Maintaining Weight Loss
Why is Maintaining Weight Loss So Difficult?
Weight loss is difficult for many individuals. Many people have tried a variety of approaches and many are variations of the tired mantra “less calories in, more calories out”.
Obviously, if healthy weight loss were as simple as a math equation, then addressing weight related diseases such as high blood pressure, type 2 diabetes, obstructive sleep apnea, metabolic liver disease and many others, could be resolved without a visit to the doctor and addressed just by plugging in numbers and ensuring there is a straight forward calorie deficit. But calorie deficit is only part of the equation and therefore, weight loss is not that simple.
Many who have done calorie counting, point systems, food weighing, meal replacement programs have adhered to this principle of calorie deficit. And for some, this works. The issue and one I frequently hear in my clinic office, is that while weight loss was at first achievable, it was not sustainable. Then what happens is that weight regain starts, which feels discouraging and defeating.
Why does weight regain happen?
One important factor in and of itself is that severe calorie restriction for months/years is pretty unsustainable. Another reason is because deducing foods to points without understanding how they make a person feel or impact health fails to lead to healthy sustainable nutrition habits.
Another important reason that many of us obesity medicine physicians make sure to explain to individuals is due to the biology of obesity. Namely, the phenomenon called metabolic adaptation that pulls weight back to the starting point. Let’s explore this further.
Metabolic Adaptation
Metabolic adaptation is the body’s process of resisting further weight loss and the counter-resistance it puts forth to bring a person back to the original weight they started at. Metabolism expert and researcher, Kevin Hall Ph.D. from the National Institute of Health uses the best analogy I have come across to provide a mental picture to this phenomenon. He explains that the weight loss a person experiences is like pulling on a spring that is anchored at one end. At first, with a constant steady force, there is very little tension and it is easy to pull the non-anchored end of the spring away, which is like the beginning of weight loss when many people may find that it is easiest to lose weight. If we go back to the spring analogy, as one continues to pull on the spring with the same steady and constant force, more resistance to pulling the spring away from the starting point mounts until there is a point at which the spring will no longer give against the force being applied and in fact, starts to pull back. This is similar to what people experience as they continue a weight loss journey. Despite putting in the same amount of effort as ever, weight loss over time becomes more challenging until the body reaches a plateau and then, many individuals experience a slow pull back toward their original starting weight. This is called metabolic adaptation.
Why does this happen?
A major driver of this is due to the overwhelming increase in the hunger hormone, ghrelin, and significant decline in the satiety hormones, such as cholecystikinin, peptide YY, oxyntomodulin, amylin, leptin, GLP-1 and GIP. With increasing hunger hormone concentrations and decreased satiety hormones, food seeking behaviors and food choices can start to deviate despite the best knowledge and intention to the contrary.
Other reasons are due to the fact that with weight loss, total energy expenditure (how many calories we burn in a day) goes down and when we regain weight, this energy expenditure tends to stay down, making further weight loss attempts more difficult. Ugh.
So what are some ways to set yourself up for the best chances of success with weight loss maintenance?
Find a healthy and sustainable nutrition plan
I recommend choosing a high-fiber, low saturated fat, and lean protein nutrition plan that nourishes primarily from whole-food ingredients and avoids ultra-processed foods that are filled with added fats, salts, and sugars. Not only does this nutrition pattern help increase satiety, but it also increases the thermogenic effect of food, a component of total energy expenditure.
Establish a consistent exercise routine
This is non-negotiable. Excuses related to not having enough time won’t do. This has to be a combination of cardiovascular and strength training. In fact, studies have shown that the individuals who have the best success with keeping weight off are those individuals who are exercising 60 minutes a day.
Get 7-9 hours of sleep every night
Shorter sleep leads to higher cortisol and ghrelin levels leading to increased hunger, and decreased leptin, which leads to decreased satiety
Use FDA-approved medications to compliment your weight loss success
We have well-studied, well-understood, effective medications that when prescribed responsibly and under the supervision of a physician who is monitoring important health markers (blood tests, blood pressure, body composition), leads to healthy sustainable long-term weight loss that compliments the necessary lifestyle habits to support weight loss maintenance. Using one of these medicines is not an ‘easy-way-out’ and unfortunately, there is still a lot of stigma surrounding the use of the medicines. However, they address the hormonal component of metabolic adaptation and are effective in maintaining weight loss.
As with anything, it is important to sit down with your health care team and come up with a personalized plan that will set you up with the best opportunity for weight loss maintenance success!