Repeated weight loss attempts do not guarantee the best outcome

Individuals who had repeatedly attempted to lose weight had higher body mass index than those without prior weight loss attempts, according to a recent study from the University of Eastern Finland.

In addition to a higher BMI, individuals who had repeatedly attempted to lose weight reported a higher tendency to purposefully restrict food intake for weight control, and more uncontrolled eating with a tendency to overeat, than those with no prior weight loss attempts. The study explored weight management among Finnish adults with a special reference to weight loss history, defined as the number of weight loss attempts during one’s lifetime.

The researchers studied the relationships between a lifetime history of weight loss and eating behaviour tendencies, that is, cognitive eating restraint, uncontrolled eating, and emotional eating, as well as anthropometric features such as body mass index and waist circumference, and metabolic features, such as plasma insulin and cholesterol. In addition, the study explored motivations behind individual efforts to manage weight, barriers challenging these efforts, and common strategies to achieve weight goals.

The data were collected within two projects. In the Kuluma (Consumers on the Weight Management Market) project, 2,346 participants were contacted either at the entrance hall of two supermarkets or via a web-based survey. The StopDia (Stop Diabetes) study, on the other hand, involved 2,684 adults at high risk for developing type 2 diabetes, and its data consisted of measurements collected before and after a lifestyle intervention aimed at reducing risk factors of type 2 diabetes. In both projects, the lifetime history of weight loss was assessed by the question ‘Have you tried to lose weight during your lifetime?’. The answers could be ‘no’, ‘no, but I have been trying to keep my weight stable’, ‘yes, 1-2 times’, ‘yes, 3 or more times’, and ‘yes, continuously’.

StopDia participants who reported several prior weight loss attempts also showed larger waist circumferences. In addition, those who had attempted to lose weight more often reported more emotional eating, defined as the tendency to overeat in response to negative emotions, compared to those with no previous weight loss attempts. Instead, those with no prior weight loss attempts displayed a noticeable decrease in their fasting plasma insulin concentrations following the one-year lifestyle intervention.

According to the study, the most important motivators of weight management were maintaining mobility, health, and well-being. Physical exercise and paying attention to the type of food eaten were the most frequently used strategies for weight management. Enjoying eating food and treats, and lack of self-discipline were reported as the most important barriers to weight management.

Participants could be categorised into three different clusters based on the motivators, barriers, and strategies of weight management: 42% were categorised as “Struggling”, 34% as “Independent” and 24% as “Determined”. The “Struggling” seemed to be the least and the “Determined” the most successful in weight management, as the “Struggling” reported the highest body mass index and the lowest level of weight satisfaction and they perceived the barriers to weight management the most strongly. On the other hand, the “Determined” reported the lowest body mass index, the highest weight satisfaction and they perceived the barriers the least to harm their weight management efforts.

Repeated attempts to lose weight should be avoided

Globally, the prevalence of obesity is steadily increasing.

“Nowadays, people are well aware of the health consequences of excess weight such as type 2 diabetes, cardiovascular disease, and cancers. Along with thinness being idealized at the same time, attempting to lose weight has become a common practice in society. Since most weight loss outcomes are short-term and not sustained over time, recurrent attempts to lose weight occur,” says Doctoral Researcher Faranak Halali from the University of Eastern Finland, presenting the findings of her PhD thesis.

Obesity is a chronic disease, which needs to be treated with a tailored approach like any other chronic disease. The management of obesity requires lifelong adjustments in individuals’ daily routine, which demands identification of factors having the potential to affect weight management.

“Repeated attempts to lose weight should be avoided due to their potential negative associations with less favourable eating behaviours and anthropometric and metabolic profile, as well as benefitting less from the lifestyle modifications,” Faranak Halali says.

However, it remains unclear whether repeated attempts to lose weight are a cause or consequence of these outcomes. Therefore, health care professionals should discuss with their clients whether losing weight is health-wise necessary, as well as their clients’ current resources and motivations to lose weight.

“Next, an appropriate and concrete plan based on evidence-based strategies for long-term weight management should be set, considering the potentially disadvantageous outcomes of repeated weight loss attempts,” Faranak Halali concludes.

For further information, please contact:
Doctoral Researcher Faranak Halali, faranak.halali@uef.fi

The PhD thesis is available at http://urn.fi/URN:ISBN:978-952-61-4559-4

The results presented in the thesis are based on peer-reviewed articles published in Eating Behaviours (https://doi.org/10.1016/j.eatbeh.2018.08.009), Appetite (https://doi.org/10.1016/j.appet.2020.104650.), and International Journal of Obesity (https://doi.org/10.1038/s41366-021-01061-4).