Where Do We Stand in Terms of Long-term Weight Loss Maintenance?

Maintenance is More Dreadful than Losing Weight

Difficult it is to lose weight but even more difficult it is to keep off the lost weight. Staying thin seems heavenly but not all of us are indeed blessed with a naturally slim body. Exercise and an active lifestyle are recommended for all people-those on a healthy body weight, overweight/obese individuals and of course, underweight people too. But individuals staying on a healthy body weight needn’t bother about the complexities of weight loss, post weight loss lifestyle changes and weight loss maintenance strategies.

The world is exposed to obesity which has become a universal epidemic. Treating obesity is challenging but the main challenge does not involve losing weight but in successful long-term weight loss maintenance. Diets, do’s and don’ts, lifestyle modifications, articles, publishing, ads that promise instant weight loss, machines that try to act magical on human fat and pills for weight loss-all of these exist for what? ONLY FOR WEIGHT LOSS. What about maintaining the lost weight? It’s not treated as important as weight loss because people strongly believe that the scope of long-term weight loss maintenance is out of question. But, in order to determine if we are successful in keeping off the weight in the long term, firstly we need a strong definition that promptly defines it.
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Long-term weight loss maintenance is intentionally losing at least 10% of the initial body weight and keeping it off for at least 1 year. While this definition makes us feel positive and even data exists that at least 20% of obese/overweight patients are able to achieve it, current obesity treatment programs are not quite effective over the period which again leads us back to our belief that people who lose weight will regain all the lost weight within 5 years. So, how do our evidences measure up to these notions?

Long-term Weight-Loss Maintenance: A Comparison
Extremely obese individuals generally follow a very-low energy diet (VLED) to lose around 20-25 kilograms. But it has been proved that weight loss through VLED is no better than that achieved by other means in terms of long-term maintenance. Discussed below is a meta-analyses of different US reports of weight loss maintenance from 2 to 5 years after successful weight-loss programs that were completed using either a VLED or a hypoenergetic balanced diet (HBDs).

Results of combined data of 29 studies most of which included both men and women aged between 30 and 60 years and whose treatment period was between 8 and 30 weeks showed that individuals maintained 67% of their initial weight loss at 1year, 44% at 2year, 32% at 3year, 28% at 4year and 21% at 5year. 13 studies used VLED and 14 studies used HBDs. 
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Weight measures:
Initial body weight of women: Between 74 and 121 kg
Initial body weight of men: Between 100 and 148 kg
Average initial weight loss in women: 3-38 kilograms
Average initial weight loss in men: 6-44 kilograms

The final results are tabulated below:

Group	Years of Follow Up	Initial Weight (kg)	Weight Loss (kg)	Weight Loss Maintenance (kg)
All	4.5	98	14	3
Men	4.4	115	18.3	4.7
Women	4.4	95	16.6	4.66
VLED	4.5	106	24.1	7.05
HBD	4.5	93	8.8	1.99
Lower Exercise	2.7	110	22	7.47
Higher Exercise	2.7	110	20.9	14.99

Though men weighed more than women, percentage of weight loss, period of weight regain and weight loss maintenance values did not differ greatly between the two sexes. Four VLED-studies that included 578 participants provided follow-up data for 4-5 years and eight HBD studies that included 448 participants provided follow-up data for 4-5 years. Weight loss maintenance, percentage of weight loss maintenance and reduced weight were all lower in the case of HBDs compared to VLED. All the 4 VLED studies reported weight loss ≥20 kg `while HBDs reported weight loss ‹10 kg. Six studies that compared weight loss maintenance numbers of those who performed vigorous exercise to others showed that people who did higher amounts of exercise were even more successful in keeping off the lost weight.

Final results of the analyses showed that obese individuals managed to maintain weight loss close to 3 kg after 5 years which is close to 23% of their initial weight loss.
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Random Weight Loss Studies
A random analysis of 500 adults of which 228 of them were overweight/obese showed that 47 met the criteria for successful weight loss maintenance of having lost at least 10% of their initial body weight and maintaining it for up to a year. In many standard weight loss programs patients were successful in achieving weight loss of 7-10% (7-10 kg) of their body weight at the end of the 6-month treatment program and also maintained the weight loss of 5-6 kg at 1-year follow-up. Some studies followed these participants for 5 years or so and found that 13-20% participants managed to maintain weight loss of 5 kg or more at 5years.

All these bring us the good news that close to 20% of overweight/obese individuals are successful in losing weight and maintaining it. There are some who are extremely successful too in maintaining their weight loss. A registry was set up in 1994 to track a list of those who successfully lost weight and managed to keep it off. This registry consisted of 4000 members aged 18 years and above who lost 13 kg of weight and managed to keep it off for a year. Participants reported a 33-kilogram weight loss and successfully managed to maintain a 13-kg weight loss for an average of 5-7 years. At least 13% of them maintained this minimum weight loss for more than 10 years. This shows the high success rate of some individuals who indeed are victorious in keeping off lost weight. While three behaviors: eating a low-calorie and low-fat diet, doing high levels of physical activity and weighing frequently were common there was an additional behavior identified-eating breakfast (consisting of cereal and fruit) daily that played a critical role in helping these individuals. So, reducing portion sizes alone is not the key but also to eat the right quantity of diet at the right time. Is equally important.

Its seen that individuals who are successful in preventing weight regain for at least 2 years after weight loss are at a 50% reduced risk of regain. Critical factors that impact and promote weight regain include depression, loss of eating control, inability to maintain diet routines and lack of regular physical activity. The registry results show six ways in which individuals can maintain long-term weight loss:
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1. Performing high-intense physical activity
2. Consuming a low-calorie, low-fat diet
3. Eating daily breakfast
4. Checking weights regularly
5. Having a well-defined eating pattern
6. Preventing small mistakes from burning off your long-term goals.
   
   

References
Long-term Weight Loss Maintenance: A Meta-analysis: https://academic.oup.com/ajcn/article/74/5/579/4737391

Long-term weight loss maintenance:
https://academic.oup.com/ajcn/article/82/1/222S/4863393

​Successful weight loss maintenance:
​https://www.ncbi.nlm.nih.gov/pubmed/11375440