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Background: Keeping your weight down can be trickier than losing it in the first place. Many weight-loss interventions are successful in short-term studies, but few studies have assessed what makes it possible not to regain.

The study: This systematic review of qualitative studies investigated the experiences, challenges, and strategies related to long-term weight maintenance after substantial weight loss. The included 15 studies assessed a total 294 people who were or had been overweight or obese, had lost weight, and had tried not to regain it for at least one year.

The results: Ten factors were found to affect long-term weight-loss maintenance:

  1. Self-monitoring. Successful maintainers monitored their food intake (with tools such as calorie-tracking apps, food diaries, and food scales) and tended to weigh themselves regularly. They set eating routines and generally limited their food choices. They made plans for social events, often checking the menu in advance to decide what they would eat.

  2. External monitoring. Maintenance was facilitated by healthcare professionals, loved ones, and (physical or online) support groups providing motivation, support, and accountability.

  3. Intrinsic motivators. Maintainers were motivated to improve their health, fitness, and quality of life, or to prevent weight-related conditions. They reported an improved self-image after weight loss and spoke of an identity shift to a new lifestyle.

  4. Extrinsic motivators. Some maintainers were motivated to improve their social image. Support systems also gave them a sense of belonging.

  5. Self-defined goals. Maintainers had clear goals, which they continually reassessed. They described their dietary goals in terms of macronutrients or food categories. They had gym schedules or engaged in regular sports events.

  6. Externally defined goals. Such goals (supplied by sports events, healthcare professionals, or weight-loss clubs) provided motivation but weren’t essential.

  7. Enduring internal challenges. Time constraints, lack of structure, everyday stress, emotional eating, trigger foods, and life events (pregnancy, illness, injury, death, divorce, job loss …) created internal challenges that had to be endured and overcome.

  8. Enduring external challenges. These included obesogenic food environments, unsupportive peers, relationship changes, stress from work and personal life, and social events (holidays, weddings, birthday parties …).

  9. Encouraging experiences. Successful maintainers reported feeling liberated; free from weight concerns, they felt like new people. They spoke of having developed new identities, transforming into people who lived healthy lives, took chances, and pursued previously daunting life opportunities.

  10. Discouraging experiences. Many people reported an intense fear of regaining, making the journey feel like a constant battle. The process was often lonely, as maintainers felt criticized at times for their lifestyle choices. Because, after their weight loss, they had to refrain from resuming their previous consumption patterns, some of them felt deprived.

Note: Successful weight-loss maintenance was defined differently by different studies. Seven defined it as a weight loss of ≥10% sustained over one year. Others described it as a weight loss of ≥10% sustained over five years, a weight loss of ≥10% sustained over seven years, a weight loss of ≥5% sustained over one year, a weight loss of ≥13.6 kg sustained over one year, a weight loss of ≥6.35 kg sustained over one year, or a weight loss of ≥7% sustained over one year.

This study was preregistered, meaning that the authors had to state the outcomes they planned to investigate prior to conducting their research. Preregistration strengthens the findings of a study considerably, because it reduces the possibility that the authors only reported findings that appeared interesting or significant.

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