Sustained Weight Loss
Written by: Marie Spreckley, MSc
What really sets individuals who achieve successful, substantial long-term weight-loss maintenance apart? Trying to answer to this question has become my calling in life as both a clinician and researcher.
My research team and I recently published a systematic review looking into the experience of successful, substantial long-term weight-loss maintenance from the view of individuals who have achieved this to gain a comprehensive picture of what sets their experience apart.
We conducted a systematic review including the accounts of 294 individuals who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight.
From this, we created a comprehensive framework healthcare practitioners (HCPs) can utilise when trying to devise evidence-based treatment strategies for their patients and clients to help them both achieve and maintain their weight loss long-term.
A snapshot of our findings about Sustained Weight Loss:
1. Continuous monitoring
The theme of continuous monitoring was the most consistently mentioned topic throughout all studies.
Particularly self-monitoring including exercising portion control, tracking calories and foods, meal planning and pre- planning for events, visual reminders, relapse protocols and regular weighing were potent tools utilised by successful participants. External support from HCPs, weight loss groups, friends and family also encouraged participants to remain focused.
Both intrinsic and extrinsic motivators were strong, underlying drivers that encouraged participants to stay on track. Participants were highly motivated to improve their health, self-image and confidence.
They were also motivated to improve their social opportunities both at work and on a personal level. External motivators included improving their sense of belonging as well as social standing and career opportunities.
The wish to experience less stigmatization and to become a role model were also motivational drivers.
3. Goal Setting
Having clear, self-defined, personalised goals as well as externally defined goals were important factors that enhanced long-term success.
Self-defined goals ranged from diverse activity goals to eating goals and were continuously re-assessed and re-adjusted to ensure their suitability and applicability.
Externally defined goals included HCP defined goals, weigh loss club goals and sports events participants prepared for.
4. Enduring challenges
This is a very important area to consider in context with weight loss maintenance.
Participants consistently highlighted both intrinsic and extrinsic challenges they were confronted with on a continuous basis. Intrinsic challenges included stress, a lack of time to plan and engage in health seeking behaviours and life events like pregnancy, illness and injury.
Social isolation, an overreliance on the support system, a lack of daily structure, unforeseen life events like the death of a loved one and being confronted with trigger foods also posed continuous threats to maintenance.
External challenges included increased stress at work and stress brought on by peers including relationship changes, sabotage by unsupportive peers as well as trying to conform to cultural norms. Holidays and celebrations were also daunting due to a loss in routine and the omnipresence of the obesogenic food environment was also a daily, continuous threat to their success.
5. Overall experience
The overall experience was both encouraging and discouraging at times. Participants spoke of feeling liberated and having found a new identity. They felt that they had reinvented themselves and found their purpose in live, which brought with it new communities and opportunities.
Some, however, felt isolated, lonely and excluded from previous communities and were frequently criticised for their new life choices by peers.
They felt frustrated because they couldn’t go back to their previous behaviours and lifestyle and continuously feared regain and a return to their previous reality.
The good news about Sustained Weight Loss:
As we can see, trying to help patients and clients achieve sustained weight loss and weight loss maintenance is a complex challenge that requires agile, personalised treatment strategies and long-term support.
The good news is that it can be achieved and can truly provide individuals with ‘a second chance at life’, as some described.