Weight loss can be a challenging endeavor.  At any given time, nearly 25% of men and 40% of women in America are on a diet (Muth, n.d.).  Despite this, obesity rates have hit 41.9% in the U.S. according to the CDC (CDC, 2022). 

Nearly half of the population!  The consequences of overweight and obesity are significant, and include but are not limited to the following (CDC, 2022):

• heart disease,
• stroke, 
• type 2 diabetes 
• certain types of cancer. 
• preventable, premature death 

Despite widespread knowledge of these consequences, weight loss can be a real challenge.

Even more challenging can be the maintenance of weight loss in the months and years that follow even successful programs and efforts (Hall & Kahan, 2018). 

In a review of 29 studies focused on weight loss, approximately 80% of participants had regained their weight after 5 years (Hall & Kahan, 2018).  On the positive side, 20% of participants have managed to successfully keep their weight off (Varkevisser et al., 2019).  

Still, with 8 out of 10 persons regaining their weight, the question has to be addressed!  Why is it so hard to keep the weight off after you have lost it? 

How can people assure that once they lose weight, they will be one of the 20% that keep it off for good?

This post will share research findings on why weight loss is so difficult to maintain–and, more importantly, strategies you can implement to keep the weight off for good!

Why do we gain the weight back after losing it?

While clients who struggle with maintaining weight loss may feel a sense of failure, the reasons for weight regain are complex and involve a number of factors–many of these operating levels outside our conscious awareness (Hall & Kahan, 2018).

How do our living and working environments promote obesity and weight regain?

With obesity rates high and continuing to climb, it is clear that Americans live and work within environments that promote obesity (Hall & Kahan, 2018).  

Environmental factors that drive weight gain and regain are reviewed as below.

Do ultra-processed foods explain weight regain and obesity?  

 

• Cheap, readily available for take out or purchase, convenient, calorie dense, and now accounting for the majority of calories now consumed by Americans, these foods have replaced natural, whole foods that were once prepared with greater prevalence at home (Hall & Kahan, 2019).
• Ultra-processed foods are designed to pack maximum flavor with high levels of sugar, fat, and sodium, along with texture and color enhancements to promote high levels of consumption (Ahima, 2009).  
• Ultra-processed foods have little to do with nourishment, and rather are intended to stimulate our brain’s pleasure and reward centers through stimulating dopamine and opioid receptors (Ahima, 2009).  

The Heart and Stroke Foundation of Canada (2022) provides excellent examples of whole, processed, and ultra processed foods as noted in this table:

Minimally processed foods: whole foods need to serve as the foundation of your diet if you are to manage your weight long term.	Processed but still health promoting:  these foods increase convenience but when chosen wisely can promote health	Ultra-processed:  these foods are major drivers of overweight and obesity and their rise in consumption has matched the rise in obesity
Vegetables,  Grains,  Legumes,  Fruits,  Nuts/ Seeds Meats,  Seafood,  Herbs,  Spices,  Garlic,  Eggs  Milk.	Whole Grain Breads,  Cheeses,  Tofu,  Canned Tuna/ Fish  Canned Vegetables,  Some Canned Fruits (Minimal Sugar),  Canned Beans	Soft Drinks,  Chips,  Chocolate,  Candy,  Ice-Cream,  Sweetened Breakfast Cereals,  Packaged Soups,  Chicken Nuggets,  Hotdogs,  Fries  And much, much more.

How do restaurants, meals away from home, and takeout food contribute to weight regain?

Americans now eat more frequently at restaurants, consume take out food, or otherwise eat away from home for more than half of their food expenditures (Bleich et al., 2020).

One in 3 Americans eat fast food on a given day (Bleich et al., 2020).  Research has shown that the more frequent consumers eat out at either a fast food restaurant or a sit down restaurant, the higher their body weight/ BMI (Bhutani et al., 2018).  

In fact, eating out has a “dose effect” that for each additional meal consumed away from home per day/ week, a reliable increase in body mass index is noted (Bhutani et al., 2020).

How does our sedentary lifestyle affect weight regain and obesity?

From Netflix to sedentary jobs to urban sprawl to long commuting distances, our environment discourages movement and encourages a sedentary lifestyle (Hall & Kahan, 2018).  

Combined with increasing caloric intake due to reasons described above, it’s not surprising that the decrease in caloric burn due to our increasingly sedentary lifestyle is leading to greater calorie intake versus output imbalances and skyrocketing obesity rates.

How do body composition changes due to weight loss contribute to weight regain?

Weight loss without exercise results in a loss of muscle mass

Weight loss can result in both fat mass loss and muscle mass loss (Willoughby et al., 2018).  When people lose muscle mass, the following negative effects occur:

• Lowered resting energy expenditure/metabolism, 
• Increase sense of fatigue, 
• Declines in neuromuscular function, 
• Increased risk for injury 
• Subsequent body fat overshoot, or a regain in fat mass resulting in a less favorable body composition.

Fortunately, exercise can counter these effects, increasing lean muscle mass, increasing fat loss, and improving overall body composition.  Indeed, exercise is a key component of sustaining weight loss (Muth, n.d.; Donnelly et al., 2009).  

Does our metabolism change and appetite increase when we lose weight?

Research has noted that for each kg (or 2.2 lbs) of body weight lost, we expend 20-30 less calories per day (Hall & Kahan, 2018).  This makes sense, after all, every step and move we make requires less energy due to us being lighter.  

In addition to the reduction in calories burned daily due to being a smaller body size, research notes that for every kg (or 2.2 lbs) of weight loss, our appetite increases approximately 100 calories per day above our baseline appetite prior to the weight loss!!

Sticking to the “diet?”  Research suggests without knowing it, you probably are not.

To compensate for this increase in appetite, people will subconsciously gradually increase their portion sizes even though they may truly believe they are still “sticking to the diet” that helped them lose weight originally (Hall & Kahan, 2018).  

This slow and progressive creep of increased food intake due to increased appetite explains the plateau effect along with the subsequent weight gain (Hall & Kahan, 2018).

How can I avoid weight regain?

While the above factors can make permanent weight loss a challenge, many people successfully lose weight and are successful at keeping the weight off long term (Varkevisser et al., 2019).  

In fact, 1 in 5 persons that lose weight successfully maintain their weight loss for years in spite of all the challenges noted above (Varkevisser et al., 2019).

Factors according to research compiled from nearly 50 studies describe the following factors below that contribute to the success of lasting weight loss (Varkevisser et al., 2019).

Behaviors/ habits that prevent weight regain

Strong evidence supports the following behavior interventions (Varkevisser et al., 2019):

• Weigh yourself routinely, such as daily or weekly. 
• Monitor what you eat, such as by completing a food journal ongoing.
• Maintain a high activity level that is increased over what you did prior to losing weight. 
• Healthy eating habits as defined by maintaining ongoing portion management, elimination of unhealthy foods, and overall ongoing lower daily caloric intake.
• Increased fruit and vegetable intake are strongly associated with ongoing weight loss.
• Reduction in sweetened beverages is strongly associated with sustained weight loss.
• Reduction in fat intake is positively associated with sustained weight loss.

The above findings are not surprising, as they mirror research noting whole-food/ minimally processed plant-based diets (diets naturally high in fruits, vegetables, with naturally low fat levels) are highly effective in helping people lose weight and improve a variety of long term health conditions.

Psychological predictors of long term weight loss success

Interestingly, reports of high stress levels were NOT associated with weight regain ((Varkevisser et al., 2019).

The following psychological factors WERE strongly predictive of long term sustained weight loss (Varkevisser et al., 2019):

• Having high levels of self-efficacy (self-confidence) for ability to exercise
• Having high levels of self-efficacy for ability to successfully manage weight
• Moderate evidence supported high levels of self-efficacy for ability to manage diet
• Having a high level of physical self worth
• Having the ability to inhibit self from binge eating or overeating in response to negative emotions was strongly associated with ongoing weight loss 

Also noted under psychological factors was that family discouragement of healthy eating undermined long term weight loss (Varkevisser et al., 2019).

Wrap-up

Weight regain affects nearly 80% of persons who initially succeed in losing weight.  However, it is possible to avoid this outcome by adopting research-backed habits and belief systems.

Believing in your self-worth and the the value of having a healthy body, eating a diet high in fruits and vegetables and low in fat, having confidence and ability in maintaining an exercise program, maintaining high levels of physical activity, intentionally choosing healthy foods and portions, reducing or eliminating sugary beverages, and overcoming urges to overeat due to emotions–these are all key factors in long term weight loss success.

How Lancaster Wellness can help!

At Lancaster Wellness, we have a multi-pronged approach to support you in your weight loss journey:

• Coaching with weekly check-in’s and high accessibility throughout the week
• Meal plans customized to suit your needs and goals
• Fitness programming customized according to your abilities and fitness levels
• Medical management including FDA-approved medications, hormone assessments when appropriate, and oversight by a physician-led medical team
• A focus on LONG-TERM interventions that enhance both short-term and long-term success
• A track record of successfully weaning many clients off of weight loss medications after achieving their final goals
• Clients frequently lose 20-40 lbs in the first 3 months of care (10-15% or more of their bodyweight in just 3 months!) and many go on to hit their ultimate goals of 50, 60, 70…100+ lbs off with Lancaster Wellness
• Proven track record of weaning clients off the medications for those who desire to use lifestyle measures to manage their weight long term
• Maintenance program for those that need / desire ongoing support after hitting their goals

Lancaster Wellness offers the following evidenced-based plant-based meal plans, we are able to support your health and nutrition goals using:

• Mediterranean diet meal plans
• Flexitarian diet meal plans
• Vegetarian diet meal plans 
• Vegan diet meal plans 
• Custom based nutrition strategies that bypass the need for meal plans for clients who choose not to use a meal plan

Reach out today to learn more about how we can help you optimize your health and nutrition!!!  Live well!

-Written by Donovan Carper MSN RN CPT CHC

References

Ahima R. S. (2009). The end of overeating: Taking control of the insatiable American appetite. The Journal of Clinical Investigation, 119(10), 2867. https://doi.org/10.1172/JCI40983 

Bleich, S. N., Soto, M. J., Dunn, C. G., Moran, A. J., & Block, J. P. (2020). Calorie and nutrient trends in large U.S. chain restaurants, 2012-2018. PloS one, 15(2), e0228891. https://doi.org/10.1371/journal.pone.0228891 

Bhutani, S., Schoeller, D. A., Walsh, M. C., & McWilliams, C. (2018). Frequency of Eating Out at Both Fast-Food and Sit-Down Restaurants Was Associated With High Body Mass Index in Non-Large Metropolitan Communities in Midwest. American journal of health promotion : AJHP, 32(1), 75–83. https://doi.org/10.1177/0890117116660772 

Centers for Disease Control and Prevention. (2022). Adult obesity facts. Retrieved from https://www.cdc.gov/obesity/data/adult.html 

Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., Smith, B. K., & American College of Sports Medicine (2009). American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine and science in sports and exercise, 41(2), 459–471. https://doi.org/10.1249/MSS.0b013e3181949333 

Hall, K. D., & Kahan, S. (2018). Maintenance of Lost Weight and Long-Term Management of Obesity. The Medical clinics of North America, 102(1), 183–197. https://doi.org/10.1016/j.mcna.2017.08.012

The Heart and Strong Foundation of Canada. (2022). What is ultra-processed food and how can you eat less of it? Retrieved from https://www.heartandstroke.ca/articles/what-is-ultra-processed-food#:~:text=These%20foods%20go%20through%20multiple,%2C%20hotdogs%2C%20fries%20and%20more. 

Muth, N. D. (n.d.). Module 5: Practical applications in nutrition for weight management. American Council on Exercise: Weight Management Specialist Program.

Varkevisser, R., van Stralen, M. M., Kroeze, W., Ket, J., & Steenhuis, I. (2019). Determinants of weight loss maintenance: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity, 20(2), 171–211. https://doi.org/10.1111/obr.12772

Willoughby, D., Hewlings, S., & Kalman, D. (2018). Body Composition Changes in Weight Loss: Strategies and Supplementation for Maintaining Lean Body Mass, a Brief Review. Nutrients, 10(12), 1876. https://doi.org/10.3390/nu10121876