Cognitive and behavioural strategies employed to overcome “lapses” and prevent “relapse” among weight‐loss maintainers and regainers: A qualitative study

Abstract

Summary While many behavioural weight management programmes are effective in the short‐term, post‐programme weight regain is common. Overcoming “lapses” and preventing “relapse” has been highlighted as important in weight‐loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome “lapses” and prevent “relapse” by people who had regained weight or maintained weight‐loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight‐loss maintenance. Semi‐structured interviews were conducted with 26 participants (58% female) recruited from the 5‐year follow‐up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight‐loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5‐year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio‐recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high‐risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow‐ups of a weight loss trial to date, offering unique insights into long‐term maintenance. Future programmes should emphasize strategies focusing on self‐monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight‐loss in the longer‐term.

Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

“…In addition, we conducted primary research to fill several evidence gaps that we identified. Full reports of each of these primary studies have been published elsewhere [ 9 , 28 ]. The key methods and findings relevant to the intervention development are briefly described below.…”

“…We conducted semistructured interviews [ 28 ] with 26 participants (15/26, 58% female) from the Weight loss program Referrals for Adults in Primary care (WRAP) trial [ 8 ]. Participants randomized to the intervention arms of the WRAP trial (referral to 12 or 52 weeks of a commercial weight loss program) and who had lost ≥5% baseline weight during the active intervention (year 0-1) were recruited at the 5-year follow-up.…”

“…The key intervention objectives and design features of the guiding principles and supporting evidence are listed in Multimedia Appendix 1 [ 9 , 14 , 15 , 19 , 24 , 28 , 31 ]. The logic model of the hypothesized mechanisms of change in the intervention is presented in Figure 2 .…”

How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature

“…46 The most effective strategies involved avoidance of the foodprovisioning environment, for example, by shopping less often 46 or never entering certain supermarket aisles. 41,46,48 In some cases, people avoided certain types of food, such as less nutritious snacks 36 or delivery food. 39 People have more confidence in employing effective strategies after workshop-style education that includes a nutrition expert and some form of ongoing support…”

“…31,38,53 Participants across various studies saw social situations as one of the strongest challenges, as going out acted as a "trigger" for consuming HFSS food. 39,41,43,49 This was the case even outside of restaurants and cafes, as friends and colleagues were likely to bring less nutritious foods to social occasions. 53,54 How others expect someone to engage with the food environment can present a challenge to weight management strategies People's social networks often included people who ate the same way and disliked any change in one person's eating practices.…”