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872 PA R T V / Health Promotion and Disease Prevention
obstructive sleep apnea, weight-bearing OA, and depression. 121,126 ongoing registry of individuals who have been successful at los-
The literature supports a mean percent excess weight loss between ing and maintaining a minimum of 13.6 kg for at least 1 year. 139
47% and 70% for all procedures. 126,127 The most recent data from Behavioral strategies used by these successful individuals include
the Swedish Obesity Study (SOS), a large prospective controlled increasing physical activity, consuming a low-fat diet, regularly
trial that began in 1987, found a significant difference between the self-monitoring food eaten and body weight, 140 restricting the va-
control group and the surgical groups. 128 The average change in riety of food eaten, 141 consuming a consistent weekly diet, 142 eat-
weight among the control group remained 2% during the obser- ing breakfast, 143 and limiting the amount of time spent watching
vation period, whereas in the three surgical groups the mean weight television. 144 The importance of self-weighing for weight mainte-
loss standard deviation reached the maximum after 1 to 2 years nance has been confirmed by others who reported that a higher
with gastric bypass 32% 8%, vertical banded gastroplasty, 25% frequency of weighing was related to less weight regain. 130,145,146
9% and gastric banding at 20% 10%. After 10 years, when Men belonging to the National Weight Control Registry report
compared to the baseline weight, losses were 25% 11% with by- expending 3,293 kcal/week through physical activity while
pass, 16% 11% with gastroplasty, and 14% 14% with band- women report expending 2,545 kcal/week; these amounts are
ing; after 15 years, the weight losses consisted of 27% 12%, 18% similar to walking 28 miles/week or about 1 hour of moderately
11%, and 13% 14%, respectively. Reports after 16 years of intense activity daily. 140 This finding underscores the importance
follow up revealed that patients in the surgery group had an overall of exercise as a maintenance strategy; yet, adherence to exercise re-
lower mortality rate compared with the control group. 128 mains a problem. 77 Maintenance of weight loss requires long-
term adherence to the numerous changes in lifestyle that created
the initial weight loss. 132 Therefore, the provider needs to imple-
Maintenance of Weight Loss
ment strategies to enhance adherence throughout the treatment
Successful long-term weight loss maintenance has been defined as
and maintenance phases; these strategies for promoting adherence
intentionally losing at least 10% of one’s initial body weight and are detailed in Chapter 40 of this book.
maintaining that loss for at least 1 year. 129 Using this definition,
successful weight loss maintenance occurs in approximately 20% of
overweight or obese individuals who lose weight. Yet, 30% to 35% SUMMARY
of the weight a person loses is often regained during the first year af-
55
ter treatment. Because weight loss tends to level off after 6 months
Obesity is a chronic medical condition with numerous adverse ef-
of treatment, the focus of weight-management programs are shift-
fects on the cardiovascular system and health-related quality of
ing from emphasizing only weight loss to introducing weight main-
tenance. 130 The greatest challenge remaining for health care profes- life. The significant increase in its prevalence and the epidemic of
type 2 diabetes that is following it demand attention at all levels.
sionals is not only assisting people to lose weight but also helping
them to sustain the weight loss they have achieved. 131 The goal of treatment is reduced morbidity and improved health.
Current treatment consists of lifestyle modification interventions
Some strategies associated with improved weight loss mainte-
and when indicated, pharmacotherapy or bariatric surgery. Since
nance include extended contact with the provider, exercise/physical
activity, and pharmacotherapy. 132 Ongoing follow-up to promote 1998, we have had evidence-based guidelines for use in the identi-
fication, evaluation, and treatment of overweight and obese patients
adherence to behavioral changes is consistent with the continuous 15
6
care model for obesity as a chronic disease. Continued contact in the clinical setting. Although these guidelines are 10 years old
and in the process of being updated, they still represent the stan-
with the treatment provider presents opportunities for discussion of
dards of treatment and emphasize multidisciplinary approaches to
problem-solving strategies for overcoming obstacles to long-term
the treatment of this chronic disorder. Practitioners can teach
maintenance. Updated physical activity recommendations from the
patients strategies for self-management, following the precedent
ACSM and the AHA specify that individuals should engage in 60
established in treating similar conditions (e.g., hypertension, dys-
to 90 minutes of moderate-intensity physical activity each day in
order to maintain weight loss. 73 Recently, individuals who re- lipidemia, and diabetes). Similar to the role nurses play in the
treatment of these chronic conditions, nurses need to take the lead
ported expending more than 2,500 kcal/week in physical activity
in addressing the needs of this ever-growing subgroup of the pop-
(approximately 75 minutes of daily walking) maintained an aver-
ulation. To reduce the high prevalence of this chronic disorder, in-
age weight loss of about 7 kg after 2.5 years compared with a 1 kg
loss in those who expended less energy. 77 Other researchers have creased focus needs to be given to prevention of weight gain and
sustaining the weight loss achieved.
corroborated the finding that increased physical activity during
weight maintenance supports sustained weight loss. 133–135 The Acknowledgment: The authors were supported by grants R01
use of obesity medications, orlistat and sibutramine, has also been DK58387, R01 DK071817, and F31 NR 009750, National Institute of
shown to be beneficial for weight loss maintenance. In a recent Health, National Institute of Diabetes, Digestive, and Kidney Disorders,
meta-analysis, 80% to 100% of initially lost weight was main- and National Institute of Nursing Research.
tained in 10% to 30% more sibutramine patients compared with
those taking placebo. 136 A long-term study found that persons
REFE R E NC ES
who received orlistat regained 2.4 kg less weight after 3 years in
comparison to the placebo group. 137 After 2 years, the use of 1. Centers for Disease Control and Prevention. (2007). Prevalence of over-
weight loss pharmacotherapy resulted in persons maintaining an weight and obesity among adults: United States, 2003–2004. Retrieved
average of 2% to 5% more of their lost weight than those who February 5, 2008, from http://www.cdc.gov/nchs/products/pubs/pubd/
only received dietary and exercise interventions. 138 hestats/overweight/overwght_adult_03.htm
2.Ogden, C., Carroll, M., Curtin, L., et al. (2006). Prevalence of over-
Valuable information regarding weight loss maintenance has weight and obesity in the United States, 1999–2004. JAMA, 295(13),
been obtained from the National Weight Control Registry, an 1549–1555.