Losing weight is difficult, but maintaining a significant weight loss is harder.
Patients need better strategies to cope with normal weight fluctuations, including the confidence and motivation to keep trying.
People who successfully maintain long-term weight loss are usually physically active, avoid high-calorie foods, and monitor their weight at least weekly.
Patients lose weight using a wide range of strategies. Whether it’s “going keto,” adopting veganism, or resorting to old-fashioned calorie counting, there’s more than one way to reduce the number on the scale.
Unfortunately, one thing most weight losers have in common is the likelihood of putting it back on. Teaching patients to maintain a healthy weight for the long term is a challenge, but it can be overcome by the knowledge gained from decades of real-world experience. Here’s what we’ve learned so far about the quest to lose weight and keep it off.
What happens after losing weight
Regaining weight after losing it isn’t just a possibility, it’s typical, according to research. A meta-analysis of 29 studies found that within 5 years of substantial weight loss, people regained an average of 80% of the weight they lost. And in just 2 years, they put about half the weight back on.
Several factors contribute to these dismal statistics, including the obesogenic food environment, increased appetite after weight loss, and waning motivation when the momentum of weight loss inevitably stalls.
Many people operate under the misconception that obesity is cured by weight loss. But treating weight reduction as a state of remission rather than a permanent fix is a more pragmatic approach that can unlock the door to better outcomes. Clinicians can lead the way by promoting resilience and encouraging patients to focus on the big picture when setbacks happen.
A clinician’s role in weight management
Counseling patients as they’re sliding upward on the scale requires a tactful approach. It’s crucial to avoid blaming and further stigmatizing patients who may be losing hope, but you also don’t want to encourage ambivalence.
Clinicians must empower patients with insight for successful weight maintenance, telling them that it’s challenging but doable and helping them take control of their future without getting derailed. Fostering self-efficacy is necessary if you want patients to stay the course.
You can acknowledge their struggles without letting them fall into the trap of believing they are incapable of success.
Shifting your counseling from weight loss to weight maintenance requires new safeguards and supports. Unlike the frequent rewards in active weight loss (smaller clothes, lower numbers on the scale, blood pressure improvements, etc.), weight maintenance can feel like a thankless job to the patient. It’s easy to fall back into old habits and ignore gradual weight gain when you’re no longer receiving the same affirmation.
Patients graduating from weight loss to maintenance must be diligent about using regular weigh-ins to track continued progress. They should be informed that fluctuations are expected and be advised to focus on trends. Graphing weight changes is a good way to visually represent how far they’ve come.
Accountability to a healthcare provider or support group may also be essential for success, particularly within the first year. In addition, patients need to find a form of physical activity they enjoy and are willing to sustain. Finally, helping patients identify their deeper motivations to eat well and be active should help them look beyond short-term weight loss incentives.
Qualities of successful “maintainers”
It’s normal to expect some weight fluctuations, both during the weight loss phase and during weight maintenance. People who are successful over the long term are self-aware when their weight is increasing and take action to avoid excessive gains. They’ve learned to identify internal and external triggers and have strategies and resources to get back on track.
The National Weight Control Registry (NWCR) tracks people who have lost at least 30 pounds and kept it off for a year or more. Since its founding in 1994, the NWCR has collected data from over 10,000 people using questionnaires and annual surveys.
90% of maintainers exercise regularly
78% eat breakfast every day
75% weigh themselves at least once a week
62% watch less than 10 hours of television per week
On average, successful maintainers are active for an hour per day. Walking is the most commonly reported exercise. In addition, most follow a low-calorie and low-fat diet.
What this means for you
Most patients who lose weight will gain some of it back. You can help by reflecting on their achievements rather than their failures, in order to promote feelings of self-efficacy. Consistent monitoring, accountability, and sustainable habits are essential as people transition to maintenance.