Forget Weight Loss, Let’s Talk About Weight Loss Maintenance
In an ocean of weight loss rebounds, what do weight loss maintainers have in common?
Even as a coach, I still struggle with with weight loss maintence.
Have you ever lost any weight in your life? If you’ve struggled with your weight, I bet you have.
I have struggled with my weight since I was in grade 3. In fact, I went on my first diet at age 13 where I would lose 60 pounds.
Above, you see that I still struggle with my weight, just to a smaller degree. Well, more accurately, I struggle with weight loss maintenance more than anything (mostly when I get pretty lean).
Which I am surely not alone in.
Weight loss can actually be achieved pretty easily, at least in the very short term.
If you go on any sort of intense fad diet, you’ll probably lose some weight. You may even have known someone who’s went on seemingly all of them and succeeded to some degree with plenty of them.
The issue though, is that they always find themselves right back where they started. Looking for a new diet. Looking for a new answer.
This is because weight loss maintenance is much harder than weight loss itself — in the long term, that is.
Weight loss maintenance requires you to continue to work without the same level of reward.
Meanwhile your own biology, psychology and even environment (you could say sociology here) can be driving you toward behaviours that would promote weight regain.
Your biology could do so via metabolic adaptation (Eric Trexler wrote an absolute behemoth of an article on metabolic adaptation that I highly recommend).
Metabolic adaptaion is the body adapting to weight loss or energy restriction by reducing metabolic rate. This is partly product of simply weighing less and requiring less energy to move less mass. Along with that, there is evidence of higher rates of metabolic adaptation than predicted from body mass loss alone. Even after maintaining weight loss past one year.
Your biology could also work against you by increasing your drive to eat at the same time. Creating what is called an “energy gap”. This is where your energy expenditure declines while your appetite increases. Creating a gap that promotes weight gain.
The last thing I’ll talk about how your biology could work against you is via hormones.
Before I go on, please don’t be sucked into the obsession with hormones surrounding weight loss. There are no shortage of hormone based charlatans out there that are waiting to prey on the neurosis of someone who is looking for the hormone solution.
With that being said, hormones are still important . One example is leptin. Leptin is secreted from your fat cells. If you lose plenty of fat, your fat cells will get smaller and secrete less leptin. Mainly because energy reserves are now lower. Lower levels of leptin will typically contribute to an increased amount of hunger combined with a reduction in energy expenditure. Once again, contributing to the energy gap.
Psychologically, if you once struggled with emotionally regulating with food, this is something you’ll always have to respect. This is something I’ve struggled with for a lifetime. I was also an obese child. In times of stress, I lean on food. Plenty of other folks who struggle with their weight (and folks who don’t) also do this. If this resonates with you, this is something you’ll need to be aware of and aim to work on.
Lastly, your environment also can work against you. Especially your food environment. Imagine you have higher levels of hunger, a history of emotionally regulating with food AND you find yourself in an environment that promoted the consumption of highly palatable and rewarding foods.
This is an absolute recipe for weight gain/weight loss rebounding. Your food environment and environment in general are often far too overlooked. In fact one study compared energy intakes of ad libitum (eating as much as you want) food intakes between ultra processed vs unprocessed foods for 2 weeks. Energy intake in the ultra processed group was around 500 more calories per day on average. One thing to note, this was just food enviornment too. This didn’t include being encouraged to eat more in the processed groups. I say this because we all know what it’s like to be encouraged to eat more, even when we’re not hungry by our peers/family members.
The other part of this as I briefly mentioned is your social enviornment. If your social life is centred around high calorie environments, this is also another factor you’ll need to consider. This could be something like always going out to eat or drink with friends.
I love me some beer and wings. But, if I’m in an evironment such as this often, it makes weight maintenance much harder to achieve.
This is not me saying you shouldn’t do this. It’s me saying that it’s something to be factored in. If it’s an every night thing, it could surely get in the way of your weight loss maintenance.
This culminates into the bio-psycho-social model of weight regain. Since humans are not just biological beings, this model is important to factor in for almost anything. Weight management is no exception to this.
So before you start to think your weight regain is solely impacted by one thing, factor in all of these variables. Conversely, when trying to keep the weight off, also factor them in.
Positive Spin — The Role Models We Need to Learn From
Now, I can imagine that was all a bit grim. The iron clad case against successful weight loss. Here is the caveat though, we know people can maintain significant, long term weight loss.
How do we know? Well, because we’ve literally seen it. Which brings me to the paper that I want to review. This paper is a systematic review that covered 15 studies and 294 subjects who lost and maintained a significant amount of weight from anywhere between 1–7 years.
So this is going to breakdown a paper that investigated the qualitative experiences and tendencies of successful weight loss maintainers.
Research Breakdown — The Shared Traits of People Who Maintained Their Weight Loss
As mentioned before, losing weight is actually an overrated component of the average weight loss goal.
The real issue is keeping it off — hence the importance of maintaining your weight loss. Unfortunately it’s a much less discussed topic even though it is crucial.
One study even showed that within 3 years of significant weight loss, around 95% of people will gain it all back and perhaps even more.
Grim… again… I know.
With that being said, let’s shed some positive light onto this subject!
Methods
This paper was a systematic review of 15 studies. The sample was of 294 adults of varying genders and varying ethnicities.
This was a qualitative review, so they weren’t just looking at numbers. This was to explore the behaviours and experiences of those who lost and maintained a significant amount of weight.
A significant amount of weight is usually defined as 10 or more % of one’s body weight in this literature.
Most papers in this review looked at people who lost 10% and maintained it over a year but some were as little as 5% of body weight lost and one was for as long as 7 years.
So there was variety and some really impressive weight loss maintenance here.
One other caveat was that all of the weight loss had to be intentional, without bariatric surgery and in adults to make the cut.
Once all of this info was collected, they coded it to find the most commonly occurring themes from the folks who had maintained their weight loss.
Results
The most common themes that showed up were as followed:
Continuous Monitoring — This included a variety of behaviours, but this was I believe the most common trait. This included self monitoring and external monitoring.
Self monitoring would be behaviours like continuing to weigh yourself, continued portion control practices (calorie tracking etc), pre-planning before events (looking at the menu beforehand) and even having relapse protocols in place (basically, how to get back on track when things don’t according to plan).
External monitoring would fall under the category of having a support group or feedback from peers/coaches/ or even your doctor.
Motivation — This theme also came up consistently. It was broken down into extrinsic and intrinsic motivators.
Extrinsic motivators were along the lines of being a role model and having decreased stigmatization or feeling more accepted (heart breaking, in all honesty).
Intrinsic motivators were along the lines of the desire to improve their health, having a better self image and having stronger self-confidence.
What was also interesting was in the intrinsic motivator category, the idea of self reinvention was commonly mentioned. Folks consistently felt like they had reinvented themselves. They lived much different lives now after weight loss and the enjoyment of their new life was an important motivator.
Goal Setting — Continued goal setting was a theme that also commonly occurred. This was broken into two subcategories.
Externally defined goals were beneficial, but not as important for success. This could be guided goals from your health care practitioner or an upcoming althletic event.
Self-defined, personal goals were more important and showed up more frequently. This would include clearly defined activity goals. Helping the weight loss maintainers to train more consistently, engage in more general physical activity and maintain stronger movement habits.
This also included specific eating goals. Whether it was meal centric, calorie centric or food group centric. Having eating goals that were conducive to the goal and achievable showed up consistently.
One final point was the mentioning of having highly personalized goals that were also adjustable with life was deemed important to increase success and have a sense of autonomy.
Enduring Challenges
The ability to endure the challenges that threatened weight loss maintenance was a crucial component to weight loss maintenance success. This was also broken into two subcategories.
Intrinsic challenges would consist of enduring the struggles of unforeseen events (death, divorce etc) without reverting back to old patterns. As well as enduring the drive to emotionally regulate with food. This could be to cope with sadness or even just boredom. Enduring the drive to fall back into that pattern was commonly seen in weight loss maintainers.
Extrinsic challenges would consist of being able to endure the struggles of holidays and celebrations without having it spiral into old behaviours. Being able to deal with work and personal stress and even overcoming unsupportive peers. We have all been there where one our peers is pressing us to go against our goals (I can admit, I’ve been on both sides of this equation).
Overall Experience
This is the last key component.
Encouraging experiences such as feeling like you had developed a new identity and perhaps even cultivated new community was consistently mentioned in the maintainers.
While being reminded of discouraging experiences also was consistent. This could be the fear to regain the weight or the fear of being criticized by their peers for their actions. An example is choosing not to drink and a peer being unsupportive and criticizing you for “being no fun”. Being able to endure that is challenging but can be quite important depending on your peer groups.
A larger list can be seen below.
Summary & Takeaways
There is a lot to be taken away from this paper, but I’ll try to keep this part short.
I think this paper just highlights how much work needs to be put into the goal after the goal. If you want to lose weight and keep it off, this will be something you’ll have to work to maintain indefinitely.
This only gets magnified when we look at weight regain statistics and all of the obstacles we need to overcome in the process.
The work is not done when you achieve the goal.
Similar to the work you put in to achieve a promotion.
Sure, it may be a grind. But once you achieve the promotion, you can’t just mail it in and stop working.
There is a level of effort that needs to be maintained in order to keep your progress. If you don’t respect this, you can fall right back into old habits much faster than you built your new ones.
This is why you need to plan for longevity when you’re aiming to lose weight and keep it off. This may involve some self reinvention, engaging with new communities, planning ahead of time and continuing to monitor your behaviour indefinitely.
This is not a sexy idea to sell, but let’s respect the process of people who managed to maintain significant weight loss while in an ocean of weight loss relapse statistics.
Cheers🍻
-Coach Dylan
References
1. The Metabolic Adaptation Manual: Problems, Solutions, And Life After Weight Loss
https://www.strongerbyscience.com/metabolic-adaptation/
2. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight
https://pubmed.ncbi.nlm.nih.gov/18842775/
3. Biology’s response to dieting: the impetus for weight regain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174765/
4. Role of leptin in energy expenditure: the hypothalamic perspective
https://pubmed.ncbi.nlm.nih.gov/28356295/
5. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake
https://pubmed.ncbi.nlm.nih.gov/31105044/
6. Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review
https://www.tandfonline.com/doi/full/10.1080/17482631.2020.1862481
7. [The mediocre results of dieting]
https://pubmed.ncbi.nlm.nih.gov/23859104/