F. Provide Brief Reinforcement and Lifestyle Education

objective

Promote healthy lifestyles for patients with normal weight.

background

Independent of weight or BMI, all adult patients should consistently receive counseling about healthful diet and physical activity in the context of primary care.

recommendations

1. Patients of normal weight should be praised, encouraged to maintain their normal weight, and educated regarding a healthy lifestyle to include:  [Expert Opinion]
   • A balance between caloric intake and energy expenditure
   • A healthy diet emphasizing, whenever possible, fresh fruits and vegetables (see – MyPyramid at http://www.mypyramid.gov )
   • Regular, moderately intense physical activity for more than 30 minutes, five or more days per week
   • Additional healthy lifestyle elements related to weight maintenance that may include tobacco use cessation, limited caffeine intake, sleep hygiene, and stress management

discussion

The benefits of reinforcing healthy weight messages include:

• Health promotion, primary prevention, and early detection through greater public awareness about healthy lifestyles
• Access to primary prevention programs, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment
• Prevention of morbidity and premature mortality from overweight and obesity with associated diseases
• Prevention of human and economic costs of overweight and obesity with associated diseases
• Prevention of individual and collective risk of overweight and obesity with associated diseases

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge.  In several experimental studies, participants of a structured weight loss program regained all of their weight loss within five years.  Dietary and physical activity modifications need to be integrated and accepted as a way of life (Anderson et al., 2001).

The identification of factors associated with weight loss maintenance can enhance our understanding of the behaviors and prerequisites that are crucial in sustaining a lowered body weight.  The limited knowledge of behaviors that contribute to successful weight maintenance comes from reports of individuals who have lost significant weight and sustained the loss for several years.  The diet and intake of selected nutrients of subjects, who had maintained a weight loss of at least 13.6 kg for at least 1 year, were compared with that of similarly aged men and women in the NHANES III cohort. Those original enrollees in the on-going National Weight Control Registry, who were able to maintain their weight reported consuming less energy and a lower percentage of energy from fat, increased levels of physical activity, and frequent weighing.  Women in the registry reported eating an average of 1,306 kcal/day (24.3 percent of energy from fat); men reported consuming 1,685 kcal/day (23.5 percent of energy from fat) (Schick et al., 1998; Wing & Hill, 2001). These changes in lifestyle produced long-term weight loss maintenance; however, the minimally necessary behaviors have not been established in clinical trials.  Weight loss maintenance may get easier over time.  Once the weight loss is maintained for 2 to 5 years, the chances for longer term success greatly increase (Wing & Hill, 2001).

A review of the literature of factors associated with weight loss maintenance and weight regain suggests that successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, and a regular meal rhythm including breakfast and healthier eating.  In addition, these individuals exhibit control of over-eating and self-monitoring of behaviors.  Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability.  Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems (Elfhag et al., 2005).