Successful Long‐term Weight Maintenance: A 2‐year Follow‐up

Abstract

VOGELS,NEELTJE AND MARGRIET S. WESTERTERP-PLANTENGA. Successful long-term weight maintenance: a 2-year follow-up. Obesity. 2007;15: 1258 -1266. Objective: To find factors associated with successful weight maintenance (WM) in overweight and obese subjects after a very low-calorie diet (VLCD). Research Methods and Procedures: Subjects (133) followed a VLCD (2.1 MJ/d) for 6 weeks in a free-living situation. Of these, 103 subjects (age, 49.6 Ϯ 9.7 years; BMI, 30.9 Ϯ 3.8 kg/m 2 ) completed the following 2-year WM period. Body weight (BW), body composition, leptin concentration, attitude toward eating, and physical activity were determined right before (t0) and after (t1) the VLCD, after 3 months (t2), after 1 year (t3), after 1.5 years (t4), and after 2 years (t5). Results: BW loss during VLCD was 7.2 Ϯ 3.1 kg. After 2 years, follow-up BW regain was 69.0 Ϯ 98.4%. After 2 years of WM, 13 subjects were successful (Ͻ10% BW regain), and 90 were unsuccessful (Ͼ10% BW regain). At baseline, these groups were significantly different in BMI (33.7 Ϯ 4.7 vs. 30.5 Ϯ 3.5 kg/m 2 , respectively; p Ͻ 0.05) and fat mass (38.3 Ϯ 9.8 vs. 32.1 Ϯ 8.3 kg, p Ͻ 0.05). Successful subjects increased their dietary restraint significantly more during the whole study period (dietary restraint score, Ϫ4.9 Ϯ 4.4 vs. Ϫ2.1 Ϯ 3.8). Furthermore, %BW regain was associated with the amount of percentage body fat lost during VLCD, which indicates that the more fat lost, the better the WM, suggesting a fat free mass-sparing effect. Discussion: Characteristics such as the ability to increase dietary restraint and maintain this high level of restraint, fat free mass sparing, and a relatively high baseline BMI and fat mass were associated with successful long-term WM (Ͻ10% regain after 2 years).

Human Biology of Weight Maintenance after Weight Loss

“…A high baseline BMI, waist circumference or fat mass indicated a lower weight regain 1 year after weight loss by a very low-calorie diet (VLCD) as reported by Vogels and Westerterp-Plantenga [10]. Even after 2 years, a high baseline BMI and fat mass were still associated with <10% weight regain [11,12], which was confirmed in another study [13]. Also, the percentage of body fat lost during the VLCD was found to be negatively associated with the percentage of body weight regain [11].…”

Peripheral neuropeptide Y Y1 receptors regulate lipid oxidation and fat accretion

“…Most importantly from a clinical perspective, peripheral Y1-receptor knockdown protected against high fat diet-induced increases in body weight and total adiposity in the absence of effects on lean mass or inguinal fat mass. As preservation of lean mass and inguinal fat during loss of excess adiposity is desirable because of known beneficial effects of these tissues on metabolic rate and disease risk, [54][55][56][57][58] and as these benefits could be achieved without the need to deliver Y1 antagonists to the brain, this finding has significant implications for the pharmacological management of obesity. The increased fat oxidation seen in Y1-deficient mice is likely mediated by increased capacity for fatty acid transport into mitochondria and increased b-oxidation.…”

Behavioural factors related with successful weight loss 15 months post-enrolment in a commercial web-based weight-loss programme

“…Eating patterns play an important role in long-term weight-loss success, with higher levels of dietary restraint and lower levels of emotional eating associated with maintenance of lost weight (40,(43)(44)(45)(46) . The results from our study are consistent, demonstrating that for each 1 point increase in the emotional eating score, the likelihood of being successful decreased by 16 %, whereas for each 1 point increase in restraint score the likelihood of being successful increased by 18 %.…”