Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence

Weight regain is a multifactorial phenomenon, with several factors contributing to the difficulty of maintaining weight loss achieved through BWMPs (4).

These factors include:

• Physiological factors: Hormonal changes, such as decreased levels of leptin and increased levels of ghrelin, can lead to increased appetite and reduced energy expenditure following weight loss (5).
• Environmental factors: Exposure to an obesogenic environment, characterized by an abundance of high-calorie, palatable foods, and limited opportunities for physical activity, can make it challenging for individuals to maintain weight loss (6).
• Psychological factors: Emotional eating, stress, and lack of social support can contribute to weight regain after the completion of BWMPs (7).

Weight regain following BWMPs has been associated with an increased risk of cardiometabolic diseases (8).

The relationship between weight regain and cardiometabolic disease risk can be explained through several mechanisms:

• Increased adiposity: Weight regain leads to increased adipose tissue, which can contribute to insulin resistance and inflammation, increasing the risk of type 2 diabetes and cardiovascular disease (9).
• Elevated blood pressure: Weight regain has been associated with increased blood pressure, which is a significant risk factor for cardiovascular disease (10).
• Altered lipid profile: Weight regain can lead to an unfavorable lipid profile, characterized by increased levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides, and decreased levels of high-density lipoprotein cholesterol (HDL-C) (11).

Several strategies have been proposed to minimize weight regain and improve long-term outcomes following BWMPs:

Extended care programs: Providing ongoing support and follow-up after the completion of BWMPs can help individuals maintain weight loss and prevent weight regain (12).

Physical activity: Engaging in regular physical activity has been shown to be an effective strategy for maintaining weight loss and preventing weight regain (13).

Mindfulness-based approaches: Incorporating mindfulness techniques, such as mindful eating and stress reduction, can help individuals better manage emotional eating and prevent weight regain (14).

Dietary modifications play a crucial role in preventing weight regain following BWMPs (15).

Several dietary strategies can help individuals maintain weight loss:

• Caloric restriction: Consuming fewer calories than expended can help maintain weight loss (16). Individuals should work with healthcare professionals to determine the appropriate caloric intake for their needs.
• Macronutrient composition: A diet rich in protein, fiber, and healthy fats may promote satiety and help prevent weight regain (17). Additionally, reducing the intake of refined carbohydrates and added sugars can be beneficial.
• Meal timing and frequency: Eating regular, balanced meals and avoiding long periods of fasting can help regulate appetite and prevent overeating (18).
• Portion control: Being mindful of portion sizes can help prevent weight regain by avoiding excessive caloric intake (19).

Social support can play a significant role in preventing weight regain following BWMPs (20).

Individuals who have strong social support systems are more likely to maintain weight loss and adopt healthier lifestyles (21).

Strategies to enhance social support include: Joining support groups or online communities for individuals who have completed BWMPs.

Engaging friends and family members in healthy lifestyle changes, such as participating in physical activities together or sharing healthy meal planning tips.

Working with healthcare professionals, such as dietitians and exercise physiologists, who can provide ongoing guidance and support.

Adequate sleep and effective stress management are essential for maintaining weight loss and preventing weight regain (22).

Sleep deprivation has been linked to increased appetite and poorer dietary choices, while chronic stress can lead to emotional eating and weight gain (23).

Strategies for improving sleep and managing stress include:

• Establishing a consistent sleep schedule and creating a sleep-friendly environment.
• Practicing relaxation techniques, such as deep breathing, progressive muscle relaxation, or meditation.
• Engaging in regular physical activity, which has been shown to improve sleep quality and reduce stress levels (24).

In some cases, pharmacotherapy or bariatric surgery may be considered as adjunct treatments to help individuals maintain weight loss and prevent weight regain (25).

However, these options should be carefully evaluated on a case-by-case basis and should not replace the need for lifestyle modifications.

Pharmacotherapy: Several weight loss medications have been approved for long-term use in individuals with obesity (26).

These medications can help promote weight loss and prevent weight regain by suppressing appetite, increasing feelings of fullness, or altering nutrient absorption.

Bariatric surgery: Bariatric surgery is a surgical intervention that can result in significant weight loss for individuals with severe obesity (27).

The surgery can also improve or resolve obesity-related comorbidities, such as type 2 diabetes and hypertension (28).

However, it is important to note that bariatric surgery is not a cure for obesity and requires a lifelong commitment to lifestyle modifications to maintain weight loss.

In conclusion, weight regain following the completion of behavioral weight management programs is a significant concern that can increase the risk of cardiometabolic diseases.

Healthcare professionals and individuals who have participated in these programs should consider adopting a comprehensive approach that incorporates dietary modifications, regular physical activity, mindfulness-based techniques, social support, adequate sleep, and stress management to prevent weight regain and reduce cardiometabolic disease risk.

In some cases, pharmacotherapy or bariatric surgery may be considered as adjunct treatments to support long-term weight loss maintenance.

Future research should focus on identifying the most effective strategies to prevent weight regain and reduce cardiometabolic disease risk following BWMPs.

Longitudinal studies with larger and more diverse samples are needed to better understand the factors contributing to weight regain and the most effective interventions for maintaining weight loss.

Additionally, research should investigate the potential synergistic effects of combining multiple strategies, such as extended care programs, physical activity, and dietary modifications, to optimize long-term outcomes.

Healthcare professionals should be aware of the challenges associated with weight regain following BWMPs and incorporate evidence-based strategies into their practice to support individuals in maintaining weight loss.

This includes providing ongoing education and support, promoting regular physical activity, encouraging a healthy diet, fostering social support, and addressing sleep and stress management issues.

By adopting a comprehensive approach to weight loss maintenance, healthcare professionals can help individuals achieve lasting health improvements and reduce their risk of cardiometabolic diseases.

What are the long-term effects of weight regain on cardiometabolic disease incidence and risk?

Sources

1. World Health Organization. Obesity and overweight. 2021. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology. 2007;132(6):2226-38. https://pubmed.ncbi.nlm.nih.gov/17498514/
3. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-225S. https://pubmed.ncbi.nlm.nih.gov/16002825/
4. MacLean PS, Wing RR, Davidson T, et al. NIH working group report: Innovative research to improve maintenance of weight loss. Obesity (Silver Spring). 2015;23(1):7-15. https://pubmed.ncbi.nlm.nih.gov/25469998/
5. Sumithran P, Proietto J. The defence of body weight: A physiological basis for weight regain after weight loss. Clin Sci (Lond). 2013;124(4):231-41. https://pubmed.ncbi.nlm.nih.gov/23126426/
6. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: Shaped by global drivers and local environments. Lancet. 2011;378(9793):804-14.
7. Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67-85.
8. Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-54.
9. Bluher M. Adipose tissue dysfunction contributes to obesity-related metabolic diseases. Best Pract Res Clin Endocrinol Metab. 2013;27(2):163-77.
10. Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: Results of the Trials of Hypertension Prevention, phase II. Ann Intern Med. 2001;134(1):1-11.
11. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: A meta-analysis. Am J Clin Nutr. 1992;56(2):320-8.
12. Perri MG, Nezu AM. Applying the methods of randomized controlled trials to test the effectiveness of weight loss maintenance interventions. Am Psychol. 2019;74(2):240-50.
13. Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56(4):441-7.
14. Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review. Eat Behav. 2014;15(2):197-204.
15. Rolls BJ. Dietary strategies for weight management. Nestle Nutr Inst Workshop Ser. 2012;73:37-48.
16. Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018;102(1):183-97.
17. Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, Woods SC, Mattes RD. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015;101(6):1320S-1329S.
18. Alhussain MH, Macdonald IA, Taylor MA. Irregular meal-pattern effects on energy expenditure, metabolism, and appetite regulation: A randomized controlled trial in healthy normal-weight women. Am J Clin Nutr. 2016;104(1):21-32.
19. Zuraikat FM, Roe LS, Privitera GJ, Rolls BJ. The impact of portion size and energy density on eating in the absence of hunger in men. Appetite. 2019;135:88-93.
20. Kiernan M, Moore SD, Schoffman DE, Lee K, King AC, Taylor CB, Kiernan NE, Perri MG. Social support for healthy behaviors: Scale psychometrics and prediction of weight loss among women in a behavioral program. Obesity (Silver Spring). 2012;20(4):756-64.
21. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357(4):370-9.
22. Chaput JP, Tremblay A. Insufficient sleep as a contributor to weight gain: An update. Curr Obes Rep. 2012;1(4):245-56.
23. Dallman MF, Pecoraro N, Akana SF, et al. Chronic stress and obesity: A new view of “comfort food”. Proc Natl Acad Sci U S A. 2003;100(20):11696-701.
24. Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med. 2014;44(1):81-121.
25. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-62.
26. Kushner RF, Sorensen KW. Lifestyle medicine: The importance of firm grounding on evidence. Am J Lifestyle Med. 2013;7(1):6-16.
27. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159-91.
28. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297-304.