For a while, Chuck Duncan was a big loser.
After eight months on a low-carbohydrate diet, he'd shed nearly a quarter of his body weight and was down to a lean, mean 178 pounds. Then, like a yo-yo, his weight shot back up.
Now, a year after starting the diet, he has regained all but a few of the 50 pounds he lost.
"Once you start cheating it's a slippery slope," said Duncan, 44, a public television producer from Dundalk. "You get lazy and it starts coming back."
Duncan's dietary recidivism is a common tale - and now it has some solid scientific credence, thanks to a study published Wednesday in the Journal of the American Medical Association.
The study was the largest ever comparing the effectiveness and safety of popular diets, ranging from the low-carb Atkins plan to the low-fat Ornish program.
It tracked 313 overweight women who were randomly assigned to one of four weight-loss plans. The women, ages 25 to 50, all read the appropriate diet book and took eight weekly classes on how to follow their assigned plans.
Although Atkins came away with bragging rights for the greatest weight loss, the study also unearthed a disturbing similarity in the results: for most of the volunteers, none of the diets worked well in the long run.
After a few months of losing weight, most began to pack on the pounds again, regardless of the plan they followed. Even the Atkins group only averaged 10 pounds of weight loss after a year.
"They don't follow those diets very well a year out," concluded Dr. Christopher D. Gardner, a professor of medicine at Stanford University and lead author of the study.
Why do so many dieters backslide? Weight-loss experts and successful dieters offer a variety of theories - along with some tips for keeping off the pounds.
Dr. Lawrence J. Cheskin, director of the Johns Hopkins Weight Management Center, said many people err from the outset in viewing diets as quick fixes. They focus on dropping a certain amount of weight over a fixed period of time. Reaching their goal, they assume the work is done.
Lasting success, however, depends upon "recognizing it's a long-term issue," Cheskin said. "It's less your diet than your motivation, and whether you are committed to long-term change."
After years on one diet or another, Pamela Waltos, 46, of Bowie, said her motivation for losing weight has changed. "It's not really trying to get down to any goal weight" she said. "I just want to feel better."
Waltos, a research analyst for the National Association of Home Builders, said she has lost 22 pounds since the beginning of the year on the Atkins diet and is down to 220 pounds. She is also optimistic about keeping the weight off. "I think I've finally gotten a grip on it," she said.
Dealing with underlying problems - including depression, stress and boredom - which lead to habitual overeating, is also key.
"You have to deal with the deeper issues," said Dr. Dean Ornish, a cardiologist at the University of California, San Francisco, who developed one of the diets in the Stanford study. "A lot of people are stressed or isolated."
Having the support of other people - be it family, other dieters or a dietitian - can also help, experts said.
Floyd E. Brown, 59, a retired truck driver from Bridgeport, Conn., said he was motivated to lose weight but found it difficult on his own. For a decade he tried various diets, but by 2005 he was up to about 330 pounds.
"Without proper education, the diet doesn't mean nothing," he said.
In November 2005 he found a plan that allowed for a chat with a consultant when he hit bumps in the dietary road. Since then he's lost 91 pounds.
"Don't give me no book and tell me this is what to eat," he said. "I needed somebody to grab my hand and lead me through it."
Experts also suggested avoiding certain foods and getting more exercise - common and important advice too often ignored.
Consumption of sugary drinks and foods made with refined carbohydrates such as white flour should be reduced, experts say. In fact, Gardner hypothesized that avoiding sweet drinks might have explained why his diet study showed the Atkins diet was modestly more effective than the other diets.
Atkins calls for participants to drink lots of water. "They seemed to have replaced more of their sweetened beverages," he said of the low-carb dieters. "That could potentially account for all of their weight loss."
He also pointed out that this year the U.S. Department of Agriculture changed its guidelines to recommend people get half of their carbohydrates from whole grains.
Hopkins' Cheskin suggested that no matter how people lose weight initially, to keep it off they need to eat more whole grains, fruits, vegetables and lean meats, fish, chicken and turkey. The protein and fiber in those foods are more filling, he said, and may help cut overall calorie intake.
He added, however, that the temptation to eat unhealthy foods can be overwhelming. "It's difficult," he said, "if our marketing is all geared to eating as much food of questionable nutritional value as you can."
The results of eating large portions and calorie-rich foods are evident in Maryland. More than half of adults in Maryland are overweight or obese, according to a 2005 survey by the Maryland Department of Health and Mental Hygiene.
"It's pretty comparable to the rest of the country," said Carol Miller, a registered dietitian and consultant for the agency, which estimates the cost of treating Marylanders' obesity-related medical problems at $1.5 billion annually.
In addition to poor diet, Miller said lack of exercise was one of the reasons people are so heavy.
"Just parking farther away from where you need to walk can help," she said. "We are seeing a lot of churches and communities promoting walking."
Duncan said lack of a consistent exercise regime is one reason he regained much of the weight he lost last year. Now he's going back on his diet, but this time has joined a gym and is attending with his roommate. He's also taking the long view.
"It's not a miracle cure," he said. "It's not going to stay off if you don't keep up with it."
Baltimore Sun