Weight loss is difficult, for certain. However, keeping weight off is far beyond difficult. Some influential behavioral scientists are even saying sustained weight loss in obese individuals is nearly impossible. They suggest the expenditure of resources for such work has had so little pay off that we should instead focus our efforts and dollars on helping people before they reach an unhealthy weight. My view is less extreme.
It was well-established that physical activity was the best predictor of sustained weight loss. However, research repeatedly indicated less than 5% of U.S. adults were completing minimum recommended amounts. In preparation for a new intervention, we investigated the lower limits for effects on weight control and its expected psychological predictors. Possibly, this could help us better understand exercise’s proven effects on weight loss, beyond caloric expenditures.
The research showed that just several sessions of walking per week reliably decreased depression and anxiety, and increased energy level and feelings of ability to succeed (self-efficacy). This was great news because even when we were successful at building adherence to an exercise program, after the initial “high,” amounts remained relatively low for almost all.
could help us better understand exercise’s proven effects on weight loss, beyond caloric expenditures.
Then, an even more important finding surfaced. It appeared the positive effect regular physical activity had on weight was not dependent on caloric expenditure.
We found that the primary value of exercise on weight control came from the carry-over of self-regulatory skills needed to stay with the exercise program; participants were using those skills to control their eating. This was important, and has large implications on future intervention designs. We thought that physical activity should no longer be just an adjunct to extreme dieting—it should be the centerpiece.
We surmised that our highly researched 6-month program for exercise adherence, THE COACH APPROACH, could be leveraged in group nutrition sessions. We focused on exercise adherence first (primarily to build an array of self-regulator skills), and then added group nutrition sessions after about 2 months. A near complete focus on generalizing the individually tailored self-management skills to controlling one’s eating turned out to be quite successful.
Although many programs are able to obtain substantial weight loss for 6-9 months, this program, recently named Weight Loss For Life, maintained nearly all the weight loss over 2 years. This was unusually positive, especially when the field seemed to be rating treatment effects not by whether they could maintain weight loss but, rather, how long it would take to regain the weight.
body image and emotional eating are a larger part of the equation than was originally thought
Because both our physical activity and nutrition programs were based on social cognitive theory, we wanted to further improve our effects by testing variables consistent with that theory. In our recent report in Translational Behavioral Medicine (Psychosocial Predictors of Decay in Healthy Eating and Physical Activity Improvements in Obese Women Regaining Lost Weight: Translation of Behavioral Theory into Treatment Suggestions), we tested women who had obesity at the start of the program and both lost weight and gained a portion of it back. Although these were not the typical participants, we felt if we could sufficiently understand behavioral changes of these “re-gainers,” we could improve overall outcomes.
After the initial 6 months of weight loss, expected plateaus in weight occurred. The female participants were probably discouraged, and it adversely affected their use of the previously taught self-regulatory skills such as restructuring self-talk, short-term goal setting, and resetting behaviors after “slips” in their exercise routines and eating plans.
This led to lack of confidence (self-efficacy) and slow “decay” in weight control behaviors and their psychosocial predictors. In our dissection of the interrelationship of these variables within the study, we confirmed the weight maintenance phase (after the initial 6 months of treatment) required a far different focus than that of active weight loss.
Weight Loss For Life, maintained nearly all the weight loss over 2 years.
Findings provided data in which we could more effectively bolster these individuals’ self-regulation of their eating and, after imposing a focus on weight maintenance for some time, re-energize and revise their efforts for continued movement toward their goal weights.
After supplementing this study with research suggesting how body image and emotional eating are a larger part of the equation than was originally thought, we are now revising the Weight Loss For Life treatment. That’s the benefit of a persistent and systematic program of applied research.
Hopefully, even the participants who were the least successful can effectively counter the predicted decay in the psychological factors that were associated with their initial success. Consistent with the focus of much of the research in Translational Behavioral Medicine, we seek to administer this treatment through YMCA and other community-based settings where tens of thousands might be positively affected at very low cost.