Maintenance of long-term weight loss.

J. Graham Thomas, MS, and Rena R. Wing, PhD A key problem in the area of weight control is the maintenance of weight loss. Behavioral treatment programs are able to consistently produce weight losses of 7 – 10% of initial body weight at the end of 6 – 12 months of treatment. However, even with ongoing contact, clients often regain the weight, a finding documented by the Diabetes Prevention Program. 1 What makes weight loss maintenance so difficult? Physiological changes which occur during weight loss can promote weight regain; e.g., decreases in metabolic rate, increases in catecholamine excretion and thyroid function, increase in ghrelin, and increases in lipoprotein lipase activity. Psychological and behavior changes are also related to weight regain. People may become bored on restricted diets and more responsive to palatable foods and social cues that pressure them to eat more and exercise less. Finally, dieters’ motivation may decrease after an initial weight loss; clothes fit better, health may have improved, and the psychological effort or “costs” of adhering to a weight loss regimen may come to outweigh the benefits. Two approaches have been used to better understand the behavioral factors associated with weight loss maintenance and regain. One approach is to study those who have been successful at longterm weight loss maintenance. The other approach is to conduct randomized trials evaluating specific approaches to improve long-term weight loss. Both of these approaches are discussed below.