Refuse to Regain!: 12 Tough Rules to Maintain the Body You've Earned!

by Barbara Berkeley

Diets work, but what good are they if the weight returns? Statistics show that 80 to 90 percent of dieters regain every lost pound. This fact represents the largest and least addressed problem in obesity management. The recidivism of dieters fuels a $30 billion weight-loss industry, an industry that would shrink like Al Roker’s waistline if the newly-thin could only make weight loss stick. But here is the The skills needed to maintain a new, smaller body size are not obvious or intuitive; they must be taught. Inexplicably, books that deal successfully with ways to prevent regain have gone unwritten. Refuse to Regain , by longtime weight-management authority Barbara Berkeley, MD, fills this void. Berkeley, former medical director for the Optifast program and founder of Weight Management Partners, is a board-certified internist. She continues to have close ties to Novartis Medical Nutrition (recently acquired by Nestlé), producer of the weight-loss supplement Optifast, which has 300 weight-loss centers nationwide.

288 pages, Hardcover

First published October 1, 2008

Reviews

[CatReader]

Barbara Berkeley, MD, is a physician board-certified in obesity medicine who spent years of her practice directing a weight management clinic. In her 2008 book Refuse to Regain!, she gives advice to people who've lost weight on how to maintain their new, lower weight -- which, as we all likely realize, is a lot easier said than done (the statistics for people who maintain significant weight loss are quite dismal).

Dr. Berkeley's advice is based on her clinical practice as well as her own experience maintaining a more modest weight loss (~20 lbs). Much of the advice is common sense (regularly weigh yourself, maintain the same healthy habits that enabled your weight loss, eat mostly whole foods, prepare most of your meals at home from a variety of healthy recipes), some of it is dated (what she calls the Primarian diet would likely be called paleo, unprocessed/minimally processed, and/or whole food-based today), and some of it is more extreme (exercise vigorously for >1 hour/day, eat only 1 large meal/day, maintain some version of intermittent fasting long-term).

The glaring absence from this book, reading it in 2025, is mention of total daily energy expenditure (TDEE), the number of calories needed to maintain one's current weight given one's biological sex, height, and age. Nowadays there are ways to estimate it online, as well as ways to approximate it using fitness trackers, getting DEXA scans/BOD POD testing, etc. While much of weight loss focuses on eating a calorie deficit, there's less focus on continually adjusting down your TDEE as you lose weight, and aiming to eat at your TDEE when maintaining weight, which requires the discipline to continue calorie-counting or at least accurating approximating calories to be consistent over the course of weeks and months. The discussion of weighing oneself daily also doesn't mention how to use that data over time (which many smart scales and scale-connected apps available today do seamlessly) - as those of us who weigh ourselves daily know, daily fluctuations of several pounds are common and shouldn't be causes for panic, since weekly and monthly averages are a lot more important.

Overall, worth a skim if you're a maintainer (or an aspiring maintainer), but there are better resources available on the market today (I'd highly recommend this Youtube channel).

My statistics:
Book 167 for 2025
Book 2093 cumulatively

[sleeps9hours]

Some decent advice, a lot said better elsewhere, like Pollan’s “Eat food, not too much, mostly vegetables”. Realistic in how hard the maintenance will be, true lifestyle change. A bit overzealous in the “Primarian" part but then she undercuts herself later by suggesting processed snacks like low-fat frozen yogurt, fat-free pudding, and diet drinks.

p. 113 Establish a Life Charter
As an example, let me share my own charter with you. Mine is based on my belief in eating scarcely and in consuming a Primarian diet. It is constructed to keep me at a low, healthy weight based on my belief that lower weights convey the best lifelong health outcomes. My charter also reflects my belief that healthy nutrition can only work in the setting of a body that runs well, and therefore includes a commitment to exercise.
The primary goal of my charter is to achieve the longest possible life in the best possible health, hopefully avoiding periods of illness or disability as I age. A secondary goal, important to me personally, is to properly honor the gift of life I have been given and to appreciate the miraculous nature of my body by treating it with utmost respect.
Here is my life charter:
1. I eat one major meal per day, and 90 percent of my diet is Primarian.
2. I eat starches and sugars extremely rarely.
3. I eat one allowable treat daily (more if the scale cooperates).
4. I eat processed foods extremely rarely.
5. I eat no trans fats and very few saturated fats.
6. I honor my body by not allowing junk foods to enter it.
7. When I gain weight, I immediately reduce to below Scream Weight
8. I work out vigorously 6 days per week.

The 12 Tough Rules
1. Be tough, not moderate
2. Commit yourself to a three-month opt out period
3. Weigh yourself every day
4. Reverse small regains immediately
5. Eat Primarian 90 percent of the time
6. Eat one major meal per day
7. Perform a daily scan and plan
8. Stop eating at 8p.m.
9. Eat from a limited menu
10. Have one acceptable treat per day
11. Have a love affair with exercise
12. Maintain with support and support others

[Caille]

I picked it up at the library thinking it was a book to help you maintain weight loss, but it's actually about eating "Primarian" meaning eating only things you could find in nature. Interesting, but let's be real, Who's going to do that?! But it did make me consider all the processed food I eat.

[Cindy Marsch]

There are some important concepts here for maintaining weight loss, but in my experience some of the counsel is not good for those of us who have real carb-addiction problems. Recommended occasional "treats" of low-fat ice cream and artificially-sweetened items, as well as ongoing meal replacement shakes do not work well for people for whom sugar (or refined starch) cause reactions similar to those of alcohol for an alcoholic. Anyone in this camp might do better with the "tough rules" of the Bright Line Eating system instead. Works for me!

[Heather]

Wow! Well worth the read. I learned not to feel guilty and ashamed for my food problem, to be aware of the addictive properties of most starchy & fatty foods, to be aware of "food flood" that is constantly part of our culture (especially b/c a lot of people are making money on our weakness for sweets & fats), to always be on guard as a "warrior" in this culture of food everywhere and at all times. Also, I got tips for maintaining my weight once I reach my goal, and how to deal with sabotage of all kinds. The book even talked about Optifast meal supplements (which is the program I did to start the ball rolling on my weight loss), and how they are a wonderful method of 'weight reversal' when the "food creep" begins to happen (when addiction to starches and fats starts to take over and cravings grow).... b/c it fills your dietary needs and hunger without feeding your addiction. Helps you break the addiction's hold on you. Great book! I borrowed it from the library, but I may need to buy it, to reread sections as needed. I want to stay a "POW" (previously overweight) person, and it will be a lifelong job.

[Barbara]

There are many books about weight loss on the market. This one is about weight MAINTENANCE! Not a whole lot of those out there. Making the distinction between those of us who have been Previously Over Weight (POW) and those who have Never been Over Weight (NOW), Berkeley makes the case that many rules of nutrition that work for NOWs may not be as valid for POWs.

Interestingly, I read this from the perspective of being in my own 5th year of maintaining a significant weight loss, and I find that without having gone through her program (she's a doctor who works with weight loss patients), I actually follow my own version of almost all of her rules. I do what I do because it works. I learned by trial and error, and having to re-lose weight more than one.

Great resource if you're wanting to lose, are successfully losing, or struggling to maintain. Learn the rules, adapt them to fit your own life... and short cut the trial and error!