Accomplishing your goals—whether they include reaching a goal weight, fitting into old clothes, or improving your lab values—is a milestone that should be celebrated. You have worked hard to get here and should be incredibly proud! While reaching a maintenance phase can be exciting, it can also bring about feelings of fear and anxiety, especially if you have struggled to maintain your progress before.
We’re here to remind you that you are not alone. More than 80% of individuals who have had successful weight loss regain their weight after just one year. While having a strategy for weight loss is key, establishing a plan to maintain your weight loss that fits into your lifestyle is equally as important.
Maintenance will look different for everyone. Some members will stay on their current dose of medication to maintain, some may titrate down to a lower dose, and some may come off their medication completely. It’s helpful to start these conversations with your clinician and care team early on and develop a plan that supports your long-term goals.
Preparing for maintenance starts at the beginning of your weight loss journey
Weight loss medications work in part by acting on both the gut and the brain to control appetite and cravings, making it easier to plan balanced meals without the distraction of “food noise,” stress or emotional eating, and late-night cravings. In short, weight loss medications help to create a new mental landscape that is more conducive to behavior change that many individuals struggle with.
This is why creating strong habits—like learning how to build a balanced plate and incorporating exercise—early on in the process rather than as you are approaching maintenance sets you up for a much greater chance of maintaining weight loss. Our team wil work with you along the way, helping you to identify strategies that facilitate your desired behavior change and assisting you as you navigate life’s road bumps and determine what may or may not work for you long-term. In the name of weight loss, thinking with the end in mind can be a powerful strategy to shift your mindset (and thus your behavior) and ensure long-term success.
Behavioral strategies for weight maintenance
Regardless of if you are staying on a maintenance dose or coming off of the medication, weight maintenance requires continuous effort and commitment to lifestyle changes. When researchers look at individuals who have been able to maintain weight loss long-term, they see common themes among them. Let’s take a look at some of these.
Set personalized goals
A systematic review of nearly 300 individuals who pursued weight loss showed that those with clear, personalized goals that were continuously reevaluated and adjusted had a greater commitment to weight loss. Once an initial goal has been achieved, it’s important to set new goals to have something to work toward, after a quick celebration of course! Setting small goals, like planning meals for the week or strength training twice a week, for example, can help to achieve larger, long-term goals.
Interestingly, people with self-defined goals and external input were more successful than those with externally defined goals. This allows individuals to set goals they feel are achievable and realistic and meaningful for them. Throughout the process, dietitians or coaches can help with strategies to achieve those personal goals by providing that external input.
Determine your why
During a weight loss process, the reward of seeing the scale go down or fitting into old clothes can be a strong motivator. When a goal is reached, the absence of those significant changes can be demotivating. In those times, recognize your progress and celebrate how far you’ve come! Comparing old pictures or speaking with your healthcare provider to review improvements in lab markers can provide reassurance that your continued efforts are worth it.
It may be beneficial to use overall health and non-scale victories as motivators or outcomes as opposed to just focusing on the number on the scale. If your weight trends up one week, you are less likely to give up if the motivation is being able to play with your kids or grandkids or having less pain for example. Finding motivations that align with your personal values is a critical part of the process.
Continuously monitor your progress
Individuals that have been able to maintain weight loss report that having monitoring tools in place helped them stay aware and accountable. Continuous monitoring includes both self and external monitoring.
Self-monitoring includes monitoring progress through frequent weigh-ins, measurements, or photos as well as monitoring food intake through meal planning, portion control, clear daily routines, clear eating times, checking menus prior to dining out or planning ahead for social events.
External monitoring refers to guidance and encouragement from health care practitioners, accountability from weight support groups, or support and feedback from friends and family.
External monitoring helps to facilitate continuous self-monitoring. Engaging in a support group with individuals on a similar journey or having a gym buddy is incredibly effective for weight loss and maintenance. Inversely, peer criticism of lifestyle changes is counterproductive for success.
Establish a relapse protocol
Another aspect of continuous monitoring is having a clear relapse protocol in place to enact when you have a setback. This includes an awareness that some weight fluctuations are a normal and expected part of the maintenance phase. Prior to reaching maintenance, identify a comfortable weight range rather than a single number as there are many factors that can cause small weight shifts (e.g., water retention, sodium intake, constipation, body composition shifts). Identify weight parameters outside of that range that signal the need to re-engage with a support group or reach out to your healthcare provider or dietitian for additional guidance and support.
Relapse protocols should also include problem-solving to anticipate challenges and formulate a plan if that situation arises.
Prepare for challenges
As weight maintenance is a lifelong process, challenges along the way are inevitable. These can be difficult to navigate, especially when they aren’t anticipated or planned for. These challenges can be internal or external. Internal challenges are things like stress, lack of time, self-doubt, emotional eating, or life events like pregnancy or injury whereas external challenges are things like unsupportive peers, relationship changes, or social events.
Weight loss maintainers report that enduring challenges is one of the hardest parts of the process. Anticipating potential challenges and having a plan in place for if they arise was a helpful strategy for these individuals.
Having coping mechanisms in place to deal with stress and emotional situations is also critical, especially if stress or emotional eating have been barriers to weight loss or maintaining weight in the past. See the linked blog posts for more information and tips on managing stress and emotional eating.
Practice cognitive restructuring
Cognitive restructuring refers to the ability to recognize and change negative thinking patterns. If you have a setback, instead of telling yourself you’ve failed, focus on the progress you’ve made, re-focus on your goals and motivations, and keep going. The goal is not perfection, it’s about staying consistent and not giving up.
A common theme among weight loss maintainers' when posed the question, “What is the one piece of advice that you would give to help someone succeed at long-term weight loss?” was perseverance. One respondent stated, “There will be peaks and valleys, plateaus, gains, holidays, bad times … Do not stop. Never accept a small failure as a total defeat”.
Shift or “reinvent” your identity
Individuals that are successful in maintaining weight loss often speak of a shift in identity or a reinvented version of themselves. Instead of viewing the changes they were making as a short-term intervention for weight loss with a defined end-point, they fully adopted a new lifestyle and were committed to engaging in those behaviors. This may also involve surrounding yourself with supportive like-minded people with similar goals.
Nutrition strategies for weight maintenance
Have a sustainable nutrition plan
If you are planning to transition to a lower dose or stop a medication altogether, you are likely to experience an increase in appetite. This can often be seen as a bad thing, but having hunger cues is a normal part of our physiology. If cravings creep back in or weight slightly increases, it may be tempting to revert back to old habits of over-restriction that yielded those short-term results but think about how that restriction served you long term. Over-restriction or following very low-calorie diets can result in increased cravings, overeating, and loss of muscle mass which poses a strong risk for weight regain (more on this later). Fueling your body adequately can help to minimize these effects.
Let’s discuss some aspects of a sustainable nutrition plan.
Avoid skipping meals
Skipping meals can lead to over-consumption and increased food cravings due to blood sugar dysregulation. Listen to your body and begin to recognize physical signs of hunger like your stomach growling or lack of focus.
Prioritize protein
Adequate protein intake is a key factor in any sustainable nutrition plan as it is satiating and helps to regulate blood sugar, which is important for curbing those cravings. Protein helps to maintain muscle mass which has been associated with improved outcomes in the maintenance phase. Protein needs are actually greater for weight loss maintenance and can range from 1.4-2 grams per kilogram of bodyweight. This number varies based on many different factors, like if someone is strength training for example, their needs may be higher.
Include fiber in all meals
Fiber can help to keep you fuller for longer periods of time and help reduce cravings by controlling your blood sugar. Fiber has also been shown to improve blood pressure and cholesterol, and support beneficial gut bacteria. We recommend at least 21-25g of fiber per day for women and 30-40g per day for men. High-fiber foods include fruits and vegetables, nuts and seeds, beans and legumes, and whole grains.
Focus on volume eating
Fill your plate with foods that have a lower amount of calories for a larger serving like non-starchy vegetables or lower-sugar fruits like berries. We recommend ~2 cups of non-starchy vegetables at lunch and dinner, but individual needs may vary.
Maintain adequate hydration
Hydration needs will look different for everyone depending on activity level and other factors, but on average, females should aim for at least ~72 oz and males should aim for at least ~100 oz. Unsure of how to know if you’re hydrated? Urine that is a pale yellow color (think light lemonade) indicates proper hydration status, while clear urine may be a sign of overhydration and dark urine may indicate dehydration.
Related: How Much Water Should You Drink Every Day?
Incorporate the foods you love
In a traditional dieting mindset, you may have avoided all foods that were deemed “unhealthy” or would not promote weight loss. But, for the sake of sustainability, it’s important to give yourself permission to eat for fun. Food is more than just the nutrients it provides, it's social and celebratory and there is a place in life to eat food for pleasure and nothing more.
Use the balanced plate model as a guide for building meals that are full of variety and meet your nutrition needs.
Add fitness to your routine
As you lose weight, it can be easy to lose muscle along with excess fat, especially if you’re under-eating and not exercising. It’s important to try to maintain as much muscle as possible throughout this process for many reasons, including weight maintenance. Studies have shown the percentage of muscle mass lost during a weight loss process is a strong predictor of weight regain after one year. This is why we recommend including exercise early on in the process. Let’s take a look at other benefits of exercise in weight maintenance.
Exercise can help to regulate appetite
You may have heard that having more muscle increases your energy expenditure—meaning the more lean mass you have, the more energy you burn at rest throughout the day, but there are other ways in which exercise influences energy balance. Fat-free mass—which includes the weight of bones, organs, skin, water, and muscle—may actually regulate energy intake through feedback signaling between fat-free mass and brain centers that control appetite. It is also thought that the loss of muscle on a low-calorie diet may lead to weight regain due to the body’s attempt to restore muscle lost by overeating. This could explain why many people regain weight above their baseline.
Another study found that exercise improved post-meal satiety and was able to better regulate appetite. The researchers looked at individuals with varying levels of physical activity and observed the groups performing the lowest amount of activity consumed more calories and had higher levels of disinhibition (i.e. the inability to refrain from undesirable or unwanted behavior). The low-activity group also gained significantly more fat mass over a 12-month period. Researchers found the threshold of activity to prevent significant fat gain and achieve energy balance was ~7,100 steps per day.
How to optimize muscle mass through physical activity
Any form of physical activity is beneficial for overall health, but strength/resistance training is the most effective form of exercise to prevent muscle loss and aid in muscle gain. This could include weight lifting, pilates, yoga, resistance band exercises, or bodyweight exercises like push-ups, squats, and lunges. A study that looked at individuals with different weight loss strategies found those who dieted alone without exercise had the greatest loss of muscle mass while those who engaged in resistance training had the greatest preservation of muscle. Baseline muscle mass and amount of muscle mass lost were significant predictors of weight regain in the study.
How to incorporate exercise
If you haven’t incorporated exercise into your plan, it may seem overwhelming to know where to start. Set goals based on where you are currently on your journey and try to ditch the all-or-nothing approach. It could be as simple as incorporating a 10-minute walk on your lunch break and slowly building from there. If you would like more support in developing an exercise plan.
Summary: Tips for maintenance
- Start preparing for maintenance prior to reaching your goals. Building healthy habits, like learning how to craft a balanced meal or incorporating fitness, while on weight loss medication can help ease the transition into a maintenance phase.
- Create self-defined goals that are personalized to what matters most to you. Continuously reassess and adjust goals as they are met.
- Create a weight range that you feel comfortable with knowing that weight fluctuations are a normal part of weight maintenance. Identify a weight threshold that signals the need to re-engage with a support team or reach out to your healthcare provider or dietitian for additional guidance and support.
- Find sustainable ways to monitor progress, like keeping a food log to hit nutrition-related goals, weighing or taking measurements, or non-scale victories.
- Join a weight support group or have a support system of family and friends in place prior to reaching maintenance.
- Anticipate potential challenges or barriers to maintaining weight and develop plans if those challenges present.
- Have support from a dietitian or health coach to help guide you and work through challenges or barriers to reaching those goals.
- Have coping mechanisms in place for stressful or emotional situations.
- Develop a sustainable nutrition plan that you will be able to follow long-term and mindfully and intentionally creates room for your favorite foods
- Incorporate exercise, specifically resistance training, and optimize protein to maintain muscle mass during the weight loss process and into maintenance.
Reaching your health-related goals is a major accomplishment, but it can come with some feelings of apprehension as well. Preparing yourself and knowing you have a plan for this new phase of life can help relieve some of the anxiety or fear of regaining weight.