Does This Study Really Show How To Maintain Weight Loss?

Studying the Studies

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Reader Barbara sent me an article with the headline “How to Maintain Weight Loss, According to People Who Succeeded.” The article was about a study called “In their own words: Topic analysis of the motivations and strategies of over 6,000 long-term weight-loss maintainers” by Phelan et. al. (as always, I don’t link to research or articles that include fatphobic content.)

The premise:

This is a study, funded by a grant for Weight Watchers (aka WW) that analyzes 6,139 subjects’ responses to six open-ended questions. Two of the study authors are current employees and shareholders in Weight Watchers.

I think it’s important to put this in context. They have 6,139  people who participated, out of a total of 7,419 who are part of Weight Watcher’s “success registry” (more on this later). Weight Watchers (aka WW) had 4.5 million subscribers at the end of 2020 alone (which was down 4.3% year over year). The subjects here represent just 0.14% of that, the total membership of their “success registry” is just 0.16% of their 2020 enrollment alone.  So, like the NWCR before it, it is highly likely that this study is simply finding commonalities among outliers.

Inclusion Criteria:

In order to be included in the study, participants had to lose greater than or equal to 20.0621lbs (9.1 kg) and they only had to maintain it for one year. The average maintenance period was 3.4 years.

About a century of research shows that people who lose weight tend to regain it within five years so the fact that they’ve used inclusion criteria less than that is questionable.

It should also be noted that at the time of the study the “maintainers” had gained an average of thirteen pounds from their lowest weight, suggesting that the study authors and I have a different interpretation of the word “maintain.”

Also, 67.3 percent of the “maintainers” were still categorized as “overw*ight” or “ob*se” Now, those are nonsense categories, made up to pathologize bodies based on size, and drive profit to the weight loss industry (and creating a lot of harm to those who are labeled as such.) But I point this out because these are categories that are used by this industry to drive profit. I think it’s important to know that two-thirds of this sample would still be targeted by Weight Watchers as potential customers, even though, here, they are considering them to be successes.

Introduction

The first half of their first sentence says “Modest weight loss can reduce long-term risk of cardiometabolic disease”

There is no citation for this, and I assume that because it’s not a statement of fact. We’ve explored this myth before, and also that research shows that weight-neutral interventions provide greater benefits with fewer risks (for example, Gaesser and Angadi found that increases in cardiorespiratory fitness and physical activity are consistently associated with greater reductions in mortality risk than is intentional weight loss.)

Back to the Weight Watchers study, the second half of their first introductory sentence /[admits that weight gain affects most individuals.

Points for honesty there.

Then they claim “Nevertheless, about 20% of individuals who have lost weight in the US population are able to keep it off long-term”

Aaaand, I take the points back. They cite three studies to support this claim. The first defines long-term weight loss as “at least one year,” ignoring that most people regain to baseline or above in years 2-5. The second has a conclusion that literally states “most women who lost a clinically significant amount of weight regained most of it,” and the third only looks at a year of data, and used a sample group who were 10% below their starting weight the year before they were studied (without looking at whether they were already regaining) and found that 33.5% had regained weight, and while they claim that 58.9% had maintained their weight, they defined maintaining has having regained less than 5% of weight, so people could regain weight, but still be considered maintainers.

This is a good example of how terrible research begets terrible research, all supporting diet industry profits. Every researcher in every one of these studies should know better, and citing them uncritically is inexcusable.

This credibility is not helped by the fact that they uncritically cite the National Weight Control Registry with its questionable science.

Results:

In terms of extrapolatability, I want to point out that 91.9% identified as female; 94.3% identified as white.

Subjects were asked six open-ended questions and only 12.9% of the subjects completed all of them. Subjects only had to complete one question to be included in the study.

• What prompted you to start your weight-loss attempt? Please describe. (n = 6,092; 82.1%)

• What currently motivates you to manage your weight? (n = 5,710; 77.0%)

• What is one piece of advice that you would give to help someone succeed at long-term weight loss? (n = 5,524; 74.5%)

• What is the single most important thing in your life that has changed as a result of weight loss? (n = 5,384; 72.6%)

• Please describe any negative consequences of successful weight loss. (n = 4,761; 64.2%)

• If applicable, please use this section to describe any other factors affecting your weight history that have not been addressed. (n = 1,010; 13.6%)

The most important thing to understand is that these questions are being answered by a tiny sample (again, each question was answered by a percentage of a miniscule percentage of Weight Watcher’s enrollment.) This means that we actually have no idea if the information provided here has anything to do with these subjects’ weight “maintenance.” It’s possible that the other 99.9+% of their enrollment did the exact same things as these people did but did not/will not maintain their weight loss (as the research suggests they will not.)

Many of the responses focus on the desire to escape weight stigma and the fear of returning to it as motivators. This make sense, weight stigma is real and does real harm. What’s heartbreaking is that Weight Watchers continues to both foment and profit from this weight stigma without actually providing significant long-term success to the vast majority of its customers, which doesn’t distinguish it from the rest of the weight loss industry.

A significant portion of the answers are about “persevering” in the face of things like “plateaus and weight gain.” This is important because even among this tiny group of “successes,” what may actually be happening is weight cycling (which could help explain why these so-called “maintainers” are an average of 13 pounds up from their lowest weight at the time of the study.) The suggestion that people losing and gaining weight endlessly constitutes weight loss “success” and improves health is not supported by the evidence. In fact, weight cycling is independently associated with harm.

I think that research and lived experience tells us that the best thing we could do for our physical and mental health is to ditch the weight-loss paradigm. In healthcare/public health we could move to a weight-neutral (and, as soon as possible, weight-inclusive) paradigm, and even if we can’t end stigma, it’s important to reconsider that we fight our bodies on behalf of weight stigma and consider that we start fighting weight stigma on behalf of our bodies.

Regardless, I would suggest that we stop trusting studies that are funded by the weight loss industry but, at the very least, we should demand far more from those studies than this.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.