What Predicts Successful Weight Loss Maintenance in WW?

DALLAS, TEXAS — Researchers identified behavioral, psychological, and environmental predictors of continued weight loss maintenance vs weight regain in a large cohort of members of Weight Watchers who had successful long-term weight loss.

On average, the participants had lost 25.5 kg (56 lb) and kept it off for 3.5 years, when they entered the 1-year study.

At study entry and 1 year later, the participants replied to several questionnaires that asked about predictors of weight loss maintenance.

Compared with people who gained weight over the 1-year study, those who maintained their weight within 2.3 kg (5 lb) reported more consistent monitoring of their diet and weight and greater acceptance of uncomfortable food cravings.

They also had reduced disinhibition (tendency to overeat) when faced with food cues, as well as less pain and a more positive body image “at any weight, shape, or size,” Suzanne Phelan, MD, PhD, reported.

Phelan, from the Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, presented the study in an Obesity symposium at ObesityWeek, and it was simultaneously published in the journal. The study was selected as one of five top papers submitted to the journal to coincide with the meeting.

Future interventions to prevent weight regain should target overeating in response to internal and external food cues and declines in self-monitoring and body image, Phelan said.

The study aimed to identify behaviors that might predict who might “beat the odds” and sustain long-term weight loss, she told Medscape.

The findings suggest that the people who maintained their weight loss had developed skills to help them cope with cravings and not respond by eating, she said. Continued self-monitoring and body acceptance and appreciation (all body sizes are beautiful) were key elements of successful weight loss maintenance.

No Antiobesity Drugs or Surgery; Don’t Forget Behavioral Stuff

Importantly, although 43% of the study participants regained more than 5 pounds during this 1-year study, they still remained at 18% below their starting weight, “indicating that they were largely successful at weight loss,” Phelan said.

Michael D. Jensen, MD, editor-in-chief of Obesity, echoed this.

The researchers “did find some weak predictors of success,” said Jensen, from Mayo Clinic, Rochester, Minnesota. “But perhaps as important,” he said, “was that at the end of the trial, even those who had regained some slight weight still had 18% weight loss — which is not trivial — after, on average, 4.5 years with a standard commercial weight management program.

“At every talk I go to here,” the message is, “Let’s stampede towards use of the drugs and skip diet and exercise and behavioral stuff,” he observed. “I would argue,” he said, “that when it works, it works really well, and it’s free. So this idea that we shouldn’t even try it, because we know it’s going to fail, is wrong.

“If you have the right group, they have a decent chance of having a sufficiently good response that you don’t have to give the medications and you don’t have to send them for bariatric surgery.

“Once you learn from these programs what to do, you’re not paying $1000 a month for a drug and you haven’t had bariatric surgery,” Jensen noted. “Their 3 years of follow-up of Weight Watchers cost less than 1 month worth of one of these [antiobesity medications].”

The predictive findings were like ‘”icing on the cake,” he said. Anybody can find five people who’ve done well with therapy, but this study was in more than 2800 people who did well with a commercial program that is not expensive.

Study Design and Findings

Between 2019 and 2020, Weight Watchers invited adult members who had maintained weight loss of at least 9.1 kg (20 lb) for at least 1 year to participate in this study.

Of 7025 participants who entered the study, 4004 individuals (57%) who did not complete the 1-year questionnaires and others with implausible weight were excluded, leaving a final sample of 2843 participants.

Most participants were women (92%), non-Hispanic White (95%), married (92%), and college educated. They had mean age of 56 years.

On average, the participants had a body mass index (BMI) of 35.9 (grade 2 obesity) at the start of the Weight Watchers program and a BMI of 26.7 when they entered the current study.

At the 1-year follow-up, 57% of the participants had maintained the same weight (within 2.3 kg) as when they enrolled in the study, and 43% had gained ≥ 2.3 kg.

On average, the weight loss maintainers had gained 0.4 kg (0.88 lb). The weight gainers had gained 7.2 kg (15.9 lb) but were still 19.1 kg (42.1 lb) below the weight they had when they started the Weight Watchers program.

At baseline, compared with the weight gainers, the weight loss maintainers were on average older (58 vs 52 years), had a lower initial BMI (26 vs 28), and had longer duration of weight loss maintenance (4 vs 3 years).

At 1 year, those who had maintained their weight loss had greater self-monitoring, psychological coping, physical activity strategies, dietary choice strategies, and eating and physical activity habits, and they had less eating initiation in the absence of hunger.

They also had less disinhibition, more willingness to ignore cravings and accept food urges, more future orientation, more mindfulness, more positive body image and body satisfaction, better general health and mental health, and less bodily pain.

This research was supported by a grant to Phelan from Weight Watchers (WW) International, and three study authors are employees and shareholders of the company. Jensen discloses consulting for Biohaven Pharmaceuticals and for Seattle Gummy Co.

Obesity. Published online October 16, 2023. Full text

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