Ch 23: Managing Weight Loss Plateaus and Maintaining Weight Loss

Question 1

Successful weight loss is a challenging endeavor for many. There are numerous obstacles to success; these barriers include

Answer 1

Physiological, psychological, and environmental factors.

Question 2

Two major challenges that people face include:

Answer 2

Weight-loss plateaus and preventing weight regain
Only 17% of adults in the United States sustain a 10% weight loss after 1 year

Question 3

A period of stalled progress of 1 month or longer.

Answer 3

Plateau

Question 4

The amount of calories consumed compared to the amount of calories expended.

Answer 4

Energy Balance

Question 5

Ways to kickstart a Plateau

Answer 5

Tracking Food, Moving More, Cutting Carbs, Increasing Hydration

Question 6

The degree to which an individual sticks with a diet.

Answer 6

Dietary Adherence

Question 7

Main reason for a weight-loss plateau

Answer 7

An increase in energy intake so that energy intake matches energy expenditure is the main reason

Key factor behind lack of weight loss

Question 8

Online tools that can help give projected weight loss

Answer 8

National Institute of Diabetes and Digestive and Kidney Diseases Body Weight Planner

Question 9

Obese people who have lost weight.

Answer 9

Reduced Obese

Question 10

Causes of Dietary Adherence Lapses

Answer 10

Physiological
Psychological
Environmental

Question 11

Physiological

Answer 11

Increase in Appetite
There is a biological drive to increase calorie intake by approximately 100 calories for every kilogram of weight loss

Question 12

Psychological causes for weight loss plateau

Answer 12

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

Question 13

Environmental causes for weight loss plateau

Answer 13

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.

Question 14

Environmental causes for weight loss plateau

Answer 14

• Social and Cultural Contexts
• Cost
• Work-related issues
• Portion Sizes
• Family Support

Question 15

What is the main reason for a weight loss plateau?

Answer 15

An increase in energy intake so energy intake matches energy expenditure.

Question 16

Periods of body weight plateaus where a client practices maintenance of habits and becomes used to the new body weight.

Answer 16

Maintenance Practice

Question 17

Plateaus Stair Step Progression
(Cognitive Reframing: Breaking through Weight Loss Plateau)

Answer 17

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)

Question 18

Re-Establishing an Energy Deficit

Answer 18

Reducing energy intake, increasing energy expenditure, or by both

Question 19

Decreasing energy intake can be done in at least one of three ways:

Answer 19

1. Reduction in energy density of food choices (i.e., food with similar volume but less calories)
2. Reduction in portion size
3. Reduction in frequency of intake

Underreporting is a frequent problem

Question 20

Increasing energy expenditure can be done in one of three ways:

Answer 20

Increasing formal exercise volume
Increasing non-exercise physical activity
Increasing recreational physical activity

Question 21

Guidelines on how to choose to decrease calorie intake, increase energy expenditure, or do both

Answer 21

1. 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.
2. If there is room to decrease calorie intake but hunger levels are high, then an increase in activity may be a better option.
3. If calorie intake is already low and the client is reporting accurately, then an increase in activity is preferable.
4. 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.
5. 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.

Question 22

A greater-than-expected decrease in energy expenditure due to weight loss.

Answer 22

Metabolic Adaptation

Question 23

Manipulation of dietary components to improve satiety

Answer 23

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

Question 24

Associated with greater satiety

Answer 24

• 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

Question 25

The tendency for people to eat more when offered a wide variety of foods.

Answer 25

Buffet Effect

Question 26

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.

Answer 26

Optimal Foraging Theory (OFT)

Question 27

The food environment can have a strong influence on adherence

Answer 27

The availability of high-reward, highly palatable foods is associated with lapses in adherence

Question 28

Steps to modify the food environment include the following:

Answer 28

1. 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
2. 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

Question 29

Creating Effort Barrier Techniques

Answer 29

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.

Question 30

Numerous psychological factors that can help promote dietary adherence. These include the following:

Answer 30

• 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

Question 31

The most important component of education

Answer 31

Teaching people how to change their behaviors. In general, behavioral education will help promote dietary adherence more than nutrition education

Question 32

Motivation can be improved

Answer 32

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

Question 33

Cognitive and behavioral skills

Answer 33

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.

Question 34

Feelings of deprivation can be managed through a variety of techniques

Answer 34

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).

Question 35

Tailoring dietary characteristics to the individual

Answer 35

These include macronutrient distribution, food choices, and the continuity of the diet (i.e., continuous dieting or intermittent approaches)

Question 36

A loss of effectiveness of the signals that travel to the brain and tell people they are full.

Answer 36

Impaired Satiety Signals

Question 37

One of the most difficult aspects of weight management.

Answer 37

Maintaining weight loss long-term

Question 38

Reasons for low success rates

Answer 38

• 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

Question 39

Factors associated with Long term Maintenance of Weight

Answer 39

• 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

Question 40

More Factors associated with Long term Maintenance of Weight

Answer 40

• 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

Question 41

Factors Associated With Regain

Answer 41

• 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

Question 42

Repetitive cycles of weight loss followed by weight regain where most or all of the weight is gained back.

Answer 42

Weight Cycling

Question 43

Alternating periods of energy restriction with periods of maintenance or diet breaks.

Answer 43

Intermittent Dietary Strategies

Question 44

A client has been struggling to lose weight on a low-carb diet. Which item is most likely to be true?

Answer 44

The client is unable to adhere to a low-carb diet.