Stages of Change and Why Most People Regain Weight Loss

Studies have found that more than half of weight loss is regained within two years and by five years, more than 80% of weight loss is regained [1]. In fact, people who have had previous failed attempts at maintaining their weight-loss often believe that weight loss is a futile endeavor[2], so why bother even trying to change?

There are lots of different reasons why people seek weight loss and in my experience it is much less about how people feel about how they look, than their health.  People already know that they need to lose weight to lower high blood sugar and high blood pressure (hypertension), but the last few months there is a greater sense of urgency due to recent studies which indicate that people requiring hospitalization for Covid-19 had one or more of these underlying conditions. But where to start?

Some people think that all they need to do is “make up their mind” to change and they will, yet in most cases these same people have “made up their minds” multiple times — lost weight, and then put it all back and then some.

Change is not a state of mind, but a process.

The Stages of Change model was developed in 1979 by James Prochaska [3] and expanded on by Prochaska, Norcross and DiClemente in a 1994 book titled Changing for Good: a Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward.

The Stages of Change are Precontemplation, Contemplation, Preparation, Action, Maintenance and Relapse.

They were originally seen as five stages (with Preparation and Action forming one stage) but are now seen as six distinct stages.

The Six Stages of Change

  1. Precontemplation – in this stage, people are just beginning to see that there is a problem, but not necessarily what it is. Oftentimes, people see the problem as being something outside of their control, or the result of someone- or something else. They may be experiencing negative consequences related to their behaviour, but don’t see the problem as being serious enough to motivate them to changing it.
  2. Contemplation – in this stage, the person realizes that the behaviour is problematic for them, but they have mixed feelings. They have a desire for the situation to change, but are not ready to commit to making changes.
  3. Preparation – in this stage, the person still has some mixed feelings about the problem, but begins to make plans to take action within a specific amount of time (usually a few weeks). At this point, most people have weighed the positive versus negative consequences of not changing their behavior and have concluded that the negative aspects outweigh any benefits they perceive their current behavior brings them, and are coming up with a plan to support their success.
  4. Action – at this stage, the person is actively involved in changing their behaviour and carrying out their plan to support their success.
  5. Maintenance – at this stage, people are consolidating what they’ve accomplished during the action stage. TA person can remain in this stage for an extended periods of time — with an adequate support system in place.
  6. Relapse – the person falls back (lapses) into their former pattern of behaviour. Some people start the process of change over again after a brief “slip”, while others continue in their lapsed behaviour patterns.

Is Relapse Inevitable?

The standard model sees relapse as part of the stages of change, and to a certain extent, it is.  No one perfectly maintains their goal weight, or their goal blood sugars or blood pressure. For some, a lapse may be eating a meal or a dessert that isn’t part of their plan, but then the next day they are “back on track”. For others, eating a meal or a dessert results in them feeling like a failure. They feel like since they’ve “already blown it”, so they might as well “go for it” and eat all the things they want.

I believe that what makes the difference between those that “slip” and then relapse and those that “slip” and get back on track is having a long-term plan for maintenance.

A Long-Term Plan for Maintenance

Just as one contemplates their plan for weight loss, then prepares to execute that plan, and takes action to carry out that plan — to be successful long term requires not only having a plan in place to support successful weight loss, but also having a plan for maintenance in place for afterwards.

Understanding what contributed to gaining weight in the first place often helps people come up with a successful plan both to lose weight, as well as a long-term plan for weight maintenance. Each person needs to find what is an appropriate plan for them.

For some, that might be an accountability partner, for others it may be support and follow-up with a Dietitian, and for others it may be getting support for a larger issue such as food addiction at a 12-step support group or addictions counsellor.

It doesn’t have to be a “vicious cycle”!

If a person was driven to eat due to high cortisol and insulin levels, then having a plan in place to keep those in check after they’ve reached their goal weight will enable them to maintain their weight loss long term.

If they came to realize that they meet many of the 11 DSM (Diagnostic and Statistical Manual) criteria for substance abuse disorder related to specific foods or food in general, then seeking support of a food addictions counsellor would be worth exploring.

If they realize that they mainly eat when they are angry, lonely, tired or stressed then coming up with healthier alternative behaviours to do instead, might be part of what would enable them to achieve and maintain long-term weight loss, or by working through some of those underlying issues with a counsellor.

A 2018 paper by Hall and Kahan titled Maintenance of Lost Weight and Long-Term Management of Obesity put it well:

“Treatment of obesity requires ongoing attention and support, and weight maintenance-specific counseling, to improve long-term weight management.” [4]

I support my clients with services through all stages of change — from the SMART goal setting session, to the Complete Assessment Package, and the Dietary Management Package and refer to others with expertise in counselling or food addiction, as appropriate.

I want you to be part of the 20% that are able to maintain your weight loss to five years and beyond, and I believe that it is entirely “doable” with good planning and appropriate support.

More Info?

If you would like more information about the different types of low carb or ketogenic diets I teach, please send me a note using the Contact Me form on the tab above.

To your good health!

Joy

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Reference

  1. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74(5):579–584.
  2. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. The American psychologist. 2007;62(3):220–233.
  3. Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. https://doi.org/10.1037/h0088437
  4. Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012

 

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