Long-term weight loss success

Are you struggling to keep weight off that you worked so hard to lose? You’re not alone.

Many people find maintaining weight loss is a life-long battle. Studies tell us that about 40 to 50% of people worldwide are currently trying to lose weight — but only 25% of people who lose weight keep it off.1That means three out of four people are unable to sustain their hard-earned weight loss.

Oftentimes, people regain the lost weight and then try to lose it again, creating what is known as “yo-yo” dieting or weight cycling. Research shows that weight cycling can result in unhealthy changes to blood pressure, lipids, blood sugar, and insulin.2

So, it is very important to find ways to not only lose weight but to keep it off.

Don’t worry. We can help. This guide will show you how.


Finding the right behavior

One important factor to consider is that the age-old message “eat less and move more” is often not the best path to long-term success for most people.

Another key concern is that many people who decide to lose weight often think of the weight loss process as a short-term event or “diet” — and not a lifestyle change. If you want long-term weight loss success, you likely cannot return to your old eating habits after you’ve lost the weight.

This guide will provide some insights about achieving weight loss, share research findings about people who have been successful, and give you some practical take-home tips for your weight loss journey.

The primary goal of any weight loss program is to produce a lasting and sustainable change in diet-related behaviors. We will break down what you need to know to create long-term weight success.


Why is it so hard to maintain weight loss?

Let’s first define successful weight loss. The action of losing weight does not make it “successful.”

Experts in the field define successful weight loss as “intentionally losing more than 10% of your initial weight and keeping it off for more than one year.”

For example, if you weighed 190 pounds (86 kilos) and lost more than 19 pounds (9 kilos) while keeping it off for at least one year, you would be considered a “weight loss success” story.3

However, weight loss success is not an easy feat due to the interactions of biology, environment, and behavior.

First of all, our biology favors weight regain after weight loss, potentially as a powerful survival mechanism. From an evolutionary perspective, it makes sense to view weight loss as a sign of trouble, such as a temporary famine, that needs to be corrected by adding pounds back on when food becomes available.

Adaptive changes in our appetite hormones (such as leptin and ghrelin) and energy balance when we lose weight actually tend to make us feel hungrier and therefore more likely to regain the weight.4

Additionally, our current environment can be considered “obesogenic” (tending to cause obesity) due to the industrialization of our food supply and the constant promotion and availability of inexpensive, highly-processed, and palatable foods full of sugar and fat.5

These two factors — our biology and the environment — are considered unmodifiable, meaning we do not have the power to change them to maintain our weight loss. However, we can “modify” our behaviors to help create successful weight loss and achieve long-term adherence to a dietary lifestyle change.


Research on people who have successfully lost weight

In order to gain insight into the problem, it helps to look at people who have been successful and learn from them.

The National Weight Control Registry (NWCR) was created in 1993 and is a vast database of information on individuals who have been successful at long-term weight loss and maintenance.

A 2001 report from NWCR explored data from approximately 3,000 people who lost more than 30 pounds (14 kilos) and kept it off for more than one year.

The three factors back then that were associated with most successful weight loss over a 10-year period were high levels of physical activity, high levels of restraint (self-control), and low levels of disinhibition, meaning they were better at suppressing an unwanted behavior.

Additionally, the report found that self-monitoring behaviors, such as calorie restriction and regular body weight measurements, were associated with success.6

Other studies have similarly reported that self-monitoring behaviors such as meal planning and measuring food were associated with successful weight loss.7

These results do not tell us what pattern of eating can help people maintain these habits, and that may be part of the problem. The NWCR evaluated people under the standard traditional teaching of eating less and moving more.

Do all eating patterns have similar success or failure when it comes to these behaviors? That is potentially helpful data we would like to know more about.

While most of the success factors are related to continuing the food behaviors that helped to create the weight loss, emerging research reveals that changes to other types of behaviors, such as those rooted in psychology, can elicit longer-lasting and even more successful weight loss.8


What is behavioral nutrition?

Behavioral nutrition is an emerging field that links psychology and nutrition. Research in this area has helped us identify the psychological factors or behaviors that are associated with successful weight loss and long-term adherence to a dietary lifestyle change.

Dr. Isobel Contento of Teachers College Columbia University, who has been at the forefront of behavioral nutrition, sums it up nicely. “Research in this area focuses on diet-related behaviors, attitudes, and mindset that shape when, what, why, and how we eat. The concept of identifying personal behavioral factors that bring about successful weight loss and maintenance is the direction of the future in nutrition.”


What can we learn from behavioral nutrition?

Many human behaviors determine our life choices and decisions, but many people don’t make the connection that it is our behaviors that drive when, what, why, and how we eat. It is only when these behaviors are identified and modified, that we can create long-term adherence to a major change in our dietary lifestyle (or any lifestyle change, for that matter).

Behavioral nutrition research taps successful psychological models used to change lifestyle behaviors such as smoking, excessive alcohol intake, and a sedentary lifestyle. One such model is the Stages of Change that identifies how ready people are to make significant changes and what type of behaviors can help them progress through the stages.9

Other models look to common psychological traits and actions that aid successful change. These are self-efficacy (self-confidence in making a change), decisional balance (weighing the pros and cons of making a change vs not making a change), identifying barriers or obstacles to change, social support from family and friends, self-monitoring, self-motivation to exercise, and goal setting.10

The research in behavioral nutrition is fairly limited but growing rapidly. What the research has identified to date is that there is not a one-size-fits-all approach. Identifying and working through these behaviors is a personal journey. The goal of any weight loss program should be to help you adopt the skills, confidence and sense of personal empowerment to control your drives and behaviors for the betterment of your health.

Here at Diet Doctor, our Weight Loss For Good and Coaching Program incorporate some of these behavioral techniques to help you bring about the most successful weight or health-related outcomes.

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Is a low-carb lifestyle better for long-term success?

There is mounting and exciting evidence suggesting that a low-carb/keto lifestyle leads to greater weight loss success when compared to other diets.11 This brings us back to the question as to why many people fail to maintain weight loss. Could it be the message of “Eat less and move more?” Studies showing greater weight loss success with low-carb diets are the early foundation of creating a new narrative that may lead to greater success.

While there are a multitude of reasons why low-carb regimens may be more successful, it appears many low-carb supporters understand this way of eating is a “lifestyle” rather than a “diet” and adopt this way of eating for the long-term because of benefits beyond weight loss only.

Studies show that people following a very low-carb or keto diet have less hunger and naturally reduce their calorie consumption without increased feelings of hunger.12

In addition, a very low-carb diet lowers insulin levels, helps burn fat stores, and likely increases resting energy expenditure.13

All of these factors can aid in weight loss success.

In addition, experienced clinicians find their patients adhere to a weight loss program better when they see additional health benefits, such as improved insulin resistance, improved diabetes control, and reduced blood pressure.14

Many low-carb followers also incorporate intermittent fasting, and some degree of physical activity, both of which can promote weight loss success, although may not be necessary for everyone.

In addition, many of the behavioral factors that lead to successful weight loss are often part of the low-carb/keto lifestyle (e.g., self-monitoring, self-regulation). A low-carb/keto lifestyle changes our biology (appetite hormones), but success also requires a change in our food and environmental-related behaviors.


Take home message

The main determinant of weight loss success and long-term adherence to a new dietary lifestyle is identifying and maintaining the behaviors that initially led to weight loss.

The primary goal is to create a way to make these behaviors become “habits” so you can continue to override the powerful biological and environmental factors that favor weight regain.

As mentioned earlier, this is a personal journey that requires dedication, commitment, self-regulation, and personal autonomy.

For some, the types of foods you eat or don’t eat, may influence your physiology and psychology enough to increase your chances of long-term success.


Tips for long-term weight loss success with a low-carb lifestyle

After reading this guide, you should have a good understanding of the forces which may make it difficult for some to achieve successful weight loss.

Fortunately, a low-carb/keto lifestyle in itself can increase your chances of success. However, identifying and finding ways to adhere to the behaviors that led to your initial success can increase the likelihood that you maintain a stable weight for life.

The following tips will help you on your journey to success:

  1. Approach a “low-carb/keto diet” as a lifestyle rather than a diet.
  2. Educate yourself on the benefits of a low-carb/keto lifestyle beyond that of weight loss. Think of weight loss as the added bonus!
  3. Think about the behaviors that helped you to lose weight and find ways to continue adhering to those behaviors.
  4. Set realistic goals and expectations.
  5. Identify the obstacles or barriers to making a long-term change and think of ways to work around them.
  6. Identify who your social support network will be and how they will support you for the long-term.
  7. Incorporate intermittent fasting and physical activity into your low-carb lifestyle.
  8. Seek out additional support from Diet Doctor or other low-carb practitioners or nutritionists to help create a new lifestyle.

 

More

Learn how to do a keto diet

 

  1. Centers for Disease Control NCHS Data Brief No. 313, July 2018: Attempts to lose weight among adults in the United States, 2013–2016 [Observational data, weak evidence]

    Obesity Reviews 2017: Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis [systematic review of randomized and nonrandomized trials, weak evidence]

    American Journal of Preventative Medicine 2014: Weight-loss maintenance for 10 years in the National Weight Control Registry [nonrandomized study, weak evidence]

  2. Journal of Obesity and Metabolic Syndrome 2017: Weight cycling and its cardiometabolic impact [overview article; ungraded]

  3. The Annual Review of Nutrition 2001: Successful weight loss maintenance [overview article; ungraded]

  4. International Journal of Obesity (London) 2015: Physiological adaptations to weight loss and factors favouring weight regain [overview article; ungraded]

  5. The Medical Clinics of North America 2018: Maintenance of lost weight and long-term management of obesity [overview article; ungraded]

  6. The Annual Review of Nutrition 2001: Successful weight loss maintenance [overview article; ungraded]

  7. The International Journal of Behavioral Nutrition and Physical Activity 2006: Dietary and physical activity behaviors among adults successful at weight loss maintenance [nonrandomized study, weak evidence]

  8. U.S. Preventive Services Task Force Evidence Syntheses 2018: Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: An updated systematic review for the U.S. preventive services task force [systematic review of randomized and nonrandomized trials, weak evidence]

  9. Eating Behaviors 2015: Intervention based on Transtheoretical Model promotes anthropometric and nutritional improvements – a randomized controlled trial [moderate evidence]

  10. Obesity (Silver Spring) 2010: Mediators of weight loss and weight loss maintenance in middle-aged women [randomized trial; moderate evidence]

    Health Psychology 2019: Week-to-week predictors of weight loss and regain in women [nonrandomized study, weak evidence]

    Obesity Reviews 2019: Determinants of weight loss maintenance: a systematic review [systematic review of randomized and nonrandomized trials, weak evidence]

  11. The Lancet and Diabetes Endocrinology 2015: Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis[systematic review of randomized trials; strong evidence]

    British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials [strong evidence]

    British Medical Journal 2018: Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial [randomized trial; moderate evidence]

  12. Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

    European Journal of Clinical Nutrition 2013: Ketosis and appetite-mediating nutrients and hormones after weight loss [non-controlled study; weak evidence]

    Other studies also show that when people drastically reduce their carb intake but eat as much protein and fat as they want, they end up eating less because they feel more satisfied with their meals.

    Annals of Internal Medicine 2014: Effects of low-carbohydrate and low-fat diets; a randomized trial [moderate evidence]

    The American Journal of Clinical Nutrition 2019: Investigating the effect of sex and ketosis on weight-loss-induced changes in appetite [non-controlled study; weak evidence]

    Frontiers in Psychology 2015: Ketosis, ketogenic diet and food intake control: a complex relationship [overview article; ungraded]

  13. Journal of the American College of Nutrition 2013: Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes [uncontrolled study; weak evidence]

    JCI Insight 2019: Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss [randomized trial; moderate evidence]

    Obesity 2015: Weight loss on low-fat vs. low-carb diets by insulin resistance status among overweight adults & adults with obesity: A randomized pilot trial [moderate evidence]

  14. This is based on the clinical experience of practitioners who use low-carb diets and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here. [weak evidence]