Keeping weight off after losing it is notoriously difficult. Why is the weight loss relapse rate so high? There are many reasons. Some of them are biological, like the metabolic adaptation that takes place after dieting, an increase in hunger hormones, or a drop in non exercise activity (NEAT). The environment works against us too, with social pressure and food temptation everywhere. Sometimes life just happens. Unexpected events and stress can disrupt even the best-made plans…
Many of the other reasons that explain the difficulty in keeping weight off are behavioral. People who gain weight back are doing certain things wrong and neglecting to do certain things right. While you can’t always change your environment or biology, fortunately you can change your behavior.
So the strategy to keep weight off seems simple: If you want to get rid of excess weight and then maintain your weight loss, don’t just study weight losers, study weight loss maintainers. Find out what the most successful weight loss maintainers do and do the same things yourself. But how do you find maintainers and discover their successful strategies? The good news is, that’s exactly what weight control registries have been doing for years.
The National Weight Control Registry
Many of our Burn the Fat Blog readers are familiar with the National Weight Control Registry (NWCR) because it’s the largest prospective investigation of long-term successful weight loss maintenance and has been in the news many times. Some of our members at the Burn the Fat Inner Circle are participants.
This weight loss maintenance registry is based in the United States. The NWCR was established in 1994 by Rena Wing, Ph.D. from Brown Medical School, and James Hill, Ph.D. from the University of Colorado. Given the prevailing belief that few people succeed at long-term weight loss, the NWCR was developed to investigate and identify the characteristics of those who did succeed, in spite of the odds.
The NWCR has been tracking over 10,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. Detailed questionnaires and annual follow-up surveys are used to examine the behavioral and psychological characteristics of weight maintainers, as well as the strategies they use to maintaining their weight losses.
What most people don’t know is that there are many other registries throughout the world. These are in countries where diet, activity, health behaviors and lifestyles vary due to cultural differences, yet they reveal that successful maintainers still have a lot in common, regardless of where they’re from.
International Weight Control Registries
A research group from Portugal recently conducted a sweeping review of 52 scientific studies on long-term weight loss maintenance from 5 major registries, including the USA, Greece, Germany, Portugal, and Finland. It was published in the scientific journal Obesity Reviews.
There is also another initiative now underway, called the International Weight Control Registry (IWCR) where researchers from different parts of the world with different areas of expertise have combined forces. The hope is that this collaboration will improve our understanding of weight loss and weight loss maintenance more than ever before.
In the recent Portuguese study, because the studies were observational, we can’t make definite cause and effect conclusions about the best ways to keep weight off. However, the data is useful by revealing what are the most common behaviors of people who lose weight and successfully keep it off.
It’s important to note that a list of behaviors in long term weight loss maintainers may not be identical to the list of behaviors people use to lose weight. We have to make the distinction between weight loss and weight loss maintenance.
For example, high activity levels have always showed up in all weight loss maintainer studies as a key behavior for keeping weight off. However, an equally high activity level may not have been the most reported strategy during the original weight loss.
Most Reported Strategies For Weight Loss Maintenance
In this study, the most frequently used strategies for successful weight loss maintenance included:
- High levels of physical activity
- Having healthy foods available at home
- Regular breakfast intake
- Regular meal frequency/schedule
- Increasing vegetable consumption
- Consuming adequate amounts of protein
- Reducing sugary foods
- Reducing high fat foods
Note: In other studies, as well as in the USA-based NWCR, two other strategies were high on the list, they simply didn’t show up with as high a frequency:
- Social support
- Self-monitoring (including frequent weighing)
Support can come in many forms, ranging from peer support to intensive long term interventions with professionals that extend beyond the weight loss phase and into the maintenance phase. It’s encouraging that in studies of long term interventions with continued support, the participants had the highest rates of successful maintenance. However, this requires long term investment and commitment. One thing is clear – having some kind of support that is long-term and extends beyond the weight loss phase increases the chances of success.
It’s widely known that not everyone reacts well to being scale-focused and weighing weekly or daily. However it’s worth remembering that weighing and other forms of self-monitoring is a well-established behavior of weight loss maintainers, especially in the USA.
Other behaviors that correlate to better weight loss maintenance but not as high on the list included increasing fiber intake, conscious food choices (reading labels, checking calories and macros), setting exercise and weight loss goals, watching less TV, reducing portion sizes, and reducing high calorie sauces and condiments.
Least Reported Strategies For weight Loss Maintenance
A unique aspect of this new review of registries is that it not only identified the most frequently used maintenance strategies, it also listed the least used strategies reported by maintainers. They included:
- Hypnosis
- Personal trainer
- Weight loss surgery
- Weight loss medication
- Supplements
- Meal substitutes
- Drastic restriction of food groups
- Following a special or fad diet
If something appears on this list of least reported strategies, it doesn’t necessarily mean it didn’t work for anyone in the group studied. Some people may have had success with a trainer, some people might have used high protein meal replacement shakes, and even bariatric surgery or medication may have been recommended by a doctor in some cases. Being on this list simply means the strategy was not used by the majority of maintainers during the maintenance phase.
For Weight Loss Maintenance Exercise is King
Legendary fitness guru Jack Lalanne used to say, “Exercise is king, nutrition is queen, put the two together and you have a kingdom.” Today many people argue that this is backwards and it’s nutrition first priority, exercise second. That’s correct if you’re talking about priorities for weight loss. However, the weight loss phase and the weight maintenance phase are two different animals. The research, including this latest study, confirms that exercise is vital for long term weight loss maintenance.
Out of all the behaviors listed, high levels of physical activity had the most consistent positive correlation with long term weight loss maintenance. In the NWCR, 90% of participants reported exercising for at least one hour per day. The most common form of exercise reported was walking. Cycling, running, and aerobics classes were also frequently mentioned.
Participation in resistance training is not always discussed in maintenance research. However, we could argue that it should be added to the list of important strategies for both weight loss and weight loss maintenance. That’s because recent research has confirmed that when muscle is lost during a weight loss phase, it increases the risk of weight regain. Want to keep fat off? Don’t lose muscle. Resistance training is the key to holding on to that lean mass when you’re dieting.
Where do these maintainers get the time for at least an hour of exercise every day? Well, another statistic from the registry gives us a clue: 62% watch less than 10 hours of TV per week. If you’re going to Netflix binge, you’d better do it on the bike or treadmill if watching it on the couch means you “don’t have time to exercise.” In fact, psychologists like Katy Milkman, author of “How To Change” suggest that only allowing yourself to indulge in TV/Netflix while exercising is one of the most effective strategies. They call it temptation bundling.
Why is exercise so important during the weight maintenance phase, while research reveals exercise alone during the weight loss phase is only modestly effective? One of the biggest reasons is because after a large weight loss, you’ve become a smaller person. Here’s a basic rule of metabolism: Bigger people burn more calories. Smaller people burn fewer calories. On top of this metabolism difference purely due to body size, there’s also an adaptive metabolic decrease after calorie-restricted dieting.
Since you burn less after weight loss, to offset that, you must either get more physically active, or get used to eating a lot less than you did before your weight loss. Another way to say this is that your old maintenance calorie level is no longer your current maintenance calories. If you go back to your old maintenance calories without being more active, you are guaranteed to regain weight.
Research also tells us that people who are physically active have better coupling between their energy intake and energy expenditure, probably due to appetite regulation hormones. The best part is, it happens automatically, so eating appropriately to maintain your weight seems like less of a struggle when you exercise daily.
In the recent International registry study, participants reported that their weight maintenance wasn’t as hard as the initial weight loss. A big reason is because they were so physically active. Almost everyone talks about how hard maintenance is, but it might be more correct to say that maintenance is hard when you don’t exercise much.
Protein, Weight Loss, And Weight Loss Maintenance
In the weight control registry research, they also found that getting enough protein was also strongly linked to maintenance success. Consistent adequate protein intake correlated strongly to the amount of weight loss maintenance achieved. Some people regain weight, but only a portion of the amount lost. Those who are diligent about their protein intake kept the most weight off. This matches what we’ve seen in the experimental research about the important of focusing on protein in every meal to optimize fat loss (as well as muscle gain). Protein is important for weight loss, weight loss maintenance, and muscle maintenance.
Although maintainers have a lot in common, they used a wide variety of strategies to achieve initial weight loss and weight loss maintenance, so it appeared there was no single superior or “one size fits all” approach. In addition, 45% of registry participants lost the weight on their own and the other 55% lost weight with the help of some type of specific program.
It’s interesting to note that despite the popularity in the mainstream diet world of low carb diets and ketogenic low carb diets, the low carb/ high fat approach was not heavily utilized by long term weight loss maintainers. It is worth acknowledging that one of the previous studies published by the NWCR said that 10.8% of the participants in the registry did lose weight on low carb diets (defined as anything less than 23% carb) and kept the weight off long term.
We know that keto diets can work, but there are major concerns about sustainability and weight regain if carbs are re-introduced. Maintainers consistently focus on protein, eat a large amount of vegetables, and reduce sugar, but they also typically reduce dietary fat as well to help control calories and they do not eliminate complete food groups.
Conclusion
I hope you found this helpful and you see how practical the strategies are because they focus on action steps that are things you can control. You can’t control your genetics, you can’t control metabolic adaptation, you can’t control everything in the environment, but you can control your behavior.
On top of being practical, these maintenance strategies are also simple. So simple in fact, that you have to be careful not to dismiss them, saying something like “I know that” or “It’s just common sense.” It may be common sense, but it’s clearly not common practice or more people would keep the weight off.
I believe it will be most useful if you think of the list of maintenance strategies as behaviors to turn into lifestyle habits. rather than something you do only until excess weight is lost.
A final piece of advice is that while the behaviors on this list sound simple, do not under-estimate the difficulty of the challenge. Knowing what to do and doing it are not the same thing, and overcoming old life-long bad habits and replacing them with new good habits is often easier said than done. Expect to succeed, but don’t expect success to be easy.
– Tom Venuto,
Founder, Burn The Fat Inner Circle
All-Natural, No-BS Body Transformation
About Tom Venuto
Tom Venuto is a natural bodybuilding and fat loss expert. He is also a recipe creator specializing in fat-burning, muscle-building cooking. Tom is a former competitive bodybuilder and today works as a full-time fitness coach, writer, blogger, and author. In his spare time, he is an avid outdoor enthusiast and backpacker. His book, Burn The Fat, Feed The Muscle is an international bestseller, first as an ebook and now as a hardcover and audiobook. The Body Fat Solution, Tom’s book about emotional eating and long-term weight maintenance, was an Oprah Magazine and Men’s Fitness Magazine pick. Tom is also the founder of Burn The Fat Inner Circle – a fitness support community with over 52,000 members worldwide since 2006. Click here for membership details
Scientific Reference:
Paixao C, et al, Successful weight loss maintenance: A systematic review of weight control registries, Obesity Reviews, 21:5.
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