Long-term maintenance of the weight lost after a diet is the primary challenge of obesity treatment, more difficult even from losing the extra weight.
In a large number of people, the initial and often rapid loss is followed by a period of stabilization and then by the gradual regain of the weight, if they are not careful.
It is not possible to predict the course for each person after the initial weight loss. This is because it depends on a range of environmental, biological, behavioral and cognitive factors, which are only partially understood by science. Nevertheless, in recent years progress has been made in recognizing those interventions that could reverse a negative outcome. We now know that the simple calculations, associating weigh loss exclusively with nutritional calorie deficit, are incorrect because they fail to consider declining energy expenditure with weight loss. That is, weight loss is accompanied by endocrine adaptations that increase appetite and decrease satiety. These changes make the body resisting continued weight loss and conspiring against long-term weight maintenance. Therefore, those who strive to be consistent in their decision to lose weight fight an increasing battle against the biological responses that oppose further weight loss. And unfortunately, this course is independent of the type of intervention that has been adopted from the beginning, i.e. the diet chosen for weight loss.
More specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20-30 kcal per day, whereas appetite increases by about 100 kcal per day above the baseline level prior to weight loss! Therefore, it is not the person to be blamed as lacking in willpower to further try to loose weigh and maintain weight loss, as is often the case.
Furthermore, fatigue from the effort may trick the brain to increase portion size to make up for the increased appetite as a result of weight loss.
However, apart from the changes that take place in the body, other factors are also responsible for the difficulty in maintaining the desired weight, including, among others, the following:
- activity level,
- any comorbidities (e.g. endocrine system problems),
- psychosocial and financial status,
- a person’s character,
- realistic or unrealistic targets,
- knowledge on how to avoid a relapse, and
- the motive to lose the extra weight.
Initially, long-term planning is necessary, since substantial and permanent results cannot be achieved with time-constrained interventions. It takes perseverance and patience, as well as finding ways to deal with mental fatigue and to avoid relapses. But above all, a scientifically planned and gradual reintegration in a healthier nutritional plan is required to determine the right balance of calories that are essential to maintain the desired weight; the required time of physical exercise both to burn calories and to manage stress (that frequently leads to overeating); and to improve our mental health. Exercise, in particular, has a prominent position in the effort to maintain weight, as well as to control metabolic disorders (e.g. cholesterol, triglycerides), given the low daily expenditure level of modern people living in urban areas. In addition, maintaining weight requires encouragement and constant confirmation of the great effort that has been made. And the best and most effective way to boost it is by focusing on the progress that has been achieved from the beginning of this course with tangible evidence, such as the results of medical exams. This is because temporary or superficial motives fade over time, while those with a deep and permanent meaning are always present.
However, none of these can be successful if it is not in line with the preferences of the person who wants to lose weight and keep it off. Any advice and encouragement from the environment should be both in line with the person’s desires and stimulating to continue striving.
Such advice is of utmost importance when it comes from professional dietitians, at least for the first year after weight loss has been achieved. With continuous care and support, most people are more likely to continue striving and avoid nutritional pitfalls. Individual or group therapy sessions have great results in maintaining behaviors for weight management and control. In-person sessions, as well as online sessions or over the phone, that place more emphasis on self-weighing and self-regulation on a daily basis, contribute more in maintaining the weight achieved, in comparison with a printed update that underlines the importance of continuing to strive or with the termination of support. In fact, the longer the care provided by the appropriate people, the greater the chances of maintaining weight. After all, professional counseling can lead to the management of “slips” and at the same time it helps people get back on track and avoid giving up. A professional is the competent person to identify the difficulties of following the instructions, to find alternative suggestions and to formulate solutions. This person is also able through the sessions to restructure counterproductive and discouraging thought processes in cases of partially regaining weight, as well as to support people to overcome emotional eating.
Knowing in depth all these factors that contribute to weight loss and maintenance, we, Myflex partners, make every effort to help people who trust us to understand that weight maintenance requires continuous efforts. That they should set realistic targets, that it is not possible to stick forever to a strict nutritional behavior, that FLEXIBILITY is essential to adopt sustainable behavioral changes and habits in the long-term that will lead to weight management.
At the same time, we support the efforts of people who want to regain their normal weight, preventing any frustration caused by the degree or rate of weight loss, through the constant provision of psychological support. Because, ultimately, the rate of weight loss and its maintenance is not the only measure of success.
Each small change in nutrition and physical activity that lasts can improve over time our health, even without extreme weight loss.
For MyFlex team and for Jim Oikonomakis himself, every attempt deserves their exclusive, continuous, consistent and scientifically proven help and support.