Certain factors predict weight regain in successful weight losers

Presenter: Suzanne Phelan, PhD, California Polytechnic State University, San Luis Obispo

Phelan S, Alarcon N, Cardel MI, et al. Predictors of weight regain in successful weight losers in a widely available weight control program. Presentation at Obesity Week, October 14–17, 2023, Abstract Poster 0-57.

Certain factors predict which people continue to maintain long-term weight loss, according to data presented by Suzanne Phelan, PhD, of California Polytechnic State University in San Luis Obispo, at the 2023 Obesity Week annual meeting,1 and published simultaneously in the journal Obesity.2

Earlier studies3–8 showed that the most consistent predictor of long-term weight loss is the magnitude of initial weight loss. Common correlates of sustained weight-loss maintenance include maintaining high levels of physical activity, self-monitoring, and low levels of disinhibition. Several novel potential determinants of weight have emerged in studies, including eating and activity habit strength; sedentary behavior; future orientation; self-compassion; acceptance of uncomfortable thoughts, feelings, urges, and cravings; and eating in the absence of hunger.

In the current study,1,2 Phelan and colleagues followed 2,843 participants in WeightWatchers, almost all of them white women, who had lost and kept off at least 9.1 kg (20 lb) for at least 1 year; in fact, on average, they had maintained a loss of 25.5 kg (56 lb) for 3.5 years. Still, their average body mass index (BMI) was 26.7 kg/m2, meaning they were still in the overweight range.

After 1 year of follow up, 43% (1,211) of the participants had gained back at least 2.3 kg (5 lb, average 7.2 kg (15.9 lb), while the rest—57% (1,632)—gained back less, 0.4 kg (0.9 lb) on average. Despite regaining weight, the regainers' weight remained 18% below their WeightWatchers starting weight, exceeding weight-loss maintenance criteria for long-term successful weight loss.

In validated questionnaires administered at baseline and at 1 year, the researchers investigated whether sociodemographic, behavioral, psychological, and home environmental factors predicted weight gain versus continued weight maintenance over 1 year.

Compared with maintainers, regainers:

  • Were younger (52 vs 58 years)
  • Had higher initial weight (BMI 37.4 vs 34.8 kg/m2)
  • Had more recent and larger weight losses.

Changes on the questionnaires after 1 year that most differentiated regainers from maintainers were:

  • Greater increases in disinhibition
  • Declines in ability to accept uncomfortable food cravings, urges, and desires to overeat
  • Decreases in self-monitoring
  • Worsening body image, body satisfaction, and bodily pain.

Sex, race, ethnicity, income, education, marital status, and home environment were not predictive of who maintained or regained weight.

Regainers' greater declines in disinhibition suggested greater challenges in sustaining eating regulation in the face of food cues, both external (the sight of food, social situations) and internal (taste and smell of food, feelings), said Dr. Phelan. Similarly, regainers' greater declines in acceptance indicated less sustained tolerance of uncomfortable food cravings, urges, and desires to overeat. “A more unhealthy food environment among gainers may have triggered uncomfortable cravings and intrinsic drives to consume unhealthy foods that conflicted with their weight-control goals,” the authors wrote.

Dr. Phelan further noted that future research should investigate whether those higher in responsiveness to cues may benefit from specialized self-regulatory skills to prevent weight regain. To prevent weight regain, the authors suggested that clinicians may work with patients to identify non–eating-related strategies to cope with uncomfortable feelings and external food cues, and identify strategies to sustain self-monitoring of weight, eating, and activity over time.

Dr. Phelan concluded: “Weight regain was common among long-term weight-loss maintainers and was associated with declines in regulating eating in response to food cues, in self-monitoring, and worsening body image.”

References

  1. Phelan S, Alarcon N, Cardel MI, et al. Predictors of weight regain in successful weight losers in a widely available weight control program. Presentation at Obesity Week, October 14–17, 2023, Abstract Poster 0-57.
  2. Phelan S, Cardel MI, Lee AM, et al. Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program. Obesity (Silver Spring) 2023; 31(11):2709–2719. doi: 10.1002/oby.23903
  3. Chopra S, Malhotra A, Ranjan P, et al. Predictors of successful weight loss outcomes amongst individuals with obesity undergoing lifestyle interventions: a systematic review. Obes Rev 2021; 22(3):e13148. doi:10.1111/obr.13148
  4. Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Obes Rev 2019; 20(2):171–211. doi:10.1111/obr.12772
  5. McKee H, Ntoumanis N, Smith B. Weight maintenance: self-regulatory factors underpinning success and failure. Psychol Health 2013; 28(10):1207–1223. doi:10.1002/oby.23148
  6. Roake J, Phelan S, Alarcon N, Keadle SK, Rethorst CD, Foster GD. Sitting time, type, and context among long-term weight-loss maintainers. Obesity (Silver Spring) 2021; 29(6):1067–1073.
  7. Ostendorf DM, Lyden K, Pan Z, et al. Objectively measured physical activity and sedentary behavior in successful weight loss maintainers. Obesity (Silver Spring). 2018; 26(1):53–60. doi:10.1002/oby.22052
  8. Forman EM, Butryn ML, Manasse SM, et al. Acceptance-based versus standard behavioral treatment for obesity: results from the Mind Your Health randomized controlled trial. Obesity (Silver Spring) 2016; 24(10):2050–2056. doi:10.1002/oby.21601

Disclosures

Suzanne Phelan – Nothing to disclose

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