Weight Maintenance

• In the early days of a weight loss programme weight will be lost fairly quickly. Weight loss slows when glycogen stores in the liver become depleted, as glycogen mobilisation is associated with water loss. Once the glycogen stores are depleted weight loss is related to the energy content of fat and with a 500 kcal deficit should be around 1/2kg/week.
• As weight is lost, resting metabolic rate will decrease and so energy requirements will fall. This is due partly to reduced requirements and partly due to a response to underfeeding. Weight loss will tend to decline. The reduction in metabolic rate is unlikely to be more than 5% so should not be over emphasised.
• This is a good time to encourage an increase in activity. This should increase metabolic rate and can help maintain good weight loss.
• It is important to make patients aware that short term fluctuations in weight are as a result of water balance.

As losses of 5-10% of body weight are usually associated with significant improvements in health, it may be a good time to consider a period of weight maintenance. This is not a time to return to old eating habits as metabolic rate will have reduced with weight reduction. This is not the time to send people off with a pat on the back to cope on their own. They may feel very concerned about controlling their weight after all their hard work.

Ideas to help support weight maintenance

• Monthly weigh-ins or telephone contacts could be offered as appropriate. These can be scaled down as the patient gains confidence in their new way of eating.
• Consider using the successful patients as part of any new programme you run.
• A food diary, completed by the patient, may help to maintain control of their eating.
• Stress the importance of continuing any exercise regime which has helped with weight loss.
• Encourage regular exercise, with the whole family, if appropriate.

Note:

If a patient or group member manages to maintain their weight after a long time of increasing weight this should be seen as a very positive outcome.

Many people may make changes to their diets making them more in line with government guidelines for a healthy diet. This is also a positive outcome as there are many health benefits associated with a healthy diet regardless of the individual's body weight.

These outcomes could be built into an audit.