Objective: To find factors associated with successful weight maintenance (WM) in overweight and obese subjects after a very low-calorie diet (VLCD).
Research methods and procedures: Subjects (133) followed a VLCD (2.1 MJ/d) for 6 weeks in a free-living situation. Of these, 103 subjects (age, 49.6 +/- 9.7 years; BMI, 30.9 +/- 3.8 kg/m(2)) completed the following 2-year WM period. Body weight (BW), body composition, leptin concentration, attitude toward eating, and physical activity were determined right before (t0) and after (t1) the VLCD, after 3 months (t2), after 1 year (t3), after 1.5 years (t4), and after 2 years (t5).
Results: BW loss during VLCD was 7.2 +/- 3.1 kg. After 2 years, follow-up BW regain was 69.0 +/- 98.4%. After 2 years of WM, 13 subjects were successful (<10% BW regain), and 90 were unsuccessful (>10% BW regain). At baseline, these groups were significantly different in BMI (33.7 +/- 4.7 vs. 30.5 +/- 3.5 kg/m(2), respectively; p < 0.05) and fat mass (38.3 +/- 9.8 vs. 32.1 +/- 8.3 kg, p < 0.05). Successful subjects increased their dietary restraint significantly more during the whole study period (dietary restraint score, -4.9 +/- 4.4 vs. -2.1 +/- 3.8). Furthermore, %BW regain was associated with the amount of percentage body fat lost during VLCD, which indicates that the more fat lost, the better the WM, suggesting a fat free mass-sparing effect.
Discussion: Characteristics such as the ability to increase dietary restraint and maintain this high level of restraint, fat free mass sparing, and a relatively high baseline BMI and fat mass were associated with successful long-term WM (<10% regain after 2 years).