New study suggests strategies for keeping off pounds
Most people seem to struggle with long-term weight loss. By some estimates, only about 20% of overweight individuals are successful in keeping off at least 10% of their initial body weight for a year or longer.
A new study, however, suggests that using specific strategies — such as weighing yourself regularly and planning for situations in which you might backslide — could modestly slow the rate of weight regain in obese adults who have lost weight.
In the study, employing such strategies in a maintenance program increased the proportion of adults who stayed at or lowered their weight, after initial weight loss, by 13.9 percentage points, said Corrine Voils, research career scientist at William S. Middleton Veterans Memorial Hospital in Madison, Wisconsin and lead author of the study.
However, more research is needed to determine which specific strategies offered the most benefit and which may have not had much of an impact. The study, which involved mostly men of various races and involved self-reports, was published in the journal Annals of Internal Medicine on Monday.
“We went into this study unsure what to expect,” said Voils, who is also a professor of surgery at the University of Wisconsin-Madison.
“We knew that maintaining weight loss is hard and that previous maintenance studies have tended to focus on middle-aged white females. We were unsure if a mainly telephone-based program would work in a population that is primarily men and of mixed race,” she said. “We were happy to see that our strategies reduced the rate of weight regain.”
More than one-third of American adults are considered to be obese, meaning their body mass index is 30 or higher, according to the Centers for Disease Control and Prevention.
Obesity has been linked to numerous health problems, including heart disease, stroke, type 2 diabetes and several types of cancer.
‘Obesity is now recognized as a chronic disease’
The new study involved 222 obese patients, of whom only 34 were women. All of the patients had lost at least 8.8 pounds in a 16-week weight loss program.
They were randomly assigned to participate in either an intervention group that provided weight maintenance strategies for an additional 42 weeks or a group that received usual medical care, with no emphasis on weight maintenance.
Those in the intervention group participated in three in-person group meetings and eight individual telephone calls, in which they were given a maintenance calorie budget and strategies on how to exercise, get support from their family and friends, and monitor their weight.
The phone calls also involved the patients reflecting on how their lives have improved as a result of weight loss, making a plan for situations when they might feel tempted to go back to old habits, and specifying how frequently they weigh themselves and revisit weight loss efforts if they have gained weight.
All participants, in both groups, were scheduled for assessment appointments at the beginning of the study and then after 14, 26, 42 and 56 weeks.
After 56 weeks, Voils said, 58.6% of patients in the intervention group either regained some weight or saw no change in weight, while 72.5% of patients in the other group regained or saw no change, a difference of 13.9 percentage points.
The average weight regain in the intervention group was only about 1.6 pounds, compared with about 5.2 pounds in the other group, the researchers found.
“Although this may not seem like a lot of weight, given the low program costs and the high benefit of carrying less weight over the longer term, this is an important finding that adds to our understanding about how best to help patients with obesity,” said Dr. Jennifer Kraschnewski, associate professor at the Penn State College of Medicine, who was not involved in the new study.
“Obesity is now recognized as a chronic disease. However, we still don’t treat it this way in the clinical setting. Clinically, we typically help patients engage in weight loss efforts, stand back and watch as they regain, and then try to re-engage them in additional weight loss efforts,” she said. “We wouldn’t treat someone’s high blood pressure with a medication for only a year and then scratch our heads as to why their blood pressure is high again two years later. For obesity to be treated as a chronic disease, new approaches to management are critical.”
Yet, the new study had some limitations.
What might help weight control the most?
It remains unclear in the study whether regular weighing, planning for high-risk situations or obtaining outside support was most effective in weight loss management, Voils said.
“Our study design did not allow us to say which component of our intervention was most effective,” Voils said.
“There is evidence that self-weighing and relapse prevention help people maintain weight loss. Our intervention incorporates those skills and adds having patients reflect on the benefits they experienced with weight loss and talking with a support person about what they can do to support weight maintenance efforts,” she said.
Though it remains difficult to establish which part of the intervention had the most impact on patients, having constant interaction with a supportive coach probably played a significant role in weight maintenance, said Dr. Samuel Grief, associate professor of clinical family medicine at the University of Illinois College of Medicine at Chicago, who was not involved in the study.
“Group dynamics tend to be more helpful, or a team-based approach using care coordination,” Grief said.
“That would be my answer. Because strategies like food journaling or diaries or writing out what activities you do every day or emotions that you’re feeling, all that is relevant, but there’s not a lot of science behind those causing weight loss or mitigation of weight regain. Otherwise, everybody would do it,” he said. “Also, it would have been helpful to gauge their self-efficacy.”
Studies suggest that having self-efficacy, or believing that you will be successful in losing weight, has been linked to greater success in weight management, Grief said.
Additionally, the researchers were unable to assess longer-term weight maintenance and relied on self-reports about dietary intake and physical activity.
“Our population was primarily middle-aged men who were white or African-American, and results may not generalize to other populations,” Voils said.
Tips for keeping the weight off
The National Weight Control Registry, which has tracked more than 10,000 individuals who have maintained significant weight losses, offers some recommendations on how to maintain weight control.
Rena Wing, a professor at Brown University’s Warren Alpert Medical School, and James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center, established the registry in 1994.
“To maintain weight loss, there must be continued adherence to a low-calorie diet and high physical activity,” Wing said.
She said the registry suggests that the following strategies may help someone who is trying to maintain their weight loss:
Maintain high levels of physical activity, in which the recommended goal is 250 minutes per week of moderate-intensity activity, such as brisk walking. Monitor your weight by weighing yourself frequently. Monitor and keep track of your diet and activity. Take immediate action in the face of small weight regains.