What Works for Long-Term Weight Control?

One of the greatest challenges for health professionals is helping overweight and obese patients or clients lose excess body fat stores and especially helping them keep off the weight they lost over the long term. This is true even when that excess weight is contributing to serious health problems such as insulin resistance, the metabolic syndrome, and type 2 diabetes mellitus (DM) and the patient/client is well informed that losing and keeping off those excessive body fat stores would likely eliminate the insulin resistance and largely cure (or fix) the metabolic syndrome and many cases of type 2 DM (1).In addition, we know weight loss can help reduce many CVD risk factors like high blood pressure, elevated serum triglyceride levels, and chronically elevated inflammation. We know obesity is associated with an increase of many types of cancer and it is likely losing excess weight and keeping it off cuts the risk of dying of cancer. Osteoarthritis is certainly promoted by excess weight and the increased inflammation associated with it too. Of course, nearly all health professionals are aware of this and certainly nearly every overweight person will be made aware of the negative health impacts of carry around too much body fat. And yet we know that most overweight people fail to lose it and even those who do succeed at losing excess weight usually fail to keep it off in the long-term (2).National Weight Control RegistryThis pattern led researchers to collect data on that small fraction of people who lost a lot of weight and then kept it off over the long term. Since 1993, the National Weight Control Registry (NWCR) has been gathering data on individuals who have had documented success at losing excess weight (at least 30 lbs) and then keeping most of the lost weight off for 5 or more years. More recently other countries (Greece, Finland, Portugal, and Germany) have started similar weight control registries with similar criteria. These weight control registries, where successful individuals are cataloged, provide data that may be helpful in better understanding the factors that impact weight loss and, more importantly, long-term weight loss maintenance (WLM).Researchers conducted what is believed to be the first systematic review of the information about successful WLM obtained from these 5 national weight control registries. Key common influential characteristics of initial weight loss success were identified, and, more importantly, the factors that were most associated with long-term WLM. While the data from this study is observational, it can help inform future prospective studies and weight management initiatives as to the types of strategies used by people who have had reasonable success at losing weight and then, perhaps more importantly, the characteristics and strategies of people who achieved WLM in the real world. Focus on the diet and lifestyle choices that enabled these people to not only lose excess weight, but more importantly to keep off most of their initial weight loss for at least several years.What Worked Best and Least Well for Weight Loss?The most frequently reported strategies (greater than or equal to 80%) for weight loss (WL) were classified in the following domains: planning content (having healthy foods available at home), dietary choices (regular breakfast intake and increasing vegetable consumption), energy compensation (engaging in physical activity/exercise), and regulation-restrictions (reducing the consumption of sugary and fatty foods, limiting intake of certain types of foods, and reducing fat in meals) domains.The least frequently reported strategies (less than or equal to 20%) that led to successful weight loss were in the following domains: support—professional (hypnosis, self-help/help from a weight control group, and help from a personal trainer or other professional), weight management aids (surgery, taking weight loss medication, using meal substitutes, and consuming “weight loss” supplements), information seeking (seeking weight control information online), and diet regulation or severe dietary restrictions (e.g., limiting intake to only one or two types of food and following a special diet or some fad weight loss diet).What Worked Best and Least Well for Long-Term WLMFor long-term WLM, the majority of participants (>80%) relied on regularly consuming breakfast; increasing the consumption of vegetables and fiber-rich foods (dietary choices domain); limiting the intake of certain types of foods; reducing the consumption of fatty and sugary foods; and reducing fat in meals (regulation-restrictions domain); having healthy foods and few high-fat foods available at home (planning content domain); and having a regular meal frequency (regulation-rule setting domain).By contrast, among the factors that were least likely (< 20% of subjects) to have been used for long term WLM included the taking of WL medication; using meal substitutes and consuming WL supplements (weight management aids domain); avoiding friends with excess weight; following a special or fad diet (regulation-restrictions domain); spending more time with normal-weight friends (regulation-rule setting domain); and having help from a weight control group (support- professional domain) (3).Keep in mind that this data is largely the result of self-reporting and is not a random sample of all the people who have successfully lost a lot of weight and kept it off. The subjects, for the most part, responded to ads looking for people who had lost a lot of weight and kept most of it off for at least several years. This is to a large degree a self-selected group of subjects. For example, the fact that relatively few relied on weight loss surgery does not mean that weight loss surgery does not help many people loss and keep off a lot of weight. However, it is likely that their weight loss success was largely not the result of their personal accomplishment may have led far fewer of the people who had bariatric surgery to respond to an ad looking for people who had successfully lost a lot of weight and kept it off. And the fact that most did not rely on a professional support group does not prove that this may not help some people to keep off weight over the long term.The fact that few relied of weight loss drugs for the long term is not surprising given that few of these drugs are approved for long term weight control. It is interesting that most reported exercise was an effective strategy for losing weight initially, regular exercise was reported far less as a successful strategy for long term weight maintenance. The fact that few relied on professionals is intriguing. Hypnosis, help from a weight control group, help from a personal trainer or other professional may reflect the lack of understanding about what does and does not likely work in the long-term WLM.Bottom Line: The results of this study should help health professionals and especially nutrition experts to focus on the types of dietary strategies that are most likely to lead to successful WLM in the real world. Next month, this reviewer will attempt to explain why the results of this systematic review of what worked best for most of these participants in weight control registries into what nutrition professionals should and should not be doing to help their clients achieve long-term weight control without any need to count calories or attempt to over-ride chronically increased hunger with will power. The latter is a formula for creating eating disorders rather than successful long-term weight control.By James J. Kenney, PhD, FACN

1. https://www.medicalnewstoday.com/articles/322662#Weight-loss-can-normalize-blood-sugar
2. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight-and-cancer-risk/health-issues.html
3. Paixao, C, Dias CM, Jorge R. et.al. Successful weight loss maintenance: A systemic review of weight control registries. Obesity Reviews. 2020;1-15 DOI:10.1111/obr.13003 or https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13003.