Why is Maintaining Weight Loss so Hard?

More than 60% of UK adults have overweight or obesity. So, the odds are that many of us will have, at some point, tried to lose weight. 

Of course, plenty of companies are keen to make a quick buck by hawking quick-fix diets, supplements, potions, apps, and hacks to help you reach your weight-loss goals. The truth is, some of these might work for you. In fact, eating only cabbage soup or a powdered shake is almost guaranteed to make you lose weight at the beginning; drastically reducing our food intake has that effect. But in reality, losing weight isn’t the ultimate goal. It’s even harder than that. It’s about not only losing weight but also keeping it off. And that’s the real challenge. Research shows that even when people successfully lose weight, whether through exercise, diet, or both, they’ll likely regain it in the following months and years. Even a proportion of those who take drugs or have bariatric surgery are likely to see some weight regain. I know. Depressing, right?

In this article, I wanted to share some of the fascinating discussions recently held by a group of crack scientists at the 2022 Pennington Biomedical Scientific Symposium. This meeting of minds focused on weight loss with an emphasis on keeping that weight off.

The trouble with weight loss

People have been trying (and often failing) to keep weight off for hundreds of years. Surely scientists have figured it all out by now?  Sadly not. It’s incredibly complex.

There is a huge range of factors involved, which makes hard and fast conclusions overly simplistic and damn near impossible. Weight loss and weight maintenance are influenced by so many things, like what you eat, when you eat, and how you eat — for instance, eating faster is associated with a higher BMI. Also, your physiology — at a cellular and organ level — has an impact, as do your genes. Oh, and don’t forget your fluctuating hormones and being surrounded by food adverts most of the day, either *eye roll*. Then, we’ve got that ridiculously complicated organ to contend with: your brain. Psychology, including past experiences, habits, trauma, and more, drives many of our food choices. And then you’ve got your immediate environment. If you live across the road from a fast food restaurant, for example, you’re much more likely to eat there than if you live in the middle of nowhere beyond the reach of delivery drivers. So, yeah. It’s really complicated.  And according to this recent paper, the factors that predict successful weight loss might be different from those that predict long-term weight maintenance. 

So, what’s going on?

As you’ve probably already guessed, many factors conspire to hamper weight maintenance. 

One example is that once someone loses weight, they tend to stop doing the things that helped them lose weight.  Whether it’s diet or exercise, once support and encouragement slows down, so does your motivation. But aside from the dip in motivation, your body also makes things difficult for you.

 A metabolic conspiracy

I’m going to touch on the “settling point theory” here because it’s a fascinating but frustrating mechanism. And it explains part of why maintaining weight loss is so challenging. Settling point theory states that as you lose weight, your body tries to put it back on. It does this by increasing your appetite and slowing your metabolism.  So, as you work hard to make yourself healthy, your body conspires against you, trying to keep things constant and steady. Thanks, body. This mechanism was useful when living in the wild thousands of years ago. Today, though, when we have access to moreish delicious, energy-dense food around the clock, it just seems cruel.

There’s a lot of really juicy science in this paper about how your metabolism makes keeping weight off extra tricky, but let’s skip to the important bit: 

How do you maintain weight loss, then?

The authors of the paper explain that, in weight-loss studies, those who lose the most weight in the first month generally lose the most weight overall.

But these people aren’t the most successful at keeping it off over the long haul. In other words, quick fixes won’t help you in the long run. So, what predicts successful long-term weight loss? First, let’s outline a few factors that you don’t have much control over. According to the paper, people who keep weight off for 2–5 years are less likely to put it back on. Success is also linked to low levels of depression and disinhibition. Disinhibition basically means people who are good at controlling their actions.  Also, people who have “internalised weight stigma” find it much harder to lose weight. These are good to know, but none of these factors are very easy to change on your own. Here are some other factors that may be easier to achieve for some:

· Support from friends and family: You might know someone who you could ask to be your cheerleader as you embark on your weight-loss mission. Ask them to check in and help you stay on track. Community can make a huge difference.

· Face-to-face interventions work better than remote: If you can, consider working with a nutritionist or dietician to help you reach your goals.

Other factors that are within your control include:

· Keep monitoring: check in on how your clothes fit and how you feel in your body, use a regular diary to take notes and use a food diary. Weigh yourself every other week.

· Keep active: half an hour of active movement every day at a minimum. 200 minutes of at least moderate aerobic activity each week or more.

· Listen to your hunger and satiety cues and Use portion control:  Eat a plate of food and wait before helping yourself to more. If you’re hungry, eat. If you’re not, don’t. Sounds simple but many of us are out of touch with our own bodies. Put less on your plate.

· Reduce your intake of ultra-processed foods: It’s virtually impossible to avoid them entirely but reduce where you can. Focus on adding more fibre rich plant foods which are filling and nutritious. Beans, mushrooms, vegetables and leafy greens are brilliant. 

So, in a nutshell, losing weight and keeping it off requires a holistic approach.  You might not be able to control how depressed you feel or whether or not you live next to a Greggs, but some of these factors are within your control. Eating more mindfully; being mindful of the amount of food you eat where possible, making sure you’re physically active, and lowering your intake of ultra-processed foods can all help your efforts.  And to ensure long-term success, these changes have to be durable — they must be sustainable.  Although this isn’t the quick-fix answer we all desire, healthy weight maintenance has to be a lifelong endeavour. It goes hand in hand with staying healthy overall.

Finding healthy foods you love and physical activity you enjoy is key. Then it won’t feel like dieting and exercise. It will just become your new, healthy life.

Thank you for your time,

Fede x

 Written by Dr Federica Amati