Weight maintenance remains to be a challenge for patients in a reduced obese state and it has been recommended to provide them more individualized support. For this purpose it is crucial to understand the barriers patients are experiencing after weight loss. Many have been identified by qualitative studies. We evaluated if a quantitative assessment of patient perspective during weight maintenance can help identify major barriers that refer to actual regain.
Follow-up data were analyzed from patients attempting weight maintenances after successful completion of a nonsurgical weight loss and lifestyle intervention for morbid obesity. The data were acquired at mandatory follow-up assessments and included rating of 26 probable difficulties. A principal component analysis was carried out to explore whether these difficulties could be grouped into meaningful factors. Associations with socio-demographics, follow-up time, and weight changes were evaluated.
Data from 88 out of 102 patients were available (baseline BMI 49.5 ± 7.4 kg/m2; 12-month weight loss 24.3 ± 9.6%; follow-up time 1.48 ± 0.6 years). Four solid factors, composed of 21 items and explaining 56% of the variance were extracted and interpreted as ‘Hedonic Hunger’, ‘Mental Distress’, ‘Binge Eating’, and ‘Demoralization’. Weight regain (12.4 ± 12%) was correlated with each factor, most closely with ‘Mental Distress’ (r = 0.38). When controlling for age and follow-up time, ‘Binge Eating’ was the most important predictor (adj. R2 = 0.297).
A quantitative assessment of patient perspective during the first years after weight loss can help identify valid barriers to weight loss maintenance.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, et al. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr. 2017;36:917–38. https://doi.org/10.1016/j.clnu.2016.11.007
MacLean PS, Wing RR, Davidson T, Epstein L, Goodpaster B, Hall KD, et al. NIH working group report: Innovative research to improve maintenance of weight loss. Obesity. 2015;23:7–15. https://doi.org/10.1002/oby.20967
Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. 2016;24:1612–9. https://doi.org/10.1002/oby.21538
Melby CL, Paris HL, Foright RM, Peth J. Attenuating the biologic drive for weight regain following weight loss: Must what goes down always go back up? Nutrients. 2017;9:E468. https://doi.org/10.3390/nu9050468
Anastasiou CA, Karfopoulou E, Yannakoulia M. Weight regaining: from statistics and behaviors to physiology and metabolism. Metabolism. 2015;64:1395–407. https://doi.org/10.1016/j.metabol.2015.08.006
Coutinho SR, With E, Rehfeld JF, Kulseng B, Truby H, Martins C. The impact of rate of weight loss on body composition and compensatory mechanisms during weight reduction: a randomized control trial. Clin Nutr. 2018;37:1154–62. https://doi.org/10.1016/j.clnu.2017.04.008
McGrice M, Don Paul K. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions. Diab Metab Syndr Obes Targets Ther. 2015;8:263. https://doi.org/10.2147/DMSO.S57054
Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: Systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:1–12. https://doi.org/10.1136/bmj.g2646
Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6:67–85. https://doi.org/10.1111/j.1467-789X.2005.00170.x
Teixeira PJ, Carraça EV, Marques MM, Rutter H, Oppert J-M, De Bourdeaudhuij I, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med. 2015;13:84. https://doi.org/10.1186/s12916-015-0323-6
Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Obes Rev. 2019;20:171–211. https://doi.org/10.1111/obr.12772
Berk KA, Buijks HIM, Verhoeven AJM, Mulder MT, Özcan B, van’t SpijkerA, et al. Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: results from the randomised controlled POWER trial. Diabetologia. 2018;61:790–9. https://doi.org/10.1007/s00125-017-4531-9
Foright RM, Presby DM, Sherk VD, Kahn D, Checkley LA, Giles ED, et al. Is regular exercise an effective strategy for weight loss maintenance? Physiol Behav. 2018;188:86–93. https://doi.org/10.1016/j.physbeh.2018.01.025
Sainsbury K, Evans EH, Pedersen S, Marques MM, Teixeira PJ, Lähteenmäki L, et al. Attribution of weight regain to emotional reasons amongst European adults with overweight and obesity who regained weight following a weight loss attempt. Eat Weight Disord. 2019;24:351–61. https://doi.org/10.1007/s40519-018-0487-0
Lauti M, Stevenson S, Hill AG, MacCormick AD. Patient perspectives about follow-up care and weight regain following sleeve gastrectomy. Obes Surg. 2016;26:2724–31. https://doi.org/10.1007/s11695-016-2178-0
Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20:349–56. https://doi.org/10.1007/s11695-009-9895-6
Ferguson S, Al-Rehany L, Tang C, Gougeon L, Warwick K, Madill J. Self-reported causes of weight gain: among prebariatric surgery patients. Can J Diet Pr Res. 2013;74:189–92. https://doi.org/10.3148/74.4.2013.189
Weimann A, Fischer M, Oberänder N, Prodehl G, Weber N, Andrä M, et al. Willing to go the extra mile: Prospective evaluation of an intensified non-surgical treatment for patients with morbid obesity. Clin Nutr. 2018:1–9. https://doi.org/10.1016/j.clnu.2018.07.027.
Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018;102:183–97. https://doi.org/10.1016/j.mcna.2017.08.012
Coughlin JW, Brantley PJ, Champagne CM, Vollmer WM, Stevens VJ, Funk K, et al. The impact of continued intervention on weight: five-year results from the weight loss maintenance trial. Obesity. 2016;24:1046–53. https://doi.org/10.1002/oby.21454
Lowe MR, Butryn ML. Hedonic hunger: a new dimension of appetite? Physiol Behav. 2007;91:432–9. https://doi.org/10.1016/j.physbeh.2007.04.006
Nagl M, Hilbert A, De Zwaan M, Braehler E, Kersting A. The German version of the Dutch eating behavior questionnaire: psychometric properties, measurement invariance, and population-based norms. PLoS ONE. 2016;11:1–15. https://doi.org/10.1371/journal.pone.0162510
Schultes B, Ernst B, Wilms B, Thurnheer M, Hallschmid M. Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery. Am J Clin Nutr. 2010;92:277–83. https://doi.org/10.3945/ajcn.2009.29007
Theim KR, Brown JD, Juarascio AS, Malcolm RR, O’Neil PM. Relations of hedonic hunger and behavioral change to weight loss among adults in a behavioral weight loss program utilizing meal-replacement products. Behav Modif. 2013;37:790–805. https://doi.org/10.1177/0145445513501319
Geiker NRW, Astrup A, Hjorth MF, Sjödin A, Pijls L, Markus CR. Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obes Rev. 2018;19:81–97. https://doi.org/10.1111/obr.12603
Meule A, Reichenberger J, Blechert J. Development and preliminary validation of the Salzburg stress eating scale. Appetite. 2018;120:442–8. https://doi.org/10.1016/j.appet.2017.10.003
Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–225S. https://doi.org/10.1093/ajcn/82.1.222S
van Strien T. Causes of emotional eating and matched treatment of obesity. Curr Diab Rep. 2018;18:35. https://doi.org/10.1007/s11892-018-1000-x
Bertoli S, Leone A, Ponissi V, Bedogni G, Beggio V, Strepparava MG, et al. Prevalence of and risk factors for binge eating behaviour in 6930 adults starting a weight loss or maintenance programme. Public Health Nutr. 2016;19:71–7. https://doi.org/10.1017/S1368980015001068
Thompson-Brenner H, Franko DL, Thompson DR, Grilo CM, Boisseau CL, Roehrig JP, et al. Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder. J Consult Clin Psychol. 2013;81:710–21. https://doi.org/10.1037/a0032946
Van der Heijden PT, Rossi GMP, van der Veld WM, Derksen JJL, Egger JIM. Personality and psychopathology: Higher order relations between the five factor model of personality and the MMPI-2 Restructured Form. J Res Pers. 2013;47:572–9. https://doi.org/10.1016/j.jrp.2013.05.001
Dalle Grave R, Centis E, Marzocchi R, El Ghoch M, Marchesini G. Major factors for facilitating change in behavioral strategies to reduce obesity. Psychol Res Behav Manag. 2013;6:101–10. https://doi.org/10.2147/PRBM.S40460
Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39:1188–96. https://doi.org/10.1038/ijo.2015.59
Yu YH, Vasselli JR, Zhang Y, Mechanick JI, Korner J, Peterli R. Metabolic vs. hedonic obesity: a conceptual distinction and its clinical implications. Obes Rev. 2015;16:234–47. https://doi.org/10.1111/obr.12246
Kristeller J, Wolever RQ, Sheets V. Mindfulness-based eating awareness training (MB-EAT) for binge eating: a randomized clinical trial. Mindfulness. 2014;5:282–97. https://doi.org/10.1007/s12671-012-0179-1
Levoy E, Lazaridou A, Brewer J, Fulwiler C. An exploratory study of mindfulness based stress reduction for emotional eating. Appetite. 2017;109:124. https://doi.org/10.1016/j.appet.2016.11.029
Hilbert A, Herpertz S, Zipfel S, Tuschen-Caffier B, Friederich HC, Mayr A, et al. Early Change Trajectories in Cognitive-Behavioral Therapy for Binge-Eating Disorder. Behav Ther. 2019;50:115–25. https://doi.org/10.1016/j.beth.2018.03.013
Prestwich A, Kellar I, Parker R, MacRae S, Learmonth M, Sykes B, et al. How can self-efficacy be increased? Meta-analysis of dietary interventions. Health. Psychol Rev. 2014;8:270–85. https://doi.org/10.1080/17437199.2013.813729
Lillis J, Thomas JG, Niemeier H, Wing RR. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obes Sci Pr. 2016;2:83–7. https://doi.org/10.1002/osp4.22
Chao AM, Wadden TA, Gorin AA, Shaw Tronieri J, Pearl RL, Bakizada ZM, et al. Binge eating and weight loss outcomes in individuals with type 2 diabetes: 4-year results from the look AHEAD study. Obesity. 2017;25:1830–7. https://doi.org/10.1002/oby.21975
Greaves C, Poltawski L, Garside R, Briscoe S. Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychol Rev. 2017;11:145–63. https://doi.org/10.1080/17437199.2017.1299583
Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assessment. 2005;10:1–9.
Zakeri R, Batterham RL. Potential mechanisms underlying the effect of bariatric surgery on eating behaviour. Curr Opin Endocrinol Diabetes Obes. 2018;25:3–11. https://doi.org/10.1097/MED.0000000000000379
Holst JJ, Madsbad S, Bojsen-Møller KN, Svane MS, Jørgensen NB, Dirksen C, et al. Mechanisms in bariatric surgery: gut hormones, diabetes resolution, and weight loss. Surg Obes Relat Dis. 2018;14:708–14. https://doi.org/10.1016/j.soard.2018.03.003
Elijah J. Steiger for help with data management.
Conflict of interest
The authors declare no conflict of interest with respect to this paper.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Fischer, M., Oberänder, N. & Weimann, A. Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction. Eur J Clin Nutr 74, 1192–1200 (2020). https://doi.org/10.1038/s41430-020-0559-x
This article is cited by
Nature Reviews Endocrinology (2023)