Why is weight loss so hard to maintain?

Here's why and what you can do about it in 2019

Have you lost weight in the past only to regain most of it if not more?

Are you losing the same 20 to 30 pounds over and over again?

Are you feeling discouraged, frustrated and not sure you want to even try again?

If you have had these experiences, you are not alone. Most people start regaining weight within a year of a weight loss effort, and it’s estimated that only 20% of people who lose weight maintain a 10% weight loss by the second year.

Why is keeping weight off so challenging?  There are many factors that affect long-term weight loss maintenance, some are within our control and some are not.  It’s important to know the difference so that we can work toward accepting the things we cannot change and channel our efforts on the things we can.

What we can’t control: Our unconscious impulses

The prevailing science suggests the body perceives weight loss as a threat to survival, even if it’s intentional weight loss.  We are equipped with a complex neuro-hormonal system that regulates our weight, says Dr. David Macklin, Director of Weight Management at Medcan and a noted expert on obesity and weight management in Canada. “This system evolved over hundreds of thousands of years in a mostly food scarce environment,” says Dr. Macklin. In response to weight loss, our bodies can adapt by reducing our energy expenditure (metabolism) and by increasing our appetite (hunger) and motivation to eat (wanting) in efforts to defend our weight and increase our chances of survival.  This system works well for the environment in which it evolved, but not so well in the modern calorie-rich environment where there is easy access to affordable tasty foods in large quantities and plenty of opportunities to eat them.

It is suggested that the strongest influence contributing to weight regain is increased energy intake, the decrease in metabolism having a smaller effect in comparison.  Researchers were able to quantify this feedback control of energy intake in response to weight loss using data from this cleverly designed study, meaning they were able to determine how many more calories people in the study started eating as they lost weight which contributed to the slowing down of weight loss and eventual plateau. Here’s what happened in the study.

The placebo-controlled study involved 150 individuals with type 2 diabetes being treated with canagliflozin for one year.  Canagliflozin, at a dose of 300 mg/day, works to control blood sugars by increasing glucose (sugar) excretion in the urine in the amount of approximately 90 grams per day (~ 360 Calories).  This loss of calories led to a gradual weight loss of 3.5 kg on average in the treatment group and eventual plateau at this lower weight without any conscious changes to dietary intake or exercise, an important consideration in isolating the impact of internal feedback control systems.

Weight loss leads to a proportional increase in appetite

The researchers used a validated mathematical model to quantify changes in energy intake contributing to this change in weight over time.  It was determined that weight loss leads to a proportional increase in appetite by about 100 calories per day above baseline for every kilogram of weight lost.  So, if an individual lost 3.5 kilograms (8 pounds) in a weight loss effort, it’s estimated he/she would eventually be consuming an extra 350 Calories from baseline in response to that weight loss.  These influences on appetite and wanting are said to be largely outside of conscious awareness, meaning, individuals may not necessarily perceive that they are eating more, but the evidence suggests otherwise.

What this means – there are certainly genetic differences in how individuals may respond to weight loss.  However, recognize the possibility that you may burn fewer calories and experience increased hunger and wanting when you lose weight.  The more weight you lose, the more significant these adaptations are likely to be.  The fact it’s hard to keep weight off is because there’s an internal drive toward food and eating as your body tries to protect you from harm and increase your chances of survival.  To avoid overeating in response to increases in appetite and wanting, a persistent and sustainable effort is required. .

What we can control: Our thoughts

Weight loss can be maintained if a persistent and sustainable effort is made, but this is hard work and requires a high level of commitment and motivation.  How do successful weight loss maintainers do it?

There are many factors that contribute to their success; however, one that stands out is their ability to think different. Just like the Apple ad of the 1990s told us, we know that thoughts lead to how we feel and what we do.  Change your thinking and you can change your behavior.

By changing their thinking, those who lose weight and keep it off can recover quickly from slips and setbacks with renewed motivation to refocus on their weight management efforts.  This is called resilience and it’s a skill that can be learned.

It’s not surprising that an individual with a slower metabolism and increased hunger/wanting in a calorie-rich environment will overeat at times and experience bouts of weight gain.  These types of slips and setbacks are common and expected.  But how individuals respond in the aftermath of these experiences will make a difference in their chances of success.  Consider the following client’s story before and after she developed a stronger skill of resilience.

A case study of resilience: Jenna’s road to resilience

Jenna has had a number of holiday events in the last month, both social and work-related.  It’s also year-end at work and she’s been working long hours and not getting enough sleep.  She’s noticed her weight creeping up on the scale.  She rescheduled two of her appointments at Weight Management at Medcan, she just didn’t want to face it.  When she finally did come in, she shared her frustration, disappointment, worry and self-blame as a result of her weight gain.  She said, “I’m not trying hard enough”, “This is just like the last time, I’m going to regain all the weight”, “I don’t think I can do this.”  Without intervention, imagine for a moment what Jenna’s next steps might be.  She would certainly be at increased risk of giving-up.  In the supportive, non-judgmental environment with her team at Medcan, Jenna’s negative and self-critical thoughts and feelings were explored further and challenged with facts and evidence which helped her change her thoughts to ones that were more balanced and resilient.  She was able to recommit to some of her weight management efforts despite the challenges of the season and made it through to the New Year without gaining any more weight.

Over the next couple of months, Jenna found that her workload became more manageable, she was sleeping better and in a better routine with eating at home more often.  She was able to start losing weight again, until her two-week cruise vacation.  She had a good time, but ate and drank more than she intended, and came home having gained some weight.  Historically, this would have been a very disappointing experience for her and she would have been beating herself up over it.  This time, however, she thought differently.  At her next appointment, she had already lost a couple of extra pounds she put on during her vacation.  She said, “I wasn’t happy to see the scale go up, but I also wasn’t surprised because I knew I ate and drank more than usual.  Cruises are tough and I might consider a different type of vacation next time.  I just reminded myself that it’s not the end of the world that I put on a bit of weight.  I know what I need to do to get back on track, and when I make those efforts, my weight settles down.  I also feel good when I eat well and exercise, and that helps motivate me to do my best every day.”

It’s not if you falter, but how you respond when you do

This is how I see it: Long-term weight loss maintenance requires a high level of commitment and motivation, especially in the face of slips and setbacks which are common and expected.  If negative and self-critical thoughts in the aftermath of an overeating or weight gain experience create a barrier for you to move forward, consider focusing on changing your thoughts to ones that are more resilient.  This is a skill that takes time to learn and develop, but it will increase your chances of long term success. I’d be happy to discuss this with you in more detail.

Christine Melanson is a registered dietitian with the Weight Management program at Medcan. To learn more about Weight Management at Medcan, you can arrange an introductory consultation by contacting Kelly Cloutier, Program Coordinator, at kellycloutier@medcan.com or call 416.350.5918. 

If you book your Annual Health Assessment between January 9 and January 31, you will be entered for a chance to win your choice of one of the following add-ons: 10 personal training sessions; Liver Health Assessment; or Genetics and Genetic Counselling. 

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