Background: While many behavioural weight management programmes are effective in the short-term, in the context of a complex obesogenic environment, post-programme weight regain is common. Overcoming relapses has been highlighted as an important phenomenon in weight-loss maintenance, but research on how this is done is sparse. By comparing strategies employed by those who had regained or maintained weight loss, we explored this phenomenon and identified effective cognitive and behavioural strategies for overcoming relapse.
Methods: We conducted face-to-face semi-structured interviews with 26 participants (58% female) recruited from 5-year follow up of the WRAP trial (evaluation of a commercial weight-loss programme). Participants who had lost >5% baseline weight during the active intervention (years 01) were purposively sampled for an even split of 5-year weight trajectories (50% regainers, 50% maintainers) and a range of demographic characteristics. Questions focused on post-programme experiences, physical activity, diet, social support and mood. Interviews were audio-recorded and transcribed verbatim. We analysed interviews using a constant comparative method, against themes of an existing model of weight-loss maintenance. Data were managed using NVivo. Two researchers independently coded all interviews with continuous discussion and a reflective log. A patient representative read a subset of transcripts, highlighted important themes, and assisted with interpretation of findings. Differences in strategies between regainers and maintainers were compared.
Results: Maintainers used more self-regulation techniques such as monitoring eating behaviour, swapping with healthier alternatives, managing impulses using distraction techniques, and compensating for lapses, usually by reducing sweet foods. Maintainers anticipated potential lapses and made plans to compensate for indulgences on social occasions. Regainers did not have such a plan, and appeared to have difficulty navigating interpersonal relationships in relation to food. Our findings were broadly in line with the weight-loss maintenance model.
Conclusion: Few studies have examined weight maintenance strategies over 5 years, and the comparison between maintainers and regainers provides valuable insights. Maintainers appeared to have a plan to employ more flexible self-regulation techniques to get back on track after lapses in comparison to regainers, suggesting these strategies should be emphasised in future programmes to ensure successful long-term outcomes.
Keywords: Qualitative, weight-loss maintenance, strategies
12 Sep 2019 - 13 Sep 2019