Have you ever wondered what it takes to maintain the weight you’ve lost long term? A systematic review by Varkevisser and colleagues in 2019 aimed to answer this question.
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The literature was searched for studies that sought to understand the factors that influence long term weight loss maintenance. Sixty-seven studies met the inclusion criteria and were used to systematically review the factors that influence weight loss.
Factors that affected energy intake and expenditure (e.g., portion control, fewer sugar-sweetened drinks, increased exercise) were found to be beneficial for weight loss maintenance. Other factors like self-monitoring of behaviour and self-belief appear to have an indirect effect on weight loss maintenance. Interestingly, demographic, and environmental factors (e.g., age, sex, socioeconomic status) appeared to have inconclusive effects on weight loss maintenance.
The authors conclude that factors that affect behaviour change relating to energy balance may be most important in weight loss maintenance. Future research should investigate self-efficacy or self-belief and the effects of this on long term weight loss maintenance.
Obesity remains a global burden with excess body fat being associated with many disease conditions like type 2 diabetes, cardiovascular disease, hypertension, etc (1). Studies show that weight loss of 5% can lead to clinically significant health improvements (2). However, during efforts to lose weight, only 2% of individuals seem to be successful in keeping off the initial weight lost (3). Understanding why individuals are unable to maintain weight loss will help guide future interventions to provide more sustainable weight loss interventions. To this end, Varkevisser and colleagues published their research investigating the determinants of weight loss maintenance for overweight and obese individuals (4).
The authors systematically reviewed the literature for papers published between 2006 and 2016. They included longitudinal studies (with a follow-up of at least a year) involving weight loss or weight loss maintenance in obese and/or overweight individuals (as classified by the WHO guidelines). All included studies were assessed for methodological quality as done previously. Studies that looked at demographic, psychological, behavioural, cognitive, and environmental factors in relation to weight loss maintenance were included.
A total of 67 articles made it through selection – from which the authors identified 124 possible determinants of weight loss maintenance. The figure below, taken from Varkevisser et al.4 shows which determinants were significant in predicting weight loss maintenance. The authors found that behavioural and cognitive factors that promote a reduction in energy intake and an increase in energy expenditure were predictive of successful weight loss maintenance. Additionally, behaviours that involve monitoring of weight, eating and exercise may indirectly affect weight loss maintenance. Another factor that seems to indirectly affect weight loss maintenance is self-efficacy or the self-belief that you can achieve the goal you’ve set for yourself. The authors hypothesise that interventions should focus on improving self-efficacy which could help change necessary eating and exercise behaviours. This is an area for future research.
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Figure 1: taken from Varkevisser et al. (2019)
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Other factors like age, sex, and socioeconomic status did not have conclusive evidence to suggest any influence on maintaining weight loss. Previous levels of physical activity and diet also appeared to have inconclusive effects. This leads the authors to believe that factors relating to behaviour change may be more important in weight loss maintenance.
The authors aimed to draw conclusions based on a determined level of evidence. They determined strong enough evidence to be an effect that occurs in >75% of the included studies. This is an arbitrary cut-off and may fail to account for methodological quality of the studies included. For example, if 5 out of 10 studies show an effect but those 5 studies were of a higher quality than the 5 that didn’t. There is an argument that there is a decent level of evidence to suggest an effect despite only 50% of the studies showing this. This means some of the factors that were found to be inconclusive or have no effect may have an undetected effect. Beyond this, the authors also highlight the variety of methods used to research weight loss maintenance and its determinants which makes it difficult to compare studies and draw robust conclusions.
To conclude, the authors suggest that weight loss maintenance is not completely reliant on demographic background but more so on behavioural factors that affect energy balance activities (e.g., exercise and eating). It also appears that self-efficacy (or self-belief) toward eating and exercising for weight loss and further maintenance should be of greater focus for future research.
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- Kopelman PG. Obesity as a medical problem [Internet]. Vol. 404, Nature. 2000 [cited 2023 Mar 2]. p. 635–43. Available from: https://www.nature.com/articles/35007508/briefing/signup/?originReferralPoint=EmailBanner
- Magkos F, Fraterrigo G, Yoshino J, metabolism CLC, 2016 undefined. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Elsevier [Internet]. [cited 2023 Mar 2]; Available from: https://www.sciencedirect.com/science/article/pii/S1550413116300535
- Wing R, nutrition SPTA journal of clinical, 2005 undefined. Long-term weight loss maintenance–. academic.oup.com [Internet]. [cited 2023 Mar 2]; Available from: https://academic.oup.com/ajcn/article-abstract/82/1/222S/4863393
- Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Obes Rev [Internet]. 2019 Feb 1 [cited 2023 Feb 24];20(2):171–211. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uct.ac.za/30324651/