The patient and the healthcare professional face a new metabolic and endocrine balance after weight loss. This requires changing long-term management strategies.
A weight loss of 5 to 10%, regardless of the method used to achieve it (physical activity, calorie restriction, pharmacological treatment), improves quality of life, biological markers and clinical parameters. The benefits of this weight loss last as long as it is sustained. As a rule of thumb, sustaining long-term weight loss achieves its goal if the patient does not gain more than 3 kg for two years.
Factors for maintaining weight loss:
Despite the variety of treatment approaches in an initial weight loss program, most patients achieve their maximum weight loss during the first six months.
When you lose weight, energy expenditure drops by about 20 kcal per kilogram of weight lost. The initial program alone (or rather the initial calorie deficit) is therefore ineffective and is no longer sufficient after weight loss.
Weight change refers to the desired weight from the start of the program, before the maintenance process. Achieving the desired weight after this first step rewards patients’ efforts and gives them long-term confidence in their ability to lose and maintain weight. It is therefore essential to avoid unrealistic goals in the care. Rapid weight loss, long considered a barrier to long-term maintenance, can also be a good way to support patient motivation.
Recognizing the emotional triggers of hunger pangs for better control also contributes to success in weight maintenance. Moreover, this maintenance does not take into account its effectiveness unless accompanied by a flexible attitude: it is therefore necessary to avoid rigid management of the diet in an all-or-nothing mode.
The “all or nothing” mode of operation is sometimes indicative of eating disorders considered to be a barrier to maintaining weight loss.
Barriers to maintaining weight loss:
In normal clinical practice, obesity is not really considered a chronic disease like diabetes or high blood pressure, which requires long-term follow-up.
It is not surprising that, in this context, after the period of weight loss, patients no longer receive appropriate follow-ups. Maintaining weight loss following a prior weight loss program puts patients in a new metabolic and endocrine balance. In fact, weight loss is accompanied by physiological survival mechanisms such as a reduction in basal metabolism and leptin levels and an increase in ghrelin, a powerful central inducer of the sensation of hunger.
Note that patients are required to observe and reinforce behavioral changes that have promoted weight loss in terms of diet and physical activity. On this point, most studies agree that several changes need to be maintained for proper maintenance of weight loss. An attitude that seems to be difficult as many patients quickly return to their old bad habits.
Generally speaking, learning new behaviors should go through a process of acquisition followed by relentless repetition. As they integrate, subjects need less and less effort to complete them.
In summary :
- Long-term follow-up is necessary to support patients during this period of adaptation to the new lifestyle.
- The follow-up of obese patients should be a long-term follow-up in the same way as patients with chronic diseases.
- Goals in the diet phase must be achievable.