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You have been working with a client for more than a year when they arrive for their after-work session with some exciting news: That morning, they had stepped on the bathroom scale and learned that they’d achieved their long-term goal of losing 60 pounds. Your client is understandably thrilled, and the achievement is certainly cause for celebration. But it should also be a moment of caution and education, as there is a tremendous risk of letdown. The client may think the hard part is behind them, but this is the time to remind them that the lifestyle changes they have made must be maintained if they are going to successfully keep the weight off.
While most people can lose weight via short-term caloric restriction, research suggests the vast majority regain that weight (and sometimes more) over time. Meta-analyses and long-term follow-ups indicate that, on average, more than 50% of the lost weight is regained within two years and more than 75% within five years, with only about 20 to 25% of people maintaining substantial weight loss over the long term. Unfortunately, with so much focus on “weight loss” in popular media, too few people recognize the long-term challenges associated with “weight-loss maintenance.” There is a great opportunity for health and exercise professionals to educate the public and expand their businesses by broadening their focus to include weight-loss maintenance.
According to Barbara Brehm-Curtis, EdD, professor emerita of exercise and sport studies at Smith College, the moment of goal attainment should be a time of reflection and appreciation of the lifestyle changes your client has adopted to reach this milestone. Clients should be reminded to “hold onto the habits” that resulted in their success.
The most important thing to realize, explains Dr. Brehm, is that finally meeting one’s goals is just another point on the continuum of long-term health. “You, as the health and exercise professional, should be preparing your clients for the shift from weight loss to weight-loss maintenance almost from the beginning of the program, or as soon as the client demonstrates that they are committed.” Goal achievement can be a catalyst for motivation loss, and it is up to you to keep clients on track. “There can be a sense of euphoria with weight loss, which disappears for some when the goal shifts to maintenance,” says Dr. Brehm, “so staying motivated can be a major challenge.”
Gina Crome, MS, MPH, RD, an ACE Certified Personal Trainer and owner of Lifestyle Management Solutions, concurs, stating that what clients learn while losing weight should be used to maintain that weight loss. “The weight-loss program should be front-loaded with learning, and the longer it takes to lose weight, the more opportunity clients have to learn what it takes to keep the weight off.” This latter point is yet another reason why quick-fix weight-loss techniques are usually platforms for failure.
Findings from the long-running National Weight Control Registry—a study of more than 10,000 adults who have lost at least 30 pounds (13.6 kg) and kept it off for a year or more—show that successful weight-loss maintainers tend to:
Given all of the potential motivational pitfalls, what can you do to facilitate long-term weight-loss maintenance for your clients? Crome and Dr. Brehm share the following tips.
Track things besides weight. Tracking only the number on the scale is problematic, even during the weight-loss phase. Crome, who herself lost 172 pounds and has maintained that weight loss for years, recommends using other tools to shift the focus off the scale, and says this should be done early in the weight-loss program.
“If you educate the client that there are many reasons to eat right and exercise, then the motivation to continue isn’t so at risk once the weight-loss goal is achieved.” Crome suggests health and exercise professionals monitor body-fat percentages and other anthropometrics when appropriate (remembering that this can be demotivating for some clients in the early stages of a program), in addition to mental health status, physical-activity levels and even hydration levels. Having multiple measures of success enables clients to recognize achievements even during periods of struggle.
Remind clients that the ultimate goal is better health and function, not simply defending a particular number on the scale, and consider tracking additional health indicators such as blood pressure, blood lipids, blood sugar levels (A1c), sleep quality, mood and daily functioning as part of your follow-up assessments.
Build an ongoing support system. Almost every client who achieves weight-loss success has both social and professional support along the way, but many will lose sight of the importance of this aspect during the maintenance phase. Take time to develop a network that, depending on your specific area of expertise, includes a psychologist, health coach, registered dietitian nutritionist and others who can be called upon to help your clients keep the weight off. Both Crome and Dr. Brehm recommend introducing group sessions for clients in this phase to foster healthy relationships and promote continued success. Throughout these conversations, use weight-neutral, non-shaming language and emphasize that clients deserve respect and quality care at any size, while you support behavior changes that improve health.
Many clients use wearables, smart scales or synced apps to track caloric intake and expenditure. Assuming a target weight-loss rate of 2 pounds (0.9 kg) per week, a 220-pound (99.8 kg) man with a goal of reaching the 200-pound (90.1 kg) mark may be consuming between 1,600 and 1,700 calories per day. A 7,000-calorie weekly deficit would cause a 2-pound (0.9. kg) weight loss, so once that goal is reached, the app tells him that he can increase his intake by 1,000 calories per day and maintain his new weight.
“Not so fast,” laughs Crome. This idea of “getting calories back” reflects that the individual is in “diet mode,” which Crome calls a mentality of failure. These calories need to be slowly added back in, and in a mindful, healthy way. “Remember,” says Crome, “the body has changed as a result of weight loss. Metabolism has shifted, some muscle mass may have been lost—the math isn’t nearly so simple.”
This is another reason why it’s so important to continue to monitor weight and other factors in the immediate aftermath of goal attainment. If clients have a simplistic understanding of calorie balance, they may overdo it and quickly sabotage what they worked so hard to achieve.
Focus on exercise. While nutritional change is the key aspect of weight loss, exercise should be the cornerstone of weight-loss maintenance. In addition to the calorie burning, there are important psychological benefits to exercise, including stress reduction, prevention of cognitive decline, mood enhancement, and alleviation of depression and anxiety. According to Dr. Brehm, educating clients on these additional benefits shifts the focus from weight loss to overall health improvement.
Educate. Ongoing education about health should be a key element of any long-term program. The more clients understand the many reasons that weight-loss maintenance is so important, the better. Teach your clients about the potential health risks of weight cycling (yo-yo dieting), which may carry risks that are comparable to, or greater than, remaining weight stable with overweight for some people, as well as about hormones, metabolism, thyroid function and the many other less-understood elements of good health. Some clients may also be using anti-obesity medications such as GLP-1 receptor agonists; while it is outside your scope of practice to recommend these drugs, you can play a key role in helping clients build the movement, nutrition, sleep and stress-management habits that are still essential for long-term weight-loss maintenance.
Share the findings of the National Weight Control Registry. The NWCR was developed to identify and investigate the characteristics of individuals who have succeeded at long-term weight loss. Sharing this type of research-based advice adds to your credibility and arms clients with actionable tips. See the sidebar, Top Tips From the National Weight Control Registry, for findings from the NWCR.
Use visualization. As clients approach their goals, Dr. Brehm recommends they incorporate visualization techniques that allow them to see themselves carrying through with the habits that allowed them to lose weight in the first place. It is essential that clients change their habits in ways that they can live with long-term (see sidebar, The Mystery of the Missing 1,000 Calories). Using dramatic caloric restriction or other drastic means of cutting weight is a sure recipe for weight regain.
Have a plan to manage changes in lifestyle. Real-world demands—work schedules, caregiving responsibilities, finances, stress levels and access to food or safe places to be active—often make “ideal” maintenance plans unrealistic. Many clients will feel that they have earned their way out of some of the restrictions they endured while losing weight. For example, a client may have been avoiding a particular restaurant for the past year, knowing that they have a hard time making wise choices when confronted with their favorite foods. Perhaps they even want to go there to celebrate their hard-earned success. It’s probably not a good idea to tell this client that they can never go to their favorite restaurant again; instead, review the menu with them and have a plan going in. Preparing for obstacles is a must if a client is going to maintain lifelong lifestyle change.
Avoid reincorporating bad habits. Once they’ve achieved their weight-loss goals, many clients may be tempted by old habits, such as having something sweet after dinner or snacking during screen time. This is a good time for you to revisit your initial sessions with a client to remind them of what caused the obesity in the first place, and of how hard they worked to eradicate those habits.
When clients achieve a lofty goal—particularly if it’s as impressive as losing a large amount of weight by sticking with a long-term program—they are likely at the peak of their self-efficacy. They just conquered the world!
It is essential that you seize that attitude and keep clients motivated, as nothing can deflate a person’s confidence like regaining weight they worked so hard to shed. Use this moment of maximal self-efficacy to set new goals—maintain this weight for three months, try new exercise classes or modalities, or take an activity-focused trip—that will keep the client on the path to lifelong health, fitness and wellness.
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