It’s no secret that we have an obesity epidemic in this country. Not just overweight … obese.
In fact, obesity has doubled in the past 30 years and is expected to affect more than 40 percent of all Americans in less than 10 years.
While obesity in and of itself is not an issue, the gamut of chronic diseases it can lead to is astounding:
- Type 2 diabetes
- Heart disease
- High blood pressure
- Sleep apnea
- High cholesterol
- Gallbladder disease
Given this, why don’t more people work to lose weight and maintain a healthy weight?
The reality is only 20 percent to 26 percent of people who lose 10 percent of their body weight are able to keep the weight off for at least two years. While this statistic is concerning, the real question is why?
In an effort to find the answer, researchers from Brigham Young University in Utah probed 18 studies across five separate online databases to unearth an explanation. They found seven factors that appeared to have an effect on a person’s ability to maintain a healthy weight after shedding excess pounds.
1. Failure to Reach Weight Loss Goals
In one study, researchers found that those people who reached their weight loss goal were more likely to keep the weight off. More importantly, this success was strongest in those people who felt they had also improved their self-esteem, health and appearance.
The second study found that those who had the most weight to lose (and were therefore further from their weight loss goal) were more likely to regain their weight. The third study found that those people who were satisfied with the amount of weight they had lost were more likely to keep the weight off.
Based on these studies, researchers concluded that the concept of satisfaction plays an important role in weight loss maintenance.
2. Black-and-White Thinking
Two studies found that people who saw the world in terms of extremes took a failure to meet their weight loss goals, regardless of how close they were to the goal, as a complete failure. Therefore, there was no point in maintaining the loss.
Researchers concluded that altering this thought process might help with weight maintenance.
3. Emotional Eating
Three studies addressed this issue. The first found that those who had regained their weight stated eating due to stressful situations, for comfort, or to distract themselves.
The second study found that participants cited several emotional reasons for overeating, including panic, nervousness and depression. It was the same story in the third study, with 52 percent of people pointing to depression as the reason for overeating, while 58 percent felt anxiety was their trigger.
Based on these studies, researchers felt strongly that people who ate emotionally were the most likely to regain weight.
4. Lack of Dietary Restraint
When it came to evaluating an inability to show restraint, researcher consulted six separate studies. Five of the six found that there was no doubt that people who were better able to show restraint when making dietary choices, as well as control the amount they ate, were more successful at keeping the weight off.
As for the reasons given for poor restraint, as you would expect, this was often driven by internal triggers such as negative feelings and emotions.
5. Costs Overweighing Benefits
On the cost versus benefits side, researchers looked at two studies that discussed the perceived benefits of weight loss (appearance, improved health, better-fitting clothes, feelings of control) with the costs (expense, time, effort, stress, and feelings of guilt or frustration).
The first study found that as weight loss slowed, the perceived benefits diminished. They concluded that, without a sustained reward, people may give up the effort.
The second study looked specifically at reasons for regaining weight. They found the most common challenges cited were:
- Falling back into old habits
- No time to exercise
- Job responsibilities
- Expense of healthy eating
The key difference between those who kept the weight off and those who regained it was the perception of these challenges. People who regained felt that weight control was either impossible or very difficult 74 percent of the time, whereas those who kept it off only felt that way 29 percent of the time.
Based on these two findings, researchers concluded that if the perceived cost of weight maintenance was greater than the benefits, people tended to regain the weight.
After careful examination of four studies, researchers identified depression as a huge indicator of relapse. One study found that, regardless of weight maintenance or regain, depression increased in both groups after one year. However, those that gained weight back were prone to have more depressive symptoms.
Another study found that those who dropped out of a weight loss program had higher baseline depression scores than those who completed the program. So researchers concluded that increased depression levels are associated with weight regain over time.
7. Poor Body Image
Finally, when it came to the role body image plays, researchers turned to four studies. The first found that people who regained weight tended to base their self-worth on their body image.
The second study determined body image at the start of a weight loss program. They found that those who completed the program had fewer body issues and greater body size satisfaction than those who dropped out. Similarly, those who were able to keep the weight off exhibited better body image scores than those who regained.
The third study found that people who had increasing dissatisfaction with their body image between three and 12 months following weight loss were more likely to regain the weight. And the fourth study found that people who avoided things like physical intimacy, tight-fitting clothes and social situations were more likely to regain weight than those who participated in these activities.
Based on these four studies, researchers concluded that body image plays a role in a person’s ability to maintain weight loss.
The Key to Maintaining Weight Loss
While it is rare for any one factor to be the cause of obesity or failure to maintain a healthy weight, examining possible stumbling blocks is key. Of the factors examined here, the ones that really stood out were emotional eating, depression and the ability to show restraint, which often had an emotional connection as well.
Similarly, perception played a big role in determining success. Whether it was the setting a realistic weight loss goal, the reward versus costs of weight loss, or how you see your body, your perceptions around weight can set you up for success or failure.
Given this, researchers suggested that health care practitioners develop tools that address each issue. I would take this one step further and suggest that to truly address weight issues you have to get to the underlying emotional triggers.
This is best accomplished with the help of a therapist, support group or even a 12-step program. By pairing your nutritional tools with emotional ones, you have a better chance at not only losing the weight, but keeping it off.
 Centers for Disease Control and Prevention. Overweight and obesity. 2007.
 Befort, CA et al. Weight maintenance, behaviors and barriers among previous participants of a university-based weight control program. Int J Obesity. 2005;32(3):519-26.
 Ohsiek, S and Williams, M. Psychological factors influencing weight loss maintenance: An integrative literature review. J Am Acad Nurse Pract. 2011 Nov;23(11):592-601.
 Byrne, S et al. Weight maintenance and relapse in obesity: A qualitative study. Int J Obesity and Related Metab Dis. 2003;27(8):955-62.
 Jeffery, RW et al. The weight loss experience: A descriptive analysis. Annals Behav Med. 2004;27(2):100-6.
 Befort, CA.
 Phelan, S et al. Recovery from relapse among successful weight maintainers. Am J Clin Nutr. 2003;78(6):1,079-84.
 Teixeira, PJ et al. Pretreatment predictors of attrition and successful weight management in women. Int J Obesity and Related Metab Dis. 2004;28(9):1124-33.