Long-term weight loss maintenance for obesity: a multidisciplinary approach

Luca Montesi, Marwan El Ghoch, Lucia Brodosi, Simona Calugi, Giulio Marchesini, Riccardo Dalle Grave, Luca Montesi, Marwan El Ghoch, Lucia Brodosi, Simona Calugi, Giulio Marchesini, Riccardo Dalle Grave

Abstract

The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient-therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called "lifestyle trainer" or "healthy lifestyle practitioner") as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment.

Keywords: cognitive behavior therapy; lifestyle modification; multidisciplinary treatment; obesity.

Figures

Figure 1
Figure 1
Constellation of factors associated with long-term weight loss maintenance in the general population of obese subjects attending nonsurgical weight loss programs.

References

    1. Christian JG, Tsai AG, Bessesen DH. Interpreting weight losses from lifestyle modification trials: using categorical data. Int J Obes. 2010;34(1):207–209.
    1. Patel D. Pharmacotherapy for the management of obesity. Metabolism. 2015;64(11):1376–1385.
    1. MacLean PS, Wing RR, Davidson T, et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity. 2015;23(1):7–15.
    1. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014;46(1):17–23.
    1. Wadden TA, Neiberg RH, Wing RR, et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity. 2011;19(10):1987–1998.
    1. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323–341.
    1. Rossner S. Defining success in obesity management. Int J Obes Relat Metab Disord. 1997;21(Suppl 1):S2–S4.
    1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–S138.
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
    1. Dalle Grave R, Cuzzolaro M, Calugi S, et al. The effect of obesity management on body image in patients seeking treatment at medical centers. Obesity. 2007;15(9):2320–2327.
    1. Dalle Grave R, Calugi S, Petroni ML, Di Domizio S, Marchesini G, QUOVADIS Study Group Weight management, psychological distress and binge eating in obesity. A reappraisal of the problem. Appetite. 2010;54(2):269–273.
    1. French SA, Jeffery RW, Folsom AR, Williamson DF, Byers T. History of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. Obes Res. 1995;3(2):163–170.
    1. Kraschnewski JL, Boan J, Esposito J, et al. Long-term weight loss maintenance in the United States. Int J Obes. 2010;34(11):1644–1654.
    1. Wing RR. Behavioral weight control. In: Wadden TA, Stunkard AJ, editors. Handbook of Obesity Treatment. New York, NY: The Guildford Press; 2002. pp. 301–316.
    1. Dalle Grave R, Calugi S, Marchesini G. The influence of cognitive factors in the treatment of obesity: lessons from the QUOVADIS study. Behav Res Ther. 2014;63C:157–161.
    1. Ryan DH, Espeland MA, Foster GD, et al. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials. 2003;24(5):610–628.
    1. Look Ahead Research Group Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity. 2014;22(1):5–13.
    1. Diabetes Prevention Program Research Group. Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–1686.
    1. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27(1):155–161.
    1. Dalle Grave R, Melchionda N, Calugi S, et al. Continuous care in the treatment of obesity: an observational multicentre study. J Intern Med. 2005;258(3):265–273.
    1. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355(15):1563–1571.
    1. Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139–1148.
    1. Perri MG, Limacher MC, Durning PE, et al. Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Arch Intern Med. 2008;168(21):2347–2354.
    1. Fuller NR, Williams K, Shrestha R, et al. Changes in physical activity during a weight loss intervention and follow-up: a randomized controlled trial. Clin Obes. 2014;4(3):127–135.
    1. Anastasiou CA, Fappa E, Karfopoulou E, Gkza A, Yannakoulia M. Weight loss maintenance in relation to locus of control: the MedWeight study. Behav Res Ther. 2015;71:40–44.
    1. Santos I, Mata J, Silva MN, Sardinha LB, Teixeira PJ. Predicting long-term weight loss maintenance in previously overweight women: a signal detection approach. Obesity. 2015;23(5):957–964.
    1. Simpson SA, McNamara R, Shaw C, et al. A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults. Health Technol Assess. 2015;19(50):v–vi. xix–xxv, 1–378.
    1. Spark LC, Fjeldsoe BS, Eakin EG, Reeves MM. Efficacy of a text message-delivered extended contact intervention on maintenance of weight loss, physical activity, and dietary behavior change. JMIR Mhealth Uhealth. 2015;3(3):e88.
    1. Young MD, Plotnikoff RC, Collins CE, Callister R, Morgan PJ. Impact of a male-only weight loss maintenance programme on social-cognitive determinants of physical activity and healthy eating: a randomized controlled trial. Br J Health Psychol. 2015;20(4):724–744.
    1. Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66(2):239–246.
    1. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S–225S.
    1. McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7(4):334–341.
    1. Keesey RE, Hirvonen MD. Body weight set-points: determination and adjustment. J Nutr. 1997;127(9):1875S–1883S.
    1. Cooper Z, Fairburn CG. A new cognitive behavioural approach to the treatment of obesity. Behav Res Ther. 2001;39(5):499–511.
    1. Melchionda N, Marchesini G, Apolone G, et al. The QUOVADIS Study: features of obese Italian patients seeking treatment at specialist centers. Diabetes Nutr Metab. 2003;16(2):115–124.
    1. Latner JD, McLeod G, O’Brien KS, Johnston L. The role of self-efficacy, coping, and lapses in weight maintenance. Eat Weight Disord. 2013;18(4):359–366.
    1. Kassin S. Psychology. 4th ed. Upper Saddle River, NJ: Prentice-Hall, Inc; 2003.
    1. Dalle Grave R, Calugi S, Compare A, et al. Personality, attrition and weight loss in treatment seeking women with obesity. Clin Obes. 2015;5(5):266–272.
    1. Sullivan S, Cloninger CR, Przybeck TR, Klein S. Personality characteristics in obesity and relationship with successful weight loss. Int J Obes. 2007;31(4):669–674.
    1. Fassino S, Leombruni P, Piero A, et al. Temperament and character in obese women with and without binge eating disorder. Compr Psychiatry. 2002;43(6):431–437.
    1. Kiesewetter S, Kopsel A, Mai K, et al. Attachment style contributes to the outcome of a multimodal lifestyle intervention. Biopsychosoc Med. 2012;6(1):3.
    1. Strauss B. Bindungsforschung und therapeutische Beziehung [Attachment research and therapeutic relationship] Psychotherapeut. 2006;51:5–14. German.
    1. Teixeira PJ, Carraca EV, Marques MM, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med. 2015;13:84.
    1. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12(Suppl):151S–162S.
    1. Perri MG, Nezu AM, Patti ET, McCann KL. Effect of length of treatment on weight loss. J Consult Clin Psychol. 1989;57(3):450–452.
    1. Latner JD, Stunkard AJ, Wilson GT, Jackson ML, Zelitch DS, Labouvie E. Effective long-term treatment of obesity: a continuing care model. Int J Obes Relat Metab Disord. 2000;24(7):893–898.
    1. Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation. 2012;125(9):1157–1170.
    1. Hutchesson MJ, Rollo ME, Krukowski R, et al. eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis. Obes Rev. 2015;16(5):376–392.
    1. Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39(8):1188–1196.
    1. Schoeller DA, Shay K, Kushner RF. How much physical activity is needed to minimize weight gain in previously obese women? Am J Clin Nutr. 1997;66(3):551–556.
    1. Centis E, Trento M, Dei Cas A, et al. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes. Acta Diabetol. 2014;51(4):559–566.
    1. Soleymani T, Daniel S, Garvey WT. Weight maintenance: challenges, tools and strategies for primary care physicians. Obes Rev. Epub October 21, 2015.
    1. Ekkekakis P, Lind E. Exercise does not feel the same when you are overweight: the impact of self-selected and imposed intensity on affect and exertion. Int J Obes. 2006;30(4):652–660.
    1. Ford ES, Herman WH. Leisure-time physical activity patterns in the U.S. diabetic population. Findings from the 1990 National Health Interview Survey – Health Promotion and Disease Prevention Supplement. Diabetes Care. 1995;18(1):27–33.
    1. Lee RE, Mama SK, Medina A, Orlando Edwards R, McNeill L. SALSA: SAving Lives Staying Active to promote physical activity and healthy eating. J Obes. 2011;2011:436509.
    1. Kattenstroth JC, Kolankowska I, Kalisch T, Dinse HR. Superior sensory, motor, and cognitive performance in elderly individuals with multi-year dancing activities. Front Aging Neurosci. 2010;2:31.
    1. Mangeri F, Montesi L, Forlani G, Dalle Grave R, Marchesini G. A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity. Diabetol Metab Syndr. 2014;6:74.
    1. Gupta H. Barriers to and facilitators of long term weight loss maintenance in adult UK people: a thematic analysis. Int J Prev Med. 2014;5(12):1512–1520.
    1. 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):342–362.
    1. Cooper Z, Fairburn CG, Hawker DM. Cognitive-Behavioral Treatment Of Obesity. New York, NY: The Guilford Press; 2003.
    1. Flechtner-Mors M, Ditschuneit HH, Johnson TD, Suchard MA, Adler G. Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res. 2000;8(5):399–402.
    1. Ptomey LT, Willis EA, Goetz JR, et al. Portion-controlled meals provide increases in diet quality during weight loss and maintenance. J Hum Nutr Diet. Epub February 9, 2015.
    1. American Medical Association House of Delegates Recognition of Obesity as a Disease. Resolution. 2013;420(A-13)
    1. Donini LM, Dalle Grave R, Caretto A, et al. From simplicity towards complexity: the Italian multidimensional approach to obesity. Eat Weight Disord. 2014;19(3):387–394.
    1. Dalle Grave R, Calugi S, Centis E, Marzocchi R, El Ghoch M, Marchesini G. Lifestyle modification in the management of the metabolic syndrome: achievements and challenges. Diabetes Metab Syndr Obes. 2010;3:373–385.
    1. Arena R, Lavie CJ, Hivert M-F, Williams MA, Briggs PD, Guazzi M. Who will deliver comprehensive healthy lifestyle interventions to combat non-communicable disease? Introducing the healthy lifestyle practitioner discipline. Expert Rev Cardiovasc Ther. 2016;14(1):15–22.

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