4 barriers to long-term weight loss

A quantitative analysis of patient perspective during the first years after a successful weight reduction has identified four solid barriers to weight loss maintenance, namely mental distress, binge eating, hedonic hunger, and demoralization.

“The current list of difficulties and analysis is an important first step to fully develop and evaluate, in a larger sample, patients’ self-reported difficulties in maintaining weight loss after clinically significant weight reduction,” the researchers said.

Following a successful completion of a nonsurgical weight loss and lifestyle intervention for morbid obesity, follow-up data were analysed from patients attempting weight maintenance. At mandatory follow-up assessments, the researchers obtained these data that included rating of 26 probable difficulties and performed a component analysis to explore whether these difficulties could be grouped into meaningful factors. They also examined the associations with sociodemographic factors, follow-up time, and weight changes.

Of the 102 participants, 88 had available data (baseline body mass index, 49.5±7.4 kg/m²; 12-month weight loss, 24.3±9.6 percent; follow-up time, 1.48±0.6 years). Four solid factors comprising 21 items and explaining 56 percent of the variance were identified and interpreted as follows: mental distress, binge eating, hedonic hunger, and demoralization. [Eur J Clin Nutr 2020;74:1192-1200]

For mental stress, the items included mental issues, negative feelings (ie, anger, frustration, depression), personal crises or blows of fate, stress, lack of time, and lack of professional supervision. Under binge eating were the following factors: loss of control when eating, binge eating episodes, boredom, and excessive craving for food.

For hedonic hunger, the items were social gatherings with food temptations, pressure to eat in social situations, vacation or travel, pleasure eating, constant temptations and food availability, and continuous feelings of sacrifice. Under demoralization, the associated factors were lacked motivation, lacked support and thoughtfulness from others, lacked faith in long-term success, health-related issues, and financial constraints.

Each of the four solid factors was associated with weight regain (12.4±12 percent), with mental distress (r, 0.38) being the most prominent. When controlling for age and follow-up time, binge eating turned out to be the most significant predictor of weight regain (adjusted R², 0.297).

“In line with previous findings, the present results suggest that binge eating and mental distress were the most important barriers with respect to actual weight maintenance,” the researchers said. “Moreover, for the first time we found that time might have mediated their importance suggesting a complementary significance.” [Obesity 2017;25:1830-1837; Obes Sci Pr 2016;2:83-87; Eat Weight Disord 2019;24:351-361]

In addition, these data indicated that patient perspective alone could not explain all differences in weight regain and that other factors, such as metabolic and endocrine responses to weight loss, must also be considered. [Med Clin North Am 2018;102:183-197; Int J Obes 2015;39:1188-1196; Obes Rev 2015;16:234-247]

“Nevertheless, evaluating patient perspective quantitatively might be useful for identifying major barriers which could then serve as a framework for providing more individualized and targeted behavioural interventions as part of a multidisciplinary approach to long-term maintenance,” the researchers noted. [Clin Nutr 2017;36:917-938; Obesity 2015;23:7-15; Diabetologia 2018;61:790-799]