Not only is it very difficult to lose weight with lifestyle changes, but keeping that weight off is even harder.  This is because our natural biology powerfully defends body weight, with hormonal and metabolic changes that drive weight regain.


For the few people who are able to fight against that powerful biology and keep weight off long term with lifestyle changes, we have data on how they do it from the US National Weight Control Registry (NWCR).


We now have a new study from over 6,000 members of WW International (formerly Weight Watchers) who have maintained weight loss, sharing their motivations, strategies, struggles, and successes.  This study is different, because it used machine learning and topic modeling to analyze responses.  Questions were asked in an open-ended format, allowing researchers to really capture the emotions, drivers, trials, and tribulations of participants’ weight management journeys.  (And it is also different in that all participants were from the WW program, whereas the NWCR includes people using any lifestyle strategy or program.)


The new study, published in the journal Obesity, surveyed WW participants who had lost at least 20lb (9.1kg) and kept it off for at least 1 year. The average age of participants was 54, mean BMI 27.8, 92% female, and the vast majority (94%) were Caucasian.  The average weight loss was actually 24.5kg, maintained for an average of 3.4 years.


Factors that motivated participants to continue their hard work to maintain weight loss included:

  • looking back at experiences when their weight was higher, with a desire to avoid negative experiences of the past, given all the time and hard work that went into achieving their weight management goals
  • a desire to maintain good health
  • appearance concerns


Rewards for keeping weight off included:

  • improved confidence
  • less pain
  • better mobility
  • better fitness
  • better body image
  • better medical status
  • better mood


Negative consequences of keeping weight off long term were also described, in particular, the cost of new clothing, and sagging skin.


Advice for others to succeed in maintaining weight loss included:

  • perseverance in the face of setbacks
  • consistently tracking: food journaling (there’s a science behind this called mindful eating – more on this here)


This study is limited in that most participants were caucasian, female, married, educated, and with at least midlevel income.   The prevalence of obesity is highest in more socially disadvantaged groups, and themes could be different in different groups of people.  However, I think there is some great guidance and supportive words in this study for people who struggle to keep weight off.  Health care providers reading this are also reminded that in setting goals with our patients, to focus on improvements in health and well being, and not the numbers on the scale.


Here are a few of my favorite quotes from study participants:

  • ‘Slow and steady.  Think of this journey not as a diet, but a lifestyle change.’
  • ‘Simply put one foot in front of the other, start and never stop. Just keep going. Know that if you persevere, you will get there. Never accept a small failure as a total defeat.’
  • ‘Success is made up of lots of little decisions made every day.’


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