One of the biggest challenges for people who have lost weight is maintaining that weight loss once they have reached their goal. In fact, the majority of people who undergo a weight loss program regain two-thirds of that loss within a year.

Researchers in the United Kingdom interviewed ‘successful maintainers’ to understand what factors contribute to sustained weight maintenance. In particular, the investigators wanted to understand the motivations and barriers that participants experienced while they were in the maintenance process.

Undertaking a qualitative evaluation, 10 women who had intentionally lost a minimum of 10% of their starting weight and kept it off for at least 1 year were interviewed. Participants who had achieved weight loss through bariatric surgery or very low calorie diets were excluded. The study was qualitative, and interviews were conducted with participants and progressively analysed for common themes, until no new themes emerged.

As might be expected, most participants had tried to lose weight before but had not succeeded in being able to maintain that weight loss. Study participants explained this might have been as a result of:
1. The absence of long-term, strongly motivating reason to lose weight
2. Use of a shorter-term, restrictive approach to weight loss, and/or
3. Setting goals that may have been unrealistic.

So what exactly was it that made this time different? When analysing the common aspects of successful weight maintenance, three major themes appeared:

1. Strong motivation and support to lose weight – often for health reasons
Often, participants described a major health issue, such as high blood pressure, as the reason that initially motivated them to reduce their weight.

For them, that meant that this time, their weight loss efforts were not a short-term intervention, but a lifelong change. They also understood that maintenance of their new weight would need to become part of their everyday lives.

Participants also described receiving structured support through a commercial weight loss organisation or health professional to help them achieve their desired weight.

2. A relaxed approach and realistic, long-term goals
Unlike previous attempts, weight maintainers described a different attitude: they avoided a diet mentality and moved away from an ‘all or nothing’ approach. They did not see lapses as failure, but would not wait long before returning to their regular routine.
This group also had well-developed strategies for coping with stressful situations which did not negatively impact their weight management efforts.

In keeping with their more relaxed approach, occasional treats were seen as being an acceptable part of overall food intake, as successful maintainers tended to avoid banning particular foods from their diet. This strategy was based on the idea that banned foods often caused feelings of deprivation, making those ‘out of bounds’ foods even more appealing.

Finally, people who dropped their weight and kept it off described taking time to make healthy meals sustainable by planning and sometimes preparing them in advance.

3. Self-monitoring and taking personal responsibility
Interviewees described being more in touch with their bodies: they would be aware of their own nutrition and activity needs; question if they really wanted a particular food, and increased their activity levels.

Interviewees also described monitoring themselves through regular weight checks and keeping food diaries.

Although there were many positive aspects contributing to the long-term weight loss of participants, several challenges were described:

Lack of positive reinforcement during the weight maintenance phase
Participants noted that sometimes it was discouraging to keep putting energy towards maintaining their weight loss, without seeing the same reward of the changing scales that they experienced during the weight loss phase.

Family or friends acting as saboteurs
Although weight maintainers did not perceive their actions as malicious, many described family or friends who downplayed or discouraged their weight loss and maintenance efforts.

Ultimately, what comes through in this research is that ‘successful maintainers’ have a realistic attitude to their weight loss journey, keep engaged with their own bodies, and respond in a positive way to challenges and mishaps along the way.
Reference: Hindle, L., & Carpenter, C. (2011). An exploration of the experiences and perceptions of people who have maintained weight loss. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 24(4), 342–50. doi:10.1111/j.1365-277X.2011.01156.x