It’s one challenge to lose weight. But for many, the biggest challenge lies in maintaining that loss for good. Often people will regain weight after a weight loss program. But could cognitive behavioural therapy help with maintaining healthy habits after weight loss has been achieved?
Background
One of the biggest issues with managing obesity is the regaining of weight after weight loss.
Research also suggests that regaining weight after weight loss could increase the risk of cardiovascular and metabolic disease. Preventing this yo-yo effect on weight could significantly improve health outcomes.
Cognitive behavioural therapy, or CBT, teaches behavioural and cognitive strategies that can assist with achieving and maintaining lifestyle changes. This could be particularly useful when it comes to supporting habits that maintain weight loss.
Previous studies have looked at CBT as an intervention for achieving weight loss, but have yet to explore its impact on weight maintenance.
The study
Researchers designed a 24-week randomised controlled trial to evaluate the effects of CBT on weight maintenance after successful weight loss. The participants were females between 18-45 years who had lost at least 10% of their body weight using a weight loss program.
Exclusion criteria included blood glucose or lipid medication use, pregnancy, breastfeeding or planned pregnancy within 6 months, smoking, participation in competitive sports, abnormal thyroid hormone levels, heart disease, cancer, depression or immune-compromised conditions.
Participants were randomly allocated to either the CBT or control group for 24 weeks of weight maintenance. The CBT group participated in CBT classes alongside instructions to follow the prescribed weight-maintenance diet. The first 5 CBT sessions were focused on continuing their healthy diet and activity habits. The final 5 sessions focused on teaching approaches for maintaining new health behaviours and strategies for changing unhelpful beliefs and solving problems.
The control group were also given the weight-maintenance diet to follow. Both groups had bi-weekly clinic visits to a dietitian for 6 months of follow-up.
The findings
Compared to the control group, the CBT group saw improved maintenance of weight loss, BMI and waist circumference. CBT group lost an average of 1.28kg, reduced their BMI by 0.49kg/m2 and waist circumference by 1.87cm. On the other hand, the control group gained an average of 0.62kg, with the BMI increasing by 0.61kg/m2 and waist circumference by 0.26cm.
The estimate energy intake reduced over time in the CBT group, but increased in the control group. Daily steps increased significantly for the CBT group, whereas the control group’s daily steps decreased over time.
There was no significant difference in lipid profiles or carbohydrate metabolism between the two groups.
Conclusions
The researchers concluded that cognitive behavioural therapy is an effective tool for weight maintenance over a 24-week period in people who had successfully lost weight. This corresponded with maintenance of a reduced energy intake and increased physical activity level which further supported weight maintenance long-term.
The researchers did note some limitations of the study. The findings cannot be applied to men, as the participants were all female. Dietary compliance was subjective, which is less accurate than more objective methods. It was also a relatively short trial, so longer-term studies are needed to confirm whether the effects of CBT are sustained.
Reference
Madjd, A., Taylor, M.A., Delavari, A., Malekzadeh, R., Macdonald, I.A. and Farshchi, H.R., 2019. Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial. European journal of clinical nutrition, pp.1-9.