Maintenance of lost weight and long-term management of obesity
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain. This review describes our current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
Robert is a 47 year old patient who initially weighed 270 pounds. He lost 85 pounds three years ago by carefully following your guidance to decrease his caloric intake to 1500 calories per day and exercise six days weekly. Today he comes in for his annual physical examination. You were excited to hear about his continued progress and see how much more he’s lost, but you felt immediately dejected to see that he had regained almost 60 pounds. “I don’t know what to do…the weight keeps coming back on. I keep trying, but there must be something wrong. I’m sure my metabolism is in the dumps. It feels like every moment of the day I can’t help but think about food – it was never like this before I lost the weight. And no matter how hard I try to stop eating after one serving, I just can’t seem to do it anymore.” Feeling defeated, he says “I don’t even know what’s the point of doing this anymore!”
Frustrated, you remind him that he was able to do it just fine when he was losing weight initially, and he just needs to keep working hard at it. “I know it’s not easy, but I can’t help you unless you’re willing to help yourself. You just need to work harder and take control of this again.” You feel for him, but you know that you need to be stern to get him past this backsliding. Hoping to motivate him, you remind him how bad he will feel if he regains more weight, and you tell him to make a follow-up appointment for six months and warn him that if he doesn’t turn things around quickly he will have to restart his blood pressure medications.
