Change is difficult. Many individuals made New Year’s resolutions surrounding diet and physical activity, but 3 months into 2024, some have begun to falter.
Anyone who’s tried to make a change in their routine knows how difficult it can be to make long-term, sustainable changes, and it’s a particularly big challenge in obesity management. So how can we as clinicians support our patients to not only make changes, but maintain behaviors related to diet and physical activity over the long-term?
Consider the following strategies for obesity treatment that promote long-term weight loss.
Behavioral treatment
Behavioral treatment revolves around dietary adjustments, increased physical activity, and lifestyle modifications, and is the cornerstone of obesity management. The primary objective is to assist patients in identifying and altering their eating and exercise patterns, fostering weight loss, and enhancing overall well-being. This approach encompasses a comprehensive set of strategies such as goal setting, self-monitoring, stimulus control, positive reinforcements, problem-solving, cognitive restructuring, as well as relapse prevention.
Relapse prevention
Incorporating relapse prevention helps patients understand that change isn’t a linear process. In fact, managing setbacks is key to long-term change. Setbacks are a normal and expected part of the weight loss and maintenance journey. They can manifest as both lapses (a transient slip without necessary weight gain, such as overeating at dinner), or a relapse (a sustained return to behaviors leading to weight gain, such as consistently drinking sugary beverages at meals).
Although setbacks are unavoidable, effective strategies exist to promptly identify, cope with, and reverse them. Treatment helps individuals recognize when they may be more likely to deviate from weight control behaviors. For instance, a patient may acknowledge a tendency to snack at their desk when they’re stressed at work. The patient and provider can brainstorm together about strategies, such as going for a short walk or practicing deep breathing, to circumvent this behavior. They also can talk about corrective actions after a lapse within the treatment framework, such as how to resume positive habits without fixating excessively on the setback itself.
Sustained patient-provider contact
Behavioral intervention for obesity can effectively lead to weight loss exceeding 5% of the initial body weight within the first 4 to 6 months, which can help achieve clinically significant improvements in obesity-related health issues. However, the likelihood of relapse is notably high beyond this period, with participants regaining one-third to one-half of their lost weight in the year after treatment cessation.
Ongoing contact between patients and providers can help prevent relapses and enhance long-term weight loss outcomes. Regular visits reinforce weight-control behaviors, such as engaging in substantial physical activity (200 to 300 minutes per week), consistently monitoring body weight (preferably on a weekly or daily basis), and maintaining a reduced-calorie diet. Combining anti-obesity medications with behavioral treatment presents an additional avenue for improving long-term weight loss.
Nurses can play a pivotal role in motivating patients to initiate and sustain behavioral changes, ultimately contributing to enhanced health outcomes.
Ariana Chao, PhD, RN, FNP-BC is Associate Professor at the Johns Hopkins School of Nursing. She has declared the following potential conflicts of interests: she has served on advisory boards for Ely Lille and Boehringer Ingelheim and has received grants from Elli Lilly and Weight Watchers. The information in this authored column is not specific to these companies’ products.
