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Recovery from relapse among weight maintainers - Obesity - Author Abstract

Nutrition Research Newsletter, Jan, 2004

The well-known problem with obesity treatment is weight regain after termination of treatment. Research has shown that three to five years after treatment, more than 50% of patients have returned to their baseline weights. Clinically, behavioral treatment teaches that recovery from relapse exists and that minor fluctuations in weight are to be expected during the weight loss and maintenance process. Whether recovery from weight regain is, in fact, a part of successful weight-loss maintenance, is unknown.

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The National Weight Control Registry (NWCR) followed 714 subjects who lost an average of 28.9 kg and kept it off for 5.7 years. The recent study examined patterns of weight change over the course of two years among the subjects in the NWCR. It was determined how frequently patients who gained weight between baseline and year one were able to recover over the following year, and examined prospectively the variables that distinguished those who recovered from those who did not.

Of the 4122 registry participants enrolled, 2492 completed the two-year assessment. Two approaches were used to categorize the regainer and recovery groups. First, regain was defined as weighing any amount above baseline at years 1 and 2. Full recovery was defined as weighing more than baseline weight at year 1 but losing it back to baseline or below by year 2, and partial recovery was defined as gaining more than 5% at year one but then losing more than 50% of the year 1 gain at year 2. Relapsers were defined as those weighing more than 5% above baseline at year 1 and weighing more than their year 1 weight at year 2. At year 1, subjects were asked to report their present weight and to again complete the behavioral measures that they had completed at baseline. At year 2, subjects only reported their weight. The 20-item Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms, while the Eating Inventory was used to assess dietary restraint and disinhibition.

The mean reported weight change from e NWCR to two years later was 3.8 kg. At year 2, 96.4% sample remained more than 10% below their maximum lifetime weight. Of the subjects who gained between baseline and year 1, only 11% returned to their baseline weight or below at year 2. Even small weight regains were rarely recovered. Of the subjects who relapsed, only 4.7% returned to their baseline weight or below at year 2 and only 12.9% lost again at least half of their year gain by year 2. The results indicated that the magnitude of the weight regain from baseline to year 1 was the only significant predictor recovery. Recovery was also significantly related to a smaller overall increase in depressive symptoms from baseline to year 1.

Although successful weight losers continued to maintain a large percentage of their weight losses over the years, recovery from even minor weight regain was uncommon. Considering these findings, clinicians may need to shift their focus from ways to reverse small weight gains to ways to prevent any weight gain.

Suzanne Phelan, James O Hill, Wei Lang, Julia R Dibello, and Rena R Wing, Recovery from Relapse Among Successful Weight Maintainers, Am J Clin Nutr 78: 1079-1084 (December 2003) [Address reprint requests to S Phelan, Brown Medical School/The Miriam Hospital, 14 Third Street, Providence, RI 02906. E-mail: sphelan@lifespan.org]

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Recovery from relapse among weight maintainers - Obesity - Author Abstract

Nutrition Research Newsletter, Jan, 2004

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