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Lifestyle Management of Adult Obesity

Weight Loss Maintenance

Studies of weight loss maintenance suggest few people who lose weight over 3-12 months are “successful.” One problem is the non-standardized definition of “successful” weight loss. Using a strict definition of maintaining 100% of weight loss for four years, Kramer et al. reported that only 0.9% and 5.3% of women were successful. [73] Other studies using 5 kg or greater weight loss maintenance at 5 years suggest that between 13% and 22% of patients are successful. [74] [75] Wing and Hill have proposed that clinical studies may underestimate the true prevalence of weight loss maintenance because they are based on only one episode of weight loss and may not be representative of the general population as most people who lose weight do so on their own. [76]

Wing and Hill in 1994 founded the National Weight Control Registry (NWCR), a retrospective study to investigate weight maintenance strategies of successful weight losers. [76] To be eligible for the registry, persons maintained a 30-lb weight loss or greater for at least 1 year. After recruitment, subjects completed several questionnaires about background, weight history, quality of life, risk factors, and weight loss and weight maintenance behaviors. Although this study is retrospective and dependent on self-reports, the NWCR provides useful information about effective strategies used by persons who have successfully lost and maintained a significant amount of bodyweight. Presently there are over 3000 subjects in the registry (80% women). [76] Average age is 45 years, average weight loss is 30 kgs and the average duration of weight maintenance is 5.5 years. [76] Ninety percent of the subjects have been unsuccessful with weight loss in the past and 50% were overweight as children. [76] Nine of ten report modifying both diet and exercise to achieve successful weight loss. [76]

Three strategies were common to nearly 90% of the NWCR participants:

1. consuming a diet low in fat and high in carbohydrate
2. frequent self-monitoring
3. regular physical activity. [76]

A few specific findings from the NWCR are summarized below:

• low calorie diet of on 1381 kcal/day on average
• 24% fat, 19% protein, and 56% carbohydrate calories
• < 1% of participants consumed a low carbohydrate diet
• the few who did eat < 24% carbohydrate calorie diets maintained their weight for less time and were less physically active
• consumed ~5 meals per day, ate at fast food restaurants only 1x/week, and 2.5 meals per week at other restaurants
• 3 in 4 participants weighed themselves either daily or weekly
• most participants monitored their dietary intake regularly, particularly if they noted more than a couple lbs of weight gain
• 91% of the registrants used exercise to assist them with weight maintenance
• women averaged 2545 kcals/wk and men 3293 kcals/wk in physical activity; this is equivalent to walking 20-30 miles per week
• most increased both lifestyle activity and regular structured exercise
• 77% of registrants used walking as their main form of exercise
• 1 in 5 engaged in weight training
• among those who regained weight, they increased fat intake, decreased physical activity by an average of 800 kcals/wk, and reduced the amount of self-monitoring activities

The results of this ongoing retrospective study are encouraging and immensely important to clinical practitioners and their clients who desire to lose and maintain weight loss. These results were shared with the client to reinforce the strategies that were developed and implemented to successfully achieve and sustain her weight loss goal.