Ch 23: Managing Weight Loss Plateaus and Maintaining Weight Loss Flashcards
Successful weight loss is a challenging endeavor for many. There are numerous obstacles to success; these barriers include
Physiological, psychological, and environmental factors.
Two major challenges that people face include:
Weight-loss plateaus and preventing weight regain
Only 17% of adults in the United States sustain a 10% weight loss after 1 year
A period of stalled progress of 1 month or longer.
Plateau
The amount of calories consumed compared to the amount of calories expended.
Energy Balance
Ways to kickstart a Plateau
Tracking Food, Moving More, Cutting Carbs, Increasing Hydration
The degree to which an individual sticks with a diet.
Dietary Adherence
Main reason for a weight-loss plateau
An increase in energy intake so that energy intake matches energy expenditure is the main reason
Key factor behind lack of weight loss
Online tools that can help give projected weight loss
National Institute of Diabetes and Digestive and Kidney Diseases Body Weight Planner
Obese people who have lost weight.
Reduced Obese
Causes of Dietary Adherence Lapses
Physiological
Psychological
Environmental
Physiological
Increase in Appetite
There is a biological drive to increase calorie intake by approximately 100 calories for every kilogram of weight loss
Psychological causes for weight loss plateau
Situational Barriers and Resisting Temptation
Stress-Related Eating
Decision Makingpeople surrounded with vending machines full of familiar, palatable foods will spontaneously overeat by up to 54% above their maintenance calories
Confusion
Perception of Choice
Difficulty with Meal and Snack Plan
Lower Palatability
Environmental causes for weight loss plateau
The abundance of hyperpalatable, energy-dense foods
–People will spontaneously overeat when surrounded with highly palatable food.
–People surrounded with vending machines full of familiar, palatable foods will spontaneously overeat by up to 54% above their maintenance calories
each clients how to construct their food environment so that highly palatable, energy-dense foods are not readily available.
Environmental causes for weight loss plateau
- Social and Cultural Contexts
- Cost
- Work-related issues
- Portion Sizes
- Family Support
What is the main reason for a weight loss plateau?
An increase in energy intake so energy intake matches energy expenditure.
Periods of body weight plateaus where a client practices maintenance of habits and becomes used to the new body weight.
Maintenance Practice
Plateaus Stair Step Progression
(Cognitive Reframing: Breaking through Weight Loss Plateau)
Build a proper mindset from the onset
It is important to educate client on the near certainty of plateaus (Normal part of weight loss journey)
“Maintenance Practice”
“Opportunities to test Program Sustainability)
Re-Establishing an Energy Deficit
Reducing energy intake, increasing energy expenditure, or by both
Decreasing energy intake can be done in at least one of three ways:
- Reduction in energy density of food choices (i.e., food with similar volume but less calories)
- Reduction in portion size
- Reduction in frequency of intake
Underreporting is a frequent problem
Increasing energy expenditure can be done in one of three ways:
Increasing formal exercise volume
Increasing non-exercise physical activity
Increasing recreational physical activity
Guidelines on how to choose to decrease calorie intake, increase energy expenditure, or do both
- If there is room to decrease calorie intake and a client’s self-reported hunger levels are not too high, then reducing calorie intake may be the best method.
- If there is room to decrease calorie intake but hunger levels are high, then an increase in activity may be a better option.
- If calorie intake is already low and the client is reporting accurately, then an increase in activity is preferable.
- If calorie intake is low but underreporting is suspected, then an increase in calorie intake (to improve adherence) or efforts to improve self-reporting accuracy combined with an increase in activity may be best.
- If there is not much room to increase formal exercise in the client’s daily schedule, then efforts to improve recreational activity or nonexercise activity (particularly in short bouts throughout the day) may work best.
A greater-than-expected decrease in energy expenditure due to weight loss.
Metabolic Adaptation
Manipulation of dietary components to improve satiety
One component that can be manipulated is the size of the energy deficit. While larger deficits may result in greater weight loss and possibly create more buy-in, they do so at the expense of greater hunger and possibly lower adherence
The quality and composition of the diet can also be modified to improve satiety
Associated with greater satiety
- Lower energy density, higher protein, and higher fiber intakes are all associated with greater satiety
- Reducing food variety and palatability can also help improve satiety
- Higher physical activity levels are associated with better adherence
- Modified foods (such as artificially sweetened foods) can enhance adherence through the substitution of lower-calorie versions of a person’s preferred foods
The tendency for people to eat more when offered a wide variety of foods.
Buffet Effect
Refers to how human brains assign value to food – OFT is defined by the calories gained from a food relative to how much energy and time is needed to obtain it.
Optimal Foraging Theory (OFT)
The food environment can have a strong influence on adherence
The availability of high-reward, highly palatable foods is associated with lapses in adherence
Steps to modify the food environment include the following:
- Reduce food cues and visibility
- Keep foods out of sight to reduce temptation and spontaneous snacking. In food-storage areas, reduce visibility of less-healthy options by burying them behind or beneath more healthy options - Create effort barriers
- ltering the food environment to increase availability of healthier choices and decrease the availability of less-healthy choices may improve eating behavior
Creating Effort Barrier Techniques
Keep less-healthy food in a locked cabinet.
Keep foods in a less-prepared form (e.g., whole oranges versus sliced oranges).
Only keep foods in the house that need to be prepared or cooked (not premade or prepackaged).
Keep energy-dense and problem foods out of the personal environment.
Numerous psychological factors that can help promote dietary adherence. These include the following:
- Education
- Motivation
- Awareness of a plan and goals associated with that plan
- Active self-regulation and self-monitoring
- Social support
- Cognitive and behavioral skills
- Flexible over rigid approaches
- Managing feelings of deprivation
- Tailoring dietary characteristics to the individual
The most important component of education
Teaching people how to change their behaviors. In general, behavioral education will help promote dietary adherence more than nutrition education
Motivation can be improved
Increasing awareness of the benefits of progressing toward and achieving goals
Can also be enhanced by increasing the perceived benefits of goal achievement and weight loss while decreasing the perceived costs
Cognitive and behavioral skills
These include skills to both prevent lapses in adherence and cope with temporary lapses in dietary adherence. Skills to prevent lapses in dietary adherence include recognizing situations that involve a high risk of lapses and then learning to modify or avoid those situations.
Feelings of deprivation can be managed through a variety of techniques
Modest deficits, flexible dieting approaches, and avoidance of dichotomous thinking around food and diets (i.e., avoiding thoughts that a person is on or off a diet or that a food is good or bad).
Tailoring dietary characteristics to the individual
These include macronutrient distribution, food choices, and the continuity of the diet (i.e., continuous dieting or intermittent approaches)
A loss of effectiveness of the signals that travel to the brain and tell people they are full.
Impaired Satiety Signals
One of the most difficult aspects of weight management.
Maintaining weight loss long-term
Reasons for low success rates
- Impaired satiety signals
- Increased biological drive to regain weight
- Hyperpalatable food environment
- Constant food cues and easy access
- Long-term reductions in physical activity energy expenditure
- Experiences of higher burden because maintaining weight loss requires much more effort compared to lean people
Factors associated with Long term Maintenance of Weight
- Low-Fat, Low-Energy Density Diet
- Less Variety
- High Physical Activity Levels (35 min/day)
- Consistent Meal Patterns and Maintaining Consistency throughout the Week
- Consistent Self-Monitoring
More Factors associated with Long term Maintenance of Weight
- Flexible Dietary Control
- Coping Capacity Eating Skills
- Ability to Manage Cravings
- Self-Efficacy
- Confidence and “Healthy Narcissism”
- Stability and Social Support
- Reaching a Self-Determined Goal Weight
Factors Associated With Regain
- Sedentary lifestyle (weight regain is more likely when physical activity energy expenditure is low (1,000 calories per week)
- Disinhibited eating
- Dichotomous view of foods and a rigid approach to dieting
- Binge eating
- Emotional eating, psychosocial stress, and low coping capacity
- Lack of social support
- Psychopathology
- Medication-induced appetite elevation
- Excessive loss of fat-free mass
- Diet burnout
Repetitive cycles of weight loss followed by weight regain where most or all of the weight is gained back.
Weight Cycling
Alternating periods of energy restriction with periods of maintenance or diet breaks.
Intermittent Dietary Strategies
A client has been struggling to lose weight on a low-carb diet. Which item is most likely to be true?
The client is unable to adhere to a low-carb diet.
