Many people lose weight, but few manage to maintain weight loss long-term. One potential reason for this is an increase in the hormone involved in hunger signals after weight loss.
What you eat for weight maintenance can be just as important as during weight loss. But what is the right approach in terms of macronutrients when it comes to suppressing hunger after reaching your weight loss goals?
Background
Weight regain is common after a weight loss regime, and may be in part due to adaptations the body makes to counteract the loss of fat stores. Diet-induced weight loss has been linked to increased hunger and ghrelin and reduced satiety hormones.
There are some diet and lifestyle factors that can influence satiety, including protein, fibre and glycaemic index, as well as physical activity. However, there is insufficient research that assesses the long-term effects of macronutrient balance, GI and physical activity on appetite and weight regain post-weight loss.
The study
Researchers designed a secondary analysis of the randomised intervention study PREVIEW, which focused on the prevention of diabetes through lifestyle interventions. The original study was 3 years, including 8 weeks of weight loss diet followed by 148 weeks of 4 weight loss maintenance interventions. The 4 groups were:
- HP MI – High protein, low GI diet with moderate physical activity
- HP HI – High protein, low GI diet with high intensity physical activity
- MP MI – Moderate protein moderate GI diet with moderate physical activity
- MP HI – Moderate protein moderate GI diet with high intensity physical activity
Data of 2223 participants was analysed. Participants were adults aged 25-70 years with a BMI ≥25 and prediabetes.
Exclusion criteria as provided in the original study included pre-existing diabetes, cardiovascular disease, blood pressure above 160/100, liver disease, cancer (current or within last 5 years), chronic digestive disorders including Coeliac, bariatric surgery and any chronic condition that affected the ability to comply with the protocol.
Medications that affect body weight or glucose metabolism within the previous 3 months, including glucocorticoids, weight loss medication and psychoactive medication, restricted diets, planned or current pregnancy and lactation and weight change of >5% within 2 months were also grounds for exclusion. Thyroxine, low-dose antidepressants and hypertensive medications were allowed as long as the participant was stable on their dose for at least 3 months.
The data assessed included appetite sensations including satiety, hunger, desire to eat and desire for something sweet, as well as body weight.
The findings
After 52 weeks, decreases in hunger were significantly greater in high protein low GI groups compared to moderate protein moderate GI groups.
Decrease in hunger was greater at 52 weeks and 104 weeks in HP HI compared to MP HI, and at 104 weeks and 156 weeks in HP HI compared to MP MI.
There was no significant difference in appetite when it came to the two physical activity types.
Conclusions
It was concluded that a high protein low GI diet helped to prevent increased hunger during 3 years of weight loss maintenance compared to a moderate-protein moderate-GI diet.
The researchers noted some limitations to the study. The drop-out rate by the end of the study was nearly 50%. Diet and appetite sensation were assessed using memory recall, so results may have been skewed.
Further studies will help to further clarify the best balance of macronutrients to minimise appetite and weight regain in those who have reached their weight loss goals.
References
Fogelholm, M., Larsen, T.M., Westerterp-Plantenga, M., Macdonald, I., Martinez, J.A., Boyadjieva, N., Poppitt, S., Schlicht, W., Stratton, G., Sundvall, J. and Lam, T., 2017. PREVIEW: prevention of diabetes through lifestyle intervention and population studies in Europe and around the world. Design, methods, and baseline participant description of an adult cohort enrolled into a three-year randomised clinical trial. Nutrients, 9(6), p.632.
Zhu, R., Fogelholm, M., Larsen, T.M., Poppitt, S.D., Silvestre, M.P., Vestentoft, P.S., Jalo, E., Navas-Carretero, S., Huttunen-Lenz, M., Taylor, M.A. and Stratton, G., 2021. A High-Protein, Low Glycemic Index Diet Suppresses Hunger but Not Weight Regain After Weight Loss: Results From a Large, 3-Years Randomized Trial (PREVIEW). Frontiers in Nutrition, 8.