When it comes to weight loss, the statistics are pretty grim. The way it looks from the statistics, losing weight isn’t the issue; Keeping it off is. Some people claim that 95% of people who lose weight regain it. When you look at it that way, it’s almost not worth looking to lose weight, since the likelihood of success is so low. Fortunately, it probably isn’t THAT grim.
My interpretation of the research is that roughly ~80% of people regain weight and within a 5 year window, roughly 1/3 of people gain more than they started with.
Even at 80% of people regaining weight, the outcomes don’t seem great. But from my experience as a dietitian working with clients, I know that the outcomes I have been getting seem to be much better than those that are found in the research, so I wanted to share some of the things that appear to improve the likelihood of success.
Some Thoughts on how to Maintain Weight-Loss (or build on it)
I have a lot of thoughts on this and there are so many different ways to achieve great results, but here are some evidence based-aspects that can improve weight-loss outcomes over the long term:
1) Volume eating – Focusing on eating a larger volume of foods that are lower in calories can make the entire process easier. When people cut down on their food volume in an attempt to lose weight, they are less likely to succeed long-term in comparison to people who increase their volume for the same number of calories.
It makes sense to focus on eating a large amount of fruits and vegetables. It makes sense to eat high fibre foods in general vs low fibre foods, since that will also be more satiating. It makes sense to drink larger volumes of water or non-caloric drinks.
If you are consuming less calories, but still feeling satisfied, that is a good situation to be in. Focusing on these concepts can increase the likelihood of success.
2) Protein - For athletes trying to optimise muscle mass, around 1.6-2.2g/kg/day is a good guide to follow. Since most people looking to lose weight aren’t as lean as athletes the number is a bit lower, due to the lower amount of lean body mass as a percentage of total body weight.
A number I would like to use with the average client I see looking to lose weight is around 1.4g/kg/day, however experience has taught me that some people struggle to reach this number while staying in calorie deficit. In those situations, aiming for at least 1g/kg/day could be a good target. Low for my liking, but still higher than the RDI. I believe that this will help people maintain more muscle, fill them up more and also be slightly thermically advantageous. More muscle = faster metabolism. More satiety = less likely to overconsume calories. Thermic advantage = being able to eat slightly more calories since slightly more are being expended.
4) Accountability – People tend to find it easier to put this knowledge into action and build and maintain the desired behaviours and habits much more easily if they are accountable to somebody such as a dietitian.
In all the research, it appears as though most people regain weight when the intervention stops, pretty much regardless of what the intervention is. Even without factoring in all the other beneficial aspects, the accountability of seeing a dietitian long-term and being accountable to them can help improve long-term outcomes.
The other factor is that investing money into the process can be a motivator. A former mentor of mine once said to me “I used to see clients for free as a government funded dietitian and some people weren’t getting great results. When I opened my private practice and these same clients had to start paying, they suddenly got incredible results even though I was giving the same advice as before.” Accountability matters.
5) Diet breaks – Diet breaks can make the process easier. In the past, people had the opinion that cheat meals or refeed days could help keep their metabolic rate high. Short-term studies showed positive outcomes, but the research doesn’t support that this does actually impact metabolic rate over the course of the week/month.
Taking regular 1-2 week diet breaks where the individual eats at maintenance however DOES appear to help keep total daily energy expenditure higher. This means people can eat more calories throughout their weight-loss phases and continue to make progress, and also end their diets on higher calories than they would have if they didn’t have diet breaks. That is another good position to be in.
It also helps from a mental perspective. If you have “dieted” for 10 days and only have 3-4 days before a diet break, it might make it easier to stick to the plan vs if you are 10 days in and have 20+ weeks to go. Plus, it gets people used to eating at maintenance (and experiencing the benefits associated with this) rather than constantly striving to be in a calorie deficit.
I’m of the opinion diet breaks are beneficial and should be utilised at times. Nobody knows the best way to implement them. Two weeks on, two weeks off is a bit excessive in my mind. Nobody wants to take twice as long as necessary to reach their goals, even if it is the “smart way to do things.” There are other options that are/have been researched such as 3 weeks on, 1 week off, but we don’t exactly have a massive amount of research on this are yet.
6) Mental Health – For people with depression that impacts their food choices, it could be best to start by addressing that first. There is plenty of research coming out showing that dietary approaches can help with depression. Using the SMILEs Trial as an example, 32% of people with severe depression went into complete remission from depression within twelve weeks by attempting to follow a Modified-Mediterranean diet. These people didn’t even come close to following exactly what the dietitians recommended, but they did make major positive changes to their diets, in a weight-neutral fashion.
Depression can seriously effect somebody’s diet. Potentially, improving that variable could help open up the door for greater success with weight-loss down the line. That being said, there are a lot of non-dietary factors in depression and only so much that can be done through dietary changes.
Weight loss is hard. Maintaining that weight loss over the long-term appears to be even harder. While the statistics suggest that ~80% of people regain weight over a period of around 5 years, implementing some of the strategies above likely can help to improve outcomes and shift the odds in your favour.