Recomendación General

their weight within a normal BMI level (Reilly et al., 2015). Most research has

focused on secondary weight maintainers; that is, people who managed to achieve and maintain weight loss. Although Reilly et al. (2015) state that much can be learnt from primary weight maintainers, there is no blanket approach. Their study indicates the complexity of weight loss maintenance, and identifies interesting differences between the groups in terms of attitudes, behaviours, strategies, resilience, emotional control, levels of family support/social support, and willpower. The consistent factor between the two groups was the desire to be slim.

Reilly et al. (2015) state that weight loss maintenance, due to the nature of society, and even for people who are considered to be primary weight maintainers, is no longer a passive process. Instead, maintaining a healthy weight requires constant cognitive attention. People currently function in an obesogenic environment, where they have to constantly pay attention to portion size, planning, organisation, planned regular exercise, and the organisation of healthy eating and regular exercise as priority areas of life. Reilly et al. (2015) assert that people who are lean constantly strive to maintain their weight. Therefore, weight loss maintenance is constructed as an ongoing process, whether a person is classified as overweight or obese.The study highlighted that balance was necessary to maintain weight loss. It was shown that people relaxed their control over their food choices at certain times or on certain occasions, such as weekends, or during the festive season, and were able to “row back” afterwards and to return to making healthier life choices, increase organisation and planning around food, and increase exercise. Weight loss maintenance is also influenced by various factors, including personal motivation, personal perceptions, and the home, work and environmental conditions (Reilly et al., 2015).

Interestingly, the primary weight maintainers in the research by Reilly et al. (2015) did not use scales to monitor their weight. They used the “waist band” measure; that

is, when the waist band of their clothes became tighter, they lowered their calorie intake or increased their exercise for a number of weeks until their clothes fit comfortably again. The participants in this group never allowed themselves to buy bigger clothes.

Motivation for remaining slim included health and vanity concerns, and wanting to be a good parental model. Being thin was an integral part of the participant’s identity (Reilly et al., 2015). Themes that emerged from the qualitative study performed by Reilly et al. (2015) included willpower, emotional balance, regulation, emotional control, and resilience. Important tools to achieve weight loss maintenance was planning and organisation, which included shopping regularly to ensure a well- stocked food store, planning meals in advance, and restricting dining out to special occasions. Eating patterns were flexible in that during the week participants followed a strict dietary pattern, followed by a more relaxed eating pattern over the weekend. An important aspect of this flexible eating pattern was the acknowledgment that treats are vital. Family support systems were also good for weight maintenance. Healthy food choices were often automatic choices, and poor food choices were not selected often. Exercise, although also undertaken for health and weight benefits, was equally important for mental health and feeling good (Reilly et al., 2015).

Primary weight maintainers also had a good understanding of portion sizes and the nutrient value of their food (Reilly et al., 2015). Eating low fat foods was not a priority in this group. Secondary weight maintainers found that weight loss interventions should have a personalised approach, and acknowledged that overweight and obesity interventions cannot have a one-size-fits-all approach (Reilly et al., 2015). They found that support from friends and family were important motivators. In addition, participants in this group also increased the intensity and duration of exercise. Some participants found it easier to join support groups such as Weight Watchers while others found that they had to make the transition alone. This group viewed weight loss maintenance as an ongoing process that requires a lifetime commitment and effort, and that the participants had to discard their bad habits. Perseverance was identified as key to weight loss maintenance (Reilly et al., 2015).

The third group that was examined were unable to achieve and maintain weight loss, and was characterised by despondency (Reilly et al., 2015). Even though the group

was concerned with both health outcomes and vanity, they were not able to change their behaviours. Unlike primary maintainers, this group was likely to buy the next clothes size up instead of modifying eating patterns to remain within their usual weight range. Lifelong fluctuations in weight were commonplace. Secret eating and guilt eating featured across the participants’ accounts. Planning around food was absent, and meals were often skipped or eaten later in the day. This resulted in excess hunger, followed by consuming more than necessary. A deficit in knowledge was not a reason for the participants’ inability to maintain weight loss. They reported that they knew they ate too much and exercised too little. Among the participants, their weight was viewed as out of control (Reilly et al., 2015). They reported critical periods of weight gain related to pregnancy, marriage, and emotionally stressful life transitions, such as moving jobs or homes. Although weight loss is extremely

important, it was not prioritised in reality. Participants in this group likened their relationship with food to an addiction. They described not only having difficulty in their eating patterns, but also within their lives (Reilly et al., 2015). They described their lives as lacking routine, and exercise as being an add-on, as opposed to an essential aspect of their lives. People in this group tended to follow fad diets in order to lose weight, in programmes that only allowed for the achievement of short-term weight loss (Reilly et al., 2015).

2.7.20 Summary of weight loss maintenance. In summary, despite the high