit into my own life, but I am so glad that the door has been opened for (hopefully) a flood of other valid, well researched maintenance strategies! Bring on the knowledge!

Barbara Berkeley 11-03-2008 04:05 PM

More on this
 
Hello to all and thanks for following the conversation. I did not respond sooner as I subscribed to this thread but did not get an email that there were further posts. I'll check periodically.

First of all, I hope that those of you who have not read the book will do so. There is alot of information in the book which is not part of a "program". And, as I've said, any program should be looked at as something that can be modified and adapted to individual needs.

In terms of the artificial sweetener issue, I would say the same thing. In my experience, both personal and with patients, artificial sweeteners don't seem to cause a problem. I have not seen convincing evidence to suggest that they are dangerous, so i consider them a useful aid in weight reduction and in maintenance. If, on the other hand, any individual finds them overly stimulating to their appetite, I would tell them not to use them. My approach is always a pragmatic one. I think I'm going to blog about this soon actually. The diet that I suggest is not necessarily "pure" or "perfect". I 'm just trying to get as close as possible to what I believe we were best tailored to eat. I take into account the fact that we don't live in the paleolithic (thank goodness!), and try to incorporate things that make it a bit easier to stick mostly to Primarian types of food.

I also have to say, that many maintainers who post on the internet say that they are having success eating smaller amounts of what they did before. Many seem to be able to get along without restricting certain types of food. In my practice, however, I find that the vast majority of people fall off the wagon as soon as crackers, bagels, cookies, bread, etc...make a re-appearance. For those of you who are able to deal with S foods in smaller amounts, you are luck and you have the best solution to maintenance. I believe, though, that you are unique and are probably in the minority. Another explanation may be that early maintainers need to be tougher until they learn skills that they can later adapt.

alinnell 11-03-2008 05:06 PM

This is a very interesting discussion.

I bought the book, but have yet to find any time to crack it open. I did hear on a previous thread that the gist of the book was to follow the Primarian diet which was rather like the Paleo diet. At that point I had to look up the Paleo diet to see what it was. What I found was that it seems to be the diet that my doctor has recommended that I follow (via the use of the book Dr. Gundry's Diet Evolution). Although in his diet, Dr. G does not allow the use of artificial sweeteners (except stevia).

I like the concept of following the Primarian diet 90% of the time. I've really had a hard time wrapping my head around the no grains, even if it is whole wheat concept. But I've been trying. Really hard. I've managed to forgo breads and pastas for breakfast and lunch about 13 days out of 14. And the same with dinner--I have pasta or bread only once or twice a month (and then it is only whole wheat). Besides, a lot of us maintainers have a deep belief that if you are forbidden to have something ever again that you will crave it and possibly cave in and binge on it. Everything in moderation is my motto! (Now if I can get my doctor to believe me!)

Barbara Berkeley 11-03-2008 05:18 PM

Thanks
 
Yes. This is a lower carbohydrate type diet (it does still include the carbs in fruits and vegetables of course). The 90% number simply means that you choose this type of food most of the time. I don't expect anyone to really tally out how much they eat off the menu and the amount that you are able to depart without regain is a function of your individual physiology.
Having been on this type of diet for about five years now, I find that I always know I can eat grains or potatoes or bread or whatever if I want to. But after choosing not to so often, I don't really care about them that much. I must add that I used to eat huge amounts of sweets, bread and pasta, so that this was a big change. Once again, I am so enjoying all of your questions and conversation. So let me ask all of you a question: Do the maintainers out there ever find that eating grains, breads, potatoes, pasta other starches cause you to gain weight or crave more? Or have you found ways to incorporate them without a problem?

mandalinn82 11-03-2008 05:24 PM

For me, grains, breads, potatoes, and pasta that are whole grain don't cause me any problems. Refined grains and starches will cause me to crave more.

I've incorporated whole grains every day into my plan, and continue to do so to maintain. For me, meals tend to follow that iconic "Meat/Vegetable/Starch" pattern, albeit in non-typical portions (small meat, small starch, heaping pile o' vegetables). I get whole grain varieties whenever possible, but I don't avoid, for example, white potatoes. I figure that if I eat things mostly the way they grew, with minimal processing, it'll all work out for me in the end. And it has worked through loss and a year of maintenance - though I'm NO expert after just a year!

alinnell 11-03-2008 05:29 PM

I do not believe it is grains that have caused my problems. I don't over eat any grains. In fact, sometimes I would prefer my burger sans bun or my sandwich open faced. I believe I only crave the grains because they have been deemed "forbidden." Also, I don't eat a lot of sweets and I don't crave them (except for an occasional desire for oatmeal raisin cookies which I STILL have not gotten around to buying/baking or eating!).

fiberlover 11-03-2008 07:22 PM

Quote:

Originally Posted by Barbara Berkeley (Post 2437117)
So let me ask all of you a question: Do the maintainers out there ever find that eating grains, breads, potatoes, pasta other starches cause you to gain weight or crave more? Or have you found ways to incorporate them without a problem?


There are certain starches that cause intense cravings for me if I eat them. They include:
White rice (brown to a much lesser degree)
Popcorn
Potato chips
White breads like French.

I have never had a problem with potatoes, although I almost always have them with the skin, so maybe that helps. Pasta doesn't give me problems either.


I got my copy of the book today!


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