Predictors of weight maintenance
01 Jan 1999-Obesity Research (North American Association for the Study of Obesity)-Vol. 7, Iss: 1, pp 43-50
TL;DR: In this article, a two-long intervention study was conducted to obtain predictors of weight maintenance after a weight-loss intervention, which revealed that 50% of the variability in weight regain could be explained by pphysiological and behavioral factors.
Abstract: Objective: To obtain predictors of weight maintenance after a weight-loss intervention. Research Methods and Procedures: An overall analysis of data from two-long intervention studies [n = 67 women; age: 37.9±1.0 years; body weight (BW): 87.0±1.2 kg; body mass index: 32.1±0.5 kg·m-2; % body fat: 42.4±0.5%]. Subjects were measured before a very low energy diet (month 0), after the very low energy diet of 2 months (month 2) and after a 14-month follow-up phase (at 16 months), in which fiber or a carbohydrate-containing food supplement was supplied. The baseline measurements and the changes in parameters induced by the diet intervention were used to predict the changes in BW in the follow-up phase [ABW(2-16)]. Results: Multiple regression analysis revealed that 50% (p<0.001) of the variability in weight regain could be explained by pphysiological and behavioral factors. These were: frequency of previous dieting (r2 = 0.27, p<0.05), hunger score (measured with the three-factor eating behavior questionnaire), and change in 24-hour resting metabolic rate (RMR). Frequent dieters showed significantly more weight regain than less frequent dieters (8.8±1.0 kg vs. 5.1±0.8 kg, p<0.01). Subjects having parents with obesity regained almost significantly more weight than subjects with lean parents (8.5±0.2 kg vs. 5.1±1.5 kg, respectively; p = 0.06). Discussion: Physiological (ΔRMR-24 hours) and behavioral factors (previous frequency of dieting and hunger score) predicted failure of weight maintenance and, as such, can be used to identify women who are at risk for weight regain. Copyright © 1999 NAASO.
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TL;DR: Successful weight maintenance is associated with more initial weight loss, reaching a self‐determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over‐eating and self‐monitoring of behaviours.
Abstract: Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
1,278 citations
TL;DR: The two primary goals of this article are to review the best individual‐level psychosocial pre‐treatment predictors of short‐ and long‐term weight loss and to identify research needs and propose directions for further work in this area.
Abstract: Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments To date, however, research efforts have resulted in weak predictive models with limited practical usefulness The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment Importantly, for a considerable number of psychosocial constructs (eg eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described
446 citations
TL;DR: Psychosocial and behavioral variables may be useful as pretreatment predictors of success level and/or attrition in previously overweight and mildly obese women who volunteer for behavioral weight control programs.
Abstract: OBJECTIVE: This study analyzed baseline behavioral and psychosocial differences between successful and nonsuccessful participants in a behavioral weight management program. Success was defined by commonly used health-related criteria (5% weight loss). Noncompletion was also used as a marker of a failed attempt at weight control. SUBJECTS: A total of 158 healthy overweight and obese women (age, 48.0±4.5 y; BMI, 31.0±3.8 kg/m2; body fat, 44.5±5.3%). INTERVENTION: Subjects participated in a 16-week lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity, and were followed for 1 y after treatment. METHODS: At baseline, all women completed a comprehensive behavioral and psychosocial battery assessing dieting/weight history, dietary intake and eating behaviors, exercise, self-efficacy, outcome evaluations, body image, and other variables considered relevant for weight management. Participants who maintained a weight loss of 5% or more at 16 months (or 10% or more of initial fat mass) were classified as successful. Nonsuccessful participants were those who dropped out and completers who had not lost weight at follow-up. RESULTS: Of all participants, 30% (n=47) did not complete initial treatment and/or missed follow-up assessments (noncompleters). Noncompletion was independently associated with more previous weight loss attempts, poorer quality of life, more stringent weight outcome evaluations, and lower reported carbohydrate intake at baseline. In logistic regression, completion status was predicted correctly in 84% of all cases (χ2=45.5, P<0.001), using baseline information only. Additional predictors of attrition were initial weight, exercise minutes, fiber intake, binge eating, psychological health, and body image. A large variation in weight loss/maintenance results was observed (range: 37.2 kg for 16-month weight change). Independent baseline predictors of success at 16 months were more moderate weight outcome evaluations, lower level of previous dieting, higher exercise self-efficacy, and smaller waist-to-hip ratio. Success status at follow-up was predicted correctly in 74% of all starting cases (χ2=33.6, P<0.001). CONCLUSION: Psychosocial and behavioral variables (eg, dieting history, dietary intake, outcome evaluations, exercise self-efficacy, and quality of life) may be useful as pretreatment predictors of success level and/or attrition in previously overweight and mildly obese women who volunteer for behavioral weight control programs. These factors can be used in developing readiness profiles for weight management, a potentially important tool to address the issue of low success/completion rates in the current management of obesity.
383 citations
TL;DR: In the short term, high-protein, low-carbohydrate ketogenic diets reduce hunger and lower food intake significantly more than do high- protein, medium- Carbohydrate nonketogenic diets.
370 citations
TL;DR: The preponderance of evidence would suggest that the biological response to weight loss involves comprehensive, persistent, and redundant adaptations in energy homeostasis and that these adaptations underlie the high recidivism rate in obesity therapeutics.
Abstract: Dieting is the most common approach to losing weight for the majority of obese and overweight individuals. Restricting intake leads to weight loss in the short term, but, by itself, dieting has a relatively poor success rate for long-term weight reduction. Most obese people eventually regain the weight they have worked so hard to lose. Weight regain has emerged as one of the most significant obstacles for obesity therapeutics, undoubtedly perpetuating the epidemic of excess weight that now affects more than 60% of U.S. adults. In this review, we summarize the evidence of biology's role in the problem of weight regain. Biology's impact is first placed in context with other pressures known to affect body weight. Then, the biological adaptations to an energy-restricted, low-fat diet that are known to occur in the overweight and obese are reviewed, and an integrative picture of energy homeostasis after long-term weight reduction and during weight regain is presented. Finally, a novel model is proposed to explain the persistence of the “energy depletion” signal during the dynamic metabolic state of weight regain, when traditional adiposity signals no longer reflect stored energy in the periphery. The preponderance of evidence would suggest that the biological response to weight loss involves comprehensive, persistent, and redundant adaptations in energy homeostasis and that these adaptations underlie the high recidivism rate in obesity therapeutics. To be successful in the long term, our strategies for preventing weight regain may need to be just as comprehensive, persistent, and redundant, as the biological adaptations they are attempting to counter.
358 citations
References
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TL;DR: The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts.
4,391 citations
TL;DR: The Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described in this article, which indicates a high degree of stability of dimensions on the eating behavior scales.
Abstract: The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
2,840 citations
TL;DR: Observed trends in overweight prevalence and body mass index of the US adult population suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000.
Abstract: Objective. —To examine trends in overweight prevalence and body mass index of the US adult population. Design. —Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight. Setting/Participants. —Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANESII), and 1988 to 1991 (NHANES III phase 1). Results. —In the period 1988 to 1991,33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg. Conclusions. —These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight. ( JAMA . 1994;272:205-211)
2,782 citations
TL;DR: It is concluded that a low rate of energy expenditure may contribute to the aggregation of obesity in families.
Abstract: The contribution of reduced energy expenditure to the development of obesity has been a point of controversy. We measured 24-hour energy expenditure (adjusted for body composition, age, and sex), in a respiratory chamber, in 95 southwestern American Indians. Energy expenditure correlated with the rate of change in body weight over a two-year follow-up period (r = -0.39, P less than 0.001). The estimated risk of gaining more than 7.5 kg in body weight was increased fourfold in persons with a low adjusted 24-hour energy expenditure (200 kcal per day below predicted values) as compared with persons with a high 24-hour energy expenditure (200 kcal per day above predicted values; P less than 0.01). In another 126 subjects, the adjusted metabolic rate at rest at the initial visit was also found to predict the gain in body weight over a four-year follow-up period. When the 15 subjects who gained more than 10 kg were compared with the remaining 111 subjects, the initial mean (+/- SD) adjusted metabolic rate at rest was lower in those who gained weight (1694 +/- 103 vs. 1764 +/- 109 kcal per day; P less than 0.02) and increased to 1813 +/- 134 kcal per day (P less than 0.01) after a mean weight gain of 15.7 +/- 5.7 kg. In a group of 94 siblings from 36 families, values for adjusted 24-hour energy expenditure aggregated in families (intraclass correlation = 0.48). We conclude that a low rate of energy expenditure may contribute to the aggregation of obesity in families.
1,187 citations
TL;DR: This review questions the appropriateness of behavioral and dietary treatments of obesity in light of overwhelming evidence that they are ineffective in producing lasting weight loss.
471 citations