Does Everyone Regain All Their Lost Weight?

Let’s begin at the end. No. Everyone who loses weight does not regain it all. Nonetheless, it’s quite popular for folks to offer up that narrative if they want to sell the idea that obesity is normal and healthy and it’s worse than a waste of time for individuals to try to do something about it. We also hear a version of that futility narrative from other folks as an excuse for making it hard for people to gain access to obesity care. Better to put the effort into prevention, they reason. But a new study in Lancet Public Health tells this is false. Amy Ahern and colleagues write:

“Our findings suggest that the common assumption that all weight lost after behaviour change is regained within 5 years is incorrect.”

Long-Term Follow Up  on the WRAP Trial

This new paper is an analysis of a randomized controlled trial five years after people enrolled and received random assignments to either 12 or 52 weeks of Weight Watchers or to a brief intervention of encouragement to lose weight. These were patients from 23 primary care practices in England and all of them had a BMI of at least 28.

Prior analysis from this study showed that the interventions were effective after two years, but the investigators wanted to understand what residual effect might be evident five years later. “We assumed that all participants returned to baseline weight by 5 years,” they wrote.

This was not the case. Though they did not find statistically significant differences in weight changes between the groups, they did find that the people in this study were still maintaining some of their weight loss after all that time.

Surprisingly Lasting Effects

Clearly, these results were a surprise. None of the test groups received support for more than a year. Yet five years later they were still maintaining some of their weight loss. The group with the 52-week program maintained the most, though their advantage had lost its statistical significance in this longer-term analysis. Patrick O’Neil, who had no involvement in this study, commented on this surprise:

“Given the general frequency of weight regain, the WW groups showed greater durability of their original, albeit modest, weight losses than might have been expected. This durability occurred even though none of the patients received any study-provided weight loss or maintenance intervention after completion of their initial assigned treatment condition.”

This and other studies of long-term outcomes should give us all pause. Yes, bariatric surgery provides the most significant and lasting reductions in weight. Obesity meds are coming along that might offer comparable responses so long as patients keep taking them.

But this study tells us that we should not assume a behavioral program like Weight Watchers can’t have a lasting benefit – however modest it might be.

Though behavior is not necessarily the cause of obesity, behavioral tools can be helpful for coping with it. It’s as simple as that.

Click here for the new analysis and here for O’Neil’s commentary.

Sisyphus, photograph by Jan Alonzo, licensed under CC BY-SA 2.0

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October 14, 2022

2 Responses to “Does Everyone Regain All Their Lost Weight?”

  1. October 14, 2022 at 6:07 am, Al Lewis said:

    Two things.

    First, I had always thought it was that “on average, people regained all their lost weight,” not everyone regained their lost weight. The former would mean some people regained more than they lost.

    Second, I don’t know if this is possible but they should try to track down the lost-to-follow-up group to see what happened to them.

    Then, average those results with the others and see if the average recruit for the study, rather than the average person who stayed in the study, lost weight. I don’t know what this analysis would show, but it would be the Gold Standard.

    • October 14, 2022 at 7:37 am, Ted said:

      These are all good questions, Al.

      One thing I’ll note is that the common feeling that “I always regain all the weight I lost plus more” may reflect the experience of someone on a trajectory of gaining weight for physiologic reasons who tries an ineffective strategy for controlling it. The condition progresses unabated. But that does not mean that the ineffective strategy causes further weight gain. What it causes is understandable frustration.