Food and health

Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction



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.

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Fig. 1: Weight maintenance difficulties as perceived by reduced obese patients after treatment completion.
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Elijah J. Steiger for help with data management.

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MF: study design, analysis and interpretation of data, drafting manuscript. NO: acquisition and interpretation of data, critical revision of manuscript for intellectual content. AW: study concept and design, interpretation of data, critical revision of manuscript for intellectual content.

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Correspondence to Martin Fischer.

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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 (2020).

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