The first day of a weight loss program can be daunting. You could go from not working out at all, no meal plan and no weigh-ins, to intense hour-long sessions, strict food monitoring, and weekly group meetings that track your weight. For some it could be too much too soon. While it would seem that you have to take the all-or-nothing approach, a more gradual entry may do you just as good as if you go all-in from day one. Called stepped-care, a new concept of weight loss has been proven cheaper and more flexible, yet just as effective as traditional weight loss programs. 

The Study

Most weight loss programs start off intense and gradually slow down in terms of time commitment and effort. In a stepped-care program, weight loss strategies are intensified according to the needs of each individual. Researchers at the University of Pittsburgh compared weight loss among 363 participants on a standard weight loss program and stepped-care program. Over 18 months those on the standard weight loss program were prescribed weekly weight loss counseling, a low-calorie diet, and increased physical activity regimen. The stepped-care participants were offered the same strategies, except they were intensified only for those who were not getting the desired results. For example, if a weekly weight loss goal was not reached, participants could step up counseling from monthly to weekly, increase physical activity beyond the originally prescribed levels, or modify their diet plans. While initial weight loss was greater in the standard behavioral weight loss program after 6 months, at the end of the 18-month study, the average weight loss of about was virtually the same, at 7% and 8% in each group. Because each group showed some weight regain after the initial weight loss, the findings do not point to how stepped-care approach applies to long-term weight loss.  

When, What, and How to Modify Your Program 

If you start off small, little by little you can add more or less to your healthy living plate. You may have advice to change your workouts every 6-8 weeks to continue to improve your level of fitness. This is a reasonable span of time and can be achieved by either increasing the time or intensity of your workouts. You can keep your workouts the same, but increase your leisure-time physical activity as well. You might also add a group class to personal training sessions, or a progressive walking or running program of ever-increasing pace, miles, or steps. If you hit a plateau or want your rate of weight loss is to be maintained, you may also have to slightly lower your calorie count each month. After 4 weeks, incorporate no more than two to three new meals each week. Trying to change things too drastically every month could get overwhelming. In the way of social and psychological support, when your motivation is waning, seek out personal counseling that can help you with problem-solving strategies to avoid returning to bad habits.  

The Staircase vs. The Moving Walkway 

While the connotation of the stepped-care approach may seem like a staircase mentality of slowly stepping up efforts to keep weight loss going, there is also an aspect of it that allows for flexibility much like a moving walkway. Just as there is a walk and a standing of the walkway, sometimes slowing down your weight loss program is also allowed. If you find you're losing weight at more than 1 or 2 pounds a week, are sore beyond three days or are consistently hungry shortly after a meal, you may want to lower the intensity of your program a little. Because maintaining your weight loss is much harder than actually losing it, there's no need to rush to the finish line. Slow and steady wins the race.


Your thoughts... 

What aspect of the stepped-care approach is most appealing to you during your weight loss journey?