Trying to answer the question of what really sets individuals who achieve successful, substantial long-term weight-loss maintenance apart has become my calling in life as both a clinician and researcher. Having worked with patients to help them achieve significant, sustainable weight loss over the past nine years has taught me an incredible amount about the personal struggles and challenges my patients go through on their journeys.
I was very fortunate to get a chance to do my PhD under the supervision of Prof.Dr. Jaap Seidell and Dr. Jutka Halberstadt who are both experts in this field. We recently published our systematic review looking into the experience of successful, substantial long-term weight-loss maintenance from the perspectives of individuals who had achieved this to gain a comprehensive picture of what sets their experience apart. We included the accounts of 294 individuals who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight. This analysis enabled us to create a comprehensive framework for healthcare practitioners (HCPs), which can be utilised when trying to devise evidence-based treatment strategies for patients to help them both achieve and maintain their weight loss long-term.
Our findings included the following:
• Continuous monitoring: The theme of continuous monitoring was the most consistently mentioned topic throughout all studies. Particularly self-monitoring including exercising portion control, tracking calories and foods, meal planning and pre- planning for events, visual reminders, relapse protocols and regular weighing were potent tools utilised by successful participants. External support from HCPs, weight loss groups, friends and family also encouraged participants to remain focused.
• Motivation: Both intrinsic and extrinsic motivators were strong, underlying drivers that encouraged participants to stay on track. Participants were highly motivated to improve their health, self-image and confidence. They were also motivated to improve their social opportunities both at work and on a personal level. External motivators included improving their sense of belonging as well as social standing and career opportunities. The wish to experience less stigmatization and to become a role model were also motivational drivers.
• Goal Setting: Having clear, self-defined, personalised goals as well as externally defined goals were important factors that enhanced long-term success. Self-defined goals ranged from diverse activity goals to eating goals and were continuously re-assessed and re-adjusted to ensure their suitability and applicability. Externally defined goals included HCP defined goals, weigh loss club goals and sports events participants prepared for.
• Enduring challenges: This is a very important area to consider in context with weight loss maintenance. Participants consistently highlighted both intrinsic and extrinsic challenges they were confronted with on a continuous basis. Intrinsic challenges included stress, a lack of time to plan and engage in health seeking behaviours and life events like pregnancy, illness and injury. Social isolation, an over-reliance on the support system, a lack of daily structure, unforeseen life events like the death of a loved one and being confronted with trigger foods also posed continuous threats to maintenance. External challenges included increased stress at work and stress brought on by peers including relationship changes, sabotage by unsupportive peers as well as trying to conform to cultural norms. Holidays and celebrations were also daunting due to a loss in routine and the omnipresence of the obesogenic food environment was also a daily, continuous threat to their success.
• Overall experience: The overall experience was both encouraging and discouraging at times. Participants spoke of feeling liberated and having found a new identity. They felt that they had reinvented themselves and found their purpose in life, which brought with it new communities and opportunities. Some, however, felt isolated, lonely and excluded from previous communities and were frequently criticised for their new life choices by peers. They felt frustrated because they couldn’t go back to their previous behaviours and lifestyle and continuously feared regain and a return to their previous reality.
This clearly highlights that, even though achieving sustainable weight loss can be complex and challenging, it is achievable and the support and guidance HCPs can provide is invaluable. Keeping in mind particularly the positive, potentially life changing accounts from patients who have achieved sustainable weight loss, this study shows just how important our role can be.
This article was written by Marie Spreckley who is the Director of Nutrition and Health at Versa Heath, a senior nutritionist in the NHS and a PhD candidate at the Vreje University Amsterdam. She is passionate about helping her patients achieve sustainable weight loss and optimal health. Marie has a Master of Science in Obesity and Weight Management (MSc), a Master of Business in International Business (MBus), is an Association for Nutrition (AfN) registered nutritionist (ANutr), a European Mentoring and Coaching Council (EMCC) certified life coach, a Barre Concept instructor and a certified personal trainer. Her research interests center around sustainable weight loss and lifestyle behaviour change.You can find Marie on Instagram @marie_spreckley and twitter @mariespreckley.
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