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Behavioral Strategies for Weight Loss Maintenance

체중감량 이후 장기적인 유지를 위한 다양한 행동전략

  • Young Hye Cho (Department of Family Medicine, Pusan National University School of Medicine)
  • 조영혜 (부산대학교 의과대학 가정의학교실)
  • Received : 2023.02.16
  • Accepted : 2023.04.11
  • Published : 2023.06.30

Abstract

Compensatory changes in energy consumption and neuro-hormonal changes following weight loss make it difficult to maintain the reduced weight and may cause weight regain. Therefore, establishing a long-term weight control plan and strategy starting from the initial weight loss period is necessary. Both the patient and doctor should know that weight loss cannot occur continuously, and that maintaining weight after the weight loss period is the basic course of obesity treatment. No single dietary pattern is effective for weight maintenance, and a variety of dietary control methods - such as calorie restriction and healthy proportions of carbohydrates, proteins, fats, and meal replacements - should be used to target an integrated and healthy dietary habit. An increase in physical activity is needed for weight loss and maintenance; however, rather than recommending an excessive amount of exercise, it is better to set realistic and long-term achievable goals. It is necessary to reset the goal according to the patient's weight maintenance stage and continuously apply behavioral therapies, such as self-monitoring and stress management. In previous studies, since the degree of weight loss and changes in behavioral patterns over the course of one year were important factors in maintaining long-term weight loss, obesity therapists should closely examine patient data and behavioral patterns across a period of one year and actively intervene when needed.

Keywords

Acknowledgement

연구는 2021년 양산부산대학교병원 임상연구비 지원으로 이루어졌음.

References

  1. World Health Organization. Obesity and overweight [Internet]. World Health Organization. 2021 [cited 2021 June 6]; Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med 2017;376:254-66. https://doi.org/10.1056/NEJMra1514009
  3. Yumuk V, Tsigos C, Fried M, et al. European guidelines for obesity management in adults. Obes Facts 2015;8:402-24. Erratum in: Obes Facts 2016;9:64.
  4. Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev 2018;39:79-132. https://doi.org/10.1210/er.2017-00253
  5. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001;21:323-41. https://doi.org/10.1146/annurev.nutr.21.1.323
  6. Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002. Am J Prev Med 2007;33:34-40. https://doi.org/10.1016/j.amepre.2007.02.040
  7. Berger SE, Huggins GS, McCaffery JM, Lichtenstein AH. Comparison among criteria to define successful weight-loss maintainers and regainers in the Action for Health in Diabetes (Look AHEAD) and Diabetes Prevention Program trials. Am J Clin Nutr 2017;106:1337-46. https://doi.org/10.3945/ajcn.117.157446
  8. Ryan DH, Espeland MA, Foster GD, et al.; Look AHEAD Research Group. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610-28. https://doi.org/10.1016/S0197-2456(03)00064-3
  9. Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. https://doi.org/10.1056/NEJMoa012512
  10. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001;74:579-84. https://doi.org/10.1093/ajcn/74.5.579
  11. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 2007;107:1755-67. https://doi.org/10.1016/j.jada.2007.07.017
  12. Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring) 2014;22:5-13. https://doi.org/10.1002/oby.20662
  13. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2014;63(25 Pt B):2985-3023. Erratum in: J Am Coll Cardiol 2014;63(25 Pt B):3029-30. https://doi.org/10.1016/j.jacc.2014.03.004
  14. Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003;348:2074-81. https://doi.org/10.1056/NEJMoa022637
  15. Foster GD, Wyatt HR, Hill JO, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 2010;153:147-57. https://doi.org/10.7326/0003-4819-153-3-201008030-00005
  16. Santesso N, Akl EA, Bianchi M, et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr 2012;66:780-8. https://doi.org/10.1038/ejcn.2012.37
  17. van Baak MA, Mariman ECM. Dietary strategies for weight loss maintenance. Nutrients 2019;11:1916.
  18. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of intermittent fasting and time-restricted feeding compared to continuous energy restriction for weight loss. Nutrients 2019;11:2442.
  19. Liu D, Huang Y, Huang C, et al. Calorie restriction with or without time-restricted eating in weight loss. N Engl J Med 2022;386:1495-504. https://doi.org/10.1056/NEJMoa2114833
  20. Astbury NM, Piernas C, Hartmann-Boyce J, Lapworth S, Aveyard P, Jebb SA. A systematic review and meta-analysis of the effectiveness of meal replacements for weight loss. Obes Rev 2019;20:569-87. https://doi.org/10.1111/obr.12816
  21. Rhee EJ. Current status of obesity treatment in Korea: based on the 2020 Korean Society for the Study of Obesity guidelines for obesity management. J Korean Med Assoc 2022;65:388-92. https://doi.org/10.5124/jkma.2022.65.7.388
  22. Liguori G; American College of Sports Medicine (ACSM). ACSM's guidelines for exercise testing and prescription. Philadelphia, PA: Lippincott Williams & Wilkins; 2020.
  23. Bellicha A, van Baak MA, Battista F, et al. Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: an overview of 12 systematic reviews and 149 studies. Obes Rev 2021;22(Suppl 4):e13256.
  24. American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42(Suppl 1):S81-9. https://doi.org/10.2337/dc19-S008
  25. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol 2001;69:722-6. https://doi.org/10.1037/0022-006X.69.4.722
  26. Lv N, Azar KMJ, Rosas LG, Wulfovich S, Xiao L, Ma J. Behavioral lifestyle interventions for moderate and severe obesity: a systematic review. Prev Med 2017;100:180-93. https://doi.org/10.1016/j.ypmed.2017.04.022
  27. Flore G, Preti A, Carta MG, et al. Weight maintenance after dietary weight loss: systematic review and meta-analysis on the effectiveness of behavioural intensive intervention. Nutrients 2022;14:1259.
  28. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med 2014;46:17-23. https://doi.org/10.1016/j.amepre.2013.08.019
  29. Wadden TA, West DS, Delahanty L, et al.; Look AHEAD Research Group. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006;14:737-52. Erratum in: Obesity (Silver Spring) 2007;15:1339.