Dieting Results Persist if Weight Maintenance Taught First

Steven Fox

October 30, 2012

It is an age-old challenge: How to keep weight off after shedding pounds on a successful diet.

Now researchers at Stanford University in Palo Alto, California, have come up with a promising new approach to that problem — one that seems to yield impressive results. The approach is based on the idea that maintaining weight loss may require a whole different set of skills than losing weight.

"Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive," Michaela Kiernan, PhD, from the Stanford Prevention Research Center in California, and colleagues write in an article published online October 30 in the Journal of Consulting and Clinical Psychology. "This randomized trial examined whether learning a novel set of "stability skills' before losing weight improved long-term weight management."

Dr. Kiernan and colleagues randomly assigned 267 overweight/obese women into 1 of 2 groups.

Women in the control group (n = 135) embarked immediately on a 20-week behavioral weight loss regimen centered on increased intake of fruits and vegetables, increased exercise, and maintaining food diaries. They also had a 90-minute weekly session with a group facilitator who helped the women learn problem-solving strategies for losing weight. At the end of the weight-loss period, they spent another 8 weeks using the same problem-solving approach with the group facilitator in an effort to learn how to maintain their now-lower weight.

The program for the women in the intervention group (n = 135) was essentially the same, except that before they started the 20-week weight loss program, they spent 8 weeks working with facilitators to learn "stability first" skills, including:

  • honing their abilities to search out low-fat and low-calorie foods — foods that taste good, satisfy their cravings for sweets, and help them avoid the feeling of deprivation when they started dieting;

  • learning how to treat themselves occasionally to small portions of high-fat, high-calorie foods;

  • weighing themselves daily to monitor how their body weight naturally fluctuates day-to-day;

  • identifying how their individual body weights tend to change ±5 pounds depending on fluctuations in water retention, as well as increased food intake during vacations and holidays

  • proactively experimenting with losing 5 pounds before anticipated water gain and vacations/holidays; and

  • proactively eating a bit more and gaining a little weight when they noticed their weight had edged down toward the lower limit of their personalized 5-pound weight range.

The researchers report that both the control and the intervention groups lost about the same amount of weight during the 28-week trial: 17 pounds on average.

However, the researchers found that compared with control patients who did not work on developing "maintenance skills" before dieting, those who did were more likely to keep the weight off during the next year.

When the women were weighed 1 year after the conclusion of the study, having had no contact with the facilitators during that time, women in the intervention group had gained back an average of only 3 pounds compared with 7 pounds in the control group.

Dr. Kiernan says in a university press release that the "maintenance first" approach may seem somewhat unorthodox, but she thinks it could be a valuable tool for people trying to lose weight and keep it off.

The researchers note a couple of limitations of the study: One is that no men were involved, and another is that the study did not include people who had reported binge eating.

Dr. Kiernan hopes to widen the focus of her study include a broader range of people and to follow up enrollees for periods extending beyond a year.

The study was funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

J Consult Clin Psychol. Published online October 30, 2012. Abstract