Behaviours associated with weight loss maintenance and regaining in a Mediterranean population sample. A qualitative study

Abstract

The Mediterranean lifestyle has not been studied relative to weight loss maintenance. This study focused on a sample of Greek maintainers and regainers. Maintainers emphasized home-cooked meals; their diet does not appear to be low-fat, as home-cooked Greek meals are rich in olive oil. Having a small dinner is a common strategy among maintainers. Health motives were not mentioned by maintainers. Maintainers, but not regainers, appeared to compensate for emotional eating. Weight loss maintenance is imperative to successful obesity treatment. We qualitatively explored lifestyle behaviours associated with weight regulation, in a sample of Greek volunteers who had lost weight and either maintained or regained it. A 10% intentional loss maintained for at least one year was considered successful maintenance. Volunteers (n = 44, 41% men) formed eight focus groups, four of maintainers and four of regainers. Questions regarded weight loss, weight maintenance or regaining, and beliefs on weight maintenance and regaining. All discussions were tape recorded. Maintainers lost weight on their own, whereas regainers sought professional help. Maintainers exercised during both the loss and maintenance phases, whereas regainers showed inconsistent physical activity levels. Health motives for weight loss were mentioned only by regainers. Emotional eating was a common barrier, but only maintainers compensated for it. Maintainers continuously applied specific strategies to maintain their weight: emphasizing home-cooked meals, high eating frequency, a small dinner, portion size regulation, and sweets' intake regulation. Regainers considered the behaviours leading to weight loss different from their normal lifestyle, and resumed their old habits when the diet was over. However, both groups believed that for long-term success, lifestyle changes need to be permanent.

Attenuating the Biologic Drive for Weight Regain Following Weight Loss: Must What Goes Down Always Go Back Up?

“…Note, those enrolled in the NWCR are not representative of all individuals who have attempted weight loss and who have experienced long-term maintenance, but rather are self-selected based on their success. Nevertheless, some findings from the NWCR are supported by those from the MedWeight registry in Greece, which includes both weight loss maintainers and regainers [82,83,84,85,86]. Among male registrants, weight loss maintainers were found to exhibit greater physical activity (approximately 200 kcal/day more than regainers), greater adherence to a dietary pattern emphasizing home-cooked meals, fruits, vegetables, unprocessed grains, nuts, lean proteins, low-fat dairy products, and olive oil, and lower daily intakes of salty snacks, sugary soda beverages, and alcohol.…”

Experiences of Reframing during Self‐Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies

“…Along the same lines, a participant who successfully maintained weight loss after repeated attempts stated that they had tried many “diets” in the past, but were only successful when they decided, “no more diets, develop a healthy eating pattern” (Klingemann et al., ). Participants reframed dieting from a fixed‐term effort to a “long‐term venture”, accepting the “permanence” of the behavior changes required (Hindle & Carpenter, ; Karfopoulou, Mouliou, Koutras, & Yannakoulia, ).…”

“…And I think this was why I thought I've got to be more relaxed about it.” A second participant from the same study explained, “I went with the belief that this wasn't a diet, but what I'd got to do was change my way of eating” (Hindle & Carpenter, ). In a Greek study of weight loss maintainers following a Mediterranean diet, a participant explained, “… to realise that the X diet plan they will give you has to be a way of life, and not a 6‐month period you're following it and then going back, to how you were before” (Karfopoulou et al., ). In another British study of weight loss maintenance, a participant elaborated on this concept by couching diet as a temporary term: “I mean people say they are on a diet when they are a member of a slimming club sometimes but I don't think that's what you're on, you don't ever intend to go back to what you were doing before so that is not a diet you have just changed the way you eat now… I think you've got to tell yourself you're not on a diet you're just changing your way of life … you're not on a diet which is a temporary thing—you've got to educate yourself to eat differently all the time” (McKee et al., ).…”

Consequences of Circadian Disruption on Cardiometabolic Health

“…Those who eat more earlier in the day lost significantly more weight (−8.2 vs −6.5 kg, p=.028), reduced waist circumference by more (−7 v −5 cm, p=.033), lost more fat mass (−6.8 vs −4.5 kg, p=.031) and improved their insulin sensitivity more. A qualitative study found that one strategy employed by individuals who maintained 10% weight loss for at least one year was eating small dinner, a strategy not employed by individuals who regained weight after an initial loss [72]. Finally, since glucose tolerance is known to be worse in the evening [73], late eating may also affect glycemic control in patients with diabetes.…”