Treatment vs. Weight Loss Maintenance – What’s the Difference?Posted: Nov 03 in Weight Management Strategies by Dr. Lazarus
I had the pleasure of hearing Dr. Michael Rosenbaum from Columbia University speak at our Obesity Medicine Association Conference on the topic of why maintaining weight loss is so hard. He has been engaged in research on this topic for decades, studying the effects of weight change on body metabolism.
In his studies, after a person has lost weight (and is now in so-called “Maintenance”), the body has a significant metabolic adaptation as a response to this weight loss such that with a loss of 10% of the body weight (20 pounds for a person who started at 200 pounds), the metabolism drops by 300-400 calories per day.
In addition, thyroid balance changes, so people feel like they are low in thyroid hormone (cold, thin hair, dry skin) even with thyroid hormone levels are measured as normal, and muscle efficiency improves, so that walking a mile now burns 20% less calories than before losing the weight (“Hypometabolism”).
Further, for each kilogram lost (2.2 pounds), the appetite increases by 95 calories per day while the energy expenditure decreases by 25 calories per day. After weight loss, one gets hungrier before eating, feels less satisfied after eating, and gets hungrier again sooner than prior to the weight loss due to hormonal mechanisms. And the greater the weight loss, the greater the changes.
Studies like these demonstrate why we need to stop talking about “Maintaining” weight loss. Instead, we need to discuss “Optimal Treatment.” Maintaining sounds easy – just keep doing what you’re doing. Weight loss has stopped so the medication can be stopped. But it ignores these metabolic adaptations which make sustaining weight loss (a.k.a. “Maintenance”) exponentially more difficult than losing it was in the first place!
Instead, let’s focus on long-term treatment to improve health. I like to teach doctors and patients that obesity is a chronic but treatable disease. Treatment includes lifestyle intervention, healthy eating, physical activity, medical management, and sometimes surgery.
So how do you keep the weight off?
Focus on losing weight using strategies that are sustainable:
- Work on eating a healthy diet! Meal replacements are an evidence-based tool that can improve on the amount of weight lost.
- Be active every day! Time matters – try to find an hour a day.
- If medication(s) are used to help lose the weight, they should be continued for long-term treatment.
- Work on stress reduction and get enough sleep.
- Remember that we are here to support you – regular visits have been shown to help people achieve and keep off more weight.
- Don’t get frustrated because you didn’t lose as much weight as you’d hoped!
One of the most common questions I get is whether or not these metabolic adaptations get better over time. Dr. Rosenbaum showed data collected for 6 years showing that they persisted, again supporting the idea that we need to focus on long-term treatment. Hopefully by taking a long-term approach and not worrying about terms like weight loss and maintenance, we can instead focus on improving health, function, wellness and lifespan!