September/October 2009
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Habits Associated With Successful Weight Loss and Maintenance
Self-monitoring strategies are a key behavioral feature of individuals who successfully lose weight.
Reviewed By Judy Kruger, PhD
Although almost half of Americans are trying to lose weight at any given time,1 there are limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults. According to research reported in the International Journal of Behavioral Nutrition and Physical Activity (2006, 3:17–27), many individuals who lose weight eventually regain most of the weight that was lost.2-4
This article summarizes an investigation that examined the difference in weight loss strategies and attitudes among individuals who successfully lost weight—and were able to keep it off—and those who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off).
BACKGROUND
It is well known that weight loss is associated with both short- and long-term health benefits, including reductions in blood pressure and triglycerides, improvements in lipoprotein subfractions and insulin response, and better pulmonary function,5,6 as well as improved blood flow7 and reduced mortality from cardiovascular disease.8
To successfully achieve weight loss, the National Heart, Lung, and Blood Institute recommends behavioral modification strategies that enable patients to reduce caloric intake and increase physical activity.9 Many factors, however, affect a person's ability to be successful in his or her weightloss endeavors. According to a 2005 review, such traits as readiness and motivation failed to predict weight loss, whereas immediate initial weight loss and goal attainment, an active lifestyle, self-monitoring weight-related behaviors, regular food intake patterns including breakfast and healthier eating, and control over eating behavior were all associated with successful weight maintenance.10
The National Weight Control Registry is a group of 4,000 adults aged ≥18 years that have lost at least 13.6 kg (30 lbs) and kept it off for at least 1 year. This is the largest registry of its kind to date. Surveys of these individuals have found that the most common dietary strategies used include restricting certain foods (mentioned by 87.5%), limiting quantities (44.0%), and counting calories (43.0%).4,11 The registry members are also physically active, with most participating in 1 hour of daily moderate-intensity activity.4,9-11
METHODS
For Dr. Kruger and colleagues' investigation, they used data from Styles 2004, a consumer survey representative of the US population and administered in two waves. A total of 6,207 people (62% response rate) completed the ConsumerStyles survey. Of that group, 6,175 were mailed the HealthStyles survey, and 4,345 responses were obtained (70% response rate).
As part of the questionnaire, patients were asked to describe their experience with weight. The choices were one of the following: (1) I lost weight and have been able to keep it off, (2) I've lost weight but haven't been able to keep it off, (3) I've tried to lose weight but haven't been successful, (4) I've maintained my weight with conscious effort, (5) I've maintained my weight without effort, (6) I've gained weight and haven't tried to lose it, or (7) I pay no attention to my weight. Participants answering that they lost weight and have kept it off were defined as successful weight losers, and those who reported losing weight but not being able to keep it off or had unsuccessfully tried to lose weight were defined as unsuccessful weight losers.
Weight-control strategies. The survey asked respondents about strategies they had tried to lose weight, and they were given a list of 18 strategies (Table 1) including reducing food intake, exercising, and eating reduced-calorie foods.
Respondents were also asked to report on their weekly weight-control practices, according to the study and were asked about the practices they engaged in on most days of the week. Respondents were to select all that applied from a list of six items (Table 2). Respondents were asked how often they weighed themselves in a separate question.
Physical activity. Respondents were asked to report all physical activities/sports they engage in from a list (Table 3) and also to select leisure-time activities that they enjoyed regularly from a list of 29 items. The authors wrote that, for descriptive purposes, various items considered similar in energy expenditure were combined.
Weight loss barriers. Respondents were given nine possible barriers to weight control and asked to rank these barriers' influence on a 7-point Likert scale (1 = no or little influence; 7 = influences a lot). The items were: (1) I eat away from home too often, (2) I'm often too tired to exercise, (3) I like to eat junk food/have a sweet tooth, (4) I don't have time to exercise, (5) I don't really pay attention to what I'm eating, (6) I don't have anyone to exercise with me, (7) Diet/healthy foods are not as filling/still feel hungry, (8) It is too hard to stick with an exercise routine, and (9) Diet/healthy foods cost too much.
People who were successful and unsuccessful losing weight were compared by demographic characteristics, weight loss strategies, self-monitoring behaviors, activities, and barriers. The investigators noted that they used multivariable logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for successful weight loss (vs unsuccessful) in a model that included sex, age, race, education, annual household income, and body mass index (BMI). Multivariable logistic regression models that adjusted for sex, age, race, education, annual household income, and BMI were used to assess the relation between being a successful weight loser and specific barriers to losing or maintaining weight, according to the report.
RESULTS
One-third (30.96%) of the sample of participants was successful at losing weight and keeping their weight off. The investigators found that women were less successful than men (adjusted OR = 0.63, 95% CI = 0.48–0.81). Individuals aged 30 to 44 years had lower odds of being successful weight losers (OR = 0.51, 95% CI = 0.30–0.89) compared with participants aged 18 to 29 years. Race/ethnicity, education, and household income did not have an impact on weight loss success. Successful participants were much more likely to have a BMI ≥35.0 (OR = 0.12, 95%CI = 0.07-0.19) than less heavy people (BMI <25.0).
The five most common weight-control behaviors did not differ significantly (P >.005) between successful and unsuccessful weight losers. These were reduced amount of food consumed (79.60%; 82.39%), more fruits and vegetables consumed (71.37%; 65.91%), smaller portions (64.57%; 64.98%), fewer fatty foods (60.13%; 57.66%), and no sweetened beverages (56.50%; 52.57%). More successful weight losers reported exercising ≥30 minutes daily (46.91% vs 37.54%) and adding physical activity to their daily routine (46.70% vs 34.88). Fewer successful weight losers reported using over-the-counter diet products (10.36% vs 15.89%).
When Dr. Kruger and colleagues analyzed self-monitoring behaviors, they found many significant differences by weight loss status (Table 4). Participants who successfully lost weight reported planning meals (35.90% vs 24.88%) tracking calories (17.73% vs 8.84%), and tracking fat (16.40% vs 6.57%). Successful weight losers reported measuring the amount of food on their plate (15.89% vs 6.73%) and were more likely to weigh themselves daily (20.30%) versus those who were unsuccessful (11.00%) at losing weight.
Walking was the most common reported physical activity/sport among all participants (61.51% vs 56.41%). The only significant difference between successful and unsuccessful weight losers was for lifting weights (19.01% of successful, 10.86% of unsuccessful; P =.002). Although all participants engaged in a variety of leisure activities, only cooking/baking for fun was more common among those who were successful (45.59% vs 36.48%; P =.004).
Regarding barriers to weight control, those who reported factors that influenced their ability to exercise consistently had odds of success that were 48% to 76% lower compared with those who reported little or no exercise barriers. Participants who reported dietary barriers (eat away from home too often, like to eat junk food, don't pay attention to diet, diet/health foods not satisfying, diet/health food costs too much) were 48% to 64% more likely to be unsuccessful versus those who reported little or no influence of diet.
DISCUSSION, IMPLICATIONS, AND RECOMMENDATIONS
Among the Styles respondents who had lost or tried to lose weight, almost one-third were successful. This report found that successful participants were more likely to engage in physical activity than unsuccessful individuals. Dr. Kruger and colleagues report that successful weight loss and maintenance was associated with higher odds of taking part in physical activity on most days of the week. An interesting finding was that people who took over-the-counter weight loss aids were less successful at losing weight than those who did not. Successful weight losers were more likely to engage in self-monitoring behaviors (eg, weighing oneself daily). Previous data have shown that people who weigh themselves at least weekly are more likely to lose weight and keep it off versus those who do not regularly weigh themselves.12,13 Members of the National Weight Control Registry reported weighing themselves regularly.4 Teixeira and colleagues reported that a "self-motivated cognitive style" predicted compliance to behaviors consistent with successful weight management.14
When questions focused on weight-control practices followed "most days of the week," Dr. Kruger and colleagues found that behaviors such as planning meals, tracking calories, tracking fat, and measuring food were all more common in participants successful in weight loss versus those who were not successful. This result has been shown previously.4,15
Weight training may enhance overall energy expenditure and aid in weight control.16,17 Twenty percent of members of the National Weight Control Registry report this activity.9,18 This study found that weight lifting was almost twice as common among successful weight losers and that men were more likely to be successful. A greater predilection for weight lifting could be part of the reason for men's greater success, Dr. Kruger and colleagues noted. It is also possible that weight lifting is a marker for a physically active lifestyle.
Not surprisingly, people who reported being influenced by dietary weight-control barriers had less success losing weight. This indicates, according to the authors, that taste, cost and convenience are factors that should be considered in initiatives aimed at helping people successfully lose weight. Cooking or baking for fun was more common among those successful at weight loss. The authors stated that it could be those individuals eat at home more often and therefore eat healthier.19
It was also not surprising that barriers to exercise were associated with being unsuccessful at losing weight. Elfhag and Rossner10 have reported that social support, better coping strategies, and the ability to handle life stress were factors associated with successful weight maintenance.10 Additionally, the Task Force on Community Preventive Services20 has suggested that environmental barriers and lack of social support play a role in exercise behavior. Therefore, increasing convenient opportunities to exercise may motivate behavior change and eliminate barriers.
Weight loss maintenance is difficult, therefore it is key for health care providers to identify factors that facilitate success. Kruger et al found that self-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising ≥30 minutes daily, and adding physical activity to the daily routine help in maintaining weight loss. These results also indicate that people who lift weights and/or cook and bake for fun are more successful in their endeavors to lose weight and keep it off.
Judy Kruger, PhD, is in the Physical Activity and Health Branch, Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention. She may be reached at jkruger@cdc.gov; or phone: 770-488–5820.
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