The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race?

Abstract

Background Controversy exists regarding the optimal rate of weight loss for long-term weight management success. Purpose This study examined whether gradual initial weight loss was associated with greater long-term weight reduction than rapid initial loss. Methods Groups were drawn from participants in the TOURS trial, which included a sample of middle-aged (mean =59.3 years) obese women (mean BMI =36.8) who received a 6-month lifestyle intervention followed by a 1-year extended care program. Participants were encouraged to reduce caloric intake to achieve weight losses of 0.45 kg/ week. Groups were categorized as “FAST” (≥0.68 kg/week, n=69), “MODERATE” (≥0.23 and <0.68 kg/week, n= 104), and “SLOW” (<0.23 kg/week, n=89) based on rate of weight loss during first month of treatment. Results The FAST, MODERATE, and SLOW groups differed significantly in mean weight changes at 6 months (−13.5, −8.9, and −5.1 kg, respectively, ps <0.001), and the FAST and SLOW groups differed significantly at 18 months (−10.9, −7.1, and −3.7 kg, respectively, ps <0.001). No significant group differences were found in weight regain between 6 and 18 months (2.6, 1.8, and 1.3 kg, respectively, ps < 0.9). The FAST and MODERATE groups were 5.1 and 2.7 times more likely to achieve 10% weight losses at 18 months than the SLOW group. Conclusion Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers.

Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research

“…The decision rule operationalizes how to use the tailoring variable to guide the tactical decision at the second-stage. In this example, the 5 lbs cutoff is based on previous research [16], which is corroborated by clinical experience, suggesting that weight loss of less than 5 lbs during the first 5 weeks of behavioral therapy treatment is associated with longer-term insufficient weight loss (<5-10 % of body weight at the end of 26 weeks), thereby indicating a need for subsequent (changes or augmentation in) treatment. Figure 1b is an example of an AI that is more deeply-tailored than the AI in Fig.…”

“…Despite the general success of interventions such as IBT (and others [7,[10][11][12][13][14]), a significant number of individuals do not lose a clinically significant amount of weight (for example, ≥7 % weight loss in a 26-week period (~6 months) [15]) or meet their targeted goals for weight loss. Further, research suggests that it may be possible to identify such individuals early, i.e., during treatment [16]. Therefore, developing new weight loss interventions that (i) begin with IBT, (ii) identify individuals showing early signs of nonresponse to IBT, and (iii) adapt subsequent treatment to these nonresponding individuals may be important for increasing the total number of people who lose weight.…”

Expectations Are More Predictive of Behavior than Behavioral Intentions: Evidence from Two Prospective Studies

“…In the present study it was hypothesized that, controlling for initial weight loss (the dominant predictor of sustained weight loss [21]) and self-efficacy: (a) expectations will be better predictors of sustained weight loss than behavioral intentions, and (b) changes in expectations will mediate the effects of initial weight loss on sustained weight loss.…”

“…Baseline, four-week follow-up and six-month follow-up, the latter two of which map on to the standard definitions of "initial" and "sustained" weight loss, respectively (21,22).…”

Liver function parameters, cholesterol, and phospholipid α-linoleic acid are associated with adipokine levels in overweight and obese adults

“…Dieting, weight loss, and exercise constitute a multi-billion dollar industry [5], but unfortunately, most dieters inevitably regain weight as current methods to maintain weight loss have poor long-term success rates [6,7]. There remains a limited understanding of the physiological processes regulating appetite control and energy expenditure, which has fundamentally hindered development of truly effective therapies to treat or prevent obesity [8].…”