Modifying Habits is Key to Long-Term Weight Loss Maintenance

by Bianca Garilli, ND

In individuals with overweight or obesity, it only takes a 5% reduction in body weight to create potentially significant improvements in LDL and total cholesterol, blood pressure, and blood glucose.¹ The challenge in the weight loss field however, is often less about losing this initial 5% but rather maintaining the loss over an extended period of time. In fact, only 20% of people maintain their weight loss over the long-term, with 10-80% of individuals returning to their baseline weight, depending on the type of intervention employed.^2,3

A startling statistic was reported in a 2017 review published in the International Journal of Environmental Research and Public Health. This article noted that if the current rate of global overweight incidence continues unchanged, nearly half of the world’s adult population will be overweight or obese by 2030.⁴ Creating and implementing novel approaches to achieve successful initial weight loss and long-term maintenance is essential to curb this epidemic.

Most long-term weight loss interventions are aimed at sustaining healthy lifestyle changes and, although an important component of weight-loss, these changes are not typically found to result in successful long-term maintenance but rather eventually end in weight regain.¹ Focusing instead on habit-changing interventions through the use of employing conscious deliberate thought, and improving awareness of self and actions has been discussed as an alternative approach to successful long-term weight loss maintenance.¹

To explore this concept more closely and investigate whether breaking old habits or whether creating new ones is effective, a team from Bond University’s Institute of Health and Sport in Gold Coast, Australia followed 75 individuals in a randomized controlled trial post-intervention for 12 months, assessing for weight loss maintenance.¹ Eligible participants ranged from 18-75 years of age, had a BMI > 25 kg/m², could attend all required appointments, had daily access to email and/or phone, and were free from exercise limitations.¹ Participants were broken into 1of 3groups: the Ten Top Tips Group (TTT), the Do Something Different Group (DSD), or the Wait List Control Group (WL).¹ Descriptions of the treatment groups include the following:¹

• The TTT group (aimed at forming new habits) utilized a self-guided, leaflet-based intervention focusing on the recommendations of habit-formation theory. Tips included 7behaviors associated with negative energy balance, 2 behaviors designed to improve awareness of food intake, and 1 behavior to promote routines. This intervention was employed for 12 weeks, with participants initially attending a 2-hour group induction meeting and followed up by weekly phone check-ins.
• The DSD group (aimed at breaking old habits) increased the behavioral flexibility critical in breaking daily habits involved in unhealthy dietary and exercise behaviors. This approach required participants to do something different each day and engage in novel, weekly activities to expand their behavioral toolbox. Individuals participated in the program for a total of 9 weeks, beginning with a 2-hour group induction meeting. Participants received 3-4 new tasks per week, which were delivered either by email or text message along with a weekly phone call.

After the initial intervention time frames were complete, each group’s anthropomorphic measures, blood biomarkers, self-reported data and an 8-item well-being questionnaire were gathered and analyzed. Additionally, weight, waist circumference and psychometric parameters were collected at the 6- and 12-month follow-up periods for the TTT and DSD groups.¹

The primary outcome was weight loss maintenance at 12 months post-intervention in the TTT and DSD groups. Secondary outcomes included group comparisons for weight, waist circumference and psychometric measures (including wellbeing, depression, anxiety, habits, openness to change).¹

Notable results in the TTT and DSD groups included:¹

• Overall 67% of participants in the TTT group and 64% in the DSD group achieved and maintained a total body loss > 5% from baseline to the 12-month follow-up
• Participants in both treatment groups continued to lose weight at 12 months post-intervention, in contrast to previous studies which indicate an average of 46-50% of weight loss is regained in this same time frame when employing lifestyle interventions alone
• All psychometric measures improved from baseline to 12-month follow-up in both treatment groups with no significant differences between the TTT and DSD groups

It should be noted that TTT participants did receive direct healthy habit recommendations including walking 10,000 steps per day and being encouraged to eat 2 fruits and 5 vegetable per day. DSD individuals did not receive similar targeted recommendations although they did receive daily individualized text messages designed to disrupt their daily routines.

Why is this Clinically Relevant?

• > 5% of weight loss in individuals with overweight or obesity leads to improved health outcomes
• Maintaining weight loss is challenging, with only ~20% of individuals successfully keeping the weight off long-term
• Interventions designed to support mindfulness, conscious decision making, and awareness of behaviors can lead to changes in daily habits
• Targeted advice on healthy habits may not be necessary for weight loss maintenance but rather altering current habits can lead to the disruption of unhealthy habits and the cultivation of healthful behaviors

Link to abstract

Citations

1. Cleo G, Glasziou P, Beller E, Isenring E, Thomas R. Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial. Int J Obes (Lond). 2018;doi:10.1038/s41366-018-0067-4.
2. Bishop FM. Self-guided change: the most common form of long-term, maintained health behavior change. Health Psychol Open. 2018;5(1):2055102917751576.
3. Dishay J, Wharton S, Rotondi M, Ardern C, Kuk J. Predictors of early attrition and successful weight loss in patients attending an obesity management program. BMC Obes. 2016;3:14.
4. Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14(4):E435.

Bianca Garilli, ND, USMC Veteran

Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.