You Lost the Weight; Now What?

You may have heard the oft-stated axiom "Diet and exercise will produce the best weight loss results." in response to "How do I lose weight?".

But what is the response to "Help!! I keep gaining the weight back!"

Regardless of the weight loss means, i.e. diet, exercise, or diet + exercise, once the mission is accomplished, another is introduced: namely, keeping it off. < STAND BACK, we're going to try science! > One culprit that may contribute to weight regain after loss appears to be the changes that occur in energy expenditure (EE). Total daily energy expenditure (TDEE) declines with weight loss, likely due to decreases in both resting energy expenditure (REE) and physical activity energy expenditure (PAEE) which occur as a result of the reduced body mass. We know increased body mass = greater energy expenditure during rest and activity; therefore a decrease in body mass must produced lower EE. Recently published research investigated why substantial weight loss produced additional decreases in REE and PAEE beyond what may be expected. Of particular interest was the relative contributions of reduced energy intake (EI) and or higher physical activity (PA) to sustained weight loss management (WLM).

In the study, a group of adults who maintained a weight loss (> 25 lbs.) for more than a year (labeled "WLM") were compared to a control group of adults with similar body mass index to the WLM group with no history of weight loss (labeled "NC") and a control group of overweight/obese adults with a BMI similar the WLM group before weight loss (labeled "OC"). The study results suggest the physical activity energy expenditure (PAEE) was substantially higher in the WLM than either control group (a controllable behavior) which resulted in higher today daily energy expenditure (TDEE) than the NC group but not the OC group. The physical activity levels of the WLM were significantly higher than either control group and were approximately equal to 60 to 90 minutes per day of moderate-intensity physical activity (such as walking) or 30 to 45 minutes per day of vigorous-intensity activity (such as running). The differences in PAEE reflected similar differences in the number of steps taken each day by members in each group: WLM (~ 12,100), NC (~ 8,900) and OC (~ 6,500). Finally, energy intake (EI) in the current study was substantially higher in the WLM than in the NC group and not significantly different from the OC group (who had a substantially higher BMI).

The results from the current study are consistent with others conducted, including a longitudinal study of "The Biggest Loser" contestants, which indicate changes in EI were not but changes in PAEE were strongly correlated with sustained weight loss management.

Bottom line: Changes in behavior are required in order to lose weight and to keep it off. These behaviors may be personal and deeply ingrained such as those associated with food and they may be new or have a history of frustration and failure such as exercise. While the challenges presented by temporary behavior change may be more agreeable (and attainable), the weight loss goal is rally only a step on the journey. Take away conclusion: In order to sustain the weight loss, folks may need to embrace a lifestyle of increased physical activity and not view it as a temporary fix if long-term health and weight loss management is (and should be) the goal.

Stay Safe, Stay Strong


(This article was originally posted in LinkedIn, 3/15/19.)

The complete study is available here.