Successful Weight Loss Maintenance

Psychological Factors Influencing Weight Loss Maintenance: An Integrative Literature Review

Ohsiek S, Williams M.
J Am Acad Nurse Pract. 2011;11:592-601

Study Summary

Background. It is well recognized that most individuals who lose weight are unable to maintain that weight loss. However, the lack of evidence about the factors that cause this regain is surprising. The purpose of this study was to review the available literature to try and identify the factors that are most consistently linked with weight regain and propose strategies to assist patients to maintain their success.

Methodology. An electronic search identified studies of patients whose weight loss had been achieved through behavior modification and who were then followed for the subsequent 12-18 months. Included studies were determined to have good methodological rigor and relevant data.

Results. The literature on factors potentially contributing to weight regain were examined and clustered into 8 categories:

Unrealistic weight loss expectations -- studies were mixed and it cannot be concluded that this issue is a consistent predictor of weight regain.
Failure to achieve weight loss goals -- satisfaction with one's initial weight loss was identified to be an important factor. Those able to reach their goal weight or, alternatively, those who were satisfied with their weight loss even if it was less than their original goal were more likely to maintain this loss.
Dichotomous thinking -- this is defined as a "black or white" thinking pattern that leads to difficulty in accepting anything less than the original goal. This type of thinking pattern was strongly predictive of unsuccessful weight maintenance.
Eating to regulate mood -- another strongly predictive factor identified in this review was use of food to relieve emotional distress.
Disinhibition vs dietary restraint -- higher levels of disinhibition, which led to more uncontrolled eating, were associated with weight regain. In contrast, those able to maintain weight loss were better able to exercise restraint in their eating.
Perceived cost vs benefit -- individuals able to successfully maintain weight loss continue to find that the benefits of weight loss, whether defined as improved appearance, better health, or some unique combination of benefits, outweighed the perceived costs of weight maintenance strategies such as regulation of diet or exercise.
Depression -- although depression has clearly been linked to obesity, its relationship to successful weight loss maintenance is less clear. Baseline depression was not necessarily a factor, but increasing levels of depression over the time of weight maintenance did predict regain.
Body image -- no surprise, individuals who were more satisfied with their appearance, with steady improvement in body image throughout the time period studied, were more likely to maintain their weight loss.

Viewpoint

This very nice review may not offer the one-size-fits-all key to helping patients maintain weight loss, but it does offer a number of insights that may help nurses in counseling their patients. Although many of the included studies were small and had similar limitations, most notably a lack of diversity in the populations studied, in aggregate they offer some potentially helpful strategies. Although it is likely beyond the scope of practice for most nurses to engage in cognitive behavioral therapy or counseling, the researchers provide some insights for nurses working with patients who are trying to lose weight or maintain a weight loss. Assessing for and observing self-defeating behaviors, and helping patients to be aware of behaviors that they may not even recognize in themselves, may be effective. Emphasizing the benefits of weight loss (even if less than hoped for) should be routine. Monitoring patients for rising levels of depression using readily available tools such as the Beck Depression Inventory should be incorporated into follow-up. A number of factors associated with unsuccessful weight maintenance are the same as those seen in patients with binge eating disorder. Nurses should therefore screen patients appropriately for this potentially serious eating disorder. The findings from this study won't guarantee successful weight maintenance; however, they are very likely to help with the often frustrating transition from diet to lifestyle.

Abstract

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