Helping Patients Maintain Successful Weight Loss

Patients who have lost significant amounts of weight, especially for health reasons, need a stronger support system than someone who simply lost five pounds for swimsuit season. Often a little cheating or relaxation of the new diet habits causes a quick backslide to old habits, which can lead patients back to their starting point with a few extra pounds tacked onto their middle. By helping patients identify possible weight gain triggers, nurses can provide a strong foundation of support to mitigate the chances of a substantial weight regain in their patients.

The Journal of the American Academy of Nurse Practitioners recently reported eight categories of potential factors leading to a weight regain in patients after a successful weight loss, which may provide talking points to a nurse counseling a patient who is struggling to maintain the loss:

Unrealistic expectations. Although not strictly identified as a cause of weight gain, even people who have lost pounds for a special event, let alone a health reason, often believe that once that weight loss is achieved, they’ll “be happy” or “life will be better.” Life can be better, but looking for a drastic change is unrealistic. Also many people don’t realize that many types of dieting only work in the short term; long-term changes must made to permanently stave off weight regain.

2. Unmet goals. When patients reach their goal weight, they are more successful at maintaining the loss than someone who has never seen that magic number on the scale that says, “I did it.” Patients who can look positively on the loss that they did achieve are more likely to maintain the loss as well.

3. Two dimensional thinking. Patients who thought of the weight loss battle as a win or lose proposition won had a difficult time maintaining the loss if they thought of themselves as failing to reach their goal. Reframing the result can turn the negative into a positive.

4. Emotional eating. Patients often equate food with feeling good; therefore, healthy alternatives to eating must replace the old behavior of eating to feel better. Even healthier food choices are less effective than alternative behaviors, as food is still being used as a stress reliever.

5. Binge eating vs. dietary restraint. Patients who allowed themselves to binge were more likely to revert to old habits than those who practiced restraint. Identifying new systems of rewards, or allowing just the occasional treat, are two approaches that are associated with maintaining weight loss.

6. Identifying cost vs. benefit. Patients found the benefits of increased vitality and better health outweighed the maintenance tasks of monitoring eating habits and engaging in regular exercise.

7. Depression. Obesity and depression often go hand in hand, but after weight loss, their connection is unclear. Worsening depression is a good predictor of weight regain, even though many times emotional eating is not the main trigger.

8. Body image. When people like what they see in the mirror, they become more invested in maintaining that image. Patients may still “see” a larger person in the mirror, or may be hypercritical of their body. Negative body image is linked with eventual weight regain.

Nurses counseling patients through weight loss maintenance (or looking to maintain their own weight loss) will need to identify self-defeating behaviors and negative self-image mechanisms, which can mark a return to the patterns that led to the initial weight gain. If a nurse suspects the patient may be sliding into depression, using the Beck Depression Inventory can identify patients that may need closer monitoring and follow up.