10 proven strategies to help patients maintain weight loss

,

Applied Evidence

10 proven strategies to help patients maintain weight loss

J Fam Pract. 2020 January;69(1):20-25

By

Marijane Hynes, MD

Patients’ chances of keeping off weight long-term improve with evidence-based interventions, such as a sound diet, more exercise, and attention to more thoughtful eating habits.

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PRACTICE RECOMMENDATIONS

› Encourage patients to lose more weight early in their effort, which is predictive of successful long-term maintenance. B

› Support patients’ efforts to maintain weight loss by encouraging them to consume fewer calories and eat more nonglycemic fruits and vegetables A, eat at home and avoid processed foods B, work with you in addressing mental health concerns B, and increase time spent exercising A.

› Consider the potential value of prescribing a US Food and Drug Administration–indicated medication for weight maintenance. B

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

References

1. Thomas JG, Bond DS, Phelan S, et al. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014;46:17-23.

2. Weiss EC, Galuska DA, Kettel Khan LK, et al. Weight regain in U.S. adults who experienced substantial weight loss, 1999–2002. Am J Prev Med. 2007;33:34-40.

3. Look AHEAD Research Group. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374-1383.

4. Kulovitz MG, Kolkmeyer D, Conn CA, et al. Medical weight loss versus bariatric surgery: does method affect body composition and weight maintenance after 15% reduction in body weight? Nutrition. 2014;30:49-54.

5. Look AHEAD Research Group. Eight‐year weight losses with an intensive lifestyle intervention: The Look AHEAD study. Obesity (Silver Spring). 2014;22:5-13.

6. Bertoia ML, Mukamal KJ, Cahill LE, et al. Changes in intake of fruits and vegetables and weight change in United States men and women followed for up to 24 years: analysis from three prospective cohort studies. PLoS Med. 2015;12:e1001878.

7. Shukla AP, Iliescu RG, Thomas CE, et al. Food order has a significant impact on postprandial glucose and insulin levels. Diabetes Care. 2015;38:e98-e99.

8. Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30:67-77.e3.

9. An R. Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in US adults. Eur J Clin Nutr. 2016;70:97-103.

10. Larsen TM, Dalskov S-M, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363:2102-2113.

11. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015;101:1320S-1329S.

12. Leidy HJ, Ortinau LC, Douglas SM, et al. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013;97:677-688.

13. Bendtsen LQ, Lorenzen JK, Larsen TM, et al. Associations between dairy protein intake and body weight and risk markers of diabetes and CVD during weight maintenance. Br J Nutr. 2014;111:944-953.

14. Jacques PF, Wang H. Yogurt and weight management. Am J Clin Nutr. 2014;99(5 suppl):1229S-1234S.

15. Kjølbæk L, Sørensen LB, Søndertoft NB, et al. Protein supplements after weight loss do not improve weight maintenance compared with recommended dietary protein intake despite beneficial effects on appetite sensation and energy expenditure: a randomized, controlled, double-blinded trial. Am J Clin Nutr. 2017;106:684-697.

16. Reynolds A, Mann J, Cummings J, et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019;393:434-445.

17. Butryn ML, Phelan S, Hill JO, et al. Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring, Md). 2007;15:3091-3096.

18. Lee S, Lindquist R. A review of technology-based interventions to maintain weight loss. Telemed J E Health. 2015;21:217-232.

19. 2018 Physical Activity Guidelines Advisory Committee, US Department of Health and Human Services. Physical activity guidelines for Americans. 2nd ed. Washington, DC: US Department of Health and Human Services; 2018. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. Accessed January 13, 2020.

20. Shultz SP, Byrne NM, Dahiya MR, et al. Resistance weight training affects body composition in obese adolescents: a pilot study (Abstract 2932; Board #231). Med Sci Sports Exerc. 2011;43:834.

21. Ross KM, Graham Thomas JG, Wing RR. Successful weight loss maintenance associated with morning chronotype and better sleep quality. J Behav Med. 2016;39:465-471.

22. Khera R, Pandey A, Chandar AK, et al. Association of weight loss medications with cardiometabolic risk factors: systematic review and network meta-analysis. Circulation. 2016;134(suppl 1):A16413.

23. Verma RS, Poulter NR, Bhatt DL, et al. Effects of liraglutide on cardiovascular outcomes in patients with type 2 diabetes mellitus with or without a history of myocardial infarction or stroke: post hoc analysis from the LEADER trial. Circulation. 2018;138:2884-2894.

24. Cleo G, Glasziou P, Beller E, et al. Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial. Int J Obes (Lond). 2019;43:374-383.

25. Robertson S, Davies M, Winefield H. Positive psychological correlates of successful weight maintenance in Australia. Clinical Psychologist. 2017;21:236-244.

26. Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ. 2018;361:k1951.

27. Agarwal SM, Ahsan Z, Lockwood J, et al. A systematic review and meta-analysis of pharmacological interventions for reduction or prevention of weight gain in schizophrenia (poster). Schizophr Bull. 2018;44:S413.

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29. Jorge R, Santos I, Teixeira VH, et al. Does diet strictness level during weekends and holiday periods influence 1-year follow-up weight loss maintenance? Evidence from the Portuguese Weight Control Registry. Nutr J. 2019;18:3.

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New studies show that many people who lose weight can maintain that loss for longer than a few months by utilizing strategies that can be undertaken upon your recommendation and with your ongoing support. In this article, I review the evidence that supports the effectiveness of those interventions and activities for helping patients keep off the weight they’ve lost.

Prolonging the duration of weight maintenance

Until recently, most studies that focused on weight maintenance after weight loss followed subjects for only a few months or a year after the goal was achieved. With that limited window of follow-up, the belief arose in weight-loss medicine that most people gain back lost weight within 2 years. Findings that are emerging from recent studies with longer follow-up, however, suggest that weight loss can be maintained for as long as 8 years.¹

The National Health and Nutrition Examination Survey² and the Action in Health for Diabetes (Look AHEAD) trial^3,4reported that, among adults who lost 10% or more of body weight, approximately 60% maintained that weight loss at 1 year. Look AHEAD had a much longer duration: 42% of participants who lost at least 10% of body weight by the end of Year 1 maintained at least that 10% loss by the end of Year 4.⁵ In addition, Look AHEAD demonstrated that extended provision of maintenance interventions after weight loss can facilitate clinically meaningful weight loss for as long as 8 years—2 or 3 times longer than what was reported in earlier randomized trials.⁴

We have evidence-based guidance for achieving long-term weight maintenance and good reason to believe that success is achievable for patients. The 10 strategies that follow can help you to guide patients to become successful “maintainers.”

^{IMAGE: @JOE GORMAN}

1. Emphasize more weight loss in the first 3 months of a program

Losing more weight initially seems to point to more success in relation to maintenance. This suggests that more intensive help, such as more frequent visits with a physician and a dietitian during the first 3 months might be an important step to help patients lose and maintain weight.

These 10 strategies can help guide patients to become successful "maintainers."

Much of our information on successful maintainers comes from the National Weight Control Registry (NWCR) at the Warren Alpert Medical School at Brown University.¹ This research study has gathered information from more than 10,000 people who successfully lost ≥ 30 lb (average, 60 lb) and kept it off for at least 1 year. To challenge the widespread belief that only a few people who attempt weight loss succeed long term, the NWCR identifies and investigates the characteristics of individuals who have succeeded.

A new and encouraging finding is from a small study that showed that people can maintain weight loss brought about by either medical or surgical means: Those who lost > 15% of their starting weight and were followed closely by health care professionals maintained their weight loss at 1 year.⁵

Continue to: 2. Advise patients to consume fewer calories and eat more nonglycemic fruits and vegetables