BRAVO Meg,
What a great post! We know it can be done with effort, YOU are EXHIBIT A & many of us are exhibit B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y and exhibit Z! It can be done and many of us are living proof!
Lets hear it for us maintainers- hip, hip hoorah!

Thank you Meg. I have been around here on and off since around 1998- the very early years. I had weight loss, as I had in the past, but I had no clue about maintaining. I come to the Maintainer's area to see how you do things, because really what you do is what I need to continue to do every day to get to goal and then stay there. The women here are incredible. Knowing that it is and will continue to be a daily priority is something you hear, but when you see it in action it makes a difference. I am also impressed with the healthy eating that the maintainers do. I see women around me who maintain their weight, but the thought of a tasty meal or a vegetable is a low priority. I can't live like that, and I do not think it is healthy. A book with the daily healthy recipes of the big maintainers here, along with their stories, would be a big seller. Hello!- are there no publishing house editors here?

Originally Posted by Lydia227:
The underlying message from me was this, "If you no longer want to look like everyone else, you should no longer treat your body like everyone else."

Lifestyle changes are tough to hear. "If it came in a box or a bag you probably shouldn't eat it" (exception being frozen broccoli) "Exercise most days of the week with REAL intensity." "Learn how to lift weights and go HEAVY." etc. "Select dumb bells that say TROY on the ends instead of Campbells..."

It is an epidemic and it makes me sad, angry and scared. There are a lot of other variables in this mix as well. The food industry making foods that develop foods that trigger cravings. The availability of food on every corner 24 hours a day. The endless variety of cheese powdered carbs in the center aisles meant for our kids.

QFT! And thank you, Lydia, for being one of those role models! :carrot:

Meg, great post! And I think "obesogenic" is my new favorite word.

Count me in as one of the people who had no idea that "maintenance" existed before coming to 3FC. If my story can be called a success, it's thanks to 3FC.

It makes me angry that that doctor would say that non-surgical weight loss is impossible. What are we, chopped liver? (Of course, they would probably look at me and say, you gained back 15 lbs, you don't count. :p) And what about the people who have WLS only to regain anyway?

I've heard the depressing stats about weight re-gain, but I am hopeful that it doesn't always have to be that way. And that a place like 3fc can be instrumental in better success rates!

Meg says it all the time -- the industry is about weight LOSS, not MAINTENANCE. I think that if more people hear about successful maintenance strategies and incorporate them, then maintenance rates would increase. It will never be 100% -- and may never be really high, but I KNOW we can do better. I believe knowledge IS power!!

Thanks for a great post, and a great thread!

From what I've been reading, doctors have NO IDEA whether weight loss surgery is successful in the long run, meaning 5 years or more. Supposedly they define "success" as losing 50% of excess weight and keeping it off for 5 years, but I can't find any numbers showing how many patients are actually successful. Meg, anyone, do you have information?

Surgeons tend to gauge success by whether everything got put together right and the patient wakes up from the surgery. They aren't so interested in what happens after that.

Jay

The proportion of people keeping it off is very low, so it's easy to argue that wls has 4 to 8 times the success rate of dieting alone - but it seems to me completely illogical that there are primarily only two options for obesity treatment. Self-directed behavior change or wls. Why aren't there more treatment options in the middle (and why aren't they more affordable)?

It would be a bit like if treatments available for alcoholism and substance abuse were self-help groups (like AA) and brain surgery/shock treatments. What about the "middle?"

Our hospital has an amazing comprehensive weight loss program that includes education classes and appointments with the doctor, dietitian, and personal trainer, a gym membership and group and individual counseling. AND it's housed in a YMCA building partially funded by the hospital (the gym facilities also are a fully-equipped and accredited physical therapy program).

Virtually no insurance companies will pay for this program, but will pay for wls.

The argument is that these programs haven't been proven as effective as wls (but they're not really given the chance to, because it's rarely an option in most communities - and where it is an option, insurances not covering it does affect people's ability to choose it, and therefore the number of people interested in it).

Finding a supportive community, I believe is one of the factors that contribute
to successful weight loss and maintenance (even of wls this is true - the patients who continue to attend the support group meetings tend to be the most successful in the long-term), and yet finding that support can be difficult when a person doesn't know where to look (or is ashamed to look).

There are so many possibilities for non-surgical intervention, that have not been explored, and I wonder why, as a culture, we're willing to make the huge leap from "diets" to surgery - why aren't the intermediate possibilities explored more?

If I had had insurance that covered it, I would have gladly entered a "rehab" style treatment for obesity. These programs do exist, but unless you can pay out-of-pocket, they're not available to most people.

It just seems to me that in the field of obesity treatment, there's a huge gap in treatment - there's little to no middle-ground. Certainly there has to be more options "in the middle," less invalsive than wls, yet more comprehensive than a typical "diet" program.

Originally Posted by kaplods:
Virtually no insurance companies will pay for this program, but will pay for wls.

The argument is that these programs haven't been proven as effective as wls (but they're not really given the chance to, because it's rarely an option in most communities - and where it is an option, insurances not covering it does affect people's ability to choose it, and therefore the number of people interested in it).

If the insurance company is looking for proof, they're talking about studies. The number of people interested in a program in a community and whether they can afford a program really have nothing to do with whether a program is or ever will be considered proven by an insurance company. The proof doesn't come from giving a program "a chance" in a community, it comes from a study. At least, that is all that insurance companies are looking at.

And I think the insurance companies are not so interested in what works as in what they can find an excuse not to cover :). The long-term benefits of weight loss & maintenance don't mean much to insurance companies, who figure by then someone else will be insuring the person and benefiting from the investment of the earlier insurance company.

I'm so thrilled by today's discussion. Very exciting. I would just echo most messages above so I can get to another thought.

I'm hearing folks say in today's thread that they are interested in advocacy. Right? I happen to be a professional public policy advocate who works at the grassroots level for community change. Currently, I work in a municipal health department with a great program that has had lots of success promoting "active living" with public policy changes to the environment to support lifestyle changes. Finally, I am applying to a Public Policy PhD program (to start 9/2010).

I would like to propose, for those maintainers interested, a separate thread for advocacy about (any or all of the following):
1) maintenace is possible after weight loss
targeting: media, weight loss magazines, govt officials
2) need programs to support maintenance
targeting: govt officials, insurance, gyms, others
3) 3fatchicks is an awesome place
targeting: general media, weight loss magazines

These are my thoughts. Folks interested to consider working on promoting our thoughts might expect to:
1) write letters to editors,
2) email/call/write elected officials,
3) attend local meetings around health issues
4) follow a group email community network
5) share some/all of personal weight loss/maintenance story

What do you say? I would be very happy to participate, assist the group to brainstorm ideas, and such. If we pinpoint our message and have a consistant strategy, we will likely see our efforts pay off with more attention to 3fatchicks, potentially seeing more maintenance programs, and an increased public belief that there is life AFTER weight loss.

I wouldn't feel comfortable (as a new chick cracking out in to the maintenance area) being too far out there since I'm just too new. However, I do very strongly agree that there are NO SYSTEMIC support for successful maintenance.

Anyone interested?

Great thread!

As I've said before - I always wanted to diet for a short time and then eat normal. I did that for 20 years! It took me 20 years to realize that my "normal" made me fat and I had to change normal. Once I hit that mind set, I can honestly say it has been easier than I ever imagined (not that there haven't been challenges).

*blows a raspberry at that bariatric surgeon*

Originally Posted by iaradajnos:
What do you say? I would be very happy to participate, assist the group to brainstorm ideas, and such. If we pinpoint our message and have a consistant strategy, we will likely see our efforts pay off with more attention to 3fatchicks, potentially seeing more maintenance programs, and an increased public belief that there is life AFTER weight loss.
Anyone interested?

Yep! I'm interested. :) Let me know specifically how I can contribute. Anyone else?

Good luck with your PhD program. :D

Re: insurance - I find it very interesting that my insurance plan does not cover WLS, but it does cover you if you sign up for the Dr. Ornish Spectrum Program for a year. And that is all about prevention.

Too bad they won't pay for a gym membership LOL!

Mine will pay for a gym membership if you meet certain BMI criteria, but once the weight is off, they stop paying for it. Cause we know once you lose the weight, you don't need to exercise anymore, right?

iaradajnos, I am VERY interested!

Meg, that is an excellent post.

I find it appaling how many people seem to think surgery is the only option. Heck, I have a friend of mine who is going to get liposuction (not morbidly obese, would never qualify for "the surgery" -- she is just overweight by maybe 20 pounds) because she truly believes there is no other option. She would like to be around 50 pounds lighter than she is. I told her it's not THAT tough, if she is willing to be dedicated and PASSIONATE about losing the weight and keeping it OFF. We ALL know it's about finding something you can stick with forever.

See, most people in my life think I'm extreme. I WAS extreme for around half a year, as I was preparing for a bodybuilding contest (July 18th -- I did well, placing first in my weight class and second overall, but I will NOT do it again; I don't think it was healthy for me physically OR emotionally), which really put things into perspective for me. I was working out two hours in the morning, two hours in the evening, and on a CRAZY diet eating practically nothing but chicken, almonds, egg whites, olive oil, and green veggies. My ordinary lifestyle change was (now is, that I am back on it) not extreme at all. So what if we count calories, eat clean, and work out every day? That is not extreme; that is our responsibility to our bodies in order to maintain healthy lives. I think people just turn away from the only thing that works (eat less, move more -- how you get there is up to you :)) because it is not the easy way out. As I've said before, I've been asked all the time how I did it. Before wasting my time, I always ask them if they REALLY want to know. The other day, someone said, "I know you are just such a fitness freak because you're afraid to gain the weight back. And you probably would, because you most likely have a slow metabolism." At first, I was offended, then I thought, "Wait, the metabolism portion of that statement is BS, BUT SO WHAT if I don't want to gain my weight back? GO ME! :D"

Seriously, GO US. We're a minority. American culture easily promotes obesity with its grab 'n go lifestyle. There is SUCH a lack of healthy options from anywhere but Mother Nature. Once upon a time, going out to eat (or any other type of grab 'n go) was a TREAT, now it's just normal. Restaurants fight each other for who can serve the most food for the less money. And we buy into it, as a country, thinking we are getting a good deal. Despite this, we're more obsessed with being thin than ever -- on the surface. I believe if we REALLY wanted to be so-called thin people, we would change our lives and stop being ignorant as a whole. (This was not meant to be delivered in an insulting fashion; the media FEEDS this ignorance with all its diet product propaganda.)

Ahhh, it's time for me to step off my soap box!

Originally Posted by NightengaleShane:
Despite this, we're more obsessed with being thin than ever -- on the surface. I believe if we REALLY wanted to be so-called thin people, we would change our lives and stop being ignorant as a whole. (This was not meant to be delivered in an insulting fashion; the media FEEDS this ignorance with all its diet product propaganda.)

I think your last statement sums it up. I believe that people really DO want to be slim. They are innundated with visions of slim people in all the media--slim, happy people who are shown chowing down on mountains of fast food, who are depicted as having a great time drinking beer and eating all kinds of unhealthy stuff. So they see it as some kind of personal failure when they gain weight on the same type of diet! I really beleive that if people truly understood how many calories those foods have, and what effect that has on their bodies, that many people would make different choices.

And yeah, it's amazing to me that insurance companies will pay for WLS but won't pay for a dietician, or for an extended obesity-treatment facility. It kind of reminds me of the days when Medicare would refuse to pay for a screening mammo, but would pay for the breast cancer treatment once you had advanced disease.