In their own words: Topic analysis of the motivations and strategies of over 6,000 long‐term weight‐loss maintainers

Abstract

Objective This study aimed to identify major themes of a large cohort experiencing long‐term weight‐loss maintenance who answered open‐ended questions about weight‐loss triggers, current motivations, strategies, and experiences. Methods Machine learning and topic modeling were used to analyze responses to six open‐ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight‐loss maintenance; inclusion criteria included ≥9.1‐kg loss with weight‐loss maintenance for ≥1 year. Results Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/m2) had lost 24.5 kg and maintained the loss for 3.4 years. Descriptions of factors triggering weight loss coalesced into five topics: medical status, appearance, mobility, social prompts, and change needed. Factors currently motivating weight‐loss maintenance yielded two topics: looking back at experiences at higher weight and health/appearance concerns. Advice for others to succeed in weight‐loss maintenance coalesced on two recommendations: perseverance in the face of setbacks and consistency in tracking. Rewards for weight management included improved confidence, pain, mobility, fitness, body image, medical status, and affect. Two thematic negative consequences were clothing costs and sagging skin. Conclusions Future weight‐maintenance research should include more diverse populations and investigate weight‐loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight‐maintenance journey.

Recovery from weight regain among long‐term weight loss maintainers in WW

“…The most common reason for initiating efforts to lose regained weight by both the Gain–Lose group and Gain group was health concerns. Medical reasons are also one of the most common triggers for losing weight initially in weight loss maintainers and they are often associated with better long‐term weight maintenance [12, 23, 24]. Individuals have also been shown to shift their motives while in weight loss maintenance more toward health and well‐being [25], perhaps owing to observed physical benefits of a lower weight and/or the greater potential for disease as one ages [26].…”

“…The current study extends these findings to indicate that health issues are also a trigger for reengagement in weight loss following regain. The second most common reason for taking action to reverse weight gain was noticing clothes were fitting tighter, which was previously reported as a motivator to initiate weight loss among WWSR members [12]. Clothes may serve as a physical indicator of sizeable weight regain that is more salient than the number on the scale.…”

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery

“…Helping them verbalize the reasons why they decided to have bariatric surgery may initially enhance their current motivational level for healthy living. Weight loss maintainers describe having unpleasant memories about how it was to live with obesity, and these memories can be targeted for high-quality motivation for sustaining behavior change ( 89 ). These negative preweight loss memories were primarily concerned with declining physical health as well as shame and embarrassment about body size and shape.…”

“…Practicing self-compassion in the context of weight maintenance may include acknowledging that loss of control and focusing on health behaviors is an inevitable part of long-term weight management ( 13 , 89 ). Having days or weeks where there is less focus on the quality and quantity of food consumed or time spent engaging in physical activity should be expected as a normal part of the human experience.…”

“…How one responds to the loss of focus on weight control behaviors appears to be critically important. Specifically, weight loss maintainers commonly suggested that having “perseverance” with behavioral effort and viewing loss of focus as a temporary setback rather than total defeat was beneficial ( 89 ). Moreover, rather than being self-critical, weight loss maintainers regained focus quickly—the next day when possible—by restarting self-monitoring behaviors.…”