'Micro-Strategies' May Help Maintain Weight Loss Long Term

Liam Davenport

January 23, 2020

Behavioral and psychological strategies such as setting daily goals, maintaining a positive mindset, and thinking about past successes may be the key to maintaining weight loss long term among participants of commercial weight management programs, suggests a new US study.

Suzanne Phelan, PhD, and colleagues studied over 4500 successful weight loss maintainers who had used WW International (formerly Weight Watchers). Phelan has reported receiving a research grant from WW International.

The study, published online January 23 in Obesity and supported by WW, showed that, compared with over 500 obese individuals with stable weight, weight loss maintainers were more likely to use a variety of self-monitoring and psychological coping strategies.

They were also more willing to ignore food cravings and had stronger habits towards healthy eating, say the researchers, who also found that weight loss maintainers had better quality of life.

Phelan, of California Polytechnic State University, San Luis Obispo, and coauthors say the results reveal a series of key strategies for successful weight loss maintenance with commercial weight management programs.

These include "setting daily intake goals, recording daily intake, measuring foods, thinking about past successes, and remaining positive in the face of weight regain."

They add that future research "should consider emphasizing these components in development of effective weight maintenance programs."

Understanding the Role Micro-Behaviors Play

Although the central pillars of weight control — a lower calorie diet, high levels of physical activity, and frequent self-monitoring — are related to the degree and duration of weight loss, the role of micro-behaviors, such as setting daily goals, combating negative thoughts and keeping healthy foods visible, is less well understood, say Phelan and colleagues.

With up to 15% of individuals seeking to lose weight through commercial weight management programs, the researchers sought to identify novel behavioral and psychological strategies among weight loss maintainers using such programs.

The team identified adults from the WW Success Registry who had maintained weight loss of at least 9.1 kg (20 lb) for a year or more, alongside a control group of people with a body mass index (BMI) of at least 30 kg/m2 whose weight had been stable for 5 years or more.

A total of 4781 WW participants completed a weight control strategies questionnaire. They were an average age of 53.9 years, had a mean BMI of 27.6 kg/m2, and most were white (94.5%).

Participants had maintained an average 23.8% weight loss for 3.3 years.

In addition, 665 weight-stable obese individuals completed the questionnaire and were used as the control group. They were a mean age of 48.5 years, had a mean BMI of 38.9 kg/m2, and 83.9% were white.

Individuals in the control group were more likely than weight loss maintainers to be employed, although they were also more likely to be less educated, nonwhite, male, younger, and had a lower income, all factors that were taken into account in the analyses.

"Novel" Relationship: Weight Control Strategies, Habit Strength, QoL

Researchers found that weight loss maintainers were more likely than controls to make healthy dietary choices, at mean scores of 3.3 versus 1.9 (P = .0001).

They were also more likely to use self-monitoring and psychological coping strategies than controls, at mean scores of 2.6 versus 0.7 and 2.5 versus 1.1, respectively (P = .0001 for both).

In addition, weight loss maintainers reported a greater willingness to ignore food cravings than controls, at mean scores of 4.4 versus 3.5, and had greater habit strength towards healthy eating, at mean scores of 5.3 versus 3.2 (P = .0001 for both).

The researcher team calculates that healthy dietary strategies, self-monitoring, psychological coping strategies, and habit strength for healthy eating were independent contributors to the between-group differences, accounting for 49.5% of the variance in scores.

The results also indicate that weight loss maintainers had significantly higher quality of life scores on the Food Craving Acceptance & Action scale than controls and were more likely to make an effort to maintain their current weight (P = .0001 for both).

Describing the relationship between weight control strategies and habit strength and improved quality of life as "novel," the team says it "may serve as a motivator for continued weight loss maintenance."

However, they caution that the study is limited by its cross-sectional nature and the potential lack of generalizability to other commercial programs and more socioeconomically or ethnically diverse populations.

"The practical implications of the current study's findings are to highlight some key strategies that most characterized successful weight loss maintainers in a large, commercial weight management program," they reiterate.

"Future research should consider emphasizing these components in development of effective weight maintenance programs," they state.

Obesity. 2020;28:421-428. Full text

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