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Senior-Woman-Balance-Yoga

Why We Lose Balance and How We Fix It 

/16 March 2024/ All MFN blog/

It’s no secret that balance tends to decline with age. Your clients may notice they are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently. 

Balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand!) 

Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). The most common question I hear from older adult clients is, “Why am I losing balance?”  Let’s find out why. 

What is Balance?

Balance is a sense that lives in the brain. Balance relies on information constantly flowing into the brain from three main sensory systems including our visual, vestibular and proprioceptive systems. Moving properly depends on the ability of the brain to gather and interpret the sensory information provided by eyes, ears and joints.  This is essential because the brain then tells the body how to respond to stay upright and balanced.

The quality of the sensory input gathered directly impacts the quality of movement. The stronger the sensory signals sent to the brain, the more accurate the instructions sent to the body will be. On the flip side, as sensory signals become impaired, movement quality dwindles, as reaction time becomes slower. 

Making Sense of Balance: The 3 Systems

Let’s explore the sensory systems that make up balance.

Visual System: Your eyes tell your brain about where your body is relative to the environment, whether you are walking inside your home, in a busy airport, or strolling on the beach. With aging eyes, a great many people don eyeglasses to function day to day, and as our eyesight weakens, so too does the quality of the sensory input.

Vestibular System: The ears relay information to the brain about the motion and position of the head to adjust posture to maintain balance. Semicircular canals in the inner ears  contain fluid and tiny hair cells. As the head nods up and down, moves left to right, or tilts to the side, the fluid in the inner ear moves and the tiny hair cells sense the speed and direction the head is moving in. 

By age 70, it’s typical to have lost 40% of those sensory-detecting hair cells (Zalewski 2015).  

Proprioceptive System: Proprioception, literally meaning “sense of self”, is your sense of body awareness and is a prerequisite for balance. It’s how you understand the parts that make up your body, where they are located, how they feel and even what they can do. It’s the way your body communicates with itself so you can walk without looking at your feet. 

Proprioceptors are sensory nerves that live in and around joints, in ligaments, joint capsules, tendons, muscles and connective tissues. They sense and send signals to the brain about joint position and motion, as well as the muscle force involved in movement.  

As we age, our sense of body awareness is impaired leading to poor joint function, body alignment, control and coordination. The result: poor balance and higher risk of falling. 

Losing and Restoring Balance

As our eyes, ears and joints lose their sensory capabilities, this is why balance is gradually lost. 

To regain what was lost, we apply the SAID principle (Specific Adaptations to Imposed Demands) to improve function with targeted training. Up to 70% of the sensory input for balance comes from your joints (Peterka 2002), so improving joint function can be a highly efficient way to improve proprioception at any age so clients can enjoy better balance and more confidence to prevent falls. 

Most Efficient Balance Training

I start each balance training session using the MoveMor® Mobility Trainer to warm up clients’ lower body, restore ankle mobility and foot stability while increasing proprioception. Clients are thrilled to experience improved functional abilities so they can save themselves in time to prevent falls.  

With 12-points of resistance, MoveMor® makes it simple to restore joint flexibility and strength in less time than any other tool, all from a safely seated position! This wakes up proprioceptive sensory nerves essential for balance while stimulating motor nerves for quicker reflexes. 

You can get started with training clients on their journey to feeling steadier, stronger and more confident by visiting MoveMor.com/exercise-programs. There are 7 exercise programs to choose from that vary in length from 5-30 minutes. Our Take 10 to MoveMor exercise program is proven to improve balance, ankle flexibility, strength and more in just 10 minutes! An exercise guide makes it simple to identify weaknesses and tailor exercises. 

MoveMor® seamlessly integrates into your balance and fall prevention training to accelerate functional outcomes and satisfaction so your clients can enjoy better balance and an extra spring in their step today!

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

Large group of fit and active people resting after doing exercise in nature.

Exercise Outdoors: Cross Training & Hydrate

/12 March 2024/ All MFN blog/

Exercise outdoors when it’s hot can be a challenge. Cross training exercises are a good way to mix up your workouts and give yourself time to cool off, drink water and stay hydrated in summer heat. 

Although I’m away from home, in the mountains, and not as affected by this huge triple digit heat wave, I did get a wake-up call of my own that I thought would be important to share.  I was shooting an exercise video this week in 90-degree heat. It was hot, but I got on a roll and forgot about the time. Less than an hour in, I started to swoon. Not a good shot on an exercise video. I realized immediately what had happened; I’d gotten so involved, I forgot to drink water between takes. I can say from experience that it creeps up on you. So you need to take steps to keep yourself cool and well-hydrated when you exercise outdoors. Cross-train with strength exercises mixed in with your cardio gives you a lower intensity interval so you can drink water, stay hydrated and cool off.

According to the American College of Sports Medicine losing more than 2 percent of your body weight through dehydration puts your body at risk for heat illness. This is serious business. We’ve all read the stories of team athletes who have actually died.

When you exercise in the heat you can lose up to five cups of water per hour. So it’s important to drink water before, during, and after vigorous exercise. The rule of thumb is to drink 2 cups of water a couple of hours before you start exercising so you are fully hydrated. Remember to bring that water bottle with you and drink a cup of water every 15 minutes or so while you are exercising. Don’t wait till you’re thirsty. If you’re thirsty, you’re already getting dehydrated.

But you’re not done yet. You need to drink another 2 cups over a two-hour period after exercise.

Sounds like a lot of water. It’s not. It’s just making up for the water you lose when you exercise in the heat.

Pouring water over your head during exercise won’t help you rehydrate, but it does make you feel better. A study at Cal State Fullerton with trained athletes showed that athletes exercising in 92-degree heat in a controlled setting felt cooler and that the workout was easier to perform.

But you know what Noel Coward said about “mad dogs and Englishmen.” Give yourself a break. If you can, exercise outdoors when it’s cooler, early mornings or late afternoons when the sun is less direct. Try finding shady areas.

Instead of keeping up your brisk pace for the whole workout, break it up. Go at normal pace for a bit, do a short light interval and then pick up your speed again.

Another idea is when you exercise outdoors do cross training exercises. Add intervals of strength training between shorter bouts of cardio. You’ll get a chance to drink and pour some water over your head too! Stop at a wall, a tree or a fence, and do these five exercises: two for your upper body and three for your lower.

Exercise Outdoors Video

Here is an Exercise Outdoors video with some easy cross training exercises to tone you up, no equipment necessary.  (Please subscribe to my YOUTUBE channel; I have several more health & fitness videos!)

Exercise Outdoors: Strength Exercises Using Your Own Body Weight

With all these Strength training exercises, remember to exhale on the exertion.

Standing Push Ups: Stand facing a surface with legs hip width apart and place hands shoulder width apart. Keeping your body straight, lower yourself down to the surface and then push back upright again. Muscles Worked: Chest, Triceps, and Shoulders

Calf Raises: Face surface and hold on for balance. With feet together pointing straight ahead, slowly lift your body up on to your toes, while tightening calf, abs and buttocks muscles. Then slowly lower yourself back down again.

Muscles worked: calves, abs, and buttocks.

Squats: Face surface, legs hip with apart. Hold on for balance. Shift weight back into heels. Keeping back straight, abs pulled in, gently bend at the knees and squat to about a 90-degree angle. Hold for a moment, then, using just your leg muscles, return to an upright position.

Muscles worked: Front of thigh (Quads), Back of thigh, (Hamstrings) Buttocks, Abs

Wall Sit: Stand against surface for back support. Holding on as needed for balance, slide down to a sitting position against wall, knees at about a 90-degree angle. Pull your abs in and hold for 10 to 30 seconds.

Muscles worked: Thighs and Abs

Upper Back Squeeze: Stand with your back to the surface, feet shoulder width apart. Place hands behind you on surface. Straighten your arms behind you and squeeze your shoulder blades together. Hold for 10 to 30 seconds.

Muscles worked: Back, Shoulders, Back of arms (Triceps)

Mirabai Holland MFA, EP-C, CHC is one of the foremost authorities in the health and wellness industry. Her customer top rated exercise videos are now available online 24/7 at on her website for Age-Onset health issues like Osteoporosis, Arthritis, Heart Disease, Diabetes, Orthopedic Issues & more. Mirabai also offers one-on-on Health Coaching as well as a NEW Weight Management 8 Week Course Lose To Win™ on ZOOM or Phone. For more info, visit mirabaiholland.com. Contact her at askmirabai@movingfree.com

Healthy-Lifestyle-Nutrition-Exercise-Medicine

The Power of Why: Motivation for Better Health

/15 January 2024/ All MFN blog, Conditions/

As a movement practitioner, I love it when my clients become my teachers. One conversation with someone going through the process of changing their life and fighting challenges may prompt, lead, or sometimes shove me into examining my practice, my approach, and my connection with the people I serve. Just recently Mary, one of my clients, wanted to meet with me to discuss her progress and our conversation inspired this article.

grateful

Gratitude: The Gift of Being Present

/18 December 2023/ All MFN blog/

The holiday season can be a wonderful time for gathering and celebrating with family and friends, but it can also be a source of much added stress.  You may be fretting about any number of circumstances like: how to manage your weight or chronic condition like diabetes during all the “feastivities”;  choosing the perfect gifts and worried if you can afford them; missing a loved one who can’t be with you or who has passed away; or perhaps you feel unwell or someone close has been diagnosed with a disease.

Whatever personal challenges you are experiencing, research shows that grateful people are happier and healthier; can make better decisions; and are more joyful(1).  It’s a skill anyone can learn and benefit from and best of all, it’s free!  

How it Works

An attitude of gratitude bolsters the feel-good neurotransmitters (brain chemicals) dopamine and serotonin.  Feeling thankful and appreciative also boosts the love hormone oxytocin so we feel more connected while it decreases the stress hormone cortisol(2).   

Our day-to-day lives are so busy that we often rush from one task to the next one without being mindful.  Living in the fast lane thrusts us into a chronic state of stress, consistently raising cortisol levels that end up damaging our body cells, organs and systems.  This is a major reason why stress is the silent killer that we all talk about but don’t take seriously enough.  

Slowing down, taking a few deep breaths and being grateful moves us out of the sympathetic state or fight or flight mode and into the parasympathetic state of rest, digest, heal and repair.  This is where our body and mind can relax and rejuvenate so we can sleep better and experience more energy and vitality.  And who doesn’t want more healthy energy?!

Count Your Blessings

When we focus on what we have instead of what we don’t have, it puts us in a positive frame of mind.  We become more content, satisfied and fulfilled.  The ability to notice, appreciate and savor life’s moving parts grows gratitude for better physical and psychological well-being(1,3).

Grateful people count their blessings and look at their lives and experiences as gifts(1,3). We can shift our perspective and explore: “What is this difficult situation trying to teach me?”  “What am I grateful for in this moment?”  

When my family and I were recovering from chronic Lyme, we were all thankful for each other, the support of family and friends and for having the resources to pay for exorbitant out-of-pocket medical expenses.  Gratitude played a starring role in our healing.

Mindfulness

Practicing mindfulness is an effective way to plug into the feeling of gratitude.  Dr. Jon Kabat-Zinn defines mindfulness as “paying attention on purpose in the present moment, non-judgmentally…as if your life depended on it”(4).  

When you think about it, all we really have is the present moment.  Unfortunately, we spend a lot of time and waste precious energy worrying about the future or commiserating over the past.  Focusing on the present moment helps us connect to each other, our thoughts and our own lives so we can become the best version of ourselves.  Each day we have the opportunity to do and be better. 

Cultivate Gratitude

When we are mindful we can be amazed by the power of breath, the body’s ability to heal itself from an infection or injury, the beauty of the blue sky, a pink sunrise or sunset, the miracle of a baby being born, the unconditional love of a pet, the plants and trees that clean the air and provide oxygen, the water that runs out of a faucet or down a cool Rocky Mountain stream… the possibilities are limitless.

Better Health 

Scientific studies show that being thankful and appreciative is associated with less physical illness, fewer aches and pains; lower levels of stress, anxiety, and depression(3, 5); and fostering new and lasting relationships(6).   

Being grateful also expands our scope of cognition so we can be more flexible and creative with our thinking and make better decisions.  This makes it easier to cope with stress and adversity(1).

Unwrapping the Gift

When we are grateful and thankful, we tend to be kinder and more generous.  Gratitude makes us feel good, so we want to do it again and again.  The best part is that it’s easy to get started and can feel the benefits quickly. Research shows that you can start feeling better in as little as 2 weeks by writing in a Gratitude Journal(1). 

Here’s How

Grab a notebook, pad or smart phone and each evening before bed, write 3 things you are grateful for.  Write novel blessings, trying not to repeat the same ones, because the possibilities are endless.  Practice this for 2 weeks and see what happens.  

The best time to get started is now, in the present moment. Today, tell someone how grateful you are for them.  You will be sharing a great gift.

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

References

  1. Emmons, R & McCullough, M (2003). Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life. Journal of Personality & Social Psychology.  www.greatergood.berkeley.edu.
  2. Gottfried, S (2016). www.saragottfriedmd.com/thanksgiving-what-gratitude-does-to-your-brain/
  3. Hill, PL et al (2013).  Examining the Pathways between Gratitude and Self-Rated Physical Health across Adulthood.  Pers Individ Dif. www.ncbi.nlm.nih.gov/pubmed/23139438
  4. Jon Kabat-Zinn, Ph.D. www.psychalive.org | videos
  5. Cheng, S et al. (2015) Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention.” Journal of Consulting and Clinical Psychology. https://www.ncbi.nlm.nih.gov/pubmed/25222798
  6. Williams, L & Bartlett M (2015). Warm thanks: gratitude expression facilitates social affiliation in new relationships via perceived warmth. Emotion.  www.ncbi.nlm.nih.gov/pubmed/25111881
holidays-xmas

Surviving the Holiday Season

/11 December 2023/ All MFN blog/

The hardest time of year for weight management is from Halloween until Valentine’s Day – temptations are everywhere from home to the workplace and everywhere else you go, people wear more clothes and are more covered up because of the weather, and people tend to exercise less because they are stressed, exhausted, it is cold, and they have very little time.

Here are some tips to manage weight during the holiday season…

Plan ahead

  • Eat something before you go out so that you are not inclined to eat everything or anything in sight.
  • Stock your home, office, and/or car with healthy snacks such as fruit in your home, almonds in your office, and a nutrition bar in your car.
  • Plan on making healthy choices for your meals such as mustard instead of mayonnaise or light Italian rather than ranch dressing.

Manage stress

  • Make a list of stress relieving activities that do not include food or eating such as getting a massage, exercising, listening to music, or talking on the phone.

Party responsibly

  • If you are attending a pot-luck party, bring something healthy so you know there will be at least one healthy choice at the party.
  • Eat small portions of your favorite sweets at parties.
  • Try to fill your plate with mostly fruits and veggies at parties.
  • If you want to try new dishes, only take a taster size portion so that you are not tempted to eat more than you should. Then go back and get more of what you like if you are still hungry.
  • Drink a glass of water after each glass of soda or alcoholic beverage in order to cut beverage calories in half.
  • Focus on socializing with other guests rather than eating the food available.

Keep moving

  • If you know you will not have time to exercise, try to fit other small activities into your day such as parking farther away, taking the stairs, and putting the shopping cart away instead of putting it to the side.
  • If you have a stationary bicycle or a treadmill that you haven’t used for a while, take it out and put it in front of the TV, so you can watch TV when you work out.
  • Take a walk alone or with your spouse, kids, or other family and friends after dinner.

Kristy Richardson is a dietitian and exercise physiologist, specializing in sports nutrition and weight management, She is the founder of OC Nutrition and also works as a nutrition professor at Fullerton College.

References

Cleveland Clinic. (2009). 8 Steps to Surviving the Holiday Weight Gain. Retrieved December 22, 2009 from: http://my.clevelandclinic.org/heart/prevention/nutrition/holidayeating12_01.aspx

Zamora, Dulce. (2007). Holiday weight management; Surviving the Feasting Season. Retrieved December 22, 2009 from: http://www.medicinenet.com/holiday_weight_management/article.html

scale

The Habits of Successful Weight Losers

/8 December 2023/ All MFN blog/

In a national television interview with Barbara Walters in 2014, Oprah Winfrey confessed that not being able to maintain her weight loss was her biggest regret. In that interview, Walters asked Winfrey to finish the sentence, “Before I leave this Earth, I will not be satisfied until I…”

“Until I make peace with the whole weight thing,” Oprah replied. Losing weight is hard; keeping it off is even harder. What is unique about those who succeed? The answer is buried deep in the archives at the Weight Control and Diabetes Research Center in Providence, Rhode Island: The National Weight Control Registry (NWCR), the largest database ever assembled on individuals successful at long-term maintenance of weight loss. Founded in 1994, the NWCR includes more than 10,000 individuals who complete annual questionnaires about their current weight, diet and exercise habits, and behavioral strategies for weight loss maintenance.

Habit #1: Live with Intention

Living with intention eliminates the random approach to weight loss maintenance in favor of the systematic and methodical one that leads to results. The NWCR has shown that, when intention is behind weight loss maintenance, 21 percent of overweight people are successful weight losers. [1]

The longer people keep their weight off, the fewer strategies they need to continue keeping weight off. [2] In other words, weight maintenance gets easier. The longer your clients persist in their intention and behave in accord with that intention, the easier it is for that behavior to “stick” and turn into a habit.

What makes one individual persist at a specific behavior while another individual doesn’t? For starters, the persistent individual has a conscientious personality. In the most recent NWCR study published in 2020, conscientiousness was compared between successful weight losers from the NWCR and non-NWCR weight regainers. [3] The successful weight losers were found to be more conscientious than the weight regainers and scored higher on measures of order, virtue, responsibility, and industriousness. The scientists suggest that being conscientious may help individuals maintain their weight loss by improving adherence to specific behaviors.

In a review of 56 studies that contained 58 health behaviors, researchers at Université Laval in Quebec, Canada and the University of Limburg in The Netherlands found that intention remained the most important predictor of health behavior, explaining 66 percent of the variance. [4] In half of the reviewed studies, perceived behavioral control (believing that you have control over your behavior) significantly added to the prediction.

Habit #2: Control Yourself

Being a successful weight loser requires a lot of self-control, delaying gratification now (e.g., dessert) for the more desirable reward later (e.g., a slimmer waistline, better health, enhanced self-esteem, and happiness).

Compared to typical unsuccessful dieters, successful weight losers are better able to resist temptation, control themselves, and push back against the environment. They restrict certain foods, [5] weigh themselves regularly, [6, 7] and use digital health technology. [8]

One of the key factors of self-control is disinhibition, which literally means not being inhibited. Some inhibition is good, because it prevents people from not giving into temptation and eating whatever and how much they want. High levels of disinhibition are bad, because it leads to risky behavior. Disinhibited eating is a failure to maintain control over eating. The opposite of disinhibited eating is dietary restraint. Several NWCR studies have found that increased disinhibition leads to regaining lost weight. [9, 10, 11, 12, 13] Other studies have found strong relationships between a lack of self-control—impulsivity—and obesity. [14, 15, 16]

Habit #3: Control Calories

Successful weight losers consume fewer daily calories than the general population. Table 1 shows the number of calories the NWCR members consume per day, from the several studies that have reported it, along with the amount of weight they lost at the time they entered the NWCR.

Table 1 – Caloric Intake of Successful Weight Losers

 Calories Per DayPounds Lost
 1,381 [17, 18]

1,297 (women)

1,725 (men)

66

63 (women)

78 (men)

 1,306 (women) [19]

1,685 (men)

63 (women)

77 (men)

 1,390 [20]69
 1,462 [21]124
 1,400 [22]62
 1,399 [23]73
Average

Women

Men

1,406

1,302

1,705

79

63

78

Successful weight losers consume a low-calorie diet of about 1,400 calories per day, with women consuming about 1,300 and men consuming about 1,700 calories per day. By comparison, the U.S. adult population consumes an average of 2,120 calories per day (women consume about 1,820 calories per day and men consume about 2,480 calories per day). [24, 25]

Successful weight losers control calories several ways, including limiting how often they eat out at restaurants, [26] rarely eating fast food, [27] and limiting how many calories they drink. [28] They are also more likely than normal-weight individuals to have plans to be extremely strict in maintaining their caloric intake, even during times of the year when it’s easy to consume calories, like during holidays. [29]

Want to learn about more of the habits of successful weight losers? Check out Dr. Karp’s book, Lose It Forever: The 6 Habits of Successful Weight Losers from the National Weight Control Registry

A competitive runner since sixth grade, Dr. Jason Karp pursues his passion every day as a run coach, exercise physiologist, bestselling author of 10 books and 400+ articles, speaker, and educator. He is the 2011 IDEA Personal Trainer of the Year and two-time recipient of the President’s Council on Sports, Fitness & Nutrition Community Leadership award. His REVO₂LUTION RUNNING™ certification has been obtained by fitness professionals and coaches in 23 countries. His new book, “Lose It Forever: The Habits of Successful Weight Losers from the National Weight Control Registry” is available on Amazon.

References

[1] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[2] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[3] Gold, J.M., Carr, L.J., Thomas, J.G., Burrus, J., O’Leary, K.C., Wing, R., and Bond, D.S. Conscientiousness in weight loss maintainers and regainers. Health Psychology, 2020.

[4] Godin, G. and Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2):87-98, 1996.

[5] Wing, R.R. and Phelan, S. Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82:222S-225S, 2005.

[6] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21: 323-341, 2001.

[7] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[8] Goldstein, C.M., Thomas, J.G., Wing, R.R., and Bond, D.S. Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health. Obesity Science and Practice, 3(2):117-126, 2017.

[9] McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W. and Hill, J.O. What predicts weight regain among a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67:177-185, 1999.

[10] Niemeier, H.M., Phelan, S., Fava, J.L., and Wing, R.R. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity, 15:2485-2494, 2007.

[11] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[12] Thomas, J.G., Bond, D.S., Phelan, S., Hill, J.O., and Wing, R.R. Weight-loss maintenance for 10 years in the National Weight Control Registry. American Journal of Preventive Medicine, 46(1):17-23, 2014.

[13] Lillis, J., Thomas, J.G., Niemeier, H., and Wing, R.R. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obesity Science and Practice, 2(1):83-87, 2016.

[14] Chamberlain, S.R., Derbyshire, K.L., Leppink, E., and Grant, J.E. Obesity and dissociable forms of impulsivity in young adults. CNS Spectrums, 20(5):500-507, 2015.

[15] Fields, S.A., Sabet, M., and Reynolds, B. Dimensions of impulsive behavior in obese, overweight, and healthy-weight adolescents. Appetite, 70:60-66, 2013.

[16] Amlung, M., Petker, T., Jackson, J., Balodis, I., MacKillop, J. Steep discounting of delayed monetary and food rewards in obesity: a meta-analysis. Psychological Medicine, 46(11):2423-2434, 2016.

[17] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill, J.O.  A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66:239-246, 1997.

[18] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[19] Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., and Seagle, H.M. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 98:408-413, 1998.

[20] McGuire, M.T., Wing, R.R., Klem, M.L., Seagle, H.M., and Hill, J.O. Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity, 22:572-577, 1998.

[21] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[22] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[23] Ogden, L.G., Stroebele, N., Wyatt, H.R., Catenacci, V.A., Peters, J.C., Stuht, J., Wing, R.R., and Hill, J.O. Cluster analysis of the National Weight Control Registry to identify distinct subgroups maintaining successful weight loss. Obesity, 20(10):2039-2047, 2012.

[24] Wright J.D., Wang, C.Y., Kennedy-Stephenson, J., Ervin, R.B. Dietary intake of ten key nutrients for public health, United States: 1999-2000. Advance Data From Vital and Health Statistics, 334:1-4, 2003.

[25] U.S. Department of Agriculture, Agricultural Research Service. Energy intakes: percentages of energy from protein, carbohydrate, fat, and alcohol, by gender and age. What We Eat in America, NHANES 2015-2016, 2018.

[26] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[27] Thomas, J.G. and Wing, R.R. Maintenance of long-term weight loss. Medicine & Health Rhode Island, 92(2):56-57, 2009.

[28] Catenacci, V.A., Pan, Z., Thomas, J.G., Ogden, L.G., Roberts, S.A., Wyatt, H.R., Wing, R.R., and Hill, J.O. Low/no calorie sweetened beverage consumption in the National Weight Control Registry. Obesity, 22(10):2244-2251, 2014.

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