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Published: Dec 15, 2014
By Kristina Fiore, Staff Writer, MedPage Today

Maintaining weight loss is foiled by a combination of behavioral challenges and physiological adaptations that promote weight gain, according to a new report from a National Institutes of Health working group.

Behavioral fatigue is a big problem, causing patients to grow weary of diet and exercise regimens that seem to yield little benefit after the first 6 months, the report says.

Dieters also have to work against biology: reductions in resting and non-resting energy expenditure occur in response to caloric restriction and initial weight loss, according to the report, which was published in the January issue of Obesity.

The working group, led by Paul MacLean, PhD, of the University of Colorado in Denver, andRena Wing, PhD, of Brown University, was tasked with documenting the reasons that weight loss maintenance is such a challenge.

“Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment, with both the body and the mind conspiring against individual efforts to maintain weight loss,” MacLean said in a statement.

The group brought together experts from several disciplines, including physiology, genetics, endocrinology, and behavioral and cognitive sciences.

The “overwhelming conclusion” from the meeting was that there is a need for greater collaboration between physiological and behavioral researchers.

“The development of intervention strategies to improve maintenance of weight loss must be informed by an understanding of the physiological changes that occur with weight loss and promote weight regain,” they wrote.

MacLean also noted a need for individualized treatment of obesity: “There are many differences in individuals ranging from genetic to behavioral that lead some to do well on one approach, whereas others do not,” he said in the statement. “Therefore, what works for a friend or coworker may be very different from a weight-loss program that’s most effective and sustainable for you over the long term.”

The working group concluded that effective treatment strategies and improved outcomes will arise from a better understanding of how these behavioral and physiological barriers are related and how they vary between individuals.

George Bray, MD, of Pennington Biomedical Research Center in Louisiana, and Thomas Wadden, PhD, of the University of Pennsylvania, wrote in an accompanying commentarythat individualization of treatment will need to be accompanied by “collective societal actions to change the food and activity environments, which currently only exacerbate the long-term struggles that most individuals have with their weight.”

“As clinicians and researchers,” they concluded, “we must also help bridge the divide between individual and collective responsibility for successful long-term weight loss maintenance.”