Reversed condition.

[childofthesea43]

Every weight loss lifestyle intervention produces results over time which look like this:

View attachment 29231


(Picked at random - it doesn't matter which study - they all look similar: WW, low fat, low carb, whatever. The concrete numbers differ but the shape of the "waterfall" doesn't.)

People like me (and apparently you) over on the left hand side can find it hard to see what the big fuss is all about. But the fact is that anything like smugness over our superior motivation etc etc is completely misguided. People way over on the right hand side very very ofteh show far more motivation, effort & application than we do. It's just that their biology means that they are indeed trying to climb Mt Everest in terms of weight loss maintenance.

On the other hand, all of these programs tend to show *average* long-term weight loss of 5%-10% which is a worthy outcome, clinically.


And also, this is the beginning of the era of pharma solutions to the biological issues: semaglutide, tirpezatide, and a huge pipeline of future candiates.

EDIT: Where I think Taylor & Lean verged a little into crank territory was their apparent belief that *motivation* might be sufficient to preserve weight loss in a large proportion of the DiRECT population. I think that there was a huge body of evidence that this was unlikely to be true, and as it turns out, the 5-year DiRECT results act as a great demonstration that weight loss maintenance depends primarlily on motivation.

I agree with your points. As I said, in my own case there were no opposing circumstances, including uncooperative biology, so a matter of luck rather than virtue. I think Taylor does recognize that dietary adjustment is best done by most people under helpful professional supervision, as so successfully shown by Dr Unwin.

 

[Eddy Edson]

I agree with your points. As I said, in my own case there were no opposing circumstances, including uncooperative biology, so a matter of luck rather than virtue. I think Taylor does recognize that dietary adjustment is best done by most people under helpful professional supervision, as so successfully shown by Dr Unwin.

Just to note that the waterfall pic I showed is what "intensive" lifestyle interventions produce, with all kinds of support. Also, there is zero evidence that programs like Unwin's do betetr than eg Weight Watchers or any other support program.

The classic gold standard is the long-term Look AHEAD trial, comparing "standard care" with intensive lifestyle intervention amongst obese/overweight subjects with T2D. It's well worth taking a look at this - it's the largest evidence base for this kind of thing. I don't know of any program with evidence of better long term outcomes than LooK AHEAD (certainly not Unwin's).

Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 ...

www.ncbi.nlm.nih.gov

Abstract​

Objective​

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.

Design and Methods​

Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned to ILI or usual care (i.e., diabetes support and education [DSE]). The ILI provided comprehensive behavioral weight loss counseling over 8 years; DSE participants received periodic group education only.

Results​

All participants had the opportunity to complete 8 years of intervention before Look AHEAD was halted in September 2012; ≥88% of both groups completed the 8-year outcomes assessment. ILI and DSE participants lost (mean±SE) 4.7±0.2% and 2.1±0.2% of initial weight, respectively (p<0.001) at year 8; 50.3% and 35.7%, respectively, lost ≥5% (p<0.001), and 26.9% and 17.2%, respectively, lost ≥10% (p<0.001). Across the 8 years ILI participants, compared with DSE, reported greater practice of several key weight-control behaviors. These behaviors also distinguished ILI participants who lost ≥10% and kept it off from those who lost but regained.

Conclusions​

Look AHEAD’s ILI produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions.

......


So 11% of the ILI group managed to hang on to 15%+ weight loss at year 8, which is as good as DiRECT at year 5, if I recall correctly. There was never any good reason as far as I can see for thinking that DiRECT (or any other program) would do much better than this.

The study identified key behaviours of people who managed to maintain 10%+ weight loss at year 8: frequent weighing, lots of physical activity and counting calories.

As a neat summary:

ILI participants achieved their maximum weight loss (of 8.5%) in the first year, when they received the most intensive intervention and reported their highest adherence to the prescribed weight control behaviors, compared with DSE. The ILI group, on average, regained weight from years 1 to 5, at which time body weight stabilized at approximately a 4.0–4.7% loss for the remainder of the trial (compared with 0.7–2.1% for DSE at this time). Look AHEAD’s large sample size permitted examination of patterns of long-term weight change among subgroups of participants, rather than simply the mean change. This analysis revealed that of 825 individuals who lost ≥10% of initial weight at year 1, 39% maintained this degree of weight loss at year 8, and another 26% maintained a loss of 5.0 to <10%. Those who maintained the full ≥10% loss at year 8, compared with those who regained above baseline, reported greater practice of several weight-maintenance behaviors, including high levels of physical activity, reduced calorie intake, and frequent monitoring of body weight. These behaviors have been identified in prior studies of successful weight loss maintainers.28–32

 

[childofthesea43]

Every weight loss lifestyle intervention produces results over time which look like this:

View attachment 29231


(Picked at random - it doesn't matter which study - they all look similar: WW, low fat, low carb, whatever. The concrete numbers differ but the shape of the "waterfall" doesn't.)

People like me (and apparently you) over on the left hand side can find it hard to see what the big fuss is all about. But the fact is that anything like smugness over our superior motivation etc etc is completely misguided. People way over on the right hand side very very ofteh show far more motivation, effort & application than we do. It's just that their biology means that they are indeed trying to climb Mt Everest in terms of weight loss maintenance.

On the other hand, all of these programs tend to show *average* long-term weight loss of 5%-10% which is a worthy outcome, clinically.


And also, this is the beginning of the era of pharma solutions to the biological issues: semaglutide, tirpezatide, and a huge pipeline of future candiates.

EDIT: Where I think Taylor & Lean verged a little into crank territory was their apparent belief that *motivation* might be sufficient to preserve weight loss in a large proportion of the DiRECT population. I think that there was a huge body of evidence that this was unlikely to be true, and as it turns out, the 5-year DiRECT results act as a great demonstration that weight loss maintenance depends primarlily on motivation.

I agree with your points. As I said, in my own case there were no opposing circumstances, including uncooperative biology, so a matter of luck rather than virtue. I think Taylor does recognize that dietary adjustment is best done by most people under helpful professional supervision, as so successfully shown by Dr Unwin

Just to note that the waterfall pic I showed is what "intensive" lifestyle interventions produce, with all kinds of support. Also, there is zero evidence that programs like Unwin's do betetr than eg Weight Watchers or any other support program.

The classic gold standard is the long-term Look AHEAD trial, comparing "standard care" with intensive lifestyle intervention amongst obese/overweight subjects with T2D. It's well worth taking a look at this - it's the largest evidence base for this kind of thing. I don't know of any program with evidence of better long term outcomes than LooK AHEAD (certainly not Unwin's).

Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 ...

www.ncbi.nlm.nih.gov

Abstract​

Objective​

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.

Design and Methods​

Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned to ILI or usual care (i.e., diabetes support and education [DSE]). The ILI provided comprehensive behavioral weight loss counseling over 8 years; DSE participants received periodic group education only.

Results​

All participants had the opportunity to complete 8 years of intervention before Look AHEAD was halted in September 2012; ≥88% of both groups completed the 8-year outcomes assessment. ILI and DSE participants lost (mean±SE) 4.7±0.2% and 2.1±0.2% of initial weight, respectively (p<0.001) at year 8; 50.3% and 35.7%, respectively, lost ≥5% (p<0.001), and 26.9% and 17.2%, respectively, lost ≥10% (p<0.001). Across the 8 years ILI participants, compared with DSE, reported greater practice of several key weight-control behaviors. These behaviors also distinguished ILI participants who lost ≥10% and kept it off from those who lost but regained.

Conclusions​

Look AHEAD’s ILI produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions.

......
View attachment 29233

So 11% of the ILI group managed to hang on to 15%+ weight loss at year 8, which is as good as DiRECT at year 5, if I recall correctly. There was never any good reason as far as I can see for thinking that DiRECT (or any other program) would do much better than this.

The study identified key behaviours of people who managed to maintain 10%+ weight loss at year 8: frequent weighing, lots of physical activity and counting calories.

As a neat summary:

ILI participants achieved their maximum weight loss (of 8.5%) in the first year, when they received the most intensive intervention and reported their highest adherence to the prescribed weight control behaviors, compared with DSE. The ILI group, on average, regained weight from years 1 to 5, at which time body weight stabilized at approximately a 4.0–4.7% loss for the remainder of the trial (compared with 0.7–2.1% for DSE at this time). Look AHEAD’s large sample size permitted examination of patterns of long-term weight change among subgroups of participants, rather than simply the mean change. This analysis revealed that of 825 individuals who lost ≥10% of initial weight at year 1, 39% maintained this degree of weight loss at year 8, and another 26% maintained a loss of 5.0 to <10%. Those who maintained the full ≥10% loss at year 8, compared with those who regained above baseline, reported greater practice of several weight-maintenance behaviors, including high levels of physical activity, reduced calorie intake, and frequent monitoring of body weight. These behaviors have been identified in prior studies of successful weight loss maintainers.28–32

Very interesting summary of the data, thank you.

 

[Burylancs]

Just to note that the waterfall pic I showed is what "intensive" lifestyle interventions produce, with all kinds of support. Also, there is zero evidence that programs like Unwin's do betetr than eg Weight Watchers or any other support program.

The classic gold standard is the long-term Look AHEAD trial, comparing "standard care" with intensive lifestyle intervention amongst obese/overweight subjects with T2D. It's well worth taking a look at this - it's the largest evidence base for this kind of thing. I don't know of any program with evidence of better long term outcomes than LooK AHEAD (certainly not Unwin's).

Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 ...

www.ncbi.nlm.nih.gov

Abstract​

Objective​

To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.

Design and Methods​

Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned to ILI or usual care (i.e., diabetes support and education [DSE]). The ILI provided comprehensive behavioral weight loss counseling over 8 years; DSE participants received periodic group education only.

Results​

All participants had the opportunity to complete 8 years of intervention before Look AHEAD was halted in September 2012; ≥88% of both groups completed the 8-year outcomes assessment. ILI and DSE participants lost (mean±SE) 4.7±0.2% and 2.1±0.2% of initial weight, respectively (p<0.001) at year 8; 50.3% and 35.7%, respectively, lost ≥5% (p<0.001), and 26.9% and 17.2%, respectively, lost ≥10% (p<0.001). Across the 8 years ILI participants, compared with DSE, reported greater practice of several key weight-control behaviors. These behaviors also distinguished ILI participants who lost ≥10% and kept it off from those who lost but regained.

Conclusions​

Look AHEAD’s ILI produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions.

......
View attachment 29233

So 11% of the ILI group managed to hang on to 15%+ weight loss at year 8, which is as good as DiRECT at year 5, if I recall correctly. There was never any good reason as far as I can see for thinking that DiRECT (or any other program) would do much better than this.

The study identified key behaviours of people who managed to maintain 10%+ weight loss at year 8: frequent weighing, lots of physical activity and counting calories.

As a neat summary:

ILI participants achieved their maximum weight loss (of 8.5%) in the first year, when they received the most intensive intervention and reported their highest adherence to the prescribed weight control behaviors, compared with DSE. The ILI group, on average, regained weight from years 1 to 5, at which time body weight stabilized at approximately a 4.0–4.7% loss for the remainder of the trial (compared with 0.7–2.1% for DSE at this time). Look AHEAD’s large sample size permitted examination of patterns of long-term weight change among subgroups of participants, rather than simply the mean change. This analysis revealed that of 825 individuals who lost ≥10% of initial weight at year 1, 39% maintained this degree of weight loss at year 8, and another 26% maintained a loss of 5.0 to <10%. Those who maintained the full ≥10% loss at year 8, compared with those who regained above baseline, reported greater practice of several weight-maintenance behaviors, including high levels of physical activity, reduced calorie intake, and frequent monitoring of body weight. These behaviors have been identified in prior studies of successful weight loss maintainers.28–32

Thanks for the timely reminder about Look Ahead study. It was first on this Support Group eleven years ago in June 2013 posted by Northerner.
Thread 'Diabetes study finds new weight-loss benefits' http://forum.diabetes.org.uk/boards/threads/diabetes-study-finds-new-weight-loss-benefits.38244/

 

[mhtyler]

I think that losing the weight and then keeping it down is not hard for everyone. I found it a complete doddle but had no circumstances opposing it to contend with. Cutting carbs totally suppressed hunger for me. I’ve not had even a moment’s peckishness in three years. Dealing with our weight is not Taylor’s responsibility, it is our own. He has just shown its consequences.

I agree with you, but there's no shortage of obese people who would not. I'm a sugar addict, and so I have two appetites to deal with. What keeps me sane and on the Newcastle Wagon? Tea. I have 3-4 cups of stevia-sweetened tea between meals. It's my methadone, and has kept me eating shakes and salads for more than 4 weeks. Its allowed me to give up diet sodas too. My weight loss is just as predicted by Prof Taylor so far, and my sugar this AM was 5.7 mmol/L. That said, I'm not finding it a doddle.

 

[childofthesea43]

I agree with you, but there's no shortage of obese people who would not. I'm a sugar addict, and so I have two appetites to deal with. What keeps me sane and on the Newcastle Wagon? Tea. I have 3-4 cups of stevia-sweetened tea between meals. It's my methadone, and has kept me eating shakes and salads for more than 4 weeks. Its allowed me to give up diet sodas too. My weight loss is just as predicted by Prof Taylor so far, and my sugar this AM was 5.7 mmol/L. That said, I'm not finding it a doddle.

I wouldn’t think anyone would find the Newcastle regimen easy but you’re clearly doing very well with it. I got my weight down by a much easier regimen, about twice the calories of the Newcastle, and did it over several months.

 

[Franthepotter]

I think that losing the weight and then keeping it down is not hard for everyone. I found it a complete doddle but had no circumstances opposing it to contend with. Cutting carbs totally suppressed hunger for me. I’ve not had even a moment’s peckishness in three years. Dealing with our weight is not Taylor’s responsibility, it is our own. He has just shown its consequences.

I'm 4 kg down and now really font feel like eating as much. It's gone alongside exercise ... rarely at the gym but obsessively walking ... today I even got my family to park away from the store do we walked for 10 mins to a trip to TKMaxx. Ah the delights of family life

 

[Franthepotter]

I agree with you, but there's no shortage of obese people who would not. I'm a sugar addict, and so I have two appetites to deal with. What keeps me sane and on the Newcastle Wagon? Tea. I have 3-4 cups of stevia-sweetened tea between meals. It's my methadone, and has kept me eating shakes and salads for more than 4 weeks. Its allowed me to give up diet sodas too. My weight loss is just as predicted by Prof Taylor so far, and my sugar this AM was 5.7 mmol/L. That said, I'm not finding it a doddle.

I'm doing similar... Good luck !!!!

 

[Franthepotter]

I agree with you, but there's no shortage of obese people who would not. I'm a sugar addict, and so I have two appetites to deal with. What keeps me sane and on the Newcastle Wagon? Tea. I have 3-4 cups of stevia-sweetened tea between meals. It's my methadone, and has kept me eating shakes and salads for more than 4 weeks. Its allowed me to give up diet sodas too. My weight loss is just as predicted by Prof Taylor so far, and my sugar this AM was 5.7 mmol/L. That said, I'm not finding it a doddle.

I'm doing similar... Good luck

I wouldn’t think anyone would find the Newcastle regimen easy but you’re clearly doing very well with it. I got my weight down by a much easier regimen, about twice the calories of the Newcastle, and did it over several months.

I'm going to get my weight right down before heading back to carbs xx

 

[Franthepotter]

I'm doing similar... Good luck

I'm going to get my weight right down before heading back to carbs xx

OK folks - here's my weight update please give me good motivation to continue!!! I lost 4 kg then had a plateau. But my glucose is much more stable now. I am now mid point bmi and want to get to lower bmi whilst in healthy range (I'm average build).

 

[Franthepotter]

OK folks - here's my weight update please give me good motivation to continue!!! I lost 4 kg then had a plateau. But my glucose is much more stable now. I am now mid point bmi and want to get to lower bmi whilst in healthy range (I'm average build).

It's hard when life gets in the way... I have 90 pots to make before May, and today my dad has heart surgery ... both sort of distracting. I am hoping g to avoid the chocolate and sarnies option and have a packed lunch to enjoy xxx wish me luck. I hope to lose another 4kg

 

[Franthepotter]

It's hard when life gets in the way... I have 90 pots to make before May, and today my dad has heart surgery ... both sort of distracting. I am hoping g to avoid the chocolate and sarnies option and have a packed lunch to enjoy xxx wish me luck. I hope to lose another 4kg

Sorry to ask for motivation - I'm finding the habit of snacking quite hard to break!! Comfort food I think

 

[grovesy]

I find it easier to be, what I think of as being on the wagon, more than off it. I also find if I get the odd craving that having what I crave,rather than other options as they don't stop or satisfy the crave.

 

[AndBreathe]

The notion of being “on pause” is an interesting one, and important too for the morale of those achieving remission. I asked Prof Taylor whether he had ever encountered anyone whose T2 had returned post-remission and whose weight had not increased. He said no, none so far. Only time will tell.

I personally know of several, on another forum who have been on a Newcastle Diet revolving door.

Who knows why? Some fell off the wagon, for some, weight increased and for some it seems their condition just couldn’t be halted for a protracted period.

 

[mhtyler]

I find it easier to be, what I think of as being on the wagon, more than off it. I also find if I get the odd craving that having what I crave,rather than other options as they don't stop or satisfy the crave.

On the wagon says it all; the days of wine and roses are over for us.

 

[Gwynn]

When dieting and exercising but the weight remains the same, I am told it may be due to the body internally adjusting itself, which is a good thing and has to happen, sometimes several times during the 'diet'.

motivation here comes from knowing that good things are happening.

 

[mhtyler]

I personally know of several, on another forum who have been on a Newcastle Diet revolving door.

Who knows why? Some fell off the wagon, for some, weight increased and for some it seems their condition just couldn’t be halted for a protracted period.

I've just sent the following message to Professor Roy for his comment. I don't like to bother him, but this does deeply concern us all. Here is the heart of what I wrote:

In the Counterbalance study it strikes me as odd that the pancreas response is so binary. It recovers, or it doesn't; there's little or no grey area. Has the DIRECT study shown that extended periods of weight loss can create additional responders, or is the pancreas truly dead if it shows no recovery by 8 weeks?

He's been quite good about responding to questions, although it can take a bit of time. He must be quite busy. I just noticed on his Newcastle site, that there is a new study and diet protocol under the heading of, "NewDawn" that they're developing if the current diet isn't your cup of tea.

 

[childofthesea43]

I personally know of several, on another forum who have been on a Newcastle Diet revolving door.

Who knows why? Some fell off the wagon, for some, weight increased and for some it seems their condition just couldn’t be halted for a protracted period.

Among that group you know, were there any who achieved remission by weight loss, remained so for a good while, never regained weight at all, and then their hba1c started to rise significantly for no discernible reason?

 

[childofthesea43]

None, although that doesn't make losing and maintaining weight loss any easier. Personally, I would love to trade in my glucose meter for a scale.

I was actually asking AndBreathe!

 

[mhtyler]

I was actually asking AndBreathe!

no worries, I deleted it.