10 proven strategies to help patients maintain weight loss
Patients’ chances of keeping off weight long-term improve with evidence-based interventions, such as a sound diet, more exercise, and attention to more thoughtful eating habits.
PRACTICE RECOMMENDATIONS
› Encourage patients to lose more weight early in their effort, which is predictive of successful long-term maintenance. B
› Support patients’ efforts to maintain weight loss by encouraging them to consume fewer calories and eat more nonglycemic fruits and vegetables A, eat at home and avoid processed foods B, work with you in addressing mental health concerns B, and increase time spent exercising A.
› Consider the potential value of prescribing a US Food and Drug Administration–indicated medication for weight maintenance. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
A retrospective review of a sample of US adults’ caloric and nutritional intake determined that eating at a full-service restaurant is not associated with consumption of fewer calories than eating at a fast food restaurant: Eating at either type of restaurant was associated with excess (approximately 200 kcal/meal) caloric intake.9
4. Emphasize the importance of eating breakfast and increasing protein intake
Increased protein throughout the day, particularly at breakfast, has been suggested to help with weight maintenance. In a large European study,10 even slightly increased protein intake (approximately 1.2 g/kg of body weight and of low glycemic index food) was associated with weight maintenance. In another review,11 researchers concluded that 25 to 30 g of protein at each meal can provide improvement in appetite and weight management, although they cautioned that further research is needed. A study that looked at increasing intake of protein at breakfast to 35 g in adolescent females resulted in less snacking later in the day.12
In the NWCR, successful maintainers had breakfast daily, a lower fat diet, and fewer calories (approximately 1500 kcal/d)— routines that were all associated with greater success.1 Therefore, eating protein at approximately 1.2 g/kg of body weight (possibly, even more [35 g] at breakfast) and ingesting less fat and fewer calories all contributed to successful maintenance. Eating nuts and legume-based proteins, such as beans and tofu, should be encouraged.
Only a few studies have looked at dairy protein intake and weight maintenance. In one study, consumption of dairy proteins was not associated with a change in body weight or other metabolic risk markers during weight maintenance.13 Yogurt, because of its probiotic content, might be good for weight maintenance, but this has not been studied well, and studies that have been conducted are inconclusive.14
Another study looked at consumption of protein supplements. It found no improvement in body composition over a 24-week period when protein intake was increased to 1.45 g/kg when compared to 1.16 g/kg in controls. Although subjects felt less hungry, this was not reflected in a reduction in caloric intake.15
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