Saturday, October 3, 2009
FACTORS ASSOCIATED WITH WEIGHT REGAIN
Registry participants are followed over time to identify variables related to continued success at weight loss and maintenance. Findings from the initial follow-up study (15) indicated that, after 1 y, 35% gained 2.3 kg (5 lbs) or more (7 kg on average), 59% continued to maintain their body weight, and 6% continued to lose weight.
Participants who regained weight (>2.3 kg) were compared with those who continued to maintain their body weight to examine whether there were any baseline characteristics that could distinguish the two groups. The single best predictor of risk of regain was how long participants had successfully maintained their weight loss (Table 1). Individuals who had kept their weight off for 2 y or more had markedly increased odds of continuing to maintain their weight over the following year. This finding is encouraging because it suggests that, if individuals can succeed at maintaining their weight loss for 2 y, they can reduce their risk of subsequent regain by nearly 50%.
Another predictor of successful weight loss maintenance was a lower level of dietary disinhibition, which is a measure of periodic loss of control of eating. Participants who had fewer problems with disinhibition [ie, scores <6 on the Eating Inventory subscale (14)] were 60% more likely to maintain their weight over 1 y. Similar findings were found for depression, with
lower levels of depression related to greater odds of success. These findings point to the importance of both emotional regulation skills and control over eating in long-term successful
weight loss.
Several key behavior changes that occurred over the year of follow-up also distinguished maintainers from regainers. Not surprisingly, those who regained weight reported significant decreases in their physical activity, increases in their percentage of calories from fat, and decreases in their dietary restraint. Thus, a large part of weight regain may be attributable to an inability to maintain healthy eating and exercise behaviors over time. The findings also underscore the importance of maintaining behavior changes in the long-term maintenance of weight loss.
Triggering events
Another variable that has been examined in the registry is the presence of a “triggering event” leading to participants’ successful weight loss. Most registry participants reported a trigger for
their weight loss (83%). Medical triggers were the most common (23%), followed by reaching an all time high in weight (21.3%), and seeing a picture or reflection of themselves in the mirror
(12.7%).
Because medical triggers have been shown to promote longterm behavior change in other areas of behavioral medicine (16), we examined whether individuals who reported medical triggers
were more successful than those who reported nonmedical triggers or no triggers. A medical trigger was defined broadly and included, for example, a doctor telling the participant to lose
weight and/or a family member having a heart attack. Findings indicated that people who had medical reasons for weight loss also had better initial weight losses and maintenance (17). Specifically, those who said they had a medical trigger lost 36 kg, whereas those who had no trigger (17.1%) or a nonmedical trigger (59.9%) lost 32 kg. Medical triggers were also associated
with less regain over 2 y of follow-up. Those with medical triggers gained 4 kg (=2 kg/y), whereas those with other or no medical triggers gained at a significantly faster rate, averaging 6
kg in both groups.
These findings are intriguing because they suggest that the period following a medical trigger may be an opportune time to initiate weight loss to optimize both initial and long-term weight
loss outcomes.
