New Study Identifies a Six-Phase Cycle Associated with Weight Loss and Regain in Individuals with Obesity
People with obesity who are struggling to lose weight go through six common phases that are accompanied by a set of shared beliefs, experiences, attitudes and emotions, according to recent research findings. Classified as a disease by the American Medical Association in 2013, obesity impacts nearly 80 million adults in the United States. , This research uncovered a Weight-Loss Cycle paradigm that helps explain the chronic nature of obesity. The six phases include1:
1. Defining Moment: Feel energized and motivated to lose weight. Defining moment can be triggered by: frustration to find clothes that fit properly, seeing a picture of oneself, embarrassment at not fitting on a bus or plane seat, or being diagnosed with a weight-related health condition. It is at this stage that the person makes the decision to focus on weight loss.
2. Consideration: Feel hopeful and determined. Assess which weight-loss method is appropriate based on recommendations from family, friends, media (TV, magazines) and health care professionals.
3. Momentum: Feel confident and excited. Strive to maintain a specific regimen and work hard to maintain discipline. Proud of weight-loss accomplishments and positive feedback from family and friends.
4. Plateau: Feel anxiety, uncertainty and frustration as life gets in the way of weight-loss efforts. Confidence erodes, and frequent missteps result in weight no longer coming off.
5. Collapse: Feel tired and unable to continue the effort. Feel a sense of relief that the pressure to lose weight is off.
6. Fatigue: Feel exhausted and unwilling to focus any mental energy on weight-loss efforts. Eventually regain the weight that was lost, and more.
The Weight-Loss Cycle characterizes the oft-repeated emotional and psychological journey of study participants’ efforts to lose weight, and aligns with previous research on the physiological struggle to maintain that weight loss. It is known that obesity changes how the body uses food and the energy it produces. As a result, for up to 12 months after weight loss, the body turns up the signals that trigger appetite, which can potentially cause overeating and, consequently, prevent some people from maintaining the weight loss they have achieved.
Supporting this scientific explanation of the body’s propensity to regain lost weight in people with obesity is a recent retrospective, longitudinal study presented at the annual meeting of the Endocrine Society. Including over 175,000 cases of patients with obesity, this study revealed that regardless of initial weight loss, after two years, participants in the modest, moderate and high weight-loss groups (40.0%, 35.9%, and 18.6%, respectively) regained more than 50% of their weight loss.
“The cycle of weight is often extremely frustrating for individuals affected by the disease of obesity,” says Joe Nadglowski, Obesity Action Coalition president and CEO. “For far too long, individuals have been met with the ‘eat less and move more’ response, which simply does not work. We know more about the science of obesity today than ever before, and we need to utilize this knowledge to help individuals effectively manage their weight and improve their health through safe and effective treatment options.”
According to Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness, the Weight-Loss Cycle findings could help both health care professionals and patients initiate a dialogue with one another, resulting in personalized weight-management care that evolves with patients’ needs over time.
“Obesity is a complex, chronic and multifaceted disease that is best managed through a partnership between patients and their healthcare providers,” says Dr. Kahan. “Addressing weight is not easy, but finding a support network, which may include a doctor, nurse, registered dietitian, mental health provider or others, can provide resources that help with short- and long-term weight management. Patients are more likely to achieve progress when, in collaboration with their healthcare network, they have opportunities to discuss treatment options, establish plans, monitor results and evaluate responses to the plans.”
Data were collected through ethnographic research, a methodology designed to provide in-depth qualitative insight and information not typically available in quantitative research. The study was conducted by an independent research firm and sponsored by Novo Nordisk.
About the Weight-Loss Cycle Ethnographic Study
Ethnographic research is a qualitative research approach that studies the patterns and perspectives of people in their daily lives. The purpose of ethnographic research is to describe, analyze and interpret the commonalities of a group to understand shared beliefs, behaviors and language.
The Weight-Loss Cycle study included 27 patients with obesity, ranging in age from 40 to 62 years. The 18 female and nine male participants had body mass index (BMI) ranging from 33 kg/m2 to 60 kg/m2. Data were collected via in-home interviews (two to four hours in duration), written and video documentation (10-day diary for 24 patients, five-day diary for three patients), and phone debriefs with each participant for final clarification and discussion of diary contents.1
References
. Ethnographic Weight-Loss Patient Journey Study. Novo Nordisk Inc. Custom Research Study. January 2015.
. American Medical Association House of Delegates. Recognition of obesity as a disease. Resolution 420 (A-13). http://www.npr.org/documents/2013/jun/ama-resolution-obesity.pdf. Received May 15, 2013. Accessed December 8, 2015.
. Centers for Disease Control and Prevention. Adult obesity facts. http://www.cdc.gov/obesity/data/adult.html. Updated September 21, 2015. Accessed October 26, 2015.
. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. NEJM. 2011;365(17):1597-1604.
. Rosenbaum M, Kissileff HR, Mayer LE, Hirsh J, Leibel R. Energy intake in weight-reduced humans. Brain Res. 2010;1350:95-102.
. Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes. 2010;34:S47-S55.
. Huang J, Buchs S, DerSarkissian M, et al. Patterns of weight loss, maintenance, and gain in patients with obesity. Abstract presented at: The 97th Annual Meeting of the Endocrine Society. April 1-4, 2016; Boston, MA.
. Gay, Mills, and Airasian. Chapter 17: Ethnographic research. http://wps.prenhall.com/wps/media/objects/2466/2525549/Volume_medialib/PowerPoint/CH17.PPT. Accessed March 28, 2016.
. Obesity Education Inititative; National Heart, Lung, and Blood Institute; National Institutes of Health; US Department of Health and Human Services; Identification, evaluation, and treatment of overweight and obesity in adults: The practical guide. Bethesda, MD: National Institutes of Health; 2000. NIH publication 00-4084.
. Wright SM, Aronne LJ. Causes of obesity. Abdom Imaging. 2012;37(5):730-732.
. Jensen MD, Ryan DH, Apovian CM, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 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. J Am Coll Cardiol. 2014;63(25ptB):2985-3023.
. Crawford AG, Cote C, Couto J, et al. Prevalence of obesity, type II diabetes mellitus, hyperlipidemia, and hypertension in the United States: Findings from the GE centricity electronic medical record database. Popul Health Manag. 2010;13:151–161.
. Loureiro ML, Nayga RM Jr. Obesity, weight loss, and physician’s advice. Soc Sci Med. 2006;62(10):2458-2468.