NIH working group report: Innovative research to improve maintenance of weight loss

Abstract

Objectives The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long-term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long-term weight control. Results Specific barriers to successful weight loss maintenance include poor adherence to behavioral regimens and physiological adaptations that promote weight regain. A better understanding of how these behavioral and physiological barriers are related, how they vary between individuals, and how they can be overcome will lead to the development of novel strategies with improved outcomes. Conclusions Greater collaboration and cross-talk between physiological and behavioral researchers is needed to advance the science and develop better strategies for weight loss maintenance.

Living a successful weight loss after severe obesity

“…Many terminate weight loss efforts in an early phase, and weight regain is frequent (Christiansen, Bruun, Madsen, & Richelsen, 2007; Knowler et al, 2009; Look AHEAD Research Group, 2014; Ryan et al, 2010; Thomas et al, 2014). This means that long-term maintenance of weight loss via lifestyle changes is possible, but difficult (Frühbeck, Toplak, Woodward, Halford, & Yumuk, 2014; MacLean et al, 2015). …”

Psychosocial predictors of decay in healthy eating and physical activity improvements in obese women regaining lost weight: translation of behavioral theory into treatment suggestions

“…Theoretical tenets of social cognitive [22] and self-efficacy [23] theory were supported. However, as has been the case with most weight management studies [8], behavioral changes and the resulting mean weight regain of only 0.6 kg over 2 years varied greatly between participants (SD = 4.6 kg).…”

“…Repeating a pattern of weight loss and regain might increase individuals' health risks [7]. Researchers suggest that weight loss maintenance differs considerably from weight loss and thus should be distinctly studied and addressed [8]. In a recent trial incorporating a yearlong, state-of-the-science behavioral weight management protocol directed primarily at reductions in energy intake [9], an initial weight loss of 9 % demonstrated a 91 % regain of baseline weight over the subsequent 3 years [10].…”

“…Because of the failure of this seemingly comprehensive protocol that was highly focused upon maintaining weight loss from its outset, along with the long history of behavioral treatments' association with weight regain [1-3], its developers questioned the merits of any further pursuits of such weight management interventions [10]. Although other researchers disagreed [11][12][13], it seemed clear that new and different approaches were needed.As a reaction to this and (a) a consensus that exercise is a primary predictor of maintained weight loss [6,14,15], (b) suggestions that the development of self-regulation prior to pursuing reductions in energy intake is advisable [8], (c) proposed behavioral models of the relationship between exercise and weight loss [11,16,17], and (d) indications that physical activity affects weight loss more through its impact on psychosocial predictors of controlled eating than energy expenditure [11], a novel experimental intervention was Implications Practice: Practitioners should expect a decay in healthy eating and physical activity after weight loss in many individuals and plan follow-ups to improve deteriorations in psychological predictors of those behavioral changes such as mood, emotional eating, self-regulation, and self-efficacy.Researchers: Future research is warranted to further evaluate methods in which decays in postbehavioral intervention eating and physical activity behaviors, that are expected for many individuals, might be improved in order to better-enable sustained losses in weight.Policymakers: Resources should be focused on scalable evidence-based methods designed to sustain behaviors that are consistent with maintaining loss of weight after behavioral intervention. …”

“…As a reaction to this and (a) a consensus that exercise is a primary predictor of maintained weight loss [6,14,15], (b) suggestions that the development of self-regulation prior to pursuing reductions in energy intake is advisable [8], (c) proposed behavioral models of the relationship between exercise and weight loss [11,16,17], and (d) indications that physical activity affects weight loss more through its impact on psychosocial predictors of controlled eating than energy expenditure [11], a novel experimental intervention was Implications Practice: Practitioners should expect a decay in healthy eating and physical activity after weight loss in many individuals and plan follow-ups to improve deteriorations in psychological predictors of those behavioral changes such as mood, emotional eating, self-regulation, and self-efficacy.…”