Challenges of weight loss: maintenance & stretagies for long term

Question 1

define weight loss

Answer 1

> 5% of weight lost

Question 2

define weight loss management

Answer 2

weight loss is maintained for at least 12 months & the weight does not fluxuate more than 3%

Question 3

what do trends suggest is the time people loose their most amount of weight in their weight loss journey if they stay consistent

Answer 3

6 month mark and less frequently up to 12 monthsw

Question 4

why is there limited evidence to show maintenace of long term weight loss?

Answer 4

• how long term is defined as the critical period is past the 1 year mark (many studies only go for 12 months)
  -long term can be a burden on the participant and takes a lot of resources

Question 5

what are some findings from long term weight loss studies?

Answer 5

-weight regain is very common after weight loss that is achieved with behavioural interventions
-legacy effect: the longer you can keep the weight off the lesser the chance you will regain it
-when weight has been regained within 1-2 years years it is likely to have weight regain in linear fashion

Question 6

what happens when we lose weight (1)

Answer 6

• food/energy restriction can cause short term changes in weight but over the longer term the brain will work to bring the body back to the same weight it had before energy was restricted
  -we are programmed to resist weight loss

Question 7

define ‘set point theory’

Answer 7

the brain controls our weight and will bring it back to its set point

Question 8

what factors determine set point (2)

Answer 8

genetics, environment

Question 9

adaptions to weight loss (5)

Answer 9

1. Increase drive to eat- brain responds to appetite regulating hormones that put the body into a heightened sense of hunger
2. Improve efficency of systems to use less energy- activity thermogenesis (and NEAT) are reduced. To conserve energy, systems (MSK/CVD) become more efficient and we move around less/take away bodily functions (menstration)
3. Brain changes how it reacts/responds to food- food becomes more attractive, more appealing to foods we previously didn’t like, images/smells of food are more tempting & food taste better (palpability)
4. Slows RMR- Metabolic adaptions. RMR slows by 10-20% to compensate for energy stores lost. Loss of lean muscle mass- 13-20% of LBM is lost

Question 10

why is it easier for people with more fat have an easier time losing fat compared to someone who is lean

Answer 10

tooth paste tube analogy
-body will take muscle/protein first in someone who is lean

Question 11

how long do physiological changes from weight loss last?

Answer 11

• gap between measured and predicted RMR among participants was greater than predicted after 6 years
  -metabolic adaptaions pursist even with regaining the weight
  -found that leptin & triglycerides remained lower than baseline while HDL & adiponectin were elevated from baseline

Question 12

describe low calorie diet (LCD) & very low calorie diet (VLCD) & are they safe?

Answer 12

LCD- restricts calories to 800-1200 kcals/day
VLCD- <800 kcals/day
when medically supervised it is safe

Question 13

does rate of weightloss influence long term success?

Answer 13

studies suggest the rate of weight loss has no impact on weight regain. Behaviours are what dictate outcomes

Question 14

what characteristics contribute to success in long term weight loss

Answer 14

-behaviours
-those who made between 5-8 behaviour changes had the highest % of successful weight loss maintenence after 3 years:
-flexible vs rigid dietary control
-meal regularity
-eating situations
-food choice
-restriction of food quantity
-physical activity and stress coping

Question 15

can we modify our set point, how?

Answer 15

yes it is modifiable.
But once we go go to an unhealthy behaviour our set point will go back too
How to modify your set point:
-aerobic & resistence training
-fasting to restrict calorie intake
-higher fat + protein
-less carbs
-sleep quality + quantity?
-do you make food before you eat or are the foods readilt available?

Question 16

why is it hard to keep the weight off (2)

Answer 16

weight loss maintenance is opposed by sustained physiological adaptations which facilitate weight regain
-body weight is primarily homeostatically regulated (complex hormone system)

Question 17

why even try if weight loss is likely to fail? (4)

Answer 17

1. acknowledge all that is needed to sustain weight loss
2. educate & support
3. help clients target behaviours like exercise, manage their hunger, sleep strategies/hydration & better food skills
4. after long term efforts recognize that others may benefit from more advanced efforts (surgery/prescription med.)