Winning at Losing: 
How Do Successful Weight Losers Do It?

Class Overview

In this four-session class, participants will learn what many individuals who have succeeded at losing weight and keeping it off have in common. 

Session 1:  What We Know About Weight Loss/Maintenance
																							
Participants will be introduced to two research studies of successful weight losers/maintainers.  The “parent-child pitfalls” described in Keeping It Off by Colvin and Olson will be discussed, and several letters of successful losers sent to The National Weight Control Registry will be read aloud.  

Session 2:  The Four Phases of Change in Successful Losers

Participants will review the four major phases of change that Colvin and Olson recognized in the successful weight losers/maintainers they studied:  1) stopping the vicious cycle, 2) starting the positive spiral, 3) dealing with success, and 4) maintenance.   

Session 3:   Strategies for Success

Participants will review some of the “strategies for success” in weight loss and maintenance that Colvin and Olson describe.  Participants will also review some of the findings of the National Weight Control Registry. 

Session 4:  Panel of Successful Losers in the DPP

A panel of four or five DPP participants who have lost weight and kept it off will present their weight loss stories and answer questions.  (A carefully selected individual of average weight may also be on the panel to describe his or her strategies to maintain a balance between physical activity and eating.) 
Session 1:  What We Know About Weight Loss/Maintenance

Objectives:	Participants will be introduced to two research studies of successful weight losers/maintainers.  The “parent-child pitfalls” described in Keeping It Off by Colvin and Olson will be discussed, and several letters of successful losers sent to The National Weight Control Registry will be read aloud.  
Materials needed:
C	Handouts (attached):  “Winning at the Losing Game” (article from Health, Jan/Feb. 1996) and several letters from The National Weight Control Registry participants (select those letters you believe would most likely encourage the participants enrolled in this particular class).
C	Keeping It Off by Robert H. Colvin, PhD and Susan C. Olson, PhD, 1989, Gilliland: Arkansas City, KS.  To order copies, call 1-800-535-6425.   (Purchase one copy of the book for each participant registered for the class plus a few extras to bring to class for participants who don’t bring their copies with them.) 
C	For Lifestyle Coach reference only (attached): “A descriptive study of individuals successful at long-term maintenance of substantial weight loss” (in press; do not quote without written permission from Dr. Klem) and “Maintenance and relapse after weight loss in women: Behavioral aspects.”  

Before the session:
C	Give (or send) the participants who register for the class a copy of the book Keeping It Off.   Ask them to read Chapters 1 and 2 before the first session.  Instruct them to bring the book with them to refer to during the class.

1.		Explain the purpose of the class:  to give participants a chance to learn what individuals who succeed at losing weight and keeping it off have in common.   Recently there has been an increased effort to study and describe these “winners,” and the good news is that most of the data suggest that winners are ordinary people varying in age, sex, and marital status, who don’t possess superhuman will power, and who use simple but predictable strategies of their own making. 

2.		Review the topics, schedule and locations for each upcoming session.   

3.		Have participants share their reasons for signing up for the class.  Ask them to discuss what they think might be helpful about learning more about people who are “models” of successful weight loss/maintenance.  (Note: If not brought out in the discussion, introduce the possibility that the success of others may be discouraging at times.  Remind participants that we want them to make reasonable, healthy changes over time, keep an open mind about the weight loss/maintenance strategies that have worked for others, and consistently practice those strategies that work best for themselves.  Also, encourage participants to remember that the weight loss and physical activity goals for the DPP may seem modest compared to the amount of weight loss and levels of activity that some others have achieved.  However, the DPP goals have been carefully established, based on previous research, as the goals most likely to support long-lasting lifestyle change and diabetes prevention.  In addition, these are minimum goals, and we encourage participants to surpass them.)  

4.		Introduce the book, Keeping It Off.  In 1983, Robert Colvin, PhD and Susan Olson, PhD, looked at 54 men and women who lost weight and kept it off.  They found that these “winners” had in common some of the same “hows” and “whys” for successful weight loss but the bottom line was that successful weight loss strategies were “highly personal and individualized.”  Colvin and Olson published a book, Keeping It Off, about their research, which we sent you to begin reading before this session.  (Ask if anyone needs a copy to refer to during the discussion.)   

5.		Discuss the “parent-child pitfalls” from Keeping It Off.  In Chapter 2 of Keeping It Off, Colvin and Olson describe the dieting “pitfalls” that plagued their participants before becoming winners.  A defining feature of their success was taking personal responsibility for one’s efforts, and many of the most common traps that got in the way of their success fit into a category of either “parent” or “child” states (thoughts and related behaviors).  (There’s nothing inherently pathological about these thoughts/behaviors, and many of us fall in and out of them when we are engaged in the difficult process of changing our eating and activity habits.)  Several “child” states are the “guilty but rebellious” child, the “I believe in magic” child, the “watch me be good” child, and the “I’m not having any fun” child.  (Ask participants to name some examples for each of these.)  The parent states include the “perfectionist parent”:  whenever you experience a slip, you talk to yourself like a critical and punitive parent who says, “shape up or ship out.”  Unfortunately, that kind of black and white, all-or-nothing thinking puts us at risk for frustration, hopelessness, and giving up.  (Ask participants to name some other parent traps.)  It’s important to remember that the DPP Lifestyle Coaches are not perfectionistic parents but rather we are here to help you in whatever ways we can to take personal responsibility for your weight control efforts.

6.		Introduce The National Weight Control Registry.  The National Weight Control Registry is an ongoing study of individuals who have lost at least 30 pounds and maintained the loss for at least 1 year.  As of 1996, 851 women and 196 men have enrolled.  The Registry was established by Rena Wing, PhD of the University of Pittsburgh Obesity Nutrition Research Center (she is the Principal Investigator at the Pittsburgh DPP center and directs the Lifestyle Intervention for the DPP) and James Hill, PhD of the Center for Human Nutrition at the University of Colorado.  During the coming sessions, we’ll review some of the Registry’s findings.

7.		Ask volunteers to read aloud several of the attached letters to the Weight Control Registry.  Discuss participants’ responses to hearing the letters.  Be sure to emphasize  the points outlined on the cover sheet to the letters.  

8.		Distribute the “Winning at the Losing Game” article, (if desired) additional letters from Registry participants, and the handout, “Parent-Child Pitfalls.”  Assign home activity: 
C	Read the article and letters.  
C	Stay on the look-out for any “parent” or “child” thoughts/behaviors you experience and record them on the “Parent-Child Pitfalls” worksheet.

Session 2:  The Four Phases of Change in Successful Losers

Objectives:	Participants will review the four major phases of change that Colvin and Olson recognized in the successful weight losers/maintainers they studied:  1) stopping the vicious cycle, 2) starting the positive spiral, 3) dealing with success, and 4) maintenance.   
Materials needed:
C	Handouts:  How Do Successful Weight Losers Do It?

1.	Briefly review the main points of the last session.   Also, ask what “parent” or “child” thoughts/behaviors the participants noticed since the last session.
2.	Explain purpose of this session:  to discuss the readings distributed last week (the article from Health and Chapters 1 and 2 of Keeping It Off), review the four major phases of change that Colvin and Olson describe, and discuss how the phases of change apply to the participants’ own paths of weight loss and maintenance.
3.	Discuss the readings distributed last week.  Use the following or similar questions to stimulate discussion:
C	Were you surprised by anything you read?
C		Did you identify particularly strongly with anything or anyone in the article, book chapters, or letters?
C		Comment on what this quote means to you: “While losing weight is obviously a necessary goal in a program of permanent weight loss, that alone is not a sufficient goal.” (Keeping It Off, page 41)
C		The author of the Health article refers to a stage called “tentative acceptance” in which “dieters come to terms with their lot and achieve a peaceful sense of resolve” (last paragraph on page 68).  Comment on what this means to you.
You may want to also ask for comments on any particularly significant quotes from the Registry letters you distributed.
4.	Discuss the four phases of change.  Ask participants to name the four phases of change that Colvin and Olson describe in Chapter 1 (write these on the board):  1) stopping the vicious cycle, 2) starting the positive spiral, 3) dealing with success, and 4) maintenance.  Use the following or similar questions to stimulate discussion:
C	What is the “vicious circle” in general and in terms of your own experience?  
C		Have you experienced a “critical moment”?
C	What is the “positive spiral”?  Have you experienced “small wins”?
C		Have you experienced tough times dealing with weight loss success?  Maintenance?

5.	Distribute the handout, How Do Successful Weight Losers Do It?  Explain that it summarizes much of the findings reported in Keeping It Off.  Have volunteers read the handout aloud.  

6.	Assign home activity:
C	Answer the two questions at the bottom of the handout.   
C	Stay alert to any specific examples in your own life of the kind of behaviors in the right hand column of the handout.  Record on the back of the handout an example you would like to share with the group (if any; sharing is completely voluntary).
C	Bring the handout back with you to the next session. 

Session 3:   Strategies for Success

Objectives:		Participants will review some of the “strategies for success” in weight loss and maintenance that Colvin and Olson describe.  Participants will also review some of the findings of the National Weight Control Registry. 
Materials needed:
C	Handouts:	How Do Successful Weight Losers Do It?  (extra copies for people who forget to bring their copy back to class), The National Weight Control Registry.

Note:   Because of unavoidable technical terms, the handout, The National Weight Control Registry, is written at a 10th-grade reading level.  Be sure to review the main points of the handout aloud and reinforce them in several ways, so that participants with lower literacy skills need not rely on reading the handout to benefit from the information.

1.	Briefly review the main points of the last session.   Also, ask participants who wish to do so to share a specific example of one of the behaviors from the right hand column of the handout that they noticed in their own lives since the last session. 

2.	Explain purpose of this session:   to review some additional conclusions from Keeping It Off and some of the findings from The National Weight Control Registry.  

3.	Discuss some additional conclusions from Keeping It Off.  As we’ve said, Colvin and Olson concluded that successful weight control strategies tend to be highly personal and individualized.  Yet they also found some strategies that many of the “winners” used in common (write these on the board or flip chart):
C	A new eating and cooking style (much less food, less sugar and fat, more fruits and vegetables).
C	Setting small, attainable goals.
C		Persisting until there was a sense of stability and personal ownership of the new eating patterns.
C	De-emphasizing food in their lives.
C		Developing a variety of coping strategies besides eating to deal with life’s problems.
(Ask participants to comment in general about their own past experience of using any of these strategies.  Also ask them where they are right now with respect to each one.)	

 4.	Review the handout, The National Weight Control Registry.  Ask participants the following or similar questions to prompt discussion:  Are you surprised by any of the findings?  Encouraged by any?  (If a general discouragement is expressed, briefly acknowledge and reframe it in a positive light, such as by reminding participants that we don’t expect perfection, that we set high standards in order to do our best to prevent diabetes, and that change takes time.  However, if a participant expresses marked discouragement, ask to problem solve with him or her privately after the session.  Keep in mind that the purpose of the discussion is to encourage DPP lifestyle participants to continue their efforts to reach and maintain their DPP goals.  For example, emphasize the findings that Registry members had tried to lose weight before and on this attempt were successful with a stricter approach to diet and exercise.  Emphasize that, like the Registry members, DPP lifestyle participants are contributing to our understanding of how people lose weight and maintain it and that their contributions will help their families and future generations.)

Session 4:  Panel of Successful Losers in the DPP

Objectives:	A panel of four or five DPP participants who have lost weight and kept it off will present their weight loss stories and answer questions.  (A carefully selected individual of average weight may also be on the panel to describe his or her strategies to maintain a balance between physical activity and eating.) 
Materials needed:
C	Handout:  Facing the Music.  

The style and content of this session will depend on the participants who serve on the panel, the size of the audience, and the questions that come from the audience.  

Although the panel of DPP participants will present their stories, the Lifestyle Coach should firmly manage the tone and content of this session.  Meet with the panel members individually and well in advance of the session to develop an outline for them to use that will keep their presentations brief, positive, and on topic.  Feel free to ask them not to include particular details that you think would have a negative impact on the audience or to reframe their presentation of those details so that the message delivered is set in the context of problem solving and movement toward the DPP goals.  

You may wish to invite an individual of average weight who is not a DPP participant to join the panel and describe the strategies he or she uses to maintain a balance between physical activity and eating.  Select this individual very carefully.  For example, you do not want someone who says, “I’ve always eaten whatever I want and I just don’t gain weight,” but rather someone who stays alert for any weight gain and responds by making behavioral adjustments in eating and activity in order to stay weight stable.  The purpose is to dispel the myth that weight stable individuals have “miracle genes” and don’t need to work at behavior changes.

Another way for the Coach to manage the session is to ask the audience to write their questions on note cards.  This may have the added benefit of encouraging the more reticent participants to contribute, and it will also allow the Lifestyle Coach to briefly screen the questions, remove those that might be unhelpful, and insert other questions as needed to stimulate or direct the discussion.  The purpose is to have a group experience that is uplifting, encouraging, and supportive of the DPP goals.  

After the panel presentation, distribute the handout, “Facing the Music?”  Ask participants to take a few minutes to think seriously about the strategies for weight loss success that are listed on the handout.  Then have them break up into pairs or small groups and if they choose to, gently confront themselves about what strategies they are not using wholeheartedly in their efforts to lose weight and be more active.  (Make it clear that sharing their worksheet answers is completely voluntary and that any participant may pass.)  Emphasize that at this point, participants should not go on to problem solve about particular strategies, although ultimately that is the outcome we’re looking for and will undoubtedly happen in their individual sessions with their Lifestyle Coaches.  For now, the purpose is to seriously reflect on what’s honestly going on for them and courageously name the areas in which they are not “facing the music” (the work required for behavior change). 

Parent-Child Pitfalls. 

It’s natural to think or act like a parent or child when you’re making lifestyle changes.  And sometimes it works.  For example, “tricking yourself” into doing the right thing or being “good” to please someone else might work for the moment.  But in the long run, being stuck in the role of a parent or child can get in the way of real progress.

During the coming week(s), be as honest as you can be.  Check any of the following you notice in yourself.  Do these approaches work for you?
 “There you go again.  
 	You’ll never learn!”

Parent States

9	Scolding yourself.
9	Demanding that you “shape up or ship out.”
9	Labeling yourself or calling yourself names.
9	Expecting yourself to be perfect.
9	Punishing yourself for poor choices (e.g., denying yourself pleasure)

9	Comparing yourself to someone else.
9	Shaming yourself.
9	Trying to “trick yourself” into doing the right thing.
9	Lecturing yourself.  
 “I can’t help it.  
 I just don’t have the willpower.”
9	Other                                                                               

Child States

9	Feeling guilty but rebellious (like you “got away with” something).
9	Blaming something or someone else for poor choices you’ve made.
9	Sneaking food.
9	Asking someone else to make a decision about your eating or activity.
9	Acting helpless.  
9	Waiting to “get motivated” by something or someone else before taking action.
9	Blaming a lack of willpower or control.
9	Believing in magic.
9	Expecting a miracle.
9	Being “good” to impress someone else.
9	Seeking approval or forgiveness from someone else.	
9	Complaining that you’re “not having any fun.”
9	Thinking that you shouldn’t have to “work at it.”
9	Other                                                                               

How do successful weight losers do it?

There’s an old saying, “A path is made by walking on it.”  
Researchers have studied people who’ve lost weight and kept it off.  What path did these successful weight losers “make by walking on it”?  What steps did they take?  What turns in the road did they navigate?  Studies suggest the following:

Successful weight losers move from:	Toward:	
Trying to fool themselves	º	Being honest with themselves	
Looking for a “magic” cure	º	Recognizing that behavior change takes hard work and persistence	
Looking for a “cookbook” approach that applies to everyone	º	Fitting the tried-and-true ways of losing weight into their own lifestyle 	
Looking for someone else to fix their weight problem or take the blame for it	º	Taking “lonely responsibility” for doing what needs to be done or for not doing it	
Thinking of weight loss as an end in itself	º	Thinking of weight loss as part of an overall process of learning about themselves and their priorities	
Being afraid to fail and/or punishing themselves when they do fail	º	Being willing to make mistakes, learn from them, and try again	

Wanting to do it perfectly right away	º	Being willing to settle for “small wins” and build on the positive, one step at a time	
Seeking approval or forgiveness from others	º	“Owning” their own successes and mistakes	
Relying on willpower, control, or discipline	º	Making choices one at a time, being flexible, and trusting themselves 	
Blaming themselves or seeing the needs of others as more important than their own	º	Maintaining a healthy self-interest	

Think about yourself.  What path have you been on?                                            
                                                                                                             
What steps can you take now on your own path toward weight loss?                            
                                                                                                                               
The National Weight Control Registry.

The National Weight Control Registry is the first large study
of people who have lost at least 30 pounds and kept it off 
for at least one year. 

Who is in the National Weight Control Registry?  (As of 1996)
C	196 men, 851 women (1047 total).
C	On average, they have lost 66 pounds. 
C	They have kept off at least 30 pounds for an average of 5 ½ years.
C	71% were overweight as a child.
C	73% have one or two overweight parents.

How did they lose weight?
C	55% used a formal program; 45% lost weight on their own.
C	77% had a “triggering event” before this weight loss.
C	89% changed both diet and physical activity to lose weight.
C	They used many different ways to change diet and be more active. 

How do they keep the weight off?
C	88% are still very active and watch calories and fat closely.  
C	On average, they eat 24% of calories from fat (a eat 20% or less).
C	On average, they eat five times a day.  
C	On average, they eat less than one meal per week 
	in fast food restaurants.
C	75% weigh themselves at least once a week.

How was this weight loss different than before?
C	81% used exercise more during this attempt to lose weight than before.
C	63% used a stricter dietary approach than before.

How has their weight loss affected their lives?
C	85% or more reported an improvement in their:
C	General quality of life,
C	Energy level, 
C	Physical mobility,
C	General mood,
C	Self-confidence, and
C	Physical health.

C	50% or more reported improved interactions with same and opposite-sex friends and strangers, time spent interacting with others, job performance, 
	and hobbies.
Letters from Members of the 
National Weight Control Registry

The attached letters were written by members of the National Weight 
Control Registry.  

Please keep the following points in mind as you read the letters:

C	These letters describe the members’ own ideas about weight loss.  These ideas are not necessarily supported by the DPP or scientific evidence. 

C	The purpose of reading the letters is not to endorse or argue with the information in them but rather to convey the spirit and determination with which Registry participants approached their weight loss programs.

C			The DPP wants you to make reasonable, healthy changes over time, keep an open mind about the weight loss/maintenance strategies that have worked for others, and consistently practice those strategies that work best for you.  

C	The weight loss and physical activity goals for the DPP may seem modest compared to the amount of weight loss and levels of activity that some Registry members describe.  However, the DPP goals have been carefully established, based on previous research, as the goals most likely to support long-lasting lifestyle change and diabetes prevention.  In addition, the DPP goals are minimum goals, and we encourage you to surpass them.

Facing the Music.  

Those who win at weight loss agree.  To lose weight and keep it off, you’ve got to “face the music.” That is, accept the work that needs to be done.  Then do it. 

Take a few minutes to complete the chart below.  Be courageous in your honesty.

To be completely honest, I have NOT really accepted that I need to: 	
9  Eat much less food.	
9  Eat less fat.	
9  Eat fewer desserts and/or drink less alcohol.	
9  Eat more fruits and vegetables.	
9  Find the time to be active on most days of the week.	
9  Be active even when I don’t feel like it.	
9  Set small goals that I can reach.	
9  Be satisfied with “small wins.”	
9  Do what works even if “I shouldn’t have to.”	
9  Take charge of what’s around me.	
9  Find ways to enjoy myself and other people that don’t center around food.	
9  Say “No” at times, even when it’s hard to do.	
9  Do what works even if I don’t feel ready or motivated to.	
9  Do what I need to do no matter what those around me are doing.	
9  Take responsibility for my choices (stop blaming a lack of willpower or control).	
9  Do what’s right for me out of a healthy self-interest.	
9  Stop trying to fool myself or other people.	
9  Stop waiting until a “better time” to do what I need to do.	
9  Make food less important in my life.	
9  Find other ways to cope with life’s problems besides eating.