#352: Do Diets Even Work in the Long-term? - A Look at Weight Loss Maintenance
Sep 15, 2020
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Danny and Alan, experts in weight loss maintenance, discuss the evidence on weight loss maintenance, the effect of ApoE4 allele on lipid metabolism, and address nonsensical and harmful nutrition recommendations. They emphasize the patterns of weight loss and regain, the long-term effectiveness of weight loss interventions, the role of diet composition and physical activity in weight loss maintenance, and the misleading claims made by medical professionals.
Maintenance beyond two to four years is crucial for long-term weight loss success.
Psychological factors such as restrained eating and poor body image may predict weight regain.
Combining dietary modification with behavioral counseling is key for maintaining long-term weight loss.
Deep dives
Weight loss maintenance and regain patterns
Weight loss maintenance and regain patterns typically follow a consistent trend. After an initial peak in weight loss within six months, gradual weight regain occurs over the months and years ahead. The prevalence of weight regain and the amount of weight regained vary, but studies suggest that maintenance beyond two to four years is crucial for long-term success. Duration spent in maintenance and the frequency of practitioner contacts are important factors for successful maintenance.
Factors influencing weight maintenance
Behavioral factors play a significant role in weight maintenance. Flexible dietary restraint, engagement in multiple behaviors, physical activity, and self-weighing (when not maladaptive) are associated with successful maintenance. Psychological factors such as restrained eating, disinhibited eating, low self-esteem, and poor body image may predict weight regain. Appropriate screening and addressing psychological factors before starting an intervention are crucial.
Long-term weight loss maintenance strategies
Long-term weight loss maintenance requires a multimodal approach and regular practitioner contacts. Intensive intervention with frequent in-person sessions, individual counseling, and behavioral support has been associated with better weight maintenance outcomes. Gradual transition from a weight loss intervention to maintenance phase is beneficial. It is important to have realistic weight maintenance goals within a range and consider overall health and behaviors rather than solely focusing on bodyweight measurements.
The Importance of Initial Weight Loss for Long-Term Maintenance
A study conducted by Diana Thomas and her colleagues found that a larger initial weight loss was associated with a higher probability of maintaining long-term weight loss. Other studies have also shown that faster initial weight loss, especially in individuals with obesity, correlated with better long-term maintenance. However, the key factor in maintaining weight loss at two years was the combination of dietary modification and behavioral counseling, emphasizing the importance of post-intervention support.
Significance of Physical Activity in Weight Loss Maintenance
Physical activity has consistently been associated with successful weight loss maintenance. Higher levels of physical activity increase the probability of maintaining weight loss, while lower levels or a decrease in physical activity correlate with weight regain. While cardiorespiratory fitness is important for individuals with lower BMIs, there is a point at which physical activity alone cannot compensate for achieving significant weight loss. However, physical activity remains a crucial behavior for weight loss maintenance.
Danny and Alan take a look at the evidence on weight loss maintenance, answer a question about ApoE4, and admit another nonsensical claim into the quack asylum. In this episode:
[02:56] Today's Topic in Focus: Weight Regain vs Weight Loss Maintenance
[58:56] I Have a Question!: "How does the ApoE4 allele affect lipid metabolism? And how should someone structure their diet around having one or both alleles due to it resulting in higher LDL-C than someone without the gene?"
