How to maintain weight loss
Many of us find at least some success with our efforts to get lean, strong, and healthy.
Some of us, however, seem to find better success than others.
Some of us get to a point where we look and feel awesome and stay that way indefinitely.
Others of us struggle.
We lose weight, then gain it back, then lose it again, then gain it back.
We then either quit or repeat the process indefinitely.
What makes those of us who see long-term success different from those of us who just can’t seem to keep our momentum going?
This exact question was explored in a 2018 study published in Obesity Reviews, titled “Determinants of weight loss maintenance: a systemic review”.
In this study, researches searched through 8,222 articles about weight loss maintenance in overweight or obese adults without surgery or medication.
They ended up selecting 67 of those 8,222 articles for their final analysis.
Once the authors narrowed down their list of studies, they assessed the quality of the studies according to the following criteria:
“Quality assessment was conducted using a modified quality assessment tool formerly used by Uijtdewilligen et al.. A maximum of one point could be awarded per category, and a total score of six points could be awarded per article. The categories, as previously described by Uijtdewilligen et al., in which studies could score points, were as follows:
- The representativeness of the exposed cohort. A point was given if the participation rate at baseline was at least 80% or if the non‐response was not selective.
- Non‐selective non‐response during follow‐up measurements. A point is given if the response rate at follow‐up was greater than or equal to 80% or if the non‐selective dropout on key characteristics (age, gender, determinants or weight) is reported.
- Determinants were measured with a valid and reliable tool. If the determinant measure showed test-retest correlations of ≥0.80 or κ/ICC ≥ 0.70, one point is given 13. If the article investigates multiple determinants, this criterion is scored on a scale of 0–1. For example, if a study assessed four determinants, of which one was measured with a reliable tool, a score of 0.25 is given.
- Weight was measured with a valid and reliable tool. A point is given only if weight was assessed with an objective measurement instrument, or questionnaire with test-retest correlations of ≥0.80 or κ/ICC ≥ 0.70.
- Sample size ≥ 10 times the number of independent variables.
- Appropriate statistical model adjusted for relevant confounders. In experimental studies, the findings of a determinant analysis were included (i.e. b‐path of mediation analysis).
This was converted to a percentage by calculating the mean and multiplying 100. A score ≥ 75% was considered high quality and <75% low quality.”
Once the quality of each study was determined, the authors categorized the studies according to the factors they explored and determined how consistently those studies showed an association between the factor in question and long-term weight loss maintenance.
“Determinants of weight loss were categorized as significantly positively predictive, significantly negatively predictive or not significant in either direction of weight loss maintenance. Dividing the number of times a determinant is reported in a certain direction by the total number of times the determinant is measured multiplied by a hundred gave a percentage of consistency.”
Then, for each factor, the authors categorized the overall strength of the evidence according to the consistency and quantity of research showing a relationship between a given factor and weight loss maintenance.
“If the determinant was reported more than 75%, we considered this a consistent finding in a certain direction. As previously used in Uijtdewilligen et al., the quality of evidence was identified as follows:
- Strong evidence: consistent findings in multiple (≥2) high‐quality studies.
- Moderate evidence: consistent findings in one high‐quality study and one or more low‐quality studies, or in multiple (≥2) low‐quality studies.
- Insufficient evidence: only one study available or inconsistent findings in multiple (≥2) studies.
A determinant that was reported in a certain direction greater than 75% with two or more of these studies being high quality would result in the conclusion that there is strong evidence that the determinant is positively, negatively or not predictive of weight loss maintenance.”
Here are factors for which there is “moderate” or “strong” evidence to suggest are positively predictive of long-term weight loss maintenance:
- Monitoring weight, eating habits, and physical activity
- Increasing physical activity
- Portion control
- Cutting or decreasing sweet/junk food, fried food, fast food, and dessert consumption
- Increase in fruit and vegetable intake
- Decrease of sugar-sweetened beverage intake, including coffee and tea with sugar and juice
- Substituting protein for fat or carbohydrates
- Increasing self-efficacy for diet, exercise, and weight management
- Increasing physical self-worth
Just as there are several emotional and mental factors that were positively predictive of long-term weight loss maintenance, the two that factors for which there is “moderate” or “strong” evidence to be negatively predictive of long-term weight loss maintenance were:
- Binge eating, uncontrolled eating, and emotional eating
- Internal disinhibition (“When I feel lonely, I console myself by eating,” as well as items that describe dichotomous thinking such as, “While on a diet, if I eat a food that is not allowed, I often then splurge and eat other high calorie foods.”, per Niemeier et al.)
The things that don’t appear to predict long-term weight loss maintenance one way or the other:
- Age, gender, ethnicity, race, and socioeconomic status
- Weight cycling and history of weight loss
- Meal replacement usage
- Eating out at restaurants
- Psychological stress
- Increasing fish consumption
- Increasing whole grain consumption
- Protein intake
- External and introjected self-regulation (doing things for others or to maintain self-esteem or pride or to avoid guilt or anxiety)
- Low impulse control and impulsivity
- Increasing the ratio of food-related substitutions for unhealthy eating patterns versus food-free substitutions
- Baseline measurements of pretty much any factor were found not to be predictive of long-term weight loss maintenance success
You might find it particularly encouraging that neither demographics nor baseline measurements seemed to be predictive of long-term weight loss maintenance.
This suggests that no matter your current situation, you can see long-term weight loss success.
The things to focus on include a variety of dietary changes, as outlined above, as well as a host of mental and emotional factors like building a sense of self-efficacy and self-worth and working to avoid problematic thought patterns.
There were other factors analyzed in this study, the evidence for which were determined to be “insufficient” according to the criteria described above, that you might find interesting, so I’d highly recommend you look through the study yourself to see which factors had what predictive value.
If you’d like to read more about self-monitoring and dietary changes for long-term weight loss success, you might find the following articles of mine helpful:
Looking, feeling, and performing your best comes down to consistently nailing the basics.
Prioritize minimally processed food.
Find physical activities you enjoy.
Get some sunlight and fresh air.
Spend time with people that you love.
Manage your stress.
Go to bed.
Pursue activities that give you a sense of purpose.
Do this for you and you alone.
Because you deserve nothing but your best life.
Because you are worthy.
You’ve got this.
Originally published at https://coachroba.com on June 30, 2019.