In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing, so-called “toxic” environment, losing weight is hard work. But implementing a healthy and sustainable approach that keeps the weight off is even harder.
Short-term weight loss can be easier than long-term weight maintenance
Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious spiral of weight loss followed by regain. Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained. This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.
What is so special about weight loss maintainers?
Based on studies from the National Weight Control Registry, a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year, we have insight into some tried and true tactics. These include various energy intake-reducing behaviors — limiting calorie-dense foods and sugar-sweetened beverages, portion control and a consistent eating pattern across days, increased fruit and vegetable consumption — as well as being physically active for at least an hour per day.
This makes sense and is consistent across the scientific literature. Any successful weight loss necessitates tipping and keeping the scale toward greater energy expenditure and less energy intake (a net negative energy balance). But how do these people actually sustain those weight loss-promoting behaviors over time, in order to build a lifestyle that does not leave them feeling persistently deprived, lethargic, and hangry (hungry + angry)?
The most important determinants of weight loss maintenance are those that cement changes in behavior. As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.
Self-regulation and self-efficacy are key to long-term success
Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. We all have anecdotal evidence from family, friends, and colleagues. But systematically collecting, processing, and analyzing the qualitative experiences, strategies, and challenges from successful weight loss maintainers is difficult.
The data to date confirm the importance of self-regulation, and in particular self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors. Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss. And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.
One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles, and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained over 9 kilograms (about 20 pounds) of weight for at least a year. Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.
Studies about successful weight loss miss many people
The evidence suggests that age, gender, and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated, and midlevel income-earning females. Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need richer, more representative data to paint a full and inclusive picture of a successful weight loss psychology. We need to better understand the lived experience of all people so that we can determine the most powerful and unique motivations, effective behavioral strategies, and likely challenges and setbacks, particularly the environmental determinants that dictate the opportunities and barriers for engaging in and maintaining a healthier lifestyle.
Maintaining weight requires multiple tools, training, and support
What we can say for certain is that for any and all of us, maintaining weight loss necessitates getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods. This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences, and our genetic wiring. In order to help each other achieve health and weight loss in our modern environment, we need to learn and practice the psychological tools that help us not only accept, but eventually embrace, this inevitable discomfort.
About the Author
Richard Joseph, MD, Contributor
Dr. Richard Joseph is the founder of VIM Medicine, cofounder of Vital CxNs, a practicing clinician in the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston, MA, and a faculty member at Harvard … See Full Bio View all posts by Richard Joseph, MD